( Pms ) Premenstrual syndrome

Premenstrual syndrome

1. Premenstrual syndrome BY DEEPIKA GUPTA GROUP 633

2. Premenstrual syndrome Pms is a psychoneuroendocrine disorder of unknown etiology , often seen prior to menstruation. There is a cyclic appearance of large number of symptoms during last 7-10 days of MC.

3. American College of Obstetricians and Gynecologists (ACOG) criteria for PMS Not related to any organic lesion. Regularly occurs during luteal phase of each ovulatory MC Symptoms must be severe enough to disturb the life style of the women or she requires medical help. symptom – free period during rest of the cycle When these Symptoms distrupt daily functioning they are grouped under the name Premenstrual dysphoric disorder (PMDD).

4. Pathophysiology The exact cause is unknown but the following hypothesis are postulated - Alteration in the level of estrogen and progesterone starting from the midluteal phase .Either there is altered etrogen : progesterone ratio or diminished progesterone level . Neuroendocrine factors- Serotonin – during pms decreased synthesis of serotonin observed .

5. 2 Endorphins : withdrawal of endorphins from CNS during luteal phase leads to Symptom complex of PMS. 3 Alpha –aminobutyric (GABA) –supresses the anxiety level in the brain . Psychological and Physiological factors may be involved to produce behavioral changes .

6. Clinical features More common in women aged 30-45 .It may be due to childbirth or distrubing life event. There are no abnormal pelvic findings expecting features of pelvic congestion .

7. Tabel Symptomatology of PMS and PMDD Related to water Abdominal bloating Breast tenderness Swelling of extremities Weight gain Neuropsychiatric symptoms Irritability Depression Mood swings Forgetfulness Restlessness
Increased appetite
Tearfulness Anxiety Confusion Headache anger

8. Treatment General non pharmacological – yoga , stress management , diet manipulation, avoidance of salt intake , caffeine , alcohol especially in second half of the cycle improves the symptoms. Non harmonal Tranquilizers and anti depressants , Pyridoxine 100 mg twice daily for correcting tryptophan metabolism Diuretics in the second half of the cycle – furesemide 20 mg daily for 5 days a week reduces fluid retention Anxioltyics - alprazolum 0.25mg ,BID given in luteal phase Selective serotonin reuptake inhibitors and noradrenaline reuptake inhibitors -

9. Other drugs used are Sertaline 50mg /day and venlafaxine Harmone therapy Oral contraceptive pills – to suppress ovulation and to maintain an uniform harmonal milieu. The therapy is to be continued for 3-6 cycles. Drospirenone containing OPCS are found to be better. Progesterone is not effective in testing PMS . Levonorgestrel intrauterine system had been used to suppress ovarian cycle. Spironolactone : it is a potassium sparing diuretic . It has anti- mineralocorticoid and anti androgenic effects. It is given in luteal phase (25-200mg/day) .It improves the symptoms of PMDD. Bromocriptine : 2.5 mg daily or twice daily may be helpful to relieve breast complaints. Suppression of ovarian cycle- Danazol 200 mg daily is to be adjusted so as to produce amennorhea GnRH analogues – the gonadal streoids are suppressed by administration of GnRH agonist for 6 months . Goserelin – 3.6 mg subcutaneously at every 4 weeks

10. GnRH agonist therapy is conbined with estrogen progesterone “ add-back” to combat the hypoestrogenic symptoms. Oophorectomy – in established cases of primary PMS with recurrence of symptoms and approaching to menupause , hysterectomy with bilateral oophorectomy is last resort.