Nursing Case Study: Comprehensive Analysis of Premenstrual Syndrome

This nursing case study provides an in-depth analysis of Premenstrual Syndrome (PMS), exploring its physiological causes, symptoms, and management strategies. It discusses the hormonal imbalances, such as estrogen excess and progesterone deficiency, and neurotransmitter alterations, particularly serotonin, that contribute to PMS symptoms like mood swings, breast tenderness, acne, nausea, and bloating. The study differentiates PMS from Polycystic Ovary Syndrome (PCOS), highlighting key differences in symptoms like menstrual irregularity and hirsutism. Furthermore, it outlines various treatment interventions, including selective serotonin reuptake inhibitors (SSRIs), alternative therapies like relaxation techniques and acupuncture, and lifestyle modifications such as dietary changes and stress-reducing activities. The case study emphasizes a holistic approach to managing PMS, combining pharmacological, behavioral, and lifestyle adjustments for effective symptom relief. Desklib offers a wealth of similar resources for students.

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

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NURSING CASE STUDY
Table of Contents
Question 1:.................................................................................................................................2
Question 2:.................................................................................................................................2
Question 3:.................................................................................................................................3
Question 4:.................................................................................................................................4
References:.................................................................................................................................6

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NURSING CASE STUDY
Question 1:
The most abundant theoretical explanation of the physiological course of changes in
the body that leads to the occurrence of the PMS symptoms includes estrogen excess,
estrogen withdrawal, deficiency of progesterone and pyridoxine, fluid-electrolyte imbalances,
and alteration of the glucose metabolism (Safari et al., 2015). On a more elaborative note,
there is a distinctive altercation in the serotonin levels during the PMS period which has a
strong impact on the mood swings. Serotonin is the hormone that controls the emotions of
happiness and hence any imbalance is directly related to sadness and irritability and also
causes terrible mood swings in the patients which has been the case for the patient in the case
study as well. Along with that, the rapid changes in the hormones estrogen and progesterone
also exaggerates both the physical and emotional responses. The fluctuating hormonal levels
also result in premenstrual breast swelling and tenderness which Tracey had been
experiencing as well, especially in the prolactin hormone causes the swelling and the
tenderness (Imai et al., 2015).
The hormonal changes also affects the skin of a woman and can cause acne which is
another symptom experienced by Tracey. Before and during the menstrual cycle the level of
testosterone is usually extremely high which triggers over-activeness of the sebaceous glands
and produces more oils in the face, leading to aggravated acne. The nausea that Tracey had
been experiencing is caused by the imbalances in the magnesium and calcium levels of the
body due to the PMS which has been attributed to cause nutritional deficiency and nausea.
Lastly, Tracey had been experiencing abdominal blotting as well, which is facilitated by the
changes in the water retention mechanism of the body caused by hormonal changes and the
alteration in the endocrinal system (Dimmock et al., 2017).

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Question 2:
Premenstrual syndrome is a very common condition which is associated with the
physical, mental and emotional symptoms that is usually known to occur more or less one to
two weeks before the start of the menstrual cycle. Premenstrual syndrome is a fairly common
health adversity which has been reported to be affecting more than 50 percent of the women
all across the world. As mentioned by Ryu and Kim (2017), the exact cause of the
Premenstrual syndrome is unclear, however there are various theories and schools of thoughts
that are pertinent. First and foremost, the premenstrual symptoms are intricately linked with
the luteal phase which is the latter phase of the menstrual cycle that begins with the formation
of the corpus luteam and is controlled primarily by the hormone progesterone, however the
exact causes of the PMs has not been illustrated. The cyclic changes in the body that takes
part in preparation of beginning a new luteum phase for an optimal ovulation can be a
significant contributing factor. However, Pearlstein and O’Brien (2017), have argued that the
chemical alterations in the brain due to the fluctuating concentrations of the neurotransmitter
serotonin to play the crucial role in facilitating the series of events accumulating to the PMS.
However, undiagnosed depression that the patient has been suffering from has been reported
to aggravate or accelerate the process of PMS as well, however there is need for extensive
research to discover the exact reasons contributing to the PMS.
Question 3:
Polycystic ovarian syndrome is a commonly observed endocrinopathies that has been
reported to be the cause of menstrual irregularity and androgenic excess observed in women
of reproductive age. The clinical manifestations of the polycystic ovarian syndrome or PCOS
includes irregular menstruation, hirsutism, acne, bloating and behavioural as well appearance
oriented alterations. The symptoms or clinical manifestations of this particular disease in the
early onset period bears certain similarities with the symptoms of the Premenstrual syndrome,

