PMS is an elusive diagnosis, you yourself have to make your own diagnosis by tracking your symptoms, the symptoms are emotional and physicial, that most gynecologists do not even ask the question as to whether you have symptoms around your menses.
PMS is the mild form of symptoms around the menstrual cycle, PMDD is the more severe form standing for Pre Menstrual Dysphoric Disorder. The ‘pre’ is significant as it is mostly a syndrome that occurs just before a natural menstrual cycle’s period when both estrogen and progesterone levels plummet. But formal definitions incorporate hormonal symptoms that occur as the menses is ending and during ovulation, when hormone fluctuations are also common.
Women with PMS and PMDD think they know the condition when they have it. But just walking into your gyno and having a conversation about your suspicions is less accurate a diagnosis than actually doing what it takes to get a formal diagnosis. You have to chart your symptoms, as they occur during two or three cycles, prospectively. If you don’t you may be misdiagnosed and actually have PMS, depression, anxiety, a bad day, or the flip side, this important diagnosis might get missed. So if your gyno asks you to go home and chart your symptoms for two months, it’s important to do so.
PMS can be manifest by either physical symptoms or the emotional symptoms. . In order to really determine whether this is depression, or a mood disorder, or PMS women are encouraged to track their symptoms relative to their cycle and let their gyno know not only which symptoms you have but which symptoms are actually bothersome to you.
Yes, the DSM IV (the Bible of psychiatric diagnosis) “allows” health care providers to make a “provisional” diagnosis just from a visit without a diary of symptoms, so those suffering do not have to have effective treatment withheld, but it’s best to get an accurate diagnosis.
What is not clear, is how the cycling of symptoms relate to those brain hormones, particularly seratonins, that trigger the mood changes known as PMs. This effect is at the receptors called the 5-HT receptor. Actually there are 15 known 5-HT receptors in the brain, which is why not all seratonin reuptake inhibitor medicines are the same, and not all work for PMS.
Eventually for many its best to just try a treatment if the diagnosis is still in doubt. The treatments can give you a clue as to whether you have PMS. If your moods improve when on hormonal management, you may in fact have PMS. However there are choices in treatments, so once you have a diagnosis may range from birth control pills to control your cycles to actual anti-depressants given just at that time of month. Although they are both effective, the birth control solution, of which the birth control YAZ has the best research on the PMDD aspect, is best for improving swelling, bloating, headaches, muscle pains and breast tenderness.
Long term health consequences of PMS are first being studied. We are seeing that women with PMS have an earlier menopause.
Dietary and exercise strategies seem to be beneficial as well, and really that is where we begin PMS solutions at Women’s Health Practice.
If you are interested in finding out more about PMDD talk to your Gyno Gab Gal, research continues