Premenstrual Syndrome : Dr Sharda Jain

L
Lifecare CentreDirector at Dr. Sharda jain
Premenstrual
Syndrome
Dr. Sharda Jain
Dr Jyoti Agarwal
"Management of Premenstrual Tension (PMT)"
PMT (Premenstrual Tension) or PMDD
(Premenstrual Dysphoric Disorder) is common
problem.
Its impact on women's lives, family life in big way
emphasizing the need for effective management.
Premenstrual Syndrome- क्या
है
1.Distressing psychological problem:-
with over 200 physical, and/or behaviural
symptoms.
2.Occurrence during the luteal phase of
the menstrual cycle (or cyclically after
hysterectomy with ovarian conservation).
3.Significant regression of symptoms with
onset of or during the period.
Prevalence of PMS
In the general population  study at PGIMER Very common
• Only 15% of women are asymptomatic,
• 50% have mild PMS symptoms.
• 30% moderate
• 5-10% severe.
Etiology
1. Cyclical ovarian activity the central component (ovarian
'trigger', such as ovulation, may initiate a cascade of
events).
2. Central: increased responsiveness to a combination of
steroids, chemical messengers
3. Psychological sensitivity
Diagnosis
• Most women self-diagnose it
• History :- can suggest a diagnosis of PMS
• Symptom record :- can establish its true nature.
• Symptom charts :- PRACTICE Guidelines of
Premenstrual
Syndrome.
• Moderate/severe PMS
1.disruption of work and interpersonal
relationships
2.interference with normal activities.
• Diagnostic criteria for premenstrual dysphoric disorder:
equivalent to severe PMS,but need psychiatrist in the
loop to manage severe form.
• It is important to exclude organic disease and significant
psychiatric illness.
• Perimenopausal women may have increasing
premenstrual symptoms as well as menopausal
symptoms.
Criteria for premenstrual dysphoric
disorder
At least 5 symptoms present for most of the late luteal phase
with remission within a few days of onset of menses and absence
of symptoms in the week post menses.
At least: one symptom must be from the following first four.
1. Marked depressed mood, feeling of hopelessness, or Self
deprecation .
2. Marked anxiety; tension (being 'on edge).
3. Marked affective lability(e.g. feeling suddenly sad or tearful).
4. Persistent and marked anger/irritability/increased conflicts.
5. Decreased interest in usual activities ( friends, hobbies).
6. Subjective sense of difficulty in concentrating.
7. Lethargy. Easy fatigability lack of energy.
8. Marked Change in appetite, overeating. or specific food
cravings.
9. Hypersomnia or insomnia.
10. Subjective sense of being overwhelmed or out of control.
11. Other physical symptoms, such as breast tenderness or
swelling, headaches; Joint or muscle pain, a sense of 'bloating';
Diagnosis -PMS
Clinical diagnosis of PMS requires that the symptoms are confirmed
by prospective recording (that is recorded as they occur) for at least
two menstrual cycles and that they cause substantial distress or
impairment to daily life.
Non-Hormonal Management
Non-hormonal options are often considered as the first-line
treatment for PMT.
The following are non-hormonal approaches:
 Lifestyle Modifications
 Dietary Changes
 Stress Reduction Techniques
 Exercise
Dietary Changes
Dietary changes can help manage PMT:
 Reducing salt and sugar intake & High fat diet
 Increasing consumption of fibre , fruits, vegetables, and
whole grains
 Calcium - effective
 Magnesium effective
 and Vitamin D supplementation
Stress Reduction Techniques
Various stress reduction techniques:
* Mindfulness and meditation
* Yoga
* Deep breathing exercises
* Biofeedback
Exercise
Benefits of regular exercise are immence in managing
PMT: moderate Exercise / Aerobic
