Premenstrual syndrome: diagnosis

The main diagnostic criteria for premenstrual syndrome

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

Diagnosis of premenstrual syndrome involves the recording 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 within 2-3 cycles. It is also important to carefully collect anamnesis, especially associated with the nature of mood changes and stresses of life, the data of a physical and psychiatric examination and differential diagnosis.

Laboratory and instrumental research

Methods of laboratory-instrumental research depend on the form of premenstrual syndrome.

• Psycho-vegetative form.
  • Radiography of the skull.
  • Echoencephalography.
• Edematous form.
  • Determination of diuresis and the amount of fluid drunk within 3-4 days in both phases of the cycle.
  • Mammography in the first phase of the menstrual cycle (before the 8th day) with soreness and engorgement of the mammary glands.
  • Evaluation of the excretory function of the kidneys (determination of the concentration of urea, creatinine in the blood).
• Cephalic form.
  • Echoencephalography, rheoencephalography.
  • Assessment of the state of the fundus and peripheral fields of vision.
  • Radiography of the skull and cervical spine.
  • MRI of the brain (according to indications).
  • Determination of the concentration of prolactin in the blood in both phases of the cycle.
• The shape of the neck.
  • Measurement of diuresis and the amount of liquid drunk.
  • Measurement of blood pressure.
  • Determination of prolactin in the blood in both phases of the cycle;
  • Echoencephalography, rheoencephalography.
  • Assessment of the condition of the fundus, fields of vision.
  • MRI of the brain.
  • For the purpose of differential diagnosis with pheochromocytoma, the content of catecholamines in the blood or urine is determined, ultrasound or MRI of the adrenal gland 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 diseases (manic-depressive psychosis, schizophrenia, endogenous depression).
• Chronic kidney disease.
• Migraine.
• Tumors of the brain.
• Arachnoiditis.
• Prolactin-secreting adenoma of the pituitary gland.
• Cryous form of hypertensive disease.
• Pheochromocytoma.
• Diseases of the thyroid gland.

Indications for consultation of other specialists

With the diseases described above, the appointment of therapy aimed at reducing the symptoms of premenstrual syndrome does not lead to a significant improvement in the condition. In these cases, a consultation of specialists is needed, which will prescribe the treatment of the underlying disease.

• Consultation of a neuropathologist is indicated for suspected psycho-vegetative, cephalgic and crisis forms of premenstrual syndrome.
• If you suspect a psycho-vegetative form, consult a psychiatrist.
• Consultation of the therapist is necessary if you suspect a premenstrual syndrome.
• If you suspect a cephalic form, consult an ophthalmologist.

[1], [2], [3], [4], [5], [6], [7]