1
Q
Define PMS
A
Premenstrual Syndrome
Physiological and emotional disturbances which generally occur 1-2 wks preceding menses until a few days after onset of menses. Common symptoms include depression, irritability, tearfulness and mood swings.
synonyms: “ovarian cycle syndrome;’ “menstrual molimina” (moodiness)
2
Q
Aetiology of PMS
A
serotonergic dysregulation - currently most plausible theory
3
Q
Diagnostic Criteria of PMS
A
- 1+ of affective and somatic symptoms in the 5 d before menses for the last menstrual cycles
- symptoms relieved within 4 days of menses start
- not from any substance/medication
- dysfunction in social or economic performance
4
Q
Affective PMS Symptoms
A
- depression,
- angry outbursts,
- irritability,
- anxiety,
- confusion,
- social withdrawal
5
Q
Somatic PMS Symptoms
A
- breast tenderness,
- abdominal bloating,
- headache,
- swelling of extremities
6
Q
PMS Management
A
Symptom relief
- psychological support
- diet/supplements
- medications
- mind/body approaches
- herbal remedies (variable evidence)
7
Q
PMS Diet/Supplements
A
- avoid sodium, simple sugars, caffeine and alcohol
- calcium (1200-1600 mg/d)
- vitamin E (400 IU/d)
8
Q
PMS Medications
A
- NSAIDs for discomfort, pain
- SSRI antidepressants:
- used during luteal phase x 14 d or continuously
- Fluoxetine or sertraline
- OCP
- primarily beneficial for physical/somatic symptoms
- Yaz (ethinyloestradiol & drospirenone)
- SSRI antidepressants:
9
Q
Mind/body approaches for PMS
A
- regular aerobic exercise
- cognitive behavioural therapy
- relaxation
10
Q
Herbal remedies for PMS
A
- St. John’s wort
- kava
- evening primrose oil
- black cohosh
- ginkgo
11
Q
Define premenstrual dysphoric disorder
A
- Official diagnosis in the DSM-V
- Described as a more severe form of PMS with specific diagnostic criteria with at least five symptoms present
Management
- SSRis (first line)
- Yaz~ COCP (highly effective)
- ethinyloestradiol & drospirenone
4C - Womens
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