PMS or premenstrual syndrome - symptoms and treatment. When can I expect the PMS to start? During PMS there are three stages:

Doctors have long puzzled over the causes of female malaise before menstruation. Some healers associated it with the phases of the moon, others with the area in which the woman lived.

The girl’s condition before her period remained a mystery for a long time. Only in the twentieth century the veil of secrecy was lifted a little.

PMS is a mix of 150 different physical and mental symptoms. To one degree or another, about 75% of women experience manifestations of premenstrual syndrome.

How long does PMS last for girls? Unpleasant symptoms begin to appear 2-10 days before the start of menstruation, and disappear with the advent of the “red” days of the calendar.

• Crime chronicle. PMS is not only frayed nerves and broken plates. Most road accidents, crimes, and thefts committed by women occurred between the 21st and 28th days menstrual cycle.
• Shopping therapy. According to research, a few days before their period, women are most susceptible to the temptation to buy as much as possible.
• Women who exercise are more susceptible to PMS symptoms. mental labor and residents of big cities.
• The term PMS was first used by Robert Frank, an obstetrician-gynecologist from England.

Why does premenstrual syndrome occur?

Numerous studies have not been able to identify the exact causes of premenstrual syndrome. There are many theories of its occurrence: “water intoxication” (violation water-salt metabolism), allergic nature (increased sensitivity to endogenous), psychosomatic, hormonal, etc.

But the most complete is the hormonal theory, which explains the symptoms of PMS by fluctuations in the level of sex hormones in the 2nd phase of the menstrual cycle. For the normal, harmonious functioning of a woman’s body, the balance of sex hormones is very important:

• - they improve physical and mental well-being, increase tone, Creative skills, speed of information assimilation, learning abilities
• progesterone - has sedative effect, which can lead to depressive symptoms in phase 2 of the cycle
• androgens - affect libido, increase energy, performance

During the second phase of the menstrual cycle, a change occurs hormonal levels women. According to this theory, the cause of PMS lies in the “inadequate” reaction of the body, including the parts of the brain responsible for behavior and emotions, to cyclical changes hormonal levels, which is often inherited.

Since the days before menstruation are endocrine unstable, many women experience psycho-vegetative and somatic disorders. In this case, the decisive role is played not so much by the level of hormones (which may be normal), but by fluctuations in the content of sex hormones during the menstrual cycle and how the limbic parts of the brain, responsible for behavior and emotions, react to these changes:

• an increase in estrogen and first an increase and then a decrease in progesterone- hence fluid retention, swelling, engorgement and tenderness of the mammary glands, cardiovascular disorders, irritability, aggression, tearfulness
• hypersecretion - also leads to fluid and sodium retention in the body
• excess prostaglandins— , digestive disorders, migraine-like headaches

The most likely factors influencing the development of the syndrome, about which medical opinions do not differ:

• Decreased serotonin levels- this is the so-called “hormone of joy”, can be the cause of the development of mental signs of premenstrual syndrome, since a decrease in its level causes sadness, tearfulness, melancholy and depression.
• Vitamin B6 deficiency— a lack of this vitamin is indicated by symptoms such as fatigue, fluid retention in the body, mood swings, and breast hypersensitivity.
• Lack of magnesium - magnesium deficiency can cause dizziness, headaches, cravings for chocolate.
• Smoking. Smoking women twice as likely to experience premenstrual syndrome.
• Overweight . Women with a body mass index of over 30 are three times more likely to suffer from PMS symptoms.
• Genetic factor— it is possible that the peculiarities of premenstrual syndrome are inherited.
• , complicated childbirth, stress, surgical interventions, infections, gynecological pathologies.

Main symptoms and manifestations of premenstrual syndrome

Groups of symptoms for PMS:

• Neuropsychiatric disorders: aggression, depression, irritability, tearfulness.
• Vegetovascular disorders: changes in blood pressure, headache, vomiting, nausea, dizziness, tachycardia, .
• Exchange-endocrine disorders: swelling, increased body temperature, chills, engorgement of the mammary glands, itching, flatulence, shortness of breath, thirst, memory loss, .

PMS in women can be divided into several forms, but their symptoms usually do not appear in isolation, but are combined. In the presence of psychovegetative manifestations, especially depression, in women it decreases pain threshold and they perceive pain more acutely.

