Premenstrual Syndrome Clinical Presentation

Updated: Feb 19, 2021
  • Author: Megan A Moreno, MD, MSEd, MPH; Chief Editor: Andrea L Zuckerman, MD  more...
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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 two cycles. This usually demonstrates symptoms clustering around the luteal phase of ovulation, with resolution when menses begin.

Advise the patient to use a numeric scoring system to specify severity (1 for mild, 2 for moderate, 3 for severe) when recording symptoms. Ask the patient to bring her lists to the next appointment. The categories of PMS symptoms may be divided into five basic categories—A, C, D, H, and O—as follows. [17, 18, 12, 19]

PMS-A (anxiety) symptoms include the following:

  • Difficulty sleeping
  • Tense feelings
  • Irritability
  • Clumsiness
  • Mood swings

PMS-C (craving) symptoms include the following:

  • Headache
  • Cravings for sweet foods
  • Cravings for salty foods
  • Cravings for other types of food

PMS-D (depression) symptoms include the following [20] :

  • 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) symptoms include the following:

  • Weight gain
  • Abdominal bloating
  • Breast tenderness
  • Swelling of extremities

PMS-O (other) symptoms include the following:

  • Dysmenorrhea
  • Change in bowel habits
  • Frequent urination
  • Hot flashes or cold sweats
  • General aches or pains
  • Nausea
  • Acne
  • Allergic reactions
  • Upper respiratory tract infections

Physical Examination

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. [18]