In this episode of The Good GP, Karin Sekhon speaks with Professor Jayashri Kulkarni, a renowned psychiatrist, about premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Professor Kulkarni explains the distinctions between PMS and PMDD, emphasising that PMS is more prevalent and generally involves physical symptoms like bloating and headaches, while PMDD affects a smaller percentage of women and includes severe psychological symptoms such as major depression, anxiety, and brain fog. She talks about the genetic and environmental factors contributing to PMDD, highlighting a specific gene complex that may be activated by trauma.

Discussing the primary pharmacological treatments for PMDD, Professor Kulkarni advises starting with hormonal treatments like the combined oral contraceptive pill; she recommends the pill "Zoely" for its balanced hormone levels. She also elaborates on the use of SSRIs like sertraline for additional support and gives a stepped approach to treatment, including the possible need for hormone replacement therapy (HRT) or menstrual suppression in complex cases.

They also touched on the potential role of complementary therapies and the importance of holistic care, involving psychological support and lifestyle modifications. Professor Kulkarni provides guidance on when GPs should consider referring patients to specialists and emphasises the collaborative role of GPs in managing PMDD effectively.

If you want to learn more about this topic, consider the HER Centre Australia's online short course on Women's Mental Health: https://www.monash.edu/medicine/translational/psychiatry/short-courses/womens-mental-health

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