premenstrual tension syndrome 2010

8/9/2019 Premenstrual Tension Syndrome 2010

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Premenstrual TensionPremenstrual Tension

SyndromeSyndromePremenstrual tension syndrome is a mishmash ofPremenstrual tension syndrome is a mishmash of

symptoms both physical and emotional that tend tosymptoms both physical and emotional that tend tooccur many days leading up to menstruation. Theseoccur many days leading up to menstruation. These

physical and emotional symptoms can be very severe inphysical and emotional symptoms can be very severe insome women, and has been known to lead tosome women, and has been known to lead to

devastating consequences in some cases. They aredevastating consequences in some cases. They arethought to be due to the hormonal changes prior tothought to be due to the hormonal changes prior tomenstruation, though the specific changes have notmenstruation, though the specific changes have not

been fully worked out. These symptoms tend to easebeen fully worked out. These symptoms tend to easeoff with the onset of menstruation and affected womanoff with the onset of menstruation and affected woman

may remain free for up to two weeks.may remain free for up to two weeks.


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Distinguish from PMDDDistinguish from PMDD PMDD is a severe form of premenstrual syndrome,PMDD is a severe form of premenstrual syndrome,

affecting about 75 percent of women of childbearingaffecting about 75 percent of women of childbearingage. About 2 to 10 percent of women in this ageage. About 2 to 10 percent of women in this agegroup have PMDD.group have PMDD.

The symptoms of PMDD are:The symptoms of PMDD are: Sadness and cryingSadness and crying Feeling nervous, anxious, and irritableFeeling nervous, anxious, and irritable Strong cravings for certain foodsStrong cravings for certain foods Problems paying attention and concentratingProblems paying attention and concentrating Physical problems such as breast tenderness,Physical problems such as breast tenderness,

headaches, joint or muscle pain and swelling orheadaches, joint or muscle pain and swelling orbloating, sleeping disordersbloating, sleeping disorders

These symptoms can affect relationships and workThese symptoms can affect relationships and workability, and occur 10 to 14 days before the period,ability, and occur 10 to 14 days before the period,improving when the period starts.improving when the period starts.


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PMSPMS Over 150 symptoms.Over 150 symptoms.

headache, backache, weight gain, breastheadache, backache, weight gain, breasttenderness, abdominal fullness and feeling oftenderness, abdominal fullness and feeling ofbloatedness, ankle swelling, and sometimesbloatedness, ankle swelling, and sometimes

abdominal pain or cramps, irritability whichabdominal pain or cramps, irritability whichmay developed to highly aggressive levels andmay developed to highly aggressive levels andepisodes of knife and gun attacks have beenepisodes of knife and gun attacks have beenreported.reported.

The symptoms disappear in pregnancy, andThe symptoms disappear in pregnancy, andwith fewer pregnancies nowadays, women arewith fewer pregnancies nowadays, women arespending more of their life with symptoms ofspending more of their life with symptoms of

premenstrual tension syndrome.premenstrual tension syndrome.


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AetiologyAetiology

UnknownUnknown

High oestrogen levelsHigh oestrogen levels

Increased or decreased progesteroneIncreased or decreased progesterone

Imbalance in oestrogen/progesterone levelsImbalance in oestrogen/progesterone levels

Increased aldosterone secretion causing fluidIncreased aldosterone secretion causing fluidretentionretention

Serotonin deficiency, hence SSRISerotonin deficiency, hence SSRI

Conclusion : abnormal response to normalConclusion : abnormal response to normalhormone levelshormone levels


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Psychological andPsychological and

behavioural symptomsbehavioural symptoms

Mood swings and depressionMood swings and depressionTearfulness or feeling lowTearfulness or feeling low

Tiredness, fatigue or lethargyTiredness, fatigue or lethargyTension or uneaseTension or uneaseIrritabilityIrritabilityClumsiness/poor coClumsiness/poor co--ordinationordinationDifficulty in concentratingDifficulty in concentratingAltered interest in sexAltered interest in sexSleep disordersSleep disordersFood cravingsFood cravingsAggressionAggression

Loss of selfLoss of self--controlcontrol


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Physical symptomsPhysical symptoms

..Breast tendernessBreast tendernessSwollen/bloated feelingsSwollen/bloated feelingsPuffiness of face, abdomen or fingersPuffiness of face, abdomen or fingersWeight gainWeight gain

HeadachesHeadachesAppetite changesAppetite changesAcne or other skin changesAcne or other skin changesConstipation or diarrhoeaConstipation or diarrhoeaMuscle or joint stiffnessMuscle or joint stiffness

General aches and pains, esp. backacheGeneral aches and pains, esp. backacheAbdominal pain/crampsAbdominal pain/crampsExacerbation of epilepsy, migraine, asthma, rhinitisExacerbation of epilepsy, migraine, asthma, rhinitisor urticariaor urticaria


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TreatmentTreatment

Campbell EM et al(1997), Singh BB and SimpsonCampbell EM et al(1997), Singh BB and SimpsonRL (1998) and Pullon SR et al have done studiesRL (1998) and Pullon SR et al have done studiesdescribing womens perception of thedescribing womens perception of theeffectiveness of various treatment options.effectiveness of various treatment options.

