– a cyclically recurring symptom complex observed in the second half of the menstrual cycle (3-12 days before menstruation). It has an individual course and can be characterized by headache, severe irritability or depression, tearfulness, nausea, vomiting, skin itching, swelling, pain in the abdomen and in the heart area, palpitations, etc. Swelling, skin rashes, flatulence, painful engorgement of the mammary glands. In severe cases, neurosis may develop.

General information

Premenstrual syndrome, or PMS, are called vegetative-vascular, neuropsychic and metabolic-endocrine disorders that occur during the menstrual cycle (usually in the second phase). Synonyms for this condition found in the literature are the concepts of “premenstrual illness”, “premenstrual tension syndrome”, “cyclic illness”. Every second woman over the age of 30 is familiar with premenstrual syndrome firsthand; in women under 30, this condition occurs somewhat less frequently - in 20% of cases. In addition, manifestations of premenstrual syndrome are usually associated with emotionally unstable, thin, asthenic women who are more often engaged in intellectual activities.

Causes of premenstrual syndrome

The course of the crisis form of premenstrual syndrome is manifested by sympatho-adrenal crises, characterized by attacks of increased blood pressure, tachycardia, heart pain without abnormalities on the ECG, and panic. The end of a crisis is usually accompanied by copious urination. Often attacks are provoked by stress and overwork. The crisis form of premenstrual syndrome can develop from untreated cephalgic, neuropsychic or edematous forms and usually manifests itself after 40 years. The background for the crisis form of premenstrual syndrome is diseases of the heart, blood vessels, kidneys, and digestive tract.

Cyclic manifestations of atypical forms of premenstrual syndrome include: increased body temperature (in the second phase of the cycle up to 37.5 ° C), hypersomnia (drowsiness), ophthalmoplegic migraine (headaches with oculomotor disorders), allergic reactions (ulcerative stomatitis and ulcerative gingivitis, asthmatic syndrome, uncontrollable vomiting, iridocyclitis, Quincke's edema, etc.).

When determining the severity of premenstrual syndrome, they proceed from the number of symptomatic manifestations, distinguishing between mild and severe forms of premenstrual syndrome. A mild form of premenstrual syndrome is manifested by 3-4 characteristic symptoms that appear 2-10 days before the onset of menstruation, or by the presence of 1-2 significantly pronounced symptoms. In severe forms of premenstrual syndrome, the number of symptoms increases to 5-12, they appear 3-14 days before the onset of menstruation. Moreover, all of them or several symptoms are significantly expressed.

In addition, an indicator of a severe form of premenstrual syndrome is always a disability, regardless of the severity and number of other manifestations. Decreased ability to work is usually observed in the neuropsychic form of premenstrual syndrome.

It is customary to distinguish three stages in the development of premenstrual syndrome:

1. compensation stage - symptoms appear in the second phase of the menstrual cycle and disappear with the onset of menstruation; the course of premenstrual syndrome does not progress over the years
2. stage of subcompensation - the number of symptoms increases, their severity worsens, manifestations of PMS accompany the entire menstruation; Premenstrual syndrome becomes more severe with age
3. stage of decompensation - early onset and late cessation of symptoms of premenstrual syndrome with minor “light” intervals, severe PMS.

Diagnosis of premenstrual syndrome

The main diagnostic criterion for premenstrual syndrome is cyclicality, the periodic nature of complaints that arise on the eve of menstruation and their disappearance after menstruation.

The diagnosis of premenstrual syndrome can be made based on the following signs:

• State of aggression or depression.
• Emotional imbalance: mood swings, tearfulness, irritability, conflict.
• Bad mood, feeling of melancholy and hopelessness.
• State of anxiety and fear.
• Decreased emotional tone and interest in current events.
• Increased fatigue and weakness.
• Decreased attention, memory impairment.
• Changes in appetite and taste preferences, signs of bulimia, weight gain.
• Insomnia or drowsiness.
• Painful tension in the mammary glands, swelling
• Headaches, muscle or joint pain.
• Worsening of the course of chronic extragenital pathology.

The manifestation of five of the above signs with the obligatory presence of at least one of the first four allows us to speak with confidence about premenstrual syndrome. An important part of the diagnosis is the patient’s keeping a self-observation diary, in which she must note all disturbances in her well-being over the course of 2-3 cycles.

A study of hormones (estradiol, progesterone and prolactin) in the blood allows us to determine the form of premenstrual syndrome. It is known that the edematous form is accompanied by a decrease in progesterone levels in the second half of the menstrual cycle. Cephalgic, neuropsychic and crisis forms of premenstrual syndrome are characterized by an increase in the level of prolactin in the blood. The prescription of additional diagnostic methods is dictated by the form of premenstrual syndrome and leading complaints.

