Pre-menstrual syndrome (PMS) Flashcards
What is pre-menstrual syndrome (PMS)?
Any of a complex of symptoms experienced by some women in the days immediately before menstruation.
What % of women get pre-menstrual symptoms?
95%
To be classed as PMS, the symptoms must impact daily living. True/false?
True
What is the pathophysiology behind PMS and oestrogen/progesterone concentrations?
Not clearly understood
Sensitivity to progesterone - serum concentrations of oestrogen and progesterone are the same in those with and without PMS.
What is the relationships between PMS and SSRI medication?
Serotonin receptors are responsive to oestrogen and progesterone as a result of this SSRI’s are proven to reduce PMS symptoms.
When do symptoms usually present for PMS?
Symptoms must be present in luteal phase (around a week or so before menstruation).
Decreased during menstruation and then followed up by a symptom-free week.
Physical symptoms of PMS?
- Breast tenderness
- Bloating
- Headache
- Weight gain
- Swelling
- Fatigue
Psychological symptoms of PMS?
- Mood swings
- Anger
- Depression
- Tension
- Lack of interest
- Loneliness
- Suicidal ideation
Behavioural symptoms of PMS?
- Sleep disturbance
- Change in appetite
- Restlessness
- Confusion
- Social withdrawal
- Poor concentration
Investigations for PMS?
- Record symptoms prospectively, over 2 cycles using a symptom diary.
- Symptom diary should be completed by patient prior to starting treatment.
- Can use GnRH analogues if diagnosis from diary is inconclusive.
First line management of PMS?
Exercise
CBT (cognitive behavioural therapy)
Luteal phase (days 15-28) can use low dose SSRI’s i.e. citalopram/escitalopram 10mg
Second line management of PMS?
Increase SSRI dosage - e.g. citalopram/escitalopram 20-40mg
Oestradiol patches 100 mg
Third line management of PMS?
GnRH analogues + HRT
Fourth line management of PMS?
Surgery +/- HRT
