Premenstrual Syndrome - Causes

There are many theories about the origin of premenstrual syndrome:

• dysfunction of the hypothalamus-pituitary-adrenal system;
• hyperprolactinemia;
• changes in the adrenal cortex (increased secretion of androstenedione);
• increase in prostaglandin levels;
• decrease in the level of endogenous opioid peptides;
• changes in the metabolism of biogenic amines and/or disturbances of chronobiological rhythms in the body.

Apparently, in the genesis of the syndrome, the determining factor is not the level of sex hormones in the body, which may be normal, but their pronounced fluctuations during the menstrual cycle.

Estrogens and progesterone have a significant effect on the central nervous system, not only on the centers regulating reproductive function, but also on the limbic structures responsible for emotions and behavior. The effect of sex hormones can be opposite. Estrogens affect serotonergic, noradrenergic and opioid receptors, have an exciting effect and have a positive effect on mood. Progesterone, or rather its active metabolites, affecting GABAergic mechanisms, have a sedative effect, which in some women can lead to the development of depression in the luteal phase of the cycle.

The pathogenesis of the disease is based on disturbances in the central neuroregulatory mechanisms, a kind of neurobiological vulnerability of women predisposed to the development of symptoms of premenstrual syndrome in response to hormonal changes in the body, which can be aggravated by the influence of adverse external influences.

Premenstrual syndrome is more often observed in women of reproductive age with a regular ovulatory cycle. No connection has been found between premenstrual syndrome and postpartum depression, intolerance to oral contraceptives, spontaneous abortions and gestosis, but it has been noted that the disease often occurs in women engaged in intellectual work, in conflict families and with alcohol abuse. In city dwellers, especially in megalopolises, 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 women's reactions to cyclical, biological changes in their bodies.

The incidence of premenstrual syndrome currently varies from 5 to 40%, increases with age and is independent of socio-economic, cultural and ethnic factors. However, a relatively high incidence of the disease is noted in Mediterranean countries, the Middle East, Iceland, Kenya and New Zealand.

Classification

The following clinical forms of premenstrual syndrome are distinguished.

• Psychovegetative.
• Edema.
• Cephalgic.
• Crisis.
• Atypical.

Premenstrual syndrome is also divided into stages.

• Compensated: symptoms of the disease do not progress with age and stop with the onset of menstruation.
• Subcompensated: the severity of premenstrual syndrome worsens with age, symptoms disappear only with the cessation of menstruation.
• Decompensated: PMS symptoms continue for several days after the cessation of menstruation, with the intervals between cessation and the onset of symptoms gradually decreasing.

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