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Dr .sarab salih
Definition:
premenstrual syndrome (PMS) is the
occurrence of cyclical somatic, psychological and
emotional symptoms that occur in the luteal (premenstrual)
phase of the cycle and resolve by the time menstruation
ceases.
-premenstrual symptoms occur in almost all women of
reproductive age. In 3 – 60% symptoms are severe, causing
disruption to everyday life.
Etiology :
precise etiology is unknown but cyclical
ovarian activity and the effects of oestradiol and
progesterone on certain neurotransmitters including
serotonin, appear to play a role .
History and examination :
Cyclical nature of the
symptoms is the corner stone of the diagnosis. The patient
may have some or all of the following :
- Bloating. - Cyclical weight gain - Mastalgia.
- Abdominal cramps. - Fatigue. - Headache
- Depression. – Irritability
-A symptom chart to be filled by the patient prospectively
may help.
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Figure (1)Luteal phase relation of symptoms
Figure (2) symptoms chart
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Figure- 3-Severity of symptoms
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Figure -4- Algorithm for treatment of PMS
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Management:
1.Simple therapies:
includes stress reduction,alcohol and
caffaine limitation and exercise.
2.Medical treatments:
include
Combined oral conraceptive pills:The most effective
regime is bicycling or tricycling pill packets (taking 2
or 3 packets in araw without scheduled break).
Transdermal oestrogen:Significantly reduce PMS
symptoms by overcoming the fluctuations of the
normal cycle.
GnRH analogues :Are very effective because they turn
off ovarian activity.Contineous combined form of
hormone replacement therapy should be adminstered
concurrently to reduce the risk of osteoporosis.
Selective serotonine reuptake inhibitors(SSRIs):There
is good evidence that they significantly improves
PMS.
3.Vitamins:
Magnisium,calcium,isoflavones and vitamin
B6 may be useful in the treatment.
4.Alternative therapies:
St John’s Wort improve mood. Evening prime rose
although commonly used but there is no evidence to
support its use in treating PMS.
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Cognative-behavioral therapy(CBT):Is particularly
effective when combined with SSRIs
5.Hysterectomy
with bilateral salpingo-oophrectomy:This
should only be perfomed when all other treatments fail.
Preoprative trial of GnRH analogue as a( test) to ensure that
switching off ovarian function (by oophrectomy) will
indeed cure the proplem