We talk all the time about how embarrassed we are when we yell and get irritated with kids, but if you're sick, for example, it's doubly difficult to keep your composure. Just imagine, you are sick with the flu, do you have children jumping on your head? Most likely, the partner understands that the flu is a serious illness, and will try to take care of the children. With PMS, the story is quite different. Premenstrual syndrome is usually perceived as a kind of "female hysteria", some kind of "women's little things." "What are your days?" - a classic sexist argument in any conflict between a man and a woman. In fact, PMS is not nonsense or whims at all, but a serious disease that requires intervention and treatment. Yes - it is very difficult for a woman suffering from PMS to be understanding and calm, because she does not feel well. Psychiatrist Sergey Kistenev said on his blog why PMS is serious and what to do about it.

Modern ideas and tactics of conducting

Many women of reproductive age experience irritability, weakness, outbursts of aggression or depression about once a month. According to some reports, up to 40% of women experience certain inconveniences in the second phase of the cycle. Some of them have reconciled and consider it their "highlight", but most still feel significant discomfort. As you may have guessed, we will talk about PMS.

Premenstrual syndrome (PMS) is a real disorder that needs to be diagnosed and treated, and not hushed up and waiting for menopause as a relief.

Premenstrual syndrome is a complex psychoendocrine disorder that affects a woman's emotional and physical well-being. In a broad sense, PMS is a combination of emotional, behavioral and somatic disorders that begin in the luteal (prior to menstruation) phase of the menstrual cycle and end with the onset of menstruation. Quite unpleasantly, premenstrual dysphoric syndrome (PMSD) proceeds - a variant of the severe course of PMS, in which mood and behavior disorders can turn into aggression.

How do you know if you have PMS?

• First, if you've never thought about it, most likely not.
• Secondly, you can refer to the options for the course of PMS.

Clinical classification of PMS

The clinical classification according to the forms of premenstrual syndrome, which quite fully describes the possible variants of clinical manifestations, is given below.

Neuropsychic form (dysphoric)

The clinic is dominated by mood disorders, aggressiveness, irritability, depression, apathy, tearfulness.

edematous form

Characterized by the formation of edema, fluid retention, bloating, swelling of the mammary glands.

Cephalgic form

Patients complain of headaches, increased sensitivity to light and sound, depressed mood, headache, which is sometimes accompanied by nausea and vomiting.

crisis form

Reminds me of panic attacks. A woman may experience acute fear, which is accompanied by sweating, tachycardia, chest pain.

The frequency of occurrence of these forms depends on age, for example, at 16-20 years old and at 25-34 years old, as a rule, a neuropsychic (dysphoric) form occurs, and at 20-24 years old - an edematous form. There is no clear justification for such a distribution by age, but statistically the edematous form occurs more often in this age group: 20-24 years. Crisis and cephalgic forms are less common, their origin may be associated with stress.

If you have the symptoms described above, and they interfere with your activity in the days before your period, this is an occasion to consult a gynecologist.

I want to separately focus on premenstrual dysphoric syndrome (the most severe form of PMS). Often a woman writes off PMDS as a feature of her character. This is quite paradoxical, because objectively she suffers from this. I want to give the most reliable diagnostic criteria for PMDS, so that any woman who finds them in herself will realize that she needs to seek help.

Clinical criteria for PMDS according to DSM (Diagnostic and Statistical Manual of mental disorders):

(BUT) During the last year, in most menstrual cycles (at least three), five (or more) of the symptoms listed below are observed, with one of them from the first four; symptoms persist during the last week of the luteal phase, disappear a few days after the onset of menstruation, are absent within a week after menstruation:

• sadness, hopelessness, self-condemnation (belittling one's own value);
• tension, anxiety;
• pronounced lability of mood with intermittent bouts of tearfulness;
• constant irritability, anger, conflict;
• decreased interest in habitual activities, which may be associated with alienation from social ties;
• difficulty concentrating;
• fatigue, lack of energy, drowsiness;
• changes in appetite with overeating or a need for specific (sometimes inedible) foods;
• hypersomnia or insomnia (insomnia);
• subjective feeling of being overwhelmed or lacking control;
• somatic symptoms (tension or pain in the mammary glands, a feeling of swelling of the body or weight gain, headaches, joint and muscle pain).

(B) These symptoms prevent:

• professional activity,
• learning, as well as habitual social activity,
• interpersonal relationships.

(AT) The symptoms are not the result of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or personality disorder (although they may overlap with any other disorder).

Dysphoria and fatigue in the premenstrual period may be associated with an exacerbation of a somatic disease (endocrine disorders, oncological pathology, systemic lupus erythematosus, anemia, endometriosis, various infections). The differential diagnosis in these cases is aided by (1) history data, as well as data from (2) laboratory tests and (3) physical examination.

The basis for the diagnosis is the cyclicity of symptoms. For a definitive diagnosis of PMDS, criteria A, B, and C (simultaneously) must be observed for two menstrual cycles.

Treatment or who to go to

Treatment of premenstrual syndrome is carried out by a gynecologist, but if the course becomes complicated and mood and behavior disorders appear, then a psychiatrist should be consulted.

Treatment methods:

• Non-drug method: Physical activity, normalization of the work regime, sex, rest.
• This method is effective only at the initial stage and you should not rely on it, if complaints do not go away within two cycles, it is better to visit a doctor immediately.
• Hormonal treatment: the gold standard for treating PMS, prescribed by a gynecologist.
• Oral contraceptive (OC) therapy is used to suppress ovulation.
• Antidepressants: this group of drugs is used if the symptoms of PMS have not been reduced during OC therapy for two complete cycles.
• The second option is if a woman does not want to use OK or there are contraindications for their use. For the correct appointment of antidepressants, you need to seek the advice of a psychiatrist.
• Other methods: tranquilizers, non-steroidal anti-inflammatory drugs, diuretics. They are used only symptomatically and cannot replace the main method of therapy!!!

