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Premenstrual syndrome
Last reviewed: 23.04.2024
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Premenstrual syndrome (PMS) is characterized by irritability, anxiety, emotional lability, the presence of depression, swelling, pain in the mammary glands, headaches. These symptoms occur within 7-10 days before menstruation and end several hours after its onset. The diagnosis is based on the clinical manifestations of the disease. Treatment is symptomatic with the appointment of the right diet and medications.
Premenstrual tension syndrome (premenstrual syndrome) is a complex of neuropsychic, vegetovascular and endocrine-metabolic disorders that occur in the second half of the menstrual cycle and rapidly regresses in the early days of menstruation. Characteristic of its development in conditions of insufficiency of the 2 nd or both phases of the cycle.
Most women notice that their mental state or physical health depends on the menstrual cycle, worsening before the onset of menstruation. Symptoms can be very severe in one month and very minor in another, which is probably due to external causes. Increase in symptoms is observed after 30-40 years; Combined contraceptive pills are effective. In 3% of women, symptoms associated with menstruation are so severe that it prevents them from leading a normal life: this is premenstrual syndrome (PMS) or premenstrual tension (PMN).
Premenstrual syndrome is a cyclic symptom complex that occurs in the premenstrual period (2-10 days before menstruation) and is characterized by somatic, neuropsychic, vegetative-vascular and metabolic-endocrine disorders, adversely affecting the woman's habitual lifestyle and alternating with a period of remission (continuing no less than 7-12 days) associated with the onset of menstruation.
The syndrome of premenstrual tension is the most severe form of premenstrual syndrome, which is manifested by severe attacks of anger, irritability and is accompanied by internal tension.
[Causes of premenstrual syndrome
The causes of clinical manifestations of PMS are multiple endocrine factors (eg, hypoglycemia, changes in carbohydrate metabolism, hyperprolactinaemia, fluctuations in circulating estrogen and progesterone levels, pathological reactions to estrogens and progesterone, excessive production of aldosterone or antidiuretic hormone (ADH)). Estrogens and progesterone are the cause of fluid retention in the body due to the production of an increased amount of aldosterone or ADH.
Symptoms of premenstrual syndrome
The type and intensity of the symptoms are different for every woman from cycle to cycle. Symptoms last from several hours to 10 days or more. Symptoms usually end with the onset of menstruation. Patients in the period of peri-menopause symptoms can persist until the end of menstruation. The most common symptoms are irritability, anxiety, excitement, anger, insomnia, decreased concentration, drowsiness, depression and severe fatigue. The retention of fluid in the body is the cause of edema, a transient increase in body weight, engorgement of the mammary glands and pain in them. There may be pain and tension in the pelvic organs and pain in the lower back. Some women, especially young people, suffer from dysmenorrhea when menstruation begins. There are also other nonspecific symptoms, such as headache, dizziness, paresthesia of the limbs, fainting, palpitation, constipation, nausea, vomiting and changes in appetite. Eels and neurodermatitis can also be observed. There may be deterioration of the skin (due to allergies or infections) and eyes (for example, visual impairment, conjunctivitis).
Diagnosis of premenstrual syndrome
Ask the patient to keep a diary of symptoms and incidents. In the presence of premenstrual syndrome, the symptoms will be most pronounced on days before the onset of menstruation, they subside after their arrival, and after their termination for at least a week the woman does not experience any of the symptoms listed above. The diary can reveal other problems, for example, mental disorders (which may worsen before the onset of menstruation) or menstrual disorders.
Diagnosis is based on taking into account typical manifestations of the disease (depression or asthenovegetative syndrome, headaches, discomfort, edema, swelling and pain in the lower abdomen, engorgement and soreness of the mammary glands), their temporary connection with the premenstrual period and rapid regression of clinical symptoms after the onset of menstruation.
Treatment of premenstrual syndrome
Treatment is symptomatic, begins with adequate rest and sleep and regular exercise.
Nutritional changes are necessary: increasing protein intake, reducing sugar intake, using a complex of B vitamins (especially pyridoxine), increasing the magnesium content in the diet, can also help reduce stress loads. Fluid retention can be reduced by reducing sodium intake and administering diuretics (eg, hydrochlorothiazide 25-50 mg orally once a day in the morning) just before the onset of symptoms. However, a decrease in fluid retention in the body does not contribute to the disappearance of all symptoms and may not have any effect. Selective serotonin inhibitors (for example, fluoxetine 20 mg orally once a day) are prescribed to reduce anxiety, irritability and other emotional symptoms, especially if stress can not be avoided.
For some women, the effective use of hormonal drugs. The drugs of choice are oral contraceptives (eg, norethindrone 5 mg once a day), progesterone in the form of vaginal suppositories (200-400 mg once a day), oral progestin (eg, microdosed progesterone, 100 mg at bedtime) for 10-12 days before the onset of menstruation or progestin prolonged action (eg, medroxyprogesterone, 200 mg intramuscularly every 2-3 months). In severe premenstrual syndrome and the absence of treatment effects, gonadotropin-releasing hormone agonists are prescribed (eg, leuprolide intramuscularly at 3.75 mg once a month, goserolin at 3.6 mg subcutaneously once a month) with simultaneous administration of low-dose estrogens and progestins (eg, estradiol 0.5 mg once daily plus micro-dosed progesterone, 100 mg at bedtime). The administration of these drugs can reduce cyclic fluctuations. The administration of spironolactone, bromocriptine and monoamine oxidase inhibitors (MAO) is not recommended.
ICD-10 code
N94.3 Premenstrual tension syndrome.