Premenstrual syndrome


Published on

1 Comment
  • 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.
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

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