Medicines to relieve PMS symptoms. Premenstrual syndrome (PMS). Non-drug treatment for PMS

Many are sure that premenstrual syndrome is just another female “whim,” a manifestation of character and banal whims. But doctors take the phenomenon under consideration quite seriously - they conduct various types of research, select medications To alleviate the woman’s condition, preventive measures are being developed.

You urgently wanted to buy yourself a ring, you burst into tears at the sight of your neighbor’s baby, do you think that your feelings for your husband have passed? Don’t make hasty conclusions, but try to quickly figure out how soon your period should start. Such strange, unmotivated behavior is most often explained by premenstrual syndrome. Surprisingly, at the beginning of the 20th century, such deviations were considered a sign of the development of a mental illness, and only after research did doctors and scientists make an unambiguous conclusion - the condition in question is directly related to fluctuations in the level of hormones in the blood, which are considered natural.

For example, if the level of estrogen and/or progesterone decreases, this can provoke:

• increased levels of monoamine oxidase - this substance is produced by brain tissue, its increased level causes depression;
• decreased serotonin levels - the substance is also released by brain tissue, but it affects mood and activity;
• increased production of aldosterone - it provokes various changes in the body, from taste preferences to a feeling of fatigue.

Premenstrual syndrome It can occur in different ways: for some women this condition practically does not change their usual way of life, but some representatives of the fair sex literally suffer from their own irritability, mood swings and even hysterics. The only thing that will always indicate the manifestation of premenstrual syndrome is its cyclicity. Remember one simple fact - if any deviations in behavior and well-being appear on specific days of the menstrual cycle, and disappear with the arrival of menstruation or immediately after them, then this is clearly premenstrual syndrome.

Note:if the symptoms characteristic of PMS do not disappear even after menstruation and appear in the middle of the menstrual cycle, then this is a reason to seek help from a therapist and psychiatrist.

In order not to make a mistake in diagnosis, it is worth keeping a diary in which you need to record all changes in health, pathological manifestations according to the dates of onset - this way you can determine the cyclical occurrence of symptoms. The best option is to immediately contact a specialist for an accurate diagnosis.

Causes of PMS

Even modern medicine finds it difficult to name specific reasons for the appearance and development of the premenstrual cycle, but there are identified factors that will contribute to the phenomenon in question. These include:

• lack of vitamin B6;
• genetic predisposition;
• decrease in serotonin levels.

Note:The appearance of premenstrual syndrome is influenced by the number of induced abortions, the number of births, and various pathologies gynecological nature.

In medicine, it is customary to classify PMS symptoms into groups:

1. Vegeto vascular disorders – dizziness, sudden “jumps” in blood pressure, headaches, nausea and rare vomiting, and rapid heartbeat will be present.
2. Neuropsychiatric disorders– characterized by increased irritability, tearfulness, and unmotivated aggression.
3. Exchange-endocrine disorders– there is an increase in body temperature and chills, peripheral edema, extreme thirst, disruptions in work digestive systems s (flatulence, diarrhea or constipation), decreased memory.

In addition, premenstrual syndrome in a woman can manifest itself in various forms:

Neuropsychiatric

In this form, the condition in question will manifest itself as disturbances in the mental and emotional sphere. For example, there will be sleep disturbances, sudden mood swings, short temper and unmotivated irritability, and aggression. In some cases, a woman, on the contrary, develops apathy towards the world around her, lethargy, depression, panic attacks, an ongoing feeling of fear and anxiety.

Edema

Krizovaya

With the development of this form of PMS, women are usually diagnosed with diseases of varying degrees of severity of the kidneys and organs gastrointestinal tract, of cardio-vascular system. And the syndrome in question will manifest itself as pain in the heart, “jumps” in blood pressure, attacks of rapid heartbeat and feelings of fear/panic, and frequent urination.

Cephalgic

When diagnosing this form of premenstrual syndrome, it is imperative that a woman has a history of gastrointestinal diseases, cardiovascular diseases, .

The cephalgic form of PMS is manifested by pain in the heart area, increased sensitivity to previously familiar aromas and sounds, nausea and vomiting.

It is worth mentioning separately that there are atypical manifestations of premenstrual syndrome - an increase in temperature to subfebrile readings, increased drowsiness, ulcerative gingivitis, stomatitis, allergic manifestations (for example, Quincke's edema), attacks of vomiting.

Note:the described disorders can manifest themselves in women to varying degrees - for example, they are most often observed increased irritability, chest pain, weakness. Other manifestations may either be completely absent or be too mild.

Many women try to solve the problem of premenstrual syndrome on their own - they use some sedatives, painkillers, take out sick leave to avoid problems at work, and try to communicate less with relatives and friends. But modern medicine offers every woman clear measures to alleviate her well-being with the syndrome in question. You just need to seek help from a gynecologist, and he, in tandem with other specialists, will select an effective treatment for PMS.

How can a doctor help?

Usually, specialists select symptomatic treatment, so first the woman will be fully examined and interviewed - you need to clearly understand how premenstrual syndrome manifests itself in a particular patient.

General principles for alleviating a woman’s condition with PMS:

Please note two factors:

1. Antidepressants and tranquilizers are prescribed only in the presence of many neuropsychiatric symptoms - such drugs include Tazepam, Zoloft, Rudotel and others.
2. Hormone therapy will be appropriate only after the woman has been assessed for the condition her hormonal system.

How to get rid of PMS on your own

There are a number of measures that will help a woman alleviate her condition and reduce the intensity of the manifestations of the premenstrual cycle. They are quite simple, but no less effective. Women should follow the following recommendations:

What does it give: regular classes physical culture increase the level of endorphins, and this helps get rid of depression and insomnia.

1. Nutrition correction. A week before the expected start of the premenstrual cycle, a woman should limit the consumption of coffee, chocolate, and refuse alcoholic drinks. It is necessary to reduce the amount of fatty foods consumed, but increase the amount of foods in the diet that are high in calcium in the body.

What this gives: carbohydrate metabolism remains within normal limits, mood swings and irritability are not provoked by caffeine-containing products.

1. Full-fledged night rest . We are talking about sleep - it should be deep and long enough (at least 8 hours). If a woman cannot fall asleep quickly, then she is recommended to take walks in the fresh air in the evenings and drink a glass of water before bedtime. warm milk and take a honey bath.

What does this give: it is proper sleep that is “responsible” for the strength of the immune system and the normal functioning of the central nervous system.

1. Taking vitamin B6 and magnesium supplements. This should be done 10-14 days before the start of menstruation, but only under the supervision of a doctor - by the way, he will competently select specific complexes. Often a woman is prescribed Magnerot, Magne B6.

What this gives: rapid heartbeat, unmotivated anxiety and irritability, fatigue and insomnia will either be completely absent or of low intensity.

1. Aromatherapy. If a woman is not allergic to essential oils, then it will be useful to use juniper or bergamot oil for taking warm baths. Moreover, aromatherapy sessions should begin 10 days before the start of menstruation.

