Could it be PMS? PMS - what is it in women. When to contact a specialist

In women, this condition usually develops a few days before their period and is called “premenstrual syndrome.”

Unpleasant symptoms

This condition is familiar to most women. Many of them, several days (from one to 14) before the onset of menstruation, complain of:

• nagging pain in the lower abdomen;
• soreness and engorgement of the mammary glands;
• dizziness and nausea;
• swelling and constant thirst;
• poor appetite or, on the contrary, an irresistible desire to eat;
• feeling of palpitations, pain in the heart area;
• chills, fever.

In addition to physical discomfort, women may feel:

• irritability and aggression;
• tearfulness, bad mood;
• a sharp increase or decrease in sexuality;
• memory impairment;
• sleep disorders.

These manifestations disappear immediately after the onset of menstruation or in the first days after it.

Where does it come from?

It is believed that the condition is based on hormonal disorders, namely the excessive production of female sex hormones, which leads to disruption of the neuroendocrine regulation of various organs and systems of the body.

There is a point of view that nagging pain in the lower abdomen appears because the endometrial rejection has already begun in the uterus, which occurs during menstruation, and the cervix has not yet opened, which leads to the accumulation of blood and mucous fragments in the uterus, its overstretching and, accordingly, pain .

How to relieve PMS

PMS is a typical female ailment and, unfortunately, we cannot get rid of it, but we can alleviate it. To make it easier to overcome premenstrual irritation, a woman should monitor her health not only on the eve of her period.

1. Contact the specialists:

• visit a gynecologist and get tested to identify hormonal disorders;
• in case of severe emotional disturbances, consult a neurologist;
• Since diseases of other endocrine glands can worsen the condition, visit an endocrinologist.

2. Depending on the severity and duration of PMS manifestations, start taking medications prescribed by your doctor in advance (2-3 days in advance):

• if you have severe pain, antispasmodics will help you;
• good means are aimed at normalizing the activity of the autonomic nervous system;
• normalize the functioning of the central nervous system during PMS with the simplest sedatives - preparations of plant origin: motherwort, valerian, peppermint;
• the doctor may recommend that you take oral contraceptives, which eliminate discomfort on the eve of menstruation;
• in case of excessively heavy menstrual bleeding, a decoction of raspberry leaves (or adding them to brewed tea) has a good effect.

3. It is important to follow some nutritional principles a few days before the onset of menstruation:

• try to drink less strong tea and coffee;
• limit fluid intake (up to 1.5 liters per day);
• Add less salt to your food;
• limit the consumption of potassium-rich foods: raisins, dried apricots, potatoes;
• try to eat less fatty foods;
• exclude spices, hot seasonings, and alcohol from your diet;
• try to give up meat and dairy products.

4. At least a week before and during your period, your diet should include plenty of calcium-rich foods. There is a lot of calcium in fresh green leafy vegetables: spinach, lettuce, cabbage, parsley. It is recommended to take multivitamins (especially those containing vitamins A, B and E). It is equally important to consume seafood, grains and nuts, which are rich in macro- and microelements.

5. To prevent PMS, proper rest and sleep are important.

6. It is important to fall asleep before 23.00, because it is at this time that hormones are produced and later falling asleep disrupts the processes of neuroendocrine regulation. It's better to sleep in a cool room. IN Get enough sleep and rest before and during your period.

7. Walk more, breathe clean air, but heavy physical labor should be limited.

8. Try to quit smoking.

9. Take a contrast shower in the morning and evening. Complete the procedure with cool water. A 15-minute bath with a water temperature of 38-39 °C with a decoction of peppermint, chamomile and horehound (1:1:1) will help reduce premenstrual tension. After this, rub lavender or lemon wormwood oil into your lower back.

10. Try to worry and be less nervous.

11. During PMS, as during all periods, you should not go to the bathhouse. High temperature can cause severe pain, and menstruation will be delayed.

12. Breathing exercises and relaxation are good for strengthening the nervous system. Relax, close your eyes, concentrate your attention and try to mentally drive away the illness.

Women by nature are emotional individuals. However, it happens that a lady’s emotions arise out of the blue. And most often they are negative. What could this be, why is this happening? We will look for the answer to this question in this article.