* Reduces mood swings
* Enhances overall well-being
* Improves sleep quality
Hormonal Management
Introduce hormonal options for PMT
management.
These treatments are considered when non-
hormonal approaches are insufficient or not
tolerated.
Hormonal Options
Following hormonal treatment options:
 Progesterone
 Oral Contraceptive Pills (OCPs)
 GnRH Analogues
 Selective Serotonin Reuptake Inhibitors (SSRIs)
Progesterone
Progesterone may be used to manage PMT.
No potential benefits.
Oral Contraceptive Pills (OCPs)
 OCPs can help manage PMT.
 Useful in some women regulate hormonal fluctuations.
 Yasmin /YAZ are good with least side effects.
 Continuos therapy is better
 New pill are demand with withdral bleeding after 90 days
OESTRGEN PATCHES + PROGESTERONE
WELL ESTABLISHED & ACCEPTED
GnRH Analogues
Use of GnRH analogues in PMT management is seen in severe cases.
They suppress ovulation and hormonal fluctuations.
ADD BACK THERAPY
USED FOR 6 MONTHS  ,BMD EVERY 2 YRS FOR BONE RESERVE
Selective Serotonin Reuptake
Inhibitors (SSRIs)
 The use of SSRIs as an First line treatment option for PMT management.
 Their mechanism of action in managing mood-related symptoms.
Selective Serotonin Receptor
Inhibitors (SSRI)
First-line treatment of PMS with predominantly emotional symptom
SSRIs were found to be effective for reducing the overall symptoms
of PMS and also for reducing specific types of symptoms
(psychological, physical and functional symptoms, and irritability)
Agent Dosing
Paroxetine (CR) Starting dose: 12.5 mg/day
Up to 25 mg/day
Continuous or intermittent
Fluoxetine (Sarafem) Starting dose: 20 mg/day
0 Up to 60 mg/day
Continuous or intermittent
Sertraline Starting dose: 50 mg/day
Up to 150 mg/day continuous
0 50 mg/day to 100 mg/day intermittent
FDA-Approved SSRIs
Luteal Phase and Symptom Onset Dosing
Luteal Phase Dosing
• Start SSRI at day 14 of
a 28-day
• cycle Take SSRI during
last 2 weeks of cycle
only
• Stop when menses
begin
Symptom Onset Dosing
• Dose when symptoms
begin and as long as
they last
• Cycles must be regular
Continuous Dosing
• Take SSRI during
whole month
• One meta-analysis
showed slightly
better response
DANAZOLE
DEFINITE BENEFIT
MASCULINISING SIDE EFFECTS +
SO USED IN LUTEAL PHASE ONLY
Combination Therapies
 Please note a combination of hormonal and non-
hormonal approaches may be used for severe PMT
cases.
 Experts have their rationale and benefits.
SURGERY
BSO
HYSTERCTOMY + BSO
VERY rare SEVERE CASE
GnRH a test is test of cure
Alternative Tt
Homeopathy -90%
MIND BODY THERAPY
AROMA THERAPY
REFLEXOLOGY
Prognosis -PMS
Symptoms of PMS can mostly recur after
stopping the treatment, except after
oophorectomy and menopause
Complications- PMS
• Untreated PMS are likely to affect sexual life, thereby leading to a
higher level of sexual distress, which can, in turn, lead to
relationship problems and more psychological issues.
• There is also evidence that relates the PMS to increased suicidal risk
in hormone-sensitive females
Monitoring and Follow-Up
Emphasize the importance of monitoring and follow-
up appointments to assess treatment effectiveness
and adjust as needed.
Patient & family must be counselled
Conclusion
The management of PMT  ALL GYNAECOLOGIST MUST KNOW.
PMS is underestimated -80% suffer frm it.
Symtoms Diary tobe used for 2 months minimum to plan Tt
We Encourage personalized treatment plans.
Lifestyle changes ,diet ,exercise & complimentary therapy to be
planned & offered simultaneously with Medical Treatment
COCP & SSRI ARE MAIN STAY OF TREAMENT
GnRH a & SUGICAL Tt is last resort for very severe cases .
Questions and Discussion
Premenstrual Syndrome : Dr Sharda Jain
1 of 34

