Tracey PMS Case Study: Symptoms and Pharmaceutical Management
The case study involves a 38-year-old female patient named Tracey. She has a history of severe urinary tract infection thirteen years ago. She has a surgical history of ovarian cyst removal about eight years ago. Tracey has presented with the chief complaint of mood swings, anger, breast tenderness, acne associated with menstruation since four months. Her symptoms appear just before menstruation. These symptoms are associated with Premenstrual syndrome (PMS). PMS symptoms occur in a cyclic fashion and mostly appear before menses (Rosenfield & Ehrmann, 2016). The PMS symptoms are largely associated with mood swings, irritability, breast tenderness, nausea and even acne. Both physical and emotional changes are associated with hormonal changes in the female’s body. Pathophysiology behind the Tracey’s symptoms can be explained on the basis of increases production of progesterone by the ovary (Rosenfield & Ehrmann, 2016).
Premenstrual syndrome (PMS) is a chronic condition of the luteal stage, symbolized by physical, mental and emotional changes of a certain severity, resulting in disturbance of personal relationships and normal functioning. The two most well researched and appropriate pathophysiological mechanisms for the symptoms of PMS include GABArgic and serotonergic framework mechanism (Smithe et al., 2016). The progesterone hormone formed by the corpus luteum in the ovaries and in hippocampus of the brain adhere to the neurosteroid-restricting site on the gamma-aminobutyric acid (GABA) receptor, altering its location, making it impenetrable to facilitate initiation ultimately reduces the GABA focal limit. With a comparable component, progesterone in some hormonal contraceptives are also thought to adversely affect the GABAergic functioning. Resulting insufficient amount of serotonin production in brain can be the cause of the symptoms experienced by Tracey consisting of irritability and mood swings.
Tracey is experiencing symptoms that include mood swings, irritability, breast tenderness, nausea and acne. The symptoms are exhibiting a cyclic pattern, appearing before her menstrual cycle. This premenstrual syndrome can be caused by several factors; however, the exact cause of premenstrual syndrome is unknown. Various factors which may contribute to the condition include:
Cyclic variations in hormones: Symptoms and unwanted effects of premenstrual disorder change with hormonal fluctuations and disappear with pregnancy and menopause. Events of irritability, mood swings and abdominal bloating are associated with the increased production of progesterone from the ovaries (Smithe et al., 2016).
Chemical changes in the brain: Serotonin, present in brain (synapse), which is thought to play a significant role in thinking and emotional states can cause symptoms related to premenstrual syndrome. The lack of measures of serotonin can lead to premenstrual syndrome and in addition to fatigue, increased desire for salty food and rest issues (Pearlstein & O’Brien, 2017). Women experiencing premenstrual syndrome complain of insomnia, fatigue, food craving for salty food and depressive episodes. Premenstrual depression has been seen to be associated with elevated serotonin levels (Ju, 2016).Depression: Several ladies with extreme premenstrual disorder have non diagnoses depressive episodes. Depression, however, does not cause most of the events. Tracy must be analyzed for any signs of dysfunctional behavior due to premenstrual disorder. It has been found that about 30% of women experience the effects of anxiety and depression caused by premenstrual syndrome (Pearlstein & O’Brien, 2017).
Increased production of androgens is the main cause of the symptoms of Polycystic Ovary Syndrome, whereas; hormonal imbalance due to increased production of progesterone causes symptoms associated with Premenstrual Syndrome.
PMS is "premenstrual side effects or premenstrual disorder" is a group of different side effects seen by different women one or two weeks before their cycle and usually dies at the beginning of the period (Smithe et al., 2016). These manifestations include inflammation of the skin, tenderness of the chest, temperature changes in mood, swelling, fatigue and irritation (Johnson et al., 2015). Whereas, PCOS is a complex clinical condition and is generally considered to be a set of three symptoms oligomenorrhea, hirsutism and obesity, and is currently perceived as a complex problem that leads to over production of androgens, mainly from the ovary, and is associated with contraindications for insulin, PCOS may lead to amenorrhea, infertility, hyperacidemia (HA), indications of metabolic complications such as insulin obstruction and dyslipidemia. The seemingly hidden cause is laborious anovulation in a long period (Safari et al., 2015).
There are relatively few clinical contrasts between both; many women with Polycystic Ovary Syndrome experiences various signs of PMS. Hormonal variations are the main cause of these symptoms, and it also depends on the severity of the condition. The research conducted by the Medical School at the Kerman University of Medical Sciences of Iran, on the production of prostaglandin (PG) from normal and polycystic ovaries, revealed that production of prostaglandin was found to increase from polycystic ovaries as compared to normal ovaries (Safari et al., 2015). Increased inflammatory response, hospital depression anxiety scale and pain are related to increased production of prostaglandin (organic compound) with an extended decline and distress, which also clarifies the severity of Polycystic Ovary Syndrome (Houghton et al., 2017).
Pharmaceutical management can be used to treat the different symptoms of Premenstrual Syndrome. Medicaments such as selective serotonin reuptake inhibitors (SSRIs), diuretics, analgesics, oral contraceptives, antidepressants and medicines that suppress ovarian capacity are used (Dimmock et al., 2017).
Analgesics (painkillers): These are usually given for menstrual problems, migraines and menstrual pain. The most effective collection of analgesics appears to be, in general, non-steroidal sedative drugs (NSAIDs). Cases include ibuprofen, naproxen and mefenamic acid (Houghton et al., 2017).
Antidepressants: They are commonly used in the treatment of depressive episodes and irritability identified with premenstrual syndrome. Antidepressants act by expanding the levels of the mind (opioids, serotonin and others) that are affected by ovarian hormones (PGs). These synapses are critical in controlling the state of mind and feelings (Ryu & Kim, 2015). The group of anti-depressants of the serotonin reuptake inhibitor is best for the side effects of premenstrual syndrome. Fluoxetine (Prozac) and paroxetine (Paxil) are cases of antidepressant drugs.
Lifestyle modification: Modifying lifestyle may be helpful in preventing recurrence and recurrence of symptoms associated with premenstrual syndrome. The overall modification includes a healthy lifestyle including - work; psychological help during the premenstrual period; retaining salt before menstruation; decreased caffeine consumption before the monthly cycle; smoking; restricting the intake of alcohol; and the reduction of refined sugar intake (Smithe et al., 2016).
Tracey is a busy business woman. She often smokes and often consumes alcohol in moderation. She should be advised to dedicate at least one hour for exercise in her daily routine. Exercise has been associated with decreasing depressive symptoms and thus can prevent both physical as well as emotional issues associated with PMS. Also, she should be provided counseling for smoking cessation and limit intake of alcohol as well as caffeine (Ryu & Kim, 2015).