Premenstrual syndrome( PMS) - Causes, symptoms and treatment. MF.

Premenstrual syndrome( PMS) is a complex of symptoms arising in the premenstrual period caused by the pathological course of the second phase of the menstrual cycle.

The incidence of PMS varies from 5-40%.

Synonyms of PMS : premenstrual tension, cyclic disease, premenstrual disease.

Causes of premenstrual syndrome( PMS)

It has been established that the risk of PMS morbidity increases with age. Known is the fact that statistically in the inhabitants of megacities PMS is more likely than in rural women.

In the generalized version, the most common reasons leading to the emergence of PMS include:

- a violation of the ratio of hormones estrogen and progesterone in the second phase of the menstrual cycle. There is an increase in the level of estrogen - hyperestrogenism and malnutrition of the yellow body with a decrease in progesterone, which affects the neuro-emotional state of a woman;
- increased prolactin secretion - hyperprolactinemia, stimulating changes in the mammary glands;

- diseases of the thyroid gland;
- violation of water-salt metabolism: retention of sodium and water by the kidneys;
- hypovitaminosis - lack of vitamins B6, magnesium, calcium and zinc;
- genetic predisposition;
- psychogenic factors - frequent stresses, conflict situations in the family, etc. PMS more often fall ill with women with a certain mental make-up: irritable, lean, overly attentive to their health.

Symptoms of premenstrual syndrome( PMS)

Symptoms of PMS appear 2-10 days before menstruation. With the onset of menstruation, all symptoms decrease or completely go away. Clinical manifestations of PMS are very diverse, more than 150 symptoms appear in premenstrual days.

There are several main clinical forms of PMS with characteristic symptoms:

1. Psycho-vegetative form of PMS : possible symptoms - irritability, tearfulness, touchiness, drowsiness or insomnia, forgetfulness, weakness, fatigue, numbness of hands, conflict, sudden outbursts of anger or depression, decreased libido( sexual desire), increased sensitivity to sounds and smells, flatulence, constipation. It should be noted that in young women of the reproductive period, PMS is more often expressed in bouts of depression, and in adolescents of transitional age, aggressiveness prevails.

2. Respiratory system : swelling of the face, shins, fingers, skin itching, acne, slight weight gain, , breast engorgement and soreness( more common than other symptoms of ), muscle pain, bloating, weakness, sweating. It is necessary to distinguish this form of premenstrual syndrome from mastopathy, because the treatment is different, and the symptoms are similar.

3. Cephalic form of PMS : headaches, irritability, dizziness, fainting, nausea, vomiting. Headaches can be paroxysmal, accompanied by redness or swelling of the face.

4. "Krysovaya" form of - symptoms of "panic attacks": increased blood pressure, attacks of rapid heart rate, feelings of compression behind the sternum, the appearance of fear of death. Panic attacks occur in the evening or at night. The PMS form is characteristic of women in the premenopausal period( 45-47 years).The overwhelming majority of patients with a crisis form of premenstrual syndrome noted kidney disease, cardiovascular system and gastrointestinal tract.

5. Atypical forms of PMS : fever up to 38 C, ulcerative gingivitis and stomatitis, cyclic bronchial asthma( attacks of suffocation before and during menstruation), vomiting, "menstrual migraine"( migraine attacks on menstruation days).

6. The mixed form is a combination of several forms of PMS.The most common is the combination of psycho-vegetative and edematous forms.

Depending on the number of symptoms, PMS secrete a mild and severe form of the disease:
The mild form is a manifestation of 3-4 symptoms, with 1-2 of them prevailing;
Severe form - the manifestation of 5-12 symptoms, of which 2-5 are most pronounced.

Please note that disability, regardless of the strength and duration of symptoms, indicates a severe course of premenstrual syndrome, such a disease is often accompanied by mental disorders.

The stages of premenstrual syndrome( PMS) are also differentiated:

- compensated stage - symptoms of PMS are slightly expressed, do not progress with age, with the onset of menstruation disappear;
- subcompensated stage - symptoms of PMS are pronounced and affect a woman's ability to work. Over time, the manifestations of the disease are exacerbated;
- decompensated stage - severe manifestations of PMS, which continue for several days after the termination of menstruation.

