PMS symptoms in women 35 years old. Premenstrual syndrome: symptoms of PMS in women, causes and treatment. What is premenstrual dysphoric syndrome. PMS as an aggravating factor in various pathologies

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General information

Causes

Another factor contributing to the development of the syndrome is high blood glucose levels. Therefore, women who abuse carbohydrate foods and sweets are more susceptible to the cyclic syndrome.

There is an opinion that a disease of the kidneys, reproductive organs or digestion can lead to the development of premenstrual syndrome. In addition, there is a genetic predisposition to this disorder.

Symptoms

• Sleep disturbance
• Lethargy, decreased performance, inattention
• Noise intolerance
• Migraine-like pain, incoordination, fainting
• "goosebumps" in the body or limbs, inhibition of speech
• Discomfort in the breasts
• Nervousness, mood instability, excessive emotionality
• Decreased daily urine volume, weight gain, swelling
• Joint pain, swelling, myalgia, neck pain
• Digestion disorder
• Increased appetite, cravings for sweet or salty foods, aversion to alcohol
• Slight increase in body temperature, bleeding from the nose
• Exacerbation of allergies, asthma, hemorrhoids, other chronic diseases, frequent acute respiratory infections
• Change in libido.

Pain with PMS

3. Eat less salt, it is advisable to give up nicotine.

Herbal treatment

1. Bath with a decoction of mint and oregano, rosemary, lavender, yarrow, currant leaf, meadowsweet. The herbal sachet should always be next to the pillow.

5. 2 tsp elderberry flowers pour 200 ml of boiling water for a quarter of an hour into a thermos, pass through a sieve. Drink 100 ml three times a day on an empty stomach. You can add some honey or sugar.

6. 1 tbsp blue cornflower flowers brew 200 ml of boiling water in a thermos for 2 hours, pass through a sieve. Take 70 ml three times or four times a day on an empty stomach.

7. Take 2 tbsp. St. John's wort and 1 tbsp. oregano, mix and brew 300 ml of boiling water. Keep in a thermos for 60 minutes, pour a little lemon peel and cinnamon, pass through a sieve. Consume 70 ml half an hour before a meal.

8. Take 500 gr. grind oranges in a meat grinder, not peeled, 150 gr. horseradish in a meat grinder, 0.3 kg of sugar and 1000 ml of red wine. Simmer all together in a steam bath for 60 minutes under a lid, pass through a sieve. Use 200 ml three times or four times a day.

PMS or pregnancy?

V. E. Balan, Doctor of Medical Sciences, Professor L. M. Ilyina, Candidate of Medical Sciences
NTsAGiP Rosmedtekhnologii, Moscow

Premenstrual tension syndrome, or premenstrual syndrome (PMS), is a cyclical change in the mood and physical condition of a woman, occurring 2-3 or more days before menstruation, disrupting her usual lifestyle and performance, alternating with a period of remission that occurs with the onset of menstruation and continues without less than 7-12 days, was first described by R. T. Frank in 1931. The frequency of PMS increases slightly with age, does not depend on socio-economic, cultural and ethnic factors and does not exceed 8.2-12%.

Etiology and pathogenesis

The etiology and pathogenesis of PMS are not fully understood. Since the first description of this syndrome, it has been classified as an endocrine disease, but the question is still being debated whether PMS is mental, especially in the case of a predominance of affective disorders, or an endocrine disorder.

The hypothesis that PMS is a manifestation of a violation of the content/balance of sex hormones (anovulation, insufficiency of the luteal phase) is currently not supported by most researchers. On the contrary, PMS is observed in women with a regular ovulatory cycle, that is, the formation of a full-fledged corpus luteum is one of the most important conditions for its development. It has been shown that during spontaneous anovulatory cycles, the cyclicity of symptoms is lost, and against the background of the shutdown of ovarian function with the use of gonadotropin-releasing hormone (aGN-RH) agonists, there is a significant improvement in the condition of women. During pregnancy, which is characterized by high but stable levels of estrogen and progesterone, as a rule, the symptoms of PMS stop.

It is believed that the decisive factor in the genesis of PMS is not the level of sex hormones, which does not differ from that in healthy women, but fluctuations in their content during the menstrual cycle. It has been proven that estrogens and progesterone have a significant modulating effect on the central nervous system through gene mechanisms (interaction with nuclear receptors), a direct effect on the membrane of neurons and their synaptic function, not only in the centers responsible for the activity of the reproductive system, but also in the limbic parts of the brain regulating emotions, behavior and sleep.

It is believed that PMS is associated with the action of neuroactive progesterone metabolites, including those that are spontaneously produced in the CNS. The most important of these are 3-α-hydroxy-5-α-dehydroprogesterone (allopregnenolone-3-α-OHDHP) and 3-α-5-α-tetrahydrodeoxycorticosterone (3-α-THDOC). These substances have anxiolytic, analgesic and anesthetic effects by interacting with GABA receptors, which are considered to be the main receptors that inhibit nerve transmission. On the other hand, the precursor of progesterone - pregnenolone sulfate, which is hydrolyzed into pregnenolone by sulfatases and N-methyl-D-asparginine (NMDA), which is involved in intracellular calcium metabolism, has an anxiogenic (excitatory) effect on GABA receptors. Alterations in the concentration of these neurosteroids have been shown to play a role in the development of PMS symptoms.

