Premenstrual syndrome Flashcards
What is PMS
psychological, emotional and physical symptoms that occur during the luteal phase menstrual cycle esp just before mesntruation
When is PMS not present
Before menarche
During pregnancy
After menopause
What is PMS caused by
Fluctuation in oestrogen and progesterone - perhaps increased sensitivity to progesterone or an interaction between sex hormones and NTs serotonin and GABA
Presentation of PMS
Low mood
Anxiety
Mood swings
Irritability
Bloating
Fatigue
Headaches
Breast pain
Reduced confidence
Cognitive impairemnet
Clumsiness
Reduced libido
What situations can PMS continue in
Ovaries continue to function and hormonal cycle continues -
Absence of menstruation after hysterectomy
Endometrial ablation
Mirena coil
Response to COCP, cyclical HRT containing progesterone
WHat is progesterone induced PMD
Response to COCP, cyclical HRT containing progesterone
When is PMS classed as PMDD
Features are severe and have significant effect on quality of life
How is a diagnosis PMDD made
Symptom diary spanning two menstrual cycles
Cyclical symptoms just before or resolve after menstruation
Definitiev - GnRH analogues to halt menstrual cycle and induce early menopause and see if sympotms resolve
Management for PMS
General healhty lifestyle changes - diet, exercise, alcohol, smoking, stress and sleep
COCP
SSRI antidepressants
CBT
What COCP is first line for PMS
Drospirenone eg yasmin - antimineralcorticoid effects similar to spirinalactone
Continious use of pill more effective
Treatment for severe cases
Continious transdermal oestrogen
GnRH analogues
Hysterectomy and bilateral oopherectomy
Danazole and tamoxifen
Spironolactone
What is required when being treated with continuous transdermal oestrogen
Progesterons for endometrial protection against endometrial hyperplasia eg
Cyclical pregoesterons - norethisterone (trigger withdrawal bleed)
Mirena coil
WHy are GnRH reserved for msost severe PMS cases
Adverse effects eg osteoporosis
HRT added back to mitigate
When is HRT absolutely necessary after hysterectomy and bilateral oopherectomy
Women under 45 years
What is option for cyclical breast pain
Danazole and tamoxifen
