PMS and PMDD Flashcards
1
Q
Premenstrual symptoms
- how common
- timing
A
- 75% menstruating women
- 5 days before menses, begin after ovulation in late luteal phase
- sxs are usually self limited and resolve within 4 days of menses onset
2
Q
Premenstrual symptoms
- hormone situation
A
- RAAS activated
- E drops off
- P drops off
3
Q
Premenstrual symptoms
- examples of sx
A
- bloat
- weight gain
- breast tenderness
- HA
- swelling
- irritable
- aggressive (YIKES)
- depressive
- can’t concentrate
- libido change
- lethargy
- food craving
ON AND ON AND ON
4
Q
Premenstrual syndrome (PMS)
- how common
- overview description
A
- 20-40% menstruating women
- mostly physical with minor mood disturbance
5
Q
Diagnostic criteria for PMS
A
- sx must occur during 5 days before menses X 3 menstrual cycles in a row. Must have one affective and one somatic sx
- Sx relieved within 4 days and not reoccur until cycle day 13
- Sx present in absence of medicine, hormone ingestion, etoh
- Sx occur during 2 cycles prospectively
- Pt suffers social/economic dysfunction
6
Q
PMS
- conservative tx
A
- reassurance!
- counsel pt
- aerobic exercise
- stretching
- yoga
- stress managemetn/mindfulness
7
Q
PMS
- diet/supplements
A
- lower caffeine and chocolate
- no tobacco/alcohol
- increase complex carbs
- reduce salt
- smaller, more frequent meals
- increase calcium up to 1200 mg/d (bloating and pain)
- increase magnesium 200-360 mg/d (water retention)
8
Q
PMS
- pharm tx
A
- NSAIDs for pain
- spironolactone for severe cyclic edema
- Bromocriptine for breast pain (with high PRL)
- Jingquianping - ?? evidence
9
Q
Premenstrual dysphoric disorder (PMDD)
- how common
- how dangerous
- key to dx
- sx
A
- 5% menstruating women
- 15% with PMDD attempt suicide!!!
- key: mood symptoms (vs. physical for PMS)
- loss of impulse control, negative mood, aggression, irritability
10
Q
Premenstrual dysphoric disorder (PMDD)
- hormones at play
A
E and P both influence neurotransmitters:
- decreased serotonin in luteal phase
- E increases serotonergic activity by increasing serotonin receptors, transport, and uptake
- decreased GABA in late luteal phase
- major takeaway: women are not just crazy!
11
Q
Pathophys of PMDD
A
- NOT higher levels of E/P
- Possible genetic component
- allopregnanolone is involved
12
Q
Allopregnanolone’s involvement in PMDD pathophys
A
- is a potent positive modulator of GABA receptors
- Negative mood sx occur when allopreg. levels are similar to normal luteal phase levels
- women with PMDD have increased GABA sensitivity to allopregnanolone
13
Q
Other modulators of GABA in PMDD
A
- positive modulators: pregnanolone, bentos, bartituates, alcohol
- women with PMDD show decreased GABA sensitivity to diazepam and pregnanolone
14
Q
DMS-V criteria for PMDD
A
- 5 or more sx which occur in most cycles, a week before menses, and improve within a few days after onset of menses, remit post-menses
- At least one of:
- marked affective lability
- marked irritability/anger, increased personal conflicts
- marked depressed moods, hopelessness, self-deprecating thoughts - At least one of:
- decreased interest
- diff concentrating
- easily fatigued, low energy
- increase/decrease in sleep
- overwhelmed feeling
- physical sx: breast tenderness, muscle/joint aches, bloat, weight gain - Functional impairment in life
- No psych disorder and sx not due to substance abuse or other med condition
- Criterion 1 must be confined by prospective daily ratings in at least 2 symptomatic cycles
(I hate DMS-V)
15
Q
PMDD Tx
A
- SSRIs: continuously or at start of luteal phase. VERY effective. work differently than as an antidepressant
- Combo oral contraceptives
- GnRH agonists: effective but not practical long term
- NSAIDs
- Diuretics
- Supplemnets (calcium, vit B6, Vit E, mg)
- Alt therapy: light therapy, acupuncture, etc.
