13) Gynaecological problems - PMS

Question 1

Incidence of PMS

Answer 1

40% symptoms of PMS

5-8% severe PMS

Question 2

Classification of PMS

Answer 2

Physiological/mild PMD: Cyclical, relieved by menstruation, symptom-free week but no influence on quality of life.

Core PMDD: Cyclical, relieved by menstruation, symptom-free week and affects quality of life.

Variant PMDs:

• Premenstrual exacerbation of existing non-menstrual condition. Symptoms cyclical and relieved by menstruation but no symptom free week. Affects QOL.
• Premenstrual disorder with absent menstruation. Cyclical with symptom free week. No menstruation.
• Progestogen induced PMD. As for core but with progestogen treatment.

Question 3

Diagnosis of PMS

Answer 3

2 cycle symptom diary (using DRSP or CPASS)

If inconclusive - 3/12 trial GnRH analogues

Question 4

First line treatment for PMS

Answer 4

Exercise
CBT
10mg vitamin B6
Drospirenone-containing contraceptive pill (Yasmin)
Low dose SSRI (10mg citalopram)

Question 5

Second line treatment for PMS

Answer 5

Normal dose SSRI (20-40mg citalopram)
Estradiol patches (100micrograms) with micronised progestogen (100-200mg) or mirena.

Question 6

Third line treatment for PMS

Answer 6

GnRH analogues

Question 7

Fourth line treatment for PMS

Answer 7

Surgery (hysterectomy and BSO recommended)

Question 8

Medication which can be useful for physical symptoms of PMS

Answer 8

Danazol (200mg OD)

Spironolactone