Abbreviation

Probably every lady knows what these three letters mean - PMS. Decoding, symptoms - that's what I want to talk about. So, this is a certain condition of a lady, which in medicine is called “premenstrual syndrome”. This is a special symptom complex that occurs in the fair sex about a week or two before the onset of menstruation. This condition has an individual character and is special for each lady. I would like to say that this symptom also has several other names in medical practice. If a woman hears the phrases “cyclical illness,” “premenstrual tension syndrome,” or “premenstrual illness,” it will all refer to one problem - PMS.

What happens to the body

We further consider the topic: “PMS, decoding, symptoms.” I would also like to say a few words about what exactly happens to the female body at this time. It is important to clarify that all symptoms will be observed precisely in the second phase of the menstrual cycle. In this case, the vegetative-vascular, endocrine and neuropsychological systems can most often be affected.

Some statistics

I would also like to say a few words about who is most susceptible to such a problem as PMS. Symptoms of this disease will be observed most often in girls of the asthenic type, that is, thin ladies, as well as individuals prone to stress and mental disorders. As for statistical data, doctors say that this disorder most often affects women over the age of 30. Until this time, symptoms of the disease are observed in only 20% of girls.

Classification of symptoms

If a woman suffers from a problem such as PMS, the symptoms may fall into one of the following fairly broad groups.

1. Neuropsychiatric.
2. Edema.
3. Cephalgic.
4. Krizovaya.
5. Atypical.

Neuropsychiatric group of symptoms

Let's take a closer look at the problem of PMS. Symptoms may belong to the neuropsychiatric group. Here we will talk about probably the most common problem of all women - emotional. What symptoms will be observed in this case:

• insomnia;
• irritability;
• weakness;
• instability of mood, its rapid change (from laughter to tears);
• tearfulness;
• aggression;
• causeless melancholy;
• fatigue;
• feeling of fear;
• Depressive mood (the emergence of negative thoughts, including suicidal thoughts).

Against this background, many women experience various problems related to the sexual sphere, olfactory and auditory disorders. The following problems may also occur: engorgement of the mammary glands, loss of appetite, bloating, dizziness, general painful condition.

Edema form of PMS

Let us further consider such a problem as PMS. Symptoms of its edematous form - that’s what we’ll talk about now. The main problems here will relate to fluid retention in the tissues. What, in this case, can happen to the female body?

1. Swelling of the face.
2. Swelling of the limbs.
3. Weight gain.
4. Thirst.
5. Decreased urination.

In this case, these symptoms may be accompanied by dizziness, profuse sweating, itchy skin, as well as digestive disorders (diarrhea, constipation, flatulence).

Cephalgic form of PMS

What other indicators differ in PMS in women? Symptoms may be associated with the vegetative-vascular system and neuralgia. What will happen to the lady in this case?

1. Headache (up to migraine-like attacks).
2. Increased heart rate, pain in the heart area may be observed.
3. Nervousness.
4. Severe sensitivity to sounds and smells.
5. Insomnia.

As for the headache, it will most likely be accompanied by nausea, dizziness, strong pulsation in the temples, as well as swelling of the eyelids. It is also worth saying that this form of symptoms is most often characteristic of those ladies who have suffered traumatic brain injuries, severe stress and infections. In addition, it can be observed in those representatives of the fair sex who have problems with the cardiovascular system and gastrointestinal tract.

Crisis form of PMS

This is a more serious form of PMS in women. The symptoms will have a certain procedural character. That is, this crisis will have its beginning, during which the following symptoms may be observed.

1. Pain in the heart area (without abnormalities during ECG).
2. Tachycardia - rapid heartbeat.
3. Increased pressure.
4. Panic fear.

In this case, most often the cycle of symptoms ends with excessive urination. Who is most susceptible to this form of PMS? These are women over 40 years old, as well as those ladies who have problems with kidney, heart, and digestive tract diseases.

Atypical forms

There are also atypical forms of PMS. Symptoms:

1. body temperature can rise to 37.5 ° C (this will happen precisely in the second phase of the cycle);
2. drowsiness;
3. headaches with blurred vision;
4. allergic reactions of various types.

However, all these symptoms are the least common in women, which is why they are called atypical because they are observed very rarely and only in a very small percentage of women suffering from PMS.

About gravity

It will be no secret to anyone that PMS symptoms vary among girls. For some they are minor, for others they suffer more than others at this time. It is worth saying that the severity of this problem is influenced precisely by the symptoms that are observed in the lady. There are two forms of PMS.

