1: Menstruation: PMS Flashcards
Define PMS
Distress psychological, behavioural or physical symptoms with no underlying organic or psychiatric disease occurring during luteal phase of menstrual cycle, improved by menstruation
When does PMS occur
luteal phase!
How does PMS present clinically
- Mood swings
- Irritability
- Depression
- Headache
- Bloating
- Breast tenderness
How should PMS be investigated
Keep a symptom diary for at least two cycles
Explain pathophysiology of those with PMS
Neurons in women with PMS are preferentially thought to metabolise progesterone or pregnenolone - which heightens anxiety
What is first-line for PMS
Exercise
Sleep hygiene
COCP
Luteal phase SSRI
What is second-line for PMS
Oestradiol patch
Oral progesterone
What is third-line for PMS
GnRH analogue and HRT
What is a GnRH analogue
Gosrelin
What is a type of HRT
Tibolone
Why is HRT given with GnRH analogues
As with gosrelin alone, osteoporotic changes can be seen at 6 months
What is fourth-line for PMS
Hysterectomy and bilateral salpingoopherectomy