What it gives: the aroma of bergamot and juniper improves mood and stabilizes the psycho-emotional background.

Traditional medicine for PMS

There are a number of recommendations from the series “ ethnoscience”, which will help get rid of the manifestations of premenstrual syndrome or, at least, reduce their intensity. Of course, you should first consult with a gynecologist and get approval for such a solution to the problem.

The most popular, effective and safe folk remedies for alleviating the manifestations of premenstrual syndrome are:

Premenstrual syndrome is not a whim or a “whim” of a woman, but a rather serious health disorder. And you need to take PMS seriously - in some cases, ignoring the symptoms of the phenomenon in question can lead to problems in psycho-emotional terms. Just don’t try to alleviate your condition on your own - every woman with premenstrual syndrome should undergo an examination and receive competent recommendations from a specialist.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Every second woman complains of a feeling of apathy, nervous condition and pain in the lower abdomen before the attack critical days. Special tablets will help cope with the symptoms of illness.

Regular use of medications will prevent tearfulness and irritability, calm the nerves and relieve stress. aching pain. You will notice that PMS has become easier to bear and your health has improved. The symptoms will tell you which medications can alleviate the condition.

If painful sensations during PMS interfere with your normal lifestyle, you can take medications with the active ingredient drotaverine or ketoprofen (No-shpa, Ketonal). They have a relaxing effect on the uterus and reduce the frequency of contractions. The effect is achieved after using the first tablet. Medicines can be taken as needed, following the instructions. If the pain occurs constantly, it is better to take the medicine in advance.

How to improve your mood

A frequent companion to PMS are Bad mood and depression. This condition occurs due to a sharp change in hormone levels. During the appointment, the gynecologist may prescribe lungs to the patient antidepressants, which will increase resistance to anxiety and irritability. For PMS, such tablets should be taken in a course for a good mood, the dosage should be determined by the doctor. Among modern mood-lifting drugs, Fluoxetine and Grandaxin have proven themselves well.

In more severe cases serious medications are prescribed that affect brain activity (nootropics and inhibitors). After carrying out the necessary tests, a woman may be prescribed pills such as Sonapax.

Drinking such drugs without consulting your doctor is dangerous to your health!

Pills for PMS from nerves

The nervous system is one of the first to inform the body about the imminent onset of menstruation. Many women experience increased irritability and anxiety at this time. Among sedatives, which will help put your nerves in order, the following groups can be distinguished.

Decreasing magnesium levels in the body reduces the body's resistance to anxiety. As a result, every little thing throws you off balance. You can cope with your nerves by taking a course of magnesium supplements (for example, Magne B6).

Homeopathic tablets

They have the ability to improve the condition during PMS. The advantage of such drugs is that taking them can be stopped abruptly if necessary. To achieve the effect, you should take the tablets for several weeks in a row.

A good product from this group is Remens. For several years, he has successfully helped women cope with illness. You can read more about the drug Remens on women's forums.

Vegetable

They have a gentle effect on the nervous system, reduce excitability, and eliminate feelings of anxiety. The natural components included in the composition have a beneficial effect on the body as a whole. At regular intake restore calm and good mood during PMS. The photo shows popular herbal sedatives.

PMS, or premenstrual syndrome, is a cyclically repeating complex of psycho-emotional and somatic symptoms that occur during the premenstrual period. He may have varying degrees severity and causes disruption of normal activities.

Severe manifestations of PMS occur in approximately 4-8% of women childbearing age. In almost 20% of cases, drug therapy is required.

Treatment for PMS includes:

· non-drug methods;

· drug therapy (non-hormonal and hormonal agents).

Non-drug treatment for PMS

Patients who have been diagnosed with PMS are given recommendations for lifestyle changes. Much attention needs to be given good sleep and normal work and rest schedule. The duration of night sleep should be at least 7 (preferably 8) hours. Situations accompanied by stress and psycho-emotional tension, and physical overload should be avoided. However, regular physical activity of moderate intensity and duration must be included in the daily routine. It is useful to walk, swim, jog or bike ride. Therapeutic aerobics classes are popular in fitness centers; they are often combined with hydrotherapy and massage.

Eating right is important in eliminating PMS symptoms. The daily menu should include 25% protein, 10% lipids and 65% carbohydrates. The bulk of fat should be consumed in the form of unsaturated lipids ( vegetable oils, the fat found in fish). It is necessary to limit the intake of foods that can aggravate PMS symptoms. These include coffee, caffeinated drinks and foods (including chocolate). They increase emotional lability and anxiety, which contribute to the appearance of pain in the mammary glands.

In cases where PMS is accompanied by increased body weight, headache and joint pain, swelling, it is necessary to reduce consumption table salt. It is recommended to consume grain or bran bread, more vegetables and fruits, i.e. foods rich in complex carbohydrates. In this case, simple sugars should be limited or eliminated completely.

Among non-hormonal drugs for the treatment of PMS, the following groups of drugs are used:

· vitamin and mineral supplements,

· diuretics,

· antidepressants,

· non-steroidal analgesics;

· homeopathic remedies.

1. Vitamins and minerals

Vitamin and mineral preparations are good because they are not perceived by patients as medicine. However, their effectiveness in PMS has been proven specialized research. Thus, calcium carbonate reduces the psycho-emotional component of the syndrome, improves appetite and reduces water retention. Magnesium orotate reduces swelling and symptoms of bloating. Vitamins from group B, in particular B6, reduce neuropsychiatric manifestations. Vitamin E reduces sensitivity and discomfort of the mammary glands, relieves swelling.

2. Diuretics

The use of diuretics (diuretics) is advisable for the edematous form of PMS, as well as for the cephalgic version of the syndrome, accompanied by an increase in intracranial pressure. The most commonly used potassium-sparing diuretic is Veroshpiron (Spironolactone), which is an aldosterone antagonist.

Aldosterone is an adrenal hormone that promotes water and sodium retention in the body. Veroshpiron also has some antiandrogenic activity, which can reduce manifestations of pathology such as mood swings and irritability. Spironolactone is usually prescribed from days 16 to 25 of the cycle, when the most intense fluid retention occurs. Veroshpiron cannot be used constantly, as side effects may occur in the form of drowsiness, decreased blood pressure, decreased libido, menstrual irregularities, etc.

3. Antidepressants

Drugs that selectively inhibit serotonin reuptake are used as antidepressants for PMS. They reduce the signs of the disease if among the symptoms pathological condition the psycho-emotional component predominates (depression, irritability, mood lability, etc.). Among antidepressants, Cipramil, Fluoxetine and Sertraline are the most effective and tolerable.

To reduce the risk of side effects these drugs are prescribed in intermittent courses (2 weeks before the expected menstruation). Taking antidepressants already in the first cycle from the start of treatment can reduce not only psycho-emotional, but also some somatic symptoms of PMS, such as swelling and engorgement of the breasts. Treatment with antidepressants should be carried out only if indicated and after consultation with a psychiatrist, as side effects are possible - shortening the duration of the menstrual cycle, sexual disorders. In addition, when taking drugs of this group, there is a need for reliable methods of contraception, since antidepressants may have embryotoxic properties.

