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Women's Health: PMS and Dysmenorrhea

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Begin after ovulation. They then peak prior to menstruation.
When do PMS symptoms appear?
20's
Majority with PMS report their symptoms began when they were in their _____________________ (age).
Affects 80% of women.
How common is PMS?
Unknown
Alterations in Estrogen - Progesterone balance
Alterations in Prostaglandin levels
Vitamin and Mineral insufficiencies
Altered serotonin and dopamine
Suboptimal liver function
Suboptimal GI function
Emotional, physical, sexual and other psychological stressors
Stress
Exercise
Eating habits - fast food
Elimination/Detoxification pathways
Hypothalamic-Pituitary-Thyroid
Hypothalamic-Pituitary-Adrenal
What are the suspected/possible etiologies of PMS? (As many as you can, extensive list)
PMT - A
PMT - C
PMT - D
PMT - H
Guy Abraham's created subgroups for PMS symptoms. What are the classifications? (Don't include symptoms)
1. Endometriosis
2. Tumors
3. Fibroids

We can rule them out by hormone level assessments (thyroid function, estrogen, progesterone, DHEA, cortisol), by Vitamin/Mineral Assessment, and by recording symptoms daily for 2-3 months.
A patient walks in with symptoms of PMS. What 3 pathologies must we rule out? How can we rule them out?
Symptoms:
NERVOUS TENSION
MOOD SWINGS
IRRITABILITY
ANXIETY
INSOMNIA

Suspected Cause:
Elevated Estrogen/Low Progesterone
What are the signs/symptoms and causes of PMS classified as PMT - A?
Symptoms:
CRAVINGS
HEADACHES
INCREASED APPETITE
HEART PALPITATIONS
FATIGUE

Suspected Cause:
Increased Est. to Prog. ratio
Estrogen is a CNS stimulant
What are the signs/symptoms and causes of PMS classified as PMT - C?
Symptoms:
HYPERHYDRATION
BLOATING
WEIGHT GAIN
BREAST TENDERNESS
SWOLLEN EXTREMITIES

Suspected Cause:
Not listed.
What are the signs/symptoms and causes of PMS classified as PMT - H?
Symptoms:
DEPRESSION
CONFUSION
FORGETFULNESS
CRYING

Suspected Cause:
Not listed.
What are the signs/symptoms and causes of PMS classified as PMT - D?
1. Progesterone creams
2. Herbs like Chaste Berry
3. Red Raspberry Tea
4. Regular Exercise
5. Reassurance
6. PMS Self Help Books
How do we treat Progesterone Insufficiency?
Limit PGE2:
Avoid/Limit meats, dairy fats, shellfish
Increase bioflavonoids, ginger, tumeric
Avoid Insulin resistance

Enhance PGE1 and PGE3:
Flaxseed
Leafy greens
B6, Zinc, Magnesium
EPA/DHA
If we suspect Prostaglandins are primarily responsible for PMS symptoms, how can we treat it?
Limit alcohol - stresses the liver, and destroys B vitamins,
magnesium and chromium
Supplements (Vitamin D, E, calcium, iron, potassium, zinc, L-tryptophan)
Limit Caffeine
Good GI health (Water, Vegetables)
Liver function (Liver support, indole 3 carbinol, Mg, B complex)
Limit/Avoid exogenous Estrogens (Non organic poultry, dairy, red meat. Xenoestogens sources - plastics, fuels, pesticides )
Regular Exercise
Ingestion of phytoestrogens and lignans
Decrease ingestion of refined sugars
If we suspect estrogen dominance is the cause of PMS, how can we treat it? (List as many as you can)
Vit. D
Vit. E
Calcium
Iron, Potassium and Zinc
L-tryptophan in severe cases
What supplements can help PMS in an estrogen dominant patient?
Downregulate sympathetic nervous system
upregulate parasympathetics. (Spinal Touch, Logan Basic. C1, Sacrum, Pubes)
Encourage Neurolymphatic drainage
What Chiropractic techniques can we do to treat PMS?
Aldactone
What medication do doctors use to manage edema during PMS?
Gingko biloba (80mg 2x/day during the luteal phase)
Evening primrose oil (320 mg/ day for 3 to 6 months)
Chaste berry (V.Agnus extract) (20mg 2x/day during the luteal phase)
Give three supplements that can treat Mastodynia.
Affects 50% of women.
How common is dysmenorrhea?
Daily oral contraceptive
Bromocriptine (Parlodel, Cycloset)
Tamoxifen (Nolvades, Soltamox)
What three medications can MDs use to manage Mastodynia?
Treat underlining cause
How do we manage secondary dysmenorrhea?
Begins with first ovulatory cycles
Typically a female less than 20 yoa
Resolves or subsides by age 30
Painful menses not related to any definable pelvic lesion
What does the history of a women with Primary Dysmenorrhea look like?
Cervical stenosis - pin hole cervical os or non liquefied clot dilates the os
Increased uterine activity i.e. powerful uterine contractions
Altered Est/Prog ratios
Increased Vasopressin production from hypothalamus resulting in contraction of vascular and smooth muscle
Overproduction of PGE2 leading to increased smooth muscle contraction
Constitutional factors such as anemia, diabetes, which may lower pain threshold
Psychological - low tolerance to pain
Give the proposed etiologies of Primary Dysmenorrhea.
Endometriosis
PID
Fibroids
Post surgical adhesions
Ovarian cysts
What is Secondary Dysmenorrhea?
Midline
Cramping
Spasmodic
Pain begins shortly before onset of menstruation lasts ~2-3 days
Assoc S/S - back pain, nausea, diarrhea, vomiting
What are the signs/symptoms of Primary Dysmenorrhea?
Pain begins several days before menstruation
Pain lasts for several days
Pain is typically dull achy feeling in lower abdomen
Pain is often accompanied by headaches, LBP, fatigue and in
some cases depression
What are the signs/symptoms of Secondary Dysmenorrhea?
Adjust (T/L spine, Sacrum, Coccyx, Pubes)
Sacral pump
Neurolymphatic techniques
Pelvic Exercise - Kegels
Childbirth
Orgasm
Local Heat
Massage
Herbs (Ginger, Red Raspberry Leaf Tea)
PGE1 and PGE3 Precursors
Mineral Supplements
How might we manage primary dysmenorrhea?
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