Premenstrual syndrome is a cyclically recurring symptom complex observed in the second half of the menstrual cycle (3-12 days before menstruation). It has an individual course, can be characterized by headache, sharp irritability or depression, tearfulness, nausea, vomiting, itching, swelling, abdominal and heart pain, palpitations, etc. Edema, skin rashes, flatulence, painful swelling of the mammary glands are often observed. In severe cases, neurosis may develop.
Premenstrual syndrome, or PMS, is called vegetative-vascular, neuropsychic and metabolic-endocrine disorders that occur during the menstrual cycle (more often in the second phase). Synonyms of this condition found in the literature are the concepts of “premenstrual disease”, “premenstrual tension syndrome”, “cyclic disease”. Every second woman after the age of 30 is familiar with premenstrual syndrome firsthand, in women under 30 this condition is somewhat less common – in 20% of cases. In addition, the manifestations of premenstrual syndrome are usually companions of emotionally unstable, thin, asthenic type of physique of women who are more often engaged in the intellectual sphere of activity.
Until now, gynecology as a science cannot unequivocally say what factors and causes underlie the development of premenstrual syndrome. It is believed that earlier stresses, neuroinfections, surgical termination of pregnancy (abortion), injuries and operations, as well as various gynecological and general somatic diseases that create a background for the manifestations of premenstrual syndrome contribute to the occurrence and more severe course of PMS.
The most common opinion is that the causes determining the development of premenstrual syndrome are hormonal fluctuations occurring in the female body during the menstrual cycle. These observations underlie hormonal theories of the origin of premenstrual syndrome.
One of the theories considers as the fundamental cause of premenstrual syndrome – a change in the ratio of the hormones progesterone and estrogen in the second half of the menstrual cycle. Excess production of estrogens leads to fluid retention in the tissues, swelling, swelling of the mammary glands, cardiovascular disorders. The effect of estrogens on brain structures causes neuropsychiatric disorders – depression or aggression, irritability, tearfulness, etc. Another hormonal theory links PMS with hypersecretion of the hormone prolactin, which causes water and sodium retention, changes in the mammary glands.
In the development of premenstrual syndrome, a certain role of prostaglandins, hormone–like substances produced in the tissues of the body and involved in the regulation of many physiological processes, has also been proven. An excess of prostaglandins causes migraine-like headaches, digestive disorders, vegetative-vascular reactions.
Numerous other theories consider disorders of water-salt metabolism (the theory of water intoxication), deficiency of vitamins (vitamin A, B6) and trace elements (calcium, magnesium, zinc), genetic factor, hypothalamic disorders as the causes of premenstrual syndrome. A number of researchers believe that PMS is caused by a whole complex of causes that are individual in each clinical case. Therefore, the diagnosis has its own specifics and certain difficulties.
Symptoms of premenstrual syndrome
Based on the leading symptoms accompanying premenstrual syndrome, the following forms of disorders are distinguished: neuropsychic, cephalgic, edematous, crisis, atypical. Often these forms of premenstrual syndrome do not exist in isolation, so the treatment of PMS is usually symptomatic.
The neuropsychic form of PMS is characterized by disorders in the emotional and nervous spheres: insomnia, weakness, mood instability, irritability, tearfulness, aggression, fatigue, causeless melancholy, depression (up to suicidal thoughts), unreasonable feelings of fear, sexual disorders, auditory and olfactory disorders, dizziness. Against the background of neuropsychic disorders, appetite disorders, flatulence (bloating), soreness and swelling of the mammary glands are also noted.
In the clinical picture of the cephalgic form of premenstrual syndrome, vegetative-vascular and neurological symptoms are leading: migraine-like headache attacks, diarrhea, palpitations, pain in the heart area, hypersensitivity to smells and sounds, nervousness, insomnia. A characteristic headache is throbbing in the temples, accompanied by swelling of the eyelids, nausea and vomiting. The cephalgic form often develops in women with a burdened history, who have suffered traumatic brain injuries, neuroinfections, severe stress. Of the concomitant pathologies, these women usually suffer from cardiovascular pathology, hypertension, gastrointestinal diseases.
With the edematous form of premenstrual syndrome, the leading manifestation is intracranial fluid retention and associated swelling of the face and limbs, weight gain, thirst, decreased urination. In addition, breast swelling, itchy skin, digestive disorders (flatulence, constipation, diarrhea), headaches and joint pains, etc. are noted.
The course of the crisis form of premenstrual syndrome is manifested by sympatho-adrenal crises, characterized by attacks of rising blood pressure, tachycardia, heart pain without deviations on the ECG, panic fear. The end of the crisis, as a rule, is accompanied by profuse urination. Often attacks are provoked by stress and fatigue. The crisis form of premenstrual syndrome can develop from untreated cephalgic, neuropsychic or edematous forms and usually manifests itself after 40 years. The background for the course of the crisis form of premenstrual syndrome are diseases of the heart, blood vessels, kidneys, and digestive tract.
