PMS Flashcards
(41 cards)
Evidence re PMS and vitamin B6?
Sudies for vitamin B6 efficacy in PMS are contradictory.
Advise dose restriction to 10mg
Risk of high dose of vitamin B6?
Peripheral neuropathy
restrict dose to 10mg OD
What is Core premenstrual disorder (PMD)
(premenstrual syndrome, PMS
or premenstrual dysphoric
disorder)
Core PMD also known as premenstrual syndrome, PMS
or premenstrual dysphoric disorder)
Cyclical pre-menstrual symptoms present during the luteal phase
Abate as menstruation begins
Followed by a symptom-free week
Affects quality of life
what is Premenstrual exacerbation?
The pre-menstrual exacerbation of an underlying disorder.
Symptoms cyclical and relieved by menstruation
But NO symptom-free week
Affects quality of life
Regular menstruation
Existing non-menstrual condition
what is Non-ovulatory PMD?
PMS symptoms occur in presence of ovarian activity without ovulation.
Mechanism not fully understood
Progestogen induced PMDs
Cyclical pre-menstrual symptoms
Symptom-free week
Affects quality of life
Associated with exogenous progestogen treatment
what is PMDs with absent menstruation
Functioning ovarian cycle No menstruation - Reasons such as hysterectomy, endometrial ablation or LNG-IUS cyclical symptoms Symptom-free week Affects QOL
what are symptoms of PMS?
Combination of psychological and physical symptoms. Impact on daily activity during the luteal phase Fatigue Headaches Anxiety Low mood Irritability Mood swings Bloating Mastalgia Altered appetite Altered libido
Prevalence of PMS?
Prevalence PMS 24-40%.
How is PMS diagnosed?
Diagnosis is confirmed using a symptom diary
The symptom diary should not be done retrospectively
Daily Record of Severity of Problems (DRSP) is the preferred tool.
GnRH analogues may be used for three months to establish diagnosis if symptom diary inconclusive.
First line treatments for PMS
First line treatments for PMS are
- Exercise
- Cognitive behavioural therapy (CBT)
- Vitamin B6
- Combined new generation pill (cyclically or continuous)
- Continuous or luteal phase (day 15-28) low dose SSRI e.g. citalopram 10 mg
Second line treatment for PMS
Second line treatment for PMS
- Estradiol patches (100 micrograms) WITH micronised progesterone (100-200 mg on day 17-28 orally or vaginally) ORLNG-IUS 52 mg
- Higher dose SSRI continuously or luteal phase e.g. citalopram 20-40 mg
Third line treatment for PMS
Third line treatment for PMS
- GnRH analogues AND add-back HRT (continuous combined oestrogen + progesterone)
- Tibolone
Fourth line treatment for PMS
Surgical treatment ± HRT
When should women with PMS be referred to a gynaecologist?
Referral to a gynaecologist should be considered when simple measures have failed
(e.g. combined oral contraceptives, vitamin B6, selective serotonin reuptake inhibitors, exercise)
And when the severity of the PMS justifies gynaecological intervention.
What is the role for CBT in PMS management
CBT should be considered routinely as one of the first line treatment options
Which COC has the best evidence for managing PMS, including regimens delivering ethinylestradiol?
drospirenone-containing COCs
should be considered as a first-line intervention
What is the optimum COC pill regimen
e.g. continuous, cyclical or flexible?
When treating women with PMS, emerging data suggest use of the contraceptive pill continuously rather than cyclically
How efficacious is percutaneous estradiol for treating PMS?
Percutaneous estradiol combined with cyclical progestogens has been shown to be effective for
the management of physical and psychological symptoms of severe PMS.
A barrier or intrauterine method of contraception
should be used alongside
What is the safety of using estradiol for PMS on the premenopausal endometrium and breast tissue?
When treating women with PMS using estradiol, women should be informed that there is insufficient data to advise on the long-term effects on breast and endometrial tissue.
What is the evidence for efficacy and adverse effects of danazol in the treatment of PMS?
Danazol low dose - 200mg BD - is effective in the luteal phase for breast symptoms
Potential SE = irreversible virilising effects.
Advise to use contraception due to its potential virilising effects on female fetuses
what is danazol?
Synthetic androgen
Danazol inhibits pituitary gonadotrophins;
combines androgenic activity with antioestrogenic and antiprogestogenic activity
How effective are GnRH analogues for treating severe PMS?
GnRH analogues are highly effective in treating severe PMS.
When treating women with PMS, GnRH analogues should be reserved for women with
severe symptoms.
Not recommended routinely unless they are being used to aid diagnosis or treat severe cases.
when is add-back HRT advised for Women using GnRH analogues for severe PMS?
Severe PMS treated with GnRH analogues for more than 6 months should have addback hormone therapy s
Continuous combined hormone replacement
therapy (HRT)
or tibolone
