Premenstrual syndrome (PMS ) - Causes, Symptoms and Treatment .MF .
Premenstrual syndrome (PMS) - a set of symptoms that occur during the premenstrual period, caused by pathological course of the second phase of the menstrual cycle.
PMS frequency of occurrence ranges from 5-40%.
Synonyms PMS : premenstrual tension, cyclic disease, premenstrual disease.
Causes of premenstrual syndrome (PMS)
established that the risk of PMS incidence increases with age.It is known as the fact that statistically at inhabitants of megacities PMS is more likely than rural women.
In summary form, the most common causes leading to the occurrence of PMS, include:
- violation of the ratio of the hormones estrogen and progesterone in the second phase of the menstrual cycle.There is an increase in estrogen levels - hyperestrogenia and failure of the corpus luteum function with a decrease in progesterone, which affects the nervous and emotional condition of the woman;
- increased secretion of prolactin - hyperprolactinemia, stimulating changes in the mammary glands;
- thyroid disease;
- a violation of water-salt metabolism: sodium and water retention by the kidneys;
- vitamin deficiencies - lack of vitamins B6, magnesium, calcium and zinc;
- genetic predisposition;
- psychogenic factors - frequent stress, conflict situations in the family, etc.PMS often ill women with certain mental warehouse: grumpy, thin, overly tracking their health.
symptoms of premenstrual syndrome (PMS)
PMS Symptoms appear 2-10 days before menstruation.With the onset of menstruation symptoms decrease or completely disappear.Clinical manifestations of PMS are very diverse, described more than 150 symptoms that occur in premenstrual days.
There are several major clinical forms of PMS with characteristic symptoms:
1. Psychovegetative form of PMS : possible symptoms - irritability, tearfulness, resentment, drowsiness or insomnia, forgetfulness, weakness, fatigue, numbness in hands, conflicts, sudden outbursts of angeror depression, decreased libido (sex drive), increased sensitivity to sounds and smells, flatulence, constipation.It should be noted that the young women of reproductive age PMS often expressed in fits of depression, and at puberty teens dominated aggressiveness.
2. edematous form of PMS : symptoms - swelling of the face, legs, fingers, itching, acne, slight weight gain, engorgement and breast pain (more common than others symptoms), muscle pain, swellingabdomen, weakness, sweating.It is necessary to distinguish this form of premenstrual syndrome of mastitis, because the treatment is different, and the symptoms are similar.
3. cephalgic form of PMS : headaches, irritability, dizziness, fainting, nausea, vomiting.Headaches can wear paroxysmal in nature, accompanied by redness or swelling of the face.
4. "krizovoe" form - symptoms of "panic attacks": high blood pressure, seizures, heart palpitations, feelings of pressure behind the sternum, the emergence of fear of death.Panic attacks occur in the evening or at night.Krizovoe form of PMS is typical for women in the premenopausal period (45-47 years).The vast majority of patients with krizovoe form of premenstrual syndrome marked by kidney disease, cardiovascular system and gastrointestinal tract.
5. atypical form of PMS : rise in body temperature to 38 C, ulcerative gingivitis and stomatitis, cyclic asthma (asthma attacks before and during menstruation), vomiting, "menstrual migraine" (migraine attacks in the days of menstruation).
6. mixed form - a combination of several forms of ICP.The most common combination psychovegetative and edematous forms.
Depending on the number of symptoms of PMS emit light and heavy form of the disease:
Mild - the manifestation of symptoms of 3-4, with 1-2 of them prevail;
Severe - the manifestation of symptoms of 5-12, of which 2-5 are most pronounced.
Please note that the violation of disability, regardless of the intensity and duration of symptoms, evidence of severe premenstrual syndrome, a disease often associated with mental disorders.
also distinguished stage of premenstrual syndrome (PMS):
- compensated stage - the symptoms of PMS slightly pronounced over the years, not progressive, with the onset of menstruation disappear;
- subcompensated stage - the symptoms of PMS and pronounced impact on disabled women.Over time, the manifestations of the disease are compounded;
- decompensated stage - severe symptoms that last for several days after the cessation of menstruation.
