Premenstrual syndrome Flashcards
What is premenstrual syndrome?
Psychological, emotional and physical symptoms that occur during the luteal phase of the menstrual cycle, particularly in the days prior to onset of menstruation
What are some key things to note about PMS which should be asked when taking a history
The symptoms of PMS resolve once menstruation begins
Symptoms are not present before menarche, during pregnancy or after menopause
What is thought to cause pre-menstrual syndrome?
Fluctuation in oestrogen and progesterone hormones
Increased sensitivity to progesterone or an interaction between the sex hormones and the neurotransmitters serotonin and GABA
List some common symptoms of premenstrual syndrome
Low mood Anxiety Mood swings Irritability Bloating Fatigue Headaches Breast pain Reduced confidence Cognitive impairment Clumsiness Reduced libido
When can symptoms of PMS also occur?
Hysterecotmy Endometrial ablation Mirena coil COCP Cyclical HRT containing progesterone
What is it called when PMS features are severe and have a significant impact on QOL?
PMDD
How is diagnosis of PMS made?
Symptom diary spanning two menstrual cycles
Cyclical symptoms occurring just before and resolve after the onset of menstruation
How can a definitive diagnosis of PMS be made by a specialist?
GnRH analogues to halt the menstrual cycle and temporally induce menopause to see if symptoms resolve
Describe the management of PMS
General healthy lifestyle changes - improve diet, exercise, alcohol, smoking, stress and sleep
COCP - drospirenone (ant mineralocorticoid action, continuous use)
SSRI antidepressants
CBT
MDT for severe cases
Continuous transdermal oestrogen patches
Progestogens required for endometrial protection - cyclical low dose or coil
GnRH analogues and HRT
Hysterectomy and bilateral oophorectomy in severe cases where other treatments failed
Tamoxifen and danazole for breast pain
Spironolactone - breast swelling, bloating and water retention
