Benign Gynaecology

Question 1

What is PMS?

Answer 1

Symptoms occurring in the luteal phase of the menstrual cycle (the time between ovulation and onset of menstruation)

Question 2

Symptoms of PMS

Answer 2

-Physical
=Bloating
=Breast pain
=Headaches

-Psychological
=Depression
=Anxiety
=Irritability
=Loss of confidence
=Mood swings

-Behavioural
=Reduced cognitive ability
=Aggression

Question 3

Aetiology of PMS

Answer 3

-Lack of evidence
-Some individuals are sensitive to progesterone and progestogens
-Effect of oestradiol and progesterone on the neurotransmitters serotonin and gamma-aminobutyric acid (GABA)
-Serotonin receptors respond to oestrogen and progesterone. GABA levels are modulated by the metabolite of progesterone, allopregnanolone, and in women with PMS the allopregnanolone levels appear to be reduced

Question 4

Epidemiology of PMS

Answer 4

4-0% experience symptoms of PMS, and of these 5-8% suffer from severe PMS
-It is the timing, rather than the types of symptoms, and the degree of impact on daily activity that supports a diagnosis of PMS

Question 5

Diagnosis of PMS

Answer 5

Clinical based on history, examination where relevant and review of prospective symptom diary over at least2 cycles

Question 6

Management of PMS

Answer 6

-1st: exercise, CBT, vit B6, COCP, continuous/ luteal phase (day 15-28) low dose SSRIs (citalopram, escitalopram)
-2nd: oestradiol patches and micronized progesterone, higher dose SSRI
-3rd: GnRH analogue and add back HRT
-4th: surgical and HRT