Premenstrual Syndrome (PMS).
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Premenstrual syndrome is a symptom complex that is characterized by neuropsychic, metabolic-endocrine and vegetative-vascular disorders that occur in the second phase of the menstrual cycle (about 3-10 days) and stop either at the beginning of menstruation or immediately after their completion.
Other names for premenstrual syndrome (PMS) are premenstrual disease, premenstrual tension syndrome, or cyclic disease.
As a rule, PMS is diagnosed in women after 30 years of age (found in 50% of the fairer sex), while at a young and young age it is familiar to only every fifth woman.
Depending on the predominance of certain manifestations, 6 forms of premenstrual disease are distinguished:
By the number of manifestations, their duration and intensity, 2 forms of PMS are distinguished:
- easy. There are 3-4 signs 3-10 days before menstruation, and the most pronounced of them are 1-2;
- heavy. 5-12 symptoms occur 3-14 days before menstruation, and 2-5 of them are expressed as much as possible, or all 12.
But, despite the number of symptoms and their duration, in case of a decrease in working capacity, they speak of a severe course of PMS.
- compensated. Symptoms appear on the eve of menstruation and disappear with their onset, while over the years the symptoms do not intensify;
- subcompensated. The progression of symptoms is noted (their number, duration and intensity increase);
- decompensated. A severe PMS course is observed, over time, the duration of the “bright” intervals decreases.
Causes of Premenstrual Syndrome
Currently, the causes and mechanism of development of PMS are not well understood.
There are several theories that explain the development of this syndrome, although not one of them covers the entire pathogenesis of its occurrence. And if previously it was believed that a cyclic state is characteristic of women with anovulatory cycle, now it is reliably known that patients with regular ovulation also suffer from premenstrual disease.
The decisive role in the occurrence of PMS is played not by the content of sex hormones (it may be normal), but by fluctuations in their level throughout the cycle, to which the brain regions responsible for the emotional state and behavior react.
This theory explains PMS as a violation of the proportion of gestagens and estrogens in favor of the latter. Under the influence of estrogens, sodium and fluid (edema) are retained in the body, in addition, they provoke the synthesis of aldosterone (fluid retention). Estrogen hormones accumulate in the brain, which causes the occurrence of neuropsychiatric symptoms; their excess reduces the content of potassium and glucose and contributes to the occurrence of heart pain, fatigue and physical inactivity.
Prolactin increases normally in the 2nd phase of the cycle, at the same time hypersensitivity of target organs, in particular mammary glands (pain, engorgement), is also noted. Prolactin also affects the hormones of the adrenal glands: it enhances the release of aldosterone, which retains fluid and causes swelling.
The synthesis of prostaglandins, which are produced in almost all organs, is disrupted. Many PMS symptoms are similar to signs of hyperprostaglandinemia (headaches, dyspeptic disorders, emotional lability).
Explains PMS in terms of the body’s hypersensitivity to its own progesterone.
Theory of Water Intoxication
Explains PMS by a disorder of water-salt metabolism.
Among other versions that consider the causes of PMS, one can note the theory of psychosomatic disorders (somatic disorders lead to mental reactions), the theory of hypovitaminosis (lack of vitamin B6) and minerals (magnesium, zinc and calcium) and others.
Predisposing factors of PMS include:
- genetic predisposition;
- mental disorders in adolescence and the postpartum period;
- infectious diseases;
- improper nutrition;
- frequent climate change;
- emotional and mental lability;
- insulin resistance;
- chronic diseases (hypertension, heart disease, thyroid pathology);
- alcohol consumption;
- childbirth and abortion.
As already mentioned, the signs of PMS occur 2-10 days before menstruation and depend on the clinical form of the pathology, that is, on the predominance of certain symptoms.
It is characterized by emotional instability:
- unmotivated aggression or longing, reaching depression;
- sleep disturbance;
- weakness and fatigue;
- periods of fear;
- weakening of libido;
- thoughts of suicide;
- exacerbation of smell;
- auditory hallucinations;
- and others.
