Premenstrual syndrome – cyclically repeating simptomokompleks which is observed in the second half of a menstrual cycle (in 3 - 12 days prior to periods). Has an individual current, it can be characterized by a headache, sharp irritability or a depression, tearfulness, nausea, vomiting, a skin itch, hypostases, belly-aches and in heart, heartbeat attacks etc. Hypostases, skin rashes, a meteorizm, a painful nagrubaniye of mammary glands are quite often observed. In hard cases neurosis can develop.
Premenstrual syndrome, or PMS, vegeto-vascular, neuromental and exchange and endocrine disorders are called arising during a menstrual cycle (more often in the second phase). The synonyms of this state which are found in literature are the concepts "premenstrual disease", "syndrome of premenstrual tension", "cyclic disease". With premenstrual a syndrome every second woman aged after 30 years is not by hearsay familiar, up to 30 years this state occurs at women slightly less often - in 20% of cases. Besides, manifestations of a premenstrual syndrome usually are satellites emotional and unstable, thin, asthenic type of a constitution of the women who more often are engaged in an intellectual field of activity.
Reasons of a premenstrual syndrome
So far the gynecology as science cannot unambiguously tell what factors and the reasons are the cornerstone development of a premenstrual syndrome. It is considered that are promoted emergence and heavier current of PMS by earlier postponed stresses, neuroinfections, surgical termination of pregnancy (abortion), injuries and operations, and also various gynecologic and all-somatic diseases creating a background for manifestations of a premenstrual syndrome.
The most widespread is the opinion that the reasons defining development of a premenstrual syndrome are the hormonal fluctuations happening in a female body during a menstrual cycle. These observations are the cornerstone of hormonal theories of an origin of a premenstrual syndrome.
One of theories considers as the fundamental reason of a premenstrual syndrome - change of a ratio of hormones of progesterone and estrogen in the second half of a menstrual cycle. Surplus of production of estrogen conducts to a liquid delay in fabrics, to hypostases, swelling of mammary glands, cardiovascular violations. Influence of estrogen on structures of a brain causes neuro violations – a depression or aggression, irritability, tearfulness etc. Other hormonal theory connects a premenstrual syndrome with hyper secretion of hormone of Prolactinum causing a delay of water and sodium, change in chest glands.
In development of a premenstrual syndrome a certain role of prostaglandins – the gormonopodobny substances which are produced in body tissues and participating in regulation of many physiological processes is also proved. Excess of prostaglandins causes migrenepodobny headaches, digestive frustration, vegeto-vascular reactions.
Other numerous theories consider as the causes of a premenstrual syndrome of disorder of water-salt exchange (the theory of water intoxication), deficiency of vitamins (vitamin A, B6) and minerals (calcium, magnesium, zinc), a genetic factor, hypothalamic violations. A number of researchers believes that the premenstrual syndrome is caused by the whole complex of the reasons which are individual in each clinical case. Therefore diagnostics of a premenstrual syndrome has the specifics and certain difficulties.
Symptoms of a premenstrual syndrome
Proceeding from the leading symptoms accompanying a premenstrual syndrome distinguish the following forms of frustration: neuromental, the tsefalgicheska, is edematous, krizovy, atypical. Often these forms of a premenstrual syndrome do not exist separately therefore treatment of PMS usually has symptomatic character.
Violations in emotional and nervous spheres are characteristic of a neuromental form of a premenstrual syndrome: sleeplessness, weakness, instability of mood, irritability, tearfulness, aggression, fatigue, causeless melancholy, a depression (up to suicide thoughts), unreasonable sensation of fear, sexual violations, acoustical and olfactory frustration, dizziness. Against the background of neuromental disorders violations are also noted from appetite, a meteorizm (abdominal distension), morbidity and a nagrubaniye of chest glands.
In a clinical picture of a tsefalgichesky form of a premenstrual syndrome leaders are vegeto-vascular and neurologic symptoms: migrenepodobny attacks of a headache, a diarrhea, heartbeat, pains in heart, hypersensitivity to smells and sounds, nervousness, sleeplessness. The headache pulsing in temples, which is followed by puffiness a century, nausea and vomiting is characteristic. The Tsefalgichesky form of a premenstrual syndrome often develops at the women with the burdened anamnesis who had craniocereberal injuries, neuroinfections, heavy stresses. From the accompanying pathologies these women usually have cardiovascular pathology, hypertensia, gastrointestinal diseases.
At an edematous form of a premenstrual syndrome the interstitial delay of liquid and face edemas connected with it and extremities, increase in weight, thirst, the lowered mocheotdeleniye becomes the leading manifestation. Besides, the nagrubaniye of mammary glands, a skin itch, digestion violation (a meteorizm, locks, ponosa), head and articulate pains etc. are noted.
The current of a krizovy form of a premenstrual syndrome is shown by the simpato-adrenalovy crises which are characterized by attacks of rise in arterial pressure, tachycardia, cardiac pains without deviations on the ECG, panic fear. The termination of crisis, as a rule, accompanies a plentiful mocheotdeleniye. Quite often attacks are provoked by stresses and reexhaustions. The Krizovy form of a premenstrual syndrome can develop from uncured tsefalgichesky, neuromental or edematous forms and is usually shown after 40 years. As a background for course of a krizovy form of a premenstrual syndrome serve diseases of heart, vessels, kidneys, a digestive tract.
