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PMS Present

Premenstrual syndrome (PMS) is characterized by physical, psychological, and behavioral symptoms that occur during the premenstrual phase of the menstrual cycle and resolve after menstruation begins. Symptoms must be severe enough to cause social or occupational disruption. Diagnosis involves tracking symptoms daily over two menstrual cycles using a symptom diary. Treatment options include lifestyle modifications, oral contraceptives, SSRIs, and progesterone. For severe cases, GnRH analogues or surgical options like hysterectomy may be considered.

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Muhammad Farrukh ul Islam
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38 views16 pages

PMS Present

Premenstrual syndrome (PMS) is characterized by physical, psychological, and behavioral symptoms that occur during the premenstrual phase of the menstrual cycle and resolve after menstruation begins. Symptoms must be severe enough to cause social or occupational disruption. Diagnosis involves tracking symptoms daily over two menstrual cycles using a symptom diary. Treatment options include lifestyle modifications, oral contraceptives, SSRIs, and progesterone. For severe cases, GnRH analogues or surgical options like hysterectomy may be considered.

Uploaded by

Muhammad Farrukh ul Islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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RCOG GUIDELINES OF PMS

PREMENESTRUAL SYNDROME

DR. ANAM ZAFAR


PGR 1- DGO
GU-III
OBJECTIVES

• DEFINATION
• SYMPTOMS
• AETIOLOGY
• HOW TO DIAGNOSE PMS
• MANAGEMENT OF PMS
DEFINATION

• It is difficult to give a definition which cover all aspects of premenstrual syndrome


b/c of diverse nature of symptomatology.
• It is a disorder of nonspecific physical, psychological or behavioural symptoms
recurring in the premenstrual phase of menstrual cycle and resolve by the end of
menstruation.
• Symptoms should be of sufficient severity to produce social , family , occupational
disruption and must have occurred over last 02 cycles.
• Term Premenstrual dysphoric disorder (PMDD) represents the severe
predominantly psychological form of PMS and is seen in 03-08% of women!
SYMPTOMS
• The range of symptoms patient experience in relation to menstrual cycle is very wide and
almost any body system may be affected.
• Symptoms are less frequent during early reproductive years and progressively worse with
the age towards menopause.
• Physical symptoms: Enlargement and tenderness of breasts , abdominal bloating ,
peripheral oedema , weight gain.
• Headache and pelvic discomfort.
• Psychological symptoms: Tension , irritability n tiredness sleep , libido n appetite may
also be affected.
• Behavioural changes: Poor performance at work, suicidal attempts
AETIOLOGY
The aetiology of PMS is unknown. The theories include:-
1) Sex hormones: It has been suggested that it occur due to high estrogen and progesterone
ratio, but this occurs at midcycle whereas symptoms occur premenstrually.
Secondly , it is thought that due to abrupt premenstrual withdrawal of hormones but
symptoms usually develop before decline in ovarian hormone production.
2)Fluid retention: Factors responsible for fluid retention are estrogen, aldosterone, prolactin
n ADH.
3) Behavioural changes are due to vit B6 deficiency.
4) Hunger, fatigue, anxiety overlap with symptoms of hypoglycaemia which suggest
alteration in glucose metabolism.
5) Serotonin deficiency, low beta-Endorphin levels.
HOW TO DIAGNOSE

• 1) Daily record of severity of problems DRSP:

It is a simple and reliable method, widely used tool for diagnosis. Pt


is advised to use diary for 02 months.

• 2) GnRH analogue test:

It is used where above diary is inconclusive, course is given for 03 months.


They switch off ovarian activity and if symptoms persists that must be the
consequence of underlying psychological disorder.
TREATMENT OPTIONS

Non-Medical treatment: Medical treatment:


1. Lifestyle Modification. 1. Combined Oral Contraceptive Pills (COCP)
2. Cognitive Behavioral Therapy. 2. Percutaneous Estradiol.
3. Complementary Therapy. 3. SSRIs
4. GnRH Analogues.

5. Progesterones & Progertogens.


6. Bromocriptine/ Danazol
7. Diuretics
8. Anxiolytic Agents
TREATMENT OPTIONS

Surgical treatment:
Hysterectomy and bilateral oophorectomy is curative for
ovarian hormone related symptoms!
Surgical treatment is only justified when medical
management has failed, long term GnRH analogue treatment
is required or other gynaecological conditions indicate
surgery.
IMPORTANT POINTS RELATED TO
TREATMENT

• When clinically reviewing women for PMS, symptoms should be recorded prospectively,
over two cycles using a symptom diary, as retrospective recall of symptoms is unreliable.
• Gonadotrophin-releasing hormone (GnRH) analogues may be used for 03 months for a
definitive diagnosis if the completed symptom diary alone is inconclusive. [New 2016]
• Women with PMS should be informed that there is conflicting evidence to support the use
of some complementary medicines.
• When treating women with severe PMS, CBT should be considered routinely as a treatment
option.
IMPORTANT POINTS RELATED TO
TREATMENT

• When treating women with PMS, drospirenone-containing COCs may represent effective
treatment for PMS and should be considered as a first-line pharmaceutical intervention.
[New 2016]
• Percutaneous estradiol combined with cyclical progestogens has been shown to be effective
for the management of physical and psychological symptoms of severe PMS.
• Micronised progesterone is theoretically less likely to reintroduce PMS-like symptoms and
should therefore be considered as first line for progestogenic opposition rather than
progestogens. [New 2016]
IMPORTANT POINTS RELATED TO
TREATMENT

• When treating women with percutaneous estradiol, a cyclical 10–12 day course of oral or
vaginal progesterone or long-term progestogen with the LNG-IUS 52 mg should be used
for the prevention of endometrial hyperplasia. [New 2016]
• Women treated with danazol for PMS should be advised to use contraception during
treatment due to its potential virilising effects on female fetuses. [New 2016]
• When treating women with PMS, GnRH analogues should usually be reserved for women
with the most severe symptoms and not recommended routinely unless they are being used
to aid diagnosis or treat particularly severe cases. [New 2016]
IMPORTANT POINTS RELATED TO
TREATMENT

• When treating women with severe PMS using GnRH analogues for more than 6 months,
addback hormone therapy should be used. [New 2016]
• Women on long-term treatment should have measurement of BMD (ideally by dual-energy
X-ray absorptiometry [DEXA]) every year. Treatment should be stopped if bone density
declines significantly. [New 2016]
• SSRIs should be considered one of the first-line pharmaceutical management options in
severe PMS. [New 2016]
• SSRIs should be discontinued gradually to avoid withdrawal symptoms, if given on a
continuous basis.
IMPORTANT POINTS RELATED TO
TREATMENT

• When treating women with PMS, surgery should not be contemplated without preoperative
use of GnRH analogues as a test of cure and to ensure that HRT is tolerated.
• Bilateral oophorectomy alone (without removal of the uterus) will necessitate the use of a
progestogen as part of any subsequent HRT regimen and this carries a risk of reintroduction
of PMS-like symptoms (progestogen-induced premenstrual disorder). [New 2016]
THANK YOU!

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