Premenstrual Syndrome: Treatment

The purpose of treatment of premenstrual syndrome

Blocking or inhibition of ovulation, the normalization of cyclic interactions of sex hormones with central neurotransmitters (mainly serotonin) and, thus, the maximum reduction in the manifestations of the disease, improving the quality of life of patients.

Indications for hospitalization

Severe form of premenstrual syndrome, with ineffectiveness of outpatient treatment and the threat of patient harming yourself or others with severe aggression or depression.

Non-pharmacological treatment of premenstrual syndrome

In women with premenstrual syndrome, there are interpersonal problems, conflict situations arise in the family, at work, with friends. Often their self-esteem, self-esteem, self-esteem, self-esteem, self-esteem, self-esteem, increased divorce, loss of work, accidents during driving. Treatment of patients with premenstrual syndrome should start with advice on the regime of work and rest, diet, especially in the second phase of the cycle, the conduct of psychotherapy.

• The diet should include the following activities.
  • Reducing the consumption of carbohydrates and sugar, limiting tea, table salt, liquid, animal fats, milk, excluding coffee and alcohol.
  • Increase the proportion of fruits and vegetables in the diet.
• Maximum reduction of psychoemotional loads, increase in sleep time, rest during the day.
• Physical exercises (charging in the fresh air for 30 minutes 3-5 times a week).
• Physiotherapy (electrosleep, relaxing therapy, acupuncture, general massage or massage of the collar zone, balneotherapy).
• Psychotherapy: confidential conversation with the patient, explaining to her the essence of the cyclical changes taking place in the body, rendering assistance in eliminating unreasonable fears, recommendations for strengthening self-control. Psychotherapy gives the patient the opportunity to take responsibility for their own health and control their own personality. In these cases, the patient takes a more active part in the therapy of the disease.

Drug therapy of premenstrual syndrome

Pharmacotherapy in premenstrual syndrome is performed with ineffectiveness of non-drug therapies.

Pathogenetic treatment of premenstrual syndrome

• GnRH agonists and antigonadotropic drugs are used in severe forms of the disease.
  • Buserelin in the form of depot form in / m 3.75 mg once in 28 days, a course of 6 months or Buserelin in the form of a spray at a dose of 150 mcg in each nostril 3 times a day from the 2nd day of the menstrual cycle; course 6 months.
  • Goserelin sc in a dose of 3.6 mg or leuprorelin in / m at a dose of 3.75 mg or tryptorelin / m 3.75 mg once every 28 days for 6 months.
• Estrogens are prescribed for uterine hypoplasia, infantilism and / or concomitantly with GnRH agonists to reduce the severity of psycho-vegetative symptoms.
  • Estradiol in the form of a gel applied to the skin of the abdomen or buttocks at a dose of 0.5-1.0 mg by a course of 6 months or as a transdermal therapeutic system in a dose of 0.05-0.1 mg once a week for 6-12 months or orally at a dose of 2 mg / day for 6 months.
  • Conjugated estrogens are administered orally at a dose of 0.625 mg / day at a rate of 6 months.
• Antiestrogens are used in the treatment of cyclic mastalgia: tamoxifen inside at a dose of 10 mg / day with a course of 3-6 months.
• Monophasic COCs are indicated for all forms of premenstrual syndrome. Ethinylestradiol + gestodene inside at a dose of 30 mcg / 75 mcg per day or ethinyl estradiol / desogestrel inside at a dose of 30 mcg / 150 mcg per day or ethinyl estradiol / dienogest orally at a dose of 30 mcg / 2 mg daily or ethinylestradiol / cyproterone inside 35 mcg / 2 mg per day or ethinylestradiol + drospirenone in a dose of 30 mcg / 3 mg per day from the 1st to the 21st day of the menstrual cycle with a break of 7 days course of 3-6 months.
• The gestagens are prescribed with a pronounced hypofunction of the yellow body, a combination of premenstrual syndrome and endometrial hyperplasia.
  • Dydrogesterone in a dose of 20 mg from the 16th day of the menstrual cycle for 10 days.
  • Medroxyprogesterone, 150 mg IM every 3 months.
  • Levonorgestrel in the form of an intrauterine system (T-shaped rod with a container containing 52 mg of levonorgestrel, the body of a container with a hormone is covered with a polydimethylsiloxane membrane, resulting in levonorgestrel released into the uterine cavity at 20 μg / day), injected into the uterine cavity for 4-6- th day of the menstrual cycle once.