Unfortunately, many women with PMS are late or do not go to doctors at all. Even there is an opinion that this should be normal. Some confuse the symptoms of PMS with a small pregnancy, the symptoms of PMS and pregnancy are indeed very similar. Thanks to the mass advertising of medicines, many are aware of the existence and signs of PMS and are engaged in self-medication, taking pain medications, and sometimes antidepressants without prescribing a doctor. In most cases, the use of such drugs helps temporarily weaken the manifestations of ICP, but in the absence of proper consultation and treatment with a gynecologist, the disease can go into a decompensated stage, so it is necessary to go to the gynecologist in any case and as soon as possible.

Sometimes it happens that the patients turn to the doctor on time, but not to the gynecologist, but to the therapist, neurologist or even to the psychiatrist, because the symptoms of PMS are very similar to many non-gynecological diseases. And only after a long examination and no effect of treatment is sent to the gynecologist.

Diagnosis of premenstrual syndrome( PMS)

In order to diagnose at the first admission, the gynecologist should carefully study the patient's history and complaints. PMS is that rare pathology in which a patient's questioning gives more information than an examination on the chair. The first thing that can lead to thoughts about PMS is the cyclical nature of the attacks of the disease, i.e.symptoms always appear immediately before menstruation and disappear or weaken during menstruation. There should be a clear relationship of symptoms with the menstrual cycle - the emergence of clinical manifestations 2-10 days before menstruation and their disappearance at the end of menstruation.

To confirm the diagnosis, it is necessary to pass a blood test for hormones in both phases of the menstrual cycle( prolactin, estradiol, progesterone).The hormonal characteristics of patients with premenstrual syndrome have features, depending on the form of PMS.Thus, with edematous PMS, there was a significant decrease in the level of progesterone in the second phase of the cycle. With neuropsychic, cephalalic and crisical forms, an increase in the level of prolactin in the blood was revealed.

Further, depending on the form of PMS and complaints, additional tests are prescribed:

- in psycho-vegetative and cephalgic form, consultation of a neuropathologist is necessary, if necessary, a psychiatrist( psychiatric report excluding the presence of mental illnesses);
- in the presence of pain in the mammary glands, mammography or ultrasound of the mammary glands is necessary in the first phase of the menstrual cycle and mammologist consultation;
- craniography( radiography of the skull or CT, MRI) according to the indications of the neurologist;
- with headaches make an electroencephalography and assess the state of the vessels of the brain;
- with edematous form - daily diuresis is measured( fluid retention in the body is observed up to 500-700 ml per day from the general norm);
- in the form of a crisis - consultation of the therapist, control of blood pressure.

Adequate specialists are involved in the examination of patients with PMS: neurologist, psychiatrist, therapist, endocrinologist.

Gynecologists recommend that all patients with PMS should keep a diary daily for 3 menstrual cycles with a detailed description of the complaints. Such records help not only in the diagnosis, but also reflect the dynamics of the treatment.

Treatment of premenstrual syndrome( PMS)

Treatment of PMS should be comprehensive regardless of the form of the disease. The main groups of drugs used are:

1. Psychotropic and sedative agents are prescribed to eliminate psychoemotional symptoms common to all patients with PMS:
anti-anxiety drugs( Seduxen, Rudotel), antidepressants( Cipramine, Coaxil).Preparations are prescribed in both phases of the menstrual cycle with a course of at least 2 months.

2. Hormonal drugs are prescribed to regulate the fluctuations of sex hormones. To this end, they use:
- gestagens - Utrozhestan, Dufaston in the second phase of the cycle,
- monophasic combined oral contraceptives( COC) - Zhanin, Logest, Yarina, etc. COCs are the drugs of choice for the treatment of PMS, well tolerated, and suitable for all women of reproductive age, if there are no contraindications;
- derivatives of androgens - Danazol, is prescribed for severe pain in the mammary glands;
- agronists - gonadotropin-releasing hormone agonists - Zoladex, Buserelin. These drugs disable the function of the ovaries, exclude ovulation, thereby the symptoms of PMS disappear. Assign to women in the pre-menopausal period;
- dopamine agonists - Parlodel, Dostinex - are prescribed with increased prolactin secretion during the second phase of the cycle.