1. Easy. In this case, the woman experiences from one to 4 of the symptoms listed above. Everything happens approximately 5-10 days before the start of menstruation.
2. Heavy. In this case, the number of symptoms ranges from 4 to 12. They can appear a week or two before the onset of bleeding. In this case, several symptoms will be expressed very clearly and distinctly. The lady will also experience a disability.

About the stages

Having considered the question of what symptoms of PMS a woman may have, I would also like to tell you that this problem has three stages of development.

1. Compensation stage. Here the symptoms appear in a woman precisely in the second phase of the menstrual cycle. However, the course of the syndrome does not progress over the years.
2. Subcompensation stage. In this case, the number of symptoms increases over time, and their severity may also worsen. It is also important to say that PMS symptoms do not disappear during bleeding.
3. Stage of decompensation. This is a very severe course of PMS, when symptoms are observed almost throughout the entire cycle. In this case, there are only “light” enlightenments.

About the reasons

Women may also be interested in the question of why some women experience PMS syndrome. Symptoms of this problem can most often occur after suffering stress, neuroinfections, abortions, and other operations. The background is also created by a variety of gynecological problems that can arise in women. What other causes of PMS syndrome do doctors identify?

1. Hormonal fluctuations (theory 1: violation of the correct balance of hormones in a woman’s body, such as estrogen and progesterone; theory 2: hyperactivity of the hormone prolactin, which causes sodium and water retention in the body).
2. Pathologies associated with the thyroid gland.
3. Violation of the water-salt balance of the body.
4. Deficiency of B vitamins, as well as lack of magnesium, zinc and calcium.
5. Genetic predisposition can also cause a woman to develop this syndrome.
6. Psychogenic factors: frequent stress, problems in the family or at work.

About the delay

Some ladies are also interested in the question “will PMS symptoms be observed if there is a delay?” This is certainly possible. Symptoms may occur at the right time, but bleeding may be delayed. Here you need, first of all, to figure out why menstruation is delayed: the cause could be simple stress, or it could be pregnancy.

About pregnancy

You also need to answer the following question: “is a tandem possible: symptoms of PMS and pregnancy.” This can't be true. After all, while carrying a child, the work of the ovaries is blocked. However, certain indicators can be observed in a woman during this special condition. So, this could be, for example, irritability or a change in appetite. But all these symptoms are relevant not only for one problem (PMS), but also for other conditions of the lady. It is also important for women to be able to distinguish the symptoms of PMS during a delay, so as not to confuse them with the first indicators of pregnancy (and they are often very similar).

Diagnostics

In order to correctly diagnose PMS in a woman, you must first seek help from a gynecologist. Only after a thorough study of all the symptoms that are observed in the woman, a qualified doctor will be able to make a competent diagnosis, having determined the form and severity of this syndrome. However, the doctor may need additional research. In this case, the woman may be sent for examination to other specialists.

1. You may need to consult a neurologist or psychiatrist. In this case, an MRI, CT scan or radiography of the skull may also be prescribed.
2. The doctor may prescribe an encephalography to assess the condition of the cerebral vessels if the woman’s main symptom is severe headaches.
3. If a woman has problems with chest pain, a consultation with a mammologist, as well as an ultrasound of the mammary glands, may be prescribed.
4. If a woman has an edematous form of PMS, she may be prescribed various urine tests: collection of daily urine output, Zimnitsky or Roberg test.

Also, the gynecologist will most likely advise the woman to keep a diary of PMS symptoms in order to better understand this problem.

What to do?

It is also important to educate women about how to reduce PMS symptoms. To do this, you can use a variety of methods. One of them is completely safe for a woman’s body, as it does not require the use of medications. What, in this case, can the lady do?