It has been shown that the function of the serotonergic, catecholaminergic, GABAergic and opiategic systems is impaired in PMS, while similar symptoms can be observed as a result of activation or, conversely, inhibition of one or another system. To date, the predominant role of any of these systems has not been proven.

Thus, the pathogenesis of PMS is currently presented as the result of an interaction between cyclic changes in ovarian steroid levels, central neurotransmitters (serotonin, β-endorphin, γ-aminobutyric acid (GABA)) and the autonomic nervous system responsible for the development of "somatic symptoms" .

Risk factors for PMS:

The interaction of alcohol with GABA receptors and neurosteroids affects the symptoms of PMS. During the late luteal phase, low doses of alcohol cause a decrease in the peripheral level of allopregnenolone. This supports the fact that alcohol is a risk factor for developing PMS symptoms.

Clinical picture

There are psychovegetative, edematous, cephalgic and crisis ("panic attack syndrome") forms of the disease. However, most often these symptoms are complex. In addition, at present, according to the International Classification of Mental Diseases (ICD-10) of 1994, paroxysmal disorders (panic attacks) are classified as "anxiety disorders". In this connection, the “crisis” form of PMS can rather be attributed to the “psychovegetative” form of the disease, and the difference lies only in the permanent or paroxysmal nature of the symptoms.

Symptoms of PMS are very numerous (table).

Table

The main clinical forms and symptoms of PMS (Smetnik V.P., Komarova Yu.A., 1988)

It seems not entirely legitimate to attribute headaches to "physical" symptoms, patients suffering from cyclic headaches in the luteal phase of the cycle fully meet the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for the diagnosis of PMS. In these cases, it is extremely important to make a differential diagnosis between, relatively speaking, the "cephalgic" form of PMS and the "menstrual" migraine. In the first case, tension headache is more often noted: the nature of the pain is compressive, constricting, squeezing, bilateral localization, not aggravated by habitual physical exertion, rarely accompanied by psychovegetative symptoms. According to the classification of the International Headache Society, "menstrual migraine" is a migraine without aura ("simple"), 70% of the attacks of which occur between two days before the onset of menstruation and until its end, provided that on other days of the headache cycle No. As you know, a simple migraine is characterized by attacks of pulsating (usually one-sided) headache, more often in the frontotemporal-orbital region, which are accompanied by nausea, vomiting, intolerance to light, noise, etc. It is clear that the pathogenetic mechanisms of these disorders are different: in PMS, the trigger mechanism is an increase in sex steroids in the middle luteal phase, and for menstrual migraine - a sharp decrease in their level, especially estrogens, in the late luteal phase and menstrual days.

In some women, in the luteal phase, taste preferences (craving for sweet or salty) may change and appetite increases, bulimia develops.

Atypical forms of PMS are extremely rare, which include:

The presence of such diverse disorders in PMS once again confirms the role of sex hormones as powerful neuromodulators and substances that affect not only neuroendocrine, but also vasomotor and metabolic-trophic shifts, as well as immunological reactions in the dynamics of the menstrual cycle, which in patients with PMS are excessive or "pathological" character.

Depending on the severity of the clinical manifestations of PMS, mild and severe degrees of the disease are distinguished. With a mild course, 3-4 of the above symptoms appear 2-10 days before the onset of menstruation, and only 1 or 2 of them are significantly pronounced. In severe PMS, 3-14 days before menstruation, 5-12 symptoms begin to disturb at the same time, and 2-5 of them are pronounced.

Taking into account the main characteristics of PMS, its symptoms should stop with the onset of menopause, however, often with a severe course of the disease, the severity of the symptoms may weaken somewhat, but they do not disappear completely and continue to be cyclical even in the absence of menstruation (the so-called "transformed premenstrual syndrome") . A severe clinical picture is usually observed in patients with surgical menopause (postovariectomy syndrome), who often develop asthenic psychovegetative syndrome in the absence of cyclical symptoms.

Diagnostics

First of all, when examining patients with PMS, it must be remembered that some somatic and mental illnesses worsen on premenstrual days, so differential diagnosis should be carried out with many of them.

differential diagnosis.

Symptoms caused by PMS should be differentiated from chronic diseases that worsen their course in phase II of the menstrual cycle:

The diagnosis of PMS primarily involves recording symptoms daily for at least two consecutive menstrual cycles. This allows not only to identify the relationship of symptoms with the dynamics of the menstrual cycle, which is important for clarifying the diagnosis, but also to determine which of them are subjectively the most difficult for the patient. A special questionnaire card can be prepared by the patient herself, where she lists (on the vertical axis) all the symptoms that are usually observed during the menstrual cycle, and on the horizontal axis - their severity on a 4-point system (0 points - “no symptom”, 1 - "weakly expressed", 2 - "moderately expressed", 3 - "severe", causes severe discomfort and / or negatively affects daily life) on each day of the cycle. According to generally accepted criteria, a diagnosis of PMS can be made if a woman has at least 5 of the symptoms listed in the DSM-IV, of which at least one is depression, anxiety, mood lability, or irritability. In addition, it is necessary that these symptoms were determined in at least two consecutive menstrual cycles, disrupted the usual way of life and performance, and at the same time were not the result of endogenous psychiatric disorders.

Depending on the clinical picture of the disease, the examination may include:

Treatment

Drug therapy for PMS is prescribed only after a diagnosis is made, based on an assessment of the presence and intensity of somatic and psychological symptoms (according to daily diaries) and if simple behavioral measures are ineffective.

