Which of the following modalities have shown best result for premenstrual syndrome?
Ans. is a, i.e. SSRIRef: William's Gynae 1st/ed, p300; Jeffcoate 7th/ed, p629; Novaks 15th/ed, p371,312; Leon speroff 8th/ed, p578; John Hopkins manual of obs and gynae 4th/ed, p462Premenstrual disorders:* Frequently women of reproductive age experience symptoms during the late luteal phase of their menstrual cycle, and collectively these complaints are termed, premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)* It is mostly seen in women aged to 30-45 yearsTreatment of PMS:Conservative measuresInhibition of ovulationMedications directed at symptoms* Elimination of caffeine from diet* Smoking cessation* Counselling, emotional support* Low-fat, high-fiber diet and essential fatty acids in diet.* Regular exercise* Adequate sleep* Stress reduction* Oral contraceptives (especially drospirenone containing)* GnRH agonist* For fluid retention: diuretics* For pain: Prostaglandin synthetase* For mastalgia: evening primrose oil and pyridoxine* For anxiety/depression: SSRI like fluoxetine preferred* Tricyclic antidepressants can also be usedChoice of treatment in PMSAmongst all the drugs used-SSRI's have shown the best results"For premenstrual dysphoric disorder, selective serotonin re uptake inhibitor (SSRI'S) proved effective in clinical trials".Ref: Novak 15th/ed, p312"Women who meet strict criteria for diagnosis of PMS or PMDD, including socioeconomic dysfunction, are candidates for treatment with an SSR1 (fluoxetine, sertraline, paroxetine, verlaflexine), administered daily or only during the luteal phase" Ref: Leon speroff 8th/ed, p578"SSRIs are the most effective pharmacologic treatment for moderate to severe PMS and PMDD"Ref: John hopkins manual ofobs and gynae 4th/ed, p462Remember: The most significant side effect of SSRI is sexual dysfunction including decreased libido and anorgasmia.
SSRI
Progesterone
Oestrogen
Anxiolyties
Physiology & Histology