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

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Quantification of premenstrual syndrome
and premenstrual dysphoric disorder
Vandana Dhingra and PM Shaughn O’Brien
INTRODUCTION
Gynecological practice is almost always informed by an
objective test or visual information on which to base
diagnosis and provide treatment. No such objective
tests are available for quantification for premenstrual
syndrome/premenstrual dysphoric disorder (PMS/PMDD),
and this may be a challenge for gynecologists treating
patients or undertaking research.
Psychiatrists are used to this problem in the diagnosis,
management, and documentation of most psychiatric
disorders and, while they are well acquainted with
disorders that are periodic in nature, it is rare that
prospective assessment and the wait for repeated menstrual
cycles impacts on their practice regularly. Similarly,
they are less well acquainted with the vagaries of
the menstrual cycle, its endocrinology and its other
symptoms.
As we know, PMS and even PMDD are commonly
encountered amongst women of reproductive age, and
these can have a major impact. (see Chapter 6).
Literally hundreds of symptoms have been described,
spanning a spectrum of mood and physical disturbance,
and so it is not surprising that symptomatology overlaps
with many other medical problems. We will see in
several of the following chapters that the exclusion of
both psychiatric and organic medical/gynecological disorders
is of critical importance: gynecological disorders
that may be confused include pelvic pain syndrome,
endometriosis, dysmenorrhea, and the perimenopause.
Psychological disorders to be distinguished, amongst
many others, include subtypes of depression, personality
disorder, anxiety disorders, and seasonal affective
disorder. Investigators lack agreement regarding the
particular symptoms that define PMS and the specific
methodology to diagnose this condition. Whether the
method of assessment needs to be different for clinical
purposes and research is also a matter for debate.
There is currently no objective means of assessing
PMS, and clinical diagnosis relies predominantly on the
subjective self-reporting of symptomatology. If we look
again at the criteria required for the diagnosis of PMS
and PMDD, it is clear that several factors must be
quantified.
Any technique needs to provide an easily completed
means of assessing individual symptoms on a prospective
daily basis. To ensure compliance, this must be
simple and not time consuming for the patient. The
symptoms should be easily converted into numerical
data and so free text should be avoided. The first aim is
to demonstrate that symptoms occur in the luteal phase
and, perhaps most importantly, to show that they
resolve by the end of menstruation. Secondly, the severity
of symptoms needs to be quantified in a numerical
format. Thirdly, a means of assessing whether or not
there is an underlying psychiatric disorder and how this
is to be quantified needs consideration; psychiatric
interview, rating scales, or questionnaires for psychological
illness are all possibilities. At its most simple,
given that there is considerable overlap between symptoms
of PMS/PMDD and those of other psychological
disorders, the absence of symptoms in the follicular
phase on PMS/PMDD scales may well suffice for clinical
practice for the exclusion of depression but probably
not for disorders such as obsessive compulsive disorder
(OCD) and post-traumatic stress disorder (PTSD)
which require structured psychiatric interview. Finally,
an important factor which we must measure, and in fact
the key factor which enables us to distinguish between
physiological premenstrual symptoms, PMS, and PMDD,
is the determination of the impact on normal functioning,
well-being, and interpersonal relationships.