Premenstrual Syndrome - Treatment

The goal of treatment for premenstrual syndrome

Blocking or inhibiting ovulation, normalizing cyclic interactions of sex hormones with central neurotransmitters (mainly serotonin) and, thus, maximizing the reduction of disease manifestations, improving the quality of life of patients.

Indications for hospitalization

A severe form of premenstrual syndrome, when outpatient treatment is ineffective and the patient is at risk of harming herself or others due to severe aggression or depression.

Non-drug treatment of premenstrual syndrome

Women suffering from premenstrual syndrome experience interpersonal problems, conflict situations in the family, at work, with friends. They often experience decreased self-esteem, self-respect, increased resentment, divorces, job losses, and driving accidents become more frequent. Treatment of patients with premenstrual syndrome should begin with advice on work and rest schedules, diet, especially in the 2nd phase of the cycle, and psychotherapy.

• The diet should include the following activities.
  • Reduce carbohydrate and sugar consumption, limit tea, table salt, liquids, animal fats, milk, and eliminate coffee and alcohol.
  • Increasing the proportion of fruits and vegetables in the diet.
• Maximum reduction of psycho-emotional stress, increase in sleep time and rest during the day.
• Physical exercise (exercise in the fresh air for 30 minutes 3-5 times a week).
• Physiotherapy (electrosleep, relaxation therapy, acupuncture, general massage or neck massage, balneotherapy).
• Psychotherapy: a confidential conversation with the patient, explaining to her the nature of the cyclical changes occurring in the body, helping to eliminate unfounded fears, recommendations for strengthening self-control. Psychotherapy gives the patient the opportunity to take responsibility for her own health and control her own personality. In these cases, the patient takes a more active part in the treatment of the disease.

Drug therapy for premenstrual syndrome

Pharmacotherapy for premenstrual syndrome is carried out when non-drug treatment methods are ineffective.

Pathogenetic treatment of premenstrual syndrome

• GnRH agonists and antigonadotropic drugs are used in severe forms of the disease.
  • Buserelin in the form of a depot form intramuscularly 3.75 mg once every 28 days, course 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 subcutaneously at a dose of 3.6 mg or leuprorelin intramuscularly at a dose of 3.75 mg or triptorelin intramuscularly 3.75 mg once every 28 days for a course of 6 months.
• Estrogens are prescribed for uterine hypoplasia, infantilism and/or simultaneously with GnRH agonists to reduce the severity of psychovegetative 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 for a 6-month course, or as a transdermal therapeutic system at a dose of 0.05–0.1 mg once a week for a 6–12-month course, or orally at a dose of 2 mg/day for a 6-month course.
  • Conjugated estrogens orally at a dose of 0.625 mg/day for 6 months.
• Antiestrogens are used in the treatment of cyclic mastalgia: tamoxifen orally at a dose of 10 mg/day for a course of 3–6 months.
• Monophasic COCs are indicated for all forms of premenstrual syndrome. Ethinyl estradiol + gestodene orally at a dose of 30 mcg/75 mcg per day or ethinyl estradiol / desogestrel orally at a dose of 30 mcg/150 mcg per day or ethinyl estradiol / dienogest orally at a dose of 30 mcg/2 mg per day or ethinyl estradiol / cyproterone orally 35 mcg/2 mg per day or ethinyl estradiol + drospirenone orally at 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 for a course of 3-6 months.
• Gestagens are prescribed for severe hypofunction of the corpus luteum, a combination of premenstrual syndrome and endometrial hyperplasia.
  • Dydrogesterone at a dose of 20 mg from the 16th day of the menstrual cycle for 10 days.
  • Medroxyprogesterone 150 mg intramuscularly 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 the container with the hormone is covered with a polydimethylsiloxane membrane, as a result of which levonorgestrel is released into the uterine cavity at 20 mcg/day), is inserted into the uterine cavity on the 4th-6th day of the menstrual cycle once.

Symptomatic therapy of premenstrual syndrome

Symptomatic therapy is prescribed depending on clinical manifestations.

