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NUR241 Reproductive System For Premenstrual Syndrome

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1. Explain the pathophysiology of Premenstrual Syndrome and relate Tracey’s ?symptoms to its pathophysiology?

2.
Discuss the common causes of Premenstrual Syndrome.

3.
Describe the difference between clinical manifestations of Polycystic Ovary ?Syndrome and Premenstrual Syndrome. ?

4. Outline the most common therapies for Premenstrual Syndrome and discuss the ?lifestyle changes to help with PMS syndrome.

Answer:

Tracey Wilson’s Premenstrual Syndrome (PMS) Case Study

Tracey is a 38-year-old married woman, a mother of three healthy kids; two daughters, ages 10 and 12 and a four-year-old son. Tracey is a successful businesswoman, often smokes and only consumes alcohol in moderation at social events.?

She runs Pizza hut at Belmont Village Shopping Centre. Tracey presented to Belmont Private Hospital, Belmont, complaining of a 4-month history of symptoms that include anger, irritability, breast tenderness, tiredness, nausea, acne and abdominal blotting. She also confirmed that she had food cravings for salty snacks lately.

These symptoms have been HIGHLY repetitive and predictable for the last three menstrual periods, usually, occur three days or one week before menses. Her menstrual cycle has been remarkably predictable for the last two years. However, her symptoms aggravated just before menstruation.

She had severe urinary tract infections 13 years ago, and her ovarian cyst was removed eight years ago. She was referred to the Family Planning Clinic based in Brisbane by her obstetrician and gynaecologist Dr Sarah Johnson.  

1. The pathophysiology of Premenstrual Syndrome is quite controversial with different theories .According to one of the theories, the pathophysiology of PMS is centered on the ovarian cycle. The sex steroids usually pass very easily the blood brain barrier and the receptors are many in the region of the brain such as amygdala and the hypothalamus. Metabolism of the hormone progesterone produces allopregnalone and pregananolone. This two are the ones that stimulate the gamma-aminobutyric acid inhibitory neurotransmitter system.

It is the GABA receptors that alters the mood, cognition and affect the patient as Tracey was feeling (Bauman, 2015). When the level of pregnanolone and the allopregnanolone result to anxiolytic, sedative as well as anesthetic effects. When they are low, they result to anxiety, negative mood and finally aggression which was the case of Tracey (Yonkers, Cameron, Gueorguieva, Altemus, & Kornstein, 2017). The symptoms worsen during the luteal phase due to the continuous exposure of the GABA receptors to high concentrations of allopregnanolone. (Purdue-Smithe, Manson, Hankinson, & Bertone-Johnson, 2016). The latter increase monoamine oxidase that reduce the presence of 5-hydroxyptamine and this also leads to depressed moods (Bertone-Johnson, Whitcomb, Rich-Edwards, Hankinson, & Manson, 2015). Estrogen on the other hand increase the breakdown of monoamine oxidase and this increase the presence of tryptophan in the brain and this stimulates serotonin transport that stimulate 5-HT binding sites in the brain and this leads to antidepressant effect which was the case with Tracey .It is therefore ideal to conclude that PMS is as a result of fluctuations in sex hormones that affect serotonin.

2. Premenstrual syndrome is caused by three main factors that include the cyclic changes in hormones, chemical changes in the brain and finally depression (Rahmanian, 2017). According to different studies,hormonal fluctuations such as estrogen are the ones that results to the PMS.PMS  is also as a result of fluctuations in different chemicals that are found in the brain such as the serotonin and this is the chemical substance that alters mood states and triggers the PMS symptoms (Ryu & Kim, 2015). Low levels of serotonin on the other hand may lead to premenstrual depression, fatigue, food cravings and sleep problems. Depression also cause PMS though not to a big extent.

There is another theory that attempts to explain the causes of PMS and it links the condition to the luteal phase. According to this theory, the progesterone increase in the body of women if the fused ova and sperms get implanted in the uterus. Estrogen on the other hand reduce. This condition is therefore believed to arise when there is an interaction of sex hormones and the brain. This involves the sex hormones and the neurotransmitter known as serotonin. The neurotransmitter serotonin is the one that controls several functions in the brain such as moods and sensitivity to pain. Therefore, the fluctuating levels of serotonin brought about by the interaction with sex hormones is the one that reduce levels of serotonin and eventually brings about PMS. This is the reason why during treatment of the condition, the woman would be injected with drugs such as fluoxetine that increases the levels of serotonin.

3.  Polycystic ovarian syndrome is a condition in which there is an imbalance in hormones during the reproductive age of women. Women who experience this condition experience infrequent or elongated menstrual periods. They might also have excess male hormones such as androgens. The ovaries also develop small collections of fluids referred to as follicles and this makes them fail to release the egg on a regular basis.

