Diagnosing PMS vs PMDD and Getting a Diagnosis: How PMS and PMDD Are Actually Diagnosed, and What Cycle Mapping Adds

There's no blood test for PMS or PMDD — so how do you actually get diagnosed? In this episode, Dr Georgina Standen walks through the real diagnostic process, and introduces cycle mapping, a tool that goes far beyond simply tracking your period.

In this episode:

• Why diagnosis relies on daily tracking rather than a single test — and why two full cycles matters
• The screening tools and diagnostic criteria doctors actually use (PSST, DRSP, DSM-5)
• What gets ruled out along the way, and why
• What cycle mapping is, and how it goes beyond period-tracking to reveal how your hormones and symptoms move together
• Why regular periods don't always mean regular ovulation
• Who cycle mapping is especially useful for — including women without regular periods to track against

Mentioned in this episode:

• Belle app: https://bellehealth.co/
• Flo app: https://app.flo.health/
• DRSP via ROCG (appendix III): https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/
• Mira hormone monitor (up to 30% off with SIRONAHEALTH): https://shop.miracare.com/products/fertility-max-starter-kit?variant=45163642224933
• Sirona Health PMS/PMDD page: sironahealth.co.uk/pms

A full transcript of this episode is available above.

Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health (sironahealth.co.uk), a specialist women's health practice covering menopause, PMS/PMDD and teen health. Book a consultation at sironahealth.co.uk.