Severe manifestation of cerebral symptoms (headaches, fainting, dizziness) is an indication for an MRI or CT scan of the brain to exclude focal lesions. EEG results are indicative for neuropsychic, edematous, cephalgic and crisis forms of the premenstrual cycle. In the diagnosis of the edematous form of premenstrual syndrome, an important role is played by measuring daily diuresis, recording the amount of fluid drunk, and conducting tests to study the excretory function of the kidneys (for example, Zimnitsky's test, Rehberg's test). In case of painful engorgement of the mammary glands, an ultrasound of the mammary glands or mammography is necessary to exclude organic pathology.

An examination of women suffering from one or another form of premenstrual syndrome is carried out with the participation of doctors of various specialties: neurologist, therapist, cardiologist, endocrinologist, psychiatrist, etc. Prescribed symptomatic treatment, as a rule, leads to an improvement in well-being in the second half of the menstrual cycle.

Treatment of premenstrual syndrome

In the treatment of premenstrual syndrome, drug and non-drug methods are used. Non-drug therapy includes psychotherapeutic treatment, adherence to work and proper rest, physical therapy, and physiotherapy. An important point is to maintain a balanced diet with sufficient amounts of plant and animal protein, plant fiber, and vitamins. In the second half of the menstrual cycle, you should limit the consumption of carbohydrates, animal fats, sugar, salt, caffeine, chocolate, and alcoholic beverages.

Drug treatment is prescribed by a medical specialist, taking into account the leading manifestations of premenstrual syndrome. Since neuropsychic manifestations are expressed in all forms of premenstrual syndrome, almost all patients are advised to take sedative (sedative) drugs several days before the expected onset of symptoms. Symptomatic treatment of premenstrual syndrome involves the use of painkillers, diuretics, and antiallergic drugs.

The leading place in the drug treatment of premenstrual syndrome is occupied by specific hormonal therapy with progesterone analogues. It should be remembered that the treatment of premenstrual syndrome is a long process, sometimes continuing throughout the entire reproductive period, requiring internal discipline from the woman and strict compliance with all doctor’s instructions.

The course of the menopause, as well as premenstrual syndrome, is often accompanied by the manifestation of unpleasant symptoms, which contribute to the disruption of general well-being and a decrease in the quality of life of a woman. In this review, we will pay attention to the course of PMS during menopause, and also consider in more detail what each of these conditions is and methods for mitigating the symptoms that appear.

Menopause

Natural menopause in most cases can cause symptoms such as:

• rushes of blood and a feeling of sudden heat followed by chills;
• disorders of the psycho-emotional state with manifestations of a tendency to depression;
• decreased sexual activity and;
• increased urge to urinate, with the formation of a habit or frequent desire for little nighttime adventures;
• increased risk of developing infectious lesions of the genitourinary system;
• reduction in the size of the mammary glands and loss of their elasticity;
• and loss of skin elasticity;
• changes in the structure of hair and nail plates;
• the formation of a feeling of dryness in the intimate area and other associated pathologies.

In most cases, the onset of menopause occurs after 43-44 years. But there is both an early stage of the onset of menopause, which occurs in the age group of women under 37-38 years old, and a late form of menopause, which occurs after the 55th birthday. This difference in the age transition of the female body to menopause is due to the individual characteristics of each woman.

Menopause is a fairly long life period in the life of women, which can last from 5 to 10 years, manifested by changes in the menstrual cycle, its pattern and duration. Menstruation is becoming more and more scanty and can come once every 2-3 months, or even once every six months. If menstrual flow does not appear for 12 months, then this indicates.

Over a fairly long period of time during menopause, the female body experiences a complete decline in the functioning of her reproductive system. Even taking into account the fact that the duration of human life is over last years has increased significantly, yet, according to statistics, it occurs at the turn of 45 and 50 years.

An important factor is the intimate side of women’s life, which completely influences the duration of the fertile period and the moment of menopause. It follows that if a woman stops intimate relations with a sexual partner (sexual intercourse) early, then the menopausal period may come earlier than the age of its natural onset.

If a woman does not refuse a sexual partner and maintains an intimate relationship, then the menopausal period may be delayed for several years.

If, in the premenopausal period, fertilization of the egg occurs and pregnancy occurs, then a successful delivery will contribute to a longer extension of the woman’s physiological and psychological youth.

The first signs of the onset of menopause

The first signs signaling the onset of menopause include disturbances in the psycho-emotional state of a woman. If there is a delay, it is necessary to take a pregnancy test. And if the result is negative, then it is necessary to consult with a qualified specialist to prevent the risk of developing serious pathological processes and prescribe a timely regimen.

Also, do not forget that under the influence of hormonal changes in the body, the functioning of the cardiovascular system of organs is disrupted. This may cause the following symptoms:

• manifestations of swelling;
• the formation of migraines of varying duration;
• increased functioning of the sweat glands with excessive levels of sweating;
• frequent with the appearance of small dots before the eyes;
• development of hypertension;
• decreased level of sensitivity;
• manifestation of spasm of the vascular walls.