4. Nonsteroidal analgesics

Nonsteroidal anti-inflammatory drugs have antiprostaglandin activity, as they inhibit the synthesis of these substances in the body. Their use is indicated for the cephalgic variant of premenstrual syndrome and other forms of PMS, accompanied by increased fluid retention. In the latter case, analgesics can relieve signs of swelling such as pain in the mammary glands, lower abdomen, and arthralgia. Typically, NSAIDs are prescribed in the luteal phase. Ibuprofen, Ketoprofen and other products based on them are most often used.

5. Homeopathic remedies

These drugs have a complex effect on endocrine regulation in a woman’s body. As a result, conditions are created for the normal functioning of the mammary glands, because the absolute value decreases pathologically higher level estrogens. The drug has proven itself to be the best Mabustin .

As is known, manifestations of premenstrual syndrome are associated with cyclic hormonal changes in female body. Therefore, hormonal therapy for pathology is carried out through one or another effect on the level of sex hormones. The following hormonal agents are used to treat this syndrome:

· gestagen preparations;

· antigonadotropins;

· gonadotropin-releasing factor agonists;

· KOK.

1. Gestagens

Progestin agents, including progesterone, are often used in the treatment of PMS, but according to research results, the effectiveness of this group of drugs is low. It was found that minor positive influence provides Utrozhestan (micronized progesterone). Its effect may be associated with an increase in the concentration of progesterone metabolites, which has a beneficial effect on the functioning of the central nervous system. Utrozhestan is prescribed from the 16th to the 25th day of the cycle. Synthetic forms of gestagens (Norethisterone, Medroxyprogesterone) are more effective, reducing the severity of somatic disorders, but do not eliminate the psychoneurological manifestations of pathology.

2. Antigonadopropines

Danazol is a representative of antigonadotropins, reduces the concentration of estrogen in the blood and suppresses ovulation. As observations have shown, its use can relieve symptoms of PMS in at least 85% of patients. The drug effectively eliminates mastalgia. The use of Danazol is limited due to its androgenic properties and corresponding side effects, similar to signs of hyperandrogenism. The anabolic activity of Danazol can lead to weight gain. Diet pills

3. Gonadotropin-releasing factor agonists

Drugs from the aGRF group are used to treat premenstrual syndrome, as they suppress cyclic ovarian activity. Their use can weaken or even completely stop the symptoms of PMS. Most famous the following means:

· Buserelin;

· Zoladex (Goserelin).

GRF agonists reduce signs of flatulence, relieve headaches, and eliminate depression and irritability. Goserelin is injected under the skin every 4 weeks. Buserelin is also administered intramuscularly once every 4 weeks or prescribed in the form of a nasal spray daily.

The course of treatment with aGRF should not exceed six months. Otherwise, the risk of side effects similar to the symptom complex of menopausal syndrome increases. Thus, GRF agonists are quite effective for PMS, but they should be prescribed only if other drug therapy has failed.

4. COC

Combined oral contraceptives are often used to treat PMS. The basis of their action is the suppression of ovulation, which theoretically should help eliminate premenstrual syndrome. However, the results practical application turn out to be quite contradictory.

Separate studies have shown that hormonal contraceptives reduce psycho-emotional symptoms of the disease, including preventing the development of depression. At the same time, some experts note that the use of COCs sometimes not only does not reduce the severity of symptoms, but can even worsen them. Many representatives of these drugs contain gestodene, desogesterol, levonorgestrel or norgestimate as a progestin component. All of these compounds have anti-estrogenic and androgenic qualities and, by themselves, can cause effects similar to clinical PMS.

Treatment of localized fibroadenomatosis

Nowadays, the hormonal drug Yarina is popular, which has a noticeable antimineralkorticoid effect. It contains ethinyl estradiol and the progestin drospirenone. The properties of these compounds reduce swelling and prevent fluid accumulation, resulting in slight weight loss, unlike other hormonal contraceptives. Drospirenone is similar in properties to the diuretic Veroshpiron, which explains its antimineralkorticoid and antiandrogenic activity. Although it promotes the removal of sodium and water from the body, there is no significant increase in potassium concentration (as a sodium antagonist). Thanks to this, Yarina can be prescribed even to patients with kidney pathologies.

Thus, Yarina and other combined hormonal contraceptives, which contain the gestagen drospirenone, represent the optimal solution in the treatment of premenstrual syndrome. These drugs are characterized not only high efficiency, but also a reduced risk of side effects, which, even if they occur, resolve themselves after 1-2 cycles, and good tolerability.

A seven-day break from taking COCs containing drospirenone was found to result in a return of PMS symptoms such as engorgement and tenderness. mammary glands, flatulence, headaches, swelling, etc. Therefore, prolonged use of the drug is recommended for several cycles of 21 days without a break. If the effectiveness of COC monotherapy is insufficient, it is advisable to combine it with antidepressants.

Conclusion

PMS is a fairly common pathology among women. reproductive age. Manifestations of the syndrome disrupt the normal functioning of a woman and reduce her performance. Therefore, PMS therapy remains a pressing problem. The combination of the above methods of treating pathology, as a rule, makes it possible to achieve good results. The choice of optimal therapy depends on the form of PMS, the prevailing symptoms, concomitant diseases. If signs of pathology appear, you should contact a gynecologist and receive appropriate treatment.

Causes of premenstrual syndrome PMS

Most probable cause premenstrual syndrome PMS are hormonal changes cycle. Once a month 5-10 days before the start of the menstrual cycle estrogen hormones accumulate in the female body and progesterone. The increase in their number occurs unevenly, with one hormone negatively affecting the other, and that’s when the unpleasant signs of PMS appear. Premenstrual PMS syndrome has about 150 symptoms. The word “syndrome” is translated from Latin as a cluster of symptoms. Naturally, one woman does not experience all 150, but even ten of them can significantly complicate life. Symptoms of PMS that should alert you: insomnia, weakness, drowsiness, absent-mindedness, fatigue, apathy, increased or decreased appetite, aggression, tearfulness; these are psychological symptoms of PMS. Physical ones are expressed in attacks of headaches, nosebleeds, nagging pain in the lower abdomen, constipation, flatulence, fever, decreased immunity and, as a result, a sore throat or cystitis develops.

It's sad but true: studies show that women commit most crimes in a state of PMS or in a state of uncontrolled aggression. In many countries, PMS in female defendants who have committed a crime is a mitigating factor. Increased suspiciousness and loss of self-control increases the number of women visiting a psychotherapist during this period. It was also noted that the likelihood of an accident while driving a car increases 5 times for women. Most of our compatriots do not consider these manifestations serious and do not consult a doctor, because they are convinced that apart from valerian and motherwort, or analgin tablets, they will not help themselves. However, women in Europe, Canada and the USA are confident that enduring illnesses every month is the wrong tactic, and they take a complex of “Mabustin”, minerals, herbal cocktails and dietary supplements on the advice of specialists and feel “one hundred percent.” With the onset of menopause, problems with PMS, if timely measures are not taken from a young age, do not disappear at all. In this case, ailments persist even in the absence of a menstrual cycle, and experts call this transformed premenstrual syndrome. It follows from this that the sooner you start dealing with painful sensations, the better your health will be after 40 years.