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however there are distinctive differences between PCOS and PMS symptoms. First and
foremost, the irregularity in menstruation is not observed in case of PMS, however it is a
classic clinical manifestations of PCOS (Balen, 2017). Along with that, hirsutism or facial
hair growth and abnormal hair growth in various parts of the body is also associated with
PCOS which is not observed in PMS. Although abdominal bloating is a very common
symptom of PMS, the counterpart for PCOS in case of the clinical manifestation is the
obesity which is distinctive from just abdominal bloating. Lastly, the mood swings which is a
vital sign or symptom of the PMS, is not observed in case of PCOS either (Ryu & Kim,
2017).
Question 4:
The symptoms associated with the PMS is unavoidable however they can be properly
managed if adequate interventions are implemented. The treatment or medical care that is
generally followed in case of the premenstrual syndrome is focussed on pharmacological and
behavioural interventions. As mentioned by the Dimmock et al. (2017), the most suitable and
recommended first line therapeutic intervention choice for the premenstrual syndrome and its
clinical manifestations include the selective serotonin reuptake inhibitors, which generally is
associated with acting directly on the serotonin receptors to restore the balance of serotonin
concentration in the body. However, only this particular treatment intervention is not able to
target the myriad of symptoms caused by PMS and hence a variety of alternative therapies
are also given to the patients in clinical practice. The relaxation response technique,
biofeedback and guided imagery, cognitive behavioural therapy or group therapy sessions,
bright light therapy, acupuncture and message, chiropractic therapy, homeotherapy and
herbal medication to treat bloating and nausea has been proven to be effective in varying
degrees depending on the patient characteristics (Bäckström & Bäckström, 2016).

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Along with treatment intervention, effective management of the PMS is also
associated with lifestyle modifications as well. Dietary modifications, especially with foods
rich is calcium, magnesium and antioxidants have been reported to be extremely helpful in
managing the symptoms adequately. Engaging in yoga and meditation has also been
successful in detoxifying the body and helping the women deal with the PMS symptoms
more effectively. Avoiding diet rich in saturated fat and sugar has been found to be effective
as well, along with engaging in stress relieving relaxation activity or choice depending on the
preferences of the individual (Appleton, 2018).

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References:
Appleton, S. M. (2018). Premenstrual Syndrome: Evidence-based Evaluation and
Treatment. Clinical obstetrics and gynecology, 61(1), 52-61.
Bäckström, T., & Bäckström, F. (2016). Drugs for the Management of Premenstrual
Syndrome and Related Syndromes. Gynecological Drug Therapy, 47.
Balen, A. H. (2017). Polycystic ovary syndrome (PCOS). The Obstetrician &
Gynaecologist, 19(2), 119-129.
Dimmock, P. W., Wyatt, K. M., Jones, P. W., & O'Brien, P. M. (2017). Efficacy of selective
serotonin-reuptake inhibitors in premenstrual syndrome: a systematic.
Imai, A., Ichigo, S., Matsunami, K., & Takagi, H. (2015). Premenstrual syndrome:
management and pathophysiology. Clinical and experimental obstetrics &
gynecology, 42(2), 123-128.
Pearlstein, T., & O’Brien, S. (2017). A Woman with Inexplicable Mood Swings: Patient
Management of Premenstrual Syndrome. In Bio-Psycho-Social Obstetrics and
Gynecology (pp. 183-198). Springer, Cham.
Ryu, A., & Kim, T. H. (2015). Premenstrual syndrome: a mini review. Maturitas, 82(4), 436-
440.
Safari, T., Manzari Tavakoli, A. R., Kheyr Khah, B., Saeedi, H., & Mahdavinia, J. (2015).
The relationship between premenstrual syndrome with anxiety, depression and
changes in social relations of women in Kerman University of Medical
Sciences. Report of Health Care, 1(4), 139-141.