PMS and PMDD Charlene Baldwin University Of Phoenix NRP/560.
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Transcript of PMS and PMDD Charlene Baldwin University Of Phoenix NRP/560.
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
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
Signs and Symptoms of PMDD according to DSM-IV
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 31Period__________________________________________________________________________________________________________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
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
NP Role
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.eduTeens health: 1-904-232-4100
Common problemswww.teenhealth.org/teen/sexualhealth/girls/menstrual_problemshtml
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=20120411T2349405782
Electronically retrieved on April 10, 2012.