PMS & PMDD

Question 1

Define PMDD.

Answer 1

PMS: Cyclic physical & behavioural symptoms which occur 7-10 days prior to menses, interfere with work or lifestyle, then disappear for the remainder of the cycle.

PMDD is a more severe disorder characterized by irritability, anger, internal tension, dysphoria, and/or mood lability.

Question 2

How is PMS diagnosed?

Answer 2

Prospective symptom diary, ideally using validated survey tool
1+ affective, 1+ somatic symptom prior to menses, relief from at least CD4-CD12, no use of meds/hormones/EtOH

(Too much bias when symptoms are related to menses in retrospect, plus women are conditioned to expect premenstrual symptoms)

Question 3

What is the leading theory describing the pathophysiology of PMS/PMDD?

Answer 3

Abnormal or exaggerated effect of steroid hormones on central neurotransmitter mechanisms, particularly serotonin

Question 4

What is the first-line treatment of PMS/PMDD?

Answer 4

Serotonin reuptake inhibitors - SSRIs, venlafaxine, or clomipramine

Question 5

What progestin, when used in CHC, is effective for treatment of PMS/PMDD?

Answer 5

Drospirenone

Question 6

Which common side effect of SSRIs is unlikely to be improved by lowering the dose?

Answer 6

Sexual dysfunction (diminished interest, anorgasmia)