PMS REFERRALS SHOULD BE DIRECTED TO CHALMERS VIA SCI GATEWAY.
Background
PMS is a condition which is characterised by distressing physical, behavioural and psychological symptoms that occur during the luteal phase of the menstrual cycle, and that disappear within a few days of the period starting.
Symptoms include:
- Mood change (low mood, anger, irritability, mood swings)
- Anxiety or tension
- Tiredness and fatigue, poor sleep
- Difficulty with concentration, brain fog
- Physical symptoms such as breast tenderness, bloating, joint pains, headaches
Around 30-40% of women experience some symptoms of PMS, but for around 5-8% of these women the symptoms are severe and significantly affect functioning at home, work and socially.
What is PMDD?
Pre Menstrual Dysphoric Disorder (PMDD) is one type of severe PMS. Diagnosis of PMDD requires fulfilment of strict criteria and the inclusion of 5 of 11 stipulated symptoms, one of which must be mood. Some people may have severe PMS, but do not meet the criteria of PMDD.
The Pre Menstrual Syndromes (PMS) Clinic is based within Chalmers Centre as a specialist clinic of NHS Lothian’s Sexual and Reproductive Health Service. It is staffed by a Consultant Gynaecologist and a Senior Specialist Nurse. Patients must be referred, either by their GP, or other clinician (e.g. within psychiatry or general gynaecology)
Who to refer:
- Women with severe PMS symptoms affecting their quality of life, and who have not responded to lifestyle measures or initial treatments (see Primary Care Management).
Who not to refer:
- Women with milder symptoms who have not tried initial treatments.
How to refer:
Via SCI Gateway (Primary Care referrals) or by letter to the PMS Clinic, Chalmers Centre (other clinicians). Please ask patients to keep symptom diaries.
On receipt of referral, patients will be added to the waiting list for a consultation and sent a letter asking them to complete and return a simple questionnaire, and a symptom diary for at least 2 cycles. The appointment for a consultation is not usually sent until symptom diaries have been returned. If patients have already been keeping symptom diaries they can complete and return the diaries immediately.
- Lifestyle changes can help to alleviate symptoms of PMS. These include: reducing stress, getting adequate sleep, exercise, eating a healthy diet, reducing or eliminating alcohol and nicotine.
- Dietary advice: good intake of fruit and vegetables, calcium and Vitamin D, avoiding complex carbohydrates and excess sugar. Vitamin B6 supplementation may be helpful.
- CBT may be helpful in management of symptoms (although there is no specific CBT for PMS in NHS Lothian at the moment).
- Combined hormonal contraception. First line pharmaceutical management for symptoms of PMS is the COC. Continuous rather than cyclical regimens are likely to be more effective.
- SSRIs. Second line pharmaceutical management is use of SSRIs, either continuously or in the luteal phase (days 14-28) only, for example Citalopram.