General principles of PMS therapy:

Behavioral therapy includes:

Basic requirements for drug therapy:
1. Drugs should change the menstrual cycle by blocking ovulation.
2. Drugs should be effective against the most disturbing symptom (swelling, mastalgia / mastodynia), headaches, depression, panic attacks, etc.).

Medical therapy

5% of women with severe PMS need drug therapy.

Symptomatic methods of therapy include the appointment of vitamin B 6 (Pyridoxine) at a dose of 20 to 40 mg per day, which is also used for a long time. Daily intake of magnesium in the form of MgO 200 mg. It is convenient to use the complex preparation Magne B 6 (up to 6 tablets per day in 2-3 doses). It has been established that under the influence of magnesium the symptoms of depression, hydration decrease and diuresis increases. The use of the complex preparation Magne B 6 (up to 6 tablets per day in 2-3 doses) for 6 months, which has a well-absorbed organic magnesium salt and pyridoxine, significantly reduces the severity of symptoms accompanying PMS. By the 6th month of therapy, the following results were obtained: sleep disturbances decreased by 2.5 times, swelling - by 2.7 times, mastalgia - by 2 times, pain in the lower abdomen and irritability - by 1.6 times, nervousness and tearfulness - 1.3-1.4 times compared with the initial level. The effectiveness of therapy was, on average, 67% (Mezhevitinova E. A., Akopyan A. N., 2007).

For the relief of cyclic mastalgia, the combined homeopathic preparation Mastodinone can be effective, the main active ingredient of which is Agnus castus (prutnyak), which has a dopaminergic effect and reduces the secretion of prolactin. It is used 30 drops or 1 tablet 2 times a day for at least 3 months. Agnus castus is part of the drug Cyclodinone, which can also be used to treat mastalgia, but is especially effective for menstrual irregularities associated with second phase insufficiency and mild forms of hyperprolactinemia. The drug is prescribed 40 drops or 1 tablet 1 time per day in the morning for 3 months. The results of experimental and clinical trials indicate that evening primrose oil is effective for stopping cyclic mastalgia and headaches. A number of studies have found that women with mastalgia have low concentrations of a metabolite of one of the essential unsaturated fatty acids - linoleic acid, namely γ-linoleic acid. Evening primrose oil contains this substance in high concentration and is used 2 capsules (500 mg) 3 times a day, i.e. 3 g per day for 2-3 months.

One of the most common treatments for PMS is the suppression of cyclic (endocrine and biochemical) changes that occur in the body. For this purpose, aGN-RG and combined oral contraceptives (COCs) are used.

Gonadotropin-releasing hormone agonists. The following aGN-RGs are registered in our country: Zoladex (goserelin), Decapeptyl depot and Diferelin (triptorelin), Lucrin (leuprorelin), Sinarel (nafarelin) and Buserelin (buserelin), which are available in the following forms: solutions for daily subcutaneous injections and depot suspensions, subcutaneous implants and endonasal sprays. To carry out return (“add-back”) therapy in order to prevent a decrease in bone mineral density and autonomic symptoms, phytohormones (Klimadinon) are used or, in severe cases, drugs for continuous HRT, as well as drugs containing calcium and active metabolites of vitamin D.

Combined oral contraceptives are quite successfully used for the treatment of PMS, however, only monophasic drugs (Yarina, Jeannine, Femoden, Logest, etc.) should be used. Of these, the drug containing drospirenone is preferred. Drospirenone is a unique progestogen that also has antiandrogenic and antimineralocorticoid activity, since it is a derivative of spironolactone, an aldosterone blocker. When using this drug, a significant decrease in the severity of such symptoms of PMS as fluid retention, mastodynia and mastalgia was revealed. In addition, stabilization and even some weight loss was noted, which is possibly due not only to the effect on the water balance, but also to a decrease in appetite, noted in many studies. The beneficial effect on symptoms such as mood lability and irritability appears to be due to the antiandrogenic effects of drospirenone, as does the relief of cyclic acne in some women.

Levonorgestrel-releasing intrauterine system (LNG-IUD) Mirena. One of the modern promising methods of treatment, especially if a woman needs contraception, is the introduction of the Mirena IUD, which releases only 20 μg of LNG per day directly into the uterus (local therapy). Mirena was developed as an estrogen-free contraceptive method, but it was soon noted that it has a curative effect on a number of gynecological diseases, including PMS. Since the dose of LNG in the blood is much lower than with oral progestogens, and its release is uniform (without peaks and drops), the likelihood of PMS symptoms or their severity is significantly reduced. Mirena is especially indicated for those women whose PMS is combined with dysmenorrhea and / or menorrhagia. Approximately 20% of women a year after the introduction of Mirena, reversible amenorrhea occurs.

In recent years, modern antidepressants have been widely used for the treatment of PMS, combining a mild thymoanaleptic effect (relieving anxiety, tension, improving mood and general mental well-being) with good tolerability. These drugs successfully stop both permanent and paroxysmal psychovegetative symptoms in 65-70% of women with PMS. These include drugs of various chemical structures, taking into account modern ideas about the pathogenesis of depression and affective disorders. The administration of serotonin reuptake inhibitors is known to improve tissue sensitivity to insulin and reduce body weight.

