Premenstrual syndrome: causes

There are many theories of the occurrence of premenstrual syndrome:

• dysfunction of the hypothalamic-pituitary-adrenal system;
• hyperprolactinemia;
• changes in the adrenal cortex (increased secretion of androstenedione);
• increase in the content of prostaglandins;
• reduction in the level of endogenous opioid peptides;
• changes in the exchange of biogenic amines and / or disorders of chronobiological rhythms in the body.

Apparently, the genesis of the syndrome is not determined by the level in the body of sex hormones, which can be normal, but expressed by their fluctuations during the menstrual cycle.

Estrogens and progesterone have a significant effect on the central nervous system, not only on the centers that regulate the reproductive function, but also on the limbic structures responsible for emotions and behavior. The effect of sex hormones can be of opposite nature. Estrogens affect serotonergic, noradrenergic and opioid receptors, have an exciting effect and positively influence the mood. Progesterone, more precisely its active metabolites, acting on GABA-ergic mechanisms, have a sedative effect that some women can lead to the development of depression in the luteal phase of the cycle.

At the heart of the pathogenesis of the disease are violations of the central neuro-regulatory mechanisms, as if the neurobiological vulnerability of women predisposed to the emergence of symptoms of premenstrual syndrome in response to hormonal changes in the body, which can be exacerbated by adverse external influences.

Premenstrual syndrome is more often observed in women of reproductive age with a regular ovulatory cycle. There was no association of premenstrual syndrome with postpartum depression, intolerance to oral contraceptives, spontaneous miscarriages and gestosis, but it was noted that the disease often occurs in women of intellectual work, in conflict families and in alcohol abuse. In urban women, especially megacities, premenstrual syndrome develops more often than in rural women, which confirms the important role of stress in the genesis of the disease. In addition, cultural and social factors also play a role and can influence the response of women to cyclical, biological changes in their bodies.

The frequency of premenstrual syndrome currently varies from 5 to 40%, increases with age and does not depend on socioeconomic, cultural and ethnic factors. However, a relatively high incidence of the disease is noted in the Mediterranean, the Middle East, Iceland, Kenya and New Zealand.

Classification

The following clinical forms of premenstrual syndrome are distinguished.

• Psycho-vegetative.
• Ointment.
• Cefalgic.
• Crozie.
• Atypical.

Premenstrual syndrome is also divided into stages.

• Compensated: the symptoms of the disease do not progress with age, and with the onset of menstruation cease.
• Subcompensated: the severity of premenstrual syndrome with age is aggravated, the symptoms disappear only with the termination of menstruation.
• Decompensated: the symptoms of premenstrual syndrome continue for several days after the termination of menstruation, and the intervals between cessation and the appearance of symptoms are gradually reduced.

[1], [2], [3], [4], [5]