Premenstrual syndrome (PMS), causes, symptoms, diagnosis, treatment, prevention. What is PMS and how can you alleviate a woman’s condition during premenstrual syndrome. Treatment of premenstrual syndrome

PMS or premenstrual syndrome- totality pathological symptoms, appearing a few days before menstruation and disappearing in the first days of menstruation. Premenstrual syndrome is mainly manifested by dysfunction of the central nervous system, vegetative-vascular and metabolic-endocrine disorders. Approximately 90% women reproductive age feel certain changes, or, so to speak, “signs” indicating the approach of menstruation. For most women, such symptoms are mild and do not interfere with their daily lives - this is a mild form of premenstrual syndrome that does not require treatment. However, approximately 3-8% of women experience severe forms of PMS that require special treatment.

Causes of PMS

There are many theories to explain the complexity of premenstrual syndrome. The hormonal theory suggests that the development of the syndrome is associated with an excess of estrogen and a lack of progesterone in the second phase of the menstrual cycle. The “water intoxication” theory explains the cause of premenstrual syndrome by changes in the renin-angiotensin-aldosterone system and high levels of serotonin. Activation of the renin-angiotensin system increases the levels of serotonin and melatonin.

Estrogens can also cause sodium and fluid retention in the body by increasing aldosterone production. The theory of prostaglandin disorders explains many various symptoms premenstrual syndrome by changing the balance of prostaglandin E1. Increased expression of prostaglandin E is observed in schizophrenia due to changes in brain excitation processes. The main role in the pathogenesis of premenstrual syndrome is played by disruption of the metabolism of neuropeptides (serotonin, dopamine, opioids, norepinephrine, etc.) in the central nervous system and associated peripheral neuroendocrine processes.

IN last years great attention is given to peptides of the intermedial lobe of the pituitary gland, in particular melanostimulating hormone of the pituitary gland. This hormone, when interacting with beta-endorphin, can promote mood changes. Endorphins increase the level of prolactin, vasopressin and inhibit the action of prostaglandin E in the intestines, resulting in breast engorgement and bloating. The development of premenstrual syndrome is promoted by stress, neuroinfections, complicated childbirth and abortion, especially in women with congenital or acquired inferiority of the hypothalamic-pituitary system.

PMS symptoms

Symptoms of premenstrual syndrome include:

• irritability,
• depression,
• tearfulness,
• aggressiveness,
• headache,
• dizziness,
• nausea,
• vomiting
• pain in the heart area,
• tachycardia,
• engorgement of the mammary glands,
• swelling,
• flatulence,
• thirsty
• shortness of breath,
• increase in body temperature.

Neuropsychic PMS symptoms are reflected not only in complaints, but also in the inappropriate behavior of patients. Depending on the predominance of certain symptoms, neuropsychic, edematous, cephalgic and crisis forms of premenstrual syndrome are distinguished. IN clinical picture neuropsychic form of premenstrual syndrome is dominated by irritability or depression (in young women, depression often predominates, and in adolescence aggressiveness is noted), as well as weakness and tearfulness.

Symptoms of the edematous form of PSM

The edematous form of premenstrual syndrome is manifested by severe engorgement and soreness of the mammary glands, swelling of the face, legs, fingers, and bloating. Many women with edematous form experience sweating, increased sensitivity to smells. The cephalgic form of premenstrual syndrome is clinically manifested by an intense throbbing headache radiating to the eyeball. Headache accompanied by nausea, vomiting, arterial pressure does not change. A third of patients with the cephalgic form of premenstrual syndrome experience depression, pain in the heart, sweating, and numbness of the hands. The crisis form of premenstrual syndrome is characterized by sympathetic-adrenal crises. The crisis begins with an increase in blood pressure, a feeling of pressure behind the sternum, fear of death, and palpitations. Typically crises occur in the evening or at night and can be triggered by stress, fatigue, infectious disease. Crises often end with profuse urination.

Symptoms of mild and severe PSM

Depending on the number, duration and intensity of symptoms, mild and severe premenstrual syndrome are distinguished. With mild premenstrual syndrome, 3-4 symptoms are observed, 1-2 of them are significantly pronounced. Symptoms appear 2-10 days before the start of menstruation. With severe premenstrual syndrome, 5-12 symptoms occur 3-14 days before menstruation, and 2-5 of them are pronounced. Diagnosis of premenstrual syndrome has certain difficulties due to the diversity clinical symptoms. The identification of premenstrual syndrome is facilitated by an adequate survey of the patient, during which it is possible to identify the cyclical nature of pathological symptoms that occur during the premenstrual days.

Diagnosis of PMS

For all clinical forms of premenstrual syndrome, it is advisable to perform an EEG and REG of vessels brain. These studies show functional disorders various brain structures. The hormonal status of patients with premenstrual syndrome reflects some features functional state hypothalamic-pituitary-ovarian-adrenal system. Thus, with the edematous form of premenstrual syndrome, the level of progesterone is reduced and the content of serotonin in the blood is increased; in the neuropsychic form the level of prolactin and histamine is increased, in the cephalgic form the content of serotonin and histamine is increased, in the crisis form the level of prolactin and serotonin is increased in the second phase of the menstrual cycle.