How to deal with PMS

First of all, you need to check your blood for hormone levels. Then the doctor prescribes hormonal, vitamin and painkillers medications. Vitamin-mineral complexes should include B vitamins, in particular, pyridoxine (B6) - the most effective in this group. Vitamin B6 calms the nervous system, helps with insomnia, and reduces nagging pain in the stomach and muscles. Contained in foods such as liver, fish, poultry, beef, walnuts, bananas, avocados.
The occurrence of PMS symptoms is also affected by a lack of calcium and magnesium. The more calcium a woman consumes, the less susceptible she is to stress, migraines, attacks of aggression, and everything that is associated with PMS. Getting enough calcium throughout a woman's life has been shown to help avoid devastating bone loss later in life. Calcium also keeps blood pressure at normal levels when following a low-fat diet. Brittle nails, change taste preferences also give a signal about a lack of calcium in the body. Scientists have come to a consensus that a lack of magnesium in the body is another reason for the development of PMS in women. Taking Mabusten medications significantly reduces the symptoms of PMS: irritability, tearfulness, depression, fatigue. Cooking, freezing and refining removes a significant portion of magnesium. Fatty and sweet foods, white flour products, and alcohol are the “enemies” of magnesium. It is better to replace foods rich in complex carbohydrates with bread; spaghetti, halva, nuts, and seeds are healthy. To reduce the signs of PMS, the diet should contain plant proteins, as in the diet during menopause, which contain legumes, vegetables with microelements: cauliflower, broccoli, celery, pumpkin. Alcoholic drinks contribute to the leaching of calcium and magnesium, retaining fluid in the body, which is why edema occurs. During PMS, even a small dose of alcohol causes a migraine attack. A glass of milk with honey at night will help compensate for the deficiency of two important elements: magnesium and calcium. When you feel unwell, do not rush to take analgin or valerian. Helps relieve symptoms of PMS folk remedies. Kidney tea, red currant leaves, horsetail, motherwort, peppermint - cope perfectly with this trouble. Gynecologists advise having sex more often, because orgasm relieves muscle tension, improving blood supply to the pelvic organs.

Premenstrual syndrome (PMS) includes a complex of somatic and psycho-emotional symptoms that cyclically repeat during the premenstrual period. Typically, the term "premenstrual syndrome" is used to describe fairly severe premenstrual physical and emotional manifestations that interfere with a woman’s daily activities. The prevalence of PMS in a population largely depends on how strictly such symptoms are defined. As a rule, the recorded frequency of PMS is much less than the frequency of premenstrual symptoms. Severe forms of PMS are observed in 3-8% of women of reproductive age. In at least 20% of cases, the severity of PMS symptoms is such that it requires medication therapy.

Despite the fact that over several decades, researchers studying PMS have achieved certain successes in understanding the mechanisms of development of the disease, establishing diagnostic criteria and developing pathogenetically based treatment methods, these problems are still far from being completely resolved.

Most often, the appearance of premenstrual symptoms is associated with changes in the content of sex steroid hormones in the blood during the menstrual cycle. Currently, it is widely believed that patients with PMS do not have an absolute deficiency or excess of estrogen and progesterone, but a violation of their ratio. Researchers explain PMS symptoms associated with fluid retention in the body by changes in the functioning of the renin-angiotensin-aldosterone system, as well as a relative increase in prolactin levels in the blood, which contributes to the sodium-retaining effect of aldosterone and the antidiuretic effect of vasopressin. Another biologically active substance involved in the pathogenesis of PMS is serotonin. A decrease in serotonin-dependent transmission of nerve impulses in the brain leads to the appearance of emotional and behavioral symptoms characteristic of this disease. In addition, sex steroid hormones, mostly estrogens, affect the metabolism of this monoamine, disrupting its biosynthesis and increasing the rate of its breakdown in the synaptic cleft. Prostaglandins also play a certain role in the development of premenstrual symptoms. It is believed that they increased content in body tissues can lead to fluid retention and increased pain impulses. In the central nervous system, these substances, along with serotonin, are neurotransmitters. Thus, excess prostaglandins can be the cause of PMS symptoms such as headache, mastalgia, swelling, and mood changes.

Clinical manifestations of PMS

All clinical manifestations of PMS can be divided into three main groups: emotional disorders, somatic disorders and symptoms associated with changes in general well-being.

Depending on the predominance of certain clinical manifestations of PMS, four of its forms are distinguished:

• neuropsychic - irritability, anxiety, aggressiveness, depression;
• edematous - swelling, mastalgia, engorgement of the mammary glands, bloating, weight gain;
• cephalgic - migraine-type headaches;
• crisis - attacks similar to sympathoadrenal crises that occur before menstruation.

The most severe manifestations of the neuropsychic form with predominantly emotional and behavioral symptoms are identified as a separate variant of the course of PMS - premenstrual dysphoric disorder (PMDD). PMDD is observed in approximately 3-8% of women of reproductive age in the form of complaints of irritability, feelings of internal tension, dysphoria, and psycho-emotional lability. These manifestations have a significant impact on a woman’s lifestyle and her relationships with people around her. In the absence of adequate therapy, the life activity of patients both at home and at work is significantly disrupted, which leads to a significant decrease in the quality of life and the collapse of their professional career.

The manifestations of PMS are individual and differ from patient to patient; the severity and time of occurrence of each of them can vary from cycle to cycle, despite the fact that each patient experiences similar symptoms every month. The most common psycho-emotional manifestations of PMS are: increased fatigue, irritability, anxiety, feeling of internal tension, sharp changes moods. TO somatic symptoms include swelling, weight gain, engorgement and tenderness of the mammary glands, acne, sleep disturbances (drowsiness or insomnia), changes in appetite ( increased appetite or changes in taste preferences).

Increased fatigue is the most common symptom of PMS. Fatigue can be so severe that women experience difficulties in performing daily work already in the morning. At the same time, sleep disturbances appear in the evening.

Impaired concentration. Many women with PMS experience difficulties in activities that require concentration - mathematical and financial calculations, decision making. Possible memory impairments.

Depression. Sadness or unreasonable tearfulness are common symptoms of PMS. Sadness can be so intense that even the smallest difficulties in life seem insurmountable.

Food preferences. Some women experience increased cravings for certain foods, such as salt or sugar. Others note an overall increase in appetite.

Breast engorgement. Most women report a feeling of engorgement or increased sensitivity, soreness of the mammary glands or just the nipples and areolas.

Swelling of the anterior abdominal wall, upper and lower limbs. Some women with PMS experience weight gain before their period. In others, local fluid retention occurs, most often in the anterior abdominal wall and limbs.

