NUR241: Premenstrual Syndrome Case Study of Tracey Wilson

This case study delves into the Premenstrual Syndrome (PMS) experienced by Tracey Wilson, a 38-year-old woman presenting with symptoms like anger, irritability, breast tenderness, and abdominal bloating. It explores the pathophysiology of PMS, highlighting the role of hormonal fluctuations and neurotransmitters like serotonin. The study differentiates PMS from Polycystic Ovary Syndrome (PCOS) and discusses common therapies, including lifestyle changes, SSRIs, NSAIDs, diuretics, and hormonal contraceptives. It also emphasizes the importance of a healthy lifestyle, stress management, and dietary adjustments in alleviating PMS symptoms. The analysis considers potential causes specific to Tracey's case, such as ovarian cyst removal, alcohol consumption, smoking, and high sodium intake.

Running head: CHALLENGE AND RESPONSE TO BODY INTEGRITY 2 1
Premenstrual Syndrome Case Study
Student’s Name
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CHALLENGE AND RESPONSE TO BODY INTEGRITY 2 2
Premenstrual Syndrome Case Study
Pathophysiology of Premenstrual Syndrome
Premenstrual syndrome is emotional and physical symptoms which ensue between one to
two weeks prior to a woman's period. It impacts a woman’s behavior, physical health, and
emotions before her menses because the levels of progesterone and estrogen rise during
particular periods of the month and a rise in the levels of these hormones can result in irritability,
anxiety, mood swings as illustrated in Tracey. Ovarian steroids associated with premenstrual
symptoms. Moreover, serotonin is among the gut and brain chemicals which impacts thoughts,
emotions, and moods.
In Tracey’s case, she also experiences physical changes such as tiredness and breast
tenderness, behavioral changes such as irritability, and emotional changes such as anger. It is
worthwhile noting that these symptoms can manifest themselves in late, mid or early luteal stage.
Nevertheless, the symptoms occur in Tracey one week or three days before her menses, meaning
she experiences early Premenstrual syndrome. Premenstrual syndrome is usually triggered or
prompted by hormonal events which ensue after ovulation (Walsh et al., 2015). The symptoms of
Premenstrual syndrome (PMS) are associated with the ovarian production of progesterone. The
progesterone metabolites formed by the ovarian corpus luteum impasse to the gamma-amino
butyric acid receptor membrane particularly the neurosteroid binding site altering its
configuration (Imai et al., 2015), therefore, making it resistant to additional activation and
eventually reducing central gamma-amino butyric acid mediated inhibition. In the same token,
the progesterone in certain hormonal contraceptives can as well adversely impact the gamma-
aminobutyric acid system.
Common Causes of Premenstrual Syndrome

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It is important to note that the exact causes of the premenstrual syndrome have not been
established, however, particular factors can contribute to the disorder. According to Safari et al.
(2015), chemical changes in the brain are one of the factors attributed to premenstrual syndrome.
Serotonin fluctuation, a neurotransmitter (brain chemical) is believed to play a significant role in
mood swings, therefore, triggers premenstrual syndrome symptoms. Inadequate serotonin
amounts can result in sleep problems, food cravings, fatigue as well as premenstrual depression.
Hormonal changes such as progesterone level during the menstrual cycle also acts as a crucial
factor causing the premenstrual syndrome.
Besides, inflammation is another factor attributed to Premenstrual Syndrome (PMS).
Research indicates that Premenstrual Syndrome sufferers have a significant level of
inflammatory markers. Reduction of inflammation is important in negating the Premenstrual
Syndrome symptoms. In Tracey, inflammation can be driven by gut imbalances, urinary tract
infection, and inflammatory diet or foods like snacks. Ovarian cyst removal may be another
cause of Premenstrual Syndrome in Tracey. The non-existence of ovarian cyst results in
fluctuation in the production of estrogen and progesterone leading to symptoms such as breast
tenderness. In Tracey’s case, it seems the progesterone was blunted in the luteal stage by high
cortisol; making the ratio between progesterone and estrogen abnormally high thus resulting in
Premenstrual Syndrome symptoms in one week before her menstrual period. Finally, Tracey’s
alcohol consumption, smoking and high sodium (through the consumption of salty snacks)
exacerbated symptoms such as abdominal bloating (Brahmbhatt et al., 2017). Most importantly,
Premenstrual Syndrome occurs in women between ages 20s to early 40s. Tracey being 38 years
old stands a better chance of experiencing the condition.