Debunking the Myths

The development of PMS and PMDS is NOT affected by:

• Family status;
• Amount of children;
• Irregular sexual contacts;
• Early or late age of onset of menstruation;
• cycle length;
• Use of OCs or other hormonal methods of contraception (contraceptives may be a method of treating PMS and PMDS, but not provoke their occurrence).

In fact, the risk factors for developing PMS and PMDS are:

• stress,
• obesity (BMI over 30),
• diabetes,
• asthma,

• sexual infections.

Depression and anxiety (which is observed regardless of the phase of the cycle. There is an increase in symptoms before menstruation). COCs can exacerbate depressive symptoms, so at least a screening test for depression should be performed before prescribing. In the presence of depression, it is better to discuss the tactics of prescribing COCs with a psychiatrist.

In conclusion, I would like to say: dear women, be healthy. But if you suddenly find yourself in the condition described above, or one of your loved ones suffers from it or, perhaps, is unsuccessfully treated with folk remedies (mint, valerian, celery), you do not need to wait for a miracle and suffer, seek medical help.

Sources:

1 Usman S, Indusekhar R, and O'Brien S. Hormonal management of premenstrual syndrome. Best Pr. Res Clinic Obs. Gynaecol, 2008, 22: 251–60.

2 Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990GÇô2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2163–2196

3 Yureneva S. V., Prilepskaya V. N., Ledina A. V. Premenstrual syndrome and premenstrual dysphoric disorder.

4 Guidelines for outpatient care in obstetrics and gynecology, 3rd, rev. V. N. Serov, G. T. Sukhikh, V. N. Prilepskaya, V. E. Radzinsky. M.: GEOTAR-Media, 2016: 895–907.

4 Schiller CE, Johnson SL, Abate AC, Schmidt PJ, and Rubinow DR. Reproductive Steroid Regulation of Mood and Behavior. Compr. Physiol., 2016 July, 6: 1135–1160.

5 Power RF, Mani SK, Codina J, Conneely OM, O'Malley BW. Dopaminergic and ligand-independent activation of steroid hormone receptors. Science, 1991, 254(5038): 1636–1639.

Premenstrual syndrome: symptoms of PMS in women, causes and treatment. What is premenstrual dysphoric syndrome

Premenstrual syndrome, or PMS, is part medical and part social. In everyday life, many women suffer from this disease. PMS is a nosological unit included in ICD 10. And in ICD 11 it will be considered an interdisciplinary disease.

It has long been known that women before menstruation, to put it mildly, change.

"It's like a storm - they become picky, irritable and grumpy, sometimes turn into real furies, which everyone fears and avoids."

R. Kraft-Ebing, 1895

This description is more appropriate for premenstrual dysphoric disorder. But PMS is also two facets of the same state.

• PMS - what is it and when does it start?
• Prevalence
• Causes of premenstrual syndrome
  • Violations of water-salt metabolism
  • Hyperprolactinemia
• PMS symptoms in women
  • Diagnostics
  • Physical symptoms of premenstrual syndrome in women
  • Mental manifestations and signs of PMS
  • premenstrual dysphoric disorder
  • Severity of PMS symptoms
  • Cyclicity of signs
• How to deal with PMS
• Medical treatment

What is premenstrual syndrome (PMS) and when does it start?

Premenstrual syndrome or PMS is a complex pathological complex of symptoms: neuropsychic, vegetative-vascular, metabolic-endocrine disorders, which combines at least 3-4 pronounced symptoms that appear 2-14 days before menstruation and disappear during the first days of menstruation.

There are many other modern definitions, but they all come down to these criteria: PMS symptoms appear before menstruation, and disappear in the first days of menstruation.

PMS is one of the maladjustment diseases, which is an inadequate response of the brain to unbalanced fluctuations in the levels of sex hormones during the ovulatory menstrual cycle. This happens not because the levels of hormones are inadequate, but because the stress-decompensated nervous system cannot give an adequate response to physiological fluctuations in the hormonal background.

Important! The characteristics of the menstrual cycle practically do not change; ovulation is characteristic of premenstrual syndrome.

The prevalence of premenstrual syndrome

Up to 75% of women have premenstrual symptoms, of which PMS is diagnosed in 25%. Of these, 4% of women of reproductive age have premenstrual dysphoric disorder.

Causes of PMS

The hypothalamus is involved in the pathogenesis of PMS. It is at the level of dysfunction of the hypothalamus that autonomic, psychological and other dysfunctions develop, which can be combined into premenstrual syndrome. The hypothalamus regulates fluid exchange in the body, regulates stress, eating behavior, and performs many other functions. All symptoms of PMS are directly dependent on changes in the regulation in this organ.

The main theory for the development of premenstrual syndrome is a violation at the level of the hypothalamus. The pathogenesis involves the limbic system and higher parts of the central nervous system.

The old theory was that the cause of PMS was the toxic effect of hormones on the nervous system. In modern views, we are not talking about toxic, but about an unbalanced influence and an unbalanced response of the nervous system to a normal change in the constants of the hormonal background.

In the second phase of the menstrual cycle at the level of the brain (not in the systemic circulation), the ratios change:

• progesterone and estrogen;
• progesterone and androgens;
• there is a change in the metabolism of all sex hormones.

All this leads to the appearance of signs of premenstrual syndrome.

The production of steroid hormones and their metabolism affects the level of neurotransmitters:

• norepinephrine;
• epinephrine;
• dopamine;
• serotonin;
• opioid peptides.

