Rationale
Premenstrual dysphoric disorder (premenstrual syndrome or PMS) is a combination of physical, emotional, or behavioral symptoms that occur prior to the menstrual cycle and are absent during the rest of the cycle. The symptoms, on occasion, are severe enough to interfere significantly with work and/or home activities.
Causal Conditions
(list not exhaustive)
- While the cause of premenstrual dysphoric disorder (PMS) is unknown, there are many theories as to the pathogenesis of this condition.
Key Objectives
Given a patient with premenstrual dysphoric disorder (PMS), the candidate will assess the severity and complications, and will initiate an appropriate management plan. Specifically, the candidate will differentiate PMS from normal premenstrual symptoms or from other causes of physical and mood changes, and will explore the psychosocial impact of the condition.
Enabling Objectives
Given a patient with premenstrual dysphoric disorder (PMS), the candidate will
- list and interpret critical clinical findings, including
- determining if the symptoms are cyclical (e.g., by use of a symptom diary);
- ensuring that symptoms are not related to another chronic condition (e.g., major depressive disorder);
- evaluating the severity of mood and physical symptoms, as well as their psychosocial impact;
- list and interpret critical investigations, including
- consideration and exclusion of conditions with similar symptomatology (e.g., hypothyroidism, anemia);
- recognition of the fact that, in the majority of cases, there is no need for further investigation;
- construct an effective initial management plan, including
- outlining initial management including supportive therapy and counselling on life-style issues (e.g., diet, exercise, stress reduction);
- considering the use of hormonal therapy for ovulation suppression (e.g., oral contraceptive);
- outlining indications for selective serotonin reuptake inhibitors in the management of premenstrual dysphoric disorder (PMS).