Using others additional methods diagnosis largely depends on the form of premenstrual syndrome. In the edematous form, measurement of diuresis and examination of renal excretory function are indicated. Pain and swelling of the mammary glands are an indication for ultrasound of the mammary glands and mammography in the first phase of the menstrual cycle for the differential diagnosis of mastodynia and mastopathy. A neurologist, psychiatrist, therapist, endocrinologist, and allergist are involved in examining patients.

PMS treatment

The first stage of PMS treatment is psychotherapy, including confidential conversation, autogenic training. It is necessary to normalize the work and rest regime, eliminate coffee, chocolate, spicy and salty foods, and limit fluid consumption in the second phase of the menstrual cycle. Recommend general massage and massage of the collar area. Drug therapy carried out taking into account the duration of the disease, clinical form premenstrual syndrome, age of the patient and concomitant extragenital pathology. For neuropsychiatric manifestations in any form of premenstrual syndrome, sedatives and psychotropic drugs: tazepam, rudotel, seduxen 2-3 days before symptoms appear.

In the treatment of the edematous form of premenstrual syndrome, antihistamines are effective - tavegil, diazolin, teralen, also in the second phase of the menstrual cycle; Veroshpiron is prescribed in the second phase of the menstrual cycle 3-4 days before the onset of clinical symptoms. To improve blood supply to the brain, it is advisable to use nootropil or aminalon from the 1st day of the menstrual cycle for 2-3 weeks (2-3 menstrual cycles). In order to reduce prolactin levels, parlodel is used in the second phase of the menstrual cycle for 8-9 days. In connection with the role of prostaglandins in the pathogenesis of premenstrual syndrome, antiprostaglandin drugs naprosyn and indomethacin are recommended in the second phase of the menstrual cycle, especially in edematous and cephalgic forms of premenstrual syndrome.

Hormonal therapy for PMS is carried out in case of insufficiency of the second phase of the menstrual cycle with gestagens: duphaston or uterozhestan from the 16th to the 25th day of the menstrual cycle. In severe decompensated form, young women are shown combined estrogen-progestogen drugs or Norkolut from the 5th day of the cycle, 5 mg for 21 days. In recent years, for the treatment of severe forms of premenstrual syndrome, hormone-releasing hormone agonists (zoladex, buserelin) have been proposed for 6 months, giving an antiestrogenic effect. Treatment of patients with premenstrual syndrome is carried out for 3 menstrual cycles, then take a break for 2-3 cycles. In case of relapse, treatment is resumed. If the effect is positive, preventive maintenance treatment is recommended, including vitamins and tranquilizers.

Questions and answers on the topic "PMS"

Question:Hello, I have a question for you. 5 days ago I started having PMS - in PMS time two days before its end, I had intercourse with my husband, and for two days in a row he left his seed in me! Question - can I get pregnant when I had intercourse during PMS? And should I take the ESCAPELLE tablet? I am very worried that this will somehow affect my health, and in the future that I will have problems with childbirth?

Answer: Pregnancy is not excluded and there is no point in hoping that PMS will protect you from pregnancy.

Question:Good afternoon. At 19 years old, I had terrible pain during the first 1-2 days of my period. What to do?

Answer: We recommend that you consult a gynecologist, since in some cases dysmenorrhea (severe pain during menstruation) may indicate pathological process, such as endometriosis, inflammation pelvic organs, etc.

Question:Previously, my breasts didn’t hurt before my period, but now they hurt. I had delays in the winter, I started drinking iodomarin (I still take it), the delays went away. It's summer now and sunny days more. Could it be that the breasts hurt before menstruation due to a large amount of hormones from the sun and iodine? There were no sexual acts.

Answer: No, the phenomena you mentioned cannot be the cause of pain in the mammary glands. It is quite possible that you have started Premenstrual Syndrome, which may be associated with the delays you had in the winter. Be sure to consult a gynecologist.

Question:How can you treat PMS without medications and the help of doctors?

Answer: PMS symptoms may be present for many years. This means that you should not try to simply wait out or endure them. If you notice that PMS symptoms are interfering with your quality of life, be sure to try to eliminate them with treatment. IN otherwise you risk spending a significant part of your life in bad mood and poor health.

Question:I have obvious symptoms premenstrual syndrome (PMS). What does this mean if I am taking birth control pills?

Answer: As a rule, with a properly selected contraceptive drug, all symptoms of premenstrual syndrome are minimized. If symptoms persist, it is recommended to consult a gynecologist for a personal examination and additional examination: blood for sex hormones, ultrasound of the pelvic organs, to select the optimal means of contraception. If for some time, while taking a contraceptive drug, symptoms of premenstrual syndrome were not observed and in some cycle they reappeared, before menstrual bleeding, then it is recommended to exclude pregnancy. IN in this case, it is recommended to donate blood for hCG and consult a gynecologist.

Question:How long before your period can signs of PMS appear?

Answer: Typically, the first signs of premenstrual syndrome may appear 10 days before the onset of menstrual bleeding. This period varies among different women and averages 2-10 days.

Question:What should I do if my wife has PMS? How should I behave during this time?

Answer: First of all, try to distract your wife and keep her busy with something interesting. If your care annoys her, try to leave her alone and not bother her, because... any action you take can cause an attack of irritation and an unmotivated scandal. It is recommended to support your wife and, if necessary, visit a gynecologist to prescribe adequate symptomatic treatment that will help reduce the manifestations of premenstrual syndrome. Try not to speak in hints or contradict, this irritates the woman even more, but you should not give up your opinion.

