PMS/PMDD Flashcards
PMS definition
1 affective + 1 somatic 5 days before menses lasting 3 days
relief within 4 days after onset, no recurrence before day 12
no medications used
PMS affective symptoms (6)
irritability
depression
angry outbursts
confusion
social withdrawal
fatigue
PMS somatic sx (4)
bloating
h/a
breast tenderness
swollen extremities
PMDD DSM-V criteria (7: A-G)
A. 5ssx week before menses, improves once meron and then disappears week after
B. One (or more) of the following symptoms must be present:
1. labile mood
2. angry bird
3. depressed
4. hanxiety
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Swollen everywhere
D. The symptoms are associated with clinically significant distress or interference
with layf
E. The disturbance is not merely an exacerbation of the symptoms of another disorder
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.
G. not a drugee
MOA PMS
abnormal response to normal cyclic changes in ovarian steroid production
other: GABA-ergic disturbance, dec serotonin
vitamin D deficiency
Treatment for PMS/PMDD
SSRI
Alprazolam
Drosperinone OCPs
GnRh agonist
Danazol
Exercise
CBT
Magnesium
Spironolactone
1st line pharma drugs
drosperinone OCPs (better if continuous)
constant level hormones
Tx 1st line
exercise
SSRI/SNRI sample
Fluoxetine prozac 20mg OD
Sertraline zoloft 50-150mg OD
paroxetine paxil 20-50mg OD
citalopram celexa 20-30mg OD
venlaxafine effexor 50-200mg OD - snri
x 3 days or PRN during luteral phase
Dysmenorrhea MOA
myometrial ischemia secondary to prolonged endometrial contractions
inc basal tone, inc frequency of cx that are not coordinated or rhythmic
inc PGE2, PGF2a, leukotrienes = prostaglandins
risk factors dysmenorrhea
skinny bitch BMI <20
menarche <12
longer intermenstrual cycles
longer duration menses
irregular/heavy flow
premenstrual molimina
previous sterilization
smoking
sexual assault
decreased dysmenorrhea
married/stable relationship
OCPs
exercise
inc parirty
menstrual migraine MOA
experienced due to decrease estrogen during luteal phase with resolution with rise in Estrogen
dec serotonin or inc serotonin clearance
tx migraine (serotonin agonist) - inhibit vasoactive peptide release
vasoconstriction
sumatriptan 25mg TID
naratriptan 1mg BID
frovatriptan 2.5mg OD/BID
riszatriptan 10mg OD
begin 2-3 days before menses then cont 5-6 days after
tx migraine
OCPs (continuous)
NSAIDs
Erenumab (monoclonal antibody to CGRP)
