Week 11 - PMS Flashcards
PMS vs PMDD
PMS - a wide range of symptoms, with a cyclic pattern – recurrence around the luteal phase, resolved after onset of menses. Typical symptoms include irritability, tension and dysphoria, breast tenderness, fatigue, irritability and depression.
PMDD – a more severe form of PMS – incapacitating symptoms, many of which are affective.
how to dx PMS?
Clinical Diagnosis – impairment of some facet of a woman’s life during luteal phase and a diagnosis of exclusion.
Mostly based on clinical history
Other affective disorders may be worse in luteal phase but are not symptom-free during mid-follicular phase (days 6-10)
Other conditions may mimic symptoms of PMS
Epidemiology of PMS
Up to 80% of women report one or more symptoms during their luteal phase without reporting substantial disruption to daily functioning
20-30% of women report symptoms that affect some facet of life
3-8% of women report more severe symptoms and may meet the criteria for PMDD diagnosis
how to dx PMDD?
In most menstrual cycles in the past year, 5 or more symptoms present for most if the time during the last week of luteal phase. Begin to remit within a few days after the onset of follicular phase. Absent post-menses.
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, feelings of being “keyed up” or “on edge”
Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection)
Persistent and marked anger or irritability or increased interpersonal conflicts
Decreased interest in usual activities (e.g., work, school, friends, hobbies)
Subjective sense of difficulty in concentrating
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
A subjective sense of being overwhelmed or out of control
Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of “bloating,” weight gain
Aetiology of PMS
Various and mostly theoretical
Complex and multifactorial and may vary between women
Ovarian hormones may play some role as symptoms often improve when ovulation is suppressed
Changes in hormone levels may influence serotonin
Genetic factors (twin studies)
Deficiencies in prostaglandins – inability to convert linoleic acid to prostaglandin precursors
Enhanced sensitivity to estrogen and progesterone
Women whose normal cycles were blocked with administration of a gonadotropin-releasing hormone agonist and were then given exogenous homrones –those who previously had PMS experienced more symptoms of sadness, anxiety, irritability, bloating and impaired function than those without PMS
Women with PMS experience more symptoms of menopause
Increased aldosterone and plasma renin activity are the hypothetical mechanisms for PMS and PMDD associated fluid retention and bloating
Lifestyle modification for PMS
Smoking cessation – women who smoke experience greater levels of PMS
Stress exacerbates mood disturbance associated with PMS
Infertility – women who dread the onset of menses may have exacerbated symptoms – treat cause?
Education as treatment strategy for PMS
Tracking menses and symptoms (see tracking sheet) to develop awareness of relation to hormonal fluctuations in cycle
Women who have been educated about biologic basis and prevalence of PMS report an increased sense of control and relief of symptoms
Maintaining a symptom diary may help patients identify optimal times for implementing behavioural changes
Exercise & PMS
Women with PMS who practiced aerobic exercise reported fewer symptoms than controls
Various interventions –
Aerobic exercise for 60min/day, 3x/week for 8 weeks (1)
Running 51 km/month (2)
Moderate (60-80% of HR max) to high intensity (80-90% of HR max) 4x/week (3)
Overall, decrease severity of various symptoms. Aerobic exercise is key.
Consumption of ____, _______, and high sodium foods associated with PMS (SAD diet) and lower nutrient foods.
Consumption of dairy, refined sugar, and high sodium foods associated with PMS (SAD diet) and lower nutrient foods. .
Women with PMS consume 62% more _______ _______ than women without PMS.
Women with PMS consume 62% more refined carbohydrates than women without PMS.
Exercise: ______ for 1 year reduced PMS significantly.
Yoga for 1 year reduced PMS significantly.
The body is more sensitive to which hormone during the luteal phase?
The body is more sensitive to insulin during the luteal phase.
4 dietary modifications for PMS
- Sodium restriction– to minimize bloating, fluid retention, and breast swelling/tenderness
- Caffeine restriction – to reduce irritability and insomnia
- Avoiding caffeine specifically helped reduce breast tenderness in women with PMS.
- Soy – some research showed to help reduce PMS symptoms (68mg of soy isoflavones from food sources). Reduction in headaches, breast tenderness, cramps, edema, after 2 cycles.
8 Supplementations for PMS?
- B vitamins
- Mg & B6
- B6
- Mg
- Ca & Vit D
- Ca
- Vit E
- 5-HTP or L-tryptophan
all alleviate sxs and risk of PMS
4 Botanical Medicines for PMS?
- EPO - breast tenderness, bloating
- Hypericum - improving sxs
- Vitex - statistically as effective as prozac for PMDD; better for physical; prozac better for psychological sxs
- Gingko biloba - useful in sxs w congestion