Recommended

Premenstrual syndrome by
Premenstrual syndromePremenstrual syndrome
Premenstrual syndromeNick Harvey
6.7K views14 slides
Premenstrual Syndrome by
Premenstrual SyndromePremenstrual Syndrome
Premenstrual SyndromeKervindran Mohanasundaram
2.6K views33 slides
Premenstrual tension syndrome hennawy by
Premenstrual  tension syndrome  hennawyPremenstrual  tension syndrome  hennawy
Premenstrual tension syndrome hennawymuhammad al hennawy
866 views50 slides
Premenstrual Problems by
Premenstrual ProblemsPremenstrual Problems
Premenstrual ProblemsMithun Patel
968 views50 slides
Depressionsuicide 120223170018-phpapp01 by
Depressionsuicide 120223170018-phpapp01Depressionsuicide 120223170018-phpapp01
Depressionsuicide 120223170018-phpapp01University of Miami
388 views36 slides
Premenstrual changes lugansk state-medical-university by
Premenstrual changes lugansk state-medical-universityPremenstrual changes lugansk state-medical-university
Premenstrual changes lugansk state-medical-universityLSMU-Lugansk State Medical university
969 views50 slides

More Related Content

Similar to Premenstrual Syndrome : Dr Sharda Jain

Premenstrual syndrome Prof. Aboubakr Elnashar by
Premenstrual syndrome Prof. Aboubakr ElnasharPremenstrual syndrome Prof. Aboubakr Elnashar
Premenstrual syndrome Prof. Aboubakr ElnasharAboubakr Elnashar
5.6K views44 slides
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-Maps by
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-MapsPremenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-Maps
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-MapsArwa M. Amin
126 views2 slides
Review article premenstrual syndrome different approaches of management by
Review article  premenstrual syndrome different approaches of managementReview article  premenstrual syndrome different approaches of management
Review article premenstrual syndrome different approaches of managementApollo James
689 views6 slides
Depression across women life cycle by
Depression across women life cycleDepression across women life cycle
Depression across women life cycleMagda Fahmy
298 views94 slides
Reproductive organs by
Reproductive organsReproductive organs
Reproductive organsshamim dharodia
389 views16 slides
Dysmenorrhoea by
DysmenorrhoeaDysmenorrhoea
DysmenorrhoeaHussein Ali Ramadhan
26K views37 slides

Similar to Premenstrual Syndrome : Dr Sharda Jain (20)

Premenstrual syndrome Prof. Aboubakr Elnashar by Aboubakr Elnashar
Premenstrual syndrome Prof. Aboubakr ElnasharPremenstrual syndrome Prof. Aboubakr Elnashar
Premenstrual syndrome Prof. Aboubakr Elnashar
Aboubakr Elnashar5.6K views
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-Maps by Arwa M. Amin
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-MapsPremenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-Maps
Premenstrual Syndrome and Premenstrual Dysphoric Disorder Mind-Maps
Arwa M. Amin126 views
Review article premenstrual syndrome different approaches of management by Apollo James
Review article  premenstrual syndrome different approaches of managementReview article  premenstrual syndrome different approaches of management
Review article premenstrual syndrome different approaches of management
Apollo James689 views
Depression across women life cycle by Magda Fahmy
Depression across women life cycleDepression across women life cycle
Depression across women life cycle
Magda Fahmy298 views
Premenstrual syndrome by kiranatmuri
Premenstrual syndromePremenstrual syndrome
Premenstrual syndrome
kiranatmuri543 views
Menstruation disorders and treatment by Areej Abu Hanieh
Menstruation disorders and treatmentMenstruation disorders and treatment
Menstruation disorders and treatment
Areej Abu Hanieh15.1K views
Clinical pharmacology of antidepressants by Domina Petric
Clinical pharmacology of antidepressantsClinical pharmacology of antidepressants
Clinical pharmacology of antidepressants
Domina Petric553 views
Menstrual cycle disorders, Menopause and Drugs in Pregnancy and Lactation by google
Menstrual cycle disorders, Menopause and Drugs in Pregnancy and LactationMenstrual cycle disorders, Menopause and Drugs in Pregnancy and Lactation
Menstrual cycle disorders, Menopause and Drugs in Pregnancy and Lactation
google806 views
MENSTRUAL CYCLE DISORDERS by google
MENSTRUAL CYCLE DISORDERSMENSTRUAL CYCLE DISORDERS
MENSTRUAL CYCLE DISORDERS
google725 views
Overview of Hormones and Epilepsy by EFEPA
Overview of Hormones and EpilepsyOverview of Hormones and Epilepsy
Overview of Hormones and Epilepsy
EFEPA23.9K views
المستند.docx by ShahadMu2
المستند.docxالمستند.docx
المستند.docx
ShahadMu27 views
Prememenustrual dysphoric disorder and post menopausal syndrome by Pavan kulkarni
Prememenustrual dysphoric disorder and post menopausal syndromePrememenustrual dysphoric disorder and post menopausal syndrome
Prememenustrual dysphoric disorder and post menopausal syndrome
Pavan kulkarni1.1K views
Pms management by Fiqah Amin
Pms managementPms management
Pms management
Fiqah Amin343 views
Premenstrual Syndrome (P.M.S.) by Sami Shawer
Premenstrual Syndrome (P.M.S.)Premenstrual Syndrome (P.M.S.)
Premenstrual Syndrome (P.M.S.)
Sami Shawer33.3K views

