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Diagnosis of premenstrual syndrome (PMS)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Diagnosis of premenstrual syndrome (PMS)

When clinically reviewing women for PMS, symptoms should be recorded prospectively, over at least two cycles using a symptom diary, as retrospective recall of symptoms is unreliable.

  • several patient-rated questionnaires are available which can be used to record the symptoms:
    • Daily Record of Severity of Problems (DRSP)
      • the most widely used and is simple for patients to use
      • provides a reliable and reproducible record of symptoms
    • Premenstrual Symptoms Screening Tool (PSST)
      • it is retrospective and has been validated for screening but not diagnosis
  • gonadotrophin-releasing hormone (GnRH) analogues may be used for 3 months for a definitive diagnosis if the completed symptom diary alone is inconclusive (specially in those patients with variant pre menstrual disorders)
    • this is to allow a month for the agonist to generate a complete hormonal suppressive effect, as well as providing 2 months' worth of symptom diaries (1,2)

Laboratory studies may also be conducted in order to screen for medical conditions e.g. thyroid function tests, complete blood cell count and follicle-stimulating hormone level (3)

Once patient records menstrual symptoms and effect on daily life for two consecutive menstrual cycles, they may have:

  • physiological (mild) premenstrual disorder
    • symptoms cyclical an relieved by menstruation
    • symptom-free week
    • no influence on quality of life
  • core premenstrual disorder (premenstrual syndrome or premenstrual dysphoric disorder)
    • symptoms cyclical and relieved by menstruation
    • symptom-free week
    • affects quality of life
  • premenstrual exacerbation
    • symptoms cyclical and relieved by menstruation
    • no symptom-free week
    • affects quality of life
    • existing non-menstrual condition
  • premenstrual disorder with absent menstruation
    • symptoms cyclical
    • symptom-free week
    • affects quality of life
    • no menstruation
  • progestogen induced premenstrual disorder
    • symptoms cyclical and relieved by menstruation
    • symptom-free week
    • affects quality of life
  • underlying psychological disorder, not premenstrual disorder
    • non cyclical symptoms
    • no symptom-free week
    • constant influence on quality of life (1)

Reference:

  1. Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.
  2. Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women's Health. 2013;9(6): 537-556
  3. Khajehei M. Aetiology, Diagnosis and Management of Premenstrual Syndrome. J Pain Relief. 2015:4: 193

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