MANAGEMENT OF PRE MENSTRUAL SYNDROME.pptx

Related to Gynaecology

1. MANAGEMENT OF PRE MENSTRUAL SYNDROME By, PRAVEEN KUMAR Roll no. - 66

2. Life style modification and congnitive behavior therapy are important steps. TREATMENT

3. NON- PHARMACOLOGICAL: (a) Assurance, yoga, stress management, diet manipulation. (b)Avoidance of salt, caffeine and alcohol specially in second half of cycle improves the symptoms.

4. NON – HORMONAL : Tranquilizers or antidepressant drugs , may be of help. „ Pyridoxine - 100 mg twice daily is helpful by correcting tryptophan metabolism specially following ‘pill’ associated depression. „ Diuretics- In the second half of the cycle – Frusemide 20 mg daily for consecutive 5 days a week reduces fluid retention. „ Anxiolytic agents- are found to be helpful to women having persistent anxiety. Alprazolam 0.25 mg, BID is given during the luteal phase of the cycle.

5. SSRI’s and SNRI’s: Fluoxetine- Is an antidepressant that inhibits neuronal uptake of serotonin (SSRI). A single oral dose of 20 mg was found to improve the psychiatric and behavioral symptoms significantly. These drugs are usually prescribed at least two days prior to the onset of symptoms and to be continued till menstruation starts. Other drugs used are: Sertaline (50 mg/day) and Venlafaxine.

6. HORMONAL: Oral contraceptive pills (OCPs): The idea is to suppress ovulation and to maintain an uniform hormonal milieu. The therapy is to be continued for 3–6 cycles. Newer OCPs contain progestin drospirenone . It has anti mineralocorticoid and antiandrogenic properties. Drospirenone containing OCPs are found to have better control of symptoms. „ Progesterone : It is not effective in treating PMS. Levonorgestrel intrauterine system (IUS) had been used to suppress ovarian cycle.

7. Spironolactone : It is a potassium sparing diuretic. It has anti-mineralocorticoid and anti-androgenic effects. It is given in the luteal phase (25–200 mg/ day). It improves the symptoms of PMDD. „ Bromocriptine : 2.5 mg daily or twice daily may be helpful, at least to relieve the breast complaints

8. SUPRESSION OF OVARIAN CYCLE: Danazol - 200 mg daily is to be adjusted so as to produce amenorrhea. Barrier method of contraception should be advised during the treatment. GnRH analogs: The gonadal steroids are suppressed by administration of GnRH agonist for 6 months (medical oophorectomy). GnRH analog in PMS are used: ( i ) To assess the role of ovarian steroids in the etiology of PMS. (ii) This can also predict whether bilateral oophorectomy would be of any help or not.

9. The preparations and doses used are : – Goserelin ( Zoladex ): 3.6 mg is given subcutaneously at every 4 weeks. – Leuprorelin acetate ( Prostap ): 3.75 mg is given by SC or IM at every 4 weeks. – Triptorelin ( Decapeptyl ): 3 mg is given IM every 4 weeks.

10. SURGICAL: Hysterectomy with bilateral oophorectomy: In established cases of primary PMS with recurrence of symptoms and approaching to menopause, hysterectomy with bilateral oophorectomy is a last resort.