PMS- This is a large group of physical and psycho-emotional pathological changes in the body of a cyclical nature, which are closely associated with the approaching menstruation. Perhaps there is no woman who has not experienced at least once unpleasant changes in the general condition on the eve of another menstruation. Moreover, if the incidence of PMS in girls does not exceed 20%, then among women who have overcame a thirty-year age limit, it is found in every second.
PMS is rightfully one of the most mysterious states of the female body. Its reliable causes are unknown, so it is customary to talk about the predisposing conditions for its development.
PMS is not a disease, it is an extensive list of possible pathological symptoms that can occur in a woman before menstruation and pass without a trace after her termination. The severity of PMS and the nature of the clinical manifestations of all patients is different, so this syndrome does not have certain clinical signs, but it has one clear diagnostic criterion - connection with the approaching menstruation. One or two weeks before the next menstruation, the woman’s well-being changes: there are psycho-emotional disorders, peripheral edema of the extremities, weight gain, increase and sensitivity of the mammary glands, vegetative-vascular manifestations and so on.
The clinical characteristic of PMS consists of a huge number (about 150) of potential symptoms, but each patient has her own, sometimes unique, set of clinical signs. Finding two women with identical symptoms of PMS is almost impossible.
The presence of a clear connection of the regular deterioration of the woman’s condition on the eve of the next menstruation indicates the hormonal nature of PMS. Often found PMS in adolescents, obviously, is associated with the incomplete process of formation of the hormonal function of the ovaries, and PMS in women of menopause is caused by its natural extinction.
The clinical signs of PMS in women are expressed unequally, and vary widely from mild malaise to severe, disrupting the usual rhythm of life, condition. Regardless of the form and severity of pathological signs, their appearance in the second phase of the cycle and the disappearance in the first is usually correlated with PMS.
Since PMS is accompanied by a large number of symptoms that are not associated with gynecology, patients often initially turn to other specialists: neurologists, endocrinologists, general practitioners, and others. Unfortunately, before you get to the right specialist, they often undergo long-term treatment of non-existent ailments.
Physiological changes in the body on the eve of menstruation are always accompanied by changes in well-being. Periodically occurring mood changes, increased appetite, an increase in the mammary glands and other common precursors of menstruation are associated with physiological hormonal changes in the body and are not always manifestations of PMS. In healthy women, these symptoms do not recur regularly before each menstruation, but occasionally appear.
About PMS indicates the presence of a certain number of symptoms that recur before each menstruation and go away independently after its completion.
Diagnostic measures include a mandatory study of indicators of hormonal function, and a list of other studies depends on the clinical manifestations of PMS.
Clear treatment regimens or special pills for PMS do not exist, because its manifestations are individual and very diverse. Used drugs for PMS belong to different groups and are intended for the gradual elimination of all existing symptoms and predisposing factors.
The success of the treatment is determined by the normal hormonal function of the ovaries, the biphasic cycle and the disappearance of the pathological symptoms.
There is an erroneous belief among women that PMS, especially its milder form, is the norm and does not need medical correction. Meanwhile, PMS over the years can get more severe forms, and pathological menopause in women with PMS develops more often.
Causes of PMS
PMS can not be associated with disorders in one system, since its manifestations belong to almost the entire body. Therefore, all existing theories of the onset of PMS explain the development of pathological symptoms in only one system of the body, but cannot link them together.
One of the most reliable reasons for the development of PMS is hormonal dysfunction. It is she who explains PMS in adolescents during unstable ovarian work. It can appear with the first menstruation or after several normal cycles. If the period of formation of hormonal function in adolescence passed properly, the chances of developing PMS in girls are significantly reduced.
Changing the normal ratio of hormones provokes a temporary disruption of the entire body. Therefore, PMS in women often occurs after abortions, pathological pregnancy, removal or ligation of the fallopian tubes, as well as against the background of incorrectly used hormonal contraception.
A hormonal imbalance, namely a violation of the normal ratio of estrogen and progesterone, increases the lability of the nervous system and causes psycho-emotional disorders inherent in PMS.
There is also an assumption about the initial effect of changes in the central nervous system on the development of PMS. It is based on the fact that more often PMS is diagnosed in emotionally labile patients with high mental loads, frequent stresses, or on the background of significant overwork. Among the residents of megacities, the owners of the ICP are significantly larger than those living in rural areas.
Changes in the mammary glands on the eve of the next menstruation also has hormonal causes. In response to the provoking factor in the pituitary gland, too much of the hormone prolactin, which is responsible for the state of the mammary glands, is synthesized. On the eve of menstruation, they become sensitive, dense and increase in volume.
When PMS change the normal indicators of water-salt balance. Delayed fluid and sodium in the kidneys cause edema.
A significant role in the formation of PMS belongs to tissue hormones prostaglandins, which are synthesized by almost all organs and tissues. It is noted that some symptoms of PMS are similar to those with prostaglandins similar to those in excess: migraine headaches, impaired bowel movements, dizziness, nausea or vomiting, and various behavioral changes. Prostaglandins are also responsible for autonomic and vascular disorders in the premenstrual period.