The most effective selective serotonin reuptake inhibitors are: fluoxetine (Prozac, Profluzak) - 20 mg; sertraline (Zoloft) - 50 mg; paroxetine (Paxil) - 20 mg; fluvoxamine (Fevarin) - 50 mg; citalopram (Cipramil) - 20 mg. Despite the fact that all these drugs belong to the same group, they have the so-called "secondary" effects: stimulating (fluoxetine, sertraline) or sedative (paroxetine, fluvoxamine), which must be taken into account when choosing therapy. Citalopram is considered the most selective, since it has practically no effect on the catecholaminergic neurotransmitter systems. Taking into account that PMS is a chronic disease with a long course and cyclic manifestation of symptoms, it is very important not only to select an adequate dose of the drug, but also the treatment regimen. The above drugs are prescribed at a dose of 1/4 tablet per day once a day in the morning or evening (taking into account the sedative or stimulating effect), after 7 days the dose is gradually increased to 1-2 tablets per day (the minimum effective dose is selected clinically). Most often, in patients with PMS, a sufficient dose is one tablet of the drug, while the intake is carried out cyclically: in the first phase, the dose is slightly reduced, reaching a maximum value by the time of the most pronounced manifestation of PMS symptoms. The full therapeutic effect usually occurs after 2-4 months. The course of treatment is 4-6 months, but maintenance therapy up to 12 months is possible.

With sleep disturbance and anxiety disorders, patients are often more sensitive to the so-called "noradrenergic" antidepressants, which are also prescribed one tablet daily at bedtime:

During treatment, it is extremely important to continue filling out the menstrual card, which helps to assess its impact on individual symptoms, identify possible side effects and, if necessary, change the dose of the drug or switch to another type of treatment.

Evaluation of the effectiveness of treatment. Evaluation of the effectiveness of therapy is carried out according to menstrual diaries with a daily assessment of symptoms in points:
0 - no symptoms;
1 - slightly worried;
2 - disturbs moderately, but does not interfere with daily life;
3 - severe symptoms causing concern about them and / or their impact on daily life.

A decrease in the intensity of symptoms to 0-1 points as a result of treatment indicates the correct choice of therapy. Therapy for PMS is long-term, but there is no consensus on the duration of therapy. Most often this has to be decided individually with each patient.

Forecast. More often favorable. If the recommendations are not followed and there is no treatment, a relapse of the disease is possible. It is necessary to explain to the patient that lifestyle changes (diet, exercise, massage) will lead to an improvement in well-being and quality of life. In addition, patients should be advised that PMS symptoms return with discontinuation of therapy, may increase with age or after childbirth, and are absent during pregnancy and menopause.

Most women are familiar with the symptoms of premenstrual syndrome. Many of them suffer not so much from the ailments of menstruation itself, but from the condition that precedes it. The reason for this is the hormonal changes that occur in the body on the eve of menstruation. The functioning of various organs, as well as the nervous system, is disrupted. This leads to headaches, depression, irritability. It is necessary to know what physiological processes they are associated with. Then, perhaps, it will be easier to cope with unpleasant symptoms.

After ovulation, the so-called luteal phase begins, preceding the onset of menstruation. Preparation for it begins in the body in advance. Under the influence of hormones, changes occur in the state of the mammary glands and genital organs. The brain, the central nervous system reacts to hormonal processes.

Most women experience characteristic symptoms before their period as a result. For some, they begin 2 days before menstruation, for others - 10. Violations with varying degrees of severity appear. With the onset of critical days, they disappear. These symptoms are collectively referred to as premenstrual syndrome (PMS). It has been noticed that PMS is stronger in women who suffer from gynecological or any other diseases.

Night shift work, exposure to harmful substances, lack of sleep, malnutrition, troubles and conflicts are all factors that increase ailments before menstruation.

Note: There is such a theory that discomfort before menstruation is the body's reaction to the lack of conception, which is a natural completion of the physiological processes occurring in the female reproductive system.

Signs of approaching menstruation

The symptoms of PMS can vary from woman to woman. The nature of the manifestations is influenced by heredity, lifestyle, age, state of health. The most obvious signs of approaching menstruation include the following:

• irritability;
• depressed state, feeling of inexplicable melancholy, depression;
• fatigue, headaches;
• drop in blood pressure;
• inability to concentrate, deterioration of attention and memory;
• sleep disturbance;
• constant feeling of hunger;
• pain in the chest;
• the occurrence of edema and weight gain due to fluid retention in the body;
• indigestion, bloating;
• drawing pains in the back.

There is a mild form of PMS (the presence of 3-4 symptoms that disappear with the onset of menstruation) and a severe form (the appearance of most symptoms at the same time 5-14 days before menstruation). It is not always possible for a woman to cope with severe manifestations on her own. Sometimes only hormonal drugs can help.

Varieties of PMS

Depending on what signs prevail in a woman before menstruation, the following forms of PMS are distinguished.

Edema. With this form, women feel pain in the mammary glands more acutely, their legs and arms swell, skin itching appears, and increased sweating.

Cephalgic. Every time before menstruation there is dizziness, nausea, vomiting, headache, radiating to the eyes. Often these symptoms are combined with pain in the heart.

Neuropsychic. Symptoms such as depressed mood, irritability, tearfulness, aggressiveness, intolerance to loud sounds and bright lights predominate.

Crisis. Before menstruation, women experience crises: blood pressure rises, pulse quickens, limbs go numb, pains appear in the retrosternal region, and fear of death arises.

