Pre-menstrual Syndrome

Question 1

Define Pre-menstrual Syndrome.

Answer 1

Distressing symptoms occurring in the luteal phase of the menstrual cycle (in the absence of disease)

• Affects 90% of women

Question 2

What is the cause of pre-menstrual syndrome?

Answer 2

• Unknown cause
  
  • Likely due to cyclical effect of oestradiol and progesterone on NTs (serotonin and GABA)

Question 3

What are the signs and symptoms of pre-menstrual syndrome?

Answer 3

• Mood swings
• Anxiety
• Headache
• Poor concentration
• Lack of energy
• Changes in appetite
• Disturbed sleep
• Bloating
• Breast tenderness

Question 4

What are the appropriate investigations for suspected pre-menstrual syndrome?

Answer 4

Symptoms diary over at least 2 cycles

Question 5

What is the management of pre-menstrual syndrome?

Answer 5

• All PMS = conservative lifestyle measures, painkillers
  
  • Regular meals
  • Exercise
  • Stress reduction/Sleep
  • Smoking cessation and Alcohol restriction
  • Simple analgesia
• Moderate = COCP ± CBT + above
  
  • COCP – cyclical or continuous
• Severe (Premenstrual Dysphoric Disorder) = SSRI ± CBT + above
  
  • SSRI - continuous or just during the luteal phase