Managing Premenstrual Symptoms

1
Managing Premenstrual Symptoms
Association of Reproductive Health
Professionalswww.arhp.org
2
Learning Objectives

• Identify 2 types of premenstrual disorders.
• Apply evidence-based management strategies for
  treatment of premenstrual symptoms.

3
Premenstrual Symptoms
Disorders
4
Prevalence of Premenstrual Symptoms in US Women
Ginsberg KA, et al. 2000.
5
PMS vs PMDD

• PMDD may be viewed as a more severe form of PMS

Rapkin A. Psychoneuroendocrinology. 2003.
6
Signs and Symptoms of PMS/PMDD
Symptoms occur
Ovulation
Follicular Phase
Luteal Phase
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 21 22 23 24 25 26 27 28
Days of Menstrual Cycle
more
Malone DC. Am J Manag Care. 2005 Dickerson LM et
al. Am Fam Physician. 2003.
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Signs and Symptoms of PMS/PMDD (continued)

• More than 200 symptoms associated with PMS

Malone DC. Am J Manag Care. 2005 Dickerson LM et
al. Am Fam Physician. 2003.
8
Diagnosis of PMS/PMDD
Occur in luteal phase
Resolves near the start of menstruation
Creates problems or impairment
Not better explained by another diagnosis
Johnson SR. Obstet Gynecol. 2004 Rapkin AJ. Am J
Manag Care. 2005 ACOG. ACOG Practice Bulletin
No. 15. 2000 Dickerson LM et al. Am Fam
Physician. 2003.
9
Menstrual Symptoms Chart for Diagnosis of PMS/PMDD

• List the symptoms you have in the left column.
  Circle the dates of your menstrual period. Fill
  in the boxes on the days your symptoms occur.
  Indicate severity by filling in the boxes as
  shown Mild, Moderate, Severe

Download from www.arhp.org/menstrualsymptomschart
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Multiple Visit Diagnostic Approach for PMS/PMDD
more
Kaur G, et al. Cleve Clin Med. 2004. Johnson SR.
Obstet Gynecol. 2004.
11
Multiple Visit Diagnostic Approach for PMS/PMDD
(continued)
Kaur G, et al. Cleve Clin Med. 2004. Johnson SR.
Obstet Gynecol. 2004.
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PMS/PMDD Treatment Considerations
no single intervention is effective for all
women.
Dimmock PW et al Lancet 2000
Dimmock PW et al. Lancet. 2000. Steiner M. Am Fam
Physician. 2003.
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PMS/PMDD Hierarchical Approach to Treatment
Dimmock PW et al. Lancet. 2000. Johnson SR.
Obstet Gynecol. 2004.
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Treatment of Mild PMS Dietary Changes
Johnson SR. Obstet Gynecol. 2004.
15
Treatment of Mild PMS Nutritional
Supplementation/OTC Medications
limited benefit
Bhatia SC et al. Am Fam Physician.2002 Bowman
MA. 2000. Freeman EW, Sondheimer SJ. J Clin
Psychiatry. 2003 Endicott J et al. Patient Care.
1996 Johnson WG et al. Psychosom Med. 1995
Rapkin AJ. Am J Manag Care. 2005.
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Treatment of Mild PMS Behavioral Changes

• Aerobic exercise/Yoga
• Relaxation and stress management
• Anger management
• Self-help support groups
• Therapy (individual, couples, cognitive-behavioral
  , light)
• Smoking cessation
• Regular sleep

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PMS/PMDD Pharmacologic Treatment with
Serotonergic Agents
Johnson SR. Obstet Gynecol. 2004. Wyatt KM et al.
Cochrane Library. 2007
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PMS/PMDD Pharmacologic Treatment with Oral
Contraceptives

• Women using OCs for PMS often experience symptoms
  during the hormone-free interval, so the selected
  treatment strategy should minimize or eliminate
  the hormone-free interval.

more
Sulak PJ. Am J Manag Care. 2005 Pearlstein TB et
al. Contraception. 2005 Yonkers KA et al. Obstet
Gynecol. 2005.
19
PMS/PMDD Pharmacologic Treatment with OCs
(continued)

• 3 treatment strategies to eliminate or ?
  hormone-free intervals

more
Sulak PJ. Am J Manag Care. 2005 Pearlstein TB et
al. Contraception. 2005 Yonkers KA et al. Obstet
Gynecol. 2005.
20
PMS/PMDD Pharmacologic Treatment with OCs
(continued)
Sulak PJ. Am J Manag Care. 2005 Pearlstein TB et
al. Contraception. 2005 Yonkers KA et al. Obstet
Gynecol. 2005.
21
PMS/PMDD Pharmacologic Treatment with CAM
Johnson SR. Obstet Gynecol. 2004. Bhatia SC, et
al. Am Fam Physician. 2002. Kaur G, et al. Cleve
Clin Med. 2004. Ford O, et al. Cochrane Database
Syst Rev. 2006.
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PMS/PMDD Patient Counseling


treatment is highly individualized, and an
empathetic approach contributes to therapeutic
success.
Rapkin AJ.AM J Manag Care 2005
Rapkin AJ. AM J Manag Care. 2005.
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PMS/PMDD Patient Resources Available

• American College of Obstetricians and
  Gynecologists
• Association of Reproductive Health Professions
• National Center for Complementary and Alternative
  Medicine (NCCAM)
• National Institutes of Health
• National Womens Health Information Center