Causes of various PMS symptoms

The severity of PMS manifestations depends mainly on the degree of hormonal changes and the state of the nervous system. An important role is played by the psychological attitude. If a woman is active, busy with interesting things, then she does not feel the symptoms of the onset of menstruation as acutely as a suspicious pessimist suffering from the mere thought of impending ailments. The appearance of each symptom can be found an explanation.

Increase in body weight. On the one hand, its cause is a decrease in the level of estrogen in the blood in the second phase of the cycle. By accumulating adipose tissue capable of releasing estrogens, the body makes up for their shortage. There is also a deficiency of glucose in the blood, which leads to increased feelings of hunger. For many women, eating delicious food is a way to take their mind off troubles and worries.

Changes in mood. The cause of aggressiveness, irritability, anxiety, depression is the lack of “pleasure hormones” (endorphin, serotonin, dopamine) in the body, the production of which decreases during this period.

Nausea. Before menstruation, the uterus increases slightly due to the growth and loosening of the endometrium. At the same time, it can exert pressure on the nerve endings, the irritation of which causes the appearance of a gag reflex. To provoke the occurrence of nausea can take hormonal drugs and contraceptives. If a woman constantly has such a symptom before menstruation, then perhaps this remedy is contraindicated for her. It must be replaced with something else.

Warning: Nausea before the expected period can be a sign of pregnancy. With this in mind, a woman should first of all do a test and visit a doctor to clarify her condition.

Pain in the lower abdomen. Weak pulling pain in the lower abdomen is considered normal before menstruation, if the woman has no cycle disorders, there are no pathological discharges and other signs of diseases of the genital organs. If the pain is severe, does not subside after taking painkillers, then it is imperative to go to the doctor, undergo an examination to find out the causes of the pathology.

Temperature increase. Before menstruation, the temperature can normally rise to 37 ° -37.4 °. The appearance of a higher temperature becomes a sign of the presence of an inflammatory process in the uterus or ovaries. As a rule, there are other signs of violations, forcing a woman to visit a doctor.

The appearance of acne. Such a symptom occurs before menstruation as a result of endocrine disorders, intestinal diseases, a decrease in the body's defenses, a violation of fat metabolism due to changes in hormone production.

The appearance of edema. Hormonal changes cause a slowdown in the process of water-salt metabolism in the body, which leads to fluid retention in the tissues.

Enlargement of the mammary glands. There is an increase in the level of progesterone and the preparation of the body for a possible onset of pregnancy. The ducts and lobules swell, blood circulation increases. The breast tissues are stretched, which leads to a dull pain when touched.

Video: Why appetite increases before menstruation

Under what conditions do similar manifestations occur?

Often women confuse the manifestations of PMS and pregnancy. Nausea, dizziness, enlargement and soreness of the mammary glands, increased whiteness are characteristic of both conditions.

If there are symptoms, and menstruation is delayed, then, most likely, pregnancy has occurred. To make sure that this is the case, it is recommended to take a blood test for the content of chorionic hormone (hCG is formed after pregnancy).

Similar symptoms also appear with endocrine diseases, the formation of tumors of the mammary glands, and the use of hormonal drugs.

Symptoms of the approach in adolescents of the first menstruation

Puberty begins in girls at the age of 11-15 years. Their character is finally established only after 1-2 years. A girl can learn about the imminent onset of the first menstruation by characteristic manifestations. Already 1.5-2 years before the onset of this event, a teenage girl has white discharge. Immediately before the appearance of the first menstruation, the whites become more intense and liquid.

There may be a slight pulling pain in the ovaries due to their growth and stretching. PMS often manifests itself quite weakly, but there may be deviations comparable in nature to the manifestations of PMS in adult women. One of the characteristic signs of teenage PMS is the formation of acne on the face. The reason is the fluctuation in the level of sex hormones, the effect of this process on the condition of the skin.

Video: Signs of approaching menstruation in girls

Symptoms of PMS in premenopausal women

After 40-45 years, women show the first signs of aging and a decrease in the level of sex hormones. There are menstrual disorders, metabolism slows down, chronic diseases of the genital organs often become aggravated. The condition of the nervous system worsens. As a result of this, the manifestations of PMS are even more intensified.

Many women of this age experience severe headaches, dizziness, increased sweating, increased heart rate, mood swings, and depression before menstruation. Often, such manifestations of PMS are so painful that hormone therapy is prescribed to alleviate the condition with drugs that regulate the content of estrogens, progesterone and other hormones in the body.

- a cyclically recurring symptom complex observed in the second half of the menstrual cycle (3-12 days before menstruation). It has an individual course, may be characterized by headache, severe irritability or depression, tearfulness, nausea, vomiting, skin itching, swelling, pain in the abdomen and in the heart, palpitations, etc. Edema, skin rashes, flatulence, painful engorgement of the mammary glands. In severe cases, neurosis may develop.

General information

premenstrual syndrome, or PMS, are called vegetative-vascular, neuropsychic and metabolic-endocrine disorders that occur during the menstrual cycle (more often in the second phase). Synonyms for this condition, found in the literature, are the concepts of "premenstrual illness", "premenstrual tension syndrome", "cyclic illness". Every second woman over 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, manifestations of premenstrual syndrome are usually companions of emotionally unstable, thin, asthenic body types of women, who are more often involved in the intellectual field of activity.

Causes of premenstrual syndrome

The course of the crisis form of premenstrual syndrome is manifested by sympathetic-adrenal crises, characterized by attacks of rising blood pressure, tachycardia, heart pain without ECG deviations, panic fear. The end of the crisis, as a rule, accompanies profuse urination. Often attacks are provoked by stress and overwork. 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, digestive tract.

