Lecture 8 Flashcards
PMS and PMDD
What are the effects of estrogen on neurotransmitters ?
Positive 5HT ( receptors, more affinity)
What are the effects of progesterone on neurotransmitters ?
Positive and negative on 5HT
active metabolite (allopregnanolone) agonist binds to GABA
What is PMS ?
symptoms at the luteal phase ( 2 weeks ) before periods
Mood, physical and cognitive symptoms
Who can have PMS ?
25-35 yo
What is severe PMS ?
PMDD
What are the theories behind PMS ?
NT and hormones ( 5HT)
estrogen : progesterone
Less GABA
calcium dysregulation
What is the diagnostic criteria for PMS ?
Pt has emotional or physical symptoms before mens start for 3 prior menses. gets better in 4 days and severe to interfere with daily activities
S/S of PMS must appear in _____ phase ?
luteal phae
What are the emotional and physical symptoms ?
emotional : angry, anxiety, confusion, insomnia, poor concentration, more naps
physcial : cramps, bloating, aches, headahce, skin problems , food craving
What food can be limited to help with PMS ?
caffeine, sodium, complex carbohydrate ( prevent spike of insulin)
What NHP can help with PMS ?
Calcium ( reduce fluid retention)
Magnesium ( reduce bloating)
Vitamin b6
Vitamin E ( mood and breast tenderness)
Chasteberry fruit ( breast tenderness)
Evening primrose oil
St john wort
Gingko
When and how does NSAID help with PMS ?
reduce the physical symptoms of PMS
start 1-2 days before mens start
When and how does spironolatone ( diuretics) help with PMS ?
reduce bloationg, breast tendernes, fluid retention
take in the luteal phase - before mens
What is Midol ?
combination product ( diuretic, APAP/NSAIDs and antihistmamine)
NOT added benefit
What do we know of the efficacy of contraceptives ?
CHC –> mixed results –> continuous
Progesterone –> NO benefit
When would you see the benefit of SSRI or SNRI for PMS/PMDD ?
takes 3 mens cycles
How long should a pt take SNRI or SSRI for PMS/PMDD ?
14 days before luteal and stop on day 1-3 of mens
What are the options for severe PMS if the first line don’t work ?
SSRI/SNRI →intermittent or continuous, start 14 days before and stop 1-3 days of mens, takes3 menstrual cycles to see an improvement
Benzo → if antidepressants don’t work
Ovulation suppression → GnRH agonist , danzol , bilateral oophorectomy
if pt just has severe PMS , what can they try ?
SSRI ( continuous or intermittent) –> ( try 2) –> ( switch continuous or intermittent) –> try SNRI
what are the hormonal pathogenesis of endometriosis ?
estrogen stimulates the implants
less progesterone receptors on the endometrial tissues or implants
What are the mechanica factors for endometriosis ?
endometrial flow backwards in the fallopian tubes to the peritoneal cavity
Cervical stenosis
What is the immunological factors of endometriosis ?
altered T/B cells, higher levels of inflammation and growth factors int he endometrial tissue
immune system: inflammation, no clearance of the endometrial tissue from the peritoneum
What are the other theories behind endometriosis ?
stem cells –> implants
embryonic development –> implants are in other parts
coelomic metaplasia –> peritoneal turns into the implants
Lymphatic and vascular metastases –> travel to other parts
What are the s/s of endometriosis ?
Pain
Dyspareunia ( painful sex)
BTB
GI symptoms
Dysuria and urgency
