HNY Policy and Pathway Repository - Humber

This pathway should be accessed when managing this condition in Primary Care and prior to referring for specialist care.

Premenstrual Syndrome (PMS) is a severe chronic condition whose symptoms often cause misery for the sufferer and those around them. Recording the timing and pattern of symptoms experienced within the menstrual cycle is the most reliable means of identifying PMS and should be carried out as a diagnostic test for 2 months minimum. Symptoms may be predominantly physical or psychological or both. Typically, they must occur in the luteal phase of the menstrual cycle, resolve by the end of menstruation and be followed by a symptom-free week. Some women report a flick up of symptoms at the presumed time of ovulation.

The pathway should be accessed to diagnose and initiate management.

If patient presents with suicide ideation, perform a thorough assessment of mental health status and risk to self. High-risk patients should be referred to a Duty Psychiatric Assessment Team. Low-risk patients should be referred to a Community Mental Health Team.   

Exclude Red Flag Symptoms

Conditions to exclude when diagnosing premenstrual syndrome (PMS)  include the following, but women may suffer these with pre-menstrual exacerbation:

- depression
- anxiety and panic disorders
- hypothyroidism
- anaemia
- dysmenorrhoea
- irritable bowel syndrome
- endometriosis
- chronic fatigue syndrome
- fibromyalgia
- mastalgia

Do Not Refer

Do not refer if charting does not indicate the presence or exacerbation of physical or mental symptoms in the luteal phase of the cycle.

Management In Primary Care Leaflet

When assessing women with premenstrual syndrome (PMS ), symptoms should be recorded prospectively over three cycles, using a symptom diary (retrospective recall of symptoms is unreliable).

Symptom diary should include;
- detailed account of symptoms
- daily record of severity of problems (DRSP)
- level of distress experienced
- impact on:
   - social life (including hobbies)
   - performance at work/school
   - interpersonal relationships

In women who do not menstruate but report a regular pattern of symptoms (eg due to hysterectomy, endometrial ablation or a levonorgestrel releasing intrauterine system measuring progesterone blood concentrations and noting a peak of symptoms will help to show the association between symptoms and ovulation.

Women with mild physiological premenstrual symptoms that have no substantial impact on their functioning may need no more than support and reassurance of normality - advise good nutrition, exercise , and stress reduction.

Women must be post-menarche and pre-menopause and unless by telephone discussion with the receiving consultant, have a minimum of 2 months charting to establish the diagnosis. A full medical summary including physical and mental health history and current medication should be included. 

Referrals

E-Referral (choose and Book) - Please note, this is for indirect booking only; please issue the client with their ID number and ask them to ring 01482 247111 after 48hrs to initiate the referral. 

Completed Healthcare Professional referral forms can be sent via email to CHCP.247111@nhs.net or Fax: 01482 347637. 

Or postal: Integrated Sexual Health Service Unit 4 Priory Park Henry Boot Way Hull HU4 7DY (NOTE: we are able to action the referral quicker if sent via email or fax).

Self referral via 247111 Care co-ordination centre.

Management In Primary Care Leaflet

Sexual Health Service Information For GPs

National Association for Premenstrual Syndrome website for professionals and patients. To get in touch email contact@pms.org.uk, telephone is 0844 8157311.

Patient information:

'Managing premenstrual syndrome (PMS)' (PDF) from the Royal College of Obstetricians and Gynaecologists

Premenstrual syndrome leaflet from from Patient UK at www.patient.co.uk

A minimum of 2 months charting to establish the diagnosis. A full medical summary including physical and mental health history and current medication should be included. 

NOTE: referrals from GP/HCP must be completed in full of the relevant requested information attached failure to provide this will result in delay of appointment for client.

All self referred patients must agree to have their GP contacted to provide relevant medical summary and must state the reason for requiring an appointment. Failure to provide this information will result in the referral not being accepted