PMS GT48 Flashcards
How long should a symptom diary be kept?
Prospectively, 2 months
How long can GnRH analogues be used for a definitive diagnosis?
3 months
Otherwise can be used for severe cases
What should be considered first line treatment including pharmaceutical intervention in PMS?
Exercise, CBT, Vitamin B6
Drospirenone-containing COC, continuously rather than cyclically (ie Yasmin)
Or consider SSRIs (either luteal or continuous)
What should be considered first line for progestogenic opposition when using percutaneous/transdermal oestradiol?
What dosing should be used?
Micronised progesterone - less likely to induce PMS like side effects (Utrogestran)
10-12 day course or long term via Mirena
Also need barrier contraception
What is the advice re: danazol and PMS?
200mg BD in luteal phase effective for breast symptoms but may cause irreversible virilisation (also: contraception to prevent virilisation of female fetus)
What is the advice with GnRH analogue treatment of PMS?
Use continuous combined addback HRT or tibolone if >6/12
DEXA scan every year
When should hysterectomy and BSO be considered in the treatment of PMS?
When medical management has failed
When on long term GnRH analogues
Other gynaecological conditions requiring surgery
Advise to use HRT post op especially if <45 yo
What is second line treatment of PMS?
Estradiol patches (100mcg) + micronised PG (100-200mg a day, day 17-28 PO/PV) or Mirena Higher dose SSRI continuously or luteal phase
What is third line treatment of PMS?
GnRH analogue with add-back therapy
What is fourth line treatment of PMS?
Hysterectomy and BSO
How many women have symptoms of PMS, and how many suffer with severe PMS?
40%
5-8% severe
Which neurotransmitters are implicated in PMS?
Serotonin
GABA
Which complementary therapies have shown benefit in PMS?
Calcium/Vitamin D
Vitex agnus castus - variability in preparation
Saffron
Which complementary therapies have shown ‘some benefit’ in PMS?
Exercise
Reflexology
Gingko bilboa
Evening primrose oil - cyclical breast symptoms
What is the recommendation for St John’s Wort in PMS?
Not recommended - mixed results
Interacts with meds - not to be used with SSRIs and may render low dose OCP ineffective
