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PREMENSTRUAL SYNDROME (PMS)

AND PREMENSTRUAL DYSPHORIC


DISORDER (PMDD)
PREMENSTRUAL PREMENSTRUAL
DYSPHORIC
SYNDROME (PMS) DISORDER (PMDD)
Many women feel physical or Severe, sometimes disabling
mood changes during the days extension of premenstrual
before menstruation. When syndrome (PMS)
these symptoms happen month
after month, and they affect a PMDD causes extreme mood
woman’s normal life, they are shifts that can disrupt work
known as PMS efforts and damage
relationships

Premenstrual disorders affect up to 12% of women


PMS: PMDD:
SYMPTOMS SYMPTOMS
Affective Symptoms PMS Symptoms Plus:
Depression Decreased interest in usual activities
Angry outbursts Subjective sense of having difficulty
Irritability in concentrating
Anxiety
Confusion Lethargy, fatigue, or marked lack of
Social withdrawal energy
Somatic Symptoms Marked change in appetite and
cravings for certain foods
Breast tenderness
Abdominal bloating Hypersomnia or insomnia
Headache Feeling overwhelmed or out of
Swelling of extremities control
PMS: PMDD:
DIAGNOSIS DIAGNOSIS
Symptoms must be A. Experience at least one of the following:
present in the 5 days 1.Markedly depressed mood, feelings of hopelessness,
before period for at self-deprecation
least three menstrual 2.Marked anxiety, tension, feelings of being “keyed up”
cycles in a row or “on edge”
3.Suddenly feeling sad or tearful, with increased
Symptoms must end sensitivity to personal rejection
within 4 days after Persistent and marked irritability, anger, or increased
period starts interpersonal conflicts
Symptoms must B. The disturbance markedly interferes with work or
school, or with usual social activities and relationships
interfere with some with others
of her normal
C. The disturbance is not merely an exacerbation of the
activities symptoms of another disorder, although it may be
superimposed on one
*Criteria A, B, and C must be confirmed by prospective
daily ratings during at least two consecutive symptomatic
cycles
TREATMENT: CURRENT DATA SUPPORTS THEORY OF
SEROTONINERGIC DYSREGULATION
PMS = NSAIDS AND OCP PMDD = SSRI + NSAID + OCP

Treating Psychiatric Symptoms by Treating both Psychiatric and


Increasing Serotonin with SSRI: Physical Symptoms with OCP to
Suppress Ovulation:
Sertraline (Zoloft)
Paroxetine (Paxil)
levonorgestrel/ethinyl estradiol
Fluoxetine (Prozac)
Citalopram (Celexa) [off-label]
Escitalopram (Lexapro) [off-label]

The availability of serotonin is decreased in the progesterone-dominant luteal phase

GOLD STANDARD (First Line) FOR PMDD Tx = SSRI


ADDITIONAL TREATMENT OPTIONS:
Eat some fruit, don’t drink etoh, do some *aerobic exercise, *supplement with calcium
carbonate and magnesium
*demonstrated significant improvement in symptoms for both PMS and PMDD

NSAIDS: useful in PMS patients with dysmenorrhea, breast pain, and leg edema
Spironolactone: Decrease Bloating
Alternative Choices for Supressing Ovulation: danazol, or GnRH agonists
DOES MY PATIENT HAVE MAJOR
DEPRESSION DISORDER OR PMDD???
You need to delineate if this is MDD or PMDD
because treatment differs between the two
Give the patient a copy of the Daily Record of
Severity of Problems
QUESTIONS:

What is the liekly Dx?


Based on your most likely Dx, what do we need to rule out?
How will you rule this out?
She likely has PMDD, but we need to rule out MDD. Have her
fill out the Daily Record of Severity of Problems to rule out
MDD.

ANSWER:

Good Job!
WHAT ABOUT MOLIMINA?
Molimina:
normal cyclic symptoms associated with ovulation, which do not interfere with the
patient’s daily routine

Menstrual molimina refers to the occurrence of three or four mild symptoms such as
breast tenderness or mastalgia, food cravings, fatigue, sleep problems, headaches,
or fluid retention that occur during the luteal phase of the menstrual cycle. ...
Menstrual molimina is a not considered PMS or premenstrual syndrome.