An important factor is that the presence of the above symptoms in a woman may not in every case indicate the presence of menopause. There are women for whom this period can be asymptomatic, only along with a decrease in the level of menstrual flow and its further complete cessation.

During the menopause, changes from endocrine system organs characterized by dysfunction of the thyroid, pancreas, and adrenal glands. These changes can contribute to the formation of such pathological conditions as active under the influence of an unreasonable feeling of hunger, the appearance of chronic fatigue and pain in the joints.

A characteristic feature of menopause is that the manifestation of the acute form of its symptoms is mainly observed with its early onset. If menopause occurs in a timely manner, then such manifestations will be in a less pronounced form.

Alleviating the symptoms of early menopause

Often women who are faced with the early onset of menopause cannot tolerate all its manifestations, which contribute to the deterioration of not only their general condition, but also disruption of the psycho-emotional side of the nervous system and a decrease in the standard of living.

In such situations, when menopausal symptoms become too painful and there is no strength left to endure them, it is necessary to seek help from qualified specialists who can prescribe the correct treatment regimen through.

Reception hormonal drugs will significantly soften all the symptoms that appear and will help improve the general condition.

What is PMS?

Premenstrual syndrome is a certain combination of symptoms that have a negative impact on the psycho-emotional and physical state of health, occurring in anticipation of the onset of menstrual days.

Some women, being in adulthood and awaiting the onset of menopause, often cannot determine what exactly is happening to their body and what specifically manifests itself at one time or another: does PMS or menopause begin? And this is no coincidence. PMS in most cases causes the following symptoms:

• the occurrence of general malaise throughout the body;
• the formation of headaches, as well as pain in the joints;
• increased sensitivity in the mammary glands;
• the appearance of swelling;
• active gain of extra pounds;
• occurrence in the lower abdomen with a pulling character;
• increased irritability, tearfulness, absent-mindedness, short temper;
• attacks of aggression may occur;
• chronic fatigue.

Due to the presence of such a wide range of PMS symptoms, there are several forms of premenstrual syndrome:

• neuropsychic form, including all changes in the psycho-emotional state;
• cephalgic form, consisting in the formation of increasing pain symptoms in the head area;
• crisis form, consisting in the formation of disorders of the respiratory system of organs;
• edematous form of PMS.

Causes of PMS

The main reasons contributing to the occurrence of premenstrual syndrome are in a woman’s body and regular exposure to stressful situations. Also, an important role in the manifestation of premenstrual syndrome is played by women’s fixation on maintaining normal level your psycho-emotional state and general health.

In other words, we can say that the less often women think about PMS and pay attention to various little things, the easier this period will pass before the onset of their critical days.

Treatment methods for premenstrual syndrome

Treatment of PMS consists of psychotherapy and a thorough study of the woman’s behavior and their subsequent adjustment, which is presented in the following set of sequential actions:

• delivery to the patient detailed information about problems that have arisen in her body and possible ways to solve them;
• training to help cope with stressful situations;
• adjustment of the diet, which consists in excluding foods such as salt, coffee, tea, alcohol, chocolate on the days of menstrual flow and enriching the diet with microelements;
• performing exercises from the exercise therapy complex that help normalize the functioning of the whole body;
• structuring the daily routine with correct distribution physical activity and;
• introduction into the usual life activities of maintaining a calendar for menstrual cycles and PMS.

If psychotherapy does not have the desired effect, then specialists prescribe a treatment regimen with medications from the group of hormone-containing drugs, diuretics and spectrum drugs, as well as blockers of ovulatory processes and vitamin complexes.

Therefore, regardless of whether a woman is experiencing PMS, or menopause, or premenstrual syndrome in premenopause, important aspects that can effectively mitigate all unpleasant manifestations are the correct diet, healthy image life, an active sex life and a positive attitude.

Educational video on this topic:

Doctors have always tried to determine the reasons why women feel unwell and irritable in the days immediately before menstruation . In ancient times, this phenomenon was associated with various factors - the phases of the moon, the woman’s health, and the characteristics of the area where she lived. However, the state before menstruation was a mystery to the Aesculapians. Only in the twentieth century were doctors able to understand to some extent what was happening to the ladies.

Speaking about PMS - what it is, you should know how PMS stands for - what it means is a manifestation characteristic of women in the days before menstruation. PMS is a set of symptoms that appear in women and girls a few days before the onset of menstruation.

Scientists are still researching what causes such manifestations and what this syndrome means. Those who are interested in how PMS is translated should learn in more detail what manifestations are characteristic of this condition. Each decoding of what PMS is in girls contains a description of all the characteristic symptoms and manifestations.

After all, PMS in women is a whole complex of symptoms, both physical and mental—scientists have counted about 150 of them. Approximately 75% of women experience premenstrual syndrome to varying degrees.

