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Premenstrual Syndrome Dr J Romain
Definition The occurrence of cyclical somatic, psychological and emotional symptoms that occur in the luteal, (premenstrual) phase of the menstrual cycle and resolve by the time menstruation ceases. (although in secondary PMS the symptoms do not totally disappear)
Prevalence Occurs in almost all women of reproductive age Particularly affects women in the third decade of life 5% of women experience severe symptoms and may seek help
Aetiology Essentially unknown May represent an exaggerated response to the physiological levels of ovarian hormones through the cycle Low serotonin levels may also play a role Commonly precipitated by stress and tension
Symptoms Mood- irritability, tearfulness, depression, hostility Cognitive function- poor concentration, forgetfulness and confusion Somatic manifestations- bloating, mastalgia, headaches, appetite and sleep disturbance Behavioural change- social withdrawl, inability to cope
 
Symptoms Often helpful to use a ‘premenstrual symptom questionnaire’ to assess severity of symptoms  Based on a scoring system of 0-3 for each symptom depending on severity Quality of life questionnaires assess degree to which woman’s life is disrupted
Diagnosis Good history and symptom charting Cycle charts- clearly differentiate cyclical symptoms from those with continuous symptoms i.e. endogenous depression, hypothyroidism, anaemia In ambiguous cases a therapeutic 3-month trial of GNRH analogue is used which suppress’s ovulation. If remains symptomatic-not PMS
 
Management List of therapies extensive as unknown aetiology Start with basic approaches - explore situations which may cause undue stress and tension, counselling useful - exercise may reduce stress due to enhancing endorphins - caffeine withdrawl, encourage vitamins and minerals - circadian modification involves sleep deprivation for 1 night in luteal phase- influence melatonin secretion
Management Oil of evening primrose, vitamin B6, calcium, magnesium, zinc supplements Hormonal medication- ovulation suppression OCP or depot  Danazol, not commonly used Oestrogen implant or high-dose patch GnRH analogue
Management Non hormonal medication - diuretics if true water retention - SSRI’s beneficial (fluoxetine) - NSAID’s to relieve pain In extreme cases bilateral oophorectomy. Proven benefit from ovarian suppression must be confirmed first
Assessment of any form of therapy is particularly difficult because of a 70-80% placebo response
Thankyou

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Premenstrual syndrome

  • 2. Definition The occurrence of cyclical somatic, psychological and emotional symptoms that occur in the luteal, (premenstrual) phase of the menstrual cycle and resolve by the time menstruation ceases. (although in secondary PMS the symptoms do not totally disappear)
  • 3. Prevalence Occurs in almost all women of reproductive age Particularly affects women in the third decade of life 5% of women experience severe symptoms and may seek help
  • 4. Aetiology Essentially unknown May represent an exaggerated response to the physiological levels of ovarian hormones through the cycle Low serotonin levels may also play a role Commonly precipitated by stress and tension
  • 5. Symptoms Mood- irritability, tearfulness, depression, hostility Cognitive function- poor concentration, forgetfulness and confusion Somatic manifestations- bloating, mastalgia, headaches, appetite and sleep disturbance Behavioural change- social withdrawl, inability to cope
  • 6.  
  • 7. Symptoms Often helpful to use a ‘premenstrual symptom questionnaire’ to assess severity of symptoms Based on a scoring system of 0-3 for each symptom depending on severity Quality of life questionnaires assess degree to which woman’s life is disrupted
  • 8. Diagnosis Good history and symptom charting Cycle charts- clearly differentiate cyclical symptoms from those with continuous symptoms i.e. endogenous depression, hypothyroidism, anaemia In ambiguous cases a therapeutic 3-month trial of GNRH analogue is used which suppress’s ovulation. If remains symptomatic-not PMS
  • 9.  
  • 10. Management List of therapies extensive as unknown aetiology Start with basic approaches - explore situations which may cause undue stress and tension, counselling useful - exercise may reduce stress due to enhancing endorphins - caffeine withdrawl, encourage vitamins and minerals - circadian modification involves sleep deprivation for 1 night in luteal phase- influence melatonin secretion
  • 11. Management Oil of evening primrose, vitamin B6, calcium, magnesium, zinc supplements Hormonal medication- ovulation suppression OCP or depot Danazol, not commonly used Oestrogen implant or high-dose patch GnRH analogue
  • 12. Management Non hormonal medication - diuretics if true water retention - SSRI’s beneficial (fluoxetine) - NSAID’s to relieve pain In extreme cases bilateral oophorectomy. Proven benefit from ovarian suppression must be confirmed first
  • 13. Assessment of any form of therapy is particularly difficult because of a 70-80% placebo response