Why guidelines ask for two cycles
A diagnosis of PMDD rests on a pattern over time, not on one conversation afterwards. Guidelines therefore ask for symptoms to be recorded prospectively, for at least two cycles.
What prospective records mean
Guidelines ask for symptoms to be recorded prospectively for at least two cycles before a diagnosis is made. Describing what you remember afterwards is too unreliable for that. This is in the RCOG guideline (Green-top 48), the ISPMD auditable standards (2016), the ACOG guideline from 2023, and the ICD-11 definition, code GA34.41.
What DSM-5 asks for as well
DSM-5 asks for the same pattern: symptoms in the week before menstruation, minimal or absent in the week after, with clear distress or impairment, confirmed over at least two cycles. The tool used most often for this is daily DRSP records. The app makes that pattern visible. The app does not make a diagnosis.
Which guideline applies in the Netherlands
In the Netherlands, the NVOG wrote a guideline on premenstrual syndrome in 2011. It recommends the ISPMD criteria and a calendar, and it was based on the 2007 RCOG guideline. The current international documents are newer: ACOG Clinical Practice Guideline No. 7 (December 2023) and RCOG Green-top Guideline No. 48 (2016, published in 2017). RCOG reviewed the text in May 2023 and an update is in development. NICE Clinical Knowledge Summaries draws on those sources.
Sources
- Royal College of Obstetricians and Gynaecologists. Management of Premenstrual Syndrome. Green-top Guideline No. 48. BJOG. 2017;124(3):e73–e105. www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/
- Ismaili E, et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Archives of Women’s Mental Health. 2016. doi.org/10.1007/s00737-016-0631-7
- American College of Obstetricians and Gynecologists. Management of premenstrual disorders. Clinical Practice Guideline No. 7. Obstetrics & Gynecology. 2023;142(6):1516–1533. www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/12/management-of-premenstrual-disorders
- World Health Organization. ICD-11 for Mortality and Morbidity Statistics. GA34.41 Premenstrual dysphoric disorder. icd.who.int/browse/2025-01/mms/en#1526774088
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). 2013. Premenstrual dysphoric disorder. www.psychiatry.org/psychiatrists/practice/dsm
- National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Premenstrual syndrome, supporting evidence. Based on RCOG, ISPMD, ACOG 2023 and BMJ Best Practice 2024. cks.nice.org.uk/topics/premenstrual-syndrome/supporting-evidence/
- Nederlandse Vereniging voor Obstetrie en Gynaecologie. Richtlijn Premenstrueel syndroom. Utrecht: NVOG; 2011. www.nvog.nl/wp-content/uploads/2020/06/Richtlijn-Premenstrueel-Syndroom.pdf
This page summarises published research and guidelines. It is not medical advice and not a clinical guideline. The app does not diagnose.
PMDD Tracker is not a medical device and does not replace professional advice. The cyclic overview is a tool for pattern recognition, not a medical judgement. Always see a healthcare provider for professional advice. Medical disclaimer.
Frequently asked questions
- Does one severe cycle count?
- Guidelines ask for at least two cycles, because one cycle does not confirm the pattern.
- Can I fill this in afterwards?
- Describing symptoms afterwards is too unreliable for the diagnosis, according to these guidelines.
- Does the app diagnose after two cycles?
- No. The app does not diagnose. The overview is meant to take the pattern to a clinician.
Bring two cycles to the conversation
Filling in the DRSP each day makes the pattern visible for you and for a clinician. The app does not diagnose.
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