T/F: normal cyclic symptoms that precedes menstruation is known as pre-menstrual disorder
False; it is called molimina. Premenstrual disorder is the presence of both physical AND behavioral symptoms that occur repetitively in the luteal phase of the menstrual cycle
What is premenstrual disorder?
Presence of both physical and behavioral symptoms that occur repetitively in the luteal phase of the menstrual cycle and functionally interfere with some aspect of the woman’s life
What is premenstrual dysphoric disorder?
Severe form of PMS in which sxs of irritability, anger, and emotional tension predominate over somatic symptoms such as bloating
T/F: PMS is the most prevalent complaints amongst menstruating women
False; premenstrual/moliminal symptoms affect up to 75% of women, vs PMS affects 3-8%
PMS and PMDD are cyclic symptoms that correspond to _____ phase of the menstrual period, and completely remit after the cessation of menses
Luteal
How does PMDD differ from PMS?
PMDD there is predominance of mood symptoms and it is more severe with significant impairment in daily life
Changes in estradiol and progesterone could cause deficiency in which neurotransmitter?
Serotonin, which is highly contributory to PMS/ PMDD symptoms
How could bloating and weight gain be explained physiologically?
RAAS system interacts with estrogen and progesterone
Activation by estrogen could explain symptoms
How long should the daily symptom diary be used for after initial visit?
For at least 2 full cycles
T/F: the symptom diary only pertains to when the patient is menstruating
False; need every day so the doctor can tell if it fall on the luteal phase of the cycle
T/F: symptom diary only asks the patient to document their affective symptoms, ie emotion, irritability, anxiety, confusion, insomnia
False; wants both affective and somatic symptoms
Components needed from a patient symptom diary:
Cover all days of month/cycle
Rate the severity of symptoms
Affective symptoms
Somatic symptoms
How is PMS/PMDD diagnosed?
History of 2 or more consecutive menstrual cycles with luteal phase symptoms
Based on self-reported symptoms of at least 1 affective and 1 somatic symptom during the 5 days prior to menses
Ends within 4 days after her period starts
Interferes with some of her normal activities
Diagnosis of PMS must have symptoms ____ Days before menses, consist of ___ somatic, _____affective symptom(s), and symptoms end within _____ days after period starts
5
1
1
4
T/F: to diagnose PMS/PMDD, patient must be somnolent on exam and require a psychiatric evaluation
False; no physical examination finding, lab or imagining studies are needed to diagnose PMS/PMDD
Medical conditions that could caus similar symptoms as PMS/PMDD:
Endometriosis
Ovarian cysts
Thyroid disorder
Anemia
Chronic fatigue syndrome
Irritable bowel syndrome
Depression
Anxiety
Bipolar
Most common conditions that overlap with PMS and PMDD are:
Depression
Anxiety
(these conditions are present everyday and not just during luteal phase
T/F: PMS/PMDD can worsen other conditions such as asthma, migraines, allergies, seizure
True
Treatment for PMS/PMDD:
Lifestyle for mild-moderate symptoms
SSRI for moderate to severe
Diet supplement – calcium, magnesium Vitamin B6 E D, chaste tree berry extract?
OCP
OMT- of course – balance autonomic, focus on sacrum