There are no laboratory tests that can diagnose PMDD, so measuring blood levels of estrogen or progesterone or anything else will not provide a diagnosis. The diagnosis of PMDD is based on the regular presence of certain clinical symptoms for part of each menstrual cycle. More specifically, here are the symptoms that make up the diagnosis of PMDD.

All of the symptoms need not be present and they may vary from month to month. At least 5 are required to make the diagnosis, including at least one of the first four.*

1. Very depressed mood, feeling hopeless
2. Marked anxiety, tension, edginess
3. Sudden mood shifts (crying easily, extreme sensitivity)
4. Persistent, marked irritability, anger, increased conflicts
5. Loss of interest in usual activities work, school, socializing
6. Difficulty concentrating and staying focused
7. Fatigue, tiredness, loss of energy
8. Marked appetite change, overeating, food cravings
9. Insomnia (difficulty sleeping) or sleeping too much
10. Feeling out of control or overwhelmed
11. Physical symptoms such as weight gain, bloating, breast tenderness or swelling, headache, and muscle or joint aches and pains

*Adapted from Diagnostic and Statistical manual of Mental Disorders, Fourth Edition, Text Revision, 1994 with permission from the American Psychiatric Association
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There is more to making the diagnosis of PMDD than just the symptoms. For example, the symptoms must be linked to the menstrual cycle -- appear in the premenstrual phase, improve or disappear when menses begins or shortly thereafter and be absent in the week following menses. Also, if the symptoms are relatively mild the diagnosis is not made. The premenstrual symptoms have to be severe enough to interfere markedly with relationships, work, school, or social activities.

In a nutshell, here is what is necessary to diagnose PMDD -- severe symptoms linked predictably to the premenstrual phase of the cycle.

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