More from Lifecare Centre

CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ... by
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...Lifecare Centre
7 views22 slides
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel... by
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...Lifecare Centre
19 views34 slides
Addressing the challenge of lack of Sleep in INDIA by
Addressing the challenge of lack of Sleep in INDIA Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA Lifecare Centre
5 views23 slides
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J... by
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Lifecare Centre
60 views29 slides
Stress Urinary Incontinence (SUI) : Dr Sharda Jain by
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Lifecare Centre
8 views39 slides
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain by
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Lifecare Centre
3 views22 slides

More from Lifecare Centre(20)

CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ... by Lifecare Centre
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
Lifecare Centre7 views
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel... by Lifecare Centre
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
Lifecare Centre19 views
Addressing the challenge of lack of Sleep in INDIA by Lifecare Centre
Addressing the challenge of lack of Sleep in INDIA Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA
Lifecare Centre5 views
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J... by Lifecare Centre
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Lifecare Centre60 views
Stress Urinary Incontinence (SUI) : Dr Sharda Jain by Lifecare Centre
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Lifecare Centre8 views
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain by Lifecare Centre
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Lifecare Centre3 views
Thymosin Alpha 1 in Recurrent Implantation Failure : Dr Sharda Jain by Lifecare Centre
Thymosin Alpha 1 in Recurrent Implantation Failure : Dr Sharda Jain Thymosin Alpha 1 in Recurrent Implantation Failure : Dr Sharda Jain
Thymosin Alpha 1 in Recurrent Implantation Failure : Dr Sharda Jain
Lifecare Centre69 views
Urinary incontinence at Menopause : Dr Sharda Jain by Lifecare Centre
Urinary incontinence at Menopause : Dr Sharda JainUrinary incontinence at Menopause : Dr Sharda Jain
Urinary incontinence at Menopause : Dr Sharda Jain
Lifecare Centre4 views
22 Common Misconceptions and Misinformation about Menopause : Dr Sharda Jain by Lifecare Centre
22 Common Misconceptions and Misinformation about Menopause : Dr Sharda Jain 22 Common Misconceptions and Misinformation about Menopause : Dr Sharda Jain
22 Common Misconceptions and Misinformation about Menopause : Dr Sharda Jain
Lifecare Centre9 views
MENOPAUSE MISINFORMATION & MANAGEMENT 20 TIPS FOR SIMPLE WOMEN : Dr Sharda... by Lifecare Centre
MENOPAUSE MISINFORMATION & MANAGEMENT 20 TIPS FOR SIMPLE WOMEN : Dr Sharda...MENOPAUSE MISINFORMATION & MANAGEMENT 20 TIPS FOR SIMPLE WOMEN : Dr Sharda...
MENOPAUSE MISINFORMATION & MANAGEMENT 20 TIPS FOR SIMPLE WOMEN : Dr Sharda...
Lifecare Centre9 views
Nourish your cells with VIT E HARD FACTS : Dr Sharda Jain by Lifecare Centre
Nourish your cells with VIT E HARD FACTS : Dr Sharda Jain  Nourish your cells with VIT E HARD FACTS : Dr Sharda Jain
Nourish your cells with VIT E HARD FACTS : Dr Sharda Jain
Lifecare Centre11 views
CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts ... by Lifecare Centre
CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts ...CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts ...
CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts ...
Lifecare Centre18 views
COMMON MYTHS & MISCONCEPTIONS IN for PCOD आम PUBLIC के लिए : Dr Sharda Jain ... by Lifecare Centre
COMMON MYTHS & MISCONCEPTIONS IN for PCOD आम PUBLIC के लिए : Dr Sharda Jain  ...COMMON MYTHS & MISCONCEPTIONS IN for PCOD आम PUBLIC के लिए : Dr Sharda Jain  ...
COMMON MYTHS & MISCONCEPTIONS IN for PCOD आम PUBLIC के लिए : Dr Sharda Jain ...
Lifecare Centre80 views
“Integrated Approach: Utilizing Biomarkers, Non-Invasive Prenatal Screening (... by Lifecare Centre
“Integrated Approach: Utilizing Biomarkers, Non-Invasive Prenatal Screening (...“Integrated Approach: Utilizing Biomarkers, Non-Invasive Prenatal Screening (...
“Integrated Approach: Utilizing Biomarkers, Non-Invasive Prenatal Screening (...
Lifecare Centre20 views
Premarriage Counseling : Dr Sharda Jain & Dr Renu Chawla by Lifecare Centre
Premarriage Counseling : Dr Sharda Jain & Dr Renu Chawla Premarriage Counseling : Dr Sharda Jain & Dr Renu Chawla
Premarriage Counseling : Dr Sharda Jain & Dr Renu Chawla
Lifecare Centre53 views
TIPS TO YOUNSTERS ON TEACHERS DAY To Become Great Teacher : Dr. Sharda Jain by Lifecare Centre
TIPS TO YOUNSTERS ON TEACHERS DAY   To Become Great Teacher : Dr. Sharda Jain TIPS TO YOUNSTERS ON TEACHERS DAY   To Become Great Teacher : Dr. Sharda Jain
TIPS TO YOUNSTERS ON TEACHERS DAY To Become Great Teacher : Dr. Sharda Jain
Lifecare Centre13 views
Lets Talk Making India Iron Strong : Dr Sharda Jain by Lifecare Centre
Lets Talk Making India Iron Strong : Dr Sharda Jain Lets Talk Making India Iron Strong : Dr Sharda Jain
Lets Talk Making India Iron Strong : Dr Sharda Jain
Lifecare Centre155 views
Is our Diet responsible for PCOS & NCDs : Dr Sharda Jain by Lifecare Centre
Is our Diet responsible for PCOS & NCDs : Dr Sharda Jain Is our Diet responsible for PCOS & NCDs : Dr Sharda Jain
Is our Diet responsible for PCOS & NCDs : Dr Sharda Jain
Lifecare Centre11 views
What is importance of Fiber the diet : Dr Sharda Jain by Lifecare Centre
What is importance of Fiber the diet : Dr Sharda JainWhat is importance of Fiber the diet : Dr Sharda Jain
What is importance of Fiber the diet : Dr Sharda Jain
Lifecare Centre16 views