As a rule, PMS in girls begins to appear approximately 2-10 days before the day when signs of menstruation appear. After menstruation ends, menstrual syndrome also completely disappears.

Why does PMS develop?

So far, all the studies conducted have not made it possible to determine why premenstrual syndrome manifests itself? There are many theories that explain why this condition develops.

• The so-called “water intoxication” is a disrupted water-salt metabolism.
• Allergic nature – high sensitivity of the body to endogenous substances.
• Psychosomatic – the development of physiological symptoms due to the influence of mental factors.

The most complete and broadest theory today is the hormonal theory, according to which PMS is explained by strong hormonal fluctuations in the second phase of the cycle. After all, for the female body to function correctly, normal hormonal balance is important:

• are able to improve well-being, both physical and mental, activate mental activity, increase vitality;
• progesterone provides a sedative effect, which can lead to a depressive state in the second phase;
• affect libido, increase performance and energy.

In the second phase of the cycle, a woman’s hormonal background changes. Consequently, the hormonal theory suggests that the body reacts inadequately to such a “storm”. Interestingly, premenstrual tension syndrome is inherited.

Since during the premenstrual period the body experiences endocrine instability , this leads to the manifestation of somatic and psycho-vegetative disorders. The main reason for this is the fluctuation of sex hormones during the monthly cycle and the reaction of the limbic parts of the brain to this.

• When the level increases estrogen and first increases, and then decreases the level progesterone , swelling, tenderness of the mammary glands, dysfunction of the heart and blood vessels, pressure surges, irritability are also observed in women.
• With increased secretion fluid is also retained in the body.
• When content increases , there are vegetative-vascular disorders, digestive disorders - diarrhea, nausea, as well as headaches reminiscent of.

Thus, modern doctors identify the following factors that determine the development of PMS:

• A decrease in the level, which leads to the manifestation of mental symptoms of premenstrual syndrome: when this hormone decreases, sadness and melancholy are noted.
• Deficiency leads to fluid retention, increased breast sensitivity, and mood changes.
• A lack of magnesium leads to the development of symptoms such as headache, desire to eat sweets.
• Smoking – women who smoke suffer from PMS twice as often.
• – Those with a body mass index greater than 30 are much more likely to experience symptoms of this syndrome.
• Genetics – the tendency to PMS can be inherited.
• Difficult childbirth, abortion, gynecological operations.

The main symptoms of PMS in women

Speaking about what are the symptoms of PMS, how many days before menstruation do they appear in girls and women, you should take into account individual characteristics every organism. Doctors divide the main signs of PMS before menstruation into several different groups. The following symptoms of premenstrual syndrome are distinguished (by groups):

• Neuropsychiatric : depression, aggression, irritability and tearfulness.
• Exchange-endocrine : chills, swelling due to impaired water-salt metabolism, fever, discomfort in the mammary glands, bloating, blurred vision and memory.
• Vegetative-vascular : headache, pressure changes, nausea, vomiting, tachycardia,.

Speaking about what symptoms women experience before menstruation, it should be taken into account that they can be conditionally divided into several forms. However, as a rule, they are combined. So, if pronounced psycho-vegetative disorders are observed, the pain threshold decreases, and the woman perceives pain very acutely - a week or a few days before menstruation.

What signs of menstruation can be observed in a week or in a few days?

Wikipedia and other sources indicate that each woman experiences PMS differently, and the symptoms may vary.

Scientists, having conducted a series of studies, determined the frequency of symptoms of premenstrual syndrome:

In addition, PMS can significantly aggravate the course of other diseases:

• anemia ;
• thyroid diseases;
• migraine ;
• chronic fatigue syndrome;
• inflammatory diseases of the female genital area.

What conditions and diseases can masquerade as PMS?

To know how many days before menstruation begins, every woman needs to keep a calendar or a special notebook and write down the start date of menstruation, how long menstruation lasts, as well as the day of ovulation (to do this, just measure basal temperature). It is also worth noting the manifestation of symptoms before menstruation and how you feel during ovulation.

If a woman keeps such records over several cycles, this helps her determine how often signs of PMS appear. Also, the diary will help determine whether there is a delay in menstruation, etc.

To establish a diagnosis of PMS, the doctor determines the presence of at least 4 signs listed below:

• , insomnia ;
• deterioration of attention and memory;
• increased appetite, decreased appetite;
• severe fatigue, weakness;
• chest pain;
• swelling;
• pain in joints or muscles;
• exacerbation of chronic diseases.

This condition can also be diagnosed if at least one of the following signs is observed:

• conflict, tearfulness, nervousness and irritability, sudden mood swings in women;
• groundless anxiety, fear, tension;
• feeling of melancholy without reason, depression;
• depression;
• aggressiveness.

