Diagnosis of premenstrual syndrome (PMS)

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