1. Changes in diet. To avoid severe symptoms of PMS, a woman can try to adjust her diet two weeks before the appearance of spotting. To do this, you need to reduce the consumption of salt and sugar (reduce to a minimum); eliminate alcohol consumption; completely exclude from the diet foods that contain various additives and flavorings; you need to limit the intake of animal fats as much as possible, since they are the main source of cholesterol, which affects blood circulation; It is best to replace butter with vegetable oil; Consume plenty of fresh vegetables and fruits.
2. It's also good to start leading a healthy lifestyle. To do this, you need to go in for sports (this will significantly increase the body’s endurance); get enough rest (the body needs 7-8 hours of sleep at night), and you need to go to bed before 23-00; do not overload the nervous system by avoiding stressful situations; breathing exercises, yoga, relaxation practices - by mastering these activities, you can avoid problems such as PMS.
3. Are there other ways to relieve PMS symptoms? Of course! It’s good for a woman to pamper herself at this time as well. This will help cope with tearfulness, bad thoughts and bad mood. In this case, you can arrange a shopping trip or an excursion to an interesting place. Or you can just try to always be in a fun company that simply won’t let you get bored.

Treatment

We further consider the topic: “PMS, symptoms.” Treatment of this problem with medications is what I would like to talk about more. What, then, can a doctor prescribe to his patient? Here you will need to look at special symptoms. After all, treatment will depend on the form to which the symptoms accompanying the woman belong. However, the doctor will almost always prescribe sedatives, i.e. sedatives. This can be either the simplest drug “Valerian” or a more serious complex of sedatives, for example drugs such as “Glycine” or “Glycised”. The doctor may also prescribe diuretics if a woman has an edematous form of PMS. The modern method of treating this problem is the use of hormonal therapy. However, it should be prescribed only on the basis of the tests performed. Self-medication in this case is very dangerous.

Traditional medicine

Our grandmothers can also tell us how to relieve PMS symptoms. After all, there are a huge number of different folk remedies that help cope with this problem.

Fighting swelling

If a woman suffers from an edematous form of PMS, then she can try making her own medicine from horsetail. You need to take 30 grams of this dry herb and pour a glass of boiling water. Let the medicine sit for no more than 10 minutes. After this, the liquid is filtered. You need to take it a glass 2-3 times a day after meals.

Fighting irritability

Motherwort herb is very helpful in calming the nervous system during PMS. To prepare the medicine, take one tablespoon of finely chopped herbs, pour a glass of boiling water, leave for about an hour. You should take this remedy one glass twice a day, morning and evening. This can be done regardless of meals.

Fighting mood swings

Mood swings are common symptoms before PMS. In this case, you can prepare yourself a relaxing bath. To do this, you need to take 20 grams of the following herbs: lemon balm, wormwood, yarrow, oregano, peppermint leaves and calamus roots. All this is poured with 10 liters of boiling water, infused for about half an hour, and cooled. Now you need to prepare the bath correctly: the water temperature in it should be approximately 37-38 °C. After this, the infusion is added to the water. Bath time is no more than 15 minutes. During PMS, you can give yourself such a bath no more than once a day.

Massage

Massage helps to cope with symptoms of PMS very well. In this case, you just need to know how to massage correctly and which parts of the body need to be massaged.

1. Massage of the rectus and oblique abdominal muscles. For this purpose, stroking, shaking, kneading, and vibration are used.
2. Massaging pain points located in the pubic and lumbar areas. Rubbing, pressing.
3. Massage of the gluteal area. Rubbing, stroking, kneading, vibration.

The massage course is designed for approximately 5-10 procedures of 10 minutes each. In this case, the woman can both lie and stand.

Minerals

Traditional healers also say that special stones - minerals - can help cope with PMS. In this case, ladies should always wear pearls, tiger's eye, topaz, diamond, hematite or amber as jewelry. It is believed that these stones perfectly correlate with “feminine nature”, helping girls cope with exclusively female problems.

Prevention

If a woman suffers from PMS, various preventative measures can be tried. What should you pay attention to in this case? So, you need to properly adjust your diet, devote enough time to exercise and physical activity. It is also very important to avoid all kinds of stressful situations and overstrain of the nervous system. To do this, it is good to master yoga, breathing and relaxation techniques. And, of course, you need to rest enough time and constantly be in a positive frame of mind. By already following all these fairly simple recommendations, you can avoid severe forms of premenstrual syndrome.

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

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

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

Clinical manifestations of PMS

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

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

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

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

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

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

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

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

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

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

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

Diagnosis of PMS

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

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

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

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

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

(L - F/L) x 100,

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

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

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

PMS treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The appearance of unmotivated aggressiveness or the desire to cry after watching a melodrama: which woman has not encountered such feelings? Many people have heard of premenstrual syndrome, but the percentage of people seeking medical help remains low. Unfortunately, some doctors and psychologists consider this condition to be far-fetched and do not take the manifestations of premenstrual syndrome seriously. But the problem exists and requires appropriate treatment.

