Term
| normally occurring premenstrual symptoms without significant impact on patient's function or QOL |
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Definition
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Term
| more severe than premenstrual syndrome with significantly greater psychological symptoms |
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Definition
| premenstrual dysphoric disorder |
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Term
| an array of PREDICTABLE physical, cognitive, affective, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation |
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Definition
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Term
TRUE OR FALSE
there are no universally accepted diagnostic criteria for PMS |
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Definition
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Term
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Definition
| period of time between ovulation and that first day of menstrual bleeding |
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Term
| American College of Gynecology (ACOG) PMS diagnosis |
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Definition
a patient must have at least one of the affective symptoms (mood) and one of the somatic symptoms (body) beginning at least 5 DAYS prior to the onset of menses in 3 CONSECUTIVE cycles and cease within 4 DAYS of the onset of menses
the symptoms must adversely affect social or work-related activities |
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Term
| affective symptoms of PMS |
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Definition
depression
angry outbursts
irritability
confusion
anxiety
social withdrawal |
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Term
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Definition
breast tenderness
abdominal bloating
headache
swelling of extremities |
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Term
| other symptoms of PMS (non-diagnostic symptoms of PMS) |
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Definition
insomnia
hypersomnia
mastalgia
bloatedness
weight gain
joint pain
generalized pain
relationship issues
worsening of underlying disorders: criminal behavior, suicidal ideations, absenteeism |
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Term
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Definition
1) in most menstrual cycles in the past year at least 5 of these symptoms (including at least 1 of the symptoms in category A) were present for most of the time 1 week before menses, began to remit within a few days after the onset of the follicular phase (menses), and were absent in the week of menses
A) primary symptoms:
markedly depressed mood
marked anxiety, tension
marked affective liability (feeling suddenly sad or tearful)
persistent and marked anger or irritability or increased interpersonal conflicts
B) other symptoms:
decreased interest in usual activities such as friends or hobbies
difficulty concentrating
lethargy
marked changes in appetite, overeating, or specific food cravings
hypersomnia or insomnia
sense of being overwhelmed or out of control
other physical symptoms: breast tenderness, bloating, weight gain, headache, joint pain, muscle pain
2) the symptoms markedly interfere with work, school, usual activities, or relationships with others
3) Symptoms are not merely an exacerbation of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or
a personality disorder (although it may be superimposed on any of these disorders).
4) Criteria 2, 3, and 4 are confirmed by prospective daily ratings for at least two consecutive symptomatic menstrual cycles.
symptoms must persist for a year prior to reaching a diagnosis of PMDD
must clearly differentiate from a catamenial trigger of other underlying disorders |
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Term
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Definition
most of the symptoms of PMS and PMDD can be attributed to other diseases
the central point of diagnosis of PMS and PMDD is the relationship of the symptoms to the menstrual cycle
THE SYMPTOMS DO NO APPEAR AT ALL DURING OTHER PORTIONS OF THE MENSTRUAL CYCLE |
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Term
| risk factors for PMS and PMDD |
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Definition
age > 30 years
family history (mother and sisters)
stress (?) or response to stress
history of traumatic events:
childhood sexual abuse
severe accidents
severe physical threat history (rape, physical abuse) |
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Term
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Definition
PMS and PMDD only occur in ovulating women
both appear to be mediated by a sensitivity to the progesterone levels in the luteal phase
women with PMS and PMDD do NOT have higher progesterone levels than the general population
women who suffer from severe PMS and PMDD have been shown to have lower platelet concentrations of serotonin during the last 10 days of the cycle than the general population
serotonin deficiency may lead to increased sensitivity to the effects of progesterone |
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Term
catamenial diseases
these are NOT PMS of PMDD |
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Definition
any disease that is worsened during the premenstrual period
often responsive to hormone manipulation (OCP)
common examples:
seizures
migraines
irritable bowel disease
diabetes
asthma
rheumatoid arthritis |
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Term
| non-drug therapy for PMS and PMDD |
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Definition
education of expectations:
symptoms will improve, but won't go away completely
aerobic exercise:
30-60 mins per day has signifcant reduction of mood symptoms
stress management:
biofeedback
meditation
therapeutic massage
accupressure and accupuncture
chiropractic adjustment (?)