To determine the severity of PMS, it is important to take into account the number of manifestations, their severity and duration:

• Mild form - manifests itself from 1 to 4 symptoms, if these are 1-2 signs, then they are significantly pronounced.
• Severe form - manifests itself from 2 to 12 signs, if these are 2-5 symptoms, then they are significantly pronounced. Sometimes they can lead to a woman becoming unable to work the day or several days before her period.

The cyclical nature of manifestations is the main feature that distinguishes premenstrual syndrome from other diseases. That is, this condition is premenstrual syndrome when it begins before menstruation (from 2 to 10 days) and completely disappears after menstruation. But if psychovegetative symptoms disappear, then physical sensations sometimes turn into painful periods or migraines in the first days of the cycle.

If a woman’s feelings in the first phase of the cycle are relatively good, then this is precisely PMS, and not an exacerbation of chronic diseases - depression, neurosis, fibrocystic disease.

If pain is observed only immediately before menstruation and during menstruation, and is combined with bleeding in the middle of the cycle, this indicates that, most likely, a gynecological disease is developing in the body - and etc.

To determine the form of PMS, hormones are examined: estradiol , prolactin , progesterone .

Additional research methods may also be prescribed, depending on which complaints predominate:

• If you are concerned about very severe headaches, dizziness, fainting, or blurred vision, it is necessary to perform a CT or MRI to exclude organic diseases of the brain.
• If neuropsychiatric symptoms predominate, an EEG is performed to exclude epileptic syndrome.
• If swelling is a concern, the amount of urine per day changes, tests are performed to diagnose the kidneys.
• In case of significant breast engorgement, an ultrasound of the mammary glands should be performed.

Women who suffer from PMS are examined not only by a gynecologist, but also by other specialists: neurologists, psychiatrists, nephrologists, endocrinologists, cardiologists, and therapists.

How to figure it out - PMS or pregnancy?

Since some symptoms during pregnancy are very similar to signs of PMS, it is important to take into account the differences that can distinguish between these conditions.

After conception occurs, the hormone increases in the female body progesterone . As a result, a woman may confuse pregnancy with PMS when the following symptoms begin to appear: breast tenderness and swelling, vomiting, nausea, mood swings, lower back pain, irritability.

Often, when you go to one or another thematic forum, you can see women’s arguments about how to distinguish PMS from pregnancy before a delay. Of course, if your periods started on time, then the issue goes away by itself. However, even pregnant women sometimes experience discharge during the day. When should your period be? There are differences between discharge before menstruation and during pregnancy - in pregnant women it is usually more scanty. But still, in order to verify the presence or absence of pregnancy, it is worth doing a test or conducting tests at the medical center. institution.

Below is a comparison of the most common symptoms during pregnancy and PMS.

Since the symptoms for these conditions are actually similar, and in some cases it is even possible to become pregnant during your period (at least that is the impression a woman gets if discharge appears), it is important to act correctly.

It is best to wait until your period begins. If a woman notes that she is already experiencing a delay, it is imperative to conduct a pregnancy test, which reliably determines pregnancy after a delay. For those who want to immediately verify whether conception has occurred, you can take (pregnancy hormone). Such a test accurately determines pregnancy already on the tenth day after conception.

The most appropriate thing to do in such a situation is to visit a gynecologist who will help you figure out what a woman actually has - PMS or pregnancy through an examination and an ultrasound. Sometimes the question also arises of how to distinguish pregnancy from – in this case, you also need to consult a doctor or do a test.

When should you contact a specialist?

If pain, irritability, and increased tearfulness in women, the causes of which are associated with PMS, significantly reduce the quality of life and are very pronounced, you should consult a doctor and carry out the treatment prescribed by him. The doctor can also give effective recommendations on how to alleviate certain unpleasant symptoms.

As a rule, with such manifestations, symptomatic therapy is prescribed. How to treat PMS, and whether it is worth prescribing any drugs for treatment, the specialist determines, taking into account the form, symptoms, and course of premenstrual syndrome. The following treatment methods may be prescribed:

• For mood swings, depression, and irritability, psychotherapy sessions, relaxation techniques, and sedatives are prescribed.
• If you are worried about pain in the abdomen, lower back, or headaches, it is recommended to take non-steroidal anti-inflammatory drugs to relieve pain (tablets, and etc.).
• Drugs are also prescribed for the treatment of premenstrual syndrome - diuretics to remove excess fluid and eliminate swelling.
• Hormonal treatment is prescribed if there is insufficiency in the second phase of the cycle, after conducting functional diagnostic tests, guided by the results of the changes that have been identified. Assign gestagens — medroxyprogesterone acetate , they should be taken from the 16th to 25th day of the menstrual cycle.
• Tranquilizers and antidepressants are prescribed to women who develop numerous neuropsychiatric symptoms before menstruation: aggressiveness, nervousness, panic attacks, insomnia, etc. In such cases, they are prescribed. The drugs should be taken in the second phase of the cycle, two days after the onset of symptoms.
• If crisis or cephalgic forms are diagnosed, it may be prescribed in the second phase of the monthly cycle. If prolactin is elevated, then Parlodel must be taken continuously.
• If a woman develops edematous or cephalgic forms, antiprostaglandin medications are prescribed (,.
• The doctor may also prescribe homeopathic remedies, as well as vitamin and mineral complexes - for example, anti-depression vitamins for women.

