Premenstrual Syndrome Flashcards
What is premenstrual syndrome?
A cyclic recurrence of physical and/or behavioural symptoms that occurs during the luteal phase of the menstrual cycle (second phase)
Occurs after ovulation and before the onset of menses
Affects 90% of people who menstruate at some point
What is premenstrual dysphoric disorder (PMDD)?
A more severe presentation of premenstrual syndrome (increased mood symptoms)
What is premenstrual exacerbation?
Worsening of other disorders during the premenstrual phase
What are some cognitive symptoms associated with premestrual syndrome?
- Aggression and anger
- Anxiety and depression
- Fatigue and lethargy
- Poor concentration and forgetfulness
- Mood changes and reducing coping skills
What are some physical symptoms associated with premenstrual syndrome?
- Acne and appetite changes
- Bloating and fluid retention
- Breast pain/swelling
- Headaches and muscle aches
- nausea and dizziness
What are some patterns of PMS symptoms timing?
Symptoms at ovulation and gradually worsen during luteal phase, and only stop once menses is over
What are the three theories for the pathophysiology of PMS?
- Hormonal fluctuations (oversensitivity to circulating progestins, highest during luteal phase)
- Dysregulation of neurotransmitter systems (HPO-axis, low serotonin)
- Nutritional deficiencies (low Ca2+ causing high PTH)
What are some risk factors associated with developing PMS?
High body mass (BMI over 30 has 3x risk of having PMS)
History of trauma and substance abuse
Some genetic link
What is the diagnostic criteria for PMS?
5 or more symptoms that change in severity throughout cycle for at least 2 cycles
PRISM can be used to assess diagnostic criteria for PMS
What is the diagnostic criteria for PMDD?
5+ symptoms with at least 1 severe mood symptom for at least 2 cycles - resulting in functional impairment
Also rule out other disorders
What are some conditions that should be ruled out before making a diagnosis of PMS?
- Anemia
- DM
- Thyroid disorders
- Chronic fatigue syndrome
- Endometriosis
- PCOS
- Adverse effects from CHC
- Perimenopause
- Fibrocystic breast changes
- Various psychiatric disorders
Review slide 14 for differentiating between PMS and dysmenorrhea
What are the two main therapeutic approaches for treating PMS?
- Calcium carbonate
- SSRIs
Other options have inconclusive evidence for PMS, but could be useful for some patients
What are some additional therapeutic options for PMS that have lower evidence for efficacy?
NSAIDs
Pryidoxine (B6)
OCPs
Misc.
Natural Health Products
What PMS symptoms can calcium carbonate therapy help resolve?
Negative affect, fluid retention, food cravings, pain
3 month trial (set expectations)
What are some counselling points for calcium carbonate therapy for PMS?
May cause constipation
Space from other meds that could chelate or interact with CaCO3
What PMS symptoms can SSRI therapy help resolve?
Cognitive > physical symptoms
More for PMDD vs PMS
Effect seen in 1st cycle
Continuous use, use in luteal phase only, or at symptom onset are all acceptable
Use small doses and consider taper when d/c if doses are higher
Which symptoms of PMS can be addressed with NSAIDs?
Headache, breast pain, muscle aches
Use naproxen or ibuprofen (OTC)
Start at onset of pain, short-term use and lower doses preferred
Which symptoms of PMS can be addressed with Pyridoxine?
Excitatory symptoms (anxiety, irritability, panic attacks)
Reduced b6 may be associated with physiological symptoms
Which symptoms of PMS can be treated with oral contraception?
May help with physical and cognitive symptoms
Monophasic preferred
Most widely prescribed for this indication despite mixed evidence for efficacy
Good option for patients with severe PMDD and want contraception
Review slide 32 for PMS treatment ladder
