Premenstrual Syndrome

Question 1

Premenstrual syndrome (PMS)

Answer 1

Psychological, emotional and physical symptoms that occur during the luteal phase of the menstrual cycle particularly prior to menstruation

Question 2

When are synptoms of PMS present

Answer 2

Symptoms resolve once menstruation begins

Not present before menarche, during pregnancy or after menopause.

Question 3

Pathophysiology of PMS

Answer 3

Caused by a fluctuation in oestrogen and progesterone hormones during the menstrual cycle.

May be due to increased sensitivity to progesterone or an interaction between the sex hormones and the neurotransmitters serotonin and GABA

Question 4

Presentation of PMS

Answer 4

Low mood

Anxiety

Mood swings

Irritability

Bloating

Fatigue

Headaches

Breast pain

Reduced confidence

Cognitive impairment

Clumsiness

Reduced libido

Question 5

Progesterone-induced premenstrual disorder

Answer 5

PMS due to a response to the COCP or cyclical hormone replacement therapy containing progesterone

Question 6

How to diagnose PMS

Answer 6

Symptom diary - 2 menstrual cycles

Specialist:
- GnRH analogue to temporarily stop the menstrual cycle to see if symptoms resolve

Question 7

Management of PMS

Answer 7

General healthy lifestyle changes

COCP - Yasmin

SSRI antidepressants

CBT