phototherapy - especially effective for women who have worsening of symptoms during the winter months
cognitive behavioral therapy:
focusing on changing dysfunction thoughts, emotions, and behaviors
equivocal results |
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Term
| dietary modifications for PMS |
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Definition
increasing carbohydrates helps with:
mood, memory, carbohydrate draving
complex carbs are less likely to be craved, but may satisfy cravings with less weight gain
decrease Na, alcohol, and caffeine:
helps with water retention and mood
may be related to Mg deficiency
low-fat high-fiber diet throughout the month:
may lessen excursions of estrogen and progesterone through the cycle |
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Term
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Definition
vitamin B6:
serves as cofactor in the synthesis of serotonin
equivocal results show some benefit
dose 50-100 mg/day
>100 mg per day may lead to neuropathies
calcium:
shows benefit in the reduction of water retention, food cravings, and generalized pain
1200-1500 mg per day (divided) of calcium carbonate was used in most clinical trails |
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Term
| herbal and natural products |
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Definition
chasteberry:
may reduce irritability, mood alteration, anger, headache, and breast tenderness
may alter estrogen and progesterone production by corpus luteum
perhaps similar response as fluoxetine (1 small study)
should not be used during pregnancy or lactation
20 mg per day is max recommended dose
poorly studied in comparison to legend drugs
ginkgo bioba:
improves breast tenderness, fluid retention, and mood
dose: 80 mg BID from day 16 through day 5 of cycle
may increase bleeding risk and has multiple CYP450 interactions
ginkgo biloba and NSAIDs are CONTRAINDICATED to use together
St. John's Wort:
similar but lesser effects as SSRIs
more drug interactions than SSRIs
should not generally be recommended
much safer to be on an SSRI than to be on St. John's wort
evening primrose oil:
used to treat PMS symptoms for centuries
not effective in clincal trails, except for the reduction of breast pain and tenderness |
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Term
| use of NSAIDS for PMS and PMDD |
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Definition
NSAIDs may help reduce generalized pain and breast tenderness
dose starting on day 15 (day of ovulation) through 5 of the cycle dose around the clock rather than prn
prevention is slightly better than treatment
naproxen is moderately superior to IBU in 2 small trials |
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Term
| use of spironolactone for PMS and PMDD |
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Definition
may help treat the symptoms of breast tenderness, bloating, and fluid weight gain
dose: 100 mg per day on days 15-28
some sources suggest using only in women with regular weight gain > 3 lbs during luteal phase of cycle |
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Term
| use of bromocriptine for PMS and PMDD |
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Definition
dopamine agonist and reduces prolactin levels
useful only to treat breast symptoms (pain, tenderness, fullness)
dose: 2.5 mg BID-TID on days 10-28
caution in those with HTN
should not use in those with seizure disorders
new FDA indication to treat type II diabetes!!!
EXAM QUESTION: a patient with type II diabetes is already taking metformin and needs more diabetes control and has breast tenderness...use bromocriptine |
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Term
| use of SSRIs for PMS and PMDD |
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Definition
psychological aspect
SSRIs are the drugs of first choice for severe PMS and PMDD
SSRIs improve all psychological and many physical manifestations of the disease
PMS symptoms response much quicker than does depression to SSRI therapy (1-2 days is not uncommon)
the sue of intermittent SSRIs (days 14-28) is typically as effective with fewer toxicities
ADRs: stimulation, sleep disturbances/insomnia, sexual dysfunction
fluoxetine is the most widely studied of the SSRIs for PMS and PMDD
20 mg per day is as effective as higher doses with fewer toxicities
there is no reason to use Sarafem rather than generic fluoxetine |
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Term
| other meds for psychological symptoms |
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Definition
clomipramine (TCA) may be used
less effective than SSRIs
fewer sexual ADRs than SSRIs
benzodiazepines may be added for the treatment of anxiety |
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Term
| hormaonal therapy to treat PMS and PMDD |
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Definition
contraception:
anything that leads to total suppression of ovulation will treat PMS and PMDD
typical oral contraception does not totally suppress ovulation
OCP containing drospirenone (YAZ) is superior to those containing other progestins
anti-mineralocorticoid and pro-estrogenic effects
chimically similar to spironolactone (acting as an aldosterone antagonist)
depo-provera has some benefit, but oral progestin only pills are not effective |
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Term
| use of GnRH agonists for PMS and PMDD |
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Definition
leuprolide, danazol
result in initial surge of LH and FSH but within 1-4 weeks result insuppression of LH and FSH
result in "chemical oopherectomy"
used for no more than 6 months typically
will cause hot flashes, may cause osteoporosis
may identify women who would benefit from surgical oopherectomy
EXAM QUESTION: a partial hysterectomy will NOT cure PMDD b/c one ovary will remain
full hysterectomy = uterus and both ovaries |
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Term
| surgical treatment of PMS and PMDD |
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Definition
bilateral oopherectomy with or without hysterectomy will CURE PMS and PMDD
the risks of these procedures generally outweigh the benefits
surgery should never be performed without a prior trial of GnRH agonist |
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