The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Premenstrual syndrome called symptom, which is characterized by neuro-psychiatric, metabolic and endocrine and vegetovascular disorders occurring during the second phase of the menstrual cycle (approximately 3-10 days) and terminated either at the beginning of menstruation, or immediately after completion.
Other names of premenstrual syndrome (PMS) - premenstrual disease, premenstrual tension syndrome or cyclic disease.
Usually, PMS diagnosed in women over 30 years (seen in 50% of the fairer sex), while the young and young age he knew only one in five women.
Depending on the prevalence of various forms of displays are distinguished 6 premenstrual disease:
By the number of displays, their duration and intensity isolated form 2 ICP:
- easy. There is a 3-4 attribute for 3-10 days before menstruation, and most of them expressed 1-2;
- heavy. There is a 5-12 signs for 3-14 days before menstruation, and most pronounced 2-5 of them, or all 12.
But, in spite of the number of symptoms and their duration in the event of reduced performance talking about severe PMS.
- compensated. Symptoms appear the day before menstruation and disappear from their beginning, the signs over the years are not amplified;
- subcompensated. There progression of symptoms (increase the number, duration, and intensity);
- decompensated. There has been heavy during PMS, decreased with time duration of the "light" intervals.
Causes of PMS
Currently, the causes and mechanism of development of PMS are not well understood.
There are several theories to explain the development of this syndrome, although none of them covers the whole pathogenesis of its occurrence. And if earlier it was believed that the cyclic condition is typical for women with anovulatory cycles, the Now it is known that premenstrual disease and patients suffer with regular ovulation.
A decisive role in the onset of PMS plays the content of sex hormones (it may be normal), and their fluctuations level over the cycle, which react parts of the brain responsible for emotional state and behavior.
This theory explains PMS violation proportion of progestogens and estrogens in favor of the latter. Under the action of estrogens in the body are retained and the liquid sodium (swelling), in addition, they provoke the synthesis of aldosterone (fluid retention). estrogenic hormones accumulated in the brain, which causes the occurrence of psychoneurological symptoms; excess reduces their potassium and glucose, and contributes to cardiac pain, fatigue and inactivity.
The increase in prolactin
prolactin increases in rate during the second phase of the cycle, at the same time is noted and hypersensitivity of the target organs, in particular the mammary gland (pain, bloating). Prolactin also affects the adrenal hormones increases the release of aldosterone, which retains fluid and causes swelling.
It violates the synthesis of prostaglandins, which are produced in almost all organs. Many PMS symptoms are similar to symptoms of giperprostaglandinemii (headaches, dyspeptic disorder, emotional lability).
It explains PMS in terms of the body's hypersensitivity to own progesterone.
Theory of water intoxication
Explains PMS disorders of water-salt metabolism.
Among other versions, considering the causes of PMS, it is possible to note the theory of psychosomatic disorders (somatic disorders lead to the emergence of psychiatric reactions), theory hypovitaminosis (deficiency of vitamin B6) and minerals (magnesium, zinc and calcium), and others.
PMS Predisposing factors include:
- genetic predisposition;
- mental disorders in adolescence and the postpartum period;
- infectious diseases;
- improper diet;
- part of the climate change;
- emotional and mental lability;
- insulin resistance;
- chronic disease (hypertension, Heart disease, thyroid pathology);
- alcohol consumption;
- childbirth and abortion.
As already mentioned, the symptoms of PMS occur for 2-10 days before menstruation and depend on the clinical form of the disease, that is, on the predominance of certain symptoms.
Characterized by emotional instability:
- unmotivated aggression or anguish, reaching to the depression;
- sleep disturbance;
- weakness and fatigue;
- fear periods;
- weakening of the libido;
- thoughts of suicide;
- aggravation of smell;
- auditory hallucinations;
- and others.
In addition, there are other symptoms: numbness in hands, headaches, poor appetite, abdominal distension.
In this case, prevail:
- swelling of the face and extremities;
- tenderness and engorgement;
- weight gain (and thus hidden edema);
- headaches and joint pain;
- negative diuresis;
This form is characterized by a predominance of vegetative-vascular and neurological symptoms. characterized by:
- headaches by type migraine;
- nausea and vomiting;
- diarrhea (A sign of high content of prostaglandin);
- palpitations, heart pain;
- intolerance of odors;
Proceeds as sympathoadrenal crises or "psychic attacks" that are different:
- increasing pressure;
- increased heart rate;
- heart pains, although there are no ECG changes;
- sudden onset of fear.
Leaky type hyperthermic (with increasing temperature up to 38 degrees), gipersomnicheskoy (characterized by daytime sleepiness), allergic (occurrence of allergic reactions, not excluding angioedema), Ulcers (gingivitis and stomatitis) And iridotsiklicheskoy (inflammation of the iris and ciliary body) forms.