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Difference between Clinical Manifestations of Polycystic Ovary Syndrome and
Premenstrual Syndrome
Polycystic ovary syndrome refers to a set of certain symptoms in females as a result of
elevated or eminent androgens. Its signs and symptoms include pelvic pain, acne, excess facial
hair, heavy periods, no or irregular menstrual period, and patches of velvety, thick, darker skin.
According to Ryu and Kim et al. (2015), women with polycystic ovary syndrome develop oily
skin or acne due to hormone changes. They also experience sleeping difficulties and feel tired all
the time. Carmina, Fruzzetti & Lobo (2018), argue that polycystic ovary syndrome is associated
with conditions such as mood disorders, heart disease, obstructive sleep apnea, obesity, and type
2 diabetes. Its diagnosis is based on findings such as ovarian cysts, high levels of androgen, and
non-occurrence of ovulation. It is important to note that many of the women having polycystic
ovary syndrome have insulin resistance, and it the elevated insulin levels which causes or
contribute to the abnormalities.
On the other hand, premenstrual syndrome is associated with the presence of both
behavioral and physical symptoms which repeatedly occur in the second half of the menstrual
cycle. Premenstrual syndrome is characterized by signs and symptoms such as internal tension,
irritability, and anger. It usually occurs during five days prior to the inception of menses and may
be present in almost three consistent menstrual cycles. Tracey can be said to suffer from
premenstrual syndrome because she experiences the symptoms from three days to one week
before her period. Other symptoms of polycystic ovary syndrome include bloating, depression,
and breast pain which were encountered in Tracey. Abnormally high progesterone to estrogen
ratio or progesterone deficiency during the luteal stage is the primary cause of the premenstrual
syndrome.

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Common Therapies for Premenstrual Syndrome and the Lifestyle Changes to Help
with Premenstrual Syndrome
Notably, for many females, lifestyle changes like smoking and alcohol cessation, and
exercising can aid relieve premenstrual syndrome symptoms. However, depending on the
severity of the symptoms a doctor may prescribe certain therapies including antidepressant.
Dimmock (2017), portends that selective serotonin inhibitors such as paroxetine (pexena, Paxil),
fluoxetine (Sarafem, Prozac), and sertraline play a critical role in decreasing mood symptoms.
Selective serotonin inhibitors are the best therapy for the severe premenstrual syndrome.
Secondly, non-steroidal anti-inflammatory drugs such as Motrin IB and Advil can ease breast
discomfort and cramping. Thirdly, diuretic is another therapy of Premenstrual Syndrome.
Limiting salt intake and exercising are not sufficient to reduce bloating, swelling of Premenstrual
Syndrome and weight gain. Taking diuretics or water pills such as Spironolactone can aid the
body shed off fluid via the kidney. Lastly, hormonal contraceptives treat Premenstrual Syndrome
by stopping ovulation.
The first lifestyle change in managing PMS is the development and maintenance of a
healthy lifestyle; including possibly taking vitamins, managing stress, exercising, mineral
supplements such as calcium, and eating a well-balanced diet. Individuals need to eat a diet with
low saturated fats and rich in vegetables, fruits, and whole grains. In the same vein, women need
to cease consumption of salt, alcohol, caffeine (Kaushik et al., 2017), and sugary foods about two
weeks prior to their menstruation period and drink plenty of fluid including water. Women also
need to reduce stress because high levels of stress tend to worsen premenstrual syndrome
symptoms. Reduction of tress should also be accompanied by relaxation or more rest.

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References
Brahmbhatt, S., Sattigeri, B. M., Shah, H., Kumar, A., & Parikh, D. (2017). A prospective survey
study on premenstrual syndrome in young and middle aged women with an emphasis on
its management. International journal of research in medical sciences, 1(2), 69-72.
Carmina, E., Fruzzetti, F., & Lobo, R. A. (2018). Features of polycystic ovary syndrome (PCOS)
in women with functional hypothalamic amenorrhea (FHA) may be reversible with
recovery of menstrual function. Gynecological Endocrinology, 34(4), 301-304.
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.
Kaushik, D., Sheetal, D., Sharma, L., & Ajmera, P. (2017). Pre menstrual syndrome among
females.
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
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Walsh, S., Ismaili, E., Naheed, B., & O'Brien, S. (2015). Diagnosis, pathophysiology and
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