Pre menstural syndrome

1. P.M.S.
PremenstrualSyndrome
MRS.DEEPTIKUKRETI
PGNURSINGTUTOR
OBSTETRICS&GYNAECOLOGY
SGRRCON

2. Definition
“Acondition which manifests with distressing physical,
behavioural and psychological symptoms, in the
absence of organic or underlying psychiatric disease,
which regularly recurs during the luteal phase of each
menstrual cycle and which disappears or
significantly regress by the end of menstruation”

3. Epidemiology
Varies with different definitionsof PMS. (RCOG –
American Psychiatric Association –WHO).
80% of women experienced at least one symptom
attributed to PMS.
5% suffer from severe PMS (withdrawal fromsocial
and professional activities).

4. Typesof P.M.S.
Mild: Does not interfere with personal/social and
professional life.
Moderate: Interferes with personal/social and
professional life but still able to function and interact.
Severe: Unable to interact personally/socially or
professionally – withdraws from social and professional
activities.
PMDD (PremenstrualDysphoric Disorder): Severe
PMS (USA institutes).

5. Aetiology
.
Effect of cyclic ovarian hormones on neurotransmitters (Serotonin – GABA)
appears to bea key factor.
40% of symptomatic women have significant decline in beta-endorphins.
May have genetic factor: (93% of identical twins will both C/O PMS compared
to 44% in dizygotictwins).
Cultural factors (reported to be of less intensity in war times).

7. RiskFactors
High caffeine intake.
Alcohol abuse.
Stress.
Anxiety.
History of Depression.
Increasing age (worse in late30s).
Overweight.
Family history.
Dietary Factors (low levels of certain vitamins and
minerals).

8. S
ymptoms
Psychological:
Irritability.
Mood swings.
Depression.
Feeling out ofcontrol
Behavioural:
Aggression.
Reduced cognitive abilities andforgetfulness.
Increase in accidents (reducedconcentration).

9. S
ymptoms
Physical:
Fatigue.
Headaches.
Breast tenderness.
Bloating.
Pelvic pain.
Joints pain.
Acne.
Appetite changes.
Swelling.

10. Howto
diagnose?!
Symptoms should
be recorded
prospectively for
at least two cycles
using symptoms
diary.
Daily record of
severity of
problems (DRSP):

11. Treatment
Traditional and Complementary medicines should be
considered.
Although many complementary therapies are not
evidence-based but it is generally agreed that it is
beneficial and may beused.
Most efficacious treatments used in PMS are
unlicensed for PMS.

12. Complementarytherapies
Data limited .
Interactions with conventional medicines should be
considered.
Regular monitoring of the response using charts
should be done.
Best data appear to exist for:
Vitamin D/Calcium
Magnesium
Agnus Castus

13. MEDICAL TREATMENT
 ANTI-DEPRESSANTS AND TRANQUILIZERS: These drugs
are helpful to some extent in reliving anxiety,
irritability, restlessness, stress, etc. Eg: Alprazolam
0.25mg.
 DIURETICS: This helps to reduce symptoms related to
water retention like abdominal bloating, breast
tenderness, swelling of extremities, weight gain.
 Selective serotonin re-uptake inhibitors.

14. HORMONAL TREATMENT
 ORAL CONTRACEPTIVE PILLS: to suppress ovulation
and to have a normal cyclic period. This is given 3-6
cycles.
 BROMOCRIPTINE: This is provided in cases having
certain breast symptoms the dose being 2.5 mg
daily or twice a day.
 DANAZOL: helps to suppress the ovarian cycle.
200-400 mg daily helps in producing amenorrhea.

15. SurgicalApproach(TAH+BSO)
Rarely done for treatmentof
PMS.
For severe cases where
medical treatment failed.
GnRH should be use pre-
operative as test of cure.
HRT should be considered.

16. Summary
PMS is usually underestimated.
Symptoms diary should be used at least for 2 cycles
before making a diagnosis and to evaluate treatment
plans.
Multi-disciplinary team should beinvolved.
Lifestyle change, diet, exercise and complementary
therapies should beconsidered.
C.O.C. and SSRIs in severecases.
GnRHa and Surgical approach as last lines of
treatment.