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443-SRH and MSK > PMS/PMDD > Flashcards

PMS/PMDD Flashcards

1
Q

what is PMS/PMDD

A

Cyclic recurrence of sx during luteal phase of menstrual cycle- often sx dissipate with onset of menses (mix of mood, physical, cog sx)

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2
Q

when does PMS/PMDD start

A

25-35yrs, maybe earlier

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3
Q

PMDD could be categorized as

A

severe PMS

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4
Q

estrogen effects on NT

A

+ effect on 5HT- increased synthesis, 5HT1 receptors, binding affinity

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5
Q

progesterone effect on hormones

A

increased 5HT uptake and turnover

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6
Q

what are the pathophysiology theories of PMS/PMDD

A

Correlation of hormones and + central NT (5HT)
Greater susceptibility to normal cyclic changes in hormones or ratio of estrogen to progesterone
Progesterone key mediator of PMS/PMDD: allopregnanolone is a metabolite of progesterone and an agonist of GABAr

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7
Q

RF for PMS/PMDD

A

genetics, traumatic or major life events/ stressors, comorbidity with depression/ anxiety, psychosocial factors (ex- fewer social supports)

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8
Q

diagnosis of PMS/PMDD must include

A

characteristic of PMS/PMDD
Limited to luteal phase- often worse few days before menses
Impacting daily life
Sx present for at least 2 previous cycles
Not explained by some other dx

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9
Q

what is the dx if the pt has sx consistent with PMS but do not interfere with daily functioning

A

mild premenstrual sx

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10
Q

nonpharm options for PMS/PMDD

A

Pt education on bio basis of PMS- may help give pt sense of control + establish expectations
Daily charting of sx = greater awareness of sx by pt
Exercise: regular, aerobic, reduces severity of sx
Adequate rest + relaxation
Stress reduction (CBT)
Diet: sodium restriction (if fluid retention, bloating, breast swelling), caffeine restriction (if irritability or insomnia), complex carb diets, some foods (maybe bananas)

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11
Q

NHPs for PMS/PMDD

A

Calcium 1200mg daily for improvement in mood and physical sx (esp fluid retention)
Most evidence
Magnesium 200-400mg daily to reduce fluid retention/ bloating
Vit B6 100mg daily for mild mood and physical sx
Vit E 400IU daily for mild sx of breast tenderness and mood
Chasteberry fruit - breast tenderness, mood
Evening primrose oil (EPO)- prostaglandin precursor, no better than placebo
St John’s wort- open label found benefit in mood
Gingko- 1 RCT showed improved physical and mood

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12
Q

what has the most evidence as a NHP for PMS/PMDD

A

calcium

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13
Q

calcium is used in PMS for

A

mood and physical sx- esp fluid retention

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14
Q

magnesium is used in PMS for

A

reducing fluid retention/ bloating

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15
Q

vit B6 is used in PMS for

A

mild mood and physical sx

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16
Q

vit E is used in PMS for

A

breast tenderness and mood

17
Q

how long should pharm therapies be trialed in PMS/PMDD

A

2-3 cycles, ~3 mths

18
Q

pharm options for PMS/PMDD

A

NSAIDs
spironolactone
CHC
POP (no benefit)
SSRIs
anxiolytics
GnRH agonists
danazol
bilateral oophorectomy

19
Q

what is teh drug of choice for PMS/PMDD

A

SSRIs

20
Q

how to use SSRIs for PMS/PMDD

A

Intermittent: start on luteal phase or sx day, then d/c on first day of menses or 1-3 days after
Not assoc with SSRI d/c sx
If interim not eff = switch to cont

21
Q

with SSRIs for PMS/PMDD sx may improve within ____ but may take ___menstrual cycles to see full benefit

A

24-48hrs
3

22
Q

If initial SSRI not tolerated/ ineff for PMS/PMDD= try _______before abandoning class + switch to ______

A

2 additional SSRIs
cont if on interm

23
Q

how to use NSAIDs for PMS/PMDD

A

Start in luteal phase, stop 1-2 days after menses starts

24
Q

how to use diuretics in PMS/PMDD

A

spironolactone 25-10mg/d during luteal phase
Most helpful for fluid retention, bloating, and breast tenderness

25
Q

how effective are CHCs in PMS/PMDD

A

50% see no change, 25% improvements, 25% worsened

26
Q

how should CHCs be used in PMS/PMDD

A

Use continuous to prevent hormone fluctuations
Consider drospirenone containing CHC for those with fluid retention

27
Q

which CHC should be considered for those with fluid retention

A

Consider drospirenone containing CHC for those with fluid retention

28
Q

progesterone eff on PMS/PMDD

A

SR of progesterone in PMS found no benefit

29
Q

how to use anxiolytics for PMS/PMDD

A

BZs like alprazolam during luteal phase has been shown to be eff for PMS/PMDD esp for anxiety
Usually reserved for those who do not respond or used in conj with antidepressants
Can also premedicate if known anxiety

30
Q

what pharm therapy can be used if nothing else worked- what is alst line

A

ovarian suppression with GnRH agonists, danzol ,or bilateral ophorectomy

443-SRH and MSK (24 decks)

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