LECTURE 51 - PMS, PMDD, female sexual disorders Flashcards
List the somatic symptoms of PMS
- Abdominal pain/bloating
- Breast swelling/tenderness
- Headache or migraine
- N/V/C/D
(C/D → constipation/diarrhea) - Acne
- Changes in appetite
List the affective symptoms of PMS
- Anger
- Confusion
- Anxiety and/or depression
- Irritability
- Sadness
- Food cravings
How is PMS diagnosed?
> /= 1 symptom present during 5 days before menses in the last 3 months
Describe the pathophysiology of PMS
Hormonal fluctuations:
- Decrease in estrogen &/ progesterone leads to release of norepinephrine (norepi) from the hypothalamus
- Norepi causes a decline in dopamine & serotonin
Lifestyle:
- Dietary consumption of sugars & fats is associated with PMS
- Decreased exercise & poor sleep quality exacerbate symptoms
Describe premenstrual dysphoric disorder (PMDD)
Mood disorder accompanied by emotional, cognitive & physical symptoms
Occur in a cyclic patterns leading up to menstruation
List the risk factors for PMDD
- Preexisting mental health conditions
- Cigarette smoking
- Obesity
- Genetics
List the “criteria list” of symptoms for PMDD
Lability → rapid and intense shifts in emotions
Irritability
Anxiety
Markedly depressed mood
List all other symptoms of PMDD
Anger
Decreased interest in activities
Fatigue
Difficulty concentrating
Changes in appetite or sleep
Breast tenderness or swelling
Bloating
Headaches
Describe how PMDD is diagnosed
Symptoms associated with last week of luteal phase
- > /= 5 symptoms related to PMDD & at least one from criteria list
- Symptoms have occurred over two menstrual cycles in the past year
List possible causes of female sexual disorders
- age
- mental health
- metabolic disorders - obesity, diabetes
- postpartum
- aggravating medications
- stress
- medications
List non-pharmacological options to treat PMS / PMDD
- Limit sodium, caffeine & alcohol
- Aerobic exercise
- Relaxation techniques
- Structured sleep schedule
- Calcium & magnesium
List pharmacological treatment options for PMS
“first line”
- SSRIs for mood/emotional & physical sx, psychosocial functioning, QOL
- COCs (triphasic or monophasic) for physical sx but NOT mood
“second line”
- SNRIs for mood/emotional & physical sx, psychosocial functioning, QOL
- GnRH agonist for emotional sx, bloating, breast tenderness
“last line”
- Clomipramine: tricyclic antidepressant
- Alprazolam: benzodiazepine
List pharmacological options for the treatment of PMDD
- SSRIs
fluoxetine, paroxetine, sertraline, (citalopram, escitalopram - off label) - SNRIs
venlafaxine - COCs
monophasic for mood
drospirenone (fda approved)
levonorgestrel (off-label)
List non-pharmacological treatment options for sexual disorders
managing etiologies
- mental health
- metabolic disorders - obesity, diabetes
- hormone fluctuations
(postpartum, aggravating medications, stress, menopause)
List pharmacological treatment options for sexual disorders if the patient is pre-menopausal
Flibanserin:
- Indication: hypoactive sexual desire disorder
- Adverse effects: hypotension & syncope
- Avoid concomitant alcohol use
Bremelanotide:
- Indication: hypoactive sexual desire disorder
- Monitor - BP & HR
List hormonal pharmacological treatment options for sexual disorders if the patient is post-menopausal
Testosterone:
Short-term, transdermal use for postmenopausal women with interest or arousal disorders
Estrogen:
Genitourinary symptoms related to menopause
Ospemifene:
- Genitourinary sx of menopause (painful intercourse &/ vaginal dryness)
List non-hormonal pharmacological treatment options for sexual disorders if the patient is post-menopausal
Prasterone
Useful for genitourinary symptoms, specifically painful intercourse