Premenstrual syndrome (PMS) is the physical and emotional symptoms experienced by women 1-2 weeks before their period. Symptoms often vary from woman to woman and stop when menstruation begins. Common symptoms include acne, tender breasts, bloating, feeling tired, restless and mood changes. Symptoms often last for six days. Symptoms may change over time. During pregnancy or after menopause, symptoms disappear. Diagnosis of PMS requires the presence of a consistent pattern of emotional and physical symptoms between ovulation and the onset of menstruation, and the severity of these symptoms must be sufficient to interfere with the woman's normal functioning in daily life. Emotional symptoms should be absent at the beginning of the menstrual cycle. Diagnosis can be made by keeping a diary of symptoms over several months. Before making a diagnosis, other diseases that may cause similar symptoms should be excluded. The cause of PMS is unknown. Some symptoms may worsen if the diet contains a large number of salt, or . It is believed that the basis of the PMS mechanism is a change hormonal levels. If present weakly severe symptoms, women are advised to reduce their intake of salt, caffeine and stress levels, as well as increase physical activity. In some cases, taking supplements and may be helpful. WITH physical symptoms Anti-inflammatory drugs such as help fight. For more severe symptoms may be used contraception or . Up to 80% of women report having some symptoms before their period begins. In 20-30% of women, these symptoms qualify as PMS. (PMDD) is a more severe form of PMS with more pronounced psychological symptoms. PMDD affects three to eight percent of premenopausal women. In addition to the usual drugs used for PMS, classes of drugs can be used for PMDD. selective inhibitors serotonin reuptake.

Signs and symptoms

More than 200 different symptoms have been associated with PMS. Common emotional and nonspecific symptoms include stress, anxiety, difficulty falling asleep (insomnia), headache, fatigue, mood changes, increased emotional sensitivity and changes in libido. Physical symptoms associated with the menstrual cycle include bloating, lower back pain, abdominal cramps, constipation or diarrhea, swollen or tender breasts, cyclic acne, joint or muscle pain and gluttony. Exact symptoms and their intensity is different for all women. One woman in different cycles Symptoms may vary and change over time. Most women with PMS experience only a few of the following: possible symptoms, and the onset of symptoms is relatively predictable.

Causes

Although PMS has been linked to the luteal phase, the exact causes of the syndrome are unclear, but it is clear that several factors may be involved in the pathogenesis. One important factor is hormonal changes during the menstrual cycle; these changes are more pronounced in some women than others. Chemical changes in the brain, stress and emotional problems such as depression do not cause PMS, but can make it worse. Low consumption and minerals, high level sodium intake and/or may worsen symptoms such as water retention and bloating. PMS is more common in women between 20 and 40 years of age; in women who have at least one child; in women with a family history of depression; and in women with a history of illness postpartum depression or mood disorder.

Diagnosis

Does not exist laboratory methods testing or unique methods physical examination to confirm the diagnosis of PMS. The three main signs of PSM include:

A woman's chief complaint is one or more emotional symptoms associated with PMS (most often irritability, tension or a feeling of unhappiness). If physical symptoms alone (bloating or abdominal pain) are present, PMS cannot be diagnosed.

Symptoms begin predictably during the luteal (premenstrual) phase and decrease or disappear predictably immediately before or during menstruation, and do not appear until before ovulation.

Symptoms must be severe enough to disrupt or interfere with the woman's daily life.

Often meets soft form PMS. More severe symptoms will indicate PMDD. PMS, unlike PMDD, is not listed in the Diagnostic and Statistical Manual, fourth edition. mental illness(DSM-IV). To diagnose PMDD, a doctor must ask a woman to keep a record of her symptoms for at least two menstrual cycles. This will help determine whether symptoms are limited to the premenstrual period, are predictable, and interfere with the woman's normal functioning. For PMS descriptions A number of standardized instruments have been developed, including a premenstrual syndrome calendar, prospective recording of menstrual impact and severity, and visual analogue scales. When making a diagnosis, it is necessary to exclude other disorders that may be associated with the observed symptoms. A number of disorders tend to worsen during menstruation, which can lead to the misconception of PMS. These disorders include anemia, hypothyroidism, disorders eating behavior and drug addiction. Key difference The thing about PMS about these diseases is that they are observed not only in the luteal phase of the cycle. Conditions and symptoms such as depression or other symptoms may worsen in the period leading up to your period. affective disorders, migraines, epilepsy, fatigue, irritable bowel syndrome, asthma and allergies. When making a diagnosis, problems associated with other aspects of the woman's life should be excluded. reproductive system, including dysmenorrhea (pain during menstruation, not before it), endometriosis, perimenopause, and side effects of oral contraceptives. National Institute mental health conducted a study in which they compared the intensity of symptoms observed from days 5 to 10 of the cycle with symptoms observed six days before the onset of menstruation. To make a diagnosis of PMS, the intensity of symptoms must increase by at least 30% in the 6 days before menstruation. This pattern should be observed according to at least for two consecutive cycles.