In the pathogenesis of PMS, the most interesting are violations of dopaminergic and serotonic regulation. These reasons lead to the appearance of such symptoms of PMS as:

• mood variability;
• violations of all types of behavior, including food;
• the appearance of somatic symptoms;
• change in mental behavior.

Premenstrual syndrome is realized at the level of the central nervous system, is inextricably linked with a change in the balance and metabolism of hormones, neurotransmitters at the level of the central nervous system.

Violations of water-salt metabolism as the cause of PMS

In the development of premenstrual syndrome, there is a peripheral effect of hormones on the renin-angiotensin-testosterone system. An imbalance of estrogen and progesterone can lead to fluid retention. Edema in PMS is one of the most important somatic manifestations of the syndrome: swelling of the face, limbs, the appearance of internal edema. Fluid retention in the female body leads to pain symptoms.

Hyperprolactinemia in the pathogenesis of premenstrual syndrome

Prolactin is one of the main adaptogens, it affects more than 80 body functions, including the mental and physical spheres. When transient hyperprolactinemia is involved in the pathogenesis of PMS, women experience mastalgia (chest pain), mastodynia (discomfort, increased sensitivity and a feeling of swelling of the mammary glands).

Mastalgia and mastodynia are the most common signs of PMS (75-85%), they are not always associated with an excess of prolactin in the blood. These manifestations may be a manifestation of fluid retention. Treatment of transient hyperprolactinemia in PMS is part of the therapeutic approach.

Hyperprolactinemia is well corrected by preparations of Prutnyak ordinary (Prutnyak sacred, Abraham tree). plant action:

• has a dopaminergic effect;
• normalizes elevated prolactin levels;
• affects opioid receptors;
• pronounced antioxidant effect.

All these effects are scientifically proven and useful for the treatment of physical and mental symptoms of PMS.

PMS symptoms in women

The symptoms of PMS in women vary in severity. Most women feel them, and feel the approach of menstruation. Very rarely, PMS symptoms are pleasant. If the signs of PMS are mild and do not limit the activity of a woman in any way, in this case PMS is not a disease, but simply premenstrual well-being.

Premenstrual syndrome is those symptoms that make you feel so bad that they are already a complaint that limits activity and is a reason to see a doctor.

The most severe premenstrual dysphoric symptoms include behavioral disturbances and are the most severe degree of PMS.

Diagnosis of PMS

PMS becomes a disease when it interferes with a woman's quality of life. This determines the complexity of diagnosis, because the quality of life is a subjective concept. It is difficult for a doctor to assess how pathological each of the symptoms of premenstrual syndrome is. Therefore, there is no complete unity in medical circles on the diagnosis of PMS.

Premenstrual syndrome is considered a disease if its symptoms:

• changes the habitual way of life;
• reduces the quality of life;
• leads to a decrease in performance;
• disrupts relationships with others.

Physical symptoms of PMS

The most common somatic symptoms of PMS are:

• flatulence;
• puffiness;
• breast engorgement and soreness;
• hot flashes, sweating;
• nausea, vomiting, constipation, dyspepsia;
• tachycardia, pain in the heart;
• increased sensitivity;
• headache;
• skin rashes, acne;
• dizziness.

These signs are common, but not required for the diagnosis - premenstrual syndrome. Among the physical symptoms, there are more than 100 different ailments.

Mental symptoms of PMS

The most common signs of premenstrual syndrome on the part of the psyche:

• restlessness, anxiety;
• depression;
• emotional instability;
• weakness, fatigue;
• drowsiness;
• bulimia;
• aggressiveness;
• tearfulness;
• violation of concentration;
• memory loss;
• emotional isolation;
• increased appetite.

The American College of Obstetricians and Gynecologists considers that 1 of the following somatic or emotional symptoms of PMS* is sufficient to make a diagnosis.

Table 1.

* - the sign leads to disturbances in the social or daily life of the patient.

premenstrual dysphoric disorder

Premenstrual dysphoric disorder is more of a mental illness that should be treated by psychiatrists. But most often women turn to gynecologists.

Premenstrual dysphoric syndrome is 5 of the following signs that are determined in the premenstrual period.

*Attention! One of them must be the main one (with an asterisk) and any 4 more (with or without an asterisk).

Symptoms should recur in most menstrual cycles within a year as retrospective confirmation and 2 cycles as prospective confirmation.

Severity of PSM symptoms

To assess the severity of PMS symptoms, there is a visual analogue scale from 0 to 10.

Assessing the cyclicity of PMS symptoms

To determine the cyclicity of PMS symptoms, the manifestations are assessed retrospectively and prospectively on certain days of the menstrual cycle. Expert advice on diagnosing premenstrual syndrome recommends:

1. Assess symptoms for 14 days before the end of the ovarian cycle and 5 days after the onset of menstruation.
2. For initial screening, 2 of the last 3 MCs are taken.
3. With PMS, the duration of the symptomatic period should be from 2 to 14 days. That is, the symptom should not only appear, but also persist for at least 2 days, as a maximum - 14. If the symptom persists for more than 14 days, this is no longer premenstrual syndrome.
4. In PMS, there is an asymptomatic phase when signs of PMS are completely absent or are assessed as mild. The duration of the asymptomatic phase is 6-10 days of MC.
5. The symptom is absent if its severity is estimated from 0 to 3 points.

To confirm the cyclical manifestations of PMS and for the correct verification of points, it is necessary to use a diary of premenstrual observation, in which the most common symptoms of premenstrual syndrome are noted and you can enter your own signs that are not indicated in the table by the doctor. A woman who disturbs her symptoms notes with points. This allows assessing the severity of tolerated signs and determining the presence of an asymptomatic period. The diagnosis of PMS is made when there is a significant difference in the 1st and 2nd phases of the menstrual cycle.

How to deal with PMS

It is unlikely that it will be possible to completely overcome the symptoms of PMS, but if they interfere with life, their manifestations can be reduced.

