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

database by electronic means. The MiniDoc method
has had limited use; it uses electronic data collection,
but has not been published as a technique. At least one
research study (within a clinical trial) using this technique
was terminated prematurely because of difficulties
with the system; the authors have been unable to
locate other publications using the technique.
North Staffordshire Hospital/Keele University and
Nottingham University investigated the menstrual
symptometrics device, which was developed and validated
against paper-based techniques. This method
used a very early PDA (Amstrad PenPad, which is now
obsolete). Visual analog scales were used to record
scores for symptoms of PMS, dysmenorrhea, and perception
of blood loss by means of a ‘pen’ on the touchsensitive
screen. It also incorporated the menstrual
pictogram, a previously published pictorial method of
measuring menstrual blood loss volume – hence, all
symptoms related specifically to disorders of the
menstrual cycle could be measured. 30
Menstrual symptometrics was a simple ‘palmtop’
personal computer system programmed to collect the
daily menstrual cycle symptoms of PMS, blood loss,
and pain, it was also programmed to include questionnaires
to assess the woman’s general health quality of
life using an SF-36 (see next section for description)
and a simple measure of underlying psychological
pathology (General Health Questionnaire, GHQ) were
also documented with other questionnaires incorporated
into the system. It avoided the need to measure by
hand the VAS, as the touch-sensitive screen allowed the
instant measuring and storage of scores from VAS. It
had a high level of patient acceptability and could
provide instant pictorial feedback on symptoms for
patients and clinicians.
This method is now obsolete, because of advances in
PDA technology, and the menstrual pictogram is no
longer valid because the blood absorbancy of those
menstrual sanitary products acceptable to most women
has changed dramatically.
MEASURES OF IMPAIRMENT
The measurement of impact or luteal phase impairment
is critical in research and clinical practice if we are to
distinguish PMS/PMDD from what are essentially
normal or physiological symptoms of ovulatory menstrual
cycles.
The diagnosis of PMDD also requires the confirmation
of luteal phase impairment of social and/or work
functioning. Commonly utilized ratings of role functioning
and quality of life reported in prevalence and
treatment studies include the Quality of Life Enjoyment
and Satisfaction Questionnaire (Q-LES-Q), the
Sheehan Disability Scale (SDS), the Short Form of the
Medical Outcomes Study functioning scale (SF-36),
and the Social Adjustment Scale (SAS). The DRSP monitors
three functioning items daily that assess impairment
at work, school or home; interference with
hobbies or social activities; and interference with relationships
with others. Most researchers consider that to
be adequate for most clinical trials.
CONCLUSION
QUANTIFICATION OF PMS AND PMDD 35
The definitions and diagnosis of PMDD are still fragmented,
not widely accepted, and, if accepted, not
always applied in day-to-day clinical practice. We are
still far from a biomedical and/or biopsychological
model of a diagnostic entity based on etiology, pathophysiology,
phenomena, time course, and treatment
response.
Methods which use bipolar scores, optimize the
thresholds separating PMS + from PMS – cycles, and are
based on known PMS symptom patterns are likely to
be satisfactory whatever their level of sophistication.
The vast amount of paperwork involved in recording
a woman’s premenstrual symptoms daily over several
months has meant that the data collection, measurement,
and analysis of such data is time-consuming and
labor-intensive, requiring many hours of data acquisition.
A personal computer system for data collection
and symptom measurement provides a simplified means
of collecting large amounts of data on a daily basis,
such as measurement of VAS, categorical scores, menstrual
icons, and documentation of questionnaires. The
ability to provide a graphic display provides an instant
cyclic image of all the woman’s menstrual cycle symptoms,
making diagnosis and appropriate management
of any disorder more accurate and straightforward.
Further studies are needed to validate the possibility
of circumventing the need for prospective daily charting
in establishing the diagnosis of PMS or PMDD
possibly by validation of the PSST against the DRSP.
Until an objective means (genetic or magnetic resonance
imaging [MRI]) of diagnosing PMS/PMDD is
achieved, diagnosis is likely to rely on daily questionnaires
such as the DRSP which most closely relates to
the symptom factors within DSM-IV PMDD, unless of
course the PSST can be shown to be valid. The concept
of PMSD is a new one and, together with new rating
tools, it warrants further exploration.
If such large numbers of data points continue to be
required, electronic methods will increasingly be necessary
and are really the only practical way forward. To
consider PMS/PMDD management without reference