Laboratory Testing for Women with PMDD
No routine laboratory tests are required to diagnose PMDD, as the diagnosis is made clinically through prospective symptom charting over 2 menstrual cycles. 1, 2
Why Laboratory Testing is Not Needed for PMDD Diagnosis
PMDD is a clinical diagnosis based on symptom patterns, not laboratory abnormalities. The diagnosis requires documentation of emotional and behavioral symptoms occurring during the luteal phase that resolve shortly after menses onset, confirmed through prospective daily symptom ratings over at least 2 consecutive menstrual cycles. 1, 3, 2
There are no specific biomarkers or hormonal abnormalities that define PMDD. The current understanding is that PMDD results from normal ovarian function triggering biochemical events in the central nervous system, rather than from hormone imbalances that would be detectable on laboratory testing. 3
Laboratory Tests to Rule Out Other Conditions
While PMDD itself requires no labs, you should order targeted testing to exclude medical conditions that can mimic or coexist with premenstrual symptoms:
Essential Exclusionary Tests
Thyroid-stimulating hormone (TSH) to rule out thyroid dysfunction, which commonly causes mood symptoms and menstrual irregularity. 4, 5
Prolactin level (morning resting serum sample, not post-ictal) to exclude hyperprolactinemia, with levels >20 μg/L considered abnormal. 4, 5
Additional Tests Based on Clinical Presentation
Complete blood count if the patient reports heavy menstrual bleeding or fatigue suggestive of anemia. 1
Fasting glucose or hemoglobin A1c if metabolic symptoms or risk factors for diabetes are present. 1
Comprehensive metabolic panel if there are concerns about electrolyte disturbances or renal/hepatic dysfunction that could contribute to symptoms. 1
Common Pitfalls to Avoid
Do not order sex hormone panels (estrogen, progesterone, LH, FSH, testosterone) for PMDD diagnosis. These tests are indicated for evaluating menstrual irregularity, infertility, or suspected PCOS—not for PMDD, where hormone levels are typically normal. 4, 1
Do not confuse PMDD with premenstrual exacerbation of an underlying psychiatric disorder. If symptoms persist throughout the entire menstrual cycle (not just the luteal phase), consider primary mood or anxiety disorders rather than PMDD. 1, 2
Do not diagnose PMDD without prospective symptom charting. Retrospective recall is unreliable; require patients to complete daily symptom ratings for at least 2 cycles before confirming the diagnosis. 1, 3, 2
The Diagnostic Approach
Provide the patient with a validated symptom rating form to complete daily for 2 consecutive menstrual cycles, documenting the timing and severity of mood, behavioral, and physical symptoms. 1, 3
Confirm that symptoms occur exclusively during the luteal phase (the 2 weeks before menses), with significant improvement or resolution within a few days after menstruation begins. 1, 3
Verify functional impairment in work, relationships, or daily activities during symptomatic periods. 2