Questions and Answers
What is premenstrual tension syndrome characterized by?
A group of disorders and symptoms cyclically recurring in relation to premenstrual period
What is one of the emotional symptoms of premenstrual tension syndrome?
Irritability
Which of the following is a behavioral symptom of premenstrual tension syndrome?
Absenteeism
What is the ovarian hormone hypothesis of premenstrual tension syndrome?
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What is the purpose of diet modification in managing premenstrual tension syndrome?
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Which of the following foods is recommended in the diet of women with premenstrual tension syndrome?
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Which of the following medications is used to treat premenstrual tension syndrome?
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What is the goal of non-pharmacologic treatment of premenstrual tension syndrome?
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Why is it important to exclude organic disease in the diagnosis of premenstrual tension syndrome?
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What is one of the differential diagnoses of premenstrual tension syndrome?
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Study Notes
Premenstrual Tension Syndrome (PMS)
- A group of disorders and symptoms that cyclically recur in relation to the premenstrual period
- Symptoms can be severe enough to interfere with a patient's regular lifestyle
Manifestations of PMS
- Emotional symptoms:
- Irritability
- Depression
- Mood swings
- Fluid retention symptoms:
- Breast pain
- Weight gain
- Bloating
- Behavioral symptoms:
- Absenteeism
- Aggressive behavior
- Suicide
- Musculoskeletal symptoms:
- Headache
- Tiredness
- Ache
Pathogenesis
- Ovarian hormone hypothesis:
- Progesterone deficiency
- Progesterone receptor insensitivity
- Serotonin hypothesis:
- Serotonin deficiency
- Serotonin receptor insensitivity
- Psychological hypothesis:
- Unconscious conflicts
- Maladaptive coping
Diagnosis
- Exclude organic disease
- Explore underlying psychological troubles
- Helpful diagnostic points:
- Positive family history on the female side
- Symptoms start early but worsen with age
Differential Diagnosis
- Premenstrual syndrome
- Major depression
- Dysmenorrhea
- Substance abuse
- Perimenopausal symptoms
- Sexual dysfunction
- Fibromyalgia
Management
- Non-pharmacologic treatment:
- Reassurance
- Lifestyle changes
- Leisure time (stress reduction)
- Exercise
- Avoiding bad habits
- Psychotherapy
- Diet
- Diet and PMS:
- Frequent small meals
- Avoid salty and sweet diet
- Protein intake
- Complex carbohydrates
- Foods containing 5HT (e.g., oatmeal, bananas)
- Drug therapy:
- Diuretics
- Laxatives
- Vitamins
- PUFA (primrose)
- Pain killers
- Mood elevators (SSRI, e.g., Fluoxetine)
- Agnucaston
- GABA (gamma amino butyric acid)
- OCP (oral contraceptive pills)
- Calcium, vitamin B6, B12
- Long-acting GnRH agonist
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