PMS is a psychoneuroendocrine disorder that causes a variety of physical and behavioral symptoms in the week before a woman's period begins, due to alterations in estrogen and progesterone levels. Common symptoms include mood swings, breast tenderness, bloating, headaches, and fatigue. While the exact cause is unknown, potential contributing factors include neurotransmitter levels, psychological factors, and hormones. Treatment focuses on lifestyle changes like diet, exercise and stress reduction, as well as hormonal birth control, antidepressants, vitamins, and herbal supplements to manage symptoms.

1. PREMENSTRUAL
SYNDROME
PRESENTED BY ANUSUYAMMA. V
PHD NURSING SCHOLAR

2. PMS
•Pms is a psychoneuroendocrine disorder of
unknown etiology. Often noticed just prior to
menstruation. There is cyclic appearance of a
large number of symptoms during the last 7-
10 days of the menstrual cycle

3. PATHOPHYSIOLOGY OF PMS
• A] alteration in the level of estrogen and progesterone starting from the
midluteal phase either is altered estrogen progesterone level
• B] neuroendocrine factors ;
serotonin:-is an important neurotransmitter in the cns during the luteal
phase, decreased synthesis of serotonin is observed in women suffering from pms
endorphins:- the symptoms complex of pms is thought to be due to the
withdrawal of endorphins[neurotransmitters]from cns during the luteal phase

4. PATHOPHYSIOLOGY
CONTINUED
• C]psychological and psychosocial factor may be involved to produce behavioral
change
• D]others:-[TRH]thyrotropin releasing hormone ,prolectine,renin,aldosterone
prostaglandins and others unfortunately
nothing is conclusive.

5. CLINICAL FEATURES OF PMS
• Pms is more common in women aged 30-45 it may be related to childbirth or a
disturbing life event.
Symptomatology of pms and pmdd [premenstruate dysphoric disorder]
A]related water retention:-1] abdominal bloating
2]breast tenderness
3]swelling of the extremities
4]weight gain

6. CLINICAL FEATURE OF PMS
CONTINUE
B] Neuropsychiatric symptoms:-1]irritability 2]tearfulness
3]depression
4]mood swings 5]anxiety 6]forgetfullness
7] restlessness 8]increased appetite
9] tension 10]confusion
11]headache
12]anger

7. CLINICAL FEATURES OF PMS
CONTINUE
C]behavioural symptoms:-1]fatigue
2]dyspareunia
3]tiredness
4]insomnia
There is no abnormal pelvic findings expecting features of pelvic congestion

8. DIAGNOSIS OF PMS
• 1]most women self-diagnose
• 2]history –can establish its true nature
moderate/ severe pms
1]disruptions of work and interpersonal relationships
2]interference with normal activities

9. CLINICAL FEATURES
CONTINUED
C]behavioral symptoms:-1]fatigue
2]dyspareunia
3]tiredness
4]insomnia
There are no abnormal pelvic findings expecting features of pelvic congestion

10. TREATMENT OR MANAGEMENT OF PMS
• 1]dietary alteration:-a]less fat, sugar, salt, caffeine, and alcohol
b]frequent starchy meals
c]more fibre, fruit, and vegetables
d]4 hourly small snakes
2]dietary supplements:-a]vitamin b6-possible benefit
b]vitamin E
c]calcium{1200-1600mg}
d]magnesium
3]exercise:-moderate regular aerobic exercise promoting
cardiovascular work benificial

11. TREATMENT
CONTINUE
4]stress reduction:-relaxation techniques, yoga, meditation, breathing
technique, encouragement of healthier lifestyle
5]cognitive behavioral therapy:-long term benefit
Non –hormonal:-
a]tranquilizers or antidepressant drug may be of help
logically
B]pyridoxine-100mg twice daily is helpful by correction tryptophan metabolise
specially following ‘pill’ associated depression

12. TREATMENT OF PMS
CONTINUE
c]diuretics in the second half of the cycle frusemide 20mg daily for
consecutive 5days a week reduces fluid retention
d]anxiolytic agents:-alprazolam 0.25mg bid
e]selective serotonin reuptake inhibiters [SSRI]
f]fluoxetine –is an antidepressant that inhibits neuronal uptake of serotonin
sertraline 150mg /day venlafaxine
hormonal
a] oral contraceptive pills:-suppress ovulation and to maintain hormonal milieu

13. TREATMENT
CONTINUE
b]progesterone:-suppress ovarian cycle like progesterone
c]spironolactone:-it is a potassium sparing diuretic.it has anti-mineralocorticoid and anti-
androgenic effect
d]bromocriptine:-2.5mg daily it relieve the breast complication
e]suppression of ovarian cycle –hormones danazol 200mg daily
f] GNRH-analogues –Guerlain 3.6mg
surgery
oophorectomy

14. COMPLEMENTARY AND ALTERNATIVE THERAPIES
• 1]acupuncture :-for dysmenorrhea
• 2]phytoestrogens:-possible benefit of pms
• 3]herbal remedies:-vitex agnus cestus[20mgod]
• 4]homeopathy
• 5]mind-body-aromatherapy
reference
1]Dutta's textbook of gynecology
2]Annamma Jacob midwifery book
3]google of pdf etc.

15. Thank you