Symptomatic therapy of premenstrual syndrome

Symptomatic therapy is prescribed depending on clinical manifestations.

• Psychotropic medications are used when expressed emotionally on the fissures.
  • Anxiolytics (anti-anxiety drugs).
    • Alprazolam orally 0.25-1 mg 2-3 times a day.
    • Diazepam is administered orally at a dose of 5-15 mg / day.
    • Clonazepam is administered 0.5 mg 2-3 times a day.
    • Tetramethyltetraazobicooctanedione is inside by 0.3-0.6 mg 3 times a day.
    • Medazepam inside at a dose of 10 mg 1-3 times a day.
  • Neuroleptics: thioridazine inside at a dose of 10-25 mg / day.
  • Antidepressants (selective serotonin reuptake inhibitors or stimulants):
    • sertraline orally at a dose of 50 mg / day;
    • tianeptine orally 12,5 mg 2-3 times a day;
    • fluoxetine inside at a dose of 20-40 mg / day;
    • citalopram inside by 10-20 mg / day.
• NSAIDs are used in the cephalic form of premenstrual syndrome.
  • Ibuprofen inside at a dose of 200-400 mg 1-2 times a day.
  • Indomethacin 25-50 mg 2-3 times a day.
  • Naproxen by mouth in a dose of 250 mg twice a day.
• The selective agonist of serotonin receptors is used in the cephalic form: zolmitriptan inside at a dose of 2.5 mg / day.
• Diuretics are effective in the edematic form of the disease: spironolactone inside at a dose of 25-100 mg / day, 1 month.
• Dopaminomimetics is prescribed in the form of a premenstrual syndrome in the case of a relative increase in the concentration of prolactin in the 2nd phase of the menstrual cycle compared with the 1st. These drugs are prescribed in the 2 nd phase of the cycle from the 14th to the 16th day of the menstrual cycle.
  • Bromocriptine inside at a dose of 1.25-2.5 mg / day for 3 months.
  • Cabergoline for 0.25-0.5 mg 2 times a week. ✧ Hinagolide in a dose of 75-150 mcg / day.
• Antihistamines are prescribed in cases of severe allergic reactions.
  • Clemastin 1 mg (1 tablet) 1-2 times a day.
  • Mebhydroline at 50 mg (1 tablet) 1-2 times a day.
  • Chloropyramine 25 mg (1 tablet) 1-2 times a day.
• Vitaminotherapy.
  • Retinol 1 drop once a day.
  • Vitamins of the strong group in combination with magnesium. It was found that under the influence of magnesium symptoms of depression and hydration decrease, diuresis increases.
  • Vitamin E 1 drop once a day.
  • Calcium preparations in a dose of 1200 mg / day.
  • Homeopathic tincture of the herb of St. John's wort - a preparation made from the flowers of St. John's wort perfumed, normalizes the psycho-emotional background of the organism; appoint 1 tablet 3 times a day.
• Herbal and homeopathic medicines.

Evaluation of the effectiveness of treatment of premenstrual syndrome

Evaluation of the effectiveness of therapy is carried out according to the diaries of menstruation with a daily assessment of symptoms in scores.

• Symptoms are not present - 0 points;
• Symptoms slightly disturb - 1 point;
• Symptoms bother moderately, but do not break daily life - 2 points;
• Severe symptoms that cause concern for them and / or affect everyday life - 3 points.

The decrease in the intensity of symptoms as a result of treatment to 0-1 points indicates correct therapy. Treatment of premenstrual syndrome is a long-term, but definite opinion on its duration is not worked out and this issue is often addressed individually.

Surgical treatment of premenstrual syndrome

In the literature, there are data on the conduct of ovariectomy in severe forms of premenstrual syndrome that are not amenable to conservative therapy. It is believed that in exceptional cases, ovariectomy is possible in women over 35 years of age who have realized reproductive function, with the subsequent appointment of estrogen monotherapy as hormone replacement therapy.

Training patient

It is necessary to explain the patient that changing lifestyle (diet, exercise, massage) will lead to better health and quality of life. In addition, the patient should be informed that the symptoms of the disease resume with discontinuation of therapy, may worsen with age or after childbirth and are absent during pregnancy and menopause.

Forecast

More often favorable. If the recommendations are not followed and there is no treatment, a relapse of the disease is possible. In extremely severe cases, the forecast is questionable, possibly surgical treatment.

Prevention of premenstrual syndrome

To prevent premenstrual syndrome, stress situations, short-term climate changes, abortions and widespread use of COCs should be avoided.

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