Control

Various technologies have been used to treat PMS. Women with mild form PMS recommends reducing salt and caffeine intake, reducing stress levels and increasing physical activity. In some cases, calcium and vitamin D supplements may be helpful. Anti-inflammatory drugs such as naproxen may be used to combat physical symptoms. If symptoms are severe, birth control may be used. Diuretics may be used to combat fluid retention. Some studies have demonstrated the effectiveness of spironolactone.

Antidepressants

For severe PMS, SSRIs such as and may be used. Women with PMS may only use these medications on days when symptoms are expected to occur. Although effective in some cases, intermittent therapy may be less effective overall than long-term treatment. Common side effects of SSRIs include nausea and weakness.

Hormonal agents

For PMS, medications are often used hormonal contraception; a combination is often used oral contraceptive And contraceptive patch. For some women, this class of drugs may trigger symptoms associated with PMS, while for others it may reduce symptoms. physical manifestations syndrome. Hormonal agents do not alleviate emotional symptoms Progesterone is very often used for PMS, but there is insufficient data to support such use. At severe form Gonadotropin-releasing hormone antagonists can be used in PMS, but such drugs themselves have significant side effects.

Alternative medicine

Forecast

PMS is generally a stable diagnosis. Susceptible PMS women experience the same symptoms with the same intensity at the end of each cycle for many years. Treatment of specific symptoms is usually effective. Even without treatment, there is a reduction in symptoms during premenopausal age. However, women who suffer from PMS or PMDD are more likely to experience menopausal symptoms such as hot flashes.

Prevalence

Up to 80% women childbearing age report some symptoms a few days before menstruation. In 20-30% of women, these symptoms qualify as PMS, and in 3-8% - as a severe form of PMS.

Story

Initially, PMS was considered a fictitious disease, and women who had symptoms were told that “the cause was in their head.” It was believed that reproductive organs women have complete control over it. Women were warned against wasting energy needed for the functioning of the uterus and ovaries. In the 19th century, it became obvious that this view did not correspond to reality: young girls in America worked in factories for long and difficult hours; newspapers in the 19th century were literally full of reports about magical means to get rid of the “tyranny” of the natural processes of the menstrual cycle. In 1873, Edward Clarke published a book that would greatly influence a generation called Sex in Education. Clarke concluded that female workers suffered less than schoolgirls because they “taxed their brains less.” Presumably, among women employed physical labor, a stronger and more developed body, and a more “normally designed” apparatus of the reproductive system. Feminists would later take a position contrary to Clark's view that women should not leave the home, demonstrating that women could function in the world outside the home. Formal medical description premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder (PMDD) was realized 70 years ago in a paper presented at the New York Academy of Medicine by Robert T. Frankl entitled " Hormonal reasons premenstrual tension." The term "premenstrual syndrome" was first used in an article published in 1953 by Dalton and Green in the British Medical Journal. Since then, PMS has become firmly entrenched in popular culture, but research into PMS as medical diagnosis not much was done. Women are believed to be partly responsible for the medicalization of PMS. By legitimizing the disorder, women contribute to the idea of ​​PMS as a disease. It has also been suggested that the hype around PMS and PMDD is influenced by organizations and people who may benefit from it, such as feminists, psychologists, doctors and scientists.

Alternative theories

Most supporters of PMS as a social concept believe that PMS and PMDD have little in common: PMDD is caused by chemical processes occurring in the brain, and PMS is caused by hypochondria. Most studies of PMS and PMDD draw data exclusively from women's reports. According to sociologist Carol Tavris, in the West, women find themselves in such a situation that they are aware of the disorder in advance and expect to experience its symptoms. Anthropologist Emily Martin states that PMS is a cultural phenomenon that continues to increase in the presence of positive feedback and thus represents a social concept that contributes to or serves as an aid to women's learned helplessness. convenient excuse. Tavrit argues that PMS serves as an explanation for anger or sadness in women. The decision to call PMDD a disease has been criticized as inappropriate medicalization. In both cases, we're talking about about emotional aspects rather than normal physical symptoms.

– a cyclically recurring symptom complex observed in the second half of the menstrual cycle (3-12 days before menstruation). It has an individual course and can be characterized by headache, severe irritability or depression, tearfulness, nausea, vomiting, skin itching, swelling, pain in the abdomen and in the heart area, palpitations, etc. Swelling, skin rashes, flatulence, painful engorgement of the mammary glands. IN severe cases neurosis may develop.

General information

Premenstrual syndrome, or PMS, are called vegetative-vascular, neuropsychic and metabolic-endocrine disorders that occur during the menstrual cycle (usually in the second phase). Synonyms this state found in the literature are the concepts of “premenstrual illness”, “premenstrual tension syndrome”, “cyclic illness”. Every second woman over the age of 30 is familiar with premenstrual syndrome firsthand; in women under 30, this condition occurs somewhat less frequently - in 20% of cases. In addition, manifestations of premenstrual syndrome usually accompany emotionally unstable, thin, asthenic women who are more likely to exercise intellectual sphere activities.

Causes of premenstrual syndrome

The course of the crisis form of premenstrual syndrome is manifested by sympatho-adrenal crises, characterized by attacks of rising blood pressure, tachycardia, heart pain without abnormalities on the ECG, panic fear. The end of a crisis is usually accompanied by copious urination. Often attacks are provoked by stress and overwork. The crisis form of premenstrual syndrome can develop from untreated cephalgic, neuropsychic or edematous forms and usually manifests itself after 40 years. The background for the crisis form of premenstrual syndrome is diseases of the heart, blood vessels, kidneys, and digestive tract.

