1 / 17

PMS

PMS. A Practical Evidence Based Approach in General Practice Kalpa Sundar. Psychological & Somatic disorder of unknown aetiology ? Endocrine origin ? Exaggerated end organ response. The Syndrome – basic facts. 95% Middle age, Multiparous, Middle Class

keira
Télécharger la présentation

PMS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PMS A Practical Evidence Based Approach in General Practice Kalpa Sundar

  2. Psychological & Somatic disorder of unknown aetiology • ? Endocrine origin • ? Exaggerated end organ response

  3. The Syndrome – basic facts • 95% • Middle age, Multiparous, Middle Class • Usual symptoms – irritability, aggression, depression, bloatedness, mastalgia, behavioural symptoms…

  4. Definition • 4 out of previous 6 cycles • Resolve by the end of menstruation • Symptoms begin in late luteal phase

  5. Types • Primary • Secondary – underlying psychopathology

  6. Aetiology Endorphins, Psychosomatic, Pyridoxine, Neurotransmitters, Prolactin Na+, H20 retention, ADH, ANP, Renin angiotensin Aldosterone Prostaglandins, Oestrogen ,Progest, SHBG

  7. Diagnosis • History – Corner stone & Challenge • Severity • Qol affected • Examination • Little contribution • Opportunistic screening • Reassure no cancer • Blood tests • Diagnostic tests • GnRh depot X 3 cycles

  8. Blood tests

  9. Counsel/ Educate/ Reassure Stress management / Relaxation techniques Physiological symptoms Pyridoxine, Primrose, Diuretics Mild SSRI Moderate Prog/Bromocrip COC Danazol E2 patches / implants Severe GnRH analogue Extreme TAH+BSO

  10. Mild • Pyridoxine • 30% self prescribed • 82% improvement compared to placebo 72% • Gr II evidence • Oil of evening primrose • Limited benefit over placebo • Gr I evidence • Diuretics • Spironolactone • 20% more than placebo • demonstrable improvement in oedema

  11. Moderate • SSRI • Significant improvement • 90% compared to 76% placebo • CCP • Logical • No large study or formal evaluation of CCP • Using the pill empirically and assessing effect is worthwhile • Progestrogens/ Progestrone • Uncontrolled studies • Failed to show improvement • Anectodal reports of efficacy • Bromocriptine • 5mg day 10 to day 26 • Improvement of cyclical mastalgia • 80-90% compared to 80% placebo

  12. Severe • Danazol • Effective in mastalgia • Balance with side effects • Oestradiol implants & patches • 85% relief with cyclical Prog • Reserved for perimenopausal age

  13. Extreme • GnRH analogues • Not a permanent cure • More of diagnostic value • Surgery • Controversial • TAH BSO is curative • Needs unapposed Oestrogen replacement

  14. Conclusions • Difficult to better placebo • Could be dealt with primarily by GP, Womens’ health units • Psychiatric input in selected cases • If very severe • Referral to a gynaecologist for manipulation or suppression of normal ovarian function

  15. Links

  16. Links • N.A.P.S Helpline- 08707772177 • www.pms.org.uk • www.rcog.org.uk • PMS symptometrics- ready reckoner package-Keele University. • P.M.S. O’Brien – literature search

More Related