How to relieve the condition yourself?

If a woman is worried about PMS (sometimes mistakenly called “postmenstrual syndrome”), then she should use some recommendations to alleviate the condition.

Have a good rest

You need to sleep as much time as your body needs for proper rest. As a rule, this is 8-10 hours. Many women who write on any thematic forum note that it was the normalization of sleep that made it possible to reduce the severity of unpleasant symptoms. With a lack of sleep, anxiety, irritability, aggressiveness may develop, and worsen. For those who suffer from insomnia, taking short evening walks can help.

Aromatherapy

Provided that the woman does not suffer from allergies, you can practice aromatherapy by selecting a special composition of aromatic oils. It is recommended to use lavender, basil, sage, geranium, rose, juniper, and bergamot oils. It is worth starting to take baths with aromatic oils two weeks before menstruation.

Physical exercise

Any reasonable load has a positive effect on the body - running, dancing, yoga, bodyflex, etc. If you train fully and regularly, the body’s content increases. endorphins . And this allows you to overcome depression and insomnia, and reduce the severity of physical symptoms.

Vitamins and minerals

To reduce the severity of symptoms, two weeks before menstruation you need to take magnesium and. It is also recommended to drink and. This will help reduce the severity of a number of symptoms: palpitations, insomnia, anxiety, fatigue, irritability.

Nutrition

It is important to include as many vegetables and fruits as possible in your diet, as well as foods containing calcium and fiber. It is worth reducing the amount of coffee, cola, and chocolate consumed, as caffeine provokes anxiety and mood swings. It is important to reduce the amount of fat in your diet.

It is also not recommended to eat beef, which may contain artificial estrogens. You should drink herbal teas, lemon and carrot juices. It is better to exclude or limit alcohol, since under its influence reserves of minerals and vitamins are depleted, and the liver utilizes hormones worse.

Women often wonder why they crave salty foods before menstruation. The fact is that fluctuations in appetite are normal during PMS, and sometimes you just need to “satisfy the demands” of the body in order to feel better.

Relaxation

You need to try to avoid stressful situations, not overwork and think positively. To do this, it is recommended to practice yoga and meditation.

Regular sex

Sex also has a beneficial effect on health - it helps you sleep better, overcome stress, cope with bad emotions, strengthen your immune system and increase endorphins. In addition, in the period before menstruation, a woman’s libido often increases, which contributes to an active sex life.

Medicinal herbs

With the help of herbal teas, you can significantly relieve PMS. The main thing is to choose the right herbs. Tea can be made from St. John's wort, primrose, and other herbs that your doctor recommends.

conclusions

Thus, premenstrual syndrome is a serious condition, which sometimes becomes an obstacle for a woman to a full life and ability to work. According to research, the most severe symptoms of PMS occur in residents of large cities and women who engage in mental work.

However, with the help of specialists, as well as by practicing proper nutrition, regular physical activity, taking vitamins and minerals can significantly alleviate this condition.

Education: Graduated from Rivne State Basic Medical College with a degree in Pharmacy. Graduated from Vinnitsa State Medical University named after. M.I. Pirogov and internship at his base.

Experience: From 2003 to 2013, she worked as a pharmacist and manager of a pharmacy kiosk. She was awarded diplomas and decorations for many years of conscientious work. Articles on medical topics were published in local publications (newspapers) and on various Internet portals.

(PMS) is characterized by a pathological complex of symptoms manifested by neuropsychic, vegetative-vascular and metabolic-endocrine disorders in the second phase of the menstrual cycle in women.

In the literature you can find various synonyms for premenstrual syndrome: premenstrual tension syndrome, premenstrual illness, cyclic illness.

The frequency of premenstrual syndrome is variable and depends on the age of the woman. Thus, under the age of 30 it is 20%; after 30 years, PMS occurs in approximately every second woman. In addition, premenstrual syndrome is more often observed in emotionally labile women with asthenic physique and underweight. There was also a significantly higher incidence of PMS in women with intellectual work.

Symptoms of premenstrual syndrome

Depending on the prevalence of certain signs in the clinical picture, four forms of premenstrual syndrome are distinguished:

• Neuropsychiatric;
• edematous;
• cephalgic;
• crisis.

This division of premenstrual syndrome is arbitrary and is determined mainly by treatment tactics, which are largely symptomatic.

