Menstruation-related Diseases II

Question 1

What is Premenstrual Syndrome (PMS)?

Answer 1

PMS is defined as a cyclic disorder composed of a combination of physical and emotional (mood) changes that occur during the luteal phase of the menstrual cycle, improve significantly or disappear within the first several days of menstrual flow and are absent during the first week following menses.

Question 2

What is Premenstrual Dysphoric Disorder (PMDD)?

Answer 2

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS

Question 3

What are the requirements for the diagnosis of PMDD?

Answer 3

• Presence of symptoms on a cyclic basis
• Symptoms are severe enough to cause functional impairment

Question 4

Mention 5 symptoms of PMS?

Answer 4

i. Minor weight gain
ii. Abdominal bloating
iii. Fatigue
iv. Mood lability
v. Irritability, anxiety or tension
vi. Breast tenderness
v. Depression
vi. Food cravings

Others include:
i. Acne
ii. Oversensitivity
iii. Crying spells
iv. Forgetfulness and Difficulty concentrating

Question 5

What are the symptoms of PMDD?

Answer 5

The symptoms of PMDD are similar to those of PMS, but women with PMDD experience more significant symptoms that can impair personal relationships and the ability to function well at work.

The most common symptoms are:
i. Mood lability
ii. Irritability
iii. Fatigue
iv. Decreased interest/Depression

Other symptoms include:
i. Difficulty concentrating
ii. Lethargy
iii. Hypersomnia or Insomnia
iv. Physical symptoms

Question 6

A woman with PMS or PMDD should experience essentially a symptom-free interval during days 4 to 12 of her menstrual cycle.

True or False?

Answer 6

True.

Lack of a symptom-free interval suggests that the patient has a psychiatric disorder or another health condition (e.g., perimenopause) rather than PMS

Question 7

Mention 4 non-pharmacological treatments for PMS.

Answer 7

i. Aerobic exercise
ii. Dietary modifications
iii. Stress management
iv. Cognitive behaviour therapy

Question 8

Mention 5 non-prescription drugs used to treat PMS.

Answer 8

i. Vitamin E
ii. Vitamin B
iii. Magnesium
iv. Calcium
v. Non-prescription diuretic
vi. Gingko

Question 9

Mention 2 prescription therapies used in PMS.

Answer 9

i. Psychotropic medications e.g., alprazolam, SSRIs
ii. Menstrual cycle modifiers e.g., oral contraceptives, danazol, GnRH agonists.

Question 10

Mention 4 counselling points for patients with PMS.

Answer 10

i. Education on the condition and timing of symptoms
ii. Encourage compliance with therapy
iii. Explain proper use and adverse effects of medication
iv. Patient monitoring

Question 11

What is Toxic Shock Syndrome (TSS)?

Answer 11

Toxic shock syndrome is a multisystem life-threatening condition, often caused by bacterial toxins, characterised by malaise, myalgias, diarrhoea.

Question 12

What are the types of TSS?

Answer 12

1. Menstrual TSS
2. Non-menstrual TSS

Question 13

How can TSS be prevented?

Answer 13

By avoiding tampons, IUDs and contraceptive sponges.

Use sanitary pads instead of tampons

Question 14

What are the signs and symptoms of TSS?

Answer 14

Prodromal symptoms (malaise, myalgias and chills) occur for 2 to 3 days prior to TSS. GI symptoms (vomiting, diarrhoea and abdominal pain) typically occur early in the illness and affect almost all patients.

Symptoms are:
i. High fever
ii. Myalgias
iii. Vomiting
iv. Diarrhoea
v. Decreased urine output
vi. Severe hypotension and shock.
vii. Erythroderma
viii. Headache
ix. Confusion
x. Agitation
xi. Seizures
xii. Cardiac involvement
xiii. Adult respiratory distress syndrome
xiv. Acute renal failure
xv. Fatigue

Question 15

Mention 4 counselling points for TSS

Answer 15

• Wash hands before inserting tampons
• Change tampons every 6 hours