The term "premenstrual syndrome"

Symptoms of PMS: uncontrollable rage, aggression and others Premenstrual syndrome (another name for premenstrual tension syndrome) is a set of symptoms that repeat cyclically and occur approximately 2 weeks (3 - 14 days) before menstruation. Premenstrual syndrome manifests itself as neuropsychic, vegetative-vascular and metabolic-endocrine disorders. The frequency of this syndrome varies from 5 to 40% in the population. It has been noted that the older a woman gets, the higher the likelihood of developing premenstrual syndrome (PMS).

Causes of PMS

There are many theories about the development of this condition, but none fully explains the cause and mechanism of premenstrual syndrome. There are hormonal, allergic theories, the theory of increased aldosterone production, neuropsychic disorders and “water intoxication”. The main etiological factors include:

• violation of the ratio of estrogen and progesterone in the luteal phase (estrogens increase and progesterone levels decrease);
• increased secretion of prolactin (causes transformations in the mammary glands);
• pathological processes in the thyroid gland;
• disorders of water-salt metabolism, the production of aldosterone increases, which leads to the retention of fluid and sodium salts in the body;
• lack of vitamins and microelements (vitamin B6, magnesium, zinc);
• stressful situations.

Predisposing factors for PMS

• living in big cities;
• brainwork;
• late birth;
• psycho-emotional lability;
• a large number of pregnancies (,) or, conversely, their absence;
• surgeries on female genital organs;
• inflammatory processes of the female genital area;
• brain injuries;
• Europeans;
• unbalanced diet;
• CNS infections;
• physical inactivity.

PMS symptoms

Depending on the predominance of certain manifestations, the following forms of premenstrual syndrome are distinguished:

Neuropsychic form of PMS

The woman becomes irritable, whiny, and touchy. Characterized by rapid fatigue, apathy and or uncontrollable rage and aggression. There is sleep disturbance: at night, drowsiness during the day, a tendency to conflict, weakened sexual desire. Also intolerance to smells and sounds or acute perception of them. Possible increased gas formation, constipation, decreased appetite. A certain dependence has been noted: in girls during puberty, aggressiveness and rage predominate; in older women, there is a tendency to depression. The mammary glands become engorged, numbness of the limbs appears.

Edema form of PMS

Retention of sodium and fluid in the body leads to edema. Swelling of the face, legs, fingers, weight gain (up to 500–700 grams), flatulence, increased sweating, and weakness are noted. The classic manifestation of the edematous form is swollen and painful mammary glands. Diuresis decreases.

Cephalgic form of PMS

It is characterized by intolerance to smells and sounds, migraine-type headaches, dizziness, and irritability. Fainting, palpitations, heart pain, diarrhea, irritability, heart pain are common. Nausea and vomiting are possible.

Crisis form of PMS

This form is characterized by sympathoadrenal crises, which are manifested by attacks of arterial hypertension, tachycardia, pain in the heart, behind the sternum, and sudden fear of death. The ECG does not show any abnormalities. The crisis form is often observed in premenopausal women (after 45 years) and in patients suffering from pathologies of the digestive tract, kidneys, and heart.

Atypical forms of PMS

There are 3 subtypes of atypical forms of premenstrual syndrome: hyperthermic, which is characterized by an increase in temperature to 38 degrees before menstruation and a decrease with the onset of menstruation, hypersomnia - irresistible drowsiness in the luteal phase of the cycle, ophthalmoplegic - unilateral ptosis (drooping of the upper eyelid), hemiparesis of the body on the eve of menstruation. Separately, allergic reactions can be distinguished in the form of ulcerative gingivitis and asthmatic syndrome, iridocyclitis, Quincke's edema.

PMS classification

Premenstrual syndrome occurs in mild or severe forms. A mild course of PMS is said to occur when there are 3–4 manifestations, and of these, 1–2 signs predominate. In severe forms of PMS, there are 5–12 manifestations, the leading role among them being occupied by 2–5 symptoms.