To cyclical manifestations atypical forms premenstrual syndrome include: increased body temperature (in the second phase of the cycle up to 37.5 ° C), hypersomnia (drowsiness), ophthalmoplegic migraine (headaches with oculomotor disorders), allergic reactions(ulcerative stomatitis and ulcerative gingivitis, asthmatic syndrome, uncontrollable vomiting, iridocyclitis, Quincke's edema, etc.).

When determining the severity of premenstrual syndrome, it is based on the amount symptomatic manifestations, highlighting the light and severe form premenstrual syndrome. Light form premenstrual syndrome manifests itself 3-4 characteristic symptoms appearing 2-10 days before the onset of menstruation, or the presence of 1-2 significantly pronounced symptoms. In severe forms of premenstrual syndrome, the number of symptoms increases to 5-12; they appear 3-14 days before the onset of menstruation. Moreover, all of them or several symptoms are significantly expressed.

In addition, an indicator of a severe form of premenstrual syndrome is always a disability, regardless of the severity and number of other manifestations. Decreased ability to work is usually observed in the neuropsychic form of premenstrual syndrome.

It is customary to distinguish three stages in the development of premenstrual syndrome:

1. compensation stage - symptoms appear in the second phase of the menstrual cycle and disappear with the onset of menstruation; the course of premenstrual syndrome does not progress over the years
2. subcompensation stage - the number of symptoms increases, their severity worsens, manifestations of PMS accompany the entire menstruation; Premenstrual syndrome becomes more severe with age
3. stage of decompensation - early start and late cessation of symptoms of premenstrual syndrome with minor “light” intervals, severe course of PMS.

Diagnosis of premenstrual syndrome

The main diagnostic criterion for premenstrual syndrome is cyclicality, the periodic nature of complaints that arise on the eve of menstruation and their disappearance after menstruation.

The diagnosis of premenstrual syndrome can be made based on the following signs:

• State of aggression or depression.
• Emotional imbalance: mood swings, tearfulness, irritability, conflict.
• Bad mood, feeling of melancholy and hopelessness.
• State of anxiety and fear.
• Decreased emotional tone and interest in current events.
• Increased fatigue and weakness.
• Decreased attention, memory impairment.
• Changes in appetite and taste preferences, signs of bulimia, weight gain.
• Insomnia or drowsiness.
• Painful tension in the mammary glands, swelling
• Headaches, muscle or joint pain.
• Worsening of the course of chronic extragenital pathology.

The manifestation of five of the above signs with the obligatory presence of at least one of the first four allows us to speak with confidence about premenstrual syndrome. An important part of the diagnosis is the patient’s keeping a self-observation diary, in which she should note all disturbances in her well-being over the course of 2-3 cycles.

A study of hormones (estradiol, progesterone and prolactin) in the blood allows us to determine the form of premenstrual syndrome. It is known that the edematous form is accompanied by a decrease in progesterone levels in the second half of the menstrual cycle. Cephalgic, neuropsychic and crisis forms of premenstrual syndrome are characterized by an increase in the level of prolactin in the blood. The prescription of additional diagnostic methods is dictated by the form of premenstrual syndrome and leading complaints.

Pronounced manifestation cerebral symptoms(headaches, fainting, dizziness) is an indication for an MRI or CT scan of the brain to exclude focal lesions. EEG results are indicative for neuropsychic, edematous, cephalgic and crisis forms of the premenstrual cycle. In the diagnosis of the edematous form of premenstrual syndrome, measurement plays an important role daily diuresis, recording the amount of fluid drunk, conducting tests to study the excretory function of the kidneys (for example, Zimnitsky's test, Rehberg's test). In case of painful engorgement of the mammary glands, an ultrasound of the mammary glands or mammography is necessary to exclude organic pathology.

An examination of women suffering from one or another form of premenstrual syndrome is carried out with the participation of doctors of various specialties: neurologist, therapist, cardiologist, endocrinologist, psychiatrist, etc. Prescribed symptomatic treatment, as a rule, leads to an improvement in well-being in the second half of the menstrual cycle.

Treatment of premenstrual syndrome

In the treatment of premenstrual syndrome, drug and non-drug methods are used. Non-drug therapy includes psychotherapeutic treatment, adherence to work schedule and good rest, physical therapy, physiotherapy. An important point is compliance balanced diet nutrition with sufficient amounts of plant and animal protein, plant fiber, and vitamins. In the second half of the menstrual cycle, you should limit the consumption of carbohydrates, animal fats, sugar, salt, caffeine, chocolate, and alcoholic beverages.

Drug treatment is prescribed by a medical specialist, taking into account the leading manifestations of premenstrual syndrome. Since neuropsychic manifestations are expressed in all forms of premenstrual syndrome, almost all patients are advised to take sedative (sedative) drugs several days before the expected onset of symptoms. Symptomatic treatment Premenstrual syndrome involves the use of painkillers, diuretics, and antiallergic drugs.

The leading place in the drug treatment of premenstrual syndrome is occupied by specific hormonal therapy with progesterone analogues. It should be remembered that the treatment of premenstrual syndrome is a long process, sometimes continuing throughout the entire reproductive period, requiring internal discipline from the woman and strict compliance with all doctor’s instructions.