Unfortunately, many women with PMS quite late or do not go to doctors.Even there is an opinion that it should be OK.Some confuse PMS symptoms pregnancy of small term, PMS symptoms and pregnancy is indeed very similar.Due to the mass advertising of drugs, many people know about the existence and symptoms of PMS and self-study at home, taking painkillers, antidepressants and sometimes without a prescription.In most cases, the use of these drugs help temporarily ease symptoms of PMS, but in the absence of proper consultation and treatment of gynecological disease may progress to decompensated stage, so you need to go to the gynecologist in any case as soon as possible.
Sometimes it happens that the patient time to go to the doctor, but not to the gynecologist and a physician, neurologist or psychiatrist, as PMS symptoms are very similar to many not related to gynecology diseases.It was only after a long survey and the lack of effect of the treatment is directed to the gynecologist.
diagnosis of premenstrual syndrome (PMS)
In order to make a diagnosis on the first reception, a gynecologist should carefully examine the patient's medical history and complaints.PMS - this is a rare pathology, in which the patient survey provides more information than on the examination chair.The first thing that might lead to the idea of PMS - cyclical bouts of the disease, ie,symptoms always occur immediately prior to menstruation and disappear or become weak during menstruation.There must be a clear link symptoms with the menstrual cycle - the appearance of clinical manifestations of 2-10 days before menstruation and disappear at the end of menstruation.
to confirm the diagnosis is necessary to take a blood test for hormones in both phases of the menstrual cycle (prolactin, estradiol, progesterone).Hormonal characterization of patients with premenstrual syndrome has features depending on the form of PMS.Thus, the edematous form of PMS was a significant decrease in the level of progesterone in the second phase of the cycle.When neuropsychic, cephalgic and krizovoe forms revealed increasing levels of prolactin in the blood.
Further, depending on the form of PMS and complaints appoint additional research:
- when psychovegetative and cephalgic form should consult a neurologist, psychiatrist, if necessary (the psychiatric report that excludes the existence of mental illness);
- in the presence of pain in the breasts need a mammogram or breast ultrasound in the first phase of the menstrual cycle and breast physician's consultation;
- craniography (skull radiography or CT, MRI) on the testimony of a neurologist;
- headaches do electroencephalography and assess the condition of the brain vessels;
- the edematous form - measured daily diuresis (fluid retention observed in the body to 500-700 ml per day from the general rule);
- when krizovoe form - consultation therapist, blood pressure control.
required for the examination of patients with PMS related professionals are involved: a neurologist, psychiatrist, therapist, endocrinologist.
Gynecologists recommend that all patients with PMS every day to keep a diary for 3 menstrual cycles with a detailed description of the complaints.These records not only help in diagnosis, but also reflect the dynamics of the treatment.
treatment of premenstrual syndrome (PMS)
PMS Treatment should be complex, regardless of the form of the disease.The main drugs used by the group are as follows:
1. Psychotropic and sedatives prescribed to eliminate the psycho-emotional symptoms inherent in all patients with PMS:
anti-anxiety medications (Seduxen, Rudotel), antidepressants (Tsipramin, Coaxil).Drugs administered in both phases of the menstrual cycle rate is not less than 2 months.
2. Hormonal drugs are prescribed to resolve the fluctuations of sex hormones.For this purpose, use:
- progestin - Utrozhestan, Djufaston the second phase of the cycle,
- monophasic combined oral contraceptives (COCs) - Jeanine, Logest, and so on YarinaCombined hormonal are the drugs of choice for treating PMS, well tolerated, and are suitable for all women of reproductive age, if there are no contraindications;
- derivatives of androgens - danazol, prescribed for pain expressed in the mammary gland;
- GnRHa - agonist of gonadotropin-releasing hormone - Zoladex, Buserelin.These drugs disable the function of the ovaries, ovulation rule, thereby PMS symptoms disappear.Assign premenopausal women;
- dopamine agonists - Parlodel, Dostinex - administered with increased secretion of prolactin in the second phase of the cycle.
