PMDD, PMS, PCOS

Question 1

Definition of Premenstrual Syndrome

Answer 1

symptoms in second half of menstrual cycle that interfere with work and personal relationships

Question 2

Symptoms of PMS

Answer 2

irritable, anxiety, depression, breast tenderness, bloating, headache, abdominal bloating

Question 3

When do PMS symptoms resolve?

Answer 3

during menses

Question 4

What must be present to be diagnosed with PMDD

Answer 4

at least 1 affective symptom → marked depression, hopelessness, anxiety or tension, affective lability, persistent anger

Question 5

When do symptoms of PMDD occur?

Answer 5

last week of luteal phase of menstrual cycle

Question 6

when do symptoms of PMDD resolve?

Answer 6

during menses

Question 7

What is the timelines for symptoms for PMDD according to DSM5?

Answer 7

in majority of cycles → at least 5 symptoms in final week before menses onset → start to improve within few days after menses onset → minimal/absent in week postmensese

Question 8

Non-affective symptoms of PMDD → contribute to 5 criteria to confirm diagnosis

Answer 8

anhedonia, difficulty concentrating, lethargic/fatigued/lacking energy, hypersomnia or insomnia, feel overwhelmed or out of control, breast tenderness/joint or muscle pain/bloating/weight gain

Question 9

average age onset for PMS in women

Answer 9

26

Question 10

Risk factors for PMS

Answer 10

family history in mother, personal past or current mood disorder, history of alcohol abuse, history of postpartum depression, stress

Question 11

How is diagnosis of PMDD made?

Answer 11

history after 2 consecutive cycles of “typical” symptoms occuring during the luteal phase → have patient keep a symptom diary

Question 12

nonpharm treatments for mild PMDD

Answer 12

reassurance, increase intake of complex carbs, reduce or eliminate sugar/alcohol/caffeine/salty food/red meat, 1200 Ca/day, Vitamin B6 50mg/day, Mg 200-400mg/day, exercise, massage…..

Question 13

Pharm treatments for PMDD

Answer 13

SSRI, monophasic OC, NSAID, diuretics, gonadotropin releasing hormone agonist, surgical bilateral oophrectomy

Question 14

PCOS is also referred to as

Answer 14

stein-levanthal syndrome

Question 15

PCOS is an endocrine disorder characterized by

Answer 15

chronic anovulation, polycystic ovaries, androgen excess

Question 16

What are some conditions that PCOS is also associated with?

Answer 16

infertility, hirsutism, obesity, DM, CVD, metabolic syndrome

Question 17

what is the criteria for diagnosing PCOS?

Answer 17

Rotterdam Criteria

Question 18

According to the Rotterdam Criteria, at least ____ symptoms must be present and those are…?

Answer 18

2

excess androgen production, ovulatory dysfunction, polycystic ovaries

Question 19

Patient presents with menstrual disorder, infertility, acne, hirsutism, obesity, hyperinsulinemia (truncal obesity, acanthosis nigrans)

Answer 19

PCOS

Question 20

What conditions are a patient with PCOS at increased risk for?

Answer 20

DM, metabolic syndrome, CVD, infertility, endometrial hyperplasia and cancer

Question 21

In differentiating PCOS from premature ovarian failure, how will the labs values differ?

Answer 21

premature ovarian failure → high FSH and LH

Question 22

what is the lab test you’d order for nonclassical adrenal hyperplasia?

Answer 22

17-hydroxyprogesterone - in the morning

Question 23

How will PCOS appear on transvaginal US?

Answer 23

see 12+follicles/ovary → “string of pearls”

Question 24

What lab values should you order for PCOS?

Answer 24

B-HCG, TSH, FSH, prolactin, Hbg A1c and fasting BS, lipids

Question 25

If you are treating a patient with PCOS with Metformin what do you want to counsel them for?

Answer 25

increased risk of pregnancy

Question 26

If treating a woman with PCOS and her fertility has not returned and she wants more kids, what should you give her? What should you warn her about?

Answer 26

clomiphene

increased risk of multiple births

Question 27

If a woman with PCOS does not desire pregnancy, what are two options?

Answer 27

OC or 10 days of medroxyprogesterone acetate/month to prevent endometrial hyperplasia

Question 28

Treatment options for hirsutism

Answer 28

OC, spironolactone (2nd line), flutamide, finasteride

Question 29

How long can a woman expect to see results when taking low dose OCP for hirsutism

Answer 29

6-12 months

Question 30

This medication treats hirsutism by blocking androgen receptors and decreases testosterone production

Answer 30

spironolactone

Question 31

which hirsutism therapies are teratogenic and thus you need to ensure your patient is on a contraceptive?

Answer 31

spironolactone, flutamide, finasteride

Question 32

what do you screen for in following a patient with PCOS?

Answer 32

CVD risks, DM, sleep apnea, nonalcoholic fatty liver disease, depression and anxiety