PMS occurs differently in every woman, and symptoms vary significantly. According to the results of some studies, women with PMS have the following frequency of manifestation of one or another symptom of PMS:

Premenstrual syndrome can aggravate other diseases:

• Anemia (see)
• (cm. )
• Thyroid diseases
• Chronic fatigue syndrome
• Bronchial asthma
• Allergic reactions
• Inflammatory diseases of the female genital organs

Diagnostics: what can masquerade as symptoms of PMS?

Since dates and deadlines are easily forgotten, to make your task easier, you should keep a calendar or diary where you can write down the start and end dates of menstruation, ovulation ( basal temperature), weight, symptoms that bother you. Keeping such a diary for 2-3 cycles will greatly simplify diagnosis and allow you to track the frequency of PMS symptoms.

The severity of premenstrual syndrome is determined by the number, duration and intensity of symptoms:

• Light form: 3-4 symptoms or 1-2 if they are significantly pronounced
• Severe form: 5-12 symptoms or 2-5, but very pronounced, and regardless of the duration and their number, if they lead to disability (usually the neuropsychiatric form)

The main feature that distinguishes premenstrual syndrome from other diseases or conditions is cyclicality. That is, deterioration in well-being occurs several days before menstruation (from 2 to 10) and completely disappears with their arrival. However, unlike psychovegetative ones, physical discomfort in the first days next cycle may intensify and smoothly transform into disorders such as menstrual migraine.

• If a woman feels relatively well in phase 1 of the cycle, then this is premenstrual syndrome, not chronic illness- neurosis, depression,
• If pain appears only immediately before and during menstruation, especially when combined with - it is most likely not PMS, but others gynecological diseases — , chronic endometritis, dysmenorrhea ( painful menstruation) and others.

To establish the form of the syndrome, studies of hormones are carried out: prolactin, estradiol and progesterone. The doctor may also prescribe additional diagnostic methods, depending on the prevailing complaints:

• For severe headaches, dizziness, decreased vision and fainting, a computed tomography or MRI scan is prescribed to rule out organic brain diseases.
• If there is an abundance of neuropsychiatric diseases, an EEG is indicated to exclude epileptic syndrome.
• In case of severe edema, changes in the daily amount of urine (diuresis), tests are performed to diagnose the kidneys (see).
• In case of severe and painful engorgement of the mammary glands, it is necessary to perform an ultrasound of the mammary glands and mammography to exclude organic pathology.

Not only a gynecologist examines women suffering from PMS, but also involves psychiatrists, neurologists, endocrinologists, nephrologists, cardiologists and therapists.

Premenstrual syndrome or pregnancy?

Some symptoms of PMS are similar to those of pregnancy (see). After conception, the content of the hormone progesterone increases in a woman’s body, which also occurs during PMS, therefore following symptoms identical:

• fast fatiguability
• breast swelling and tenderness
• nausea, vomiting
• irritability, mood swings
• lower back pain

How to distinguish pregnancy from PMS? Comparison of the most common symptoms of premenstrual syndrome and pregnancy:

The signs of both conditions are very similar, so it is not easy to understand what exactly is happening in a woman’s body and distinguish pregnancy from PMS:

• The easiest way to find out what causes poor health is to wait until your period starts.
• If the calendar is already late, you should take a pregnancy test. The pharmacy test will give reliable results only if menstruation is delayed. It is sensitive to the pregnancy hormone (hCG) excreted in the urine. If you don’t have the patience and nerves to wait, you can take a blood test for hCG. It shows almost one hundred percent results on the tenth day after conception.
• The best option to find out what is bothering you - PMS syndrome or pregnancy - is to visit a gynecologist. The doctor will assess the condition of the uterus and, if pregnancy is suspected, prescribe an ultrasound.

When to see a doctor

If the manifestations of premenstrual syndrome significantly reduce the quality of life, affect the ability to work and are of a pronounced nature, treatment cannot be avoided. After a thorough examination, the doctor will prescribe drug therapy and give necessary recommendations to alleviate the course of the syndrome.

How can a doctor help?