What you need to do to cope with the manifestations:

1. No matter how trite it sounds, but first of all, a lifestyle correction is necessary.
2. The second is medical correction.

1. Balanced diet. In the list of symptoms of premenstrual syndrome, many of the signs are associated with changes in eating behavior and eating (increased appetite, bloating, nausea, vomiting, constipation). Edema is also potentiated by taking spicy, salty, smoked foods. As a result, blood pressure rises, headaches, pain in the abdomen appear.

Therefore, for women with symptomatic eating disorders, food diaries are recommended. It is necessary to write down in the diary everything that was eaten and drunk. It is important to make a ritual out of the process of eating and avoid foods that provoke PMS. It is necessary to take foods with a high content of tryptophan:

• fish;
• meat;
• legumes;
• cottage cheese;
• oats;
• dates;
• peanut.

This will reduce the lack of serotonin in the central nervous system and thereby reduce the manifestations of PMS, for which he is "responsible".

1. The second most important aspect is sleep hygiene. It is necessary to fall asleep and wake up in a semi-automatic mode. Don't let the worries of the day torment you at night. There are many techniques for this, one of them is the thought control sheet. Its essence: in the evening, thoughts that will inevitably interfere with sleep, write out on a sheet, and next to them is their decision.

The bed is a place for sleeping and making love, not for watching TV or eating.

The way to wake up from sleep is morning exercises. It will allow you to switch from sleep mode to waking mode.

1. Exercise stress. For the correct treatment of PMS, proper physical activity is very important (especially with cardiovascular symptoms of PMS - increased blood pressure, headaches, swelling). If you practice every day for 30-40 minutes, then it will be an average or fairly large physical activity. It is this intensity (3-4 points on the Borg scale) that will help improve the condition and reduce the severity of PMS manifestations.

One of the types of physical activity is walking in the fresh air. it's the same a good choice in favor of anti-stress therapy.

1. Anti-stress therapy has a wide range of activities, from drawing to yoga and meditation. Choose an activity that will calm you down. Remember that stress translates into elevated prolactin levels. Therefore, calming techniques are also able to overcome PMS.

Treatment of premenstrual syndrome

There are drugs to treat PMS. But there is no single scheme, due to the multiplicity of manifestations of the syndrome and different pathogenesis.

Medicines that are prescribed for the treatment of PMS:

Cyclodinone 1 tablet or 40 drops 1 time per day in the morning for at least 3 months without a break for menstruation. After the disappearance of symptoms and improvement of the condition, therapy is continued for several weeks. If after discontinuation of the drug there is a deterioration in the condition, then a second consultation with the doctor is necessary.

Mastodinone is a combined medicinal phytopharmaceutical preparation. It helps to normalize hormonal levels, improves well-being during critical days and eliminates pain in the mammary glands. In the indications for the use of the drug, the treatment of PMS is not indicated, since it has a wider effect than that of Cyclodinone.

Spironolactone is a potassium-sparing diuretic drug used in the treatment of premenstrual syndrome. The main action is an antagonist of aldosterone receptors. It is used if there is fluid retention in the woman's body in the mechanism of PMS occurrence.

Psychiatrists have a wider range of drugs in their hands. Taking these drugs is associated with some difficulties:

• side effects;
• are addictive;
• there is no possibility of long-term use;
• limiting certain activities, such as driving a car;
• do not affect the symptoms of fluid retention.

For the treatment of PMS, psychiatrists use the following drugs:

• neuroleptics, phenothiazine derivatives;
• antidepressants: fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, agomelatine.
• benzodiazepine tranquilizers.

Most of these drugs can only be prescribed by psychiatrists on special forms.

For therapy, hormonal drugs are also used, the action of which is aimed at suppressing hormone fluctuations within the menstrual cycle and suppressing ovulation:

• Yarina;
• Jess.

The relationship between depression and a lack of certain substances in the diet has been proven, so doctors can also prescribe them in the form of drugs:

• folic acid;
• fatty acids;
• tryptophan;
• vitamins B₆ and B₁₂;
• magnesium.

These drugs can be prescribed both as part of combination therapy and for monotherapy of premenstrual syndrome.

Remember! Treatment of PMS is based on pathogenesis, and those drugs that help one woman can harm another. Therefore, the treatment regimen should be selected only by a doctor. Self-medication is unacceptable.

The nervous state of a woman before menstruation has become an object of ridicule from men. Premenstrual syndrome (PMS) “spoils” the lives of both, often being the cause of quarrels in a couple and quarrels in the family. Therefore, what is PMS in girls, men should also know.

Women who have experienced all the “charms” of PMS know for sure that this is not a series of whims, but a really difficult condition. However, only a few of them are able to cope with the manifestations of hormonal changes in the body. Modern medicine provides such an opportunity: compliance with certain rules and the use of safe drugs will help you survive the premenstrual period without shocks and depression.

PMS in women - transcript

What it is? PMS is a special condition of a woman a few days before menstrual bleeding, characterized by emotional instability, vegetative-vascular and metabolic abnormalities. The abbreviation "PMS" stands for Premenstrual Syndrome. To make it clear what constitutes premenstrual syndrome, we will answer frequently asked questions:

• Premenstrual syndrome: are men right when they mock a woman's condition?

This time the men are clearly wrong. Premenstrual syndrome is included in the WHO classification. This means that the world medical community recognizes this deviation.

• Does PMS happen to all women?

Every second woman faces premenstrual syndrome. Moreover, the incidence of PMS and the severity of its symptoms increases with age. So, up to 30 years, only 20% of women suffer from it, after 30 - every third, and after 40 years, PMS occurs in 55-75% of women.

• Why does premenstrual syndrome occur?

