PMS Flashcards
What is the definition of PMS
symptoms defined as physical/psychological and behavioural that occur in the luteal phase of every cycle. symptom free week following menstruation prior to ovulation.
when must symptoms of PMS occur
A) follicular phase
B) ovulation
C) luteal phase
C - luteal phase
can you give two examples of physical symptoms
bloating and breast tenderness
can you give some examples of psychological symptoms someone with PMS might experience
depression, mood swings, loss of confidence, anxiety, agression and decreased cognitive function
what must the symptoms of PMS cause to the individual for it to meet the IDSM classification of premenstrual disorder
must affect quality of life
can PMS occur in the absence of periods?
yes
what is PMS called if it occurs in someone who is amenorrhoeic
pre-menstrual disorder with absent menstruation
what causes PMS
we don’t really know
? sensitivity to progesterone
? efffections of oestrogen/progesterone on serotonin
what percentage of women experience PMS
40%
can you name some risk factors for developing PMS
pre-existing mood disorders
smoking
obesity
stress
alcohol
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
A- daily for 2 months
what questionnaire should be used for patients to record their symptoms
daily record of severity of problems (DRSP)
if you are unsure the diagnosis is PMS what medication can be used and for how long to see if you can diagnose PMS?
GnRH analogues for 3 months
what are the first line Rx for PMS
exercise, CBT and vitamin b6
CHC
low dose SSRI (can take continuously or just in the luteal phase)
what are some of the second line Rx options for PMS
increase dose of SSRI to 20-40mg
estradiol patches + micronised progestogen or LNG IUS
what is the third line treatment option for PMS
Gnrh analogue with add back HRT
what is fourth line treatment for PMS
surgical RX (TAH + BSO)+ add back HRT
what happens to serum allopregnanolone levels in women experiencing PMS
decrease
what does allopregnanalone stimulate
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
what class of medications do the following drugs belong too
decapeptyl
Zoladex (goserelin acetate)
prostate (leuprorelin acetate)
GnRH analogues
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
C - vitex agnus castus L (derived from cactus fruit) showed 52% improvement in PMS symptoms
what is progesterone metabolised to in the brain
allopregnanalone and pregnanlone
what is progesterones effect on MOA and what does this lead to
increases MOA –> decrease 5HT (5 hydroxytryptamine) = depressed mood
what is oestrogen effect on MOA
decreases MOA therefore free tryptophan in the brain –> increases serotonin transport –> increase mood/ happy
what type of progestogen in CHC is the best for women with PMS
drospirenone containing CHC
e.g. yasmin, lucette, eloine, dretirine
if women using GnRH with add back HRT for treatment of PMS how often should they have a DXA scan
annually
