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Premenstrual Syndrome

Premenstrual Syndrome. Max Brinsmead PhD FRANZCOG July 2012. PMS - Diagnosis. Must use a cycle diary 50 – 60% of patients then discover that their symptoms are not exclusively premenstrual Also useful in assessing therapy Cycle to cycle – patient acts as her own control. PMS – What and Who.

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Premenstrual Syndrome

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  1. Premenstrual Syndrome Max Brinsmead PhD FRANZCOG July 2012

  2. PMS - Diagnosis • Must use a cycle diary • 50 – 60% of patients then discover that their symptoms are not exclusively premenstrual • Also useful in assessing therapy • Cycle to cycle – patient acts as her own control

  3. PMS – What and Who • A physiological condition (75% have it) • Not due to any identified hormone deficiency or excess • (Don’t get trapped into measuring serum everything!) • Best regarded as an abnormal response of brain neurotransmitters to normal cycles • Treat only those whose life is severely affected (3-8%)

  4. PMS – General Measures • Counselling and support • (involve the partner) • Diet • Exercise • Smoking cessation • Decrease caffeine – good for mastalgia • Chinese Herbs • Meditation/?Acupuncture

  5. PMS – Other Interventions • COC – 85% respond • ≈15% get worse • ?Yasmin better • NSAID when pain is an issue • Vitamin B6 and Evening Primrose Oil • Aldactone • Progesterone (doubtful role) • Danazol • Lithium • SSRIs

  6. SSRIs as Primary Therapy • Effective (46 trials, 2294 women, RR=0.55, CI 0.68-0.39) • Effective against both physical, functional & behavioural symptoms • Luteal phase use as effective as all cycle use • All SSRIs tested have been found to be effective • Side effects that result in patient withdrawal from treatment are a problem

  7. Therapies of Last Resort • E2 implant and Mirena • Hysterectomy and E2 implant

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