Premenstrual Syndrome - Symptoms

To diagnose premenstrual syndrome, it is necessary to identify the predominant symptoms and establish that their development is closely related to the luteal phase of the menstrual cycle. More than 100 symptoms of the disease have been described, but the most common are the following: bloating (90%), engorgement and tenderness of the mammary glands (90%), headaches (more than 50% of cases), increased fatigue (80%), irritability, depressed and unstable mood (more than 80% of cases), increased appetite (more than 70% of cases), forgetfulness and decreased attention (more than 50% of cases), palpitations (15%), dizziness (20%).

Each of the clinical forms of premenstrual syndrome is characterized by certain symptoms.

Psychovegetative form of premenstrual syndrome: increased irritability, depression, tearfulness, touchiness, aggressiveness, numbness of hands, drowsiness, forgetfulness, increased sensitivity to sounds and smells. It is noted that if depression prevails in women with premenstrual syndrome in reproductive age, then aggressiveness prevails in adolescence.

Edematous form of premenstrual syndrome: swelling of the face, shins, fingers, bloating, itchy skin, weight gain of 4-8 kg, engorgement and soreness of the mammary glands, increase in shoe size, local edema (e.g., swelling of the anterior abdominal wall or feet, knees). Most patients with premenstrual syndrome experience fluid retention of up to 500-700 ml in the 2nd phase of the menstrual cycle, and in 20% of patients, despite facial swelling, bloating and other signs, diuresis remains positive.

Cephalgic form of premenstrual syndrome

• Migraine-type headaches are paroxysmal pains of a pulsating nature, localized mainly in one half of the head, in the frontal and temporal regions, periodically recurring and accompanied by nausea, vomiting, photophobia and noise phobia.
• Tension headaches are diffuse headaches of a squeezing, pressing nature, which sometimes create the sensation of a "helmet" or "hoop" being put on the head. The pain is usually bilateral and lasts for several days.
• Vascular headaches are paroxysmal, pulsating, bursting, diffuse headaches or pain in the back of the head, accompanied by redness or swelling of the face, often combined with increased blood pressure.
• Combined forms of headaches (migraine, vascular and tension headaches).

Crisis form (panic attack syndrome): panic attacks (crises) begin with increased blood pressure, a feeling of pressure behind the breastbone, chills, a feeling of fear, and are accompanied by coldness and numbness of the extremities, palpitations with an unchanged ECG. Often, such crises end with profuse urination. In some women, even a slight increase in systolic pressure (by 10-20 mm Hg from the initial figures) can provoke a crisis. Panic attacks usually occur in the evening or at night and can begin against the background of an infectious disease, fatigue and/or stress.

Atypical forms of premenstrual syndrome.

• The hyperthermic form is characterized by a cyclic increase in body temperature to 37.2–38 °C in the luteal phase of the cycle and a decrease with the onset of menstruation; changes in blood parameters characteristic of inflammatory diseases are absent.
• The ophthalmoplegic form of migraine is characterized by cyclic hemiparesis in the luteal phase of the cycle, unilateral closure of the eye.
• The hypersomnic form is characterized by cyclic sleepiness in the luteal phase of the cycle.
• Cyclic allergic reactions up to Quincke's edema:
  • ulcerative gingivitis and stomatitis;
  • cyclic bronchial asthma;
  • cyclic uncontrollable vomiting;
  • cyclic iridocyclitis;
  • Menstrual migraine is characterized by migraine attacks occurring only during menstruation. Improvement is usually noted with the onset of pregnancy, or with the prevention of menstruation using gonadotropin-releasing hormone agonists. Depending on the severity of clinical manifestations, mild and severe degrees of the disease are distinguished.

In mild cases, 3-4 of the symptoms listed above appear 2-10 days before the onset of menstruation, with only 1 or 2 of them being significantly pronounced.

In severe cases, 3–14 days before menstruation, 5–12 of the above symptoms begin to bother you at the same time, with 2–5 of them being sharply expressed.

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