2017 48 PMS Flashcards
1
Q
** How is PMS diagnosed? **
A
- Symptom diary, prospective
- Recorded over 2 cycles
- Prior to commencing treatment
- GnRH analogues 3 months if inconclusive
2
Q
** What are the classifications relating to PMS? **
A
- Physiological/mild PMD
- Core PMD: PMS or PMDD
- Premenstrual exacerbation
- PMD with absent menstruation
- Progestogen-induced PMD
- Underlying psychological disorder
3
Q
** What are the 1st line treatments for PMS? **
A
- Exercise, CBT, vitamin B6
- COCP, either cyclical or continuous
- SSRIs low dose, continuous or luteal phase (d15-28) eg citalopram 10mg
4
Q
** What are the 2nd line treatments for PMS? **
A
- Estradiol patches 100 mcg + Mirena or micronised progesterone 100 or 200mg d17-28
- SSRIs higher dose eg citalopram 20-40mg
5
Q
** What are the 3rd line treatments for PMS? **
A
- GnRH analogues + add-back HRT:
Continuous combined eg 50-100mcg estradiol patches or 2-4 doses estradiol gel with micronised progesterone 200mg/d or tibolone
6
Q
** What is the 4th line treatment for PMS? **
A
Surgery +/- HRT
7
Q
** Which COCPs are best for treating PMS? **
A
Ones containing drospirenone eg Yasmin
8
Q
** How should Danazol be used in treating PMS? **
A
- 200mg twice daily
- In luteal phase
- With contraception due to virilising effects
9
Q
** What diuretic can be used to treat PMS? **
A
Spironolactone
10
Q
** How can PMS be managed surgically? **
A
- Hysterectomy & BSO
- When medical management has failed
- Must prove effectiveness of GnRH analogues
11
Q
What is the validated questionnaire for PMS?
A
Daily Record of Severity of Problems
12
Q
What complimentary therapies have evidence of benefit in PMS?
A
- Calcium & vitamin D
- Chasteberry = Vitex agnus castus
- Saffron
- Exercise
- Reflexology
- Ginkgo biloba
- Evening primrose oil
13
Q
How should women with GnRH analogues for PMS be managed?
A
- Add-back hormone therapy; continuous combined HRT or tibolone
- Advice on exercise, diet, smoking
- DEXA every year
