Menstruation

Question 1

What is pms?

Answer 1

-pre-menstrual syndrome

Question 2

What must PMS be differentiated from?

Answer 2

• physiological menstrual symptoms

Question 3

Symptoms of PMS?

Answer 3

• Depression
• Anxiety
• mood swings
• bloating
• food cravings

Question 4

When is PMS present?

Answer 4

• days immediately before menstruation

- luteal phase

Question 5

Other variants of menstrual symptoms that don’t meet PMS criteria?

Answer 5

• premenstrual exacerbation of underlying disorder
• non-ovulatory PMD
• Progesterone induced PMD
• PMD with absent menstruation
• pre-menstrual dysphoric disorder

Question 6

Diagnosis of PMS?

Answer 6

• Diary symptom tracker over 2 cycles

- GnRH analogus

Question 7

Causes of PMS?

Answer 7

• Sensitivity to progesterone
• serotonin receptors
• less allopregnalone

Question 8

1st line treatment of pMS?

Answer 8

• Exercise, CBT, Vitamin b6
• New generation COCP
• Low dose ssri

Question 9

2nd line treatment of PMS?

Answer 9

• High dose SSRI

- Estrogen + progesterone patch

Question 10

Why is low dose progesterone given in treatment of PMS with hormonal therapy?

Answer 10

• complete opposition of progesterone, can cause endometrial dysplasia -> cancer
• lowest possible dose progesterone given as protection

Question 11

3rd line treatment of PMS?

Answer 11

• GnRH analogue

Question 12

4TH Line treatment of PMS?

Answer 12

• Surgical management + hRT

Question 13

Name a GnRH inhibitor? and what must be co-prescribed

Answer 13

• danazol

- suitable contraception as can cause virilising

Question 14

GnRH analogues may cause?

Answer 14

• reduced bone mass
• should be used in unclear diagnosis of PMS
• Long term use not usually advised, but if so, HRT co-prescrbied

Question 15

Surgical management of PMS?

Answer 15

• When medical management failed
• trial of GnRH analogue before had
• hysterectomy + BSO