Pre Menstrual syndrome (PMS)- Adolescent disorder

Premenstrual syndrome is a combination of psychological and physical symptoms that begin during the luteal phase of menstrual life.
This presentation consists of concise content for PMS required for final year BPT students. I hope this helps you to clear your concepts for the same. Thank you for your time.

1. Pre-Menstrual Syndrome
Made by & Presented By: Rutvi Raualji (PT)
(MPT-Women’s Health)
Presented to: Final Yr. BPT

2. Contents
•Introduction
•Aetiology
•DiagnosticCriteria
•Clinicalfeatures
•DifferentialDiagnosis
•References

3. Introduction
•Pre-MenstrualSyndrome(PMS)isacombination
ofpsychologicalandphysicalsymptomsthat
beginduringthelutealphaseofmenstrualcycle
(upto14dayspriortomenses).
•Itischaracterizedbysymptomswhichusually
ceasebytheendofmenstruation,witha
symptom-freeperiodtillovulation.
•Severityrangesformmildtosevere-mayhinder
theirworkandADLactivities.
•ThemostsevereformofPMSisdefinedas
PREMENSTRUAL DYSPHORIC DISORDER
(PMDD).
•PrevalenceinIndiais43%;inadolescence:49.6%;
severePMS:3%to8%women.

4. Aetiology
1.Afterovulation,oestrogenandprogesteronelevels
beginfallingdramaticallyifnotpregnant-goes
awaywithinafewdaysafterawoman’speriodstarts
ashormonelevelsbeginrisingagain.
2.Accordingtomolecularbiologystudies,the
decreasedoestrogencausesthehypothalamusto
reducenorepinephrine,whichtriggersadecline
inacetylcholine,dopamine,andserotoninthat
leadstoinsomnia,fatigue,depression.
3.Dietaryfactorssuchasconsumptionoffastfood,
drinkscontainingsugar,deep-friedfoods,and
lifestylefactorssuchaslesshabitualexerciseand
poorsleepqualityissignificantlyassociatedwith
PMS.

5. DiagnosticCriteria-AmericanCollegeof
ObstetriciansandGynaecologist(ACOG)
•Symptomsmust:
1.Bepresentinthe5daysbeforeaperiod
foratleast3menstrualcyclesinarow.
2.Endwithin4daysafterperiodstarts.
3.Interferewithsomenormalactivities.

6. Clinical Presentation
Physical
1.Abdominalbloatingorcramping
2.Fatigue
3.Constipation
4.Headache
5.Breasttenderness
6.Changeinappetite(food
cravings)
7.Disturbanceinsleep
8.Skinproblems,acne
9.Musclesandjointpain
10.Swellingofhandsandfeet
Emotional
1.Depression
2.Anxiety
3.Cryingspells
4.Lessinterestinintercourse
5.Insomnia
6.Poorconcentration
7.Angeroutburst
8.Irritability
9.Confusion
10.Socialwithdrawal
11.Increasednaptaking

7. Differential Diagnosis
1.Depression
2.Anxiety
3.Perimenopause
4.Chronicfatiguesyndrome
5.Thyroiddisease

8. Management
•Aim:Toreducetheeffectofsymptomondailyroutineactivities.
•Techniques:
1.Medicalmanagement
2.Aerobicandresistedexercises
3.Yoga
4.Lifestylemodifications
5.CognitiveBehaviouraltherapy

9. 1.)Medicalmanagement
1.Selectiveserotoninuptake
inhibitors(formoderatetosevere
PMS)
2.Oralcontraceptivepills
3.Antidepressants
4.NSAIDSlikeIbuprofen-toreduce
pain
5.Diuretics-toreducewaterretention

10. 2.)Lifestylemodifications
➢Supplementations:ofcalcium,magnesium,andvitamin
E
➢Dietaryadvices:
1.Eatdietrichincomplexcarbohydrates-reducemood
symptomsandfoodcravings(example-whole-wheat
bread,pasta,cereals,barley,brownrice,beans,and
lentils)
2.Calciumrichdiet-likeyogurtandleafygreen
vegetables.
3.Decreaseintakeoffat,sugar,andsalt
4.Avoidcaffeineandalcohol
➢Eatingschedule-6meals/dayratherthan3largemeals.
Keepbloodsugarlevelstable.

11. 3.) Physiotherapy
Management
1.Aerobicsandresistedexerciseplay
majorroletoreducepainand
discomfort.
2.Modalities:TENS,Hotpack,
Acupuncture,Acupressure.
3.Abdominalstretchescanalsohelpin
reducingthesymptoms.

12. 4.) Yoga
•Why?Yogareducesthestressinducednegativeeffectstoimmunesystemby
regulatingpositivelytheadjustmentimmunoglobulinAandreducesharmful
inflammatorysecretions.
1.Kapalbhartipranayama,
2.Cat-cowpose,
3.Child’spose,
4.Plankpose,
5.Cobrapose,
6.Savasanaforrelaxation

13. 5.) Cognitive behavioural therapy
•CBTisamethodthatcanhelpmanageproblemsbychangingthewaypatients
wouldthinkandbehave.Itisnotdesignedtoremoveanyproblemsbuthelp
managetheminapositivemanner.
•Negativethoughts(example:Backpain)->Negativefeelings(depressionand
anxiety)andmaladaptivehealthbehaviours(skippingtreatmentsessions)->
reinforcesnegativecycle.
•Viaeducation,suchnegativethoughtcanbechangedorbetterunderstood,thenit
canbreakdownthisnegativecycle.

14. References
1.VaghelaN,MishraD,ShethM,DaniVB.Tocomparetheeffectsofaerobic
exerciseandyogaonPremenstrualsyndrome.Journalofeducationandhealth
promotion.2019;8.
2.Rohmah,YuniKhoiriyatulMujtahidahandMukhoirotinMukhoirotin???.
“Abdominalstretchingtoreducepremenstrualsyndrome:acaseseries.”(2020).

15. Thank You..