PMS Flashcards
What are the psychological symptoms of PMS?
- depression
- anxiety
- irritability
- loss of confidence
- mood swings
What are the physical symptoms of PMS?
Bloating, mastalgia, headache, generalised aches, fluid retention
What is the timing of symptoms due to PMS?
Must be present in the luteal phase
And abate as menstruation begins
Which is then followed by a symptom-free week
How many women (of reproductive age) experience PMS?
40%
How many women (of reproductive age) experience severe PMS?
5-8%
What are the two aetiological theories of PMS?
- Some women are sensitive to progesterone and progestogens
- Neurotransmitter involvement
- Serotonin: serotonin receptors are responsive to E+P
- GABA: GABA levels are modulated by the metabolite of progesterone, allopregnanolone, and in women with PMS, the allopregnanolone levels appear to be reduced
How is PMS diagnosed?
Prospectively over at least two consecutive cycles using a symptom diary
- Daily Record of Severity of Problems is the most widely used
OR GnRH analogue suppression test for definitive diagnosis if diary unclear.
What are first line complementary management options for PMS?
Exercise
CBT
Vit B6
What are first line pharmaceutical options for the management of PMS?
COCP - cyclically or continuously, ideally containing Drospirenone
- emerging data suggest continuous rather than cyclical use
SSRIs - continuous or luteal phase
- low dose e.g. Citalopram 10mg
What are the virilising effects of Danazol on female foetuses?
Cliteromegaly
Labial fusion
Urogenital sinus abnormalities
What are the second line management options for PMS?
Estradiol patches (100mcg) \+ micronised progesterone (100mg or 200mg Day 17-28) OR LNG-IUS
SSRIs higher dose e.g. citalopram 20-40mg
Side-effects of SSRIs: nausea, insomnia, somnolence, fatigue, low libido.
Utrogestan preferred as least likely to cause PMS symptoms.
Needs alternative contraception.
What is the third line management option for PMS?
GnRH analogues + add-back HRT (continuous-combined E + P OR tibolone).
Indication: severe PMS.
Side-effects: reduces BMD.
Advice: regular and weightbearing exercise, diet, avoid smoking, reduce alcohol intake.
If long term treatment: needs DEXA scan every year.
What is the fourth line management option for PMS?
Hysterectomy, BSO followed by oestrogen-only HRT
BSO alone not recommended as need to use progestogen for endometrial protection which may provoke PMS symptoms.
If <45 years old: needs pre-op GnRH analogue suppression test + add-back HRT to ensure will work and that HRT is tolerated.
Consider post-op testosterone replacement as risk of low libido.
What are the differential diagnoses of core PMS (PMS and PMDD)?
Premenstrual disorder with absent menstruation (Treat as core PMS)
Physiological premenstrual disorder - no influence on quality of life
Premenstrual exacerbation - of an underlying medical condition
Progestogen induced premenstrual disorder - on progesterone treatment
What is the criteria for premenstrual dysphoric disorder?
Content: 5 out of 11 symptoms, 1 must be mood-related and 1 must be somatic/functional.
Cyclicity: premenstrual onset and postmenstrual resoltuion
Severity: affects ADLs
Chronicity: majority of cycles within last 12 months
