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Updated: Aug 21 2021

Premenstrual Syndrome (PMS)

Snapshot
  • A 29-year-old female patient complains of depression, poor sleep quality, and breast tenderness. These symptoms occur on a monthly basis, about 2 weeks before menstruation. Her symptoms greatly improve with menses.

Introduction
  • Recurrent physical and behavioral symptoms manifesting during the luteal phase of the menstrual cycle
    • resolve with menstruation
    • absence of secondary causes
    • severe: premenstrual dysphoric disorder (PMDD) 
Presentation
  • Physical and behavioral symptoms
    • physical
      • abdominal bloating, breast pain, cramps
    • behavioral
      • anger, irritability, changes in appetite
Evaluation
  • Diary of symptoms for >2 cycles    
    • temporal relationship of symptoms to cycle is important
Treatment
  • Selective serotonin re-uptake inhibitors (SSRIs)
    • severe PMS, PMDD
    • paroxetine is contraindicated in pregnancy
      • first trimester exposure may lead to congenital heart disease
  • Drospirenone + ethinyl estradiol (Yaz; Yasmin)
    • drospirenone is a spironolactone analog
      • antiandrogen and antimineralocorticoid effects
  • Gonadotropin-releasing hormone agonist (GnRH agonist)

A 29-year-old female patient complains of depression, poor sleep quality, breast tenderness and abdominal bloating. These symptoms occur on a monthly basis, about 2 weeks before menstruation. Her symptoms greatly improve with menses.

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