PMS + PMD

Question 1

what is PMS?

Answer 1

the emotional, psychological and physical symptoms that occur during the luteal phase of the menstrual cycle, particularly in the days prior to the onset of menstruation

Question 2

in what phase of the menstrual cycle do women experience PMS?

Answer 2

Luteal phase

Question 3

what causes PMS?

Answer 3

Exact mechanism is unknown, it is thought that PMS is due to:

• Increased sensitivity to progesterone during Luteal Phase
  OR
• An interaction between the sex hormones and the neurotransmitters serotonin and GABA

Serotonin receptors are responsive to oestrogen and progesterone, and SSRIs are proven to reduce PMS symptoms

GABA levels are modulated by the metabolite of progesterone (allopregnanolone) and in women with PMS the levels of allopregnanolone appear to be reduced

Question 4

when are symptoms worst and when do they typically end in PMS?

Answer 4

luteal phase= worst
during period= typically end

Question 5

in who would it be unusual to see PMS?

Answer 5

before menarche, during pregnancy or after menopause

Question 6

When is PMS considered PMD?

Answer 6

if the PMS is having an impact on daily living

Question 7

how many women experience PMS and PMD?

Answer 7

95% PMS
5% PMD

Question 8

investigations for PMD?

Answer 8

Diagnosis needs minimum 2 cycles
-use symptoms diary

May also use GnRH analogues to halt the menstrual cycle, induce menopause and see if symptoms resolve

Question 9

1st line management of PMD?

Answer 9

-exercise, CBT, Vit B6
-Yasmin and Eloine COC
-Low dose SSRI (used continuously during luteal phase)

Question 10

2nd line management PMD?

Answer 10

-Oestradiol patches + micronized progesterone (must use together) OR LNG- IUS (mirena coild)
-Higher dose SSRI

Question 11

3rd line management PMD?

Answer 11

-GnRH analogues (use max 6 months without add back therapy)

OR

add back HRT

OR

Surgery +/- HRT

Question 12

what can be used to treat swelling and bloating?

Answer 12

diuretics and/or herbal supplements