In most cases, treatment is symptomatic. Depending on the form, course and symptoms of premenstrual syndrome, a woman needs:

• Psychotherapy - mood swings, irritability, depression, from which both the woman and her loved ones suffer, are corrected using stabilizing behavioral techniques and psycho-emotional relaxation.
• For headaches, lower back and abdominal pain, non-steroidal anti-inflammatory drugs are prescribed for temporary relief. pain syndrome(, Nimesulid, Ketanov see).
• Diuretics for removing excess fluid from the body during edema (see).
• Hormonal therapy is prescribed for insufficiency of the second phase of the cycle, only after functional diagnostic tests, based on the results of identified changes. Progestogens are used - Medroxyprogesterone acetate from 16 to 25 days of the cycle.
• prescribed for a variety of neuropsychiatric symptoms (insomnia, nervousness, aggressiveness, anxiety, panic attacks, depression): Amitriptyline, Rudotel, Tazepam, Sonapax, Sertraline, Zoloft, Prozac, etc. in phase 2 of the cycle after 2 days from the onset of symptoms.
• In crisis and cephalgic forms, it is possible to prescribe Parlodel in phase 2 of the cycle, or if prolactin is elevated, then in a continuous mode, it has a normalizing effect on the central nervous system.
• For cephalgic and edematous forms, antiprostaglandin drugs (Indomethacin, Naprosyn) are recommended in the second phase of the menstrual cycle.
• Since women often have elevated levels of histamine and serotonin during PMS, the doctor may prescribe 2nd generation antihistamines (see) 2 days before the expected worsening of the condition at night before the 2nd day of menstruation.
• To improve blood circulation in the central nervous system, it is possible to use Grandaxin, Nootropil, Aminolon for 2-3 weeks.
• In case of crisis, cephalgic and neuropsychic forms, drugs that normalize neurotransmitter metabolism in the central nervous system— Peritol, Difenin, the doctor prescribes the drug for a period of 3-6 months.
• Homeopathic medicines Remens or Mastodinon.

What can you do?

• Full sleep

Try to sleep as long as your body has time to fully rest, usually 8-10 hours (see. Lack of sleep leads to irritability, anxiety and aggression, and negatively affects the functioning of the immune system. If you suffer from insomnia, try walking before bed, breathing technology.

• Aromatherapy

In the absence of allergies, compositions of specially selected aromatic oils are a good weapon against PMS symptoms. Geranium and rose will help normalize the cycle. Lavender and basil effectively fight spasms. Juniper and bergamot improve mood. Baths with aromatic oils Start taking it two weeks before your period.

Hiking, running, Pilates, bodyflex, yoga, dancing are an excellent way to treat the manifestations of premenstrual syndrome in women. Regular exercise increases endorphin levels, which helps combat depression and insomnia, and also reduces the severity of physical symptoms.

• Two weeks before your period, take vitamin B6 and magnesium

Magne B6, Magnerot, as well as vitamins E and A - this will make it much more effective to combat such manifestations of PMS as: rapid heartbeat, heart pain, fatigue, insomnia, anxiety and irritability.

• Nutrition

Eat more fruits and vegetables, foods with high content fiber, and also include calcium-rich foods in your diet. Temporarily limit the consumption of coffee, chocolate, cola, as caffeine increases mood swings, irritability, and anxiety. Daily diet should include 10% fat, 15% protein and 75% carbohydrates. Fat intake should be reduced, and beef consumption, some types of which contain artificial estrogens, should also be limited. Useful herbal teas, freshly squeezed juices, especially carrot and lemon. It is better not to drink alcohol; it depletes reserves of mineral salts and B vitamins, disrupts carbohydrate metabolism, and reduces the liver’s ability to utilize hormones.

• Relaxation practices

Avoid stress, try not to overwork and maintain a positive mood and thinking; relaxation practices - yoga, meditation - help with this.

• Regular sex

It helps fight insomnia, stress and bad mood, increase the level of endorphins, strengthen the immune system. At this time, many women's sexual appetite increases - why not surprise your partner and try something new?

• Medicinal plants

They can also help relieve the symptoms of premenstrual syndrome: Vitex - relieves heaviness and pain in the mammary glands, Primrose (evening primrose) - from headaches and swelling, - excellent antidepressant, normalizes libido, improves well-being and reduces fatigue.

Balanced diet, adequate physical activity, vitamin supplements, healthy sleep, regular sex, positive attitude to life will help alleviate the psychological and physical manifestations of premenstrual syndrome.

If you suddenly find yourself craving a sandwich... butter, or burst into tears of emotion at the sight small child, or you're itching to buy a pair of earrings that you're unlikely to wear, stop for a moment and ask yourself if you're about to get your period. If soon, your unusual behavior may be caused by premenstrual syndrome or premenstrual tension syndrome (PMS). This is a specific condition that precedes menstruation and, to one degree or another, is characteristic of most women. When PMS hits, just try to calm down and control your actions. When your period starts, you will return to your normal state.

