{"id":4335,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/prementstrualdisorders\/"},"modified":"2025-06-27T10:25:46","modified_gmt":"2025-06-27T09:25:46","slug":"prementstrualdisorders","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/prementstrualdisorders\/","title":{"rendered":"Pre Menstrual Syndromes"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-4a16a7a21944f2bd9d694fd22495d639\"><strong>PMS REFERRALS &nbsp;SHOULD BE DIRECTED TO CHALMERS VIA SCI GATEWAY.<\/strong><\/p>\n\n\n\n<p><strong>Background<\/strong><\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Symptoms include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mood change (low mood, anger, irritability, mood swings)<\/li>\n\n\n\n<li>Anxiety or tension<\/li>\n\n\n\n<li>Tiredness and fatigue, poor sleep<\/li>\n\n\n\n<li>Difficulty with concentration, brain fog<\/li>\n\n\n\n<li>Physical symptoms such as breast tenderness, bloating, joint pains, headaches<\/li>\n<\/ul>\n\n\n\n<p>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.<\/p>\n\n\n\n<p><strong>What is PMDD?<\/strong><\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>The Pre Menstrual Syndromes (PMS) Clinic is based within Chalmers Centre as a specialist clinic of NHS Lothian\u2019s 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)<strong><\/strong><\/p>\n\n\n\n<p><strong>B.C. &amp; E.G. 01-06-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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).<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Women with milder symptoms who have not tried initial treatments.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer<\/strong>:<\/h4>\n\n\n\n<p>Via SCI Gateway (Primary Care referrals) or by letter to the PMS Clinic, Chalmers Centre (other clinicians). Please ask patients to keep symptom diaries.<\/p>\n\n\n\n<p>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.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n\n\n\n<li>Dietary advice: good intake of fruit and vegetables, calcium and Vitamin D, complex carbohydrates and avoiding excess sugar. Vitamin B6 supplementation may be helpful.<\/li>\n\n\n\n<li>CBT may be helpful in management of symptoms (although there is no specific CBT for PMS in NHS Lothian at the moment).<\/li>\n\n\n\n<li>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.<\/li>\n\n\n\n<li>SSRIs. Second line pharmaceutical management is use of SSRIs, either continuously or in the luteal phase (days 14-28) only, for example Citalopram.<\/li>\n<\/ul>\n\n\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>RCOG guidelines: <a href=\"https:\/\/www.rcog.org.uk\/guidance\/browse-all-guidance\/green-top-guidelines\/premenstrual-syndrome-management-green-top-guideline-no-48\/\">Premenstrual Syndrome, Management (Green-top Guideline No. 48) | RCOG<\/a><\/p>\n\n\n\n<p>NAPS website: <a href=\"https:\/\/www.pms.org.uk\/\">NAPS \u2013 National Association for Premenstrual Syndromes | NAPS (pms.org.uk)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>PMS REFERRALS &nbsp;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: Around 30-40% of women experience some symptoms<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3976,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[642],"class_list":["post-4335","page","type-page","status-publish","hentry","category-premenstrualdisorders"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/sexualreprohealth\/premenstrualdisorders\/\" rel=\"tag\">Pre Menstrual Disorders<\/a>","rttpg_excerpt":"PMS REFERRALS &nbsp;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: Around 30-40% of women experience some symptoms","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4335","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4335"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4335\/revisions"}],"predecessor-version":[{"id":24457,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4335\/revisions\/24457"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3976"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4335"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4335"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}