Premenstrual Syndrome

Question 1

what is it?

Answer 1

it describes the psychological, emotional and physical symptoms that occur during the luteal phase of the menstrual cycle

Question 2

when does it resolve?

Answer 2

once menstruation begins

Question 3

presentation?

Answer 3

• Low mood
• Anxiety
• Mood swings
• Irritability
• Bloating
• Fatigue
• Headaches
• Breast pain
• Reduced confidence
• Cognitive impairment
• Clumsiness
• Reduced libido

Question 4

when else can this occur?

Answer 4

• cocp
• cyclical hormone replacement therapy containing progestogens
• mirena coil
• after a hysterectomy / endometrial ablation

Question 5

diagnosis?

Answer 5

• symptom diary
• GnRH analogue to see if symptoms resolve

Question 6

how do GnRH analogues work in stopping periods?

Answer 6

once bound to the GnRH receptors they cause an initial increase in FSH and LSH. The drugs then stay there and block the receptor from further stimulation. This means that after the initial increase in FSH and LH, the levels in the blood quickly drop and become very low. The levels will then stay low for as long as the woman takes the gonadotropin-releasing hormone agonists.

Question 7

Mx?

Answer 7

• general healthy lifestyle measures
• COCP
• SSRI antidepressants
• CBT

Question 8

what COCP is recommended 1st line?

Answer 8

ones containing drospirenone ie yasmin - these have antimineralcorticoid effects