[ Pobierz całość w formacie PDF ]

keeping a symptom diary, getting adequate rest and
exercise, and making dietary changes.
B.Sleep disturbances, ranging from insomnia to excessive
sleep, are common. A structured sleep schedule with
consistent sleep and wake times is recommended. Sodium
restriction may minimize bloating, fluid retention, and
breast swelling and tenderness. Caffeine restriction and
aerobic exercise often reduce symptoms.
III.Dietary Supplementation
A.Vitamin E supplementation is a treatment for mastalgia.
The administration of 400 IU per day of vitamin E during
the luteal phase improves affective and somatic symptoms.
B.Calcium carbonate in a dosage of 1200 mg per day for
three menstrual cycles results in symptom improvement
in 48 percent of women with PMS.
IV.Pharmacologic Therapy
A.Fluoxetine (Sarafem) and sertraline (Zoloft) have been
approved for the treatment of PMDD. SSRIs are recom-
mended as initial drug therapy in women with PMS and
PMDD. Common side effects of SSRIs include insomnia,
drowsiness, fatigue, nausea, nervousness, headache, mild
tremor, and sexual dysfunction.
B.Fluoxetine (Sarafem) 20 mg or sertraline (Zoloft) 50 mg,
taken in the morning, is best tolerated and sufficient to
improve symptoms. Fluoxetine or sertraline can be given
during the 14 days before the menstrual period.
C.Benefit has also been demonstrated for citalopram
(Celexa) during the 14 days before the menstrual period.
Prescription Medications Commonly Used in the
Treatment of Premenstrual Syndrome (PMS)
Drug
class and
represen- Recom-
tative mendatio Side ef-
agents Dosage ns fects
SSRIs
Fluoxetine 10 to 20 First-choic Insomnia,
(Sarafem) mg per e agents drowsi-
day for the ness, fa-
treatment tigue, nau-
of PMDD. sea, ner-
Sertraline 50 to 150
Effective in vousness,
(Zoloft) mg per
alleviating headache,
day
behavioral mild
and physi- tremor,
cal symp- sexual
Paroxetine 10 to 30
toms of dysfunc-
(Paxil) mg per
PMS and PMDDtion
day
Administer
during
Fluvoxami 25 to 50
luteal
ne (Luvox) mg per
phase (14
day
days be-
fore men-
ses).
Citalopram 20 to 40
(Celexa) mg per
day
Diuretics
Spironolac 25 to 100 Effective in Antiestrog
tone mg per alleviating enic ef-
(Aldactone day luteal breast ten- fects,
) phase derness hyperkale
and bloat- mia
ing.
Drug
class and
represen- Recom-
tative mendatio Side ef-
agents Dosage ns fects
NSAIDs
Naproxen 275 to 550 Effective in Nausea,
sodium mg twice alleviating gastric
(Anaprox) daily various ulceration,
physical renal dys-
symptoms function.
of PMS. Use with
Any caution in
NSAID women
Mefenamic 250 mg tid
should be with preex-
acid with meals
effective. isting gas-
(Ponstel)
trointestina
l or renal
disease.
Androgens
Danazol 100 to 400 Somewhat Weight
(Danocrine mg twice effective in gain, de-
) daily alleviating creased
mastalgia breast
when size, deep-
taken dur- ening of
ing luteal voice.
phase. Monitor
lipid profile
and liver
function.
GnRH agonists
Leuprolide 3.75 mg Somewhat Hot
(Lupron) IM every effective in flashes,
month or alleviating cardiovas-
11.25 mg physical cular ef-
IM every and be- fects, and
three havioral osteoporo-
months symptoms sis
of PMS
Side effect
profile and
cost limit
use.
Goserelin 3.6 mg SC
(Zoladex) every
month or
10.8 mg
SC every
three
months
Nafarelin 200 to 400
(Synarel) mcg
intranasall
y twice
daily
D.Diuretics. Spironolactone (Aldactone) is the only diuretic
that has been shown to effectively relieve breast tender-
ness and fluid retention. Spironolactone is administered
only during the luteal phase.
E.Prostaglandin Inhibitors. Nonsteroidal
anti-inflammatory drugs (NSAIDs) are traditional therapy
for primary dysmenorrhea and menorrhagia. These agents
include mefenamic acid (Ponstel) and naproxen sodium
(Anaprox, Aleve).
References: See page 255.
Primary Amenorrhea
Amenorrhea (absence of menses) results from dysfunction
of the hypothalamus, pituitary, ovaries, uterus, or vagina. It
is often classified as either primary (absence of menarche by
age 16) or secondary (absence of menses for more than three
cycle intervals or six months in women who were previously
menstruating).
I.Etiology
A.Primary amenorrhea is usually the result of a genetic or
anatomic abnormality. Common etiologies of primary
amenorrhea:
1.Chromosomal abnormalities causing gonadal
dysgenesis: 45 percent
2.Physiologic delay of puberty: 20 percent
3.Müllerian agenesis: 15 percent
4.Transverse vaginal septum or imperforate hymen: 5
percent
5.Absent production of gonadotropin-releasing hor-
mone (GnRH) by the hypothalamus: 5 percent
6.Anorexia nervosa: 2 percent
7.Hypopituitarism: 2 percent
Causes of Primary and Secondary Amenorrhea
Abnormality Causes
Pregnancy
Anatomic abnormalities
Congenital abnormality in Isolated defect
Mullerian development Testicular feminization syn-
drome
5-Alpha-reductase defi-
ciency
Vanishing testes syndrome
Defect in testis determining
factor
Congenital defect of uro- Agenesis of lower vagina
genital sinus develop- Imperforate hymen
ment
Acquired ablation or Asherman s syndrome
scarring of the Tuberculosis
endometrium
Disorders of
hypothalamic-pituitary
ovarian axis
Hypothalamic dysfunc-
tion
Pituitary dysfunction
Ovarian dysfunction
Causes of Amenorrhea due to Abnormalities in the
Hypothalamic-Pituitary-Ovarian Axis
Abnormality Causes
Hypothalamic dys- Functional hypothalamic amenorrhea
function Weight loss, eating disorders
Exercise
Stress
Severe or prolonged illness
Congenital gonadotropin-releasing
hormone deficiency
Inflammatory or infiltrative diseases
Brain tumors - eg,
craniopharyngioma
Pituitary stalk dissection or compres-
sion
Cranial irradiation
Brain injury - trauma, hemorrhage,
hydrocephalus
Other syndromes - Prader-Willi,
Laurence-Moon-Biedl
Pituitary dysfunc- Hyperprolactinemia
tion Other pituitary tumors- acromegaly,
corticotroph adenomas (Cushing's
disease)
Other tumors - meningioma,
germinoma, glioma
Empty sella syndrome
Pituitary infarct or apoplexy
Ovarian dysfunc- Ovarian failure (menopause)
tion Spontaneous [ Pobierz całość w formacie PDF ]
  • zanotowane.pl
  • doc.pisz.pl
  • pdf.pisz.pl
  • mons45.htw.pl
  • WÄ…tki
    Powered by wordpress | Theme: simpletex | © (...) lepiej tracić niż nigdy nie spotkać.