There are no specific physical findings or laboratory tests that can diagnose Premenstrual Syndrome (PMS). There is also no symptom that is unique to PMS. The only way to determine whether you suffer from PMS is to record the timing and severity of your symptoms - both emotional and physical - throughout your menstrual cycle on a daily basis for two to three months.
In addition, monitoring basal body temperature (lowest body temperature during sleep) and vaginal secretion will contribute useful information to confirm when ovulation occurs. To accurately diagnose PMS, your physician will rely upon this charting. It is also useful to gauge your response to therapy.
When working with a doctor to confirm PMS, other disorders must be eliminated, since many symptoms of PMS resemble those of other underlying conditions. Your doctor may want to do a physical examination and a pelvic exam to rule out gynecologic problems.
In cases where fatigue is a major symptom, a blood test may be done to rule out anemia, hypothyroidism and contributors to Chronic Fatigue Syndrome. It is also important to be aware that more serious psychiatric problems may have a cyclic pattern of worsening emotional symptoms in the premenstrual phase. For example, depression is common in women and often worsens during premenstrual days.
Treating PMS
While many remedies have been introduced and advocated for the treatment of PMS, few have been proven truly beneficial. Serotonin agents and agents that block ovulation are the only therapies that have been found to be more effective than placebo (an inactive pill that ensures the study is "controlled"). It is interesting that a number of patients do respond to placebo in a positive way. This does not mean that the symptoms are not real; it simply represents the lack of understanding as to how or why the placebo works. For example, the belief that a medication will cure a patient may cause a production of chemicals in the brain that improve symptoms. It may also be that a patient is simply having a positive response to a sympathetic caregiver.
Help from your doctor
When your own PMS management efforts aren't working, it may be time to seek help from your doctor. If your doctor is not an expert in the latest developments and research in PMS, he or she may refer you to someone else. This is perfectly acceptable.
When visiting your doctor, bring along your cycle charts and food logs. Tell the doctor about any medications, over-the-counter drugs, vitamin/mineral supplements or herbal remedies that you take. When PMS symptoms are particularly severe, a doctor may recommend one or a combination of the following:
Serotonin
Currently, serotonin agents are the treatment of choice for PMS. Serotonin has a great deal to do with moods. Specific serotonin reuptake inhibitors (SSRI) (e.g., Prozac, Zoloft, Paxil) have been confirmed in double-blind placebo controlled trials as being the most effective treatment of PMS. These drugs may relieve such symptoms as anxiety, impulsivity, aggression and increased appetite. Serotonin agents, however, are not generally helpful in alleviating the physical premenstrual symptoms.
Prescription diuretics for fluid retention
If limiting salt intake is not effective, diuretics may be helpful if you are experiencing significant cyclic fluid retention that can be manifested as weight gain or leg and ankle swelling. Diuretics increase the kidney's ability to excrete sodium and water in urine, so the amount of fluid surrounding body tissue cells is diminished. Prescription diuretics are powerful drugs that can cause some serious side effects, so you should always take them under a doctor's supervision.
Hormone treatment
Some doctors will try hormone therapy when other treatments have not worked. Progesterone supplementation during the premenstrual phase is not consistently effective. However, hormone therapy designed to suppress ovulation has some promise. Birth control pills block ovulation, so theoretically, PMS should not exist. However, while birth control pills improve PMS symptoms for some women, others find their symptoms are unchanged or even more severe.
Another form of hormone treatment uses Gonadotrophic releasing hormone (GnRH) agonists. GnRH therapy has been used to successfully treat PMS symptoms in severe cases that have not been helped by other treatments. These agents prevent ovulation by suppressing ovarian function. Thus, oestrogen and progesterone levels remain low. Since low oestrogen levels are associated with accelerated bone loss and increased cardiovascular disease, long-term therapy with GnRH agonists is not advised.
As a result, this therapy can be combined with supplemental oestrogen to minimize these risks. Since GnRH agonists have serious risks, are expensive therapy and are usually administered by injections or implants, the combination of GnRH and estrogen is reserved for patients with severe symptoms who are not responsive to other forms of therapy.
Other medications
Tranquilizers, as well as anti-depressants that are not serotonin reuptake inhibitors (SSRI), may also relieve some PMS symptoms. The use of tranquilizers should be carefully weighed to ensure that the benefits outweigh the risks since drug dependence (addiction) is a possible risk.
For bothersome breast swelling or pain, a doctor may suggest bromocriptine, which can relieve premenstrual breast tenderness by decreasing the release of prolactin hormone from the pituitary gland. Prolactin is one of many hormones that stimulates breast tissue. Bromocriptine does not relieve other symptoms of PMS. Serious side effects of the drug are rare, but bothersome side effects such as nausea and lightheadedness are common.
Surgery
As a last resort, when no other therapies have worked and your PMS symptoms are very severe, you and your doctor may consider surgery. Oophorectomy, or removal of the ovaries, eliminates PMS. This is radical therapy and should be considered only when nothing else has relieved your symptoms and PMS has had devastating affects on your personal and professional life. In addition, it is only an option when you have completed child-bearing.
