2. Ms. S.R. is a 31-year-old unmarried woman
presented with chronic history . Her symptoms
always appear in the seven days before her menses,
then resolve completely at onset of bleeding.
Most of her symptoms are emotional, consisting of
mood swings
Physical symptoms include hot flashes (worse at
night), breast tenderness, and cyclic weight gain.
Menses occur monthly, but they are lighter than
previously and sometimes last nine days, with
variable spotting. She continues her work as a
photographer despite her symptoms, but says
sometimes she would like to stay home just to
decrease her level of stress.
3. How severe are your symptoms?
On what days during your menstrual cycle are your
symptoms at their worst?
Do you have symptom-free days during your menstrual
cycle?
Can you anticipate when your symptoms are coming on?
Does anything seem to make your symptoms better or
worse?
Do your symptoms interfere with your daily activities?
Have you recently felt down, depressed or hopeless?
Have you or has anyone in your family been diagnosed
with a psychiatric disorder?
What treatments have you tried so far? How have they
worked?
5. Premenstrual disorders affect up to 12% of women.
About 80% of women report at least one physical or
psychiatric symptom during the luteal phase of their
menstrual cycle.
Symptoms can occur anytime between menarche and
menopause.
Premenstrual dysphoric disorder (PMDD) as a severe
form of PMS in which symptoms of anger, irritability,
and internal tension are prominent.
PMDD prevalence is 1.3% to 5.3%.
6. There is a poor understanding of the etiology of
premenstrual disorders.
Several studies suggest that cyclical changes in
estrogen and progesterone levels trigger the
symptoms.
7. PMS defined (ACOG) as at least one symptom associated
with "economic or social dysfunction" that occurs during
the five days before the onset of menses and is present
in at least three consecutive menstrual cycles.
Symptoms may be affective (eg, angry outbursts,
depression) or physical (eg, breast pain and bloating).
These symptoms must be cyclical, beginning after
ovulation and resolving shortly after the onset of
menstruation.
To meet the diagnostic criteria for PMDD, a patient
must have at least five symptoms in the week before
menses, and these symptoms must improve within a
few days after the onset of menses.
8.
9.
10.
11. Prospective questionnaires are the most
accurate way to diagnose PMS and PMDD.
The Daily Record of Severity of Problems
(DRSP) is a valid and reliable tool that can be
used to diagnose PMS or PMDD
12.
13. Focuses on relieving physical and psychiatric
symptoms and improve functional impairment.
14.
15. MILD SYMPTOMS:
For women with mild premenstrual symptoms
that do not cause distress or socioeconomic
dysfunction >>>lifestyle measures such as
regular exercise and stress reduction
techniques are helpful.
16. Exercise and relaxation techniques:
Although not demonstrated in rigorous
controlled studies, there is suggestive
evidence that exercise and relaxation may
help to alleviate premenstrual syndrome
symptoms.
17. Cognitive Behavior Therapy
A 2009 meta-analysis analyzed seven trials
showed significant improvement in
functioning.
Best result with at least 8 sessions.
18. first-line treatment.
fluoxetine (Prozac): 20 mg daily.
Sertraline (Zoloft): 50 to 150 mg daily.
paroxetine (Paxil): 20 to 30 mg .
citalopram (Celexa): 20 to 30 mg daily
escitalopram (Lexapro): 10 to 20 mg daily
Bupropion (Wellbutrin) was not effective for symptom relief of
PMS or PMDD.
used to treat the psychiatric symptoms of PMS and PMDD and
have been shown to relieve some of the physical symptoms.
19. Regimens:
Continuous.
Luteal phase therapy: started on cycle day 14
& discontinued at the onset of menses.
Symptom-onset therapy: Intermittent therapy
beginning at the point of symptom onset
until the first few days of menses.
Effective for premenstrual symptoms whether
taken continuously or in the luteal phase
only.
20. Adverse effects include nausea, asthenia, fatigue, and
sexual dysfunction
Duration of therapy :
The optimal duration of therapy is unknown. Usually
recommend to continue therapy for one year and
then discuss either a taper and discontinuation of
medication or a trial of intermittent therapy.
Recurrence of symptoms is an indication that
treatment should be resumed.
Women with recurrent symptoms typically need
treatment until they become pregnant or complete
the menopausal transition.
24. American College of Obstetricians and Gynecologists. Guidelines for
Women’s Health Care: A Resource Manual. 4th ed. Washington, DC:
American College of Obstetricians and Gynecologists; 2014:607-
613.
Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives
containing drospirenone for premenstrual syndrome. Cochrane
Database Syst Rev. 2012;(2):CD006586.
American Psychiatric Association. Diagnostic and Statistical Manual
of Mental Disorders. 5th ed. Washington, DC: American Psychiatric
Association; 2013
Editor's Notes
cyclical changes in estrogen and progesterone levels trigger the symptoms.7-