Doctors do not give a definite answer. Hormonal fluctuations before menstruation, as the cause of PMS, are not always justified. In some women, changes in the levels of the hormones progesterone and estrogen are not as significant. Closest to the truth is the theory of a temporary change in neuroregulation.

• How many days before menstruation do PMS symptoms appear?

A woman's condition changes 2-10 days before the onset of menstrual bleeding. The duration of this period and the severity of its manifestations is individual. However, all painful sensations necessarily stop in the first days of menstruation.

• Do you have to endure premenstrual syndrome?

Not at all necessary. To alleviate menstrual syndrome, several rules have been developed for the daily routine and nutrition. Also, in the case of its pronounced manifestations, the gynecologist may prescribe some medications (they will be discussed below).

• Does PMS go away after childbirth?

In some women, premenstrual syndrome is initially absent and may appear after childbirth. In others, on the contrary, unpleasant symptoms disappear or weaken (especially swelling and soreness of the breast) after the birth of the child.

Important! PMS and menstruation are always connected: painful symptoms disappear after the onset of bleeding.

Most often, premenstrual syndrome occurs in smokers (the probability of PMS is doubled!), women with a weight index over 30 (divide your kg by your height squared in meters). Also, the risk increases after abortion and complicated childbirth, after gynecological operations. A genetically determined reaction of the body to physiological changes before menstruation is not excluded. However, PMS is most often recorded in depressive (phlegmatic) and emotionally labile (choleric) women.

Typical symptoms of PMS

It is unlikely that there will be women with the same picture of PMS: there are about 150 signs of premenstrual syndrome. However, in such a variety of characters, the main groups can be distinguished. Symptoms of PMS in women:

• Deviations from the nervous system and psyche

The mood of a woman can be called in one word - negative. She may cry for nothing or for no reason at all. Ready to “tear to shreds”, the degree of aggression also does not coincide much with the offense inflicted. At best, a woman is in a depressed state and experiences irritability, which she cannot always cope with.

• Hormonal changes

Due to the increased level of progesterone for 1-2 weeks. before menstruation, a woman noticeably increases and engorges the mammary glands. Many women need a bra one size larger than usual during this period. The bursting soreness in the chest can be so intense that ordinary walking causes discomfort.

In some women, veins protrude on the skin of the mammary glands. At the same time, swelling of the hands and face can be observed, and swelling on the legs at the end of the day becomes more noticeable. Often, an increase in temperature to 37.0-37.2ºС is recorded. Often the stomach increases in size due to the accumulation of gases and constipation.

• Autonomic disorders

During PMS, a throbbing headache often occurs, radiating to the eye area. Attacks are similar to migraines, sometimes accompanied by nausea and vomiting, but the pressure remains normal.

PMS after 40 years, when hormonal changes are aggravated by concomitant diseases, often provokes pressure rises in the evenings (hypertensive crisis), tachycardia (palpitations), shortness of breath and pain in the heart.

Premenstrual syndrome can occur with a predominance of certain symptoms (edematous, cephalgic, crisis), but most often a mixed form is diagnosed. Almost every woman suffering from PMS experiences:

• constant thirst and increased sweating, acne;
• dizziness and staggering, especially in the morning, and fatigue;
• desire to eat salty or sweet, increased appetite;
• heaviness in the lower abdomen and spastic pains, irradiation to the lower back is most often due to a prolonged inflammatory process in the genital organs (thrush, chronic adnexitis, etc.);
• goosebumps and less commonly numbness of the fingers and toes associated with vit. B6 and magnesium;
• rejection of strong odors, even your own perfume.

Severe PMS is diagnosed when there are 5-12 severe symptoms.

Premenstrual syndrome can proceed according to the following scenarios:

• Compensation stage - the signs of PMS are not very pronounced, they disappear immediately with the onset of menstruation. The course is stable, progression of symptoms over the years is not observed.
• Stage of subcompensation - the severity of symptoms increases over the years, as a result, the woman's ability to work is impaired for some time.
• Stage of decompensation - severe symptoms (hypertensive crises, fainting, etc.) disappear only after a few days after the end of menstrual bleeding. Women have panic attacks, suicidal thoughts are not uncommon. During PMS, women often show violence, especially towards their children (they beat them severely).

With severe symptoms of PMS, a sick leave is acceptable. However, severe premenstrual syndrome can be a reason for refusal when applying for a job. In European countries, during a divorce, if the ex-wife has a pronounced PMS, the children can be left with their father.

Premenstrual syndrome or pregnancy

The symptoms of premenstrual syndrome are very similar to those of pregnancy. The main question of women is how to distinguish: PMS or pregnancy? It is almost impossible if you do not take a pregnancy test or wait some time for menstruation. However, according to some signs, pregnancy can be assumed:

• Only during pregnancy there is a perversion of taste. In addition to cravings for salty or sweet, as with PMS, a pregnant woman refuses her previously favorite food and expresses an acute desire to consume chalk, earth. There may be an addiction, for example, to fat, which the woman could not bear before.
• Pungent odors in a pregnant woman also cause a negative reaction. In addition, a pregnant woman may experience olfactory "hallucinations": a specific smell appears in an inappropriate place.
• The pain in the lower abdomen during the onset of pregnancy is less straining, occurs periodically and has a softer, pulling character. Lower back pain appears only when there is a threat of miscarriage or at later stages of pregnancy.
• Mood swings can occur as early as the first weeks of pregnancy, which coincides in time with the period of PMS. However, a pregnant woman expresses positive emotions as violently as anger. The premenstrual period is characterized by a negative emotional reaction.
• Rapid fatigue occurs closer to 1 month. pregnancy (approximately 2 weeks delay in menstruation).
• PMS ends with the onset of menstruation. In this case, full-fledged uterine bleeding occurs. Sometimes during pregnancy, spotting also occurs on the days when menstruation is due. The difference between bleeding during pregnancy and menstruation is a smearing character: only a few drops of blood are released, and the discharge is pink or brownish.
• Only during pregnancy, frequent urination is often observed from the first weeks. For PMS, this symptom is not typical.
• Nausea can be triggered by premenstrual syndrome and is observed throughout the day. During pregnancy, nausea and vomiting occur a little later, for 4-5 weeks. and indicate early toxicosis.