In addition, there are other signs: numbness of the hands, headaches, decreased appetite, bloating.
In this case, prevail:
- swelling of the face and limbs;
- soreness and engorgement of the mammary glands;
- weight gain (and due to latent edema);
- headaches and joint pains;
- negative diuresis;
This form is characterized by the predominance of vegetative-vascular and neurological symptoms. Characteristic:
- headaches like migraine;
- nausea and vomiting;
- diarrhea (a sign of an increased content of prostaglandins);
- palpitations, heart pains;
- intolerance to odors;
It proceeds as sympathoadrenal crises or “psychic attacks”, which differ:
- increase in pressure;
- increased heart rate;
- heart pains, although there are no changes on the ECG;
- sudden bouts of fear.
It proceeds as hyperthermic (with an increase in temperature up to 38 degrees), hypersomic (characterized by daytime drowsiness), allergic (the appearance of allergic reactions, not excluding Quincke’s edema), ulcerative (gingivitis and stomatitis) and iridocyclical (inflammation of the iris and ciliary body) forms.
It is characterized by a combination of several described forms of PMS.
Diagnosis of premenstrual cider
It is recommended to conduct differential diagnosis of premenstrual tension syndrome.
This condition should be distinguished from the following diseases:
- mental pathology (schizophrenia, endogenous depression and others);
- chronic kidney disease;
- brain formations;
- inflammation of the membranes of the spinal cord;
- pituitary adenomas;
- arterial hypertension;
- thyroid pathology.
With all of these diseases, the patient complains regardless of the phase of the menstrual cycle, while with PMS, symptoms occur on the eve of menstruation.
In addition, of course, the manifestations of PMS are largely similar to signs of early pregnancy. In this case, it is easy to resolve doubts by independently conducting a home pregnancy test or donating blood for hCG.
Diagnosis of premenstrual tension syndrome has some difficulties: not all women turn to their gynecologist with their complaints, most are treated by a neurologist or therapist.
When applying for an appointment, the doctor must carefully collect an anamnesis and examine complaints, and during the conversation, establish a connection between the listed symptoms and the end of the second phase of the cycle and confirm their cyclicality. It is equally important to make sure that the patient does not have mental illness.
Then the woman is invited to note her signs from the following list:
- emotional instability (causeless crying, sudden mood swings, irritability);
- a tendency to aggression or depression;
- a feeling of anxiety, fear of death, tension;
- reduced mood, hopelessness, longing;
- loss of interest in her usual way of life;
- increased fatigue, weakness;
- impossibility of concentration;
- increased or decreased appetite, bulimia;
- sleep disturbance;
- a feeling of engorgement, soreness of the mammary glands, as well as swelling, headaches, pathological weight gain, pain in muscles or joints.
The diagnosis of PMS is established if the specialist ascertains that the patient has five signs, with the obligatory presence of one of the first four listed.
A blood test for prolactin, estradiol and progesterone in the second phase of the cycle is necessarily prescribed, based on the results obtained, the estimated form of PMS is determined. So, the edematous form is characterized by a decrease in progesterone levels. And neuropsychic, cephalgic and crisis forms are characterized by increased prolactin.
Further examinations vary depending on the form of the ICP.
- examination by a neurologist and psychiatrist;
- X-ray of the skull;
- electroencephalography (detection of functional disorders in the limbic structures of the brain).
- delivery of the LHC;
- study of excretory renal function and measurement of diuresis (secreted fluid is 500-600 ml less than consumed);
- mammography and ultrasound of the mammary glands in the first phase of the cycle in order to differentiate mastopathy from mastodynia (soreness of the mammary glands).
- Ultrasound of the adrenal glands (exclude a tumor);
- passing tests for catecholamines (blood and urine);
- examination by an ophthalmologist (fundus and visual fields);
- X-ray of the skull (signs of increased intracranial pressure);
- MRI of the brain (exclude the tumor).