Diagnosis of PMS

The diagnosis of PMS is a diagnosis of exclusion, i.e., in the process of diagnostic search, the clinician’s task is to exclude somatic and mental illness, which may worsen before menstruation. A carefully collected life history and medical history, as well as a complete general somatic and gynecological examination. Age is not significant, meaning any woman between menarche and menopause can experience PMS symptoms. Most often, the disease manifests itself by the age of 25-30.

Prospective daily assessment of premenstrual symptoms is necessary element diagnostic search. For this purpose they are used as menstrual calendars symptoms, as well as visual analogue scales (VAS), allowing respondents to determine not only the presence of a specific manifestation of PMS, but also its severity and duration relative to the menstrual cycle.

The menstrual calendar of symptoms is a table in which the days of the menstrual cycle are indicated on the abscissa axis, and the most common symptoms of PMS are indicated on the ordinate axis. The patient fills in the columns daily for two or three consecutive menstrual cycles using symbols: 0 - absence of symptoms, 1 - mild severity of symptoms, 2 - moderate severity of symptoms, 3 - high severity of symptoms. This establishes a connection between the appearance and disappearance of symptoms and the phase of the menstrual cycle.

The VAS is easy to use, convenient for both the patient and the clinician, reliable and reliable method obtaining information about PMS symptoms in a particular patient. It is a segment 10 cm long, at the beginning of which there is a point " complete absence symptom”, at the end - “the symptom is maximally expressed”. The patient puts a mark on this scale in the place where, in her opinion, the severity of the disease is located at this particular moment.

To confirm the diagnosis, it is necessary to have at least a 50% increase in the severity of a particular symptom by the end of the luteal phase of the menstrual cycle. This indicator is calculated using the following formula:

(L - F/L) x 100,

where F is the severity of the symptom in the follicular phase of the menstrual cycle, L is the severity of the symptom in the luteal phase of the menstrual cycle.

It is advisable to assess the psycho-emotional status of patients in both phases of the menstrual cycle. Hormonal examination (determining the level of estradiol, progesterone and prolactin in the blood on days 20-23 of the menstrual cycle) allows you to assess the function corpus luteum and exclude hyperprolactinemia. Ultrasonography pelvic organs is necessary to clarify the nature of the menstrual cycle (with PMS it is usually ovulatory) and to exclude concomitant gynecological pathology. Ultrasound examination of the mammary glands is carried out before and after menstruation to conduct a differential diagnosis with fibroadenomatosis of the mammary glands. Consultation with a psychiatrist allows you to rule out mental illnesses that may be hidden under the guise of PMS. For severe headaches, dizziness, tinnitus, and visual impairment, an MRI of the brain and assessment of the condition of the fundus and visual fields are indicated. In the crisis form, which occurs with an increase in blood pressure (BP), differential diagnosis with pheochromocytoma is necessary (determination of catecholamines in post-attack urine, MRI of the adrenal glands).

In the edematous form of PMS, accompanied by engorgement and tenderness of the mammary glands, differential diagnosis is carried out with kidney pathology, with antidiabetes insipidus caused by hypersecretion of vasopressin, and with episodic hyperprolactinemia occurring in the luteal phase of the cycle ( general analysis urine, daily diuresis, Zimnitsky test, electrolytes and blood prolactin). When hyperprolactinemia is detected, the determination of triiodothyronine, thyroxine and thyroid-stimulating hormone (TSH) in the blood serum allows us to exclude primary hypothyroidism. For prolactinemia above 1000 mIU/l, an MRI of the hypothalamic-pituitary region is performed to identify prolactinoma.

PMS treatment

To date, various therapeutic measures have been proposed aimed at alleviating premenstrual symptoms.

Non-drug methods of therapy. Once the diagnosis is made, it is necessary to give the woman advice on lifestyle changes, which in many cases leads to a significant weakening of PMS symptoms or even their complete disappearance. These recommendations should include adherence to work and rest schedules, night sleep duration of 7-8 hours, exclusion of psycho-emotional and physical overload, mandatory physical activity moderate intensity. Positive result Walking, jogging, cycling are provided. Physical education centers use special programs according to the type of therapeutic aerobics in combination with massage and hydrotherapy - various types of hydrotherapy. The recommended diet should include 65% carbohydrates, 25% proteins, 10% fats containing predominantly unsaturated fatty acids. Limit your intake of caffeine-containing products, as caffeine may exacerbate symptoms such as emotional lability, anxiety, increased sensitivity mammary glands. With an increase in body weight, joint pain, headaches, i.e. with symptoms associated with fluid retention in the body, it is advisable to recommend limiting the use of table salt. It is advisable to add to food complex carbohydrates: bran, grain bread, vegetables, while mono- and disaccharides are excluded from the diet.

Not hormonal drugs. Pharmacological non-hormonal means most often they are preparations of vitamins and minerals. They have minimal side effects and are not perceived by patients as a “medicine”, which increases compliance with the treatment. At the same time, their effectiveness has been proven by the results of randomized studies.

• Calcium carbonate (1000-1200 mg/day) significantly reduces affective manifestations, increased appetite, and fluid retention.
• Magnesium orotate (500 mg/day during the luteal phase of the menstrual cycle) also has the ability to reduce swelling and bloating.
• Preparations of B vitamins have proven themselves well, especially B 6 (up to 100 mg/day). Their action is aimed mainly at relieving the psycho-emotional manifestations of the disease.
• For mastalgia, vitamin E is prescribed (400 IU/day).

Diuretics. The use of diuretics is pathogenetically justified in the case of edematous PMS. In addition, diuretics may be effective in the cephalgic form of the disease, i.e., in cases of intracranial hypertension. The drug of choice in this situation is spironolactone (Veroshpiron). This potassium-sparing diuretic is an aldosterone antagonist. In addition, it has antiandrogenic properties, which makes its use justified given that some symptoms of the disease (irritability, mood swings) may be associated with a relative excess of androgens. The initial daily dose is 25 mg, the maximum is 100 mg/day. It is advisable to prescribe this diuretic from the 16th to the 25th day of the menstrual cycle, that is, during the period of expected fluid retention in the body. The use of this drug is limited by side effects such as drowsiness, menstrual irregularities, hypotension, and decreased libido.

Selective inhibitors serotonin reuptake. Selective serotonin reuptake inhibitors (SSRIs) can be prescribed to patients if mental symptoms of PMS predominate. SSRIs are the latest generation antidepressants, combining a mild thymoanaleptic effect with good tolerability, which belong to the drugs recommended for use in psychosomatic pathologies. Most often used:

• fluoxetine (Prozac) - 20 mg/day;
• sertraline (Zoloft) - 50-150 mg/day;
• citalopram (Cipramil) - 5-20 mg/day.

Although it is possible to use such drugs in continuous mode(daily), in order to reduce the number of side effects, it is advisable to prescribe them in intermittent courses (14 days before the expected menstruation). Moreover, it has been proven that such tactics are more effective. Already during the first cycle of treatment, both psycho-emotional and somatic manifestations of PMS, such as engorgement of the mammary glands and swelling, are reduced. The advantage of SSRIs when prescribed to working patients is the absence sedative effect and decrease in cognitive functions, as well as an independent psychostimulating effect. The negative properties of drugs in this group include shortening the menstrual cycle, sexual disorders, the need for reliable contraception during therapy. Application of data medicines It is advisable to carry out according to indications and under the supervision of a psychiatrist.