Among the causes of PMS are also present: deficiency of zinc, magnesium, calcium and vitamin B6, lack of weight or depletion, endocrine disorders, neuroinfections and thyroid diseases. Established genetic predisposition to the appearance of PMS.
Thus, the leading place among the causes of PMS is occupied by functional disorders in the central nervous system and hormonal dysfunction of the ovaries of a congenital or acquired nature.
Symptoms and signs of PMS
The clinical characteristics of PMS encompass numerous cyclically recurring pathological changes in virtually all body systems. However, each woman has her own unique set of symptoms. Depending on the prevalence of certain clinical signs of PMS, there are four main forms of its course:
- Neuropsychic (sometimes referred to as psycho-vegetative) form of PMS. Distinguished by severe violations of the emotional sphere and changes in the nervous system. On the eve of menstruation, the mood changes: the patient becomes depressed, irritable, crying, insomnia, depression may appear. In addition to mood changes, there are headaches and dizziness, changes in appetite, fatigue, heart pain and other neurological symptoms. In adult women, depressive disorders prevail in the clinic, and PMS in adolescents is characterized by manifestations of excessive aggressiveness.
- The edematous form of PMS is associated with a predominance of signs of impaired water-salt balance and is associated with fluid retention in the tissues. The main symptom is edema of varying severity that occurs on the face, legs and hands. Fluid retention in tissues leads to an increase in the volume of the mammary glands and their pain (mastodynia), as well as to weight gain. There is thirst, itching, joint pain, changes in the bowels.
- Cephalgic PMS occurs with severe vascular disorders. The leading signs are headaches, similar to migraines, pains. As a rule, such pains have a characteristic one-sided localization in the temple and are characterized by patients as jerking or throbbing. Often they are accompanied by nausea, vomiting, irrepressible diarrhea and dizziness. Women with cephalgic PMS usually have a history of cardiovascular disease, hypertension, stomach and intestinal diseases, and psychological trauma.
- The ICP form of crisis resembles a wave-like “panic attacks”. Suddenly, more often in the evening or at night, the patient has bouts of heart palpitations, suffocation and unmotivated fear. The critical form of PMS is inherent in the premenopausal period, therefore it is more often present in patients after 45 years of age.
Isolation of forms of PMS is conditional and does not mean that the patient can simultaneously present only the symptoms inherent in one form of PMS. In mixed forms of PMS, a combination of psychovegetative and edematous forms is more common.
The clinical picture of PMS does not always fit into the designated framework, sometimes PMS proceeds atypically. Before menstruation and during it, symptoms of bronchial asthma, fever, inflammation of the oral mucosa, vomiting appear. Any atypical symptoms, the regular appearance of which has a clear connection with menstruation, are attributed to the atypical form of PMS.
The number of symptoms and their severity determine how difficult PMS is. The presence of 3-4 clinical signs, of which only one or two are strongly pronounced, indicate a mild course of PMS. Severe is characterized by severe 2–5 symptoms out of 5–12 existing.
If PMS is manifested by small symptoms and does not progress for many years, it is considered compensated. As a rule, all its manifestations pass at the time of the beginning of the next menstruation.
The subcompensated stage of PMS is characterized by a gradual increase in clinical manifestations and disrupts the patient's usual rhythm of life.
Severe PMS with severe symptoms, disability speak of a decompensated process. His symptoms go away a few days after menstruation.
Often, patients do not know whether it is possible and how to distinguish pregnancy from PMS in the event of the appearance of similar symptoms. Indeed, short term pregnancies and PMS may have similar signs: fatigue, change in appetite and weight, increase and sensitivity of the mammary glands, edema, psycho-emotional changes, and others. As a rule, the doctor is able to distinguish these conditions by examining the history and results of a blood test for hCG - “pregnancy hormone”. However, before the onset of menstruation delay, this method is not always reliable.
So how to distinguish pregnancy from PMS in anticipation of the next menstruation? Carefully watching the change in the state of her body, the woman herself can come to the correct conclusion. You can think about the short periods of pregnancy if:
- shortly you had unprotected sexual intimacy,
- these symptoms do not recur with you monthly before menstruation,
- Your condition is not associated with a non-gynecological malady: a cold, an intestinal infection, stress, climate change, and others.
If the presence of a short term pregnancy is not excluded, the next menstruation in time will not come. In the case of its delay, you can do a rapid test, and then consult a doctor.
As a rule, patients with PMS symptoms initially turn to endocrinologists, general practitioners or neuropathologists according to the form of ICP, but their therapy does not give the desired result, so the treatment of a non-existent ailment can last for years.
If a woman manages to notice a clear connection between the deterioration of the condition and the approaching menstruation, the diagnosis of PMS begins in a timely manner. Since PMS does not have a clear list of clinical signs, its primary diagnosis relies on two diagnostic criteria: a clear link between the symptoms and the menstrual cycle and the absence of mental disorders in the patient.
