PMS

Question 1

What is PMS

Answer 1

PMS encompasses:
1. depression
2. anxiety
3. irritability
4. loss of confidence
5. mood swings
6. bloatednes
7. mastalgia
in the luteal phase of the cycle.

Question 2

How will you differentiate PMS from physiological menstrual symptoms ?

Answer 2

Based on the timing that is in the luteal phase of menstrual cycle and severe enough to affect daily functioning or interfere with work, school performance or interpersonal relationships

Question 3

Classification of PMS

Answer 3

Mild PMS

Core PMD / PMDD

Variants :

PMD with absent menstruation
Non ovulatory PMD
Premenstrual exacerbation of underlying disorder
Progestogen induced PMD

Question 4

SBA

percentage of women that have improved symptoms of PMS after taking GnRH

Answer 4

60-75%

Question 5

First line TTT of PMS

Answer 5

1. Exercise, CBT , vit b6
2. COC (new generations)
3. Low dose SSRI (citalopram 10mg)

Question 6

3rd line ttt of PMS

Answer 6

GNRH Analoues + addback therapy (E2+P) or tibolone

Question 6

Fourth line TTT of PMS

Answer 6

Surgical +- HRT

Question 7

When to do DEXA SCAN in PMS

Answer 7

When using GnRH, every year

Question 8

2nd line ttt of PMS

Answer 8

• E2 patches 100ug + micronized Progesterone 100 or 200 mg or LNG-IUD
• High dose SSRI (citalopram 20-40mg)

Question 9

PMS diagnosis

Answer 9

Daily record of severity of problems DRSP for 2 weeks (confirm luteal phase symptoms)

Question 10

If DRSP isnt inclusive for a definitive diagnosis of PMS what yo use

Answer 10

GNRH analogues for 3 months

Question 11

When woman can used danazol for PMS

Answer 11

Ttt of breast symptoms, accompanied with COC as it causes irreversible virilising symptoms

Question 12

What is recommended progesterone in COC used to treat PMS

Answer 12

Drospirenon