Is it really PMS? – Part 2
LAST week we discussed what PMS is, how it presents, and the severity of the condition ranging from mild to severe. This week we will discuss diagnosis and treatment.
How is PMS diagnosed?If a woman suffers from PMS and if other medical conditions have been excluded, she must record her signs and symptoms over the next two months in a diary. This would entail: (a) the type of signs or symptoms, (b) when they occur during the menstrual cycle, and (c) how she is able to function daily. If the signs and symptoms occur consistently during the luteal phase, then a diagnosis of PMS can be made.
How is PMS treated? Treatment is done in a stepwise manner and may involve a multidisciplinary approach with the psychiatrist and an expert OBGYN.
First-line therapyThis involves advising exercise and psychotherapy. Most women who suffer from PMS tend to be obese. Exercise has been proven to improve symptoms and is encouraged. The use of psychotherapy has also proven to be beneficial, as well as the use of new combined oral contraceptive pills such as Yasmin and low-dose antidepressive medication.
Second-line therapyThough not popular, the oestrogen contraceptive patch, which is usually placed on the woman’s back, can be used. However, this must be used in combination with some kind of progesterone, either orally or within the uterus — IUCD.
Third-line therapyIf first and secondline therapy fail, then a medication referred to as gonadotrophon releasing hormone analogue can be used. This medication manipulates hormone levels, resulting in a temporary menopausal state. It should not be used for more than six months due to the increased risk of osteoporosis.
Fourth-line therapyThis is the last resort and should be done only in extreme circumstances. This involves removal of the uterus (hysterectomy) and the ovaries (oophorectomy). Depending on the age of the patient, oestrogen replacement must be given until menopausal age (51). Other therapies such as vitamin B6, acupuncture and evening primrose oil have been suggested, but there is no evidence that these therapies are beneficial.
Dr Daryl Daley is a medical officer in OBGYN at the May Pen Hospital and consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10, and Shops 46-50, Portmore Town Centre, Portmore. He can be contacted at 929-5038/9 and 939-2859 or drdaryldaley@gmail.com.