Depending on the number of symptoms, their duration and severity, it is proposed to distinguish between mild and severe forms of premenstrual syndrome:

• Light form PMS- the appearance of 3-4 symptoms 2-10 days before menstruation with significant severity of 1-2 symptoms;
• severe form PMS- the appearance of 5-12 symptoms 3-14 days before menstruation, of which 2-5 or all are significantly pronounced.

It should be noted that disability, regardless of the number and duration of symptoms, indicates a severe course of premenstrual syndrome and is often combined with the neuropsychiatric form.

During PMS Three stages can be distinguished:

• Compensated stage: the appearance of symptoms in the premenstrual period, which disappear with the onset of menstruation; over the years, the clinical picture of premenstrual syndrome does not progress;
• subcompensated stage: over the years, the severity of premenstrual syndrome progresses, the duration, number and severity of symptoms increases;
• decompensated stage: severe premenstrual syndrome, “light” intervals gradually decrease.

The neuropsychic form is characterized by the presence of the following symptoms: emotional lability, irritability, tearfulness, insomnia, aggressiveness, apathy towards the environment, depression, weakness, fatigue, olfactory and auditory hallucinations, weakened memory, feelings of fear, melancholy, causeless laughter or crying, sexual disorders , suicidal thoughts. In addition to the neuropsychic reactions that come to the fore, the clinical picture of PMS may include other symptoms: headaches, dizziness, loss of appetite, engorgement and tenderness of the mammary glands, chest pain, bloating.

The edematous form is characterized by the prevalence of the following symptoms in the clinical picture: swelling of the face, legs, fingers, engorgement and tenderness of the mammary glands (mastodynia), itching, sweating, thirst, weight gain, dysfunction of the gastrointestinal tract (constipation, flatulence, diarrhea ), joint pain, headaches, irritability, etc. The vast majority of patients with the edematous form of premenstrual syndrome in the second phase of the cycle experience negative diuresis with retention of up to 500-700 ml of fluid.

The cephalgic form is characterized by the prevalence of vegetative-vascular and neurological symptoms in the clinical picture: migraine-type headaches with nausea, vomiting and diarrhea (typical manifestations of hyperprostaglandinemia), dizziness, palpitations, heart pain, insomnia, irritability, increased sensitivity to odors, aggressiveness. The headache has a specific character: twitching, pulsating in the temple area with swelling of the eyelid and is accompanied by nausea and vomiting. These women often have a history of neuroinfections, traumatic brain injuries, and mental stress. The family history of patients with the cephalgic form of premenstrual syndrome is often burdened by cardiovascular diseases, hypertension and gastrointestinal pathology.

In the crisis form, the clinical picture is dominated by sympathoadrenal crises, accompanied by increased blood pressure, tachycardia, a feeling of fear, and pain in the heart without changes on the ECG. Attacks often end with profuse urination. As a rule, crises occur after overwork or stressful situations. The crisis course of premenstrual syndrome can be the outcome of an untreated neuropsychic, edematous or cephalgic form of premenstrual syndrome at the stage of decompensation and manifests itself after the age of 40 years. The vast majority of patients with the crisis form of premenstrual syndrome have diseases of the kidneys, cardiovascular system and gastrointestinal tract.

Atypical forms of premenstrual syndrome include vegetative-dysovarial myocardiopathy, hyperthermic ophthalmoplegic form of migraine, hypersomnic form, “cyclic” allergic reactions (ulcerative gingivitis, stomatitis, bronchial asthma, iridocyclitis, etc.).

Diagnosis of premenstrual syndrome

Diagnosis presents certain difficulties, since patients often turn to a therapist, neurologist or other specialists, depending on the form of premenstrual syndrome. Symptomatic therapy provides improvement in the second phase of the cycle, since after menstruation the symptoms disappear on their own. Therefore, the identification of premenstrual syndrome is facilitated by an active survey of the patient, which reveals the cyclical nature of the pathological symptoms that occur in the premenstrual days. Considering the variety of symptoms, the following clinical and diagnostic criteria have been proposed: premenstrual syndrome:

• A psychiatrist's conclusion excluding the presence of mental illness.
• There is a clear connection between symptoms and the menstrual cycle - the appearance of clinical manifestations 7-14 days before menstruation and their disappearance at the end of menstruation.

Some doctors rely on diagnosis premenstrual syndrome according to the following characteristics:

1. Emotional lability: irritability, tearfulness, rapid mood swings.
2. Aggressive or depressive state.
3. Feelings of anxiety and tension.
4. Deterioration of mood, feeling of hopelessness.
5. Decreased interest in the usual way of life.
6. Fatigue, weakness.
7. Inability to concentrate.
8. Changes in appetite, tendency to bulimia.
9. Drowsiness or insomnia.
10. Breast engorgement and tenderness, headaches, swelling, joint or muscle pain, weight gain.

The diagnosis is considered reliable in the presence of at least five of the above symptoms, with the obligatory manifestation of one of the first four.

