Premenstrual syndrome

Question 1

What is premenstrual syndrome

Answer 1

Psychological, behavioural and physical symptoms that are experienced on a regular basis during the luteal phase of the menstrual cycle and often resolve by the end of menstruation

Question 2

What % of women experience premenstrual symptoms and what % are severely debilitating

Answer 2

Symptoms - 95%
debilitating - 5%

Question 3

What are the typical symptoms of premenstrual syndrome

Answer 3

Behavioural changes e.g. tension, irritability, aggression, depression, loss of control
Physical symptoms e.g. bloating, GI upset, breast pain

Question 4

What investigations should be done for premenstrual syndrome

Answer 4

Ask pt to keep a menstrual diary
Note mood, symptoms and menstruation for at least 2 cycles

Question 5

What is the management for premenstrual syndrome

Answer 5

Medication
- SSRIs either continuously or intermittently in the second half of the cycle
- Evening primrose oil for breast tenderness
- Pyridoxine (vitamin B6)
- Continuous oral contraception e.g. 100micrograms oestrogen HRT patches
- GnRH agonists and add-back oestrogen therapy (induces pseudomenopause)
Final resort: bilateral oophorectomy + contraceptive pill/combined HRT (bone and endometrial protection)