• Psychotropic drugs are used for severe emotional disorders.
  • Anxiolytics (anti-anxiety drugs).
    • Alprazolam orally 0.25–1 mg 2–3 times a day.
    • Diazepam orally at a dose of 5–15 mg/day.
    • Clonazepam orally 0.5 mg 2-3 times a day.
    • Tetramethyltetraazobicyclooctanedione orally 0.3–0.6 mg 3 times a day.
    • Medazepam orally at a dose of 10 mg 1-3 times a day.
  • Neuroleptics: thioridazine orally at a dose of 10–25 mg/day.
  • Antidepressants (selective serotonin reuptake inhibitors or serotonin reuptake inhibitors):
    • sertraline orally at a dose of 50 mg/day;
    • tianeptine orally 12.5 mg 2-3 times a day;
    • fluoxetine orally at a dose of 20–40 mg/day;
    • citalopram orally 10–20 mg/day.
• NSAIDs are used for the cephalgic form of premenstrual syndrome.
  • Ibuprofen orally at a dose of 200–400 mg 1–2 times a day.
  • Indomethacin 25–50 mg 2–3 times a day.
  • Naproxen orally at a dose of 250 mg 2 times a day.
• A selective serotonin receptor agonist is used for the cephalgic form: zolmitriptan orally at a dose of 2.5 mg/day.
• Diuretics are effective in the edematous form of the disease: spironolactone orally at a dose of 25–100 mg/day for a course of 1 month.
• Dopamine mimetics are prescribed for the crisis form of premenstrual syndrome in case of a relative increase in prolactin concentration in the 2nd phase of the menstrual cycle compared to the 1st. These drugs are prescribed in the 2nd phase of the cycle from the 14th to the 16th day of the menstrual cycle.
  • Bromocriptine orally at a dose of 1.25–2.5 mg/day for 3 months.
  • Cabergoline 0.25–0.5 mg 2 times a week. ✧ Quinagolide at a dose of 75–150 mcg/day.
• Antihistamines are prescribed for severe allergic reactions.
  • Clemastine 1 mg (1 tablet) 1-2 times a day.
  • Mebhydrolin 50 mg (1 tablet) 1-2 times a day.
  • Chloropyramine 25 mg (1 tablet) 1-2 times a day.
• Vitamin therapy.
  • Retinol 1 drop 1 time per day.
  • Vitamins of the strong group in combination with magnesium. It has been established that under the influence of magnesium, symptoms of depression and hydration are reduced, and diuresis is increased.
  • Vitamin E 1 drop 1 time per day.
  • Calcium preparations at a dose of 1200 mg/day.
  • Homeopathic tincture of St. John's wort - a preparation made from St. John's wort flowers, normalizes the psycho-emotional background of the body; prescribed 1 tablet 3 times a day.
• Herbal and homeopathic medicines.

Evaluation of the effectiveness of treatment of premenstrual syndrome

The effectiveness of therapy is assessed using menstrual diaries with daily symptom assessment in points.

• No symptoms - 0 points;
• Symptoms are slightly bothersome - 1 point;
• Symptoms are moderately disturbing, but do not interfere with daily life - 2 points;
• Severe symptoms that cause distress and/or interfere with daily life - 3 points.

A decrease in the intensity of symptoms to 0-1 points as a result of treatment indicates correct therapy. Treatment of premenstrual syndrome is long-term, but there is no definite opinion on its duration and this issue is often decided individually.

Surgical treatment of premenstrual syndrome

There are data in the literature on performing oophorectomy in severe forms of premenstrual syndrome that do not respond to conservative therapy. It is believed that in exceptional cases, oophorectomy is possible in women over 35 years of age who have realized their reproductive function, with subsequent prescription of estrogen monotherapy as hormone replacement therapy.

Patient education

It is necessary to explain to the patient that lifestyle changes (diet, exercise, massage) will lead to an improvement in well-being and quality of life. In addition, the patient should be informed that the symptoms of the disease recur when therapy is discontinued, may intensify with age or after childbirth, and are absent during pregnancy and menopause.

Forecast

Mostly favorable. If recommendations are not followed and treatment is not provided, the disease may relapse. In extremely severe cases, the prognosis is questionable, and surgical treatment may be necessary.

Prevention of premenstrual syndrome

To prevent premenstrual syndrome, one should avoid stressful situations, sudden short-term climate changes, abortions and widespread use of COCs.

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