Prostaglandin inhibitors. The use of drugs from the group of non-steroidal anti-inflammatory drugs leads to inhibition of prostaglandin biosynthesis. Their prescription is justified both in the cephalgic form of premenstrual syndrome and in the predominance of symptoms associated with local fluid retention and, as a consequence, the appearance pain symptom with compression of nerve endings, which can manifest as mastalgia and pain in the lower abdomen. In order to reduce side effects, it should be recommended to take these drugs in the luteal phase of the menstrual cycle. The most commonly used:

• Ibuprofen (Nurofen) - 200-400 mg/day;
• Ketoprofen (Ketonal) - 150-300 mg/day.

Hormonal drugs. Taking into account the connection between the occurrence of PMS symptoms and the cyclic activity of the ovaries, most often in the treatment of this disease, drugs are used that in one way or another affect the content of sex steroid hormones in the blood.

Gestagens. Despite the fact that progesterone and gestagens are still widely used for PMS, the effectiveness of drugs in this group is low. A slight positive effect of progesterone use was found with the use of micronized progesterone (Utrozhestan). This result may be a consequence of increased levels of allopregnanolone and pregnanolone (progesterone metabolites) in the blood, which have positive action on the functioning of the central nervous system (CNS). The drug is administered orally at a dose of 200-300 mg/day from the 16th to the 25th day of the menstrual cycle. Synthetic progestogens (dydrogesterone, norethisterone and medroxyprogesterone) are more effective than placebo in treating physical symptoms PMS and are ineffective for eliminating mental symptoms.

The synthetic progestogen danazol inhibits ovulation and reduces the level of 17 b-estradiol in the blood plasma. It has been shown that its use leads to the disappearance of PMS symptoms in 85% of women. The drug is most effective in patients suffering from mastalgia before menstruation. Daily dose the drug is 100-200 mg. However, the possibility of using danazol is limited by its androgenic activity (acne, seborrhea, reduction in the size of the mammary glands, deepening of the voice, androgenic alopecia) with a concomitant anabolic effect (increase in body weight).

Gonadotropin-releasing hormone agonists. Gonadotropin-releasing hormone agonists (GnRH) have established themselves as another group of drugs effective for PMS. By suppressing the cyclic activity of the ovaries, they lead to a significant reduction or even relief of symptoms. In a double-blind, placebo-controlled study, irritability and depression were significantly reduced with Buserelin. At the same time, positive effects were also noted in relation to such characteristics as friendliness and good mood. A significant reduction in bloating and headaches was recorded. Despite this, the rate of pain and engorgement of the mammary glands did not change.

• Goserelin (Zoladex) at a dose of 3.6 mg is injected subcutaneously into the anterior abdominal wall every 28 days.
• Buserelin is used both in the form of a depot form, administered intramuscularly once every 28 days, and in the form of a nasal spray, used three times a day in each nasal passage.

Drugs in this group are prescribed for a period of no more than 6 months.

Long-term use of aGRH is limited by possible side effects similar to the manifestations of menopausal syndrome, as well as the development of osteoporosis. At the same time, when simultaneous use aGRH and estrogen-progestin drugs for replacement therapy, estrogen-dependent PMS symptoms did not occur, while gestagen-dependent PMS symptoms persisted. This observation imposes restrictions on the use of drugs containing sex steroids during therapy with GnRH in women suffering from PMS.

Thus, GnRH agonists are highly effective in the treatment of PMS, however, due to side effects, they are recommended mainly for patients resistant to therapy with other drugs.

Combined oral contraceptives. Most common therapeutic tactics in the treatment of premenstrual symptoms is the use of combined oral contraceptives (COCs). Indeed, suppression of ovulation should theoretically lead to the disappearance of the above symptoms. However, the results of studies conducted to determine clinical effectiveness The use of COCs in women suffering from PMS has been controversial. Several studies have found a reduction in premenstrual psychoemotional symptoms, especially low mood, when taking COCs. But other authors have shown that when using COCs, the severity of PMS symptoms not only does not decrease, but may even worsen. As is known, the vast majority of COCs contain levonorgestrel, desogestrel, norgestimate, and gestodene as a progestin component. Each of these gestagens has varying degrees of androgenic and antiestrogenic activity, which can cause side effects similar to PMS symptoms. In addition, unfortunately, the antimineralkorticoid activity of endogenous progesterone is absent in the most common synthetic progestogens today - derivatives of 19-nortestosterone and 17α-hydroxyprogesterone.

The new progestogen drospirenone, which is part of the combined low-dose drug, has pronounced antialdosterone activity. oral contraceptive Yarin, representing a combination of 30 mcg ethinyl estradiol and 3 mg of the gestagen drospirenone. Drospirenone is a 17-alpha-spirolactone derivative. This determines the presence of antimineralkorticoid and antiandrogenic activity, characteristic of endogenous progesterone, but absent in other synthetic gestagens. The effect of the drug on the renin-angiotensin-aldosterone system prevents fluid retention in the woman’s body and, thus, may have healing effect with PMS. The antimineralkorticoid activity of drospirenone explains a slight decrease in body weight in patients taking the drug Yarina (unlike COCs with other gestagens, when taken, there is some weight gain). Sodium and water retention—and the resulting weight gain that occurs with COC use—is an estrogen-dependent side effect. Drospirenone in COCs can effectively counteract the occurrence of these manifestations. In addition, drospirenone-induced sodium loss does not lead to clinical significant increase concentration of potassium in the blood, which allows its use even in women with impaired renal function.

The antiandrogenic activity of drospirenone is 5-10 times stronger than that of progesterone, but slightly lower than that of cyproterone. It is known that many COCs inhibit the secretion of androgens by the ovaries, thus having a positive effect on acne and seborrhea, which can also be manifestations of PMS. Acne often occurs before menstruation; During this period, the number of rashes may also increase. In addition, ethinyl estradiol causes an increase in the concentration of sex steroid binding globulin (SHBG), which reduces the free fraction of androgens in the blood plasma. Despite this, some gestagens have the ability to block the increase in GSPS caused by ethinyl estradiol. Drospirenone, unlike other gestagens, does not reduce the level of GSPS. In addition, it blocks androgen receptors and reduces secretion sebaceous glands. Once again, it should be noted that this effect develops due to the suppression of ovulation, the antiandrogenic activity of drospirenone and the absence of a decrease in the content of sex steroid binding globulin in the blood.

Thus, the use of a COC containing the progestogen drospirenone is the method of choice in the treatment of premenstrual syndrome, both in terms of effectiveness and due to good tolerability and a minimal number of possible side effects, most of which are self-limiting after 1-2 cycles of taking the drug.