It is also necessary to consult a therapist and maintain a diary of blood pressure (exclude hypertension).
- electroencephalography, which reveals diffuse changes in the electrical activity of the brain (type of desynchronization of the rhythm of the cortex);
- CT scan of the brain;
- examination by an ophthalmologist (fundus);
- X-ray of the skull and cervical spine.
And with all forms of PMS, consultations with a psychotherapist, endocrinologist and neurologist are necessary.
Treatment of premenstrual syndrome
PMS therapy begins with an explanation to the patient of her condition, normalization of work, rest and sleep (at least 8 hours a day), elimination of stressful situations, and, of course, the purpose of the diet.
Women with premenstrual tension syndrome should adhere, especially in the second phase of the cycle, the following diet:
-spicy and spicy dishes are excluded ;
-a ban on the use of strong coffee, tea and chocolate;
-reduced fat intake, and with some types of PMS – and animal proteins.
The main emphasis of the diet is on the consumption of complex carbohydrates: whole grain cereals, vegetables and fruits, potatoes.
In the case of absolute or relative hyperestrogenia, gestagens (norkolut, duphaston, utrozhestan) are prescribed in the second phase of the cycle.
With neuropsychic signs of PMS, sedatives and mild tranquilizers are shown 2-3 days before menstruation (grandaxinum, orehotel, phenazepam, sibazone), as well as antidepressants (fluoxetine, amitriptyline). MagneB6 has a good calming, normalizing sleep and relaxing effect. Herbal teas, such as Aesculapius (during the day) and Hypnos (at night), also have a sedative effect.
With the edematous form, diuretics (spironolactone) and diuretic teas are prescribed.
Antihistamines (teralen, suprastin, diazolin) are indicated for atypical (allergic) and edematous forms of PMS.
With hyperprostaglandinemia, the use of non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, diclofenac), which inhibit the production of prostaglandins, is indicated.
And, of course, combined oral contraceptives from the monophasic group (Jes, Logest, Janine), which suppress the production of their own hormones, thereby leveling the manifestations of the pathological symptom complex, are indispensable drugs for PMS.
The course of treatment of premenstrual tension syndrome averages 3-6 months.
Consequences and forecast
PMS, the treatment of which the woman was not involved, threatens in the future with a severe course of menopause. The prognosis for premenstrual disease is favorable.
Premenstrual syndrome is a complex of symptoms that appear in the second half of the menstrual cycle a few days before the onset of menstruation. Every fifth woman under the age of 30 faces this condition and every second after. Symptoms are manifested both on a physical and mental level and can vary greatly among different women.
At present, the exact causes of the development of premenstrual syndrome have not been established. There are many theories that explain the occurrence of various symptoms, but not one of them covers the entire complex. The most complete at the moment is the hormonal theory, according to which the cause of PMS is a change in the hormonal balance caused by an increase in estrogen levels and a decrease in progesterone levels.
One of the likely factors for the development of premenstrual syndrome is vitamin deficiency, in particular a deficiency of vitamins B6, A and trace elements calcium, magnesium and zinc. The genetic factor is also of great importance, i.e., the nature of the course of PMS can be inherited.
Symptoms of Premenstrual Syndrome
There are about 150 different symptoms of PMS, which can also occur in different combinations, which greatly complicates the diagnosis. Based on the main symptoms, several forms of the syndrome are distinguished:
The neuropsychic form is characterized by disorders in the emotional and nervous spheres. She is characterized by emotional instability, tearfulness, irritability, aggression, weakness, fatigue, dizziness, insomnia, apathy, causeless anguish, depression, suicidal thoughts, olfactory and auditory hallucinations, a sense of fear, sexual dysfunctions, weakening of memory. Appetite disorders, bloating, soreness and enlargement of the mammary glands are also noted.
With the cephalgic form, vegetative-vascular and neurotic symptoms predominate: migraine-like, throbbing headaches, often accompanied by nausea or vomiting, swelling of the eyelids, diarrhea. About a third of women have a heartbeat, pain in the heart, nervousness, and increased sensitivity to smells and sounds. This form is more common in women with traumatic brain injuries in the past, frequent stress, and infectious diseases of the nervous system.