ProgesteroneProgesterone 3 RCTs showed some3 RCTs showed someeffectiveness, and 4 showed no benefit, ?effectiveness, and 4 showed no benefit, ?Placebo effect. Also progesterone can inducePlacebo effect. Also progesterone can inducePMTPMT

OCPs

OCPs Beneficial for some, but mood swingsBeneficial for some, but mood swingsworse in othersworse in others

DanazolDanazol effective in some, but consider sideeffective in some, but consider side--effectseffects


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Treatment contd.Treatment contd.

GNRH analoguesGNRH analogues can be effective, but sidecan be effective, but side--effects in longeffects in long--term useterm use

Diuretics help fluid retention , but avoid longDiuretics help fluid retention , but avoid longterm (K depletion)term (K depletion)

SSRIsSSRIs -- Fourteen RCTs showed improvementsFourteen RCTs showed improvementscompared with a placebo. Side effects includecompared with a placebo. Side effects includenausea, vomiting, diarrhoea, dry mouth,nausea, vomiting, diarrhoea, dry mouth,anxiety, headache, palpitations, dizziness andanxiety, headache, palpitations, dizziness and

reduction in libido.reduction in libido. Mefenamic acidMefenamic acid for pain and headachesfor pain and headaches


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Lifestyle changesLifestyle changes -- importantimportant

Frequent intake of carbohydrates:Frequent intake of carbohydrates:Tryptophan levels in the brain are associatedTryptophan levels in the brain are associatedwith serotonin synthesis. Carbohydrates arewith serotonin synthesis. Carbohydrates are

said to raise these levels with a positive effectsaid to raise these levels with a positive effecton mood and cognition.on mood and cognition.

Caffeine and fluid intake:Caffeine and fluid intake:A strong linkA strong linkbetween consumption of caffeine beveragesbetween consumption of caffeine beverages

and PMS symptoms has been found .and PMS symptoms has been found . Pyridoxine (Vitamin B6):Pyridoxine (Vitamin B6):


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Lifestyle changesLifestyle changes -- contdcontd

Pyridoxine (Vitamin B6): an extensive reviewPyridoxine (Vitamin B6): an extensive reviewshowed that vitamin B6 was more effectiveshowed that vitamin B6 was more effectivethan placebo.than placebo.

Zinc:Zinc: While studies have indicated lower zincWhile studies have indicated lower zinclevels in PMS patients, none have measured itslevels in PMS patients, none have measured itseffectiveness as a treatment for the symptoms.effectiveness as a treatment for the symptoms.


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Lifestyle changesLifestyle changes

Evening primrose oil (

EPO):

Evening primrose oil (

EPO):

? deficiency of gamma? deficiency of gamma--linoleic acid (GLA)linoleic acid (GLA)(found in EPO), a precursor of(found in EPO), a precursor ofprostaglandin E1 which may lead to :prostaglandin E1 which may lead to :

Increased sensitivity to luteal phaseIncreased sensitivity to luteal phaseprolactin and steroids.GLA has been usedprolactin and steroids.GLA has been usedin combination with vitamin B6 (100in combination with vitamin B6 (100--150mg per day) for premenstrual150mg per day) for premenstrual

symptoms, including breast pain. A recentsymptoms, including breast pain. A recentmetameta--analysis of clinical trials, in whichanalysis of clinical trials, in whichonly 5 were randomized placeboonly 5 were randomized placebocontrolled, showed that better qualitycontrolled, showed that better quality

research is requiredresearch is required


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OthersOthers

Exercise:Exercise:Although a clear physiologicalAlthough a clear physiologicalexplanation is lacking, three RCTs haveexplanation is lacking, three RCTs havefound that moderate aerobic exercisefound that moderate aerobic exercisereduces negative mood states and pain.reduces negative mood states and pain.

Dong QuaiDong Quai -- AngelicaAngelica sinensissinensis a Chinesea Chinese

herbherb


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Complementary andComplementary and

Alternative TreatmentsAlternative TreatmentsChiropracticChiropractic

AcupunctureAcupuncture

HomeopathyHomeopathyOsteopathyOsteopathy


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ConclusionConclusion

high proportion of women perceived lifestylehigh proportion of women perceived lifestyleadjustmentsadjustments rest, exercise, less caffeine/rest, exercise, less caffeine/alcohol/sugar, increased fluid intake,alcohol/sugar, increased fluid intake,

frequent starchy food, and evening primrosefrequent starchy food, and evening primroseoil (EPO)oil (EPO) plus complementary therapiesplus complementary therapies massage, acupuncture, cognitive behaviourmassage, acupuncture, cognitive behaviourtherapy (CBT), osteopathy and light therapytherapy (CBT), osteopathy and light therapy

as effective.as effective.

premenstrual tension syndrome 2010

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