View
213
Download
0
Category
Tags:
Preview:
Citation preview
The Good the Bad and The The Good the Bad and The UglyUgly
Complications of Menstruation& PMS
Jennifer McDonald DO
Premenstrual SyndromePremenstrual Syndrome
• 80% women experience one symptom (functioning not impaired)
• 20-40% moderate symptoms (two to five symptoms)
• 2-9% severe symptoms (PMDD)
What is it??
EtiologyEtiology
• Multifactorial• Hypersensitivity of the individual to
changes in gonadal activity• External stressors
• Neurotransmitter alterations• GABA
• Serotonin• Renin-angiotensin-aldosterone system (RAAS)
Neurotransmitters Neurotransmitters and and
NeurohormonalNeurohormonalSystems*Systems*
Genetic Genetic PredispositionPredisposition VulnerabilityVulnerability Increased SensitivityIncreased Sensitivity
to Changes in to Changes in Gonadal HormonesGonadal Hormones
InteractInteractwithwith
Gonadal Gonadal HormonesHormones
and Metabolitesand Metabolites
Altered Altered Responses toResponses toChanges in Changes in
Gonadal Hormone Gonadal Hormone LevelsLevels
PremenstrualPremenstrualSymptomsSymptoms
*Serotonin, renin-angiotensin-aldosterone system, -aminobutyric acid (GABA), and cholecystokinin.
Halbreich U. Psychoneuroendocrinology. 2003;28(Suppl 3):55-99.
DiagnosisDiagnosis
• Luteal phase symptoms• Symptom free interval of 7 days in the
first half of the cycle• 2 consecutive cycles
50% women who believe they have severe PMS do not have a luteal phase pattern when
menstrual cycle diaries are reviewed
Treatment Options
Dietary Changes Exercise
Stress Management
Chaste berry extract
Calcium 1200 mg/day
Magnesium 200-400 mg/day
L-Tryptophan 6g/d from ovulation to
menses
No Proven BenefitNo Proven Benefit
• Reducing caffeine intake• Reducing salt intake
• Vitamin E• Vitamin B6
• Evening primrose oil
Evidence is anecdotal and not supported in randomized clinical trials
Pharmacologic TherapyPharmacologic Therapy
• SSRIs Luteal phase dosing
Daily dosing
• Sprironolactone• Oral contraceptives
• Ovulation suppression (worst case scenario)
DysmenorrheaDysmenorrhea
Painful menstruatio
n
Primaryvs.
Secondary
14-26% adolescents miss school because of pain
Primary DysmenorrheaPrimary Dysmenorrhea
• Symptoms begin shortly after menarche• Usually regular cycles
• Pain associated with ovulatory cycles
• Prostaglandins (PGE2 & PGF2) implicated as the inducing agents
• Uterine contractions cause ischemia which in turn causes pain
Treatment options ??
Big on DefinitionsBig on Definitions
• Menorrhagia• Metrorrhagia
• Hypomenorrhea• Metrorrhagia
• Polymenorrhea• Menometrorrhagia• Oligomenorrhea
• Cryptomenorrhea
Dysfunctional Uterine BleedingDysfunctional Uterine Bleeding
• Exclusion of pathologic causes• Extremes of reproductive age
• Treatment depends on age group
Which group would be the most concerning?
Adolescents? Young women? Premenopausal?
History & Evaluation of History & Evaluation of Female ComplaintsFemale Complaints
• Menstrual history
• Reproductive history
• General medical history
• Family history
What would be important to know ??
EvaluationEvaluation
• History• Physical exam
• Endometrial biopsy• Hysteroscopy
• D&C (dilation & curettage)
HysteroscopyHysteroscopy
• 3 mm hysteroscope
• Saline or CO2
• Panoramic view of uterus
• Visualization of polyps, intramural fibroids, scar tissue
Endometrial Ablations
• Conservative treatment for menorrhagia
• Thermal energy applied directly to uterine lining
• Majority of women amenorrheic after
treatment
• Other ablation techniques
Thermachoice (water balloon)
Freezing (HER option)
Hot water (Hydrothermablator)
Recommended