Ell Fk Pms Disorders 1

8/9/2019 Ell Fk Pms Disorders 1

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Rationale

Premenstrual syndrome involves physical andemotional discomfort and may affect

interpersonal relationships.

Effective management of this condition requires an

understanding of symptoms and diagnostic

methods.


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Defnitions

PMS = Recurrent psychological or physicalsymptoms during the luteal phase omenstrual cycle, resolves by the end omenstruation, and interferes with some

aspect o unction.

Premenstrual Dysphoric Disorder PMDD! =more severe orm o PMS meeting DSM-IV

criteria.


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"ncidenceModerate to severe - 20-40%

Deilitating disease!symptoms - 2."-"%

#enerally age $0-40 yr.

Milder symptoms are elieved to occur in aout $0%to 0% of reproductive-age &omen' &hile severe

symptoms are estimated to occur in $% to "% of

menstruating &omen.


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(etiology


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Symptoms of PMSSymptoms of PMS

)ehavioral

Mood laility *+, ood cravings *, /ncreased appetite

*0,versensitivity *1, (nger *1, 3rying easily *1", eeling isolated

*1",

Psychological

/rritaility *+, atigue *2, (niety!tension

*, Depression *0, orgetfulness *"1, Poor concentration

*4,

Physical

atigue *2, )loating *0, )reast

tenderness *", (cne *+, 5&elling *1, 6eadache *10, #/ symptoms

*4, 6ot flashes *+, 6eart palpitations

*+4, Di77iness *+4,


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PMDDPMDD

D5M-/8 criteria9: " symptoms of PM5 + &ee; prior to and resolve

during menses:+ psychological symptom + year during most cyclesDepressed mood' increased sensitivity' aniety' irritaility

/nterferes &ith social' occupation' seual or schoolfunctioning5ymptoms discretely related to menstrual cycle and

not a &orsening of a psychiatric or medication condition

Documented symptoms meeting criteria for at least $cycles


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DiagnosisDiagnosis


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Functional

impairment

Prospective

charting of

symptoms

Not required

Not required

Interference with

social or role

functioning

required

Prospective

daily charting of

symptoms

required for two

cycles


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Dierential Diagnosis

Psychiatric disordersMa#or depression

Dysthymia

$enerali%ed an&iety

Panic disorder

'ipolar illness mood irritability!

(ther

Medical disorders)nemia)utoimmune disorders*ypothyroidismDiabetesSei%ure disorders+ndometriosishronic atigue

syndromeollagen vasculardisease


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Dierential Diagnosis(Continued)

Premenstrual eacer!ation( psychiatric disorders

( sei%ure disorders

( endocrine disorders

( cancer

( systemic lupus erythematosus

( anemia

( endometriosis

Psychosocialspectrum

Past history o se&ualabuse

Past, present, orcurrent domesticviolence


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=reatment

(imed at relieving symptoms' as cause un;no&n

3onservative5elf help strategies>utritional changesrequent' small meals (void s&eets' caffeineMagnesium sulfate $10 mg!dEvening primrose oil6igh-protein diet' )1

Eercise - milder symptoms


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=reatment


MedicalMood!other symptom relief>aproyn *prostaglandin inhiitor,Mefenamic 5alt restriction for &ater retention5pironolactone for &ater retention=ransdermal estrogen)romocriptine for reast symptoms (nti-aniety drugs

luoetine *Pro7ac, appears most promising as first-linemedication

(lpra7olam *?ana,


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=reatment


Medicalvulation suppression ral contraceptivesDepomedroyprogesterone acetate *DMP(,

#onadotropin-releasing hormone *#n


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SSRIs Dosage Recemmendationsfor use

Side effects

luoetine

*5arafem,

+0to 20

mg perday

irst-choice agents for

the treatment of PMDD@at present' onlyfluoetine is laeled forthis indication.3learly effective inalleviating ehavioraland physical symptomsof PM5 and PMDDor intermittent therapy'

administer during lutealphase *days eforemenses,.

/nsomnia'

dro&siness'fatigue'nausea'

nervousness'headache'

mild tremor'seual

dysfunction

5ertraline*Aoloft, "0to +"0mg perday

Paroetine*Pail,

+0to $0mg per

day


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=reatment


5urgicalophorectomy not generally recommendedPossily indicated if symptoms respond to

#n


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Summary of Management"uidelines All women with PMS or PMDD

>onpharmacologic treatment9 education' supportive therapy' rest' eercise'dietary modifications

5ymptom diary to identify times to implement treatment and to monitorimprovement of symptoms

Treatment of specific physical symptoms )loating9 spironolactone *(ldactone,

6eadaches9 nonprescription analgesic such as acetaminophen' iuprofen' ornaproen sodium *(napro@ also' nonprescription (leve, atigue and insomnia9 instruction on good sleep hygiene and caffeine

restriction )reast tenderness9 vitamin E' evening primrose oil' luteal-phase

spironolactone' or dana7ol *Danocrine,

Treatment of psychologic symptoms or symptoms of PMDD' continuous or intermittent therapy &ith an 55

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Ell Fk Pms Disorders 1