Miscellaneous

A. Bilateral salpingoophorectomy
B. Combined oral contraceptive Pills
C. Complementary therapies
D. Continuous COC with levonorgestrol containing pills
E. Cyclical COC
F. Continuous COC with Drospironone containing Pills
G. Luteal Phase SSRI in high doses
H. Referral to the secondary care
I. Transdermal estrogen patches with luteal phase micronized Progesterone
J. Progesterone containing IUD
K. Micronized progesterone 100-200mg orally
L. Cognitive behavioural therapy
M. GnRH analogue with tibolone
N. Hysterectomy with bilateral salpingooophorectomy

1. 37 year old woman mother of two children presented to her GP with symptoms of bloating, mastalgia, irritability, has arguments/ fights with her partner and tearfulness 15-20 days after her periods which increases before her periods. She feels good once she gets her periods. She has been troubled with this symptom for the past 6-7 months. She has consulted her GP for which the GP has advised exercise, lifestyle modifications, calcium supplementation. She does not have any plans on future pregnancy. She is demanding a treatment which would relieve her symptoms. The next management option is

2. 32 year old woman with three living children has presented to her GP for symptoms of distressing PMS. She is not relieved of symptoms with continuous phase SSRI. She is not keen to use Pills as she has undergone sterilisation. What is your next management Plan?

3. 29 year old, has presented herself to the GP with complaints of distressing psychological symptoms which is affecting her personal relationship with her family and friends. The first line management is

4. 36 year old P2L2 has now entered a new relationship and is keen on having a pregnancy. She has been referred to the Gynecology Clinic with distressing symptoms not relieved by CBT, Lifestyle modifications and citalopram 10 mg. The next management Option is

5. 25 year old nulliparous woman is referred to the gynaecology unit for distressing physical and psychological symptoms of PMS. The treatment given by the GP did not relieve her symptoms. She is at present not contemplating on pregnancy as she wants a complete relief for her symptoms. The best management option is

6. 45 year old who has completed her family and completely debilitated by physical and psychological symptoms. She has been treated with CBT, lifestyle modifications, SSRI at high doses, Estrogen patches with Mirena. She has not found any relief of symptoms. The next management option is