Recently uploaded

Extraordinary Far Infrared Technology - Raising Frequencies with far infrared... by
Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...
Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...corey268189
60 views87 slides
puravive ingredients.pdf by
puravive ingredients.pdfpuravive ingredients.pdf
puravive ingredients.pdfmargamharshitha062
11 views1 slide
Thrives Priority Areas: Behavioral Health by
Thrives Priority Areas: Behavioral HealthThrives Priority Areas: Behavioral Health
Thrives Priority Areas: Behavioral HealthCity of Chesapeake
100 views22 slides
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptx by
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptxINTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptx
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptxABG
121 views40 slides
vitamin c.pptx by
vitamin c.pptxvitamin c.pptx
vitamin c.pptxajithkilpart
21 views13 slides
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler) by
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler) Asthalin Inhaler (Generic Albuterol Sulfate Inhaler)
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler) The Swiss Pharmacy
16 views20 slides

Recently uploaded(20)

Extraordinary Far Infrared Technology - Raising Frequencies with far infrared... by corey268189
Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...
Extraordinary Far Infrared Technology - Raising Frequencies with far infrared...
corey26818960 views
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptx by ABG
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptxINTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptx
INTRODUCTION TO PHARMACEUTICAL VALIDATION SCOPE and MERITS OF VALIDATION.pptx
ABG121 views
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler) by The Swiss Pharmacy
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler) Asthalin Inhaler (Generic Albuterol Sulfate Inhaler)
Asthalin Inhaler (Generic Albuterol Sulfate Inhaler)
Calcutta Clinical Course - Allen College of Homoeopathy by Allen College
Calcutta Clinical Course - Allen College of HomoeopathyCalcutta Clinical Course - Allen College of Homoeopathy
Calcutta Clinical Course - Allen College of Homoeopathy
Allen College98 views
Examining Pleural Fluid.pptx by Fareeha Riaz
Examining Pleural Fluid.pptxExamining Pleural Fluid.pptx
Examining Pleural Fluid.pptx
Fareeha Riaz 25 views
Buccoadhesive drug delivery System.pptx by ABG
Buccoadhesive drug delivery System.pptxBuccoadhesive drug delivery System.pptx
Buccoadhesive drug delivery System.pptx
ABG169 views
Explore new Frontiers in Medicine with AI.pdf by Anne Marie
Explore new Frontiers in Medicine with AI.pdfExplore new Frontiers in Medicine with AI.pdf
Explore new Frontiers in Medicine with AI.pdf
Anne Marie20 views
CCDI Kibbe Wake Forest University Dec 2023.pptx by Warren Kibbe
CCDI Kibbe Wake Forest University Dec 2023.pptxCCDI Kibbe Wake Forest University Dec 2023.pptx
CCDI Kibbe Wake Forest University Dec 2023.pptx
Warren Kibbe20 views
Gastro-retentive drug delivery systems.pptx by ABG
Gastro-retentive drug delivery systems.pptxGastro-retentive drug delivery systems.pptx
Gastro-retentive drug delivery systems.pptx
ABG238 views

