Four questions to ask patients about their menstrual cycles

Premenstrual dysphoric disorder (PMDD)—an abnormal sensitivity to normal hormonal fluctuations during the menstrual cycle—is a relatively new diagnosis, and many psychologists have received no training on the disorder.

It shows.

[Related: Why are some people more susceptible to severe PMS? Psychologists seek answers]

When researchers asked more than 2,500 PMDD patients about their experiences with different kinds of health care providers, the survey participants rated psychologists and other therapists lastopens in new window in terms of their knowledge of PMDD. But patients rated therapists higher than gynecologists, psychiatrists, and general practitioners when it came to interpersonal skills, such as listening to patients, taking their concerns seriously, and being supportive.

[Related: PMS vs. PMDD: What’s the difference?]

How can you serve patients better? Here are four questions to ask:

Do you menstruate? It may not be obvious which of your patients have menstrual cycles. Trans men and nonbinary individuals, for example, may menstruate if they aren’t taking gender-affirming hormone therapy that stops their periods. Child psychologists should keep in mind that girls and those assigned female at birth are menstruating earlier than they did in decades past, with the average age for the onset of menstruation dropping from 14 to 12 over the last century. Think of the menstrual cycle as a type of vital sign and include questions on your intake forms about whether patients menstruate and when their last menstrual cycle began.

Does your menstrual cycle affect your emotional health? Open the conversation with this question, but keep in mind that you can’t diagnose a patient with PMDD just by asking them to recall their symptoms over the last year. That approach isn’t very accurate, say researchers, because most patients vastly over-report symptoms. For an official diagnosis of PMDD, the Diagnostic and Statistical Manual requires 2 months of daily ratings of symptoms. To help ensure systematic tracking, suggest that patients try the free symptom trackeropens in new window offered by the International Association for Premenstrual Disorders or a free app called Me v. PMDDopens in new window.

Have you been diagnosed with any other emotional or behavioral disorder? Not all patients with emotional or behavioral disorders experience hormone sensitivity. However, premenstrual problems and psychiatric disorders often co-occur. And the same hormonal sensitivity that causes PMDD can in some patients also exacerbate symptoms of other psychiatric disorders, including depression, anxiety, and borderline personality disorder. Keep in mind that symptoms of co-occurring disorders may fluctuate along with hormone levels, with symptoms intensifying premenstrually and then ebbing again. When it comes to diagnosing disorders, be aware of where patients are in their menstrual cycles since symptoms may vary greatly depending on what phase a patient is in when you conduct your assessment.

Have you tried any PMDD treatments before? Ask what treatments have and haven’t worked in the past. Although there is evidence showing that cognitive behavioral therapy and mindfulness help, the frontline treatments for PMDD are selective serotonin reuptake inhibitors and drospirenone-containing birth control pills. Be ready to refer patients to a physician or other health care professional who is experienced in treating PMDD and able to prescribe medical treatments, if necessary. Health care professionals can also help rule out other disorders that may be mistaken for PMDD.