Name
PREMENSTRUAL SYNDROME
DESCRIPTION
DETAIL
CAUSES Unknown, presumed hormonal; perhaps interacting with neurotransmitters -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS The major differentials are psychiatric syndromes, particularly depressive disorders and/or dysthymia. Other entities may be suggested by history or physical.LABORATORY There are no laboratory tests which confirm or refute PMS. History and physical may disclose a need for specific laboratory tests. DIAGNOSTIC PROCEDURES Patients complete questionnaires over a minimum of two months to confi rm premenstrual exacerbation of symptoms and lack of substantial symptoms in the follicular phase
TYPENOTES
RISK FACTORS: Premenstrual exacerbations can occur with other diseases (i.e., depression) β’ Caffeine and high fluid intake exacerbate PMS symptoms, Stress may precipitate, PMS increases with age, History of depression, Tobacco useGENERAL MEASURES β’ Increase daily exercise β’ Eat regular, balanced meals β’ Stop smoking β’ Get regular sleep β’ Stress reduction techniques β’ Cognitive behavioral therapy (may provide better longterm effect than SSRIs) β’ Support groups β’ Light therapy ACTIVITY β’ No restrictions β’ Exercise is recommended DIET Low-salt; low-caffeine; low-fat; frequent, small meals; high complex carbohydrates PATIENT EDUCATION Explain PMS and treatment DRUG(S) OF CHOICE No single drug works for all women. Drugs that are used with varying degrees of success are listed. β’ Antidepressants [fl uoxetine (Prozac, Sarafem), sertraline, clomipramine, citalopram or nortriptyline], particularly for patients with depressive symptoms. Antidepressants can work when used only during the luteal phase of the menstrual cycle. β’ Elemental calcium 1000 mg/day β’ Diuretics (usually spironolactone) during luteal phase β’ Symptomatic treatment of pain (ibuprofen or acetaminophen) β’ Vitamin B6 in modest doses (50 mg bid, may be toxic in higher doses) β’ Vitamin E: up to 600 IU/day β’ Evening primrose oil, high content of fatty acids, 500 mg qd to 1000 mg tid for breast tenderness, believed to decrease prostaglandin synthesis β’ Oral contraceptives may help β’ Bromocriptine 2.5 mg tid at time of symptoms and danazol 100 mg bid may also work for breast tenderness, but have more side effects β’ Danazol for the total PMS symptom complex β’ Gonadotropin-releasing hormone agonists with or without concurrent estrogens/progestins β’ L-tryptophan 2 g three times a day PATIENT MONITORING See patient to provide general support and further patient education EXPECTED COURSE/PROGNOSIS Many patients can have their symptoms adequately controlled. Disappears at menopause.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD UREA, SERUM CREATININE, URINE ROUTINE, ULTRA SOUND WHOLE ABDOMEN - FEMALE, COMPLETE BLOOD COUNT
[PREMENSTRUAL SYNDROME]