Premenstrual tension syndrome is associated with regular fluctuations in the level of hormones in the blood.

Previously, premenstrual syndrome was considered a psychological disease, until researchers proved that this condition is organic in nature, caused by changes in hormone levels in the body.

Increase the production of aldosterone, which causes a lot of changes in the body,
- increase the level of monoamine oxidase (a substance released in brain tissue that can cause depression),
- lower the level of (a substance released in the brain tissue that affects activity levels and mood).

For some women, PMS passes calmly, for others it is very violent, but the time of onset of symptoms is always predictable. This is what makes it possible to distinguish premenstrual tension syndrome from other diseases. Changes in emotional and physical state appear 7-10 days before menstruation, and disappear almost immediately after the start of menstruation. These dates can be established by keeping a menstrual diary for several months, noting in it all the symptoms and dates of the beginning and end of menstruation.
If symptoms persist throughout your menstrual cycle, PMS may not be the cause. In this case, you should contact a psychiatrist.

Causes of premenstrual syndrome

The appearance of premenstrual tension syndrome in some women and its absence in others is associated, first of all, with hormonal fluctuations during the menstrual cycle and the individual reactions of the whole body to them. However, recently scientists have begun to explore other possible reasons of this condition (no definitive evidence yet):

Monthly cyclical fluctuations in the amount of certain substances (neurotransmitters) in the brain, which include endorphins, which affect mood,
- poor nutrition: symptoms of premenstrual syndrome such as mood swings, fluid retention in the body, increased breast sensitivity, fatigue are associated with B6 deficiency, while headaches, dizziness, palpitations and cravings for chocolate are caused by magnesium deficiency,
- hereditary factor. It has been proven that identical twins are much more likely to suffer from PMS together than fraternal twins. There may be a genetic predisposition to PMS.

Symptoms of premenstrual syndrome

Physical symptoms:

Increased sensitivity or even tenderness of the breasts,
- breast enlargement,
- fluid retention in the body, leading to swelling of the legs and arms and weight gain of about 2 kg,
- headaches, especially migraines,
- nausea, vomiting and dizziness,
- and joints and specific back pain,
- in some cases constipation, diarrhea,
- extreme thirst and frequent urination,
- cravings for food, especially salty or sweet foods, intolerance to alcohol,
- lethargy, fatigue or vice versa, energy,
- palpitations and flushing of the face,
- increase in the number of acne.

Psychological symptoms:

Frequent mood changes
- , blues, feeling of depression,
- constant tension and irritability,
- insomnia or prolonged sleep,
- absent-mindedness and forgetfulness.
Some women may experience more severe symptoms:
- panic
- thoughts of suicide
- aggressiveness, tendency to violence.

What can you do

Do physical exercise. Study Shows Regular Exercise Reduces PMS Symptoms, Perhaps? this is due to the release of endorphins or other substances in the brain that relieve stress and improve mood.

Sleep 8-9 hours a day. Lack of sleep aggravates anxiety and other negative emotions, and increases irritability. If you suffer from insomnia, find a way to combat it. Deep breathing and other simple relaxation techniques before bed can be very effective in many cases. Before going to bed, take a hot bath and drink a glass of warm milk.

Eat a low-fat, high-fiber diet. During PMS, try to limit your intake of foods such as coffee, cheese and chocolate. Their use has been linked to migraines and many other PMS symptoms, such as anxiety states, frequent mood swings and palpitations.

Don't eat a lot, limit sweets, it's better to take some fruit.

Maintain a constant level of insulin in the blood by eating small meals about 6 times a day, this is better than eating a large portion once. Try to eat healthy.

Nutritionists recommend taking vitamin B6 (50-100 mg) and magnesium (250 mg) daily in the form of dietary supplements. In addition, doctors prescribe additional calcium intake, which, together with magnesium, eliminates PMS symptoms and protects against osteoporosis, and iron (to fight anemia).

Many women say that primrose oil (a substance rich in important fatty acids). Check with your doctor about the dosage for you.

Stay away from crowds, don't go outside unnecessarily if the weather is bad, and get plenty of vitamin C (an antioxidant and immune system booster) as possible. Women suffering from PMS get sick more often. Scientists believe that this is a consequence of a weakened immune system before the onset of menstruation, which makes the body vulnerable to viral, bacterial and fungal infections.