Cyclic manifestations of atypical forms of premenstrual syndrome include: an increase in body temperature (in the second phase of the cycle up to 37.5 ° C), hypersomnia (drowsiness), ophthalmoplegic migraine (headaches with oculomotor disorders), allergic reactions (ulcerative stomatitis and ulcerative gingivitis, asthmatic 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 of premenstrual syndrome 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. In 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 or several of the symptoms are pronounced significantly.

In addition, an indicator of a 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:

1. compensation stage - symptoms appear in the second phase of the menstrual cycle and disappear with the onset of menstruation; the course of premenstrual syndrome does not progress over the years
2. the stage of subcompensation - the number of symptoms increases, their severity worsens, the manifestations of PMS accompany the entire menstruation; premenstrual syndrome worsens with age
3. stage of decompensation - early onset and late cessation of symptoms of premenstrual syndrome with minor "light" intervals, severe PMS.

Diagnosis of premenstrual syndrome

The main diagnostic criterion for 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 imbalance: mood swings, tearfulness, irritability, conflict.
• Bad mood, feeling of melancholy and hopelessness.
• A state of anxiety and fear.
• Decreased emotional tone and interest in ongoing events.
• 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, swelling
• Head, muscle or joint pain.
• Deterioration 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 link in the diagnosis is the patient's keeping a diary of self-observation, in which she must note all violations in her state of health for 2-3 cycles.

A study in the blood of hormones (estradiol, progesterone and prolactin) allows you to establish the form of premenstrual syndrome. It is known that the edematous form is accompanied by a decrease in the level of progesterone in the second half of the menstrual cycle. Cephalgic, neuropsychic and crisis forms of premenstrual syndrome are characterized by an increase in the level of prolactin in the blood. The appointment of additional diagnostic methods is dictated by the form of premenstrual syndrome 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 for neuropsychic, edematous, cephalgic and crisis forms of the premenstrual cycle. In the diagnosis of the edematous form of premenstrual syndrome, the measurement of daily diuresis, accounting for the amount of fluid drunk, and conducting tests to study the excretory function of the kidneys (for example, Zimnitsky's test, Reberg's test) play an important role. With painful engorgement of the mammary glands, an ultrasound of the mammary glands or mammography is necessary to exclude organic pathology.

Examination of women suffering from one form or another of premenstrual syndrome is carried out with the participation of doctors of various specialties: neurologist, therapist, cardiologist, endocrinologist, psychiatrist, etc. Assigned symptomatic treatment, as a rule, leads to an improvement in well-being in the second half of the menstrual cycle.

Treatment of premenstrual syndrome

In the treatment of premenstrual syndrome, drug and non-drug methods are used. Non-drug therapy includes psychotherapeutic treatment, compliance with the regime of work and good rest, physiotherapy exercises, physiotherapy. An important point is the observance of a balanced diet with the use of a sufficient amount of vegetable and animal protein, vegetable fiber, vitamins. In the second half of the menstrual cycle, you should limit the intake of carbohydrates, animal fats, sugar, salt, caffeine, chocolate, and alcoholic beverages.

Drug 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 taking sedative (sedative) drugs a few days before the expected onset of symptoms. Symptomatic treatment of premenstrual syndrome involves the use of painkillers, diuretics, antiallergic drugs.

The leading place in the medical treatment of premenstrual syndrome is occupied by specific hormonal therapy with progesterone analogues. It should be remembered that the treatment of premenstrual syndrome is a long process, sometimes continuing throughout the entire reproductive period, which requires a woman to have internal discipline and the steady implementation of all doctor's prescriptions.

Doctors have long puzzled over the causes of women's malaise before menstruation. Some healers associated it with the phases of the moon, others with the area in which the woman lives.

The condition of the girl before menstruation remained a mystery for a long time. Only in the twentieth century the veil of secrecy was slightly opened.

PMS is a mix of 150 different physical and mental symptoms. To one degree or another, about 75% of women experience manifestations of premenstrual syndrome.

How long does PMS last for girls? Unpleasant symptoms begin to appear 2-10 days before the onset of menstruation, and disappear with the advent of the "red" days of the calendar.

• Crime chronicle. PMS is not only shattered nerves and broken plates. Most traffic accidents, crimes, thefts committed by women occurred between the 21st and 28th days of the menstrual cycle.
• Shopping therapy. According to research, a few days before menstruation, women are most susceptible to the temptation to buy as much as possible.
• PMS symptoms are more prone to women engaged in mental work and residents of large cities.
• The term PMS was first used by Robert Frank, an obstetrician-gynecologist from England.

Why does premenstrual syndrome occur?

Numerous studies do not allow to identify the exact causes of premenstrual syndrome. There are many theories of its occurrence: “water intoxication” (violation of water-salt metabolism), allergic nature (increased sensitivity to endogenous), psychosomatic, hormonal, etc.

But the most complete is the hormonal theory, which explains the symptoms of PMS by fluctuations in the level of sex hormones in the 2nd phase of the menstrual cycle. For the normal, harmonious functioning of a woman's body, the balance of sex hormones is very important:

• - they improve physical and mental well-being, increase tone, creativity, speed of assimilation of information, learning abilities
• progesterone - has a sedative effect, which can lead to depressive symptoms in the 2nd phase of the cycle
• androgens - affect libido, increase energy, performance

During the second phase of the menstrual cycle, a woman's hormonal levels change. According to this theory, the cause of PMS lies in the “inadequate” reaction of the body, including the brain regions responsible for behavior and emotions, to cyclic changes in hormonal levels, which is often inherited.

