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
If you are treating a patient with PCOS with Metformin what do you want to counsel them for?
increased risk of pregnancy
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?
clomiphene
increased risk of multiple births
If a woman with PCOS does not desire pregnancy, what are two options?
OC or 10 days of medroxyprogesterone acetate/month to prevent endometrial hyperplasia
Treatment options for hirsutism
OC, spironolactone (2nd line), flutamide, finasteride
How long can a woman expect to see results when taking low dose OCP for hirsutism
6-12 months
This medication treats hirsutism by blocking androgen receptors and decreases testosterone production
spironolactone
which hirsutism therapies are teratogenic and thus you need to ensure your patient is on a contraceptive?
spironolactone, flutamide, finasteride
what do you screen for in following a patient with PCOS?
CVD risks, DM, sleep apnea, nonalcoholic fatty liver disease, depression and anxiety