Important! An hCG test will help diagnose pregnancy. Some tests are highly sensitive and can detect pregnancy within 4 days. before the onset of the expected menstruation. However, the optimal time for the test is the 2nd day of the delay in menstruation and the next week.

It is quite possible to reduce and, at best, completely get rid of premenstrual syndrome. If the symptoms are not too severe, the following recommendations will help manage PMS without drug therapy:

• Full sleep for at least 8 hours. Walking and breathing exercises will help improve sleep.
• Physical activity - stimulates the synthesis of endorphins, which improve mood and calm the nervous system. During the premenstrual period, dancing, yoga and other relaxing practices (massage, bathing) are especially useful.
• Correction of nutrition - the rejection of sweet and fatty, the saturation of the diet with fruits and vegetables. Coffee, alcohol, energy drinks and chocolate irritate the nervous system. These products should be excluded for the period of PMS.
• Regular sex is a source of oxytocin (the hormone of happiness). In addition, the uterus relaxes, spastic pains disappear. You should not drown out the increased sexual desire: nature itself tells you what the body needs.
• Hold on to your emotions. The best tactic for the premenstrual period - I'll think about it later. Of course, you should not ignore the serious negative that coincided with PMS. But knowing that it is easy to "go too far" and say too much, it is better to postpone a serious conversation until later.
• You should not go shopping during the premenstrual period. There is a high probability of wasting money, which in the future can develop into a family conflict.

In severe cases, a woman is prescribed drug therapy:

• Pain with PMS, what to do? - let's say No-shpy. However, you should not get carried away with this drug. Having an antispasmodic effect, No-shpa in large doses can increase menstrual bleeding. A good analgesic effect is given by NSAIDs (Ibuprofen, Naproxen). It is worth remembering: Ibuprofen (Nurofen, Mig-400) is not recommended for women over 40 due to a negative effect on the heart.
• Soreness in the chest and swelling - easily eliminated by taking diuretics (Veroshpiron 25 mg, Furosemide 40 mg).
• Multivitamins - will compensate for the lack of magnesium, calcium and vit. AT 6. An excellent remedy for PMS is the drug Magne-B6, the reception lasts 1 month. followed by a repeat course. A good effect is given by the homeopathic remedy Mastodinon and a decoction of saffron.
• Removal of excitation of the nervous system - herbal preparations are most often used (Novo-Passit, Persen). Mixed tinctures of valerian and motherwort will help reduce stress and improve sleep, take 15-25 caps. 2-3 times a day or only an hour before bedtime. In severe cases, a tranquilizer Afobazol is prescribed, which effectively eliminates the state of anxiety. At the same time, the drug does not have a negative effect on the psyche, women can drive a car while taking it. It is advisable to take antidepressants (Fluoxetine, Zoloft, Paxil) and antipsychotics (Nootropil, Sonapax, Aminalon). Tranquilizers, antidepressants and antipsychotics are used only on prescription!
• Hormonal agents - oral contraceptives (Midiana, Yarina) are used to stabilize the hormonal level and level the symptoms of PMS, the course is 3 months, followed by a repeat. Prevents engorgement of the glands and swelling of the progestogen drug Drospirenone (Anabella, Angelik, Vidora).

Premenstrual syndrome is not to be tolerated. The condition with PMS, especially in women with an unstable psyche and neurosis, may worsen over time, which ultimately will negatively affect the quality of life and working capacity.

It is also worth remembering that diseases of the genital area, endocrine disorders (including hypo- and hyperthyroidism) only aggravate the course of premenstrual syndrome. Their treatment, adherence to recommendations for lifestyle changes and, if necessary, medications will help to cope even with severe PMS.

It is believed that almost every girl a few days before menstruation. The stomach pulls, my head hurts, I feel sick, and my mood jumps at an incomprehensible speed. Let's find out what the symptoms of PMS are and should we write off another quarrel on it?

How is PMS deciphered?

PMS is an abbreviation for the medical term premenstrual syndrome. This is the name of a complex of symptoms, negative deviations in the well-being and state of health of a woman. Usually occurs a few days before your period. The Mom In Me

Poor health is a direct consequence of the body's reaction to changes in the hormonal background. The diagnosis of PMS is made if similar symptoms occur every time a few days before the onset of menstruation. As a rule, the signs of PMS begin to bother girls after 20 years.

PMS symptoms in women

You need to understand that the signs of PMS are individual for each specific organism. It all depends on how sensitive he reacts to the corresponding changes in the hormonal background.

- indeed one of the most striking indicators. Moreover, it is precisely negative experiences that dominate, a girl can constantly experience unreasonable irritability, anxiety or anger. Sometimes it goes to extremes: there is a feeling of own uselessness and hopelessness. As a rule, during this period, women lose interest in the events of the world around them and "withdraw into themselves."

However, not all PMS symptoms are related to mood. As a rule, physical well-being also worsens. Shortly before menstruation, you may experience:

• increased fatigue, feeling that you are squeezed out like a lemon, mentally and physically exhausted;
• problems with concentration - even simple everyday tasks are difficult;
• sleep disturbances (insomnia or, conversely, constant drowsiness);
• a sharp increase in appetite or its deterioration, when literally "a piece does not fit into the throat";
• headaches;
• edema;
• swelling and soreness of the breast;
• pain in the abdomen, joints or muscles of the whole body.