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Transcript

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0:04

Hormones don't just run your cycle, they run your mood, your mind, your whole sense of self. I'm Dr. Georgina Standen, GP and founder of Sirona Health, and this is the Sirona Health Podcast, where we talk about the relationship between female hormones and mental health properly, without the mystique and without the dismissal. So over the last two episodes, I've talked about what separates PMS from PMDD and how common each of them actually is. I think the natural next question is, "Okay, so how do I actually find out which one I've got?" And that's what I want to cover today, how diagnosis actually works in practice, and then something a bit more specific, cycle mapping, which I think is one of the most useful tools we've got and one that not many people know exists I think the first thing worth saying, and I've said this before, but it bears repeating, there's no single blood test for this. None. You can't send off a sample and get a result back that says PMS or PMDD. So what do we actually use? Really, it comes down to three things: symptom tracking, screening tools, and clinical evaluation, and it has to happen over time, not in a single appointment. The tracking is the bit that matters most. We ask women to log their symptoms daily, and ideally, we want to see at least two full menstrual cycles before confirming anything. I know that sounds like a long time to wait, especially if you're already struggling, but it's really the only way to see the pattern clearly. Whether things are showing up in that luteal phase after ovulation and settling down once your period starts. There's a quick screening tool called PSST, the Premenstrual Symptoms Screening Tool, which is a helpful first pass, a way of flagging whether this is worth investigating properly. But the tool that actually confirms things is called the DRSP, the Daily Record of Severity of Problems. It's essentially a structured daily diary, and it gives us objective evidence, not just, "I think I feel worse before my period", but an actual record we can look at together. In terms of what we're using to tell PMS and PMDD apart, we work from the DSM-V criteria. For PMS, you need at least one physical or emotional symptom occurring in the luteal phase, and it has to be severe enough to affect your quality of life. For PMDD, the bar is far higher. At least five symptoms in total, and at least one of those has to be mood related, so irritability, depression, anxiety, and it has to be causing real distress or getting in the way of your daily functioning. And I think it's worth saying, we don't just take the tracking at face value and stop there. Because PMS and PMDD symptoms overlap quite a lot with other conditions, we'll often want to rule some things out. Thyroid disorders can look similar. So can straightforward depression or anxiety that isn't actually cycle-linked Perimenopause can muddy the picture too, which I talked about a bit in the last episode. So part of the assessment is making sure that what we're seeing is genuinely tied to your cycle and not something else that just happens to be there at the same time. I think for a lot of women, actually getting a diagnosis after however many years of being told this is just part of being a woman can feel enormously validating. It's not just an answer, it's often the first time someone's properly listened and tracked it with you rather than just taking a guess So that's the standard diagnostic pathway. I want to spend the second half of today on something a bit different, cycle mapping, because I think it's genuinely one of the most useful tools we've got, particularly for anyone whose picture isn't entirely straightforward. Cycle mapping is really about going a step further than just tracking your period. Instead, we're tracking your actual hormone levels across the cycle using a hormone monitor and lining that up against your symptoms day by day. So rather than just knowing I feel worse before my period, we can actually see this is what's happening with your hormones on this day, and this is what you're feeling on that same day. The tool we tend to use is called the Mira monitor, and it lets us track a few different hormones at home: LH to pin down ovulation, estradiol to map that rise before ovulation, and progesterone, which helps confirm ovulation actually happened and tells us something about how your luteal phase is behaving, and in some cases, FSH, particularly if perimenopause might be part of the picture I think what's really different about this compared to a standard ovulation test is that it's not just a yes or no. A normal ovulation test tells you, yes, you're ovulating, or no, you're not. Cycle mapping gives us an actual trend, quantitative data across the whole month, which is a much richer picture. This is particularly useful when symptoms feel unpredictable, when your cycles vary quite a lot in length, when your luteal phase seems short or a bit chaotic, Or when you're genuinely trying to work out whether ovulation itself is what's triggering things. And I think there's a common misconception worth clearing up here, which is if my periods are regular, I must be ovulating normally. That's actually not always true. There's research suggesting a fair proportion of apparently regular cycles may be anovulatory or not ovulating properly, without that being obvious from the outside. So regular periods don't automatically mean regular ovulation, and cycle mapping can actually show us that. The other misconception I hear a lot is my hormones must be abnormal if I feel like this. And as I've said a few times now, in PMDD specifically, hormone levels are very often completely normal. What cycle mapping is really showing us isn't abnormal hormones, it's the relationship between your normal hormonal shifts and your symptoms. For PMDD, the key moment tends to be ovulation itself, not the absolute level of any hormone, but that post-ovulatory shift, particularly how your brain responds to progesterone and its breakdown product allopregnanolone cycle mapping lets us see that transition really clearly in a way a single blood test never could. I think it's also worth mentioning, cycle mapping is particularly helpful for a specific group of women, those who have premenstrual symptoms but aren't having periods to track against, so after a hysterectomy where the ovaries were kept, after an endometrial ablation, or after a hormonal coil has stopped periods altogether. In those situations, you can't just watch the calendar the normal way, so hormone-based mapping becomes a much more useful tool. One thing I'd say clearly, cycle mapping isn't a replacement for the diagnostic process I talked about in the first half. PMDD is still fundamentally a clinical diagnosis based on your symptom pattern. But in more complex cases, it adds a layer of insight that symptom tracking alone doesn't give us, and it can be really helpful for distinguishing PMDD from something that looks similar but isn't quite the same, like premenstrual exacerbation, which is where an existing condition gets worse premenstrually rather than PMDD being the primary issue itself. I'll come back to that properly in a later episode. So to bring today together, diagnosis isn't a blood test. It's tracking done properly over time alongside the right screening tools and a thorough clinical assessment that rules out anything else that might be going on. And for anyone whose picture is more complicated, cycle mapping gives us a much more detailed view, actually seeing how your hormones and your symptoms move together across a month rather than just assuming. I know two cycles of daily tracking feels like a long time when you're already struggling, but I think it's worth it because it's really the thing that turns, "I think something's wrong," into an actual answer, and from there into a treatment plan that's built around your specific pattern rather than a guess. Next time, I want to talk about why, even once you know all of this, diagnosis so often still takes years and what you can do to try and speed that process up. That's it for today. I'm Georgina. Thanks for listening. A quick note before you go. This podcast is for general information, not individual medical advice. It doesn't replace seeing your own GP or a specialist. So if anything you've heard today feels relevant to you, please do talk to someone. And if you're struggling, please reach out to your GP, to someone you trust, or to a crisis line if you need one right now. You can find Sirona Health and book your appointment at sironahealth.co.uk. See you next time