Premenstrual Syndrome - Diagnosis

Main diagnostic criteria of premenstrual syndrome

• The onset of symptoms depends on the menstrual cycle. They develop during the last week of the luteal phase and cease or become less pronounced after the onset of menstruation (it is necessary to confirm a worsening of the severity of symptoms during the 5 days before menstruation by approximately 30% compared with the 5 days after menstruation).
• The presence of at least 5 of the following symptoms, with one of the first 4 necessarily included:
  • emotional lability (sudden sadness, tearfulness, irritability, or anger);
  • constant, pronounced anger and irritability;
  • marked anxiety or feeling of tension;
  • sharply depressed mood, feeling of hopelessness;
  • decreased interest in normal activities;
  • easy fatigue or significant decrease in performance;
  • inability to concentrate;
  • noticeable change in appetite;
  • pathological sleepiness or insomnia;
  • somatic symptoms characteristic of a certain clinical form of premenstrual syndrome.

Diagnosis of premenstrual syndrome includes registration of symptoms of a necessarily cyclical nature, which are recommended to be noted in a special diary with daily reflection of signs of the disease for 2-3 cycles. Also important are a thorough collection of anamnesis, especially related to the nature of mood changes and life stresses, data from a physical and psychiatric examination, and differential diagnosis.

Laboratory and instrumental studies

Laboratory and instrumental research methods depend on the form of premenstrual syndrome.

• Psychovegetative form.
  • X-ray of the skull.
  • Echoencephalography.
• Edematous form.
  • Determination of diuresis and the amount of liquid drunk over 3–4 days in both phases of the cycle.
  • Mammography in the 1st phase of the menstrual cycle (up to the 8th day) in case of pain and engorgement of the mammary glands.
  • Evaluation of renal excretory function (determination of urea and creatinine concentration in the blood).
• Cephalgic form.
  • Echoencephalography, rheoencephalography.
  • Assessment of the condition of the fundus and peripheral visual fields.
  • X-ray of the skull and cervical spine.
  • MRI of the brain (as indicated).
  • Determination of prolactin concentration in the blood in both phases of the cycle.
• Crisis form.
  • Measuring diuresis and the amount of liquid drunk.
  • Measuring blood pressure.
  • Determination of prolactin content in the blood in both phases of the cycle;
  • Echoencephalography, rheoencephalography.
  • Assessment of the condition of the fundus and visual fields.
  • MRI of the brain.
  • For the purposes of differential diagnosis with pheochromocytoma, the content of catecholamines in the blood or urine is determined, and an ultrasound or MRI of the adrenal glands is performed.

Differential diagnosis of premenstrual syndrome

Premenstrual syndrome is differentiated from chronic diseases, the course of which worsens in the 2nd phase of the menstrual cycle.

• Mental illnesses (manic-depressive psychosis, schizophrenia, endogenous depression).
• Chronic kidney disease.
• Migraine.
• Brain tumors.
• Arachnoiditis.
• Prolactin-secreting pituitary adenoma.
• Crisis form of hypertension.
• Pheochromocytoma.
• Thyroid diseases.

Indications for consultation with other specialists

In the above-described diseases, the appointment of therapy aimed at reducing the severity of premenstrual syndrome symptoms does not lead to a significant improvement in the condition. In these cases, a consultation with specialists is necessary, who will prescribe treatment for the underlying disease.

• A consultation with a neurologist is indicated if psychovegetative, cephalgic and crisis forms of premenstrual syndrome are suspected.
• If a psychovegetative form is suspected, a psychiatrist consultation is carried out.
• A consultation with a therapist is necessary if you suspect a crisis form of premenstrual syndrome.
• If a cephalgic form is suspected, an ophthalmologist consultation is prescribed.

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