Other symptoms may also occur during PMS. For example, some women have a slight causeless increase in body temperature (up to 37.6ºС).

How long does PMS last?

Again, everything is very individual. On average, PMS symptoms in women last from 2 to 10 days.

The duration of the syndrome is directly related to the girl's lifestyle and the amount of stress. Moreover, even long-awaited stress can become stress for the body - it is forced to sharply adapt to the new climate, which creates an additional burden on all systems.

Are medications needed?

In most cases, PMS is mild enough with only minor discomfort. Special drugs are used only to relieve individual symptoms, if they are very pronounced.

• To improve the general emotional background: sedatives and psychotropic drugs (Cipramin, Rudotel, Seduxen).
• To equalize hormonal fluctuations: hormonal preparations ("Dufaston", "Utrozhestan"). Please note that they should be prescribed only by a doctor after a preliminary examination!
• Against chest pain - Danazol, Buserelin, Zoladex.
• To reduce pain: Diclofenac, Indomethacion, Solpadein.
• From a headache with PMS: Aspirin, Analgin, Farmadol.
• To relieve severe edema: Spironolactone.

However, you should not abuse pills during PMS. They are drunk only in extreme cases. If possible, it is better to make do with traditional medicine. For example, tea with lavender and mint can help calm the nerves and get rid of mood swings, and a decoction of dandelion roots saves from sore breasts.

Separately, there are homeopathic preparations "Remens" and "Mastodinon". They are drunk in courses for a long time to restore the hormonal balance in the body and eliminate the very cause of the syndrome.

Important: If PMS pain is almost unbearable, do not rely on painkillers. You need to see a doctor as soon as possible, because this is a clear indicator of serious disorders in the body.

Myths about PMS

Myth #1: PMS happens to all women.

In fact, 50-80% of girls experience only a mild, mild ailment, and only 10% have pronounced symptoms.

Myth #2: PMS doesn't exist, women invented it.

Proponents of this theory should re-read the banal school textbook on biology. It has been proven that at the end of the cycle, the amount of female hormones - estrogens - sharply decreases in the blood. That is, changes occur at the physiological level, and not only in the head of the girl - which, of course, causes the corresponding reaction of the body.

Myth #3: You can't have sex during PMS.

Another misconception. Another thing is that in many women during this period, sexual desire decreases (although it happens the other way around). By the way, according to the results of some studies, it can help get rid of pain and improve mood.

To survive this period, it is important to surround yourself with maximum comfort. Treat yourself to new purchases, eat something delicious, take a break from work and devote time to communicating with loved ones.

Most women begin to experience bouts of intense irritation, sudden outbursts of anger, mood swings, and hypersensitivity once a month. But these are not manifestations of character traits, as some men believe, but a condition that depends on the woman's menstrual cycle. For a very long time, it was a mystery, but with the progress in the field of medicine, such a concept as PMS appeared and was explained.

PMS - what is it 1

So, what is PMS in women or premenstrual syndrome? This is a complex set of regularly recurring symptoms of a violation in the physical and psycho-emotional state of a woman, occurring a few days before the onset of menstruation. Symptoms are present in more than 25-75% of women on the planet and disappear on the first day of menstruation. Most often, PMS occurs at the age of 20-40 years and, as a rule, occurs in a mild form that does not require a visit to a doctor. But sometimes the symptoms become severe and the situation worsens every month, requiring medical attention.

It is interesting to note that not a single crime committed in the "premenstrual twilight state of mind" has been described in the past century. However, the complaints of the women themselves and their entourage about the painful situation that develops every month in the family and at work continue and even grow. And, according to studies, PMS is most susceptible to residents of large cities and women engaged in mental work. Also, a few days before the start of menstruation, women have an increased craving for shopping, which often leads to unplanned and excessive spending during shopping.

Symptoms 2

The peculiarity of PMS is that the variety of its symptoms is so great that it is hardly possible to find two women with exactly the same picture of its course. There are approximately 150 different mental and physical signs. Symptoms of the premenstrual period can be divided into groups:

● Neuropsychiatric disorders: irritability, tearfulness, aggression, etc.

● Vegetative (nerve) disorders: headache, nausea, vomiting, dizziness, blood pressure fluctuations, heart palpitations, pain in the heart area, etc.

● Hormonal disorders: breast engorgement, swelling, fever, chills, increased gas content in the intestines, itching, shortness of breath, blurred vision, thirst, etc.

Usually, the symptoms of PMS do not appear separately, but in combination with each other. If we conditionally divide the variants of manifestations of PMS, then we can distinguish several forms of this condition, the knowledge of which makes it easier to determine ways to alleviate it. 3

PMS classification 4

By belonging to a particular body system, there are several clinical forms of the implementation of premenstrual syndrome in women:

1. Neuropsychic (brain) form - includes disorders of the nervous system and emotional sphere. Patients complain of touchiness, tearfulness, irritability, increased sensitivity to sounds and smells, sleep problems, fatigue. Constipation, bloating may occur due to the accumulation of excess gases in the intestines. In adult women, a depressed state is noted, and in adolescents, attacks of aggression.

2. Edema form - occurs against the background of a temporary change in the functioning of the kidneys, when excess fluid accumulates in the tissues of the body, including the mammary glands. Patients note weight gain, swelling on the face, in the area of ​​​​the hands and legs, as well as discomfort in the chest.

3. Crisis (suddenly aggravated) form - a complex set of disorders of the cardiovascular and digestive systems, as well as kidney function. Patients report pain in the area behind the sternum, palpitations, high blood pressure, panic attacks. Often this form of PMS occurs in women during premenopause (the end of the period of childbearing ability).

4. Cephalgic form (a form with a predominance of neurological and vascular symptoms) - characterized by headaches, dizziness with nausea and vomiting, migraines.