Premenstrual syndrome is also classified into stages:

• compensated stage– signs of the disease are mild, there is no tendency to progress, and with the onset of menstruation they disappear;
• subcompensated stage I – the signs of the syndrome are bright, pronounced, the number of symptoms increases, there is a decrease in performance, the longer the disease exists, the more severe the manifestations become, the symptoms do not level out with the onset of menstruation;
• decompensated stage– premenstrual syndrome is severe, symptoms persist during and after the end of menstruation.

PMS treatment

Therapy for premenstrual syndrome should begin with adjusting your diet and daily routine. If possible, stressful and conflict situations should be excluded or limited, sleep duration should be at least 8 hours a day, physical exercise is useful, which helps to increase the synthesis of enkephalins and endorphins (happiness hormones). In the diet in the luteal phase of the cycle, it is necessary to limit salt, liquid, coffee and strong tea, and chocolate. The diet should contain a sufficient amount of fiber (fresh vegetables and fruits), and sweets should be avoided.

In order to normalize the psycho-emotional state, sedatives (motherwort, valerian, peony tincture) are prescribed; in more serious cases, anti-anxiety drugs (Relanium, Rudotel) and antidepressants (Zoloft, cypramine). To improve blood circulation in the brain, piracetam and picamilon are recommended. Acupuncture, physiotherapy, vitamins (vitamin B6, magnesium preparations) are effective. Progestin drugs (utrozhestan, duphaston) are prescribed in the second phase of the cycle or oral monophasic contraceptives (Zhanin, Marvelon, Yarina) are used. For the edematous form of the disease, diuretics (spironolactone) are prescribed, and for hyperprolactinemia, drugs that inhibit prolactin production (parlodel).

When premenstrual syndrome occurs, about 75% of females experience various ailments that appear a few days before the onset of the cycle. Therefore, any little thing can cause premenstrual irritability during PMS. If a hundred years ago such a phenomenon was shrouded in mystery, today doctors know how to get rid of PMS or get relief.

Unpleasant symptoms

Since each woman’s body is individual, premenstrual syndrome begins to appear 1-14 days before the onset of menstruation. Therefore, the main symptoms of PMS can be identified:

• arises ;
• the mammary glands become coarser and become painful;
• swelling occurs and thirst increases;
• unstable heart rhythm and pain in the heart area appear;
• appetite disappears completely or, conversely, increases;
• there is a feeling of nausea and dizziness;
• sometimes chills occur or rise sharply;
• allergic rashes appear;
• there is constipation or diarrhea;
• acne appears;
• noticeable weight gain.

In addition to the physical manifestation of discomfort, you have to deal with PMS symptoms such as:

• the first signs of PMS are short temper, nervousness, irritability;
• memory impairment;
• increased lacrimation;
• sleep disturbance;
• increase or decrease in libido (sexuality).

Typically, relief occurs after the onset of menstruation. People who engage in mental work or have chronic illnesses are often familiar with PMS.

What caused

The good functioning of a woman’s body directly depends on the balance between sex hormones – progesterone, androgen and estrogen. With the onset of the premenstrual period, an imbalance occurs, causing certain symptoms.

There are other factors that provoke the appearance of PMS syndrome:

1. Magnesium deficiency.
2. Insufficient amount of vitamin B6.
3. Smoking.
4. Excess weight.
5. Decreased serotonin levels.
6. Heredity.
7. Complications during abortion, difficult childbirth, gynecological diseases and stressful conditions.

To relieve PMS, you can take medications. However, if a woman has a severe form of premenstrual syndrome, then hormonal drugs are used as therapy.

How to relieve PMS

Premenstrual syndrome is considered only a female ailment, so there are several stages that indicate how to relieve PMS.

Read also 🗓 Mammography and menstruation

1. Visit a specialist:

• gynecologist;
• neurologist;
• endocrinologist.

1. You should start taking medications 2-3 days before the onset of PMS, focusing on the severity and duration of pain:

• for severe pain - antispasmodic drugs;
• medications aimed at restoring the activity of the autonomic nervous system;
• sedatives to normalize the central nervous system - tablets of plant origin: motherwort, mint, valerian, peppermint;
• it is possible to take oral contraceptives, which eliminate discomfort even before the critical days;
• against serious bleeding, a decoction of raspberry leaves is considered an effective remedy.