Premenstrual syndrome (PMS) is a complex of symptoms that occurs several days (from 2 to 10) before the onset of menstruation and disappears in its first days. At other times, there are no symptoms of PMS.

Condition includes nervously- mental disorders, vegetative-vascular and metabolic manifestations. Almost every woman has experienced signs of PMS at some point. However, it is severe only in every tenth patient.

How and why does premenstrual syndrome occur?

In the middle of the menstrual cycle, ovulation occurs in the ovary - an egg is released from a mature follicle. She starts to move along abdominal cavity To fallopian tube to meet the sperm and fertilize. At the site of the burst follicle, a corpus luteum– formation with high hormonal activity. In some women, the parts of the brain responsible for emotions react in response to such endocrine “bursts.” vascular reactions, regulation of metabolism. Often like this individual feature reactions are inherited from mother to daughter.

Previously, it was believed that PMS occurs more often in women with disrupted hormonal levels. Doctors are now confident that such patients experience regular ovulatory cycle, and in all other respects they are healthy.

Theories development of PMS:

• hormonal;
• water intoxication;
• dysfunction of the renin-angiotensin-aldosterone system;
• lack of vitamins and fatty acids in the diet;
• hyperprolactinemia;
• allergy;
• psychosomatic disorders.

With PMS, the relative content of estrogens increases with a relative decrease in the level of gestagens. Estrogens retain sodium and fluid in the body, causing swelling, flatulence, headaches, and chest pain. Estrogens activate the renin-angiotensin-aldosterone system, causing additional delay liquids. These sex hormones directly affect the area of ​​the brain responsible for the formation of emotions (the limbic system). The level of potassium and glucose in the blood also decreases, which causes weakness, heart pain, and decreased activity.

The level of gestagens determines how many days before menstruation PMS occurs. These hormones delay the onset of menstruation. They also determine how long premenstrual syndrome lasts.

As a result of disruption of the activity of the renin-angiotensin-aldosterone system, fluid retention occurs, which causes swelling of the intestinal wall. Abdominal bloating, nausea, and constipation occur.

The development of PMS is facilitated by a lack of vitamins, magnesium and unsaturated fatty acids in food. Some scientists believe that this results in depression, chest pain, irritability, elevated temperature bodies.

Of particular importance in the mechanism of development of PMS is an increase in prolactin levels in the second half of the cycle, an allergy to internal progesterone, as well as interrelated bodily (somatic) and mental (mental) changes.

Clinical picture

There are three groups of main symptoms that determine the severity of the condition:

• neuropsychic disorders: tearfulness, depression, irritability;
• vegetative-vascular changes: nausea and vomiting, headache and dizziness, palpitations, pain in the heart, increased blood pressure;
• metabolic disorders: enlarged mammary glands, swelling, bloating, thirst and shortness of breath, itching, chills, increased body temperature, pain in the lower abdomen.

An aggravating factor in PMS is depression. With it, women feel pain more strongly and others discomfort, which can smoothly transform into painful menstruation and migraine.

Forms of premenstrual syndrome

PMS can occur in the following clinical forms:

• neuropsychic;
• edematous;
• cephalgic;
• crisis.

The neuropsychic form is accompanied by emotional disturbances. Young women experience low mood levels. In adulthood, aggressiveness and irritability become the leading symptom.

The edematous form is accompanied by swelling of the legs, face, and eyelids. Becomes tight shoes, the rings don't fit well. Increased sensitivity to odors, bloating, itchy skin. Due to fluid retention, weight increases (by 500-1000 g).

In the cephalgic form, the main symptom is headache in the temples spreading to the orbit. It has a twitching, pulsating character, accompanied by dizziness, nausea and vomiting. Most of these women show changes in the pituitary gland.

The crisis form is manifested by sympathoadrenal attacks: blood pressure suddenly rises, pressing pain in the chest, fear of death. At the same time, it worries palpitations, feeling of numbness and coldness in the hands and feet. The crisis usually occurs late in the day and ends with the release of urine in a large volume. This form is more often observed as an outcome of untreated previous variants.

Flow

When does PMS start? With a mild course, three to four signs appear 2-10 days before menstruation, one or two of which are most pronounced. At severe course symptoms appear 3-14 days before menstruation. There are more than five of them, and at least two are pronounced.

The course of PMS is different for all patients. For some, symptoms appear at the same time and stop with the onset of menstruation. Other patients develop more and more symptoms over the years. The condition normalizes only after the end of menstrual bleeding. In the most severe cases, symptoms persist even after the cessation of menstruation, and the interval without complaints gradually decreases. In such a situation, a woman may even lose her ability to work. In some patients, cyclical ailments continue after menopause. The so-called transformed PMS occurs.

A mild course of PMS is accompanied by the appearance of a small number of symptoms, mild malaise, without limiting the normal rhythm of life. In more severe situations, signs of this condition affect family life, performance, conflicts with others may arise. In severe cases, especially during a crisis, a woman cannot work and needs to be issued a certificate of incapacity for work.

Diagnostics

PMS – clinical diagnosis, based on an analysis of symptoms, their severity, and cyclical occurrence. An examination by a gynecologist is prescribed, and the genital organs are performed. For the right hormone therapy it is necessary to determine the level of sex and other hormones in the blood.

