PMS

Question 1

Symptoms

Answer 1

• Depression/anxiety
• Irritability
• Loss of confidence
• Mood swings
• Bloated
• Mastalgia

Question 2

Prevelance

Answer 2

40% women
5-8% severe

Question 3

Types

Answer 3

• Core- severe sympt affecting daily function
• Variant- due to other causes (4 types)

Question 4

Variant PMS Types

Answer 4

1. PMS w exacer of underlying condition- diabetes, depression, epilepsy etc. Progesterone induced or non-ovulatory.
2. Non-ovulatory PMD- Occurs in non-ovulatory periods.
3. Progesterone induced PMD- Caused by exogenous progestogens like COCP, HRT, non-cyclical.
4. PMD with absent menstruation- For women who had hysterectomy, mirena or ablation hence do not menstruate.

Question 5

Diagnosis

Answer 5

• Symptom diary for 2/12
• Try GnRH if diagnosis cannot be made to see if it helps

Question 6

Mx - medical

Answer 6

Add table

Question 7

Mx- GnRH

Answer 7

• Try GnRH if severe sympt
• Give add back if >6/12
• Yearly DEXA
• MUST Try GnRH w HRT before surgery.

Question 8

Mx- Surgical, last resort

Answer 8

• Hysterectomy + BSO (do not offer wo)
• Give HRT after

Question 9

Danzol risks

Answer 9

• Virilizing effect on female fetus
• Advise for contraception

Question 10

PMS and preg

Answer 10

• Pre-preg counselling
• If planning preg, wean off SSRI
• If unplanned- discuss small risk of congenital abnormalities (limited data)
• PMS symptoms will stop in preg