Characterized by a combination of several forms described ICP.
Diagnosis of premenstrual syndrome
It is recommended to carry out a differential diagnosis of premenstrual stress syndrome. This condition must be differentiated from the following diseases:
- mental disorders (schizophrenia, endogenous depression and others);
- chronic renal disease;
- formations of the brain;
- inflammation of the spinal cord;
- hypophyseal adenoma;
- thyroid disease.
In all these diseases the patient complains regardless of menstrual cycle phase, whereas ICP symptoms occurs day before menstruation.
In addition, of course, PMS symptoms are similar to symptoms of early pregnancy. In this case it is easy to resolve doubts, independently conducting a home pregnancy test or passing blood on hCG.
Diagnosis of the syndrome premenstrual tension has some problems: not all women to submit their complaints to the gynecologist, the majority being treated by a neurologist or general practitioner.
When dealing with the reception the doctor should carefully collect the history and study the complaint and during the meeting to link these symptoms to the end of the second phase of the cycle and to confirm their cyclicality. It is equally important to make sure in the absence of a patient of mental illness.
Then the woman is invited to note its existing features from the following list:
- emotional lability (weeping gratuitous, sudden changes of mood, irritability);
- propensity to aggression or depression;
- feelings of anxiety, fear of death, tension;
- depressed mood, hopelessness, anguish;
- loss of interest in usual for her lifestyle;
- fatigue, weakness;
- concentration of impossibility;
- increased or decreased appetite, bulimia;
- sleep disturbance;
- feeling of engorgement, breast tenderness and swelling, headaches, abnormal weight gain, pain in the muscles or joints.
The diagnosis of "PMS" is set if the expert ascertains that the patient five grounds, with the obligatory presence of one of the first four listed.
Necessarily assigned a blood test for prolactin, estradiol and progesterone during the second phase of the cycle, based on the results determined by the intended form of PMS. Thus, the edematous form is characterized by a decrease in the level of progesterone. A neurodevelopmental, cephalgic and krizovoe forms differ increased prolactin.
Further examination vary depending on the form of PMS.
- examination by a neurologist and a psychiatrist;
- X-ray of the skull;
- electroencephalography (detection of functional disorders in the limbic brain regions).
- commissioning the LHC;
- study of excretory renal function and urine output measurement (secreted fluids 500-600ml less consumption);
- mammography and Breast ultrasound in the first phase of the cycle to differentiate from mastitis mastodynia (Breast tenderness).
Be sure to:
- US-adrenal (exclude tumor);
- commissioning tests for catecholamines (blood and urine);
- Inspection ophthalmologist (eyeground and field of vision);
- X-rays of the skull (the signs increased intracranial pressure);
- MRI of the brain (Deletion of the tumor).
It is also necessary to consult a physician and keeping blood pressure diary (excluding hypertension).
- electroencephalography, which diffuse detected changes in the electrical activity of the brain (cortex rhythm desynchronization type);
- CT of the brain;
- Inspection ophthalmologist (eyeground);
- X-rays of the skull and cervical spine.
And in all forms of PMS needed counseling therapist, endocrinologist and a neurologist.
PMS therapy begins with an explanation to the patient of her condition, the normalization mode of work, rest and sleep (at least 8 hours a day), elimination of stress, and of course, the destination diet.
Women with the syndrome premenstrual tension must adhere to, especially in the second phase of the cycle, the following diet:
- excluded hot and spicy dishes:
- restricted salt;
- imposed a ban on the use of strong coffee, tea and chocolate;
- reduced intake of fat, and in some types of PMS - and animal proteins.
The main diet focuses 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 monthly (Grandaxinum, rudotel, phenazepam, sibazon) and antidepressants (fluoxetine, amitriptyline). Good sedative, sleep and normalizing relaxing effect has magneV6. And sedation have teas such as "Aesculap" (day) "Hypnos" (night).
In order to improve cerebral circulation (cephalgic form) recommend Nootropilum, piracetam, aminolone.
In edematous form appointed diuretic drugs (spironolactone) and diuretics teas.
Antihistamines (teralen, Suprastinum, Diazolinum) shown at atypical (allergic) and edematous forms ICP.
Cephalgic and krizovoe ICP forms require receiving bromocriptine to 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 hormone levels in the body.
When giperprostaglandinemii illustrates use of nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin, diclofenac), which inhibit the production of prostaglandins.
And, of course, essential medicines for PMS are combined oral contraceptives from the group of mono- (Jess, logest, Jeanine), which inhibit the production of its own hormones, thereby leveling the pathological manifestations symptom.
The course of therapy syndrome premenstrual tension on average 3-6 months.
Consequences and outlook
PMS, which was not engaged in treatment of a woman, face in the future severe climacteric syndrome. The prognosis of the disease premenstrual favorable.