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Premenstrual disorders encompass a spectrum of cyclic affective and physical symptoms that interfere with daily functioning, occurring during the luteal phase and resolving with or immediately following menstruation. Premenstrual disorders may be caused by fluctuations of estrogen in the luteal phase, leading to dysregulation of serotonin, increased sensitivity to changes in the progesterone metabolite allopregnanolone, or both. Diagnosis can be made based on symptom assessment with daily ratings for at least 2 consecutive menstrual cycles, such as the Daily Record of Severity of Problems.1,2 Affective symptoms include lability (mood swings, sudden sadness or tearfulness, sensitivity to rejection), irritability or anger, depressed mood, and anxiety or tension. Physical symptoms include difficulty concentrating, lethargy or fatigue, appetite changes, sleep disturbances, breast tenderness, joint pain, and abdominal bloating.
Premenstrual syndrome (PMS) is characterized by the cyclic occurrence of any of these affective or physical findings during the premenstrual period and affects approximately one-quarter of menstruating individuals. Premenstrual dysphoric disorder (PMDD) is more severe than PMS and less common (affecting 2%-5% of females). Based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), the diagnosis of PMDD requires at least 5 symptoms, including at least 1 affective symptom and 1 physical symptom, the week before menses. Symptoms of PMDD substantially decrease or resolve the week after menses.1,2 Treatment choices are based on the timing and severity of symptoms and patient goals such as desire for contraception.
Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.
Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.
Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.
Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.
This JAMA Insights explores how clinicians can effectively communicate person-centered health care information to adolescents regarding sexual and reproductive health, contraception, and sexually transmitted infection testing and treatment.
Long-acting reversible contraception (LARC), including contraceptive implants and intrauterine devices (IUDs), is highly effective, with typical-use failure rates of less than 1 pregnancy per 100 person-years of use.1 Fertility returns rapidly after discontinuation of LARC.
Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.