What can a doctor do?

Since the causes of the disease are not completely clear, treatment for PMS focuses on mitigating its symptoms:

For anxiety, insomnia, and other psychological symptoms, your doctor may prescribe tranquilizers or sedatives. However, long-term use of these medications is undesirable due to the fact that they are addictive. Newer antidepressants have shown to be effective for PMS, but they must be taken under medical supervision.

For migraines associated with PMS, your doctor may prescribe special therapy aimed at preventing headache attacks. To relieve pain, most doctors prescribe non-steroidal anti-inflammatory drugs such as.

For swelling or other signs of fluid retention, diuretics are prescribed, which must be started 5-7 days before the start of menstruation.

In some cases, the doctor may prescribe progesterones and other hormones for PMS.

Prevention of PMS

Any disorder in the body, the causes of which are not clear, is difficult to prevent. At the moment the best way Control of a given situation is the ability to cope with it, not prevention.

Premenstrual syndrome (PMS) is the physical and emotional symptoms experienced by women 1-2 weeks before menstruation. Symptoms different women often differ 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. For 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 cases have been associated with PMS various symptoms. Common emotional and non-specific 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 of the important factors 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 more often occurs 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

There are no laboratory testing methods 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 feelings 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 of Mental Disorders, Fourth Edition (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 premenstrual period, whether they are predictable and disrupt the normal functioning of women. A number of standardized tools have been developed to describe PMS, including the 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 mood disorders, migraines, epilepsy, fatigue, irritable bowel syndrome, asthma and allergies may worsen in the period leading up to your period. When making a diagnosis, problems associated with other aspects of the woman's life should be excluded. reproductive system, including dysmenorrhea ( painful sensations during menstruation, not before), endometriosis, perimenopause, and side effects lane oral contraceptives. The National Institute of Mental Health conducted a study that compared the intensity of symptoms observed on days 5 to 10 of the cycle with symptoms observed six days before the start 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 for at least two consecutive cycles.

Control

For PMS treatment different technologies were used. Women with mild PMS are advised to reduce their salt and caffeine intake, reduce their stress levels and increase their 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 can trigger symptoms associated with PMS, while for others it can reduce the physical manifestations of the syndrome. Hormonal drugs do not alleviate emotional symptoms Progesterone is very often used for PMS, but there is insufficient evidence to support this 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 big influence for a generation, entitled "Sex in Education". Clarke concluded that female workers suffered less than schoolgirls because they “taxed their brains less.” Presumably, women engaged in manual labor have stronger and more developed bodies, and a more “normally designed” 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 is also 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 cultural phenomenon, which continues to increase in the presence of positive feedback and thus represents a social concept that contributes to or serves as a convenient excuse for women's acquired helplessness. 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 are talking about emotional aspects rather than normal physical symptoms.

Premenstrual syndrome (PMS) (also called premenstrual tension, cyclic or premenstrual illness) is a complex of physical and mental symptoms that are cyclical and occur several days before the onset of menstruation. This specific condition is caused by the pathological course of the second phase of the menstrual cycle, which is characteristic of most women.

It has been revealed that the risk of developing PMS increases over the years. According to statistics, city residents are more susceptible this disease than the village ones. About ninety percent of women reproductive age observe some changes in their body that occur before the approach of menstruation, usually seven to ten days before it begins. In some women, these manifestations of symptoms are mild and do not affect everyday life (mild form of PMS), and therefore do not require treatment, but in others (about 3-8%), the symptoms manifest themselves in a severe form, requiring mandatory medical intervention. The fact of cyclical manifestation certain symptoms makes it possible to distinguish PMS from other diseases.

Changes of an emotional and physical nature in a woman’s state before menstruation pass almost immediately after their onset. If symptoms are observed throughout the menstrual cycle, you should consult a doctor, since the cause this state It may not be PMS at all, but a more serious illness. IN in this case Consultation with a psychiatrist is recommended.

Causes of premenstrual syndrome.
More recently, premenstrual syndrome was considered a kind of psychological disorder until it was proven that it is based on changes in the level of hormones in the body. The presence or absence of premenstrual tension syndrome in women is due to hormonal fluctuations during the menstrual cycle and various reactions on them the body of every representative of the fair sex.

