Clinical Information on Premenstrual Syndrome

Basic information Premenstrual Syndrome

Definition

  • Genes of relapsing mental and / or somatic character which occurs in the post-ovulatory (luteal) phase of the menstrual cycle 1
  • The genes disappear during the first days of menstruation
  • Premenstrual symptoms occur in a mild form in 75% of all women
  • By premenstrual syndrome (PMS) symptoms of a difficulty level so they affect the woman’s daily functioning
  • Severe symptoms of domination of dysphoria is called in English pr√¶menstrual dysphoric disorder (PMDD)

occurrence

  • 75% of all women have shorter or longer periods of physical or psychological reactions in the luteal phase
  • 3-10% have PMS, i.e. Symptoms of a difficulty level, which affect the daily functioning
  • In ca. half of these cases are the psychological symptoms prominent
  • The symptoms can be seen throughout the fertile period but usually start in 20-35 years of age, and is most prominent in women between 30 and 40 years 2

Etiology and pathogenesis

  • The etiology is not clear, but progesterone plays a central role in the pathogenesis
  • There are normal hormone concentrations, but presumably an altered sensitivity to progesterone
  • A progesterone triggered inhibition of neurotransmitters in the CNS (serotonin and GABA-dependent systems 3 ) may contribute to the psychological symptoms
  • There may be fluid retention and changes in the gastrointestinal tract motility – perhaps secondary to relative calcium deficiency
  • PMS occurs only in ovulatory cycles
  • Cultural and personal circumstances play probably a role in the symptoms of the nature and severity

ICPC 2

  • X89 Premenstrual Syndrome
  • Premenstrual X09 (t) symptom / complaint

ICD-10

  • N94 Pain / kr. Condition comp. kvind.k√łnsorganer m / menstrual
  • N943 Premenstrual Syndrome
  • N948 An. Sufficiency. Associated w om. genitals electricity menstruation
  • N949 Mode. Associated w om. genitals electricity menstrual UNS

Diagnosis

diagnostic criteria

  • Symptoms debuts after ovulation and disappear during – or shortly after – menstruation
  • There a symptom-free interval until the next menstruation
  • The symptoms must be repeated for several cycles

Differential

  • Endometriosis
  • hyperthyroidism
  • depressive disorder

Medical history

Psychiatric sypomtomer

  • Irritability, aggression, mood swings, depressed mood, anxiety, crying trend, concentration problems

general Symptoms

  • Fatigue, insomnia, libido changes, increased appetite, changes in eating habits

somatic genes

  • mastalgia
  • Fluid retention with edema and weight gain
  • Bloating, meteorism and feeling of heaviness in the abdomen
  • Headaches, pimples tend
  • Worsening of chronic diseases such as asthma, allergies, epilepsy or migraine
  • The symptoms can vary from month to month

consequences

  • Secondary problems can arise in family life and work situation
  • In the worst cases, women have been suicidal in this period of the cycle

clinical findings

  • Normal findings on gynecological examination

When to refer the patient?

  • Reference is rare required
  • At very serious genes can be “pharmacological ovariectomy” is attempted in gynecologist

Treatment

Treatment goals

  • Information and acceptance of the condition
  • symptom relief

Generally about the treatment

  • Cyclic genes is a natural part of the women’s menstrual cycle
  • There are different views of PMS – varying from the symptoms have a healthy sign and a sign of the proper functioning of ovulations, and it is natural to live out their attacks – for a pathophysiological abnormal condition that requires medical treatment
  • The doctor’s role is to avoid medicalisation of healthy women, and help those who need
  • Treatment should only be started after the diagnosis of PMS or PMDD is asked
  • Non-pharmacological treatment is generally the first choice
    • Physical exercise
    • Stress-reducing techniques
    • Possibly. cognitive psychotherapy
    • A significant number of nonpharmacological treatments are tried, but few are effectively documented
  • Pharmacological treatment with proven efficacy
  • SSRI
  • Alprazolam
  • GnRH agonists
  • Pharmacological treatment with possible effect
    • Oral contraceptives
      • either with a drospirenonholdigt composition
      • and / or as a continuous treatment without a break – or break every 3 months
    • spironolactone

What can the patient do?

  • Accept that cyclic symptoms is a normal response to the differing hormone levels during the menstrual cycle
  • There are many “folk remedy” for increased exercise, coffee, B-vitamin supplements, dietary supplements and herbal remedies
  • Studies that document the efficacy of lifestyle changes and natural products lacking

Medical treatment

  • Oral contraceptives
    • Oral contraceptives with drospirenone with documented effect on the genes dysphoric
    • Continuous treatment (gapless) with other monophasic pill has an effect on mastalgia, bloating, pelvic pain and in some degree of mood swings

    Continuous processing by monophasic oral contraceptives containing drospirenone, would be a possible choice 4

  • SSRI – in severe PMS and the predominantly psychological symptoms 5 . You should be aware of side effects of SSRI treatment like nausea (NNH = 7), decreased energy (NNH = 9), somnolence (NNH = 13) and fatigue (NNH = 14) and sweating (NNH = 14)
    • Paroxetine or citalopram 10-20 mg daily
      • The dose can be increased if necessary
      • The treatment is given continuously or only during the luteal phase
      • Anxiolytics, which does not affect the SSRI system has no effect
  • diuretics
    • Spironolactone 25-100 mg x 1 DGL in the last 14 days of the cycle,

Course, complications and prognosis

Progress

  • There are large individual variations in the duration, severity and type of the symptoms
  • In menopause disappear premenstrual genes

complications

  • Usually no complications
  • Changing relationships to the environment and the immediate family when the condition involves severe irritability and behavior change

Forecast

  • Stop menopause
  • Symptoms will usually recur if treatment is stopped
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