PMDD, PMS, PCOS Flashcards
Definition of Premenstrual Syndrome
symptoms in second half of menstrual cycle that interfere with work and personal relationships
Symptoms of PMS
irritable, anxiety, depression, breast tenderness, bloating, headache, abdominal bloating
When do PMS symptoms resolve?
during menses
What must be present to be diagnosed with PMDD
at least 1 affective symptom → marked depression, hopelessness, anxiety or tension, affective lability, persistent anger
When do symptoms of PMDD occur?
last week of luteal phase of menstrual cycle
when do symptoms of PMDD resolve?
during menses
What is the timelines for symptoms for PMDD according to DSM5?
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
Non-affective symptoms of PMDD → contribute to 5 criteria to confirm diagnosis
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
average age onset for PMS in women
26
Risk factors for PMS
family history in mother, personal past or current mood disorder, history of alcohol abuse, history of postpartum depression, stress
How is diagnosis of PMDD made?
history after 2 consecutive cycles of “typical” symptoms occuring during the luteal phase → have patient keep a symptom diary
nonpharm treatments for mild PMDD
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…..
Pharm treatments for PMDD
SSRI, monophasic OC, NSAID, diuretics, gonadotropin releasing hormone agonist, surgical bilateral oophrectomy
PCOS is also referred to as
stein-levanthal syndrome
PCOS is an endocrine disorder characterized by
chronic anovulation, polycystic ovaries, androgen excess
What are some conditions that PCOS is also associated with?
infertility, hirsutism, obesity, DM, CVD, metabolic syndrome
what is the criteria for diagnosing PCOS?
Rotterdam Criteria
According to the Rotterdam Criteria, at least ____ symptoms must be present and those are…?
2
excess androgen production, ovulatory dysfunction, polycystic ovaries
Patient presents with menstrual disorder, infertility, acne, hirsutism, obesity, hyperinsulinemia (truncal obesity, acanthosis nigrans)
PCOS
What conditions are a patient with PCOS at increased risk for?
DM, metabolic syndrome, CVD, infertility, endometrial hyperplasia and cancer
In differentiating PCOS from premature ovarian failure, how will the labs values differ?
premature ovarian failure → high FSH and LH
what is the lab test you’d order for nonclassical adrenal hyperplasia?
17-hydroxyprogesterone - in the morning
How will PCOS appear on transvaginal US?
see 12+follicles/ovary → “string of pearls”
What lab values should you order for PCOS?
B-HCG, TSH, FSH, prolactin, Hbg A1c and fasting BS, lipids
