Premenstrual Syndrome Clinical Presentation

  • Author: Megan A Moreno, MD, MEd, MPH; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Mar 21, 2012
 

History

Elicit a description of cyclic symptoms that occur before the menstrual period and resolve with menses from patients with suspected premenstrual syndrome (PMS).

  • To establish the diagnosis, instruct patients to chart symptoms daily for 2 cycles. This usually demonstrates symptoms clustering around the luteal phase of ovulation, with resolution when menses begins.
  • Advise the patient to use a numeric scoring system (1 for mild, 2 for moderate, 3 for severe) when recording symptoms. Ask the patient to bring her lists to the next appointment.
  • Instruct the patient to rate their symptoms according to severity (1 for mild, 2 for moderate, and 3 for severe). The categories of PMS symptoms are as follows:[12, 13, 10, 14]
    • PMS-A (anxiety)
      • Difficulty sleeping
      • Tense feelings
      • Irritability
      • Clumsiness
      • Mood swings
    • PMS-C (craving)
      • Headache
      • Cravings for sweet foods
      • Cravings for salty foods
      • Cravings for other types of food
    • PMS-D (depression)[15]
      • Depression
      • Angry feelings for no reason
      • Feelings that are easily upset
      • Poor concentration or memory
      • Feelings of low self-worth
      • Violent feelings
    • PMS-H (hydration)
      • Weight gain
      • Abdominal bloating
      • Breast tenderness
      • Swelling of extremities
    • PMS-O (other)
      • Dysmenorrhea
      • Change in bowel habits
      • Frequent urination
      • Hot flashes or cold sweats
      • General aches or pains
      • Nausea
      • Acne
      • Allergic reactions
      • Upper respiratory infections
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Physical

  • Usually, no physical findings are specifically helpful in establishing the diagnosis of PMS. If the adolescent presents during the luteal phase, she may have mastalgia or edema of the breasts or legs.[13]
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Causes

  • The definitive cause of PMS is unknown.
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Megan A Moreno, MD, MEd, MPH  Assistant Professor, Department of Pediatrics, Section of Adolescent Medicine, University of Wisconsin-Madison School of Medicine and Public Health

Megan A Moreno, MD, MEd, MPH is a member of the following medical societies: Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Ann E Giesel, MD  Clinical Professor of Pediatrics, Division of Adolescent Medicine, University of Washington; Director of Pediatric and Adolescent Gynecology, Seattle Children's Hospital; Medical Director of the King County Juvenile Detention Center Health Clinic; Medical Director of the Evevning Clinics at the Country Free Doctor FreeTeen Clinic for Homeless Youth

Ann E Giesel, MD is a member of the following medical societies: North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Medicine, and Washington State Medical Association

Disclosure: Nothing to disclose.

Cara Beth Rogers  University of Rochester

Disclosure: Nothing to disclose.

Liana Roxanne Clark, MD  Assistant Professor, Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia

Liana Roxanne Clark, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Adolescent Medicine

Disclosure: Merck & Co. Inc Salary Employment

Specialty Editor Board

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Andrea L Zuckerman, MD  Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

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