Since the days before menstruation are endocrine unstable, many women experience psychovegetative and somatic disorders. In this case, the decisive role is played not so much by the level of hormones (which can be normal), but by fluctuations in the content of sex hormones during the menstrual cycle and how the limbic parts of the brain responsible for behavior and emotions react to these changes:

• an increase in estrogen and first an increase, and then a decrease in progesterone- hence the retention of fluids, swelling, engorgement and soreness of the mammary glands, cardiovascular disorders, irritability, aggression, tearfulness
• hypersecretion - also leads to fluid retention, sodium in the body
• excess prostaglandins- , digestive disorders, migraine-like headaches

The most likely factors affecting the development of the syndrome, on which the opinions of physicians do not differ:

• Decreased serotonin levels- this is the so-called "hormone of joy", may be the cause of the development of mental signs of premenstrual syndrome, since a decrease in its level causes sadness, tearfulness, melancholy and depression.
• Vitamin B6 deficiency- Symptoms such as fatigue, fluid retention in the body, mood changes, and breast hypersensitivity indicate a lack of this vitamin.
• Magnesium deficiency – Magnesium deficiency can cause dizziness, headaches, cravings for chocolate.
• Smoking. Women who smoke are twice as likely to get premenstrual syndrome.
• Overweight . Women with a body mass index over 30 are three times more likely to suffer from PMS symptoms.
• genetic factor- it is possible that the features of the course of premenstrual syndrome are inherited.
• , complicated childbirth, stress, surgical interventions, infections, gynecological pathologies.

The main symptoms and manifestations of premenstrual syndrome

Groups of symptoms in PMS:

• Neuropsychiatric disorders: aggression, depression, irritability, tearfulness.
• Vegetovascular disorders: changes in blood pressure, headache, vomiting, nausea, dizziness, tachycardia,.
• Metabolic and endocrine disorders: swelling, fever, chills, breast engorgement, itching, flatulence, shortness of breath, thirst, memory loss,.

PMS in women can be conditionally divided into several forms, but their symptoms usually do not appear in isolation, but are combined. In the presence of psychovegetative manifestations, especially depression, the pain threshold decreases in women and they perceive pain more acutely.

PMS is different for every woman, and the symptoms vary greatly. According to the results of some studies, women with PMS have the following frequency of manifestation of one or another sign of PMS:

Premenstrual syndrome can aggravate the course of other diseases:

• Anemia (see)
• (cm. )
• Thyroid diseases
• chronic fatigue syndrome
• Bronchial asthma
• allergic reactions
• Inflammatory diseases of the female genital organs

Diagnosis: what can masquerade as manifestations of PMS?

Since dates and dates are easily forgotten, in order to make it easier for yourself, you should keep a calendar or diary where you write down the start and end dates of your period, ovulation (basal temperature), weight, and symptoms that bother you. Keeping such a diary for 2-3 cycles will greatly simplify the diagnosis and allow you to trace the frequency of PMS symptoms.

The severity of premenstrual syndrome is determined by the number, duration and intensity of symptoms:

• Mild: 3-4 symptoms, or 1-2 if severe
• Severe form: 5-12 symptoms or 2-5, but very pronounced, and also regardless of the duration and their number, if they lead to disability (usually neuropsychic form)

The main feature that distinguishes premenstrual syndrome from other diseases or conditions is cyclicity. That is, a deterioration in well-being occurs a few days before menstruation (from 2 to 10) and completely disappears with their arrival. However, unlike psycho-vegetative, physical discomfort in the first days of the next cycle can intensify and smoothly turn into disorders such as menstrual migraine.

• If a woman feels relatively well in the 1st phase of the cycle, then this is a premenstrual syndrome, and not a chronic disease - neurosis, depression,
• If pain appears only immediately before and during menstruation, especially when combined with - this is most likely not PMS, but other gynecological diseases - chronic endometritis, dysmenorrhea (painful menstruation) and others.

To establish the form of the syndrome, hormone studies are carried out: prolactin, estradiol and progesterone. The doctor may also prescribe additional diagnostic methods, depending on the prevailing complaints:

• With severe headaches, dizziness, decreased vision and fainting, computed tomography or MRI is prescribed to exclude organic brain diseases.
• With an abundance of neuropsychiatric diseases, an EEG is indicated to exclude the epileptic syndrome.
• With severe edema, changes in the daily amount of urine (diuresis), tests are performed to diagnose the kidneys (see).
• With severe and painful engorgement of the mammary glands, it is necessary to conduct an ultrasound of the mammary glands and mammography to exclude organic pathology.

Conducts a survey of women suffering from PMS, not only a gynecologist, but also involved: psychiatrists, neurologists, endocrinologists, nephrologists, cardiologists and therapists.

Premenstrual syndrome or pregnancy?