Premenstrual Syndrome : Dr Sharda Jain

  • 2. "Management of Premenstrual Tension (PMT)" PMT (Premenstrual Tension) or PMDD (Premenstrual Dysphoric Disorder) is common problem. Its impact on women's lives, family life in big way emphasizing the need for effective management.
  • 3. Premenstrual Syndrome- क्या है 1.Distressing psychological problem:- with over 200 physical, and/or behaviural symptoms. 2.Occurrence during the luteal phase of the menstrual cycle (or cyclically after hysterectomy with ovarian conservation). 3.Significant regression of symptoms with onset of or during the period.
  • 4. Prevalence of PMS In the general population  study at PGIMER Very common • Only 15% of women are asymptomatic, • 50% have mild PMS symptoms. • 30% moderate • 5-10% severe.
  • 5. Etiology 1. Cyclical ovarian activity the central component (ovarian 'trigger', such as ovulation, may initiate a cascade of events). 2. Central: increased responsiveness to a combination of steroids, chemical messengers 3. Psychological sensitivity
  • 6. Diagnosis • Most women self-diagnose it • History :- can suggest a diagnosis of PMS • Symptom record :- can establish its true nature. • Symptom charts :- PRACTICE Guidelines of Premenstrual Syndrome. • Moderate/severe PMS 1.disruption of work and interpersonal relationships 2.interference with normal activities.
  • 7. • Diagnostic criteria for premenstrual dysphoric disorder: equivalent to severe PMS,but need psychiatrist in the loop to manage severe form. • It is important to exclude organic disease and significant psychiatric illness. • Perimenopausal women may have increasing premenstrual symptoms as well as menopausal symptoms.
  • 8. Criteria for premenstrual dysphoric disorder At least 5 symptoms present for most of the late luteal phase with remission within a few days of onset of menses and absence of symptoms in the week post menses. At least: one symptom must be from the following first four. 1. Marked depressed mood, feeling of hopelessness, or Self deprecation . 2. Marked anxiety; tension (being 'on edge). 3. Marked affective lability(e.g. feeling suddenly sad or tearful). 4. Persistent and marked anger/irritability/increased conflicts.
  • 9. 5. Decreased interest in usual activities ( friends, hobbies). 6. Subjective sense of difficulty in concentrating. 7. Lethargy. Easy fatigability lack of energy. 8. Marked Change in appetite, overeating. or specific food cravings. 9. Hypersomnia or insomnia. 10. Subjective sense of being overwhelmed or out of control. 11. Other physical symptoms, such as breast tenderness or swelling, headaches; Joint or muscle pain, a sense of 'bloating';
  • 10. Diagnosis -PMS Clinical diagnosis of PMS requires that the symptoms are confirmed by prospective recording (that is recorded as they occur) for at least two menstrual cycles and that they cause substantial distress or impairment to daily life.
  • 11. Non-Hormonal Management Non-hormonal options are often considered as the first-line treatment for PMT. The following are non-hormonal approaches:  Lifestyle Modifications  Dietary Changes  Stress Reduction Techniques  Exercise
  • 12. Dietary Changes Dietary changes can help manage PMT:  Reducing salt and sugar intake & High fat diet  Increasing consumption of fibre , fruits, vegetables, and whole grains  Calcium - effective  Magnesium effective  and Vitamin D supplementation
  • 13. Stress Reduction Techniques Various stress reduction techniques: * Mindfulness and meditation * Yoga * Deep breathing exercises * Biofeedback
  • 14. Exercise Benefits of regular exercise are immence in managing PMT: moderate Exercise / Aerobic * Reduces mood swings * Enhances overall well-being * Improves sleep quality
