Premenstrual syndrome

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  • We have a great resource to help understand your PMS symptoms: a free PMDD quiz and PMS symptom assessment. Plus, a website full of education and empowerment for women struggling with premenstrual symptoms. https://www.pmscomfort.com/assessments/pms-symptoms.aspx
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Premenstrual syndrome

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

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