Premenstrual syndrome is a symptom complex, which is characterized by neuropsychiatric, 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 (it occurs in 50% of the representatives of the weaker sex), whereas at a young and young age, he is familiar only to every fifth woman.
Depending on the prevalence 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 for 3-10 days before menstruation, and 1-2 of them are most pronounced;
- heavy There are 5-12 signs 3-14 days before menstruation, and 2-5 of them, or all 12, are most pronounced.
But, despite the number of symptoms and their duration, in case of a decrease in working capacity, they say that PMS is severe.
Stages of ICP:
- compensated Symptoms appear on the eve of menstruation and disappear with their onset, while over the years, the signs do not increase;
- subcompensated . There is a progression of symptoms (their number, duration and intensity increases);
- decompensated. A severe PMS current is observed, and the duration of “light” gaps decreases with time.
At present, the causes and mechanism of the development of PMS are not well understood.
There are several theories explaining the development of this syndrome, although none of them covers the entire pathogenesis of its occurrence. And if previously it was thought that a cyclical condition 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 onset 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 brain regions responsible for emotional state and behavior react.
This theory explains the PMS violation of the proportion of gestagens and estrogens in favor of the latter. Under the action of estrogen in the body, sodium and fluid (edema) are retained, in addition, they trigger 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 the mammary glands (pain, engorgement ) is noted . Prolactin also affects the adrenal hormones: it increases the release of aldosterone, which retains fluid and causes swelling.
Synthesis of prostaglandins, which are produced in almost all organs, is impaired. Many of the symptoms of PMS are similar to signs of hyperprostaglandinemia (headaches, dyspeptic frustration, emotional lability).
Explains PMS in terms of the body’s hypersensitivity to its own progesterone.
Theory of water intoxication
Explains PMS with a water-salt metabolism disorder.
Among other versions that consider the causes of PMS, 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 can be mentioned.
PSP predisposing factors include:
- genetic predisposition;
- mental disorders in adolescence and the postpartum period;
- infectious diseases;
- unhealthy diet;
- frequent climate change;
- emotional and mental lability;
- insulin resistance;
- chronic diseases ( hypertension, heart disease, thyroid disease);
- alcohol consumption;
- childbirth and abortions.
As already mentioned, the symptoms of PMS occur 2-10 days before menstruation and depend on the clinical form of the pathology, that is, on the prevalence of certain symptoms.
Characterized by emotional instability:
- unmotivated aggression or anguish, reaching depression;
- sleep disturbance;
- weakness and fatigue;
- periods of fear;
- weakening of libido;
- suicidal thoughts;
- exacerbation of smell;
- auditory hallucinations;
- and others.
In addition, there are other signs: numbness of the hands, headaches, reduced appetite, bloating.
In this case, prevail:
- swelling of the face and limbs;
- tenderness and engorgement of the mammary glands;
- weight gain (and due to hidden edema);
- headaches and joint pains;
- negative diuresis;
This form is characterized by the predominance of vegetative-vascular and neurological symptoms. Characteristic:
- headaches by type migraine;
- nausea and vomiting;
- diarrhea (a sign of increased prostaglandin content);
- heartbeat, heart pain;
- odor intolerance;
It proceeds according to the type of sympathoadrenal crises or “mental attacks”, which differ:
- increased pressure;
- increased heart rate;
- heart pain, although no ECG changes;
- sudden bouts of fear.
It proceeds as hyperthermic (with a rise in temperature of up to 38 degrees), hypersomnic (characterized by daytime sleepiness), allergic (the appearance of allergic reactions, not excluding Quincke’s edema ), ulcerative ( gingivitis and stomatitis ) and iridocyclic (inflammation of the iris and ciliary body) forms.
It features a combination of several forms of PMS.
It is recommended to carry out differential diagnostics of premenstrual tension syndrome. This condition should be distinguished from the following diseases:
- mental pathology (schizophrenia, endogenous depressed and others);
- chronic kidney disease;
- brain formations;
- inflammation of the membranes of the spinal cord;
- pituitary adenomas;
- thyroid pathology.
In all of the above diseases, the patient complains regardless of the phase of the menstrual cycle, whereas in PMS, symptoms develop on the eve of menstruation.
