Premenstrual SyndromePremenstrual Syndrome

Table Of ContentTable Of Content

IntroductionIntroduction EtiologyEtiology Pathopysiology Pathopysiology Sign and symptomsSign and symptoms DiagnosisDiagnosis ManagementManagement ConclusionConclusion BibliographyBibliography

IntroductionIntroduction

Premenstrual syndrome (PMS) is a Premenstrual syndrome (PMS) is a group of physical and behavioral group of physical and behavioral symptoms that occur in a cyclic pattern symptoms that occur in a cyclic pattern during the luteal phase of the during the luteal phase of the menstrual cycle.menstrual cycle.

Symptoms usually start between ages Symptoms usually start between ages 25-35 years.25-35 years.

PMS symptoms vary greatly from PMS symptoms vary greatly from woman to woman and cycle to cycle, woman to woman and cycle to cycle, and they can range from mild to severe and they can range from mild to severe

Menstrual CycleMenstrual Cycle

Premenstrual syndrome Premenstrual syndrome EtiologyEtiology

The exact cause is unknown but is believed to be related to The exact cause is unknown but is believed to be related to interactions between sex hormones and brain chemicals interactions between sex hormones and brain chemicals

(neurotransmitters).(neurotransmitters). Interactions of ovarian hormones with neurotransmitters – Interactions of ovarian hormones with neurotransmitters –

Alterations of serotoninergic and GABAnergic activity in the Alterations of serotoninergic and GABAnergic activity in the brain.brain.

Imbalance between Estrogen and Progesterone levelsImbalance between Estrogen and Progesterone levels

Serotonin deficiency Serotonin deficiency

Effects of hormone shift on endogenous opiodsEffects of hormone shift on endogenous opiods

Biologic, physiologic, environmental and social factors all Biologic, physiologic, environmental and social factors all seems to be contributoryseems to be contributory

Genetic factors seems to play a role.Genetic factors seems to play a role.

PATHOPYSIOLOGYPATHOPYSIOLOGY Causes of PMS include an estrogen excess, estrogen withdrawal, Causes of PMS include an estrogen excess, estrogen withdrawal,

progesterone deficiency, pyridoxine (vitamin B-6) progesterone deficiency, pyridoxine (vitamin B-6) deficiency, alteration of glucose metabolism, and fluid-electrolyte deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the imbalances. Current research provides some evidence supporting the following etiologies:following etiologies:

Serotonin deficiency is postulated because patients who are most Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels. The symptoms affected by PMS have differences in serotonin levels. The symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which are medications that increase the amount of circulating which are medications that increase the amount of circulating serotonin.serotonin.

Magnesium and calcium deficiencies are postulated as nutritional Magnesium and calcium deficiencies are postulated as nutritional causes of PMS. Studies evaluating supplementation show causes of PMS. Studies evaluating supplementation show improvement in physical and emotional symptoms.improvement in physical and emotional symptoms.

Women with PMS often have an exaggerated response to normal Women with PMS often have an exaggerated response to normal hormonal changes. Although their levels of estrogen and hormonal changes. Although their levels of estrogen and progesterone are similar to women without PMS, rapid shifts in levels progesterone are similar to women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical of these hormones promote pronounced emotional and physical responses.responses.

Other theories under investigation include increased endorphins, Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric system (GABA), and alterations in the gamma-aminobutyric system (GABA), and hypoprolactinemia. hypoprolactinemia.

Common Symptoms Of Premenstrual SyndromeCommon Symptoms Of Premenstrual Syndrome

Behavioral symptoms: fatigue, insomnia, dizziness, changes Behavioral symptoms: fatigue, insomnia, dizziness, changes in sexual interest, food cravings or overeating in sexual interest, food cravings or overeating

Psychologic symptoms: irritability, anger, depressed mood, Psychologic symptoms: irritability, anger, depressed mood, crying and tearfulness, anxiety, tension, mood swings, lack crying and tearfulness, anxiety, tension, mood swings, lack of concentration, confusion, forgetfulness, restlessness, of concentration, confusion, forgetfulness, restlessness, loneliness, decreased self-esteem, tension loneliness, decreased self-esteem, tension

Physical symptoms: headaches, breast tenderness and Physical symptoms: headaches, breast tenderness and swelling, back pain, abdominal pain and bloating, weight swelling, back pain, abdominal pain and bloating, weight gain, swelling of extremities, water retention, nausea, gain, swelling of extremities, water retention, nausea, muscle and joint painmuscle and joint pain

Premenstrual syndrome DiagnosisPremenstrual syndrome Diagnosis

Exclude medical, physical and psychiatric problemsExclude medical, physical and psychiatric problems

TSH, Drug screening, Blood glucose level etc.TSH, Drug screening, Blood glucose level etc.