5. Atypical form - an atypical combination of symptoms, such as choking, vomiting, fever and migraine.

6. Mixed form - a simultaneous combination of several forms of PMS. Most often we are talking about emotional and edematous forms.

There are also several stages in the development of premenstrual syndrome: 4

● Compensated stage - PMS is slightly expressed, does not progress over the years, all symptoms disappear immediately after the onset of menstruation.

● Subcompensated stage - the symptoms are so pronounced that they limit the woman's ability to work and continue to worsen over the years.

● Decompensated stage - the extreme severity of PMS, the symptoms of which disappear only a few days after the end of menstruation.

Based on the number of symptoms that form premenstrual syndrome in women, there are mild and severe severity of the disease. If three or four symptoms are present with a predominance of one of them, we are talking about a mild form of PMS. If from 5 to 12 symptoms constantly appear, of which several are most pronounced at once, a severe form of the disease is diagnosed. Due to the variety of symptoms characteristic of a number of pathologies of the neurological, hormonal and gynecological spectrum, the main and almost the only diagnostic criterion in the case of PMS is a clear connection between the existing symptoms and the approaching menstruation, as well as the cyclicity of repetition. In addition, it is necessary to take into account the peculiarities of the emotional warehouse of a woman.

Risk factors for PMS 1

If modern medicine already understands what PMS is in women, the reasons for its appearance still could not be established even as a result of numerous studies. There are many theories of its occurrence, but the hormonal theory can be called the most complete and closest to reality. She attributes the symptoms of PMS to fluctuations in sex hormone levels during the second phase of the menstrual cycle. In order for the female body to function normally, a balance of female sex hormones is necessary: ​​progesterone (“pregnancy hormone” that helps to bear a fetus), estrogens (“femininity hormones” responsible for the normal functioning of the female body) and androgens (“male hormones” that are also produced in female body). In the second phase of the cycle, the hormonal background of a woman changes and, according to this theory, the body as a whole and certain parts of the brain do not respond to this quite adequately. This is how PMS comes about.

According to doctors, the most likely factors affecting the development of premenstrual syndrome are: 5

● A decrease in serotonin levels (serotonin is a compound that controls the transmission of impulses from the brain to the body. Serotonin levels affect emotional states such as a sense of well-being, self-esteem, fear, etc.) - is a possible cause of the mental symptoms of PMS (depression, apathy, tearfulness, melancholy, etc.);

● Lack of magnesium - can cause headaches, heart palpitations, dizziness;

● Vitamin B6 deficiency - leads to fatigue, swelling, mood changes and increased sensitivity of the mammary glands;

● Genetic factor - manifestations of PMS can be inherited;

● Overweight - Women with a BMI over 30 are at particular risk (to calculate your BMI, divide your weight in kilograms by your height in meters squared);

● Smoking - doubles the chances of PMS in women;

● Consequences of abortions and complicated childbirth, gynecological pathologies, stress.

It is necessary to consult a doctor about premenstrual syndrome if its manifestations are pronounced and significantly reduce the quality of life, affecting, among other things, working capacity. After the examination, the doctor will give all the necessary recommendations to alleviate this condition and prescribe drug therapy to the patient, if there is a need for it.

How to deal with PMS 2

In most cases, doctors treat the symptoms of PMS, selecting treatment depending on the form and course of the syndrome. For example, psychotherapy sessions may be prescribed, consisting in methods of emotional unloading and behavior correction, as well as in prescribing the intake of certain sedatives. Anti-inflammatory drugs are prescribed for headaches and other pains. Diuretics are prescribed to remove excess fluid from the body. 6

If the test results show the insufficiency of the second phase of the menstrual cycle, the patient is prescribed hormone therapy. With many mental symptoms, antidepressants and sedatives are prescribed. In addition, due to the fact that women with PMS often have elevated levels of serotonin (a substance that transmits brain impulses between nerve cells and is responsible for good mood) and histamine (a compound involved in the regulation of vital body functions), doctors may prescribe antihistamines (suppressing the production of histamine) of the second generation. Drugs can also be prescribed to improve blood circulation and normalize the transmission of impulses from nerve cells responsible for good mood and vitality in the central nervous system.

But you can try to cope with PMS without the help of a doctor, at least in cases where its symptoms are not too pronounced. You can alleviate the manifestations of premenstrual syndrome with a full eight-hour sleep, which relieves irritability, anxiety and aggression, and also has a positive effect on the state of the immune system. To get rid of insomnia and improve the quality of your sleep, you can try breathing techniques and walking before bed.

Regular physical activity increases the level of endorphin (a substance that has a calming effect on the nervous system) and reduces the intensity of the symptoms of premenstrual syndrome. It can be walking and running, yoga, Pilates, dancing and any other type of training. The relaxation practices used in yoga can also help with PMS symptoms. To help reduce the manifestations of PMS, proper nutrition with the use of a large amount of foods rich in fiber: fresh fruits and vegetables, greens. For a while, it is worth limiting the use of coffee and chocolate, because these products increase the mental symptoms of premenstrual syndrome: irritability, anxiety, frequent mood swings. It is also desirable to reduce the consumption of fats and red meat, completely abandon alcohol. At this time, herbal teas and juices are useful. It is impossible not to say about the benefits of regular sex, which helps fight insomnia, bad mood and stress, and also increases the level of hormones of happiness and strengthens the immune system. At the same time, during PMS, women often increase their sexual desire, which in this case can be perceived as a hint of the body. Thus, we can say that the combination of a balanced diet, regular and adequate physical activity, healthy sleep and constant sex, along with a positive attitude towards life, can help you forget what PMS is or at least reduce its manifestations. But with increased ailments, you should definitely consult a doctor who will conduct an examination and prescribe the necessary treatment.

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