True PMDD is an emotional manifestation of a hormonal imbalance occurring when a woman’s ovulatory function is diminished or changes. (This is why it is common in the teenage years, the later years of a woman’s menstrual cycles, and at times in between when ovulatory function is disrupted).
Evaluating ovulatory function through daily charting of basal body temperatures and the daily recording of the associated PMDD symptoms are the keys to both establishing the diagnosis and successfully treating the disease.
This collection of ovulatory data and symptoms starts when the initial office visit is scheduled and permits us to confirm the diagnosis and start effective therapy at the first visit.
First, on a piece of loose-leaf paper, make three vertical columns to record, from left to right, the date, the day of your cycle (starting on the first day of the menstrual flow) and the basal body temperature for that day. Then, moving on from left to right, make a column for each PMDD symptom that you experience during the month. Leave this paper and your thermometer at your bedside for easy access.
Next, basal body temperatures are taken DAILY and recorded with an oral, digital thermometer first thing in the morning when you wake up. This is before you get out of bed to use the bathroom, etc. (Even this minimal activity can cause your temperature to go up leading to inaccuracies in the chart and difficulties evaluating ovulatory function and hormonal production).
At the end of the day, each PMDD symptoms is scored based on its severity at its worst during that day. The scoring system is as follows:
0 = none that day.
1 = mild at worst.
2 = moderate at worst.
3 = severe at worst.
4 = disabling at worst (cannot go to work, school, or go about your normal activities such as grocery shopping, etc.).
(I can only count to 4, so any other scale will not work for me).
The more data that we have the more easily we can evaluate and treat your symptoms. If you miss a day of charting, either the basal temperatures or the PMDD symptoms, just continue with the next observation (either basal temperature or PMDD symptom charting). We can usually work around minimally missing data.
This method of evaluating PMDD is very accurate, safe, inexpensive and forms the basis for both an accurate diagnosis of PMDD and meaningfully assessing treatment results.
If you have further questions, please reach out to me via the e-mail link on this web page or calling my office at 856-429-2212.
Gerald V. Burke, M.D.