Carry to cyclic manifestations of atypical forms of a premenstrual syndrome: temperature increase of a body (in the second phase of a cycle to 37,5 °C), a gipersomniya (drowsiness), oftalmoplegichesky migraine (headaches with glazodvigatelny violations), allergic reactions (ulcer stomatitis and ulcer gingivit, the astmoidny syndrome, unrestrained vomiting, iridotsiklit, Quincke, etc. swelled).
When determining weight of a current of a premenstrual syndrome proceed from the number of symptomatic manifestations, allocating an easy and severe form of a premenstrual syndrome. The easy form of a premenstrual syndrome is shown by 3-4 characteristic symptoms appearing in 2-10 days prior to the beginning of periods or existence 1-2 considerably of the expressed symptoms. At a severe form of a premenstrual syndrome the quantity of symptoms increases till 5-12, they appear in 3-14 days prior to the beginning of periods. At the same time all of them or several symptoms are expressed considerably.
Besides, an indicator of a severe form of a current of a premenstrual syndrome always is working capacity violation, regardless of expressiveness and the number of other manifestations. Decrease in working capacity is usually noted at a neuromental form of a premenstrual syndrome.
It is accepted to allocate three stages in development of a premenstrual syndrome:
- compensation stage – symptoms are shown in the second phase of a menstrual cycle and pass from the beginning of periods; the current of a premenstrual syndrome over the years does not progress
- subcompensation stage – the quantity of symptoms increases, their weight is aggravated, manifestations of PMS accompany all periods; with age the current of a premenstrual syndrome is made heavier
- decompensation stage – the early beginning and the late termination of symptoms of a premenstrual syndrome with insignificant "light" intervals, a heavy current of PMS.
Diagnostics of a premenstrual syndrome
The main diagnostic criterion of a premenstrual syndrome is recurrence, periodic character of the complaints arising on the eve of periods and their disappearance after periods.
The diagnosis "a premenstrual syndrome" can be made on the basis of the following signs:
- Condition of aggression or depression.
- Emotional unbalance: differences of mood, tearfulness, irritability, conflictness.
- Bad mood, feeling of melancholy and hopelessness.
- Condition of alarm and fear.
- Decrease in an emotional tone and interest in the taking place events.
- Increased fatigue and weakness.
- Decrease in attention, memory impairment.
- Change of appetite and flavoring addictions, symptoms of bulimia, increase in weight.
- Sleeplessness or drowsiness.
- Painful tension of mammary glands, hypostases
- Head, muscular or articulate pains.
- Deterioration in a course of chronic ekstragenitalny pathology.
Manifestation of five of above-mentioned signs at obligatory existence at least allows to tell one of four first about a premenstrual syndrome with confidence. An important link of diagnostics is conducting introspection by the patient of the diary in which she throughout 2-3 cycles has to note all violations in the health.
The research in blood of hormones (an estradiol, progesterone and Prolactinum) allows to establish a form of a premenstrual syndrome. It is known that the edematous form is followed by reduction of level of progesterone in the second half of a menstrual cycle. Tsefalgichesky, neuromental and krizovy forms of a premenstrual syndrome are characterized by increase in Prolactinum level blood. Purpose of additional methods of diagnostics is dictated by a form of a premenstrual syndrome and the leading complaints.
The expressed manifestation of cerebral symptoms (headaches, faints, dizziness) is the indication for carrying out MPT or KT of a brain for an exception of its focal defeats. At neuromental, edematous, tsefalgichesky and krizovy forms of a premenstrual cycle results of EEG are indicative. In diagnostics of an edematous form of a premenstrual syndrome the large role is played by measurement of a daily diuresis, the accounting of amount of the drunk liquid, conducting tests for a research of secretory function of kidneys (for example, Zimnitsky's test, Reberg's test). At a painful nagrubaniye of mammary glands performing ultrasonography of mammary glands or mammography is necessary for an exception of organic pathology.
Inspection of the women suffering from this or that form of a premenstrual syndrome is carried out with participation of doctors of various specialties: neurologist, therapist, cardiologist, endocrinologist, psychiatrist etc. The appointed symptomatic treatment, as a rule, leads to improvement of health in the second half of a menstrual cycle.
Treatment of a premenstrual syndrome
In treatment of a premenstrual syndrome medicamentous and non-drug methods are applied. Non-drug therapy includes psychotherapeutic treatment, observance of the mode of work and good rest, physiotherapy exercises, physical therapy. An important point is observance of the balanced food allowance with the use of enough vegetable and animal protein, vegetable cellulose, vitamins. In the second half of a menstrual cycle it is necessary to limit the use of carbohydrates, animal fats, sugar, salt, caffeine, chocolate, alcoholic drinks.
Drug treatment is appointed by the specialist doctor taking into account the leading manifestations of a premenstrual syndrome. As neuromental manifestations are expressed at all forms of a premenstrual syndrome, practically reception of sedative (soothing) medicines some days before alleged emergence of symptoms is shown to all patients. Symptomatic treatment of a premenstrual syndrome assumes use of soothing, diuretic, antiallergic medicines.
The leading place in drug treatment of a premenstrual syndrome is taken by specific hormonal therapy by progesterone medicines analogs. It is necessary to remember that treatment of a premenstrual syndrome is the long, sometimes proceeding throughout all reproductive period process demanding from the woman of internal discipline and steady implementation of all doctor's instructions.