Diagnosis

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Although most women experience some discomfort associated with their menstrual cycles, health care professionals note that there is a significant difference between premenstrual syndrome (PMS) and the menstrual discomfort experienced by most women. Health care professionals qualify these differences between menstrual discomfort and PMS in three ways:

• Severity
• Timing
• Consistency

There is no specific laboratory test to determine if you suffer from PMS and diagnosis can take some time because symptoms are so varied. But there are certain characteristics that health care professionals consider. To qualify as PMS, symptoms must follow this general pattern:

• They tend to increase in severity as your cycle progresses.
• They improve within a few days of your menstrual period starting.
• They are present for at least two to three consecutive menstrual cycles.

More than 150 physical and behavioral symptoms may be associated with PMS. The two most common are irritability and anxiety/tension. Other symptoms include:

• Irritability
• Sudden mood swings
• Anxiety
• Depression
• Headaches
• Joint and muscle aches
• Food cravings
• Fluid retention
• Forgetfulness
• Clumsiness
• Sleep disturbances
• Breast swelling and tenderness

The timing and severity of these symptoms is key to a PMS diagnosis. An average menstrual cycle spans 22 to 36 days. The follicular phase extends from menses to ovulation and the luteal phase extends from ovulation to menses. PMS occurs during the luteal phase -- approximately the last 14 days of your cycle.

A premenstrual symptom chart or checklist (also called a menstrual cycle diary) is the most common method currently used to evaluate menstrual cycle symptoms. With this tool, you and your health care professional can track the type and severity of your symptoms as well as when they occur to identify a pattern that may indicate PMS.

Follow these simple steps to determine if your symptoms fit the PMS pattern:

1. Track your symptoms using the first day of menstrual flow as Day 1. (Note: Don't be surprised if you do not have any symptoms to record before day 18 or so.)

2. Have a person close to you (your partner, roommate, friend) chart his or her impression of your symptoms, when they occur and their severity.

3. Chart your symptoms for at least three consecutive months to help you and your health care professional identify a pattern that may indicate PMS.

4. Record the date when/if any of the following symptoms occur over three consecutive months and note their severity (1 = mild; 2 = moderate; 3 = severe)

Physical Symptoms

• Abdominal bloating
• Breast tenderness
• Constipation
• Diarrhea
• Dizziness
• Fatigue
• Headache
• Swelling of hands/feet

Emotional Symptoms

• Anger
• Anxiety
• Depressed mood
• Irritability
• Mood swings
• Tension

Behavioral Symptoms

• Crying spells and tearfulness
• Decreased appetite
• Difficulty concentrating
• Difficulty sleeping
• Forgetfulness
• Hostility
• Appetite changes

In addition to suggesting that you keep a menstrual cycle diary, your health care professional likely will take additional steps when evaluating your menstrual cycle symptoms. You'll be asked about your personal and family medical history, and have a physical exam.

Laboratory tests are not routine but may be obtained to rule out other conditions with similar symptoms, such as low blood sugar (hypoglycemia), mania, depression, thyroid disorders, endometriosis, allergies, fibroids, dysmenorrhea, lupus, endocrine abnormalities, neurological problems such as brain tumors and heart problems.

Menopause and PMS share some of the same symptoms, so your health care professional may also want to make sure that you are indeed ovulating and therefore experiencing PMS, not menopausal symptoms.

To do this, you will probably be asked to use an over-the-counter ovulation testing kit. Or you could take your temperature each morning before you get out of bed with a basal thermometer, recording it in a chart to find your normal, or basal, body temperature. When your temperature rises 0.2 to 0.5 degrees Centigrade, you're ovulating.

If you are approaching menopause (the average age is about 51 for U.S. women, but ranges from 42 to 60 years), blood hormone tests may also be used to confirm if you are menopausal. However, a single blood test is not informative because hormone levels change often.