PMDs Flashcards
Premenstraul disorders
Premenstraul symptoms causing impairment of daily activities an interpersonal relationships
Core premenstraul disorder
Symptoms recur in a cyclical pattern with precipitation by ovulation
Symptoms must be resolved during or shortly after menstruation to give at least one symptom free week between menstruation and ovulation
Symptoms must be prospectively rated
Symptoms are not defined
Symptoms are not an exacerbation of underlying psychological or physical disorder
Symptoms cause significant impairment of daily activities including work, social interactions and family activities
(Same as PMS)
Variant premenstrual disorder:
Premenstraul exacerbation - worsening of underlying medical condition
Premenstraul disorder with absent menstruation (iatrogenic)
Progestogens-induced premenstraul disorder
Premenstraul disorder due to non-ovlatory ovarian activity
Physical symptoms of premenstraul disorder
Breast tenderness or pain Abdominal swelling or bloating Headaches Skin disorders Weight gain Swelling of extremities Joint pain Muscle pain Back pain Fatigue, lethargy, or lack of energy
Psychological symptoms
Mood swings Irritability Anger, aggression Anxiety Depressed mood Tension Not in control Lack of interest in usual activities Loneliness Hopelessness Suicidal ideation
Behavioral and cognitive symptoms
Sleep disturbances Changes in appetitive, overeating or specific food cravings Restlessness Poor concentration Confusion Social withdrawal
Neurotransmitters implicated in PMD
Serotonin Norepinephrine Dopamine Allopregnanolone Pregnant line Acetylcholine Cholecystokinin GABA endorphins
Treatment without ovulation suppression
Serotonin reuptake inhibitors
Diuretics
Non-pharm based drugs
Complementary therapies
SSRI mechanism of action in PMD
Serotonergic activity
(Not antidepressant effect)
Can give in just the luteal phase
Can get anxiety, agitation, and sleeplessness at the beginning of treatment
Caution around SE: diminished libido, delayed orgasm, and anorgasmia
Spironolactone treatment effects
Reducing: Abdominal bloating Swelling Mood symptoms Breast discomfort
Non-pharm therapies
Voted agnus - small placebo CT CBT Vitamin B6 (cofactor in final stages of neurotransmitter synthesis) Calcium Exercise
GNRH-a uses
Treatment with add back therapy only for 6 months; if long term use, need to have bone density scanning
Can be used for 3 months for a definitive diagnosis
Allows us to determine what proportion of symptoms are ovarian endocrine origin
Pinpoints women who would benefit from TAH BSO
Offers short-term therapy in women with severe symptoms
May be usefully combined with add-back therapy in women with severe symptoms in who oestrogens contraindicated and menopause soon
COC for PMD
NOT second-generation progestogens
Use those with drospirenone
(Yasmin, Eloine)
Use continuous therapy
