PMS and PMDD

Charlene Baldwin
University Of Phoenix
NRP/560
Objectives


Define PMS and PMDD

Relevance to woman's health

Analyze research

Discuss Treatment options

Discuss diagnostic studies

Discuss controversies with subject

Define relevance of PMS/PMDD in
practice
Objectives


Discuss patient education materials and
resources

Identify two relevant research questions
raised as a result to of research

Define relevance of this topic for clinical
practice
Definition of PMS

Pre-menstrual Syndrome refers to a group of

physical, cognitive, and behavioral
symptoms that occur during the luteal
phase of the mentsraual cycle and resolve
quickly at, or within, a few days of onset
of menastration. Symptoms can be severe
enough to cause interference with daily
activities.
 Premenstrual Dysphoric Disorder
Definition


PMDD is the most severe form of PMS
that results in significant impairment of
daily living for women.

PMS and PMDD are used interchangeable
in normal practice, although PMDD can be
more debilitating.
Differential Diagnosis

Thyroid, adrenal and endocrine disorders

Depression, Personality disorder
Migraine,seizure disorder
IBS,anorexia,bulimia,endocrine tumors
Chronic fatigue syndrome
Psychiatric or pyschological disorders
Family or social problems
Sexual dysfunction, rape, molestation
Signs and Symptoms of PMS

Irritability Internal tension

Fatigue Anger
Depression Body aches
Abdominal bloating Change of appetite
Headache Difficulty concentrating
Breast tenderness
Confusion
Signs and Symptoms of PMDD
according to DSM-IV
Sadness,hopelessness
Feeling of worthlessness
Anxiety or on edge
Variable moods and
frequent tearfulness
Persistant iritibility,
anger,conflicts with
family or friends
Decreased interest in usual
activities
Difficulty in concentrating
Binge eating or cravings
Feelings of being
overwhelmed and out of
control
Weight gain
Headaches
Skin changes, acne
Hypersomnia and insomnia
Lethargy ,fatigue, lack of
energy
Diagnostic and Statistical
Manuel Disorders Criteria

PMS criteria needs one symptom

PMDD needs 5 of 11 symtoms to meet

DMS IV criteria
 PMS Tracker chart

PMS symptom tracker

Mark the days when you have your period with an X, and give symptoms a ranking of 1-3.
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 29 30 31
Period__________________________________________________________________________________________________________
Acne___________________________________________________________________________________________________________
Breast symptoms_________________________________________________________________________________________________
Tiredness or trouble_______________________________________________________________________________________________
Cramps or upset__________________________________________________________________________________________________
Bloating_________________________________________________________________________________________________________
Constipation or diarrhea____________________________________________________________________________________________
Food cravings____________________________________________________________________________________________________
Headaches______________________________________________________________________________________________________
Backaches______________________________________________________________________________________________________
Joint or muscle pain_______________________________________________________________________________________________
Mood changes___________________________________________________________________________________________________
Anxiety_________________________________________________________________________________________________________
Depression______________________________________________________________________________________________________
Anger or irritability_________________________________________________________________________________________________
Other symptoms__________________________________________________________________________________________________

www.medbroadcast.com | © MediResource Inc.

 PMS QUIZ
Rate 0-4
0=no occurance
1=mild, Present but not a problem
2=moderate, tolerable
3=severe, really affects daily life
4=very severe, affects function of life
 PMS QUIZ
Angry outbursts/Agression/interpersonal
conflicts
Anxiety/Tension/ “On edge”
Avoidance of or withdrawal from social
interactions
Decreased or no interest in usual activities
Feeling out of control or overwhelmed
 PMS QUIZ
Irritability/ short tempered

Mood swings/ Moodiness

Sad/ Depressed/ Blue

Non Pharmacological
Treatments
Exercise 20-30 min per day
Adequate sleep
Relaxation and stress reduction
Dietary changes: foods rich in complex carbohydrates
Avoid caffeine, alcohol and refined sugars
Evening Primrose Oil
Accupuncture
Emotional support, education,reassurance
Consider referral for counseling
Discuss disorder with family as needed
Pathophysiology of
PMS/PMDD
Genetic vulnerability
Sensitiveity to hormonal fluctuations
Possibility of the rate of fluctuations of
gonadal hormones
Changes in the function of the brain with
lower serotonin levels
May have a genetic basis
Occurs during the luteal phase of cycle
Pharmacology for PMDD