1. The key rule is to follow the basic principles of nutrition a couple of days before the start of menstruation:

• do not abuse strong tea and coffee;
• fluid intake no more than 1.5 liters per day;
• eat less salty foods;
• reduce consumption of foods rich in calcium;
• reduce the amount of fatty foods in the diet;
• It is recommended not to consume spices, hot seasonings and alcoholic beverages;
• reduce meat and dairy products to minimal portions.

1. It is especially important to take multivitamins, including A, B, E.
2. To prevent PMS, a woman’s body needs proper rest and sleep.
3. Walk in the fresh air more often and avoid heavy physical labor.
4. It is advisable not to smoke.
5. Taking a contrast shower in the morning and evening will reduce tension.
6. Eliminate worries.
7. Visiting baths and saunas is prohibited both before PMS and during menstruation.

Treatment

Every woman is familiar with the symptoms of the premenstrual period and should know how to alleviate the condition during PMS. The main measure is the treatment of chronic diseases, such as:

• problems with the gastrointestinal tract;
• nervous disorders and other diseases present in the anatomy of the individual.

It is also necessary to maintain a healthy lifestyle and consume vitamin and mineral complexes.

In other cases, treatment is aimed at getting rid of PMS symptoms before the menstrual period.

Medicines

Sometimes there come times when medications are the only right solution to relieve PMS. The following are used as painkillers:

1. Non-steroidal anti-inflammatory drugs:

• Aspirin;
• Paracetamol;
• Ibuprofen;
• Indomethracin;
• Piroxicam;
• Ketoprofen;
• Naproxen;
• Ketolong.

1. Anti-spasm medications:

• Papaverine;
• Buscopan;
• No-shpa;
• Drotaverine.

1. Analgesics:

• Analgin;
• Spasmalgon;
• Peretin;
• Minalgin;
• Baralgin.

Tablets that relieve PMS are used according to the instructions. For example, antispasmodics begin to act after 20 minutes, analgesics, which act as relief drugs for PMS, relieve pain after 7 minutes.

Read also 🗓 When does phase 2 of the menstrual cycle begin?

An equally important role is played by sedative pills. Often such remedies and infusions consist of medicinal herbs:

• Motherwort grass;
• Valerian;
• Glod;
• Novo-passit.

In more severe cases, antidepressants such as glycine are used.

The most effective medications for treating PMS are hormonal drugs:

• Duphaston, Utrozhestan;
• Contraceptives: Logest, Yarina, Zhanine;
• If a woman feels discomfort in the mammary glands, Danazol is used;
• Buserelin, Zoladex act on the principle of shutting down ovarian function, leading to rapid reversal of PMS symptoms;
• At the onset of the premenopausal period, Dostinex and Parlodel are often prescribed.

In case of edema, the specialist prescribes diuretics for treatment, for high blood pressure - antihypertensive drugs, and during the manifestation of an allergic rash - antihistamines.

Treatment at home

Most females use folk remedies at home to relieve PMS. Only in critical cases do they resort to medical help. Will also help:

1. Taking a bath. Bathing in a warm bath helps relieve tension, relax muscles, and soothe pain.
2. Foot bath. In this case, the composition of the decoction includes: lemon balm, chamomile, dried cucumber. Add a few drops to the water. The procedure improves blood circulation, relieves spasms, calms and relaxes.
3. Relaxation with music.
4. Doing what you love.
5. Drinking tea from: lemon balm, mint, thyme, elderberry.

To alleviate the condition and normalize the menstrual cycle, the following fees are used:

• Prepare a decoction with the addition of 3 tablespoons of chamomile, 1.5 tbsp. spoons of lemon balm and yarrow. During the day, the intake is divided into 3 stages;
• Use 2 tbsp. spoons of acacia leaves and hot tea. The mixture is poured with boiling water and infused for ¼ hour. This medicinal tea should be consumed within a week before the onset of menstruation.

Reduces bleeding and spotting with an infusion of 0.5 tsp. knotweed, 1 tsp. lungwort with the addition of 1 tbsp. spoons of chamomile, yarrow and horsetail. After adding boiling water, the mixture is steamed for several minutes. Take 1 glass before bedtime.

To get rid of PMS, you need to start eating foods containing calcium (spinach, cabbage, parsley, lettuce) a week before the onset of your period and follow a diet.

Treatment after 40-45 years

PMS continues to function in women after fertility decline. This period is considered the most dangerous. Therefore, relief of PMS at 40 years old is a complex treatment: