Diagnosing PMS and Other Period Problems

Symptoms of Premenstrual Depressive Disorder and Premenstrual Dysphoric Disorder

Woman with PMS
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Ask any woman how she feels about getting her period and it’s doubtful you’ll get an enthusiastic thumbs-up. More likely you’ll hear a range of responses, from “It’s a pain in the neck but otherwise no big deal” to “It’s a week of physical discomfort and mental anguish.” If you’re a woman who dreads getting your period every month, you may have premenstrual syndrome (PMS), a common complaint that affects at least three of every four girls and women who menstruate.

If your PMS is especially problematic, you may have a severe form known as premenstrual dysphoric disorder, or PMDD. Either way, there are may be ways to treat monthly misery so that having your period is easier to endure. First, however, you need to find out exactly what you're dealing with.

Symptoms of PMS

Step one of dealing with premenstrual woes of any degree is to figure out exactly what you're up against. The most commonly used and accepted diagnostic criteria for PMS is one developed by the University of California, San Diego. To meet these diagnostic criteria for PMS, a woman must have at least one physical symptom and one mental symptom from this list during the five days before she gets her period:

Physical Symptoms

  • Sore, tender breasts
  • Headaches
  • Swelling of arms and legs

Mental Symptoms

  • Fatigue 
  • Angry outbursts or mood swings
  • Irritability
  • Confusion
  • Social withdrawal

For a diagnosis of PMS, these symptoms must disappear by day 4 and not show up again until day 14 of the menstrual cycle.

And they must be present despite taking medications or hormones, drinking alcohol, or using drugs.

In addition, for a true diagnosis of PMS a woman should be feeling some effects in her personal relationships or her work and financial life:

  • Problems with her marriage or relationship that her spouse or partner can confirm

Symptoms of PMDD

PMDD is a severe form of PMS that affects approximately 3 to 8 percent of women who menstruate. According to the Diagnostic and Statistical Manual of Mental Disorders, in order to be diagnosed with PMDD a woman must experience at least five of these symptoms: 

  • Feelings of sadness or hopelessness, or suicidal thoughts
  • Severe stress, tension, or anxiety
  • Panic attacks
  • Mood swings and crying
  • Constant irritability or anger that affects other people
  • Loss of interest in normal daily activities and relationships
  • Inability to concentrate or focus
  • Fatigue or lethargy 
  • Food cravings or bingeing

A Simple Menstrual Cycle Calendar

The easiest way to determine if you have PMS or PMDD is to keep track of your symptoms for two or three months on a standard calendar, and then make an appointment with your gynecologist to go over it. Your menstrual cycle calendar will expose your symptoms so that their cyclic nature is clearly visible to your doctor. Take these steps to fill out a menstrual cycle calendar:

  1. Print out a list of the physical and behavioral symptoms of PMS and the diagnostic criteria for PMDD. This way you'll have an easily available reference as you fill out your calendar each day.
  1. The first day you see any amount of bleeding, write Day 1 on your calendar. Note any symptoms you may experience on that day and rate each on a scale of one to 10, with one meaning very mild or hardly noticeable symptoms, and 10 denoting any symptom severe enough to disrupt your daily routine.
  2. Do this every day of your cycle for two or three months. 

Women whose symptoms of PMS are mild usually see the disappearance of their symptoms on day one. Symptoms of PMS or PMDD may persist into Days 3 or 4 of their next menstrual cycle.

True symptoms of PMS do not begin until after Day 13, so any you experience earlier in your cycle may have another cause.

However, you should still include any symptoms you experience on Days 1 to 13 on your calendar.

Sources:

C. Neill Epperson, M.D., et. al, "Premenstrual Dysphoric Disorder: Evidence For a New Category For DS-5." Am J Psychiatry. 2012 May; 169(5): 465–475.

The American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," American Psychiatric Association, 2016

Subhash C. Bhatia, M.D, and Shashi K. Bhatia, M.D., "Diagnosis and Treatment of Premenstrual Dysphoric Disorder." Am Fam Physician. 2002 Oct 1;66(7):1239-1249.

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