Premenstrual syndrome (PMS)

Table of Contents

One of a complicated collection of gynaecological problems is referred to as premenstrual disorders (PMD) is Premenstrual syndrome (PMS). PMS is now referred to as core PMD after the International Society for Premenstrual Disorders (ISPMD) reclassified PMD.
Distressing physical, behavioural, and core PMD is a condition in which depressing behavioral, psychological, and physical symptoms usually appear in the luteal phase of the monthly cycle and go away during or soon after menstruation to provide at least one week without symptoms. The degree of the symptoms is such that they seriously lower quality of life.


Aetiology of Premenstrual syndrome: the reason is unknown precisely. The connection to the luteal stage of the cycle implies that a component that causes symptoms may be produced by the corpus luteum.
Symptoms of Premenstrual syndrome: More than 200 symptoms of premenstruation have been recorded. Some women will experience flare-ups of long-term conditions like asthma, migraines, and epilepsy.
Diagnosis: Generally speaking, tests are useless. A thorough history is crucial, including the onset of symptoms and any effects on functioning. Over at least two cycles, the lady should be requested to maintain a prospective symptom journal. There are other acknowledged diaries, such as the Daily Record of Severity of Problems (DRSP). Additionally, available are patient-friendly internet-based technologies. The symptoms should go by the end of menstruation and return in the luteal phase in order to make the diagnosis. They should seriously impede as well.
Differential diagnosis: other illnesses that should be ruled out include depression, anxiety and panic disorders, hypothyroidism, irritable bowel syndrome and SLE.
Management of Premenstrual syndrome: The woman’s preferences as well as the intensity and kind of her symptoms should guide the treatment. Steroids and progesterone are not advised. In secondary care, surgery—namely, bilateral oophorectomy and hysterectomy—can be taken into consideration in some situations.
Dyspareunia
Pain experienced during sex. It can be categorized as “deep” if pain is felt deeply in the pelvis occurring on deep penetration, or “superficial” if pain occurs on penetration (commonly described as raw or burning feeling). It is possible to have both kinds of pain.
Aetiology: Frequently multifactorial; for instance, vaginismus might arise from pain brought on by vulval dermatosis. Any pelvic disease, such endometriosis or persistent PID, can manifest as profound dyspareunia.
Evaluation: a brief account of the type and timing of the symptoms together with any related complaints, such vaginal discharge or vulval itch
Examine for vulva alterations, such as lichen sclerosus (LS), and any focal discomfort that could point to vulvodynia. One sign of endometriosis is tenderness over the uterosacral ligaments.
Investigations: the clinical results should dictate the investigations. One may recommend a pelvic ultrasound, vulval swab for culture and sensitivity, or STI test.
Management: The fundamental reasons determine management. There may be benefit from lubricants or vaginal moisturizers, and a referral to psychosexual therapy might be advised. See also the chapter on sexual issues.
Bartholin’s cyst and abscess
When the duct of the Bartholin’s gland, which supplies vaginal lubricant, becomes blocked, a Bartholin’s cyst or abscess ensues. Over their lives, it affects around 2% of women. It shows as a posterior labium majus cystic swelling on one side. Unless it gets infected, in which case a painful, red, tender abscess might develop, treatment is typically not necessary. Initially appearing in the bottom region of the introitus, the abscess might spread anteriorly.
Management: Considering that swabs from the abscess can detect Chlamydia trachomatis and Neisseria gonorrhoeae (in 20% of cases), a complete STI test should be taken. There is mixed vaginal flora otherwise.
Treatment: Treatment consists on marsupialization, drainage, and incision.
Generally speaking, antibiotics are not needed unless there is surrounding cellulitis (or a STI diagnosis). Another method is to cut the abscess and then implant a Word catheter under local anaesthesia. Its expanding balloon at the tip secures the catheter in place.
Acute pelvic pain
can be brought on by gastrointestinal or urinary disease or by gynaecological aetiologies including ovarian cyst accidents, PID, and ectopic pregnancy. For assessment, PID, including investigations.
Chronic pelvic pain (CPP)

A chronic pelvic pain is a lower abdomen or pelvic pain that lasts for at least six months, not only during menstruation or sexual activity and not during pregnancy. Common, CPP affects one in six adult females. Because there are frequently several contributing causes, CPP is a symptom rather than a diagnosis.
Aetiology: The aetiology of CPP is varied and includes endometriosis, adenomysis, adhesions from prior surgery or infection (PID), IBS, and interstitial cystitis. Musculoskeletal origins of pain or nerve entrapment are further causes. Women with CPP often suffer from depression and sleep disorders, and there may be more complicated psychological or social problems, including a history of sexual abuse, including domestic violence.
Management:  a complete history of the pain and related symptoms has to be obtained. Examine the concerns and theories of the patient regarding the cause of the pain. Examinations of the abdomen and pelvis may show a pelvic lump or be normal. Keeping track of symptoms might be made easier with a pain journal
Investigations:  If clinical findings warrant, urinalysis and/or STI screening. Analysing a suspected pelvic mass can also be done with pelvic ultrasonography (albeit this could not be the source of the pain). Now that diagnostic laparoscopy is negative in more than one third of cases and has significant hazards, it is regarded as a second line inquiry. If after the operation no diagnosis is given, women could feel let down.
Treatments: The underlying disease has to be attended to.

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