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PATIENT CASE: PREMENSTRUAL SYNDROME

Patient’s Chief Complaint

“I’ve really been feeling out of sorts lately. Just before my period, I feel irritable and my breasts are
very sore. This has been going on now for three months.”

History of Present Illness

P.E. is a 34 y/o woman who went to the OB Gyne clinic for a check up. She states that she has a
3-month history of premenstrual symptoms that include irritability and breast tenderness. When
questioned further, she also confirms that she has had cravings for salty snacks lately and,
generally, she dislikes them. These symptoms have been recurrent and predictable for the last three
menstrual periods, usually occur during the entire week prior to menses, and invariably resolve
approximately two days after her menstrual flow has begun. She states that she has not been
bothered by these symptoms during the remainder of her menstrual cycle. Her menstrual cycle has
been remarkably predictable at 27–28 days for the last two years. She brought to the clinic the
daily calendar that she has been asked to complete as documentation of h er symptoms.

Past Medical History

• Severe UTI, 14 years ago
• Tubal ligation after her second child, 10 years ago
• Ovarian cyst removed 8 years ago
• S/P ultrasonic renal lithotripsy secondary to nephrolithiasis, 5 1⁄ 2 years ago
• Eczema 5 years
• GERD 2 years
• Acute sinusitis, 1 year ago

Family History
• Father, 61, has hypercholesterolemia, HTN, CAD, glaucoma, and colonic polyps
• Mother, 55, had PMDD (premenstrual dysmorphic disorder); became menopausal at age 44
• One brother, 31, is alive and well
• One sister, 30, has PMS
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Social History
• Married, mother of two healthy sons, ages 10 and 12
• Completed nursing school and is a registered nurse
• She walks on her treadmill three times each week and eats healthy
• She does not smoke and drinks alcohol only around holidays
• One cup decaffeinated coffee every morning and does not drink caffeinated soft drinks
• Socially active and volunteers extensively in the community
• Has had a strained relationship with her mother and a colleague at work for the past three months

Physical Exam and Lab Tests

General Appearance
• Significantly well
• Appearance is well kept
• In conversation she seems alert, friendly, and courteous

Vital Signs

Patient Case Table : Vital Signs

BP 122/86 RR 15 HT 5’61⁄2
P 78 T 37.5 C WT 123 lbs

What does premenstrual syndrome means? How is it correlated in

Patient Case Question 1. the case of the patient.
Patient Case Question 2. Identify three major factors that have likely contributed to the
development of premenstrual syndrome
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Skin
• Warm and dry with no rashes or lesions
• Fair complexion
• Color and turgor good

Breasts
• Mild fibrocystic changes

Genitalia/Rectum
• Patient declined exam as she just had normal pelvic exam three weeks ago

Laboratory Blood Test Results

Patient Case Table : Laboratory Blood Test Results

Hb 13.2 g/dL MCHC 33.7 g/dL • Monos 6%
Hct 38.1% Plt 155 10 3/mm3 • Eos 2%
RBC 4.7 10 6/mm3 WBC 5.2 10 3/mm3 • Basos 1%
MCV 97.7 fL • Neutros 62% TSH 1.7
µU/mL
MCH 33.0 pg • Lymphs 29% Glu, fasting 98
mg/dL

Pap smear
Within normal limits

Mammography
Within normal limits

Patient Case Question 3. What is the significant risk factor for premenstrual syndrome?

Patient Case Question 4. What is a premenstrual dysmorphic disorder? What can be the
significance to the case of the patient?

Patient Case Question 5. Present the mechanism of pathophysiology of

premenstrual syndrome (include organs involved)