GTG PMS

Question 1

How to diagnose PMS?

Answer 1

Prospective 2 month symptom diary
Can trial 3 months GnRH analogue if still unsure

Question 2

1st line management PMS?

Answer 2

CBT, exercise
Drosperinone containing COC continuously
SSRI citalopram 10mg - day 15-28

Question 3

2nd line management PMS?

Answer 3

Estrogen patch and lowest dose cyclical micronised progesterone (e.g. day 17-28).
Mirena CAN be used for progesterone component but can cause PMS type symptoms
SSRI continuous use / luteal phase higher dose (e.g. citalopram 20-40mg)

Question 4

What treatment can be considered if breast tenderness is main symptom?

Answer 4

Danazol (low dose, 200mg BD)
BUT - can cause virilisation (e.g. cliteromegaly, hair, acne, deep voice)
AND need contraception as can virilise female fetuses

Question 5

3rd line management PMS?

Answer 5

GnRH analogues if severe.
Need add-back if >6m in form of tibolone or cont comb HRT
AND yearly dexa

Question 6

Risks and adverse effects SSRIs?

Answer 6

nausea, insomnia, somnolence, fatigue, reduction in libido, withdrawal symptoms if stopped suddenly

Question 7

What unusual treatment can be used to treat physical symptoms?

Answer 7

spironolactone

Question 8

4th line management PMS?

Answer 8

Surgical rx - hysterectomy + BSO AND HRT

Question 9

Key elements of diagnosis

Answer 9

Symptoms cyclical and relieved by menstruation
Symptom-free week
Affects QoL