How is the diagnosis of PMS made?
The diagnosis of premenstrual syndrome can only be made from the history (story). There are no symptoms that are exclusively associated with premenstrual syndrome – every premenstrual syndrome symptom can occur in other situations and there is no test that can distinguish between those who have premenstrual syndrome and those who do not. Caution is required in making the diagnosis. A chart may help to distinguish whether or not the symptoms are of a
cyclical nature or not. The symptoms of premenstrual syndrome disappear completely when menstruation stops and they do not recur until ovulation two weeks before the next period.
Some women have underlying psychological problems such as depression or anxiety that become more noticeable in the premenstrual phase (secondary premenstrual syndrome). In these women not all their symptoms disappear after the period. Treatment of premenstrual syndrome in these circumstances may only partially overcome their problems although this may at times be enough to make their lives more tolerable.
The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (midcycle, or days 7-10 into the menstrual cycle) and last until the menstrual flow begins, then premenstrual syndrome is probably the accurate diagnosis. Keeping a menstrual diary not only helps the healthcare provider to make the diagnosis, it also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of premenstrual syndrome is made and understood, the patient can better cope with the symptoms.
Your doctor will ask you about your premenstrual syndrome symptoms, the timing of these symptoms in relation to your menstrual period and the regularity of symptoms (every month, every other month, etc.). Your doctor also will ask about the general quality of your life. After asking you about your premenstrual syndrome symptoms and lifestyle, your doctor will review your medical history and ask about any medications that you are taking. Next, your doctor will perform a thorough physical examination, including a pelvic exam with a Pap smear. Although no single physical finding can confirm the diagnosis of premenstrual syndrome, a thorough physical exam can help to rule out other medical problems, such as hypothyroidism or a tumor of the breast, brain or ovary. In a similar way, although no single laboratory test can confirm that you have premenstrual syndrome, blood tests can rule out medical disorders such as hypoglycemia or hypothyroidism, or other hormonal problems as the cause of your symptoms.
If there are no physical findings and your laboratory test results are normal, then your doctor may ask you to keep a daily record of your premenstrual syndrome symptoms for two or three months. This record will include the type of symptoms, the severity of symptoms, the timing of your menstrual periods and a description of any special stresses that have affected your life. Once this two- or three-month record is complete, your doctor will review the information that you've collected. If your symptoms follow a pattern that is consistent with premenstrual syndrome, then this will help to establish the diagnosis.