Keep symptoms calendar.Keep symptoms calendar.

- At least two consecutive menstrual cycles- At least two consecutive menstrual cycles

- Nature, and timing- Nature, and timing

Exclude simple Menstrual symptoms like breast tenderness Exclude simple Menstrual symptoms like breast tenderness and bloating, not affecting daily activities.and bloating, not affecting daily activities.

Premenstrual DisordersPremenstrual DisordersDiagnosisDiagnosis

Adapted from AFP Journal, April 15,2003

Premenstrual Syndrome Premenstrual Syndrome treatmenttreatment

-Bromocriptine-Bromocriptine -Oral contraceptives-Oral contraceptives

-Vitamin B-Vitamin B66

-Monoamine oxidase inhibitors-Monoamine oxidase inhibitors-Synthetic progestational agents-Synthetic progestational agents

-Spironolactone-Spironolactone-Massage therapy-Massage therapy

-Chiropractic therapy-Chiropractic therapy-Calcium-Calcium

Premenstrual SyndromePremenstrual SyndromeManagementManagement

Goals of treatmentGoals of treatment

- Reduction or elimination of symptoms- Reduction or elimination of symptoms

- Improvement in social and occupational - Improvement in social and occupational functioning. functioning.

Premenstrual DisordersPremenstrual DisordersManagementManagement

Lifestyle Changes or Conservative treatmentLifestyle Changes or Conservative treatment:: - Aerobic exercise- Aerobic exercise

- Dietary changes; Frequent small meals, High complex - Dietary changes; Frequent small meals, High complex carb., low salt carb., low salt

- Reduce caffeine intake- Reduce caffeine intake

- Reduce substance abuse e.g. alcohol- Reduce substance abuse e.g. alcohol

- Hygiene- Hygiene

- Smoking cessation- Smoking cessation

Nutritional SupplementsNutritional Supplements::

- Vitamin B6 (100mg/day) and Vitamin E (600iu/day) May - Vitamin B6 (100mg/day) and Vitamin E (600iu/day) May have some efficacyhave some efficacy

- Calcium carbonate ( 1,200- 1,600mg/day- Calcium carbonate ( 1,200- 1,600mg/day))

Premenstrual DisordersPremenstrual DisordersManagementManagement

Nutritional SupplementsNutritional Supplements::

- Magnesium ( up to 500mg/day)- Magnesium ( up to 500mg/day)

-Tryptophan -Tryptophan

Herbal TherapiesHerbal Therapies::

- Evening primrose oil- Evening primrose oil

- Chaste tree berry- Chaste tree berry

Premenstrual Syndrome ManagementPremenstrual Syndrome Management

Nonpharmacologic treatmentsNonpharmacologic treatments::

- Cognitive behavioral therapy- Cognitive behavioral therapy

- Anger management- Anger management

- Stress reduction and management- Stress reduction and management

- Education- Education

- Light therapy- Light therapy

- Therapy- Therapy

- Support groups- Support groups

Premenstrual syndrome ManagementPremenstrual syndrome Management

Pharmacologic TreatmentsPharmacologic Treatments::

Neurotransmitter modulationNeurotransmitter modulation::

-Selective serotonin reuptake inhibitors (SSRI’s)-Selective serotonin reuptake inhibitors (SSRI’s)

- GABA receptor modulators- GABA receptor modulators

Menstrual Cycle inhibitionMenstrual Cycle inhibition : :

- GnRH agonists- GnRH agonists

- OCP- OCP

Premenstrual Disorders ManagementPremenstrual Disorders Management

Adapted from AFP journal, October 1, 2002

Nursing managementNursing management

Assessment:Assessment:Assess the sign and symptoms of Assess the sign and symptoms of

patient.patient.Assess the vital signs of patient.Assess the vital signs of patient.Assess the nutritional status.Assess the nutritional status.Monitor intake and output chartMonitor intake and output chartAssess the patient for G.I symptomsAssess the patient for G.I symptoms

Nursing diagnosisNursing diagnosis

1.Acute pain in back or cramps in 1.Acute pain in back or cramps in abdomen related to PMS.abdomen related to PMS.

