Cause to Care about Premenstral Syndrome,Premenstral Tension

1. PREMENSTRUAL SYNDROME
Ozgul Muneyyirci-Delale

2. Premenstrual Syndrome
Premenstrual Syndrome (PMS) is defined as “the
cyclic recurrence in the luteal phase of the
menstrual cycle of a combination of distressing
physical, psychological, and/or behavioral
changes of sufficient severity to result in
deterioration of interpersonal relationships and/or
interference with normal activities. Nearly 200
symptoms have been associated with this
definition and it is the clustering of these signs
and symptoms that is the hallmark of PMS.

3. Catamenial
The term “catamenial” is derived from the Greek
and signifies around menses. In general an
instance where a single recognized medical
condition presented in the premenstruum was
referred to as a catamenial disorder while a
cluster of symptoms was referred to as PMS.

4. Premenstrual Magnification
Many patients with psychiatric disorders also
complain of worsening of their symptoms around
the premenstrual phase, called “premenstrual
magnification” (PMM).

5. PMS
Milder symptoms are believed to occur in about 30%
to 80% of reproductive-age women, while severe
symptoms are estimated to occur in 3% to 5% of
menstruating women.

6. Concordance Rate
The concordance rate (if both twins have PMS) was
found to be significantly higher in monozygous
twins (93%) than dizygous twins (44%) and in
non-twin control women (31%).

8. Common Symptoms of PMS
Women with PMS
Symptom Showing Symptoms
(%)
Behavioral
Fatigue 92
Irritability 91
Labile mood with alternating
sadness and anger 81
Depression 80
Oversensitivity 69
Crying spells 65
Social withdrawal 65
Forgetfulness 56
Difficulty concentrating 47

9. Common Symptoms of PMS
(Continued)
Physical
Abdominal bloating 90
Breast tenderness 85
Acne 71
Appetite changes and
food cravings 70
Swelling of the extremities 67
Headache 60
Gastrointestinal upset 48

10. Differences Between PMS and PMDD
D ia g n o stic criteria T en th R evisio n o f D ia g n o stic a n d
th e In tern a tio n a l S ta tistica l M a n u al
C la ssifica tio n o f o f M en tal
th
D isea se (IC D -1 0 ) D iso rd ers, 4 ed .
(D S M -IV )
P ro v id ers u sin g O b stetrician /g y n ec P sy ch iatrists, o th er
th ese criteria o lo g ists, p rim ary m en tal h ealth care
care p h y sicians p ro v id ers
N u m b er o f O ne 5 o f 1 1 sy m p tom s
sy m p to m s
req u ired

11. Differences Between PMS and PMDD
(Continued)
F u n ction al N ot required Interference w ith
im p airm en t social or role
functioning
required
P rosp ective N ot required P rospective
ch artin g of daily charting of
sym p tom s sym ptom s
required for tw o
cycles

12. Patterns of PMS
 Premenstrual symptoms can begin at ovulation
with gradual worsening of symptoms during the
luteal phase (pattern 1).
 PMS can begin during the second week of the
luteal phase (pattern 2).

13. Patterns of PMS
(Continued)
 Some women experience a brief, time-limited
episode of symptoms at ovulation, followed by
symptom-free days and a recurrence of
premenstrual symptoms late in the luteal phase
(pattern 3).
 The most severely affected women have
symptoms that at ovulation worsen across the
luteal phase and remit only after menses cease
(pattern 4). These women describe having only
one week a month that is symptom-free.

14. Differential Diagnosis
Psychiatric disorders Medical disorders
 Anemia
 Major depression
 Autoimmune disorders
 Dysthymia
 Hypothyroidism
 Generalized anxiety  Diabetes
 Panic disorder  Seizure disorders
 Bipolar illness (mood  Endometriosis
irritability)  Chronic fatigue
syndrome
 Other
 Collagen vascular
disease

15. Differential Diagnosis
(Continued)
Premenstrual Psychosocial
exacerbation spectrum
 Of psychiatric  Past history of sexual
disorders abuse
 Of seizure disorders  Past, present, or
 Of endocrine disorders current domestic
 Of cancer
violence
 Of systemic lupus
erythematosus
 Of anemia
 Of endometriosis

16. Diagnosis of PMS
PMS C. Presence of one or more
A. Does not meet DSM-IV of the following
criteria but does meet symptoms
ICD-10 criteria for PMS  Mild psychological
discomfort
 Bloating and weight gain
B. Symptoms occur only in
the luteal phase, peak  Breast tenderness
shortly before menses,  Swelling of hands and
and cease with feet
menstrual flow or soon  Aches and pains
after
 Poor concentration
 Sleep disturbance
 Change in appetite

17. PMDD (DMS-IV Criteria)
A. At least five of the symptoms below, with at
least one being a core symptom, are
present a week before menses and remit a
few days after onset of menses:
 Depressed mood or dysphoria (core
symptom)
 Anxiety or tension (core symptom)
 Affective lability (core symptom)
 Irritability (core symptom)
 Decreased interest in usual activities

18. PMDD (DMS-IV Criteria)
(Continued)
 Concentration difficulties
 Marked lack of energy
 Marked change in appetite, overeating, or
food cravings
 Hypersomnia or insomnia
 Feeling overwhelmed
 Other physical symptoms (e.g., breast
tenderness, bloating, headache, joint or
muscle pain)

19. PMDD (DMS-IV Criteria)
(Continued)
B. Symptoms must interfere with
work, school, usual activities, or relationships
C. Symptoms must not merely be an
exacerbation of
D. Criteria A, B and C must be confirmed by
prospective daily ratings for at least two
cycles

20. See Attached Menstrual Symptom Diary

21. Treatment of PMS
 Oral contraceptives
 Vitamin B6
 Bromocriptine
 Monoamine oxidase inhibitors
 Synthetic progestational agents
 Spironolactone
 Massage therapy
 Chiropractic therapy
 Calcium

22. Treatment of PMS
(Continued)
 Primrose oil
 Prostaglandin synthesis inhibitors
 Medical and surgical oophorectomy
 Alprazolam (Xanax)
 Naltrexone: opiate antagonist
 Fluxetine (Prozac)

24. With a placebo response rate in patients with
PMS ranging between 20% and 50%, it is
essential that double-blind, randomized
trials be conducted to assess therapeutic
effectiveness.