Premenstrual Syndrome

Question 1

What is this a presentation of?
Tension, irritability, aggression, depression, loss of control, bloatedness, minor GI upset, breast pain. Regular, during luteal phase of menstrual cycle, resolves by the end of menstruation.

Answer 1

Premenstrual syndrome (PMS)

Question 2

What is the 1st line treatment for premenstrual syndrome?

Answer 2

1. Exercise, diet, stress reduction, smoking cessation, weight loss.
2. Symptomatic diary to assess treatment effect.
3. 1COCP (Yasmin) or low dose SSRI (fluoxetine, continuous or just in luteal phase)
4. CBT as effective as SSRI
5. Vitamin D, magnesium adjunct, evening primrose oil for mastalgia

Question 3

What are the alternative treatment options for premenstrual syndrome?

Answer 3

1. 2nd line - oestradiol patches and progestogen PO/IUS, high dose SSRI
2. 3rd line - GnRH agonists, add back oestrogen to induce pseudomenopause
3. 4th line - total hysterectomy, bilateral salpingo-oophrectomy with HRT for bone and endometrial protection