NSAIDs Aleve,motrin,Naprosyn, and Advil

Yaz oral contraceptive is FDA approved for PMDD
SSRI's for deppression, initial drug of choice
Effective doses may be less than used for
treatment of depression
Started in the luteal phase 7-14 days prior to onset of
menses
Prozac 20mg QD, Zoloft 50mg. QD,paxil 12.5mg.-25mg.
QD
Pharmocological treatments for
PMS
Calcium carbonate 1200mg. Daily
Magnesium 200-400mg. Daily
Vitamin E 400 IU daily
Vitamin B6 50mg. Daily
NSAIDS: Aleve, Motrin, and Advil
Relavance to woman's health

Support
Perscriptions
Referrals
Validation
Treatment
Diagnostic testing

No objective diagnostic testing for

PMS/PMDD, only reported S/S
Important to rule out:
Hyperthyroidism,hypothyroidism, adrenal
problems,pregnancy and menopause
Baseline CBC, UA and PAP smear to rule
out other illnesses
Relevance to NP Practice

Patients seek treatment, advise and support

from their primary care provider
High volume of women go to NP for a
variety of c/o surrounding PMS/PMDD
Education is the most important and valued
thing that a primary NP can do with their
patients
Ruling out other illnesses is another
important role of the NP
NP Role

The Nurse Practitioner's role is to first confirm a

pattern of symptoms and R/O other illnesses
PMS/PMDD Symptoms must be present for 5 days
prior to menses for 3 consecutive cycles
Symptoms must end within 4 days after menses started
Interferes with normal daily functions (work, school,
social activities and etc.)
Provide psychological and emotional support
Recommend treatments and educate patient on
treatments and pathophysiology
Resources

PMS/PMDD handouts
Internet web sites referrals
Help lines
PMS take home quiz
Support groups
Counseling referral
Patient Resources

Go Ask Alice: 1-212-854-5453

www.goaskalice.columbia.edu
Teens health: 1-904-232-4100
Common problems
www.teenhealth.org/teen/sexualhealth/girls/menstrual_prob
PMSbuddy.com free online PMS reminder
PMS Comfort Education,Empowerment Natural relief
1-773-599-9767
Research

PMS occurs 20's to 40's, peaks 20-30yrs.old

Research sates 40% enriched calcium diet
assist in PMS although there is no
evidence how it works.Supplements
proved not to be as effective
PMS/PMDD has no known causes except for
the fluctuation of hormone activity and
intolerance. Along with the diminished
amount of seratonin neurotransmitters.
Research

Women with fewer pregnancies have a

higher incidence of PMDD
Black woman report more food cravings tha
white women
White women c/o more weight gain and
mood chages than black woman
Vitamin and mineral deficiencies theory has
been inconclusive
Research

Thys-Jacobs Research study showed

elemental calcium 1,200mg alleviates
tension, anxiety, fluid retension,pain,and
food cravings
Benefit is that it is safe, good for bones, good
for pregnancy
Magnesium help with mood and pain
Vitamin B6 cofactor of neurotransmitters,
relieving mood swings
Research

Not all women respond to SSRI treatment,

trying different ones may be necessary
Research states that 85% of women have
some type of PMS symptoms, 5-10% with
with serious difficulties with PMS
Most women report that PMS/PMDD
increases after giving birth and advanced
age
Research questions

What is the real cause of PMS/PMDD?

Debate on PMDD is a woman's health issue
or a psychiatric illness?
Controversies

Yaz is recommeded by the FDA for PMDD

treatment, is it safe or too high a risk for blood
clots?
Summary

Defined PMS and PMDD

Discussed treatment, non pharmacological and
pharmacological
Research findings
Diognostic tests
Patient education/resources
Importance/relevance of NP practice
reguarding PMS/PMDD
References

Cleveland Clinic Journal of Medicine April 2004 vol. 71 4 303-305. doi:

10.3949/ccjm.71.4.303. Electronically retrieved on April 8, 2012.
Dickey, Richard P., MD, PhD. (2010) Managing Contraceptive Pill/ Drug Patients. Fort
Collins, CO. Emis Medical Publishers.
European Medicines Agency. (2010) Guideline on the treatment of Premenstrual Dysphoric
Disorder (PMDD).

http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/05/
WC500090882.pdf
Electronically retrieved on April 9, 2012.
Youngkin, Ellis Quinn, PhD, RNC, ARNP, Davis, Marcia Szmania, MS, MSED, RNC,
WHCNP, ANP (2004) Women's Health A Primary Care Clinical Guide. Upper Saddle
River, New Jersey. Pearson/ Prentice Hall
American College of Obstretricians and Gynecologists. FAQ - Premenstrual Syndrome.
http://www.acog.org/~/media/For%20Patients/faq057.pdf?dmc=1&ts=20120411T234940
5782
Electronically retrieved on April 10, 2012.