Cyclic manifestations of atypical forms include: an increase in body temperature (in the second phase of the cycle to 37.5 ° C), hypersomnia (drowsiness), ophthalmoplegic migraine (headaches with oculomotor disorders), allergic reactions (ulcerative stomatitis and ulcerative gingivitis, asthma syndrome, indomitable vomiting, iridocyclitis, Quincke’s edema, etc.).
When determining the severity of the course of premenstrual syndrome, they proceed from the number of symptomatic manifestations, highlighting the mild and severe forms of premenstrual syndrome. A mild form is manifested by 3-4 characteristic symptoms that appear 2-10 days before the onset of menstruation, or by the presence of 1-2 significantly pronounced symptoms. With a severe form of premenstrual syndrome, the number of symptoms increases to 5-12, they appear 3-14 days before the onset of menstruation. At the same time, all of them or several symptoms are expressed significantly.
In addition, an indicator of the severe form of the course of premenstrual syndrome is always a disability, regardless of the severity and number of other manifestations. A decrease in working capacity is usually noted in the neuropsychic form of premenstrual syndrome.
It is customary to distinguish three stages in the development of premenstrual syndrome:
- Stage of compensation – symptoms appear in the second phase of the menstrual cycle and pass with the onset of menstruation; the course of premenstrual syndrome does not progress over the years
- Stage of subcompensation – the number of symptoms increases, their severity worsens, manifestations of PMS accompany the entire menstruation; with age, the course of premenstrual syndrome becomes heavier
- Stage of decompensation – early onset and late cessation of symptoms of PMS with insignificant “light” intervals, severe course of PMS.
The main diagnostic criterion of premenstrual syndrome is the cyclicity, the periodic nature of complaints arising on the eve of menstruation and their disappearance after menstruation.
The diagnosis of “premenstrual syndrome” can be made on the basis of the following signs:
- A state of aggression or depression.
- Emotional instability: mood swings, tearfulness, irritability, conflict.
- Bad mood, feeling of longing and hopelessness.
- A state of anxiety and fear.
- A decrease in emotional tone and interest in the events taking place.
- Increased fatigue and weakness.
- Decreased attention, memory impairment.
- Changes in appetite and taste preferences, signs of bulimia, weight gain.
- Insomnia or drowsiness.
- Painful tension of the mammary glands, edema
- Headaches, muscle or joint pains.
- Worsening of the course of chronic extragenital pathology.
The manifestation of five of the above signs with the obligatory presence of at least one of the first four allows us to speak with confidence about premenstrual syndrome. An important part of the diagnosis is the patient’s self-observation diary, in which she should note all violations in her well-being for 2-3 cycles.
The study of hormones in the blood (estradiol, progesterone and prolactin) allows you to determine the form of premenstrual syndrome. It is known that the edematous form is accompanied by a decrease in progesterone levels in the second half of the menstrual cycle. Cephalgic, neuropsychic and crisis forms are characterized by an increase in prolactin levels in the blood. The appointment of additional diagnostic methods is dictated by the form of PMS and leading complaints.
A pronounced manifestation of cerebral symptoms (headaches, fainting, dizziness) is an indication for an MRI or CT scan of the brain to exclude its focal lesions. EEG results are indicative in neuropsychic, edematous, cephalgic and crisis forms of the premenstrual cycle. In the diagnosis of the edematous form of PMS, an important role is played by measuring the daily diuresis, taking into account the amount of fluid consumed, conducting tests to study the excretory function of the kidneys (for example, the Zimnitsky test, the Rehberg test). With painful swelling of the mammary glands, it is necessary to conduct ultrasound of the mammary glands or mammography to exclude organic pathology.
Examination of women suffering from one or another form is carried out with the participation of doctors of various specialties: neurologist, therapist, cardiologist, endocrinologist, psychiatrist, etc. The prescribed symptomatic treatment, as a rule, leads to an improvement in well-being in the second half of the menstrual cycle.
Premenstrual syndrome treatment
In the treatment of premenstrual syndrome, medicinal and non-medicinal methods are used. Non-drug therapy includes psychotherapeutic treatment, compliance with the regime of work and proper rest, physical therapy, physiotherapy. An important point is the observance of a balanced diet with the use of sufficient amounts of vegetable and animal protein, vegetable fiber, vitamins. In the second half of the menstrual cycle, you should limit the use of carbohydrates, animal fats, sugar, salt, caffeine, chocolate, alcoholic beverages.
Medical treatment is prescribed by a specialist doctor taking into account the leading manifestations of premenstrual syndrome. Since neuropsychic manifestations are expressed in all forms of premenstrual syndrome, almost all patients are shown to take sedative (sedative) drugs a few days before the expected appearance of symptoms. Symptomatic treatment involves the use of painkillers, diuretics, antiallergic drugs.
The leading place in the medical treatment is occupied by specific hormone therapy with progesterone analogues. It should be remembered that the treatment is a long process, sometimes continuing throughout the entire reproductive period, requiring a woman to have internal discipline and steadily follow all the doctor’s prescriptions.