Despite the fact that taking COCs, especially those containing drospirenone, leads to the disappearance or significant reduction of PMS manifestations, during a seven-day break some women again experience headaches, engorgement and tenderness of the mammary glands, bloating, and swelling. IN in this case the use of an extended regimen of taking the drug is indicated, i.e. taking it for several 21-day cycles without a break. In case of insufficient effectiveness of monotherapy with a drospirenone-containing contraceptive, it is advisable to use it in combination with drugs that affect serotonin metabolism.

T. M. Lekareva, Candidate of Medical Sciences
Research Institute of AG named after. D. O. Otta RAMS, Saint Petersburg

Premenstrual syndrome is a complex of cyclically recurring symptoms of a woman’s physical and psycho-emotional state shortly before the start of her next menstruation. The incidence of premenstrual syndrome ranges from 5-40% and increases with age. In young patients who have not overcome the thirty-year mark, it does not exceed 20%, but after thirty years, every second woman experiences premenstrual syndrome.

The reliable causes of premenstrual syndrome are unknown, so it is customary to talk about predisposing factors for the development of this pathology. Among them there are hormonal, metabolic, neuropsychic and endocrine abnormalities.

Premenstrual syndrome can be confidently called a “mystery condition”, because... Almost no genital pathology is manifested by so many symptoms from numerous body systems. However, all owners of this condition have a pronounced hormonal imbalance.

Despite the variety of clinical manifestations and the degree of their severity, premenstrual syndrome has a close connection with the menstrual cycle, namely its second phase. 1-2 weeks before the next menstruation, a woman experiences negative changes in mood, swelling of the limbs and face, sleep disturbances, engorgement of the mammary glands, weight gain, vascular disorders, and so on. The list of pathological symptoms of premenstrual syndrome is long, and the manifestations are individual. There are no two patients with completely identical manifestations of this syndrome.

The severity of the pathological signs of premenstrual syndrome is also ambiguous, so there is a mild form, which does not cause much physical and psychological inconvenience, and a severe form, which prevents one from maintaining the usual rhythm of life.

Diagnosis of premenstrual syndrome cannot be called simple, since all the most important systems body, and the number of possible symptoms is approaching 150. Often patients initially turn to a neurologist, therapist, endocrinologist and other specialists. If during the first phase of the cycle there are no deviations in the functioning of organs and systems, the resulting disturbances are usually correlated with premenstrual syndrome.

There is a misconception among women that any deviation from the usual state of the body on the eve of the next menstruation is associated with the presence of premenstrual syndrome. For most women, the harbingers of menstruation are often enlarged mammary glands, increased appetite and excessive emotionality, but these signs can also be a variant of the norm. Such symptoms do not always recur regularly before each menstruation, but are episodic in nature.

In reality, the diagnosis confirms the presence of a certain number of symptoms that recur regularly, are associated with menstruation and disappear after it ends. The diagnosis of premenstrual syndrome can only be established after a specialist has excluded the presence of mental illness.

The scope of laboratory and instrumental studies is determined by the form of the disease and the degree of its manifestation. All patients are prescribed a laboratory study of hormonal status, an electroencephalogram and additional examinations according to the leading symptoms of the disease.

Therapy for premenstrual syndrome does not have clear regimens or a list of necessary medications. There are no special pills for premenstrual syndrome. Treatment consists of several stages and consists of sequential elimination of all existing disorders. The key to successful therapy is the correct hormonal function of the ovaries and a two-phase ovulatory menstrual cycle.

Premenstrual syndrome in the absence of adequate therapy often transforms into pathological menopause.

Causes of premenstrual syndrome

There are several assumptions about the causes of premenstrual syndrome, but each theory explains the development of pathological processes only in one or several body systems and cannot establish a single trigger mechanism that links all changes together.

Changes in the patient’s psycho-emotional status on the eve of menstruation are associated with disturbances in the proper ratio of estrogen and progesterone. The resulting hyperestrogenism and decrease in progesterone concentration increases the lability of the nervous system.

Hormonal dysfunction is considered one of the most likely triggers in the development of premenstrual syndrome, therefore its development is correlated with abortion, removal or ligation fallopian tubes, pathological pregnancy and childbirth, incorrect hormonal contraception.

Changes in the mammary glands are provoked by the hormone prolactin. With its excess, the mammary glands become engorged and become overly sensitive.

Violation water-salt balance with the subsequent development of edema occurs due to retention of water and sodium in the tissues by the kidneys.

Lack of certain vitamins (zinc, magnesium, B6 and calcium), dysfunction endocrine glands, weight deficiency and many other abnormalities can also be involved in the development of premenstrual syndrome.

Premenstrual syndrome is closely related to the state of the psycho-emotional sphere. First of all, it affects women with high mental stress, experiencing frequent stress and overwork. Among residents of large cities, there are more people suffering from premenstrual syndrome than residents of rural areas.

A genetic predisposition to the development of premenstrual syndrome has been established.

Premenstrual syndrome, which occurs infrequently in adolescents, is associated with hormonal dysfunction and neurological disorders. The disease may appear with the first menstruation or several months later.

Symptoms and signs of premenstrual syndrome

The number of symptoms accompanying premenstrual syndrome is extremely large, so we can say that there are no two women with the same manifestations of this disease. However, there is a list of symptoms that are more common than others. If they are conditionally divided according to their belonging to body systems, several forms of clinical manifestation of premenstrual syndrome can be distinguished:

— Psychovegetative (sometimes called neuropsychic) ​​form. This includes symptoms of the disorder normal operation psychoemotional sphere and nervous system. Possible irritability, touchiness, tearfulness, increased sensitivity to smells and sounds, as well as flatulence and/or. Patients complain of sleep disturbances, fatigue, and numbness of the limbs. In adult women, depression is more common, and premenstrual syndrome in adolescents is characterized by aggression.

- Edema form. It develops against the background of a temporary change in kidney function; they retain sodium and excess water accumulates in tissues, including the mammary glands. The patient experiences swelling on the face, legs and hands, slight weight gain and engorgement of the mammary glands. Due to edema, the stroma of the mammary glands is compressed nerve endings, and they experience discomfort or pain.

- Cephalgic form. It is expressed by headaches (usually migraines), with nausea and vomiting.

— Crisis form. A complex symptom complex associated with dysfunction of the kidneys, cardiovascular and digestive systems. There are chest pains and panic attacks - “panic attacks”. This form is typical for premenopausal patients (45-47 years old).

- Atypical form. According to the name, it has different symptoms of the disease from the usual ones: attacks of suffocation during the premenstrual period, fever up to 38°C, vomiting, etc.

- Mixed form. It is characterized by the simultaneous combination of several forms of premenstrual syndrome. Preference is given to the joint manifestation of the psychovegetative and edematous forms.

Premenstrual syndrome, which lasts a long time, can worsen in some women, so several stages of its development can be distinguished:

— Compensated stage. Premenstrual syndrome is mild and does not progress over the years. All symptoms that appear disappear immediately after the end of menstruation.

— Subcompensated stage. Significantly pronounced symptoms of the disease limit the patient’s ability to work and continue to worsen over time.

