PMS and PMDD Charlene Baldwin University Of Phoenix

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 Fatigue Depression Abdominal bloating Headache Breast tenderness Confusion Internal tension Anger Body aches Change of appetite Difficulty concentrating

Signs and Symptoms of PMDD according to DSM-IV Sadness, hopelessness Difficulty in concentrating Feeling of worthlessness Binge eating or cravings Anxiety or on edge Feelings of being overwhelmed and out of control Variable moods and frequent tearfulness Persistant iritibility, anger, conflicts with family or friends Weight gain Decreased interest in usual activities Hypersomnia and insomnia Headaches Skin changes, acne 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 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 20 mg QD, Zoloft 50 mg. QD, paxil 12. 5 mg. -25 mg. QD

Pharmocological treatments for PMS Calcium carbonate 1200 mg. Daily Magnesium 200 -400 mg. Daily Vitamin E 400 IU daily Vitamin B 6 50 mg. 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 problemswww. teenhealth. org/teen/sexualhealth/girls/menst lemshtml 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 -30 yrs. 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, 200 mg 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 B 6 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 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, Ph. D. (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/ WC 500090882. pdf Electronically retrieved on April 9, 2012. Youngkin, Ellis Quinn, Ph. D, RNC, ARNP, Davis, Marcia Szmania, 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%20 Patients/faq 057. pdf? dmc=1&ts=20120411 T 234940 5782 Electronically retrieved on April 10, 2012.