The most common causes of PMS are:

• Violation of water-salt metabolism.
• Hereditary predisposition.
• Frequent stressful and conflict situations in the family (in most cases, PMS develops in women of a certain mental make-up: overly irritable, thin, overly concerned about their health).
• Hormonal imbalances, namely, disturbances in the levels of the hormones estrogen and progesterone in the second phase of the menstrual cycle (the level of estrogen increases with insufficient function corpus luteum with a decrease in progesterone levels, which affects the nervous and emotional state of a woman).
• Increased secretion of the hormone prolactin, against the background of which changes occur in the mammary glands.
• Various thyroid diseases.
• Inadequate nutrition: lack of vitamin B6, as well as zinc, magnesium, calcium.
• Cyclic fluctuations in the levels of certain substances (neurotransmitters) in the brain (particularly endorphins) that affect mood.

• Psychovegetative form, in which PMS manifests itself in the form of forgetfulness, excessive irritability, conflict, touchiness, often tearfulness, weakness, fatigue, drowsiness or insomnia, constipation, numbness of the hands, decreased libido, unpredictable outbursts of anger or depression, sensitivity to odors, flatulence. . It has been noted that most often in young women of reproductive age, premenstrual tension syndrome is expressed in the form of attacks of depression, and in adolescents in transitional age Aggression prevails.
• Edema form of PMS, most often characterized by engorgement and soreness of the mammary glands, as well as swelling of the fingers, face, legs, slight weight gain, itching of the skin, acne, muscle pain, weakness, sweating, bloating.
• Cephalgic form of PMS, with this form the main symptoms of manifestation are headaches, dizziness, fainting, increased irritability, nausea and vomiting. I note that headaches with this form can be paroxysmal, accompanied by swelling and redness of the face.
• "Crisis" form, in which symptoms of so-called “panic attacks” are observed - increased blood pressure, increased heart rate, attacks of compression behind the sternum, and the presence of fear of death. Mostly similar condition worries women with this form of PMS in evening time, or at night. Mostly this form observed in premenopausal women (aged 45-47 years). In most cases, patients with a crisis form of PMS are diagnosed with diseases gastrointestinal tract, kidneys and cardiovascular system.
• Atypical form of PMS accompanied by an increase in body temperature to 38°C with migraine attacks during menstruation, ulcerative gingivitis and stomatitis, attacks of suffocation before and during menstruation.
• A combination of several forms of PMS at once (mixed). As a rule, there is a combination of psychovegetative and edematous forms.

• The mild form is characterized by the manifestation of three to four symptoms, one or two of which predominate.
• The severe form is expressed in the simultaneous manifestation of from five to twelve symptoms, in which two to five symptoms are the most pronounced.

Stages of premenstrual syndrome.
There are three stages of PMS:

• compensated, in which the severity of the symptoms of the disease is insignificant, with the onset of menstruation the symptoms disappear, while the disease does not develop with age;
• subcompensated, which has pronounced symptoms that affect a woman’s ability to work, and over the years the manifestations of PMS only get worse;
• decompensated stage, expressed in severe symptoms that persist for several days after the end of menstruation.

Since the symptoms of premenstrual syndrome are quite extensive, some women confuse it with other diseases, often turning to the wrong specialists (therapist, neurologist, psychiatrist) for help. Only a thorough examination can reveal the cause of the disease.

Diagnosis of premenstrual syndrome.
To make a diagnosis, the doctor examines the patient’s medical history and listens to any existing complaints. The cyclical nature of attacks is the first sign of PMS.

To diagnose the disease, blood tests for hormones done in both phases of the menstrual cycle (prolactin, estradiol, progesterone) are examined. Depending on the form of PMS, the hormonal characteristics of patients differ. For example, with the edematous form of PMS, a decrease in progesterone levels is observed in the second phase of the cycle, while with neuropsychic, cephalgic and crisis forms, the level of prolactin in the blood increases.

After this, taking into account the patient’s form and complaints, additional studies are carried out (mammography, MRI, blood pressure control, electroencephalography, measurements daily diuresis etc.) with the involvement of other specialists (endocrinologist, neurologist, therapist, psychiatrist).

For the most accurate diagnosis of the disease, as well as to identify the dynamics of the treatment, experts recommend that all patients with PMS write down their complaints in detail every day in a kind of diary.

Treatment of premenstrual syndrome.
Treatment is carried out comprehensively, regardless of the form of the disease.