The main manifestation of premenstrual syndrome in edematous form is fluid retention in the body and, as a result, swelling of the face, limbs, mammary glands, weight gain, sweating, thirst, decreased urination, skin itching, digestive disorders, constipation, diarrhea, bloating.
With crisis forms, sympatho-adrenal crises (a condition caused by an increase in adrenaline level) are noted, which occur with an increase in blood pressure, tachycardia, panic attacks, numbness and cold extremities. Heart pain can occur without changes on the ECG. As a rule, the end of the attack is accompanied by profuse urination. Overwork and stress can be factors that trigger seizures. This form of premenstrual syndrome is the most severe and requires compulsory medical intervention.
Due to the variety of symptoms, the diagnosis of premenstrual syndrome can be very difficult. The main diagnostic criterion is the cyclical nature of complaints and their disappearance after menstruation. A study of the level of hormones (estrogen, progesterone, prolactin) in the blood helps to establish the form of premenstrual syndrome. It is recommended to undergo the procedure of electroencephalography (EEG).
For accurate diagnosis, examination by doctors of various specialties is recommended – an endocrinologist, neurologist, cardiologist, therapist, psychiatrist.
Treatment of premenstrual syndrome
For the treatment of PMS, drug and non-drug methods are used.
Non-pharmacological methods include, first of all, psychotherapy. A woman should observe the regime, avoid excessive exertion and have good rest and sleep.
A diet high in plant and animal proteins, fiber and vitamins is recommended. In the second half of the menstrual cycle, it is necessary to limit the use of coffee, chocolate, alcohol, sugar, salt, animal fats and carbohydrates. Regular physical exercises, therapeutic aerobics, massages will help to alleviate the condition.
Among drug methods, the main role is given to hormone therapy with drugs – analogues of progesterone. In edematous and cephalgic forms, antiprostaglandin preparations are recommended – indomethacin, naprosin.
Since neuropsychic manifestations are present in any form of premenstrual syndrome, sedatives and psychotropic drugs, such as tazepam, orehotel, etc., are prescribed in the second phase of the cycle a few days before the onset of symptoms. Therefore, these drugs belong to the group of tranquilizers, so they should be used only under the supervision of a doctor.
With the edematous form of premenstrual syndrome, antihistamines (tavegil, diazolin) are used. Veroshpiron is prescribed 25 mg 2-3 times a day several days before the onset of symptoms. This drug has potassium-sparing and diuretic effects, lowers blood pressure.
In cephalgic and crisis forms, drugs normalizing hormone synthesis are used, for example, parlodel (1.25–2.5 mg per day) in the second phase of the cycle. With soreness and engorgement of the mammary glands, the use of a progestogen is recommended – a gel containing progesterone.
The use of vitamins E and B6, calcium, potassium, zinc, magnesium, manganese and the amino acid tryptophan has a beneficial effect. Alternative methods give a good effect in the treatment – acupressure (acupressure), aromatherapy.
Treatment of premenstrual syndrome is a lengthy process, lasting about 6–9 months, recurring in case of relapse. In rare cases, treatment can last the entire reproductive period. For greater effectiveness, it is necessary to strictly follow the regimen and instructions of the doctor.
The basis for the prevention of premenstrual syndrome is compliance with the regime of work and rest, and a reduction in psychoemotional stress. It is important to exclude factors – provocateurs of poor health. It is recommended to limit the use of coffee, tea, alcoholic drinks and chocolate, especially at the end of the cycle. Instead, fiber-rich foods, herbal teas, and juices (especially carrot, lemon, and pineapple) are recommended. It is necessary to increase the content of vitamin B6 in the daily diet. It is found in liver, fish, walnuts and soybeans.
The prescribed symptomatic treatment, as a rule, leads to an improvement in the second half of the menstrual cycle.