Some symptoms of PMS are similar to those of pregnancy (see). After conception, the content of the hormone progesterone in a woman’s body increases, which also happens during PMS, so the following symptoms are identical:

• fast fatiguability
• swelling and soreness of the breast
• nausea, vomiting
• irritability, mood swings
• lower back pain

How to distinguish pregnancy from PMS? Comparison of the most common symptoms of premenstrual syndrome and pregnancy:

The signs of both conditions are very similar, so it’s not easy to understand what exactly happens in a woman’s body and distinguish pregnancy from PMS:

• The easiest way to find out what caused poor health is to wait for the onset of menstruation.
• If the calendar is already late, you should take a pregnancy test. A pharmacy test will give reliable results only with a delay in menstruation. It is sensitive to the pregnancy hormone (hCG) excreted in the urine. If you do not have enough patience and nerves to wait, you can take a blood test for hCG. It shows almost one hundred percent result on the tenth day after conception.
• The best option to find out what is bothering you - PMS syndrome or pregnancy - is to visit a gynecologist. The doctor will assess the condition of the uterus and, if pregnancy is suspected, will prescribe an ultrasound.

When to See a Doctor

If the manifestations of premenstrual syndrome significantly reduce the quality of life, affect the ability to work and have a pronounced character, treatment is indispensable. After a thorough examination, the doctor will prescribe drug therapy and give the necessary recommendations to alleviate the course of the syndrome.

How can a doctor help?

In most cases, treatment is symptomatic. Depending on the form, course and symptoms of premenstrual syndrome, a woman needs:

• Psychotherapy - mood swings, irritability, depression, from which both the woman and loved ones suffer, are corrected by the methods of stabilizing behavioral techniques and psycho-emotional relaxation,.
• For headaches, pain in the lower back and abdomen, non-steroidal anti-inflammatory drugs are prescribed for the temporary relief of pain (, Nimesulide, Ketanov, see).
• Diuretics for removing excess fluid from the body with edema (see).
• Hormone therapy is prescribed for insufficiency of the second phase of the cycle, only after tests of functional diagnostics, based on the results of the identified changes. Apply gestagens - Medroxyprogesterone acetate from 16 to 25 days of the cycle.
• are prescribed for many neuropsychic symptoms (insomnia, nervousness, aggressiveness, anxiety, panic attacks, depression): Amitriptyline, Rudotel, Tazepam, Sonapax, Sertraline, Zoloft, Prozac, etc. in the 2nd phase of the cycle after 2 days from the onset of symptoms.
• With crisis and cephalgic forms, it is possible to prescribe Parlodel in the 2nd phase of the cycle, or if prolactin is elevated, then in a continuous mode, it has a normalizing effect on the central nervous system.
• With cephalgic and edematous forms, antiprostaglandin drugs are recommended (Indomethacin, Naprosin) in the second phase of the menstrual cycle.
• Since women often have elevated levels of histamine and serotonin with PMS, the doctor may prescribe 2nd generation antihistamines (see) 2 days before the expected worsening of the condition at night before the 2nd day of menstruation.
• To improve blood circulation in the central nervous system, it is possible to use Grandaxin, Nootropil, Aminolone for 2-3 weeks.
• In the crisis, cephalgic and neuropsychic form, drugs are indicated that normalize the neurotransmitter metabolism in the central nervous system - Peritol, Difenin, the doctor prescribes the drug for a period of 3-6 months.
• Homeopathic preparations Remens or Mastodinone.

What can you do?

• Full sleep

Try to sleep as much as your body has time to fully rest, usually 8-10 hours (see. Lack of sleep leads to irritability, anxiety and aggression, negatively affects the immune system. If you suffer from insomnia, try walking before bed, breathing technology.

• aromatherapy

In the absence of allergies, compositions of specially selected aromatic oils are a good weapon against PMS symptoms. Geranium, rose and will help normalize the cycle. Lavender and basil effectively fight spasms. Juniper and bergamot are uplifting. Start taking baths with aromatic oils two weeks before your period.

Hiking, running, Pilates, body flex, yoga, dancing are a great way to treat symptoms of premenstrual syndrome in women. Regular exercise increases endorphin levels, which can help fight depression and insomnia, as well as reduce the severity of physical symptoms.

• Take vitamin B6 and magnesium two weeks before your period

Magne B6, Magnerot, as well as vitamins E and A - this will make it much more effective to deal with such manifestations of PMS as: heart palpitations, heart pain, fatigue, insomnia, anxiety and irritability.

• Nutrition

Eat more fruits and vegetables, high-fiber foods, and include calcium-rich foods in your diet. Temporarily limit the use of coffee, chocolate, cola, as caffeine increases mood swings, irritability, anxiety. The daily diet should include 10% fat, 15% protein and 75% carbohydrates. Fat intake should be reduced, as well as beef, some types of which contain artificial estrogens. Useful herbal teas, freshly squeezed juices, especially carrot and lemon. It is better not to drink alcohol, it depletes the reserves of mineral salts and B vitamins, disrupts the metabolism of carbohydrates, and reduces the ability of the liver to utilize hormones.

• Relaxation practices

Avoid stress, try not to overwork and maintain a positive mood and thinking, relaxation practices help with this - yoga, meditation.

• Regular sex

It helps fight insomnia, stress and bad mood, increase the level of endorphins, strengthen the immune system. At this time, many women increase their sexual appetite - why not surprise your partner and try something new?

• medicinal plants

They can also help alleviate the symptoms of premenstrual syndrome: Vitex - relieves heaviness and pain in the mammary glands, Primrose (evening primrose) - from headaches and swelling, - an excellent antidepressant, normalizes libido, improves well-being and reduces fatigue.

A balanced diet, adequate exercise, vitamin supplements, healthy sleep, regular sex, a positive attitude towards life will help alleviate the psychological and physical manifestations of premenstrual syndrome.