Based on the analysis of the most common forms of PMS, a list of symptoms has been compiled that allow a correct diagnosis to be made. It is considered reliable if the patient has at least five of the following clinical signs with the obligatory presence of the first four:
- feeling of unmotivated anxiety and tension,
- feeling of hopelessness and longing, bad mood,
- indifference to the people and events around them,
- fatigue and physical weakness,
- memory loss, inability to concentrate,
- poor appetite, tendency to bulimia,
- changes in the usual rhythm of sleep - insomnia or drowsiness,
- severe headaches, painful mammary glands, swelling of the face and limbs, weight gain, pain in muscles and joints.
The final diagnosis is made after monitoring the patient for several menstrual cycles. She is invited to regularly record the premenstrual symptoms in a special diary of observations. After 3-4 cycles, the data presented in the diary are analyzed. If during the observation period the recordings reflect the regularity of the pathological symptoms and their clear connection with menstruation, the diagnosis of PMS is obvious.
The diagnosis of PMS implies a mandatory study of the hormonal status of the patient. The nature of changes in the amount of hormones (prolactin, estradiol and progesterone) in different phases of the cycle is determined. With different forms of PMS, these changes are not equivalent. Thus, the decrease in normal levels of progesterone in the second phase of the cycle is observed in the edematous form of PMS, and with other things, there is an increase in prolactin level.
Additional examinations are carried out in order to exclude extragenital pathology disguised as PMS. In case of neuropsychic and cephalgic PMS, consultation with a neuropathologist and a psychiatrist is obligatory. In order to exclude bulky growths in the brain with severe headaches, visual and hearing impairment, CT or MRI may be performed.
On electroencephalograms in patients with PMS, cyclical disturbances in the electrical activity of the brain are recorded.
In case of mastodynia after a visit to the mammologist, the patient undergoes an ultrasound of the mammary glands or a mammographic examination to exclude mastopathy.
The edematous form of PMS requires a study of the function of the kidneys, and in order to exclude the presence of cardiovascular pathology, patients with the crisp form of PMS are examined by a therapist.
Self-diagnosis for PMS is not allowed. The presence of poor health on the eve of menstruation has many causes and does not always imply PMS.
Treatment of PMS is a very difficult task, because this condition affects almost all important systems of the body. The close connection of PMS with the hormonal function of the ovaries explains the complete disappearance of all its manifestations after the cessation of menstruation. In young women with preserved menstrual function, complete elimination of PMS is possible only with mild forms of the disease.
Since the only reliable cause of PMS is not established, therapy is aimed at eliminating pathological premenstrual manifestations. Proper symptomatic therapy can make the course of PMS easier, return to work and improve the quality of life.
Unfortunately, not all patients resort to the help of a doctor, many choose medications for PMS on their own. Self-medication can reduce the symptoms of the disease, but does not guarantee its cure. Any self-administered pills for PMS will not replace a full-fledged comprehensive treatment.
All patients suffering from PMS, regardless of its form, have psycho-emotional disorders due to improper attitude to their condition. Before starting treatment, they need to explain in detail the essence of the illness itself and tell about the methods of treatment. In order for the patient to have the right emotional state, and the treatment to have positive results, she is recommended to change her lifestyle: follow a proper diet, be physically active, give up bad habits, and so on. If necessary, classes with a psychologist are included in the treatment plan.
Медикаментозное лечение подбирается в соответствии с формой заболевания и учитывает перечень имеющихся симптомов. It is also necessary to take into account the data of the observation diary so that the prescribed treatment coincides or is ahead of the appearance of signs of PMS.
When neuropsychiatric abnormalities are assigned sedatives and psychotropic drugs. In the second phase of the cycle, oxazepam, diazepam, amitriptyline and others are recommended.
In severe edematous forms, antihistamines (Tavegil, Suprastin and others) or light diuretics such as Spironolactone help. Antihypertensive drugs help to normalize blood pressure, eliminate high levels of prolactin with Parlodel.
Homeopathic remedies have gained much popularity for the treatment of PMS. Among them are herbal non-hormonal drugs that can restore the normal functioning of the nervous system, eliminate swelling and stabilize hormones. The presence of a large number of homeopathic remedies does not imply their independent reception without prior conversation with the doctor.
PMS has a large number of symptoms in its arsenal; therefore, for each patient, individual methods of their elimination are selected.
When expressed hormonal abnormalities resort to the use of hormonal agents. They restore the normal ratio of hormones according to the phases of the cycle. Apply gestagens (Utrozhestan, Duphaston) or monophasic agents like Logest.
To make the treatment more successful, it is necessary to exclude the onset of ovulation. This task is handled by Zoladex and his ilk.
If PMS repeatedly recurs, hormonal drugs are prescribed for a long time in a continuous rhythm.
PMS therapy lasts several months, and in case of relapses, it has to be repeated. Treatment is considered successful in case of reduction in the severity of PMS symptoms or their complete disappearance.