PMS

Question 1

What is the definition of PMS

Answer 1

symptoms defined as physical/psychological and behavioural that occur in the luteal phase of every cycle. symptom free week following menstruation prior to ovulation.

Question 2

when must symptoms of PMS occur

A) follicular phase
B) ovulation
C) luteal phase

Answer 2

C - luteal phase

Question 3

can you give two examples of physical symptoms

Answer 3

bloating and breast tenderness

Question 4

can you give some examples of psychological symptoms someone with PMS might experience

Answer 4

depression, mood swings, loss of confidence, anxiety, agression and decreased cognitive function

Question 5

what must the symptoms of PMS cause to the individual for it to meet the IDSM classification of premenstrual disorder

Answer 5

must affect quality of life

Question 6

can PMS occur in the absence of periods?

Answer 6

yes

Question 7

what is PMS called if it occurs in someone who is amenorrhoeic

Answer 7

pre-menstrual disorder with absent menstruation

Question 8

what causes PMS

Answer 8

we don’t really know
? sensitivity to progesterone
? efffections of oestrogen/progesterone on serotonin

Question 9

what percentage of women experience PMS

Answer 9

40%

Question 10

can you name some risk factors for developing PMS

Answer 10

pre-existing mood disorders
smoking
obesity
stress
alcohol

Question 11

how long should someone record their symptoms for in order to diagnose PMS

A) daily for 2 months
B) daily for 3 months
C) weekly for 2 months
D) weekly for 3 months

Answer 11

A- daily for 2 months

Question 12

what questionnaire should be used for patients to record their symptoms

Answer 12

daily record of severity of problems (DRSP)

Question 13

if you are unsure the diagnosis is PMS what medication can be used and for how long to see if you can diagnose PMS?

Answer 13

GnRH analogues for 3 months

Question 14

what are the first line Rx for PMS

Answer 14

exercise, CBT and vitamin b6
CHC
low dose SSRI (can take continuously or just in the luteal phase)

Question 15

what are some of the second line Rx options for PMS

Answer 15

increase dose of SSRI to 20-40mg
estradiol patches + micronised progestogen or LNG IUS

Question 16

what is the third line treatment option for PMS

Answer 16

Gnrh analogue with add back HRT

Question 17

what is fourth line treatment for PMS

Answer 17

surgical RX (TAH + BSO)+ add back HRT

Question 18

what happens to serum allopregnanolone levels in women experiencing PMS

Answer 18

decrease

Question 19

what does allopregnanalone stimulate

Answer 19

allopregnanalone stimulates GABA inhibitory NT and this causes decreased anxiety, sedative/calming effects.

However in women with PMS it is hypothesised that they have decreased allopregnanolone levels and so decreased stimulation of inhibitory GABA NT therefore leads to angry, moody patients

Question 20

what class of medications do the following drugs belong too

decapeptyl
Zoladex (goserelin acetate)
prostate (leuprorelin acetate)

Answer 20

GnRH analogues

Question 21

out of the following complementary therapies suggested for management of PMS which has the highest reported success rate

A) saffron
B) calcium/ vitamin D
C) vitex agnus cactus L

Answer 21

C - vitex agnus castus L (derived from cactus fruit) showed 52% improvement in PMS symptoms

Question 22

what is progesterone metabolised to in the brain

Answer 22

allopregnanalone and pregnanlone

Question 23

what is progesterones effect on MOA and what does this lead to

Answer 23

increases MOA –> decrease 5HT (5 hydroxytryptamine) = depressed mood

Question 24

what is oestrogen effect on MOA

Answer 24

decreases MOA therefore free tryptophan in the brain –> increases serotonin transport –> increase mood/ happy

Question 25

what type of progestogen in CHC is the best for women with PMS

Answer 25

drospirenone containing CHC

e.g. yasmin, lucette, eloine, dretirine

Question 26

if women using GnRH with add back HRT for treatment of PMS how often should they have a DXA scan

Answer 26

annually