3. When expressed edema associated with PMS, prescribe diuretics - spironolactone, with high blood pressure - gipotenzinye drugs.
4. Symptomatic therapy - used as a supplement to the basic treatment and the rapid elimination of PMS symptoms.These drugs can be used alone, with a confirmed diagnosis of PMS:
- nonsteroidal anti-inflammatory drugs - Indomethacin, Diclofenac;
- antihistamines used in allergic reactions - itching, rash (Tavegil, Suprastin);
- homeopathic remedies.Of these broad popular Mastodinon and Remens - herbal non-hormonal drugs.The main advantage of this group lies in the fact that these drugs act on the cause of PMS - restore the disturbed hormone imbalance, thereby reducing the psychological manifestations of the disease (irritability, tearfulness, anxiety and fear).Mastodinon - mammologists favorite drug, especially effective in the edematous form of the disease, in particular, pain in the chest.The effect of receiving occurs rapidly, but do not need to cast treatment.Mastodinon appoint 30 drops, diluted with water, 2 times a day for 3 months.The tablet form take 1 tablet 2 times a day.Remens also appointed for a term of not less than 3 months and take 10 drops or 1 tablet 3 times a day.Preparations are well tolerated.Contraindications
both drugs are minimal: hypersensitivity to the drug, age under 12 years, pregnancy and breastfeeding.
- B vitamins, magnesium (Magne B6).
average duration of treatment is from 3 to 6 months depending on the severity of the disease.
diet and lifestyle for the treatment of premenstrual syndrome (PMS)
must adhere to a certain lifestyle for a speedy recovery and rehabilitation:
1) Diet.It is necessary to reduce the consumption of coffee and salt.It is advisable to include in your diet fish, legumes, seeds, rice, dairy products, dark chocolate, spinach, vegetables and fruits.
2) Exercise regularly - at least 2-3 times a week.Exercise increases levels of endorphins (happiness hormones), which serves the best psychotherapy for PMS, but it is not necessary to play.Increased physical activity, on the contrary, aggravate the disease.
3) Try not to be nervous, eliminate stress, and do not dwell on the disease, sleep more - not less than 8-9 hours a day and relax.
As an auxiliary tool can be used independently and traditional medicine - herbal medicine:
- tincture of motherwort or valerian to 30 drops 3 times a day;
- warm tea of chamomile;
- strong black or green tea mint.
Phytotherapy used in combination for the basic treatment, but it is very individual.For example, in edematous form of PMS is better to reduce your intake of fluids.
complication of ICP in the absence of timely treatment - is the transition to the decompensated stage of the disease: severe depressive disorders, cardiovascular complications - a persistent increase in blood pressure, constant heart palpitations, heart pain.Gradually shrinking "lucid intervals" t.e.kolichestvo bezsimptomno days between cycles is reduced.
- regular oral contraceptives (if no contraindications to them);
- healthy lifestyle - not smoking, exercise;
- regular sexual life;
- prevent stressful situations.
Questions that most frequently asked gynecologist about PMS.
1. I delay menstruation and breast swelled, it PMS or pregnancy, how to distinguish?
Maybe both.You need to do a pregnancy test in order to dispel doubts.
2. Does PMS Reduces ability to conceive?
No, if there is hormonal imbalance.
3. If I happen PMS means and childbirth will be painful?
Perhaps pathological delivery in women with PMS are more likely than those who are not familiar with a similar ailment.
4. Does PMS Sometimes virgins?
Yes, if there is menstruation, then maybe PMS.
5. Could it be due to PMS spiral?
No, IUD does not affect the development of PMS.I advise you to replace the spiral on oral contraception if their symptoms are expressed.
6. Can I use Chinese fitotampony to treat PMS?
possible, but as a supplement to the basic treatment.
7. Is it possible to go to the bath or sauna for PMS?
directly with PMS symptoms sauna is not recommended, it is better to wait until the symptoms fade.
Obstetrician-gynecologist, Ph.D.Christina Frambos.