Premenstrual Syndromes : PMS and PMDD - Rutuja :: The site ...

Table 2.5 Differential diagnosis of PMS
The research procedures are for quantification of
PMDD criteria of severity (quantify ‘marked’), duration
of symptomatic period, duration of non-symptomatic
period, and degree of impairment, as well as nonexistence
of other diagnostic entities.
In addition, degree of change from non-symptomatic
to symptomatic periods and cyclicity are sometimes
measured.
The most acceptable research method to establish the
severity of symptoms, their entrainment to the menstrual
cycle, and their fluctuation and cyclicity is by
daily rating forms (DRFs).
Most widely applied DRFs provide a range of severity
for each item, from non-existent to extremely severe.
There are some anchor definitions for each level of
severity. For research purposes, a cut-off point is introduced,
mostly between mild and moderately severe.
However, that distinction is subjective and varies from
individual to individual. If there was an objective measure
of severity (at present, there is none) it would be subjectively
described by some women as not severe and by
some others as very severe – according to their tolerance,
coping style, ability, personality, perception, and subjective
definition of ‘what is severe’.
The difference between ‘mild’ and ‘moderate’ may
determine a woman’s eligibility or ineligibility for enrollment
in a clinical trial, especially if it is a symptom that
would make the fifth required symptom of PMDD or is
a crucial perception of impairment.
Since the symptoms should be absent in the week post
menses, the same cut-off (though as an upper ceiling)
applies to the mid-follicular period as well. Here another
DIAGNOSIS OF PMS/PMDD 17
Mental disorders (may be with premenstrual General medical conditions (with menstrually related
exacerbations) worsening or exacerbations)
● Major depressive episodes ● Dysmenorrhea
● Dysthymia ● Endometriosis
● Chronic major depression ● Polycystic ovaries
● Bipolar disorder ● Adverse effects of hormonal contraceptives
● Generalized anxiety disorder ● Perimenopausal symptoms
● Panic disorder ● Seizure disorders
● Seasonal affective disorder ● Autoimmune diseases (e.g. MS, SLE)
● Somatoform disorder ● Hypothyroidism
● Personality disorders ● Hyperglycemia
● Substance abuse ● Anemia
● Repeated stress ● Allergies
● ADHD
issue is pertinent. Since women are humans, there may
be external stressful situations during the mid-follicular
phase, and therefore women subjects may rate some of
the symptoms higher than ‘mild’ and thus would be
disqualified if clinical judgment was not exercised. An
average severity across 5 days may control for incidental
stressful days, but even then a more flexible-realistic
schedule (e.g. allowing for several external stress-related
items above ‘mild’ severity) may reflect a representative
patient group.
Since the duration of PMS varies among patients, a
reasonable required duration of the severe symptoms
may be at least 2 days, with lesser severity during the
rest of the PMP.
Some DRFs provide an overall daily score for the
questionnaire, which may be averaged for the entire
designated PMP (usually 7 days) as well as for the midfollicular
phase – allowing for calculation of total change
from mid-follicular to late-luteal phase, and hence a
measure of overall fluctuation and cyclicity. At least two
issues may be considered in this regard. First, a total
score does not reflect severity of PMS in a woman who
complains of only a few but very severe premenstrual
symptoms. This would also be the case with the determination
of percentage change from mid-follicular to
late-luteal periods. Secondly, the percentage change
assumes a linear continuous score from non-existent to
extremely severe that is identical for all individuals.
This is not necessarily the case with the highly subjective
description at focus here. Furthermore, a combined
requirement of a minimal late-luteal total score and a
minimal percentage increase from mid-follicular to