Premenstrual Syndrome

Question 1

Define PMS

Answer 1

a cluster of psychological, physical, and behavioural symptoms that occur in the luteal phase of the menstrual cycle and cause distress or disruption to the patient’s life.

Question 2

What is the aetiology of PMS?

Answer 2

Exact cause unclear. May be due to rise and fall of oestrogen and progesterone.

Question 3

What are common symptoms of PMS?

Answer 3

Mood swings and irritability
Depression and anxiety
Fatigue and sleep problems
Physical symptoms such as bloating, breast tenderness, headaches, and joint or muscle pain
Changes in appetite and food cravings
Difficulty concentrating

Question 4

What conditions mimic PMS?

Answer 4

Thyroid disease: Symptoms can include fatigue, depression, and weight changes.

Chronic fatigue syndrome: Main symptoms are persistent and unexplained fatigue, sleep problems, and post-exertional malaise.

Depression or anxiety disorders: These conditions can cause mood changes, irritability, and fatigue, similar to PMS.

Question 5

What investigations are required?

Answer 5

PMS is usually a clinical diagnosis based on the patient’s symptoms. Keeping a symptom diary for at least two menstrual cycles can be helpful in confirming the diagnosis.

Question 6

What are non-pharmacological management approaches for PMS?

Answer 6

Dietary modification
Increasing exercise
Vitamin supplementation
Stress reduction
CBT

Question 7

What are pharmacological management approaches for PMS?

Answer 7

COCP
Danazol
Transdermal oestrogen
GnRH analogues: effectively induce a menopausal state
Antidepressants: particularly selective serotonin reuptake inhibitors (SSRIs) and selective noradrenalin reuptake inhibitors (SNRIs)