The clinical manifestation of PMS include abdominal bloating,headaches,depression,sadness,anxiety,fatigue,constipation,food cravings, diarrhea, acne and sore breaths (Liao et al., 2017). The clinical manifestations of polycystic ovarian syndrome include irregular periods, heavy bleeding, hair growth, acne, weight gain, darkening of the skin and headaches. Women with PCOS might experience less than 9 periods in a single year. They might also experience more than thirty five days between the periods and the abnormally high or heavy periods. The clinical manifestation of the Polycystic Ovary syndrome are due to the presence of excess male hormone called androgens that make the ovary to develop follicles and this makes it difficult for the ovaries to release the eggs (Kaewrudee, Kietpeerakool, Pattanittum, & Lumbiganon, 2018).

The clinical manifestations of the PMS on the other hand is due to the exaggerated response to hormones such as serotonin. In conclusion ,the difference between the clinical manifestations of the polycystic ovarian syndrome and the premenstrual syndrome is due to the fact In PCOS ,there are high level of the male hormone androgen while in PMS ,there is fluctuations in the sex hormones that affect the neurotransmitter serotonin.

4. There are different treatment options for PMS. The first therapy is the use of Antidepressants that include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine and others have been used to reduce the symptoms of PMS especially moods. These are the first line drugs for the treatment of PMS. These drugs are taken on a daily basis but in some women it can be limited to 2 weeks before menstruation. Another drug is the Nonsteroidal anti-inflammatory drugs (NSAIDs) and they are used prior to the onset of menstruation (Yonkers, 2009). The common NSAIDs include ibuprofen and naproxen sodium that usually ease cramping as well as breast discomforts. Diuretics are also important since they assist the body reduce the body fluids to reduce swelling and bloating. There are also the hormonal therapy where certain hormones are introduced to stop ovulation that relieves the PMS symptoms. Studies have also shown that Benzodiazepines can reduce depression among patients suffering from PMS.

Lifestyle changes have also been used to treat or improve the symptoms of the PMS. This include modifying the diet by eating food with less salts, rich in calcium and the patient should avoid caffeine as well as alcohol. Exercise is also important such as swimming and this can be used to reduce fatigue and depression. The patient should also reduce stress by sleeping and massage to relax .There are natural medicines that have been used to treat this condition as well. Studies have found out that the fruit of the chaste berry can treat PMS. 

References

Bauman, D. (2015). Premenarcheal “Premenstrual” Dysphoric Disorder, Is There Such an Entity? A Case Report and Review of the Literature. Journal of Pediatric and Adolescent Gynecology, 28(2), e51-e52. doi:10.1016/j.jpag.2015.02.048

Bertone-Johnson, E. R., Whitcomb, B. W., Rich-Edwards, J. W., Hankinson, S. E., & Manson, J. E. (2015). Premenstrual Syndrome and Subsequent Risk of Hypertension in a Prospective Study. American Journal of Epidemiology, kwv159. doi:10.1093/aje/kwv159

Kaewrudee, S., Kietpeerakool, C., Pattanittum, P., & Lumbiganon, P. (2018). Vitamin or mineral supplements for premenstrual syndrome. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd012933

Liao, H., Pang, Y., Liu, P., Liu, H., Duan, G., Liu, Y., … Deng, D. (2017). Abnormal Spontaneous Brain Activity in Women with Premenstrual Syndrome Revealed by Regional Homogeneity. Frontiers in Human Neuroscience, 11. doi:10.3389/fnhum.2017.00062

Purdue-Smithe, A. C., Manson, J. E., Hankinson, S. E., & Bertone-Johnson, E. R. (2016). A prospective study of caffeine and coffee intake and premenstrual syndrome. The American Journal of Clinical Nutrition, 104(2), 499-507. doi:10.3945/ajcn.115.127027

Rahmanian, V., Zolala, F., Mohseni, M., Baneshi, M., & KHalili, N. (2017). Relationship between Body Image and Social Participation in Pregnant Women of Jahrom City, Iran. Quarterly of Horizon of Medical Sciences, 23(2), 111-116. doi:10.18869/acadpub.hms.23.2.111

Ryu, A., & Kim, T. (2015). Premenstrual syndrome: A mini review. Maturitas, 82(4), 436-440. doi:10.1016/j.maturitas.2015.08.010

Yonkers, K. A. (2009). Antidepressant Treatment for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. PsycEXTRA Dataset. doi:10.1037/e651992010-001

Yonkers, K. A., Cameron, B., Gueorguieva, R., Altemus, M., & Kornstein, S. G. (2017). The Influence of Cyclic Hormonal Contraception on Expression of Premenstrual Syndrome. Journal of Women's Health, 26(4), 321-328. doi:10.1089/jwh.2016.5941

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