In addition, of course, the manifestations of PMS are in many ways similar to the signs of pregnancy in the early stages. 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 address their gynecologist with their complaints, most are treated by a neurologist or therapist.
When applying for an appointment, the doctor should carefully collect an anamnesis and examine complaints, and during the conversation establish the connection between these symptoms and the end of the second phase of the cycle and confirm their cyclical nature. It is equally important to ensure that the patient does not have mental illness.
Then the woman is invited to note her signs from the following list:
- emotional instability (unreasonable crying, sudden change of mood, irritability);
- tendency to aggression or depression;
- anxiety, fear of death, tension;
- low 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;
- feeling of engorgement, painful mammary glands, as well as swelling, headaches, abnormal weight gain, pain in muscles or joints.
The diagnosis of “PMS” is established if the specialist finds that the patient has five signs, with the obligatory presence of one of the first four listed.
Be sure to be assigned a blood test for prolactin, estradiol and progesterone in the second phase of the cycle, based on the obtained results determine the estimated form of PMS. Thus, the edematous form is characterized by a decrease in progesterone levels. And neuropsychic, cephalgic and crisp forms are characterized by increased prolactin.
Further examinations vary according to the form of PMS.
- examination by a neurologist and a psychiatrist;
- radiography of the skull;
- electroencephalography (detection of functional disorders in the limbic structures of the brain).
- BAC surrender;
- the study of renal excretory function and measurement of diuresis (emitted fluid 500-600ml less than consumed);
- mammography and Breast ultrasound in the first phase of the cycle in order to differentiate mastopathy from mastodynia (breast tenderness).
- Ultrasound of the adrenal glands (exclude a tumor);
- catecholamine testing ( blood and urine );
- examination by an ophthalmologist (fundus and visual field);
- X-ray of the skull (signs increased intracranial pressure );
- MRI of the brain (exclude a tumor).
Consultation with a therapist and keeping a blood pressure diary are also required (exclude hypertension).
- electroencephalography, which reveals diffuse changes in the electrical activity of the brain (the 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 for all forms of PMS, consultations with a psychotherapist, an endocrinologist and a neurologist are necessary.
PMS therapy begins with explaining 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 appointment of a diet.
Women with premenstrual tension syndrome should adhere, especially during the second phase of the cycle, to the following diet:
- spicy and spicy dishes are excluded:
- salt is limited;
- a ban on the use of strong coffee, tea and chocolate;
- Fat consumption is reduced, and in some types of PMS – and animal protein.
The main focus 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 appointed progestogens (norkolut, djufaston, utrozhestan) in the second phase of the cycle.
If neuropsychiatric symptoms of PMS show reception sedatives and tranquilizers light for 2-3 days before menstruation (Grandaxinum, rudotel, Phenazepamum, sibazon) and antidepressants (fluoxetine, amitriptyline). MagneB6 has a good soothing, normalizing sleep and relaxing effect . Herbal teas, such as Eskulap (day), Hypnos (at night), also have a sedative effect.
In order to improve cerebral circulation (cephalgic form) recommend Nootropilum, piracetam, aminolone.
When edematous form prescribed diuretic drugs ( spironolactone ) and diuretic teas.
Antihistamines ( teralen , suprastin, diazolin ) are indicated for the atypical (allergic) and edematous forms of PMS.
Cephalgic and crisp forms of PMS require taking bromocriptine in the second phase of the cycle: this drug reduces the level of prolactin. Mastodinon quickly relieves pain and tension of the mammary glands, and remens normalizes the level of hormones in the body.
With hyperprostaglandinemia , nonsteroidal anti-inflammatory drugs are taken (ibuprofen, indomethacin , diclofenac), which suppress the production of prostaglandins.
And, of course, indispensable drugs for PMS are combined oral contraceptives from the monophasic group ( jess , logest , zhanin ), which suppress the production of their own hormones, thereby leveling the manifestations of the pathological symptom complex.
The course of treatment of premenstrual tension syndrome averages 3-6 months.
PMS, the treatment of which the woman was not engaged, threatens the future with a severe course climacteric syndrome The prognosis for premenstrual disease is favorable.