The patient is consulted by a neurologist, and, if necessary, by a psychiatrist, ophthalmologist, and endocrinologist. She may be prescribed tests such as electroencephalography, computed tomography of the brain, ultrasonography kidney, .

Only after comprehensive examination and observations, the gynecologist makes such a diagnosis and prescribes treatment.

PMS treatment

How to relieve premenstrual syndrome? For this purpose, the following scheme is recommended:

• psychotherapy;
• proper nutrition;
• physiotherapy;
• physiotherapy;
• treatment of premenstrual syndrome with drugs.

Psychotherapy

Rational psychotherapy helps to get rid of such unpleasant symptoms, such as excessive emotionality, mood swings, tearfulness or aggressiveness. For this purpose, psycho-emotional relaxation techniques that stabilize behavioral techniques are used. A woman is taught how to relieve PMS and is helped to cope with the fear of menstruation.

It is very useful to conduct psychotherapeutic sessions not only with a woman, but also with her loved ones. Relatives learn to better understand the patient’s condition. Conversations with the patient’s immediate circle improve the microclimate in the family. Through psychosomatic mechanisms it is possible to improve physical state patients, to alleviate the objective manifestations of premenstrual syndrome.

Lifestyle and nutrition

It is necessary to increase the content of plant fiber in the diet. It normalizes intestinal function and removes excess fluid from the body. Daily ration should consist of 75% carbohydrates (mostly complex ones), 15% proteins and only 10% fats. The consumption of fats must be limited, as they affect the participation of the liver in estrogen metabolism. It is better to avoid beef, as it often contains small doses of artificially introduced hormones. Thus, the most useful source Protein for PMS will be fermented milk products.

It is useful to increase the consumption of juice, in particular carrot juice with the addition of lemon. Herbal teas with the addition of mint, lemon balm, and valerian are recommended. Herbal sedative for PMS helps cope with emotional disorders, improve sleep and overall well-being.

You should avoid excess salt and spices, and limit your consumption of chocolate and meat. Should not be consumed alcoholic drinks, since they reduce the content of B vitamins and minerals in the body, and change the metabolism of carbohydrates. Liver function suffers, which can lead to disruption of estrogen metabolism and increased severity of the condition.

There is no need to take a lot of caffeinated drinks (tea, coffee, Coca-Cola) during PMS. Caffeine causes fluid retention, disrupts sleep, and promotes neuropsychiatric disorders. In addition, it increases engorgement of the mammary glands.

Drugs for the treatment of PMS

If you have severe symptoms of PMS, you should consult a doctor. He will tell you how to deal with its symptoms by using medications. Let's consider the main groups of drugs for the treatment of premenstrual syndrome.

1. After examination by a gynecologist, if high content estrogens (absolute or relative hyperestrogenism), gestagens are prescribed. These include Duphaston, Norkolut and others. Gonadotropin-releasing factor agonists, in particular Danazol, also have an antiestrogenic effect.
2. Antihistamines are prescribed due to increased levels of histamine and serotonin in such patients. Tavegil, Suprastin are usually used at night, starting two days before the expected onset of PMS and ending with the first day of menstruation.
3. To normalize the functioning of brain structures responsible for vascular regulation and mental disorders, nootropics are prescribed - Nootropil, Aminalon, starting from the first day of menstruation for two weeks. Such courses are repeated for three months in a row, then take a break.
4. If, after determining hormone levels, an increase in prolactin levels is detected, Parlodel (bromocriptine) is prescribed, starting two days before the expected onset of PMS, for 10 days.
5. In the presence of pronounced edema the prescription of a diuretic with a potassium-sparing effect, Veroshpiron, which is an aldosterone antagonist, is indicated. Prescribe it 4 days before the deterioration of health and stop taking it with the onset of menstruation. If edema syndrome manifests itself as headache, blurred vision, it is recommended to use Diacarb.
6. In the presence of pain, the main means for treating PMS are non-steroidal anti-inflammatory drugs, in particular Diclofenac. It is prescribed two days before your health worsens. These drugs inhibit the synthesis of prostaglandins - biologically active substances, causing many of the symptoms of PMS. Course treatment is carried out over three months. The effect of this course lasts up to four months after its termination. PMS symptoms then return, but are usually less intense.
7. Excessive emotionality depressive disorders, neuroses may be an indication for the prescription of tranquilizers. There are special “daytime” drugs that do not suppress normal activity, in particular, Grandaxin and Afobazol. Antipsychotics and antidepressants may be used. Such drugs are prescribed by a psychiatrist. They must be taken continuously for 3-6 months.
8. Vitamins A and E have beneficial effect for women's reproductive system, including reducing the severity of premenstrual syndrome. They are taken orally or administered intramuscularly for a month, alternating with each other. If anxiety and depressive disorders appear in the second half of the cycle, magnesium and vitamin B6 are prescribed.

PMS treatment is carried out in cycles. In the first three months, use a plant-based diet sedatives, vitamins, non-steroidal anti-inflammatory drugs. Then they take a break from treatment for 3-6 months. Upon return signs of PMS Other drugs with more serious effects are added to treatment. Don't expect a quick effect. Therapy should be long-term and accompanied by modifications of diet and lifestyle.