  • 15. Hormonal Management Introduce hormonal options for PMT management. These treatments are considered when non- hormonal approaches are insufficient or not tolerated.
  • 16. Hormonal Options Following hormonal treatment options:  Progesterone  Oral Contraceptive Pills (OCPs)  GnRH Analogues  Selective Serotonin Reuptake Inhibitors (SSRIs)
  • 17. Progesterone Progesterone may be used to manage PMT. No potential benefits.
  • 18. Oral Contraceptive Pills (OCPs)  OCPs can help manage PMT.  Useful in some women regulate hormonal fluctuations.  Yasmin /YAZ are good with least side effects.  Continuos therapy is better  New pill are demand with withdral bleeding after 90 days
  • 19. OESTRGEN PATCHES + PROGESTERONE WELL ESTABLISHED & ACCEPTED
  • 20. GnRH Analogues Use of GnRH analogues in PMT management is seen in severe cases. They suppress ovulation and hormonal fluctuations. ADD BACK THERAPY USED FOR 6 MONTHS  ,BMD EVERY 2 YRS FOR BONE RESERVE
  • 21. Selective Serotonin Reuptake Inhibitors (SSRIs)  The use of SSRIs as an First line treatment option for PMT management.  Their mechanism of action in managing mood-related symptoms.
  • 22. Selective Serotonin Receptor Inhibitors (SSRI) First-line treatment of PMS with predominantly emotional symptom SSRIs were found to be effective for reducing the overall symptoms of PMS and also for reducing specific types of symptoms (psychological, physical and functional symptoms, and irritability)
  • 23. Agent Dosing Paroxetine (CR) Starting dose: 12.5 mg/day Up to 25 mg/day Continuous or intermittent Fluoxetine (Sarafem) Starting dose: 20 mg/day 0 Up to 60 mg/day Continuous or intermittent Sertraline Starting dose: 50 mg/day Up to 150 mg/day continuous 0 50 mg/day to 100 mg/day intermittent FDA-Approved SSRIs
  • 24. Luteal Phase and Symptom Onset Dosing Luteal Phase Dosing • Start SSRI at day 14 of a 28-day • cycle Take SSRI during last 2 weeks of cycle only • Stop when menses begin Symptom Onset Dosing • Dose when symptoms begin and as long as they last • Cycles must be regular Continuous Dosing • Take SSRI during whole month • One meta-analysis showed slightly better response
  • 25. DANAZOLE DEFINITE BENEFIT MASCULINISING SIDE EFFECTS + SO USED IN LUTEAL PHASE ONLY
  • 26. Combination Therapies  Please note a combination of hormonal and non- hormonal approaches may be used for severe PMT cases.  Experts have their rationale and benefits.
  • 27. SURGERY BSO HYSTERCTOMY + BSO VERY rare SEVERE CASE GnRH a test is test of cure
  • 28. Alternative Tt Homeopathy -90% MIND BODY THERAPY AROMA THERAPY REFLEXOLOGY
  • 29. Prognosis -PMS Symptoms of PMS can mostly recur after stopping the treatment, except after oophorectomy and menopause
  • 30. Complications- PMS • Untreated PMS are likely to affect sexual life, thereby leading to a higher level of sexual distress, which can, in turn, lead to relationship problems and more psychological issues. • There is also evidence that relates the PMS to increased suicidal risk in hormone-sensitive females
  • 31. Monitoring and Follow-Up Emphasize the importance of monitoring and follow- up appointments to assess treatment effectiveness and adjust as needed. Patient & family must be counselled
  • 32. Conclusion The management of PMT  ALL GYNAECOLOGIST MUST KNOW. PMS is underestimated -80% suffer frm it. Symtoms Diary tobe used for 2 months minimum to plan Tt We Encourage personalized treatment plans. Lifestyle changes ,diet ,exercise & complimentary therapy to be planned & offered simultaneously with Medical Treatment COCP & SSRI ARE MAIN STAY OF TREAMENT GnRH a & SUGICAL Tt is last resort for very severe cases .