Diagnosis:

During a doctor's visit, the patient may be asked about her symptoms or to fill out a questionnaire.

The only method for obtaining a clear picture of premenstrual syndrome, however, is for the woman to chart her symptoms over 2 - 3 months. The following is an example of such a process:

• Divide symptoms into physical (such as bloating, headaches, weight gain, aches and pains, breast tenderness) and emotional and mental (such as depression, anger, changes in sexual drive, irritability). Note: Menstrual cramps are NOT part of PMS.
• Begin recording symptoms on day 1 of the cycle, which is the day bleeding begins.
• Record symptom severity using an index from 1 - 4, with 1 being no symptoms and 4 being the most severe.
• Include any medications taken or events that might contribute to emotional or physical responses. (For example, taking oral contraceptives may worsen PMS and cause symptoms that confuse the diagnosis.)

The American College of Obstetricians and Gynecologists asks that a pattern of symptoms:

• Be present in the 5 days before a woman's menstrual period for a least three cycles in a row and
• Within 4 days after the beginning of the menstrual period
• Interfere with normal daily activities

The Premenstrual Shortened Form

A number of questionnaires are used for identifying PMS. A simple scoring system called The Premenstrual Shortened Form is often used during an office visit. The woman is asked to rate the following symptoms on a score of 1 - 6, with 1 equal to no change and 6 equal to very severe.

1. Breast tenderness, pain, or swelling
2. Inability to cope and being overwhelmed by ordinary demands
3. Feeling under stress
4. Sudden bursts of irritability or anger
5. Sadness, depression
6. Muscle and joint pain
7. Weight gain
8. Steady feeling of heaviness, discomfort, or pain in the abdomen
9. Swelling or puffiness from fluid retention
10. Feeling bloated

In order to be diagnosed with PMS, a woman must score a 5 or 6 on at least 5 of the symptoms and at least 1 of the symptoms must be numbers 2, 3, 4, or 5.

Ruling Out Other Conditions Causing Similar Symptoms

If the symptoms consistently resolve at the onset of menstruation, they are most likely caused by hormonal fluctuations. If they persist, however, or do not appear to be associated with a regular cycle, other conditions may be causing them. Among the possible conditions that mimic some PMS symptoms are:

• Psychiatric disorders (depression or anxiety that persists suggests serious mood disorders that are unrelated to PMS)
• Eating disorders
• Anemia
• Thyroid disorders
• Diabetes
• Endometriosis
• Chronic fatigue syndrome
• Side effects of oral contraceptives
• Perimenopausal symptoms in women over age 40 (these can include breast tenderness, headaches, sleep disturbances, and mood swings)