In the lives of many women there are three cherished letters that turn a gentle nymph into an unpredictable, explosive person. Loving friends and the relatives quickly abstract themselves from the situation and run away. What kind of exceptional female disease, terrifying everyone? This is inevitable premenstrual syndrome, in short.

The most common manifestations of premenstrual syndrome are headaches, sometimes reaching migraines, causeless irritability, depression, depression, problems with stool and urination, thirst, acne and other rashes on the face, swelling, desire for sweet and salty foods in uncontrollable quantities.

In my practice, there were cases when a girl called an ambulance because her stomach hurt so badly before her period. And nothing helped her except to lie curled up. And for others, after 35 years, their breasts began to hurt, harden and fill up, like Pamela Anderson’s.

Unfortunately, in such a situation, little depends on the woman, because these processes are regulated by her hormonal levels.

Of course, among us there are lucky women who have never experienced the delights of premenstrual syndrome in their lives. But the majority, alas, know perfectly well what we are talking about.

By the way, I would like to note that in my practice I have also met men who used a calendar to calculate when their beloved would menstruate. And exactly a week later they began to add sedatives to the beloved’s tea and placate her with chocolates. (Men, if you are reading this article, please don't do that!)
As one of my patients said, “Do you know why this period in women is called PMS?” Because the term “mad cow disease” has already been taken¨. In fact, this is not due to a bitchy nature, but to some hormonal changes that occur in the female body during the cycle.

So, let's figure out what it is and how to make friends with it.

Premenstrual syndrome is a complex set of regularly recurring symptoms that lead to an imbalance in the physical and psycho-emotional state of a woman. It occurs in 7 out of 10 women aged 20-45 years. As a rule, it occurs cyclically several (on average 5-10) days before the onset of menstruation.

The peculiarity of PMS is that the number of symptoms is huge and varied.

Vivid emotional manifestations

• Depression
• Irritability
• Sometimes aggressive

Changes in the body

• Swelling and tenderness of the mammary glands
• Vulvovaginal or so-called ¨thrush¨
• Edema
• Insomnia
• Increased appetite, and, accordingly, weight gain

Simply put, these days some representatives of the fair sex are turning into whiny-aggressive hungry furies.

There are clear medical criteria that explain the phenomena leading to the appearance of PMS.

• Lack of certain sex hormones.
  Progesterone is traditionally considered one of the most important “female” hormones. steroid hormone, having a very wide complex impact on the woman's body. Its lack in the second phase of the cycle is directly related to the occurrence of PMS.
• 
  If you do not get enough sleep, the stress hormone begins to be produced by the body in increased quantities. Which, accordingly, causes a decrease in the hormone of healthy sleep and emotional well-being, progesterone. After all, both of these hormones are united by a single metabolic pathway in the adrenal glands. Therefore, even if three months ago you had sufficient levels of sex hormones in your body, then as a result of lack of sleep you are guaranteed to have insufficient hormones, and, as a result, PMS.
• A lack of , especially B6. This primarily applies to vegetarians.
• Flaw may cause tachycardia and headaches.
• Estrogen dominance.
  After the age of 30, a woman begins to gradually decrease the level of sex hormones. Most often, progesterone fades faster than. Factors that influence the distortion of the relationship between sex hormones include: external environment: fake estrogens (xenoestrogens). All these components lead to a state of estrogen dominance

Often women have a doomed attitude towards premenstrual syndrome and think that it is a lifelong problem. Not at all necessary! Modern medicine has wide spectrum treatment options for PMS. These are vitamins and microelements, restoration hormonal levels, physical therapy and much more.

I would like to note that women over 35 years of age with severe PMS generally need regular monitoring by a functional medicine doctor. There is a high probability that they will also have a difficult menopause.

Second, pay close attention to your menstrual cycle. If the cycle begins to change, both shortening and lengthening, this is the first signal about a decrease in ovarian function. Be sure to see a functional medicine specialist.

Most effective method check the functioning of the ovaries and adrenal glands - from 18 to 21 days of the cycle, take a multisteroid hormone test. You can understand how much your sex hormones are in balance using the estrogen-progesterone ratio.

For example, vitamin deficiencyDor may lead to menstrual irregularities and PMS.

If the tests reveal more serious deviations, the doctor expertly adds what the patient is missing. For some, monocomponent therapy is selected. But it also happens the other way around, when it is necessary to balance the lack of all hormones.

Preventive measures for PMS

1. First of all, get enough sleep! Healthy sleep until 23.00 – the key to a woman’s beauty.
2. Watch your weight. Eat small meals, maximum 3-4 times a day. Choose non-starchy vegetables, organic protein products, vegetable oils and greens.
3. Before menstruation, reduce your consumption of flour, salty and sweet foods. Eliminate alcohol strong tea and coffee.
4. Provide your daily diet the proper amount of vitamins and microelements.
5. Another secret: give up soy products . They create an imbalance in female hormonal levels.

It is also useful to do yoga and meditation during this period. These techniques will help you relax and calm down. Get plenty of rest and, if possible, remain calm.

Finally, some advice for men. Don't look for logic in women's words. Give your loved one a little more patience, love and affection during PMS days. Show her once again how dear she is to you. Give some gift, even symbolic.

Editorial opinion may not reflect the views of the author.
In case of health problems, do not self-medicate, consult your doctor.

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