Wednesday, July 16, 2014

PMS (Premenstrual Syndrome) - Day 2: Charting The Way To Wellness!

In last week's blog, PMS: Day 1: Separating Fact From Fiction! , we took a look at what PMS or PMDD (Premenstrual Dysphoric Disorder) is and what it isn't!  Please take a read if you have not already. The most important fact we learned about PMDD is that it is a legitimate medical disorder! And although it has a physiological basis for causation, symptoms manifest both physically and psychologically! Today, we are going to take a look at how PMDD is  accurately diagnosed and assessed. Along with a comprehensive blood panel and a complete medical/psychological history, most experts can confirm or rule-out PMDD by requiring their patients or clients to chart their symptoms for a minimum of three months. Why is this important? Let me explain.

Females suffering from PMDD do not experience their symptoms all month long. Symptoms typically are present for most of the time during the last week of the luteal phase (the time between ovulation and the onset of menses) and begin to remit within a few days ofter the onset of the follicular phase (the time when menses begin).  Let's take a look at an example of a diagnostic chart:

PMDD Diagnostic Chart
Here's how it works.  On a chart like this one, or using one of your making, list your symptoms along the left hand side. Don't forget to write down both physical and psychological symptoms! If you are like I was, I needed more than six lines! Then, begin charting with the first day of your menses, filling in the circles as to the degree of severity. As soon as you are not feeling any symptoms, stop filling in those respective circles. Also, put an M  in the box below the day for each day of your menses. As the month moves along and you begin feeling any symptoms, start to fill in those corresponding circles!  Keep filling in the chart as you experience symptoms until your menses begin again.  When they begin, move down to the next monthly cycle and continue your charting!                                                                              
Chart Daily!!
To make this process as easy and objective as you can, I recommend two things. First, keep your chart in a convenient place. I taped mined to the inside of my medicine cabinet where it was easily accessible. Secondly, fill this out at the end of each day. I filled mine out in the evening when I was washing my face and getting ready for bed. I felt that I could reflect upon the day as a whole more objectively and without beating myself up, especially if it had not been a good day! With today's technology, maybe it would work well to fill it out on a spread sheet in the evening before you turn off your devices! Do whatever works for you!

After a period of three months, one of several patterns will start to emerge if PMDD is present.
  • Symptoms may occur from just one day and up to ten days prior to menstruation and continue until the onset of menstruation.
  • Symptoms may occur at ovulation, resolve in a day or two, and then reappear later on in the premenstrual phase.
  • Symptoms may occur at ovulation, and continue on until the onset of menstruation.
  • Symptoms may occur at ovulation, continue on steadily through the menstrual period, and resolving toward the end of the menstrual period. 
As you can see, a female may experience PMDD just a few days a month, or sadly almost three weeks a month! Most experts agree that in order to make a clear distinction between PMDD and other mood disorders, there must be a window of time within a month where a female is symptom free. However, just as there is great fluctuation in the duration of symptoms, there can also be a wide range in the degrees of severity. The important point is that if indeed a female is suffering from PMDD - whether it is mild, moderate, or severe - there is help available!

Before a confirmed diagnosis can be made, the DSM (Diagnostic and Statistical Manual of Mental Disorders) requires these three criteria be met:
  • The disturbance markedly interferes with work or school or with usual social activities and relationships with others.
  • The disturbance is not merely an exacerbation of the symptoms of another disorder, such as Major Depressive Disorder, Panic Disorder, etc., although it may be superimposed on any of these disorders.
  • Diagnostic criteria (physical and psychological symptoms as designated in the DSM) must be confirmed by prospective daily ratings during at least two consecutive symptomatic cycles.
Over the years counseling and working with women who suffered from PMDD, I was often asked, "Holli, does my PMDD make my other problems or issues worse, or do my other issues or problems make my PMDD worse?"  In my opinion, the answer is BOTH! So, the point is this:

Knowledge Empowers Us!

Through charting our symptoms, we can get a solid handle on what we are feeling and when! And with that knowledge, we can begin implementing a strategic program for healing from PMDD. As our healing takes hold, other disorders or issues may resolve naturally and/or they will present themselves in more distinct understandable contexts wherein specific interventions can be administered accordingly. 

Let's get started today ~
 Charting The Way To Wellness! 

Next time ~ Feeling Well All Month Long! 

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