ACTIVITY NUMBER:  RES009

ACTIVITY TITLE: Premenstrual Syndrome/Premenstrual Dysphoric Disorder

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  December 1, 2012

Reviewed and Updated in 2015

Expiration Date: January 31, 2019

Under Review July 2022

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Premenstrual syndrome (PMS) is a common disorder of menstruating women with as many as 85% reporting one or more premenstrual symptoms.¹  The emotional and physical symptoms occurring during the luteal phase of the menstrual cycle can range from mild to severe with about 3-5% of menstruating women reporting significant impairment of one or more areas of daily life.¹  Symptoms of PMS can prompt women to seek care from their gynecologist or primary care provider, but diagnosis and treatment can be difficult for both patients and physicians. The wide variation in symptoms and lack of a specific endocrine diagnostic test may lead to misdiagnosis.  Women also report seeking medical attention for their premenstrual symptoms from multiple physicians over several years before being diagnosed with PMS.²  Claims in the media and lay literature of alternative remedies, such as herbal therapies for which there is scant scientific evidence, can be confusing for both healthcare providers and their patients.  An established consensus of diagnostic criteria for PMS and its severe form, premenstrual dysphoric disorder (PMDD), gives clinicians guidance in evidence-based diagnosis and in clinical management.¹  Also, use of a validated PMS calendar provides prospective recording of symptoms and assists in differential diagnosis.³  This presentation will provide clinicians with the correct diagnostic criteria for PMS, an understanding of the causes and impact of the disorder, and provide guidance in interpersonal communication and patient education to assist in treatment.

1.      American College of Obstetricians and Gynecologists. Clinical management guidelines for obstetricians-gynecologists: premenstrual syndrome. ACOG Practice Bulletin 15. Washington, DC: ACOG; 2000.

2.      Mishell DR Jr. Premenstrual disorders: epidemiology and disease burden. Am J Manag Care. 2005 Dec;11(16 Suppl):S473-9.

3.      Feuerstein M, Shaw WS. Measurement properties of the calendar of premenstrual experience in patients with premenstrual syndrome. J Reprod Med.  2002 Apr;47(4):279-89.

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.      Describe the diagnostic criteria for premenstrual syndrome (PMS).

2.      List the possible causes of PMS.

3.      Elicit a pertinent history to evaluate PMS.

4.      Describe the differential diagnosis of PMS.

5.      Treat PMS with interventions including psychosocial support or referral, counseling about lifestyle changes and medication.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Randal Robinson, MD – Speakers’ Bureau for Merck and Teva

Robert W. Rebar, MD – Nothing to Disclose
Rhonda Ruiz – Nothing to Disclose

Nanette Santoro, MD – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc – Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.