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PREMENSTRUAL SYNDROME. Ozgul Muneyyirci-Delale. Premenstrual Syndrome.

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premenstrual syndrome

PREMENSTRUAL SYNDROME

Ozgul Muneyyirci-Delale

premenstrual syndrome1
Premenstrual Syndrome

Premenstrual Syndrome (PMS) is defined as “the cyclic recurrence in the luteal phase of the menstrual cycle of a combination of distressing physical, psychological, and/or behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities. Nearly 200 symptoms have been associated with this definition and it is the clustering of these signs and symptoms that is the hallmark of PMS.

catamenial
Catamenial

The term “catamenial” is derived from the Greek and signifies around menses. In general an instance where a single recognized medical condition presented in the premenstruum was referred to as a catamenial disorder while a cluster of symptoms was referred to as PMS.

premenstrual magnification
Premenstrual Magnification

Many patients with psychiatric disorders also complain of worsening of their symptoms around the premenstrual phase, called “premenstrual magnification” (PMM).

slide5
PMS

Milder symptoms are believed to occur in about 30% to 80% of reproductive-age women, while severe symptoms are estimated to occur in 3% to 5% of menstruating women.

concordance rate
Concordance Rate

The concordance rate (if both twins have PMS) was found to be significantly higher in monozygous twins (93%) than dizygous twins (44%) and in non-twin control women (31%).

common symptoms of pms
Common Symptoms of PMS

Women with PMS

SymptomShowing Symptoms (%)

Behavioral

Fatigue 92

Irritability 91

Labile mood with alternating

sadness and anger 81

Depression 80

Oversensitivity 69

Crying spells 65

Social withdrawal 65

Forgetfulness 56

Difficulty concentrating 47

common symptoms of pms continued
Common Symptoms of PMS(Continued)

Physical

Abdominal bloating 90

Breast tenderness 85

Acne 71

Appetite changes and

food cravings 70

Swelling of the extremities 67

Headache 60

Gastrointestinal upset 48

patterns of pms
Patterns of PMS
  • Premenstrual symptoms can begin at ovulation with gradual worsening of symptoms during the luteal phase (pattern 1).
  • PMS can begin during the second week of the luteal phase (pattern 2).
patterns of pms continued
Patterns of PMS(Continued)
  • Some women experience a brief, time-limited episode of symptoms at ovulation, followed by symptom-free days and a recurrence of premenstrual symptoms late in the luteal phase (pattern 3).
  • The most severely affected women have symptoms that at ovulation worsen across the luteal phase and remit only after menses cease (pattern 4). These women describe having only one week a month that is symptom-free.
differential diagnosis
Psychiatric disorders

Major depression

Dysthymia

Generalized anxiety

Panic disorder

Bipolar illness (mood irritability)

Other

Medical disorders

Anemia

Autoimmune disorders

Hypothyroidism

Diabetes

Seizure disorders

Endometriosis

Chronic fatigue syndrome

Collagen vascular disease

Differential Diagnosis
differential diagnosis continued
Premenstrual exacerbation

Of psychiatric disorders

Of seizure disorders

Of endocrine disorders

Of cancer

Of systemic lupus erythematosus

Of anemia

Of endometriosis

Psychosocial spectrum

Past history of sexual abuse

Past, present, or current domestic violence

Differential Diagnosis(Continued)
diagnosis of pms
PMS

A. Does not meet DSM-IV criteria but does meet ICD-10 criteria for PMS

B. Symptoms occur only in the luteal phase, peak shortly before menses, and cease with menstrual flow or soon after

C. Presence of one or more of the following symptoms

Mild psychological discomfort

Bloating and weight gain

Breast tenderness

Swelling of hands and feet

Aches and pains

Poor concentration

Sleep disturbance

Change in appetite

Diagnosis of PMS
pmdd dms iv criteria
PMDD (DMS-IV Criteria)

A. At least five of the symptoms below, with at least one being a core symptom, are present a week before menses and remit a few days after onset of menses:

  • Depressed mood or dysphoria (core symptom)
  • Anxiety or tension (core symptom)
  • Affective lability (core symptom)
  • Irritability (core symptom)
  • Decreased interest in usual activities
pmdd dms iv criteria continued
PMDD (DMS-IV Criteria)(Continued)
  • Concentration difficulties
  • Marked lack of energy
  • Marked change in appetite, overeating, or food cravings
  • Hypersomnia or insomnia
  • Feeling overwhelmed
  • Other physical symptoms (e.g., breast tenderness, bloating, headache, joint or muscle pain)
pmdd dms iv criteria continued1
PMDD (DMS-IV Criteria)(Continued)

B. Symptoms must interfere with work, school, usual activities, or relationships

C. Symptoms must not merely be an exacerbation of

D. Criteria A, B and C must be confirmed by prospective daily ratings for at least two cycles

treatment of pms
Treatment of PMS
  • Oral contraceptives
  • Vitamin B6
  • Bromocriptine
  • Monoamine oxidase inhibitors
  • Synthetic progestational agents
  • Spironolactone
  • Massage therapy
  • Chiropractic therapy
  • Calcium
treatment of pms continued
Treatment of PMS(Continued)
  • Primrose oil
  • Prostaglandin synthesis inhibitors
  • Medical and surgical oophorectomy
  • Alprazolam (Xanax)
  • Naltrexone: opiate antagonist
  • Fluxetine (Prozac)
slide24
With a placebo response rate in patients with PMS ranging between 20% and 50%, it is essential that double-blind, randomized trials be conducted to assess therapeutic effectiveness.