— The decompensated stage of premenstrual syndrome is characterized by an extreme degree of severity of the symptoms of the disease, which disappear a few days after the end of menstruation.

Impaired ability to drive normal life and work, regardless of the severity of symptoms and their duration, always indicates a severe course of the disease and is often associated with mental disorders. Changes in the psycho-emotional sphere can be so pronounced that the patient does not always control her behavior; 27% of women who have committed crimes are diagnosed with premenstrual syndrome.

The number of pathological symptoms that form premenstrual syndrome in patients is unequal, therefore it is customary to distinguish between mild and severe degree severity of the disease. The presence of three or four symptoms with a leading value of only one or two of them indicates light form illness. A severe form of the disease is indicated by the appearance of 5-12 symptoms, with the obligatory severity of two or five of them.

Unfortunately, there is an opinion that premenstrual syndrome is inherent in all women without exception, and that it should not be the reason for visiting a doctor. Popularization of medical knowledge in the media allows women to independently purchase medications for premenstrual syndrome in a free pharmacy chain. Self-medication cannot cure the disease, but it can eliminate or weaken its symptoms, creating the illusion of healing. Any pills taken independently for premenstrual syndrome will not replace full-fledged comprehensive treatment.

Diagnosis of premenstrual syndrome

The diagnosis of premenstrual syndrome is not always obvious. The disease has many non-gynecological symptoms, so patients often initially turn to an endocrinologist, neurologist and other specialists. Patients often visit related specialists for years and unsuccessfully try to cure a non-existent extragenital pathology.

The only diagnostic criterion in such cases is close connection existing pathological symptoms with approaching menstruation and the cyclical nature of their recurrence.

It is also necessary to take into account the peculiarities of the psycho-emotional personality of the patient, since each woman has her own criteria for assessing her condition.

To navigate correctly among large quantity probable symptoms and to distinguish them from other conditions, there are several clinical diagnostic criteria:

— The initial conclusion of a psychiatrist about the absence of mental illness in the case of abundant psycho-emotional symptoms.

— Cyclicity of the increase and decrease of symptoms according to the phases of the menstrual cycle.

The diagnosis of premenstrual syndrome is made only if the patient has at least five of the following clinical signs, and one of them must be among the first four:

— Emotional instability: frequent mood swings, unmotivated tearfulness, negative attitude.

- Aggressive or depressed, .

- Unmotivated feelings of anxiety and emotional stress.

- Feeling of hopelessness, worsening mood.

- Indifferent attitude to events happening around.

- Fatigue and weakness.

— Impaired concentration: forgetfulness, inability to concentrate on something specific.

- Change in appetite. Often, girls with premenstrual syndrome are diagnosed during examination.

— Change in the usual rhythm of sleep: the patient cannot fall asleep at night due to anxiety and emotional stress, or experiences a constant desire to sleep throughout the day.

- Headaches or migraines, swelling, engorgement and tenderness of the mammary glands, joint and/or muscle pain (sometimes severe), slight weight gain.

A reliable diagnosis of premenstrual syndrome is established together with the patient. She is asked to keep an “observation diary” and record in it all the symptoms that arise over several menstrual cycles.

Laboratory diagnostics help to identify the nature of hormonal disorders. The levels of prolactin, progesterone and estradiol are determined. The study is carried out in the second half of the cycle, and its results are correlated with the form of the disease. A decrease in the level of progesterone is inherent in the edematous form of the disease, and a high level of prolactin is detected in patients with psychovegetative, cephalgic or crisis forms of the disease.

For headaches, tinnitus, dizziness, blurred vision and other cerebral symptoms, differential diagnosis is carried out with space-occupying formations in the brain area. Shown CT scan(CT) or magnetic resonance imaging (MRI) of the brain.

In case of severe neuropsychic abnormalities, electroencephalography is performed, confirming cyclical changes in the area of ​​the brain.

The edematous form of premenstrual syndrome requires differential diagnosis with kidney disease, as well as with pathology of the mammary glands. Kidney function is examined using laboratory (urine tests, diuresis monitoring) and instrumental (ultrasound) diagnostics. Mammography excludes and.

Related specialists help the gynecologist make the diagnosis of premenstrual syndrome, excluding the presence of “their” diseases. Therefore the list diagnostic procedures may increase significantly due to additional methods prescribed by other doctors.

The opinion that all women have premenstrual syndrome to varying degrees of severity is indeed true, but it becomes a disease if the accompanying symptoms regularly disrupt the usual way of life and bring physical and mental suffering.

Treatment of premenstrual syndrome

The mechanisms of development of premenstrual syndrome are closely related to the menstrual cycle and the psychosomatic processes that accompany it. Therefore, total elimination of premenstrual symptoms is possible only if the menstrual function. However, with the help of correctly chosen treatment tactics, it is possible to save the patient from painful monthly suffering and transform the disease into a mild form.

Therapy for premenstrual syndrome is always long-term (at least three to six months) and is aimed at all levels pathological process, depending on the form and degree of its manifestation. Unfortunately, often after completing a course of therapy, the disease returns, and we have to again look for new approaches to treating the disease.

Typically, patients with premenstrual syndrome have pronounced emotional and neurological disorders related to one’s attitude towards one’s condition. In order to healing process was successful, a positive attitude is necessary, therefore the first stage of treatment is a detailed conversation in which the attending physician talks about the disease and explains therapeutic tactics, and also recommends necessary lifestyle changes: diet, necessary physical activity, giving up bad habits and others.

Medications for premenstrual syndrome are selected according to the list of symptoms that accompany it. Are used:

- Psychotropic and sedatives to eliminate neuropsychic disorders.

— Hormonal drugs are used to restore the necessary hormonal balance. Progestins (Utrozhestan, Duphaston), monophasic contraceptives (Yarina, Logest, Zhanine) can be used. For severe pain in the mammary glands, androgen derivatives (Danazol) help. If for successful treatment it is necessary to exclude ovulation, Zoladex and similar drugs are used.

Parlodel and its analogues are used to reduce prolactin levels.

All hormonal drugs are prescribed taking into account the phase of the menstrual cycle.

- Diuretics. A group of drugs that remove excess liquid from the body and stabilizing arterial pressure, successfully copes with the edematous form of premenstrual syndrome. Spironolactone and similar drugs are prescribed.

- Symptomatic medications. Used to eliminate associated symptoms. Non-steroidal anti-inflammatory drugs (Indomethacin, Diclofenac), antihistamines (Suprastin, Tavegil) and antispasmodics(No-shpa and the like).

Treatment of premenstrual syndrome with the help of homeopathic remedies. Preparations Remens and Mastodinon are herbal non-hormonal drugs, capable of restoring proper hormonal balance and eliminate psycho-emotional disorders. Mastodinon effectively eliminates swelling and tenderness in the mammary glands.

In case of relapse of the disease, the course of treatment is repeated. At hormonal disorders Hormonal medications can be prescribed on a regular basis. The success of therapy implies a decrease in the severity or complete subsidence of the symptoms of premenstrual syndrome.