2.Altered nutrition status related to 2.Altered nutrition status related to the constipation or diarrhea.the constipation or diarrhea.

3.Anxiety related to the sudden 3.Anxiety related to the sudden changes occur due to PMS.changes occur due to PMS.

4.knowledge deficit related to 4.knowledge deficit related to syndrome and symptom management.syndrome and symptom management.

Nursing interventionsNursing interventions

Exercise regularly, at least three times a week – Exercise regularly, at least three times a week – try to exercise daily in the premenstrual period.try to exercise daily in the premenstrual period.

Don’t smoke.Don’t smoke. Cut back on caffeine and alcohol in the two weeks Cut back on caffeine and alcohol in the two weeks

before menstruation.before menstruation. Ensure that patient get good sleep.Ensure that patient get good sleep. Eat smaller meals more often – for example, have Eat smaller meals more often – for example, have

six ‘mini-meals’ instead of three main meals.six ‘mini-meals’ instead of three main meals. Reduce your intake of salty foods.Reduce your intake of salty foods. Include more fresh fruits and vegetables and Include more fresh fruits and vegetables and

wholegrain foods in your daily diet.wholegrain foods in your daily diet.

Nursing interventionsNursing interventions

Record daily intake food choices in your Record daily intake food choices in your PMS diary – charting the food intake may PMS diary – charting the food intake may help to become more aware of high-fat help to become more aware of high-fat and high-sugar snacking.and high-sugar snacking.

Aspirin, ibuprofen, and other NSAIDs may Aspirin, ibuprofen, and other NSAIDs may be prescribed for headache, be prescribed for headache, backache, menstrual cramping, and breast backache, menstrual cramping, and breast tenderness.tenderness.

Birth control pills may decrease or Birth control pills may decrease or increase PMS symptom.increase PMS symptom.

Health educationHealth education

About disease: teach the patient about About disease: teach the patient about PMS its causes and treatment to prevent PMS its causes and treatment to prevent complications.complications.

About diet: educate the patient to eat well About diet: educate the patient to eat well balanced diet with adequate protein. balanced diet with adequate protein. Reduce the intake of refined Reduce the intake of refined sugars,salts.Increase intake of food high in sugars,salts.Increase intake of food high in vit B magnesium.vit B magnesium.

About medication: Educate the patient to About medication: Educate the patient to take prescribed medication.take prescribed medication.

Health educationHealth education

Other points:Other points:Follow a regular exercise program.Follow a regular exercise program.Teach the relaxation techniques.Teach the relaxation techniques.Advise to take prostaglandin Advise to take prostaglandin

inhibitors or diuretics during inhibitors or diuretics during menstruation period.menstruation period.

Manage the stress.Manage the stress.

Premenstrual DisordersPremenstrual DisordersConclusionConclusion

PMS affects women in the reproductive age groupPMS affects women in the reproductive age group

PMS can be treated.PMS can be treated.

All women with PMS should be offered nonpharmacological All women with PMS should be offered nonpharmacological treatment first.treatment first.

Symptoms diary to help monitor symptoms are Symptoms diary to help monitor symptoms are recommendedrecommended

SSRI is the first choice for pharmacological treatment.SSRI is the first choice for pharmacological treatment.

SUMMARIZATIONSUMMARIZATION

RECAPTULIZATIONRECAPTULIZATION

1. What is PMS?1. What is PMS?2.what are the causes of PMS?2.what are the causes of PMS?3.what are the sign and symptoms of 3.what are the sign and symptoms of

PMS?PMS?4.how will you treat PMS?4.how will you treat PMS?5.what are the drugs used to treat 5.what are the drugs used to treat

PMS?PMS?

THANK YOUTHANK YOU