Premenstrual

As to be expected, the most common goal of contraception is the prevention of pregnancy. However, some patients may use contraceptive methods for other benefits, such as menstrual cycle regulation, reduction of premenstrual symptoms, or treatment of acne. 

Differentiate between premenstrual syndrome and premenstrual dysphoric disorder with respect to pathophysiology, clinical presentation, and treatment. 

Describe the clinical presentation of amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, and premenstrual dysphoric disorder. 

Premenstrual syndrome (PMS) is a constellation of symptoms including mild mood disturbance and physical symptoms that occur prior to menses and resolve with initiation of menses. It is estimated that up to 70% of menstruating women experience symptoms of PMS. However, a spectrum of premenstrual mood disturbances exists and the most severe is premenstrual dysphoric disorder (PMDD). Approximately 4% to 7% of women have PMDD. A summary of the American Psychiatric Association s criteria for PMDD is as follows1,21 ... 

TREATMENT PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER... 

If treatment with an SSRI or another antidepressant such as clomipramine is not successful, hormonal treatment with a GnRH agonist, such as leuprolide, maybe considered. The use of leuprolide improves premenstrual emotional symptoms as well as some physical symptoms such as bloating and breast tenderness. Cost, the need for intramuscular administration, and the side effects of hypoestrogenism (e.g., vaginal dryness and hot flashes) limit its use. 

A randomized, double-blind, placebo-controlled trial evaluating the use of a monophasic OC containing 30 meg ethinyl estradiol and 3 mg drospirenone, a progesterone with anti-androgenic effects, showed improvement in the treatment arm compared with placebo.31 In particular, appetite, food cravings, and acne improved. However, active treatment was not associated with a statistically significant improvement in the overall outcome measure, the Calendar of Premenstrual Experiences (COPE) scale, perhaps because of the small sample size (n = 82). 

Measure the treatment success for the various menstruation-related disorders by the degree to which the care plan (1) relieves or reverses symptoms of the disorder, (2) prevents or reverses the complications of the disorder (e.g., osteoporosis, anemia, and infertility), and (3) minimizes side effects. The return of a regular menstrual cycle with minimal premenstrual symptoms or symptoms of dysmenorrhea should occur. Depending on the desire for conception and subsequent therapy, this cycle may be ovulatory or anovulatory. 

BMD, bone mineral density NSAID, non-steroidal anti-inflammatory drug OCs, oral contraceptives PCOS, polycystic ovary syndrome PMDD, premenstrual dysphoric disorder. 

Ross LE, Steiner M. A biopsychosocial approach to premenstrual dysphoric disorder. Psychiatr Clin North Am 2003 26(3) 529-546. 

Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Primary and secondary dysmenorrhea and premenstrual syndrome Etiology, diagnosis, and management. In Stenchever MA, ed. Comprehensive Gynecolgy. 4th ed. St. Louis Mosby 2001 1065-1078. 

Premenstrual dysphoric disorder Severe psychiatric mood disorder with marked affective symptoms causing significant interference in work or relationships that is temporally associated with the luteal phase and not caused by an underlying psychiatric disturbance. 

Premenstrual syndrome A constellation of symptoms including mild mood disturbance, and physical symptoms that occur prior to menses, and resolve with initiation of menses. 

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