Steps to Diagnosis
Preface: Why is it so hard to get a diagnosis?
PMDD has only recently been formally recognized as an “official” diagnosis in the medical and mental health communities, and PME currently remains a research diagnosis only. Because of this, many healthcare providers have not received training in PMDD or PME - they may not be aware that the conditions exist, and they often don’t know where to begin in treating them. Therefore, the most reasonable place to start when seeking diagnosis and treatment of PMDD or PME is to find a provider near you who (1) knows what PMDD is, and (2) knows something about how to treat PMDD. Providers who know about PMDD will also be knowledgeable about PME, so asking about their work with PMDD is probably the best place to start.
Screening Providers
Although it may be frustrating, it is usually worth the investment to screen your providers ahead of time via phone. You might call a provider and ask the office assistant whether any of the providers at their office have experience in treating PMDD. If there are multiple providers at a single practice, you should ask which providers specifically have experience in treating PMDD. You might also ask them what treatments they typically use for PMDD. Although everyone responds differently to treatment, we recommend that you find a provider who starts by recommending the treatments that are statistically most likely to work (as outlined on our treatment recommendations page).
Preparing Ahead of Time: Collecting Prior Treatment Records
For most providers, bringing in documentation of any prior history of treatment for premenstrual or other disorders will help them to treat you more efficiently. Since it may take some time to get these records from your prior healthcare providers, we recommend you request those records as soon as possible; often you will need to sign a release of information form before records can be picked up or send to your new provider.
Preparing Ahead of Time: Daily Symptom Ratings Across the Cycle
For a healthcare provider, premenstrual disorders can be confusing to differentiate from other disorders such as dysmenorrhea (severe physical symptoms around one’s period that don’t have an emotional component), bipolar disorder, major depression, anxiety disorders, or borderline personality disorder. Because of this confusion, the medical and mental health communities have determined that, before “advanced” treatments for PMDD (i.e., options other than SSRIs and oral contraceptives) can be provided, daily symptom ratings across at least two menstrual cycles should be used to make an official diagnosis of PMDD (or PME). The DSM-5, where PMDD was recently made into an official diagnosis, specifically requires two months of daily ratings before a diagnosis can be made.
We understand that tracking symptoms (or tracking symptoms in a new way) may be frustrating for patients who have suffered with premenstrual disorders for a long time. For the moment, however, it seems to be the only way to get a clear diagnosis and the help you deserve. If you’re struggling with tracking consistently, enlist your spouse, partner, or family member to help you rate your symptoms each day for two months.
Moving Forward with a Medical Doctor (Gynecologist, Psychiatrist, GP)
As we mentioned above, many medical doctors are unaware of the existence of premenstrual disorders or don’t know how to treat them. Statistically, the medical specialties that are most likely to know about the existence of PMDD and PME are gynecologists and psychiatrists.
Here are some basic points to cover in your first visit:
Explain your symptoms and say, “I believe I have PMDD (or PME)”
Show your daily ratings across the cycle
Provide your doctor with your history of treatment, especially whether SSRIs and birth control pills have been helpful in the past.
While there are no blood tests that can diagnose PMDD, ask your provider whether a blood test is useful for ruling out any underlying disorders that may be causing your symptoms.
If you feel it would be helpful, ask your doctor for a referral to a behavior-oriented therapist who can provide practical weekly support during your journey to find effective treatment and can rule out other easily-treatable psychological symptoms (e.g., phobias).
Provide the doctor with a printout of evidence-based guidelines for the treatment of PMDs.
If the doctor recommends a treatment that you’ve already tried that has not helped, clearly say “that hasn’t helped me in the past, I’d like to try something new.” If they still do not offer a new treatment, consider selecting a new doctor.
Moving Forward with a Therapist or Other Health Care Provider
Similar to medical doctors, most therapists are unaware of the existence of premenstrual disorders and don’t know how to treat them. Since the primary evidence-based treatments for PMDs are medical (pills, patches, injections, etc.), make sure that the mental health provider you see has experience referring patients to a physician for medication prescriptions as needed.
Here are some basic points to cover in your first visit:
Explain your symptoms and say, “I believe I have PMDD (or PME)”
Show your daily ratings across the cycle
Also tell the therapist about any non-cyclical symptoms that concern you and ask if there are any evidence-based treatments that might help with those symptoms.
Provide your therapist with your history of treatment, especially whether cognitive behavioral therapy, SSRIs, or birth control pills have been helpful in the past.
Ask your therapist for a referral to a medical provider who can perform tests to rule out other underlying medical disorders.
Provide the individual with a printout of evidence-based guidelines for the treatment of PMDs.
If the therapist recommends a treatment that you’ve already tried that has not helped, clearly say “that hasn’t helped me in the past, I’d like to try something new.” If they still do not offer a new treatment, consider selecting a new provider.
Have Questions?
Email IAPMD Peer Support at support@iapmd.org.
Related Resources
Updated Nov 6, 2018 By Tory Eisenlohr-Moul PhD