3. With pronounced swelling associated with PMS, diuretics are prescribed - Spironolactone, with increased blood pressure - hypotensive drugs.

4. Symptomatic therapy - used as an adjunct to basic treatment and rapid elimination of PMS symptoms. These drugs can be used alone, with a confirmed diagnosis of PMS:

- non-steroidal anti-inflammatory drugs - Indomethacin, Diclofenac;

- antihistamines are used for allergic reactions - skin itching, rash( Tavegil, Suprastin);

- homeopathic preparations. Of these, Mastodinon and Remens are widely popular - plant non-hormonal drugs. The main advantage of this group is that these drugs act on the cause of PMS - restore the imbalance of hormones, thereby reducing the psychological manifestations of the disease( irritability, tearfulness, feelings of anxiety and fear).Mastodinone - a favorite drug of mammologists, is especially effective in the swelling form of the disease, in particular, with pain in the chest. The effect of taking up comes quickly, but you do not need to throw the treatment. Mastodinone appoint 30 drops, diluted with water, 2 times a day for 3 months. In tableted form take 1 tablet 2 times a day. Remens also prescribed for a period of not less than 3 months and take 10 drops or 1 tablet 3 times a day. Drugs are well tolerated.
Contraindications for both drugs are minimal: hypersensitivity to the components of drugs, age to 12 years, pregnancy and the period of feeding.

- vitamins of group B, magnesium( Magne B6).

The average duration of treatment is from 3 to 6 months, depending on the severity of the disease.

Diet and lifestyle for the treatment of premenstrual syndrome( PMS)

For a speedy recovery and rehabilitation, you must adhere to a certain lifestyle:

1) Diet. It is necessary to reduce the consumption of coffee and table salt. It is advisable to include fish, beans, seeds, rice, dairy products, dark chocolate, spinach, vegetables and fruits in your diet.

2) Do it regularly - at least 2-3 times a week. Physical exercises increase the level of endorphins( hormones of joy), which is the best psychotherapy from PMS, but do not play it. Increased physical activity, on the contrary, aggravate the course of the disease.

3) Try not to be nervous, exclude stresses and do not focus on the disease, sleep more - at least 8-9 hours a day and rest.

As an auxiliary, you can also use traditional medicine - phytotherapy:
- motherwort or valerian tincture for 30 drops 3 times a day;
- warm tea from chamomile pharmacy;
- strong black or green mint tea.

Phytotherapy is used in conjunction with the main treatment, but everything is very individual. For example, with edematous PMS, it is better to reduce fluid intake.

Complication of ICP in the absence of timely treatment is a transition to the decompensated stage of the disease: severe depressive disorders, cardiovascular complications - persistent increase in blood pressure, constant rapid heart rate, heart pain. Gradually reduced "light intervals" ie the number of asymptomatic days between cycles decreases.

PMS Prevention:

- regular intake of oral contraceptives( if there are no contraindications to them);
- healthy lifestyle - smoking cessation, exercise;
- regular sex life;
- prevention of stressful situations.

Questions that are most often asked by a gynecologist about PMS.

1. I have a delayed period and my chest is swollen, is it pregnancy or PMS, how to tell?
Maybe both. You need to do a pregnancy test to dispel doubts.

2. Does PMS reduce fertility?
No, if there are no hormonal disorders.

3. If I have PMS, then the birth will be painful?
Probably, pathological births in women with PMS are more frequent than those who are not familiar with such a disease.

4. Does PMS have virgins?
Yes, if there is menstruation, it means that there may be a PMS.

5. Can there be a PMS because of a spiral?
No, the intrauterine device does not affect PMS development in any way. I advise you to replace the spiral with oral contraception if symptoms of PMS are severe.

6. Can I use Chinese phytotampones to treat PMS?
It is possible, but as an addition to the basic treatment.

7. Is it possible to go to a sauna or sauna with PMS?
Directly with the symptoms of PMS sauna is not recommended, it is better to wait until the symptoms fade.

Obstetrician-gynecologist, Ph. D.Christina Frambos.