Premenstrual syndrome

Question 1

What is PMS?

Answer 1

Condition which manifests with distressing physical, behavioural and psychological symptoms in the absence of organic or psychiatric disease, regularly occurring during the luteal phase of the menstrual cycle and with significant improvement by the end of menstruation

Question 2

What are symptoms of PMS?

Answer 2

Mood swings
Irritability
Depression
Bloating
Breast tenderneess
Headache
Reduced visuospatial ability
Increase in accidents

Question 3

How is PMS diagnosed?

Answer 3

Symptom diary filled in over 2 prospective cycles

Question 4

What are first-line treatments for PMS?

Answer 4

Exercise
Improve diet
Reduce stress
Smoking cessation
Weight loss

CBT
Vitamin B6 PO
COCP
Continuous or luteal phase low does SSRI

Question 5

What are second line treatmens for PMS?

Answer 5

Estradio patches + progestogen (Mirena or dydrogesterone)

Higher dose SSRI continuously or luteal phase e.g. fluoxetine

Question 6

What are third line treatment for PMS? Risk?

Answer 6

GnRH analogues _ add back HRT
Goserelin

Risk fo bone thinning - add tibolone

Question 7

What is fourth line treatment for PMS?

Answer 7

Total hysterectomy plus bilateral salpingo-oophorectomy with HRT including testosterone replacement