PREMENSTRUAL TENSION SYMPTOMS (PMS)经前期紧张症状（PMS）

PREMENSTRUAL TENSION SYMPTOMS (PMS)经前期紧张症状（PMS） NORTH DAKOTA FAMILY PLANNING PROGRAM PROTOCOLS – GYNECOLOGY PREMENSTRUAL SYNDROME (PMS) A cluster of documented symptoms whether physical, emotional, or behavioral that are perceived to be cyclical in nature. Commonly occurs DEFINITION during luteal phase of menstrual cycle about 5-11 days before onset of menses, and must be present for at least 3 months prior. May include: SUBJECTIVE 1. LMP. 2. Irritability, anxiety, mood changes, nervous tension, decreased sexual drive, and mild depressive symptoms. 3. Fluid retention, bloating, breast tenderness, headache, fatigue, aching, and cyclic weight changes. 4. Food cravings, especially chocolate, salt, and sweets. 5. Impaired function, which alters daily activities and lifestyle, e.g., crying, confusion, forgetfulness, social withdrawal, and extreme sadness. May include: OBJECTIVE 1. Physical examination within 6-12 months without gynecological abnormalities. 2. Define symptom clusters and identify symptom patterns. No lab testing confirms PMS, however lab may be medically indicated to rule out other conditions. LABORATORY Premenstrual Syndrome ASSESSMENT May include: PLAN 1. Encourage symptom charting for three months to observe for cyclic pattern. (See peri-menstrual symptom calendar attachment.) 2. Low dose combined contraceptives suppress ovulation and may eliminate cyclic symptoms, although not in all women . May benefit from shortening homone-free interval to 4 days, tricycling, or using continuously (none of which are recommended with Ortho Evra). If using OCP’s, monophasic is recommended .Consider Yasmin if available; may be beneficial for bloating and breast tenderness. 3. Diet changes may include: a. Increase water intake to 6-8 glasses per day. b. Limit salt intake to 3 gm or less per day. c. Reduce refined sugars and increase intake of complex carbohydrates (fresh fruits, vegetables, whole grains, pasta, rice, and potatoes). d. Avoid caffeine, chocolate, tobacco, and alcohol intake. e. Consume moderate amounts of protein and fat (decrease animal fats; increase vegetable oils). 4. Stress reduction techniques, i.e., biofeedback, reflexology, meditation, or other relaxation techniques. 5. Exercise: Recommend aerobic activity, personal preference to be taken into account with a realistic achievable program; Yoga 6. Vitamin, herbal, and analgesic therapies. For mood changes may include: Page 1 of 2 Premenstrual Syndrome (PMS) GYN-17 a. Magnesium supplements 340 mg qd. b. Evening of Primrose Oil (Efamol 500 mg) begin with 2 caps bid from day 15 of cycle to onset of menses. May increase to 4 PLAN capsules bid. c. Vitamin B6 50-100 mg qd from onset of symptoms until menses; discourage high doses of over 200 mg per day to avoid peripheral neuropathy. d. Calcium 1,000 – 1,200 mg per day. e. SSRI’s or anxiolytics at very low doses may be appropriate if unresponsive to above. For physical symptoms may include: a. Ibuprofen 200-400 mg q4 hours prn to be started with onset of symptoms or prior to the onset of symptoms. b. Evening Primrose Oil may be beneficial for breast tenderness. Doseage as above. 1. Provide client education handout(s). Review symptoms, complications, and danger signs. CLIENT 2. Review safer sex education, as appropriate. EDUCATION 3. Recommend client RTC annually, PRN for problems, or appropriate per plan. 1. Any client experiencing increasing depressive symptoms or suicidal tendencies. CONSULT / 2. As appropriate if pharmacologic agents used. REFER TO PHYSICIAN Revised 02/08 References: th1. Hatcher, R.A., et al (2004). Contraceptive Technology (18 ed.). New York: Ardent Media, Inc. pp. 127-133. 2. Sulak, Patricia. (2005) Contraceptive Redesign: Eliminating Cyclic Symptomatology. Managing The Spectrum Of Premenstrual Symptoms: A Clinician’s Guide, MedPro Communications. pp 10-14. Page 2 of 2 Premenstrual Syndrome (PMS) GYN-17