Premenstrual Syndrome

Question 1

what is PMS?

Answer 1

any of a complex of symptoms experienced by some women in the days immediately before menstruation

Question 2

what are the possible psychological symptoms of PMS?

Answer 2

depression
anxiety 
loss of confidence 
mood swings 
irritability

Question 3

what are some possible physical symptoms of PMS?

Answer 3

bloating
mastalgia
food cravings

Question 4

when do symptoms need to be present for a diagnosis of PMS to be made?

Answer 4

in the luteal phase

abate during menstruation

symptom free week after menstruation

Question 5

how is PMS diagnosed?

Answer 5

symptom diary for a minimum of two cycles

can also use GnRH agonists to herp

Question 6

what is involved in the first line management of PMS?

Answer 6

exercise
CBT
combined pill
low dose SSRIs

Question 7

what is involved in the second line management of PMS?

Answer 7

estradiol patches and micronised progesterone

higher dose SSRIs

Question 8

what is involved in the third line line management of PMS?

Answer 8

GnRH analogues and add back HRT

Question 9

what is involved in the fourth line management of PMS?

Answer 9

surgical management +/- HRT

Question 10

what psychological therapy can be done for PMS?

Answer 10

CBT

Question 11

what are the four hormonal options for management of PMS?

Answer 11

COCP
HRT
GnRH inhibitor
GnRH analogues

Question 12

what must a combined pill contain to treat PMS?

Answer 12

drospirenone

Question 13

how should the pill be taken for PMS?

Answer 13

continuously

Question 14

what HRT is given for PMS?

Answer 14

percutaneous oestradiol patch with cyclical progestogen for endometrial protection

Question 15

what contraception should be used alongside HRT for PMS?

Answer 15

alternative barrier or intrauterine methods i.e. condoms, IUD

Question 16

name a GnRH inhibitor that may be used for PMS?

Answer 16

danazol

Question 17

name two GnRH analogues that may be used for PMS

Answer 17

zoladex

decapeptyl

Question 18

which is more effective for PMS - GnRH inhibitors or analogues?

Answer 18

analogues

inhibitors hardly used

Question 19

who receives GnRH analogues for PMS?

Answer 19

only the most severe symptoms

Question 20

what negative effect can GnRH analogues have and what screening needs to be done?

Answer 20

reduced BMD

annual DEXA scans if used long term

Question 21

what needs to be given alongside GnRH analogues if given for more than six months?

Answer 21

add back HRT

Question 22

what are the non hormonal options for PMS?

Answer 22

SSRIs

spironolactone

Question 23

what is the first line SSRI for PMS?

Answer 23

sertraline

Question 24

what surgical options have been shown to have benefit for PMS?

Answer 24

hysterectomy and bilateral oophorectomy

Question 25

when should surgery for PMS be considered?

Answer 25

medical management has failed

long term GnRH analogue treatment needed

other gynae conditions need surgery anyway

Question 26

what needs to be ensured prior to surgery for PMS?

Answer 26

that HRT is tolerated - done through perioperative GnRH analogues

Question 27

what needs to be given after surgical management for PMS?

Answer 27

HRT

particularly if they are <45