Premenstrual Syndrome

Question 1

What are the physical symptoms of premenstrual syndrome? [5]

Answer 1

Swelling
Breast tenderness
Aches
Headache
Bloating/weight

Question 2

What are the behavioural symptoms of PMS? [5]

Answer 2

Sleep disturbances
Appetite changes
Poor concentration
Decreased interest
Social withdrawal

Question 3

What are the mood symptoms of PMS? [5]

Answer 3

Irritability 
Mood swings
Anxiety/tension 
Depression
Feeling out of control

Question 4

What are the trigger points indicating a referral may be needed in patients presenting with symptoms of PMS? (4)

Answer 4

1. Psychological symptoms alone
2. Severe or disabling symptoms
3. Symptoms that either worsen or stay the same after the onset of menses
4. Women under the age of 30

Question 5

PMS symptoms usually appear and then disapper when?

Answer 5

7-14 days before, and then disappear a few hours after the onset of menses, are suggestive of PMS

Question 6

PMS is more common in

Answer 6

Women aged in their 30s and 40s

Question 7

What does PMS present as?

Answer 7

Patients with PMS will normally have symptoms suggestive of mental health disorders such as low mood, insomnia and irritability. This can make excluding mental health disorders such as depression difficult. However, the cyclical nature of the symptoms in conjunction with symptoms such as breast tenderness, bloatedness and fluid retention point to PMS.

Question 8

How is PMS treated?

Answer 8

Calcium and Vitamin B6 (pyridoxine)

Question 9

Calcium supplementation in the treatment of PMS should provide at least what amount of elemental calcium per day?

Answer 9

1200mg.

Calcichew provides 500mg elemental calcium per tablet.

Question 10

If a patient is taking calcium supplements to treat PMS and is prescribed tetracycline antibiotics or iron supplements what should happen?

Answer 10

2-hour gap should elapse between doses to avoid decreased absorption of the antibiotic or iron.

Question 11

What dose of vitamin b6 (pyridoxine) is required to treat PMS?

Answer 11

There is no definitive dose, however doses of up to 100mg daily have been shown to help reduce symptoms.

Side effects are extremely rare at this dose, although higher doses can cause numbness and peripheral neuropathy.

Question 12

What parkinsons treatment dose vitaming b6 (pyridoxine) interact with?

Answer 12

Levodopa, doses of pyridoxine of as low as 5mg will reduce impact of levodopa.

Question 13

What interactions, apart from with levodopa, does vitamin b6 (pyridoxine) have?

Answer 13

With phenobarbital and phenytoin.

Question 14

The side effects of calcium supplementation are

Answer 14

Nausea and flatulence