To eliminate psycho-emotional manifestations, psychotropic and sedative drugs are prescribed: seduxen, Rudotel and antidepressants Tsipramine, Coaxil. Data medicines It is recommended to take it for two months in both phases of the menstrual cycle.

To normalize the levels of sex hormones, hormonal drugs are prescribed:

• gestagens (Utrozhestan and Duphaston) during the second phase of the menstrual cycle;
• monophasic combined oral contraceptives (Zhanine, Logest, Yarina and others), which are well tolerated by patients, are suitable for all women of reproductive age in the absence of contraindications;
• androgen derivatives (Danazol) if available severe pain in the mammary glands;
• premenopausal women are prescribed GnRH agonists (gonadotropin-releasing hormone agonists) - Zoladex, Buserelin, which block the process of ovarian functioning, excluding ovulation, thereby eliminating the symptoms of PMS.

Symptomatic therapy is carried out in the form of additional treatment carried out to the main one, in order to quickly eliminate the symptoms of PMS: non-steroidal anti-inflammatory drugs (Indomethacin, Diclofenac) and antihistamines (allergic reactions) - Tavegil, Suprastin.

Often prescribed for the treatment of premenstrual syndrome homeopathic medicines, in particular Mastodinon and Remens are herbal non- hormonal agents, the effect of which extends directly to the cause of PMS. In particular, they normalize the imbalance of hormones, reducing the manifestations of the disease of a psychological nature (irritability, feelings of anxiety and fear, tearfulness). Mastodinon is often recommended for the edematous form of the disease, including chest pain. It is prescribed to be taken twice a day, thirty drops, diluted with water, for three months. If the drug is in tablet form, then take one tablet twice a day. The drug Remens is also taken for three months, ten drops, or one tablet three times a day. Both drugs have virtually no contraindications: oversensitivity to the components of the drugs, age restrictions - up to 12 years, pregnancy and lactation.

If the cause of the development of PMS is a lack of B vitamins and magnesium, then vitamins of this group (Magne B6), as well as calcium to prevent osteoporosis and iron to combat anemia, are prescribed.

The course of treatment averages from three to six months, depending on the severity of the disease.

Self-treatment of premenstrual syndrome.
To speed up the healing process, as well as rapid rehabilitation it is necessary to lead a certain lifestyle:

• Proper nutrition - limit the consumption of coffee, salt, cheese, chocolate, fats (they provoke the occurrence of PMS manifestations such as migraines), include fish, rice, dairy products, legumes, vegetables, fruits, and herbs in the diet. To maintain insulin levels in the blood, it is recommended to eat at least five to six times a day in small portions.
• Exercising two to three times a week helps increase the level of endorphins that improve your mood. However, you should not overuse exercise, as excessive amounts only aggravate the symptoms of PMS.
• You need to keep an eye on your emotional state, try not to be nervous, avoid stressful situations, get enough sleep (at least eight to nine hours of good sleep).
• As an aid, it is recommended to use herbal medicine: tincture of motherwort or valerian, thirty drops three times a day, warm chamomile tea, green tea with mint.
• It is recommended to take as much vitamin C as possible. It has been proven that women with PMS get sick more often, this is due to the weakening of the immune system before menstruation, which makes it vulnerable to viral and bacterial infections.

Prevention of PMS.

• systematic use of oral contraceptives in the absence of contraindications;
• healthy lifestyle;
• regular sex life;
• exclusion of stressful situations.

– 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, itching, swelling, pain in the abdomen and heart, attacks of palpitations, etc. Edema is often observed, 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 for this condition 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 are usually associated with emotionally unstable, thin, asthenic women who are more often engaged in intellectual 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 disturbances), allergic reactions (ulcerative stomatitis and ulcerative gingivitis, asthmatic syndrome, indomitable 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. A mild form of premenstrual syndrome appears 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 PMS.

Diagnosis of premenstrual syndrome

Main diagnostic criterion premenstrual syndrome is cyclical, the periodic nature of complaints arising 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. Purpose additional methods diagnosis 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, an important role is played by measuring daily diuresis, recording the amount of fluid drunk, and 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, medications and non-drug methods. 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, vegetable fiber, 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.

Leading place in drug treatment premenstrual syndrome has a specific hormone therapy progesterone analogue drugs. It should be remembered that the treatment of premenstrual syndrome is long-term, sometimes lasting throughout reproductive period a process that requires a woman to have internal discipline and strict compliance with all doctor’s orders.