It is advisable to keep a diary for at least 2-3 menstrual cycles, in which the patient notes all pathological symptoms.

An examination using functional diagnostic tests is impractical due to their low information content.

Hormonal studies include determination of prolactin, progesterone and estradiol in the second phase of the cycle. The hormonal characteristics of patients with premenstrual syndrome have features depending on its form. Thus, in the edematous form, a significant decrease in progesterone levels was noted in the second phase of the cycle. In neuropsychic, cephalgic and crisis forms, an increase in the level of prolactin in the blood was detected.

Additional research methods are prescribed depending on the form of premenstrual syndrome.

For severe cerebral symptoms (headaches, dizziness, tinnitus, blurred vision), computed tomography or nuclear magnetic resonance is indicated to exclude brain space-occupying lesions.

When conducting an EEG in women with a neuropsychic form of premenstrual syndrome, functional disorders are detected mainly in the diencephalic-limbic structures of the brain. In the edematous form of premenstrual syndrome, EEG data indicate an increase in the activating influences on the cerebral cortex of nonspecific structures of the brain stem, more pronounced in the second phase of the cycle. In the cephalgic form of premenstrual syndrome, EEG data indicate diffuse changes in the electrical activity of the brain according to the type of desynchronization of cortical rhythms, which intensifies during the crisis of premenstrual syndrome.

With edematous form PMS measurement of diuresis and examination of renal excretory function are indicated.

In case of tenderness and swelling of the mammary glands, mammography is performed in the first phase of the cycle for the differential diagnosis of mastodonia and mastopathy.

Mandatory examination of patients with PMS related specialists are involved: neurologist, psychiatrist, therapist, endocrinologist.

It should be remembered that in premenstrual days the course of existing chronic extragenital diseases worsens, which is also regarded as premenstrual syndrome.

Treatment of premenstrual syndrome

Unlike the treatment of other syndromes (for example, post-castration syndrome), the first stage is psychotherapy with an explanation to the patient of the nature of the disease.

How to alleviate premenstrual syndrome? Normalization of the work and rest regime is mandatory.

Nutrition should follow a diet in the second phase of the cycle, excluding coffee, chocolate, spicy and salty foods, and also limiting fluid intake. Food should be rich in vitamins; It is recommended to limit animal fats and carbohydrates.

Considering the presence of neuropsychic manifestations of varying severity in any form of premenstrual syndrome, sedative and psychotropic drugs are recommended - Tazepam, Rudotel, Seduxen, Amitriptyline, etc. Drugs are prescribed in the second phase of the cycle 2-3 days before the onset symptoms.

Antihistamines are effective for edema PMS, allergic manifestations. Tavegil, Diazolin, Teralen are prescribed (also in the second phase of the cycle).

Drugs that normalize neurotransmitter metabolism in the central nervous system are recommended for neuropsychic, cephalgic and crisis forms of premenstrual syndrome. “Peritol” normalizes serotonin metabolism (1 tablet 4 mg per day), “Difenin” (1 tablet 100 mg twice a day) has an adrenergic effect. The drugs are prescribed for a period of 3 to 6 months.

In order to improve blood circulation in the central nervous system, the use of Nootropil, Grandaxin (1 capsule 3-4 times a day), Aminolon (0.25 g for 2-3 weeks) is effective.

In cephalgic and crisis forms, the administration of Parlodel (1.25-2.5 mg per day) in the second phase of the cycle or continuously with elevated prolactin levels is effective. Being a dopamine agonist, Parlodel has a normalizing effect on the tubero-infundibular system of the central nervous system. Dihydroergotamine, which has antiserotonin and antispasmodic effects, is also an agonist of dopamine receptors. The drug is prescribed as a 0.1% solution, 15 drops 3 times a day in the second phase of the cycle.

With edematous form PMS the appointment of "Veroshpiron" is indicated, which, being an aldosterone antagonist, has a potassium-sparing diuretic and hypotensive effect. The drug is used 25 mg 2-3 times a day in the second phase of the cycle 3-4 days before the onset of clinical symptoms.

Considering the important role of prostaglandins in the pathogenesis of premenstrual syndrome, antiprostaglandin drugs are recommended, for example, Naprosyn, Indomethacin in the second phase of the cycle, especially in edematous and cephalgic forms PMS.

Hormonal therapy is carried out in case of insufficiency of the second phase of the cycle. Progestins are prescribed from the 16th to the 25th day of the cycle - Duphaston, Medroxyprogesterone acetate, 10-20 mg per day.

In cases of severe premenstrual syndrome, the use of gonadotropin-releasing hormone antagonists (GnRH agonists) for 6 months is indicated.

Treatment premenstrual syndrome long-term, takes 6-9 months. In case of relapse, therapy is repeated. In the presence of concomitant extragenital pathology, treatment is carried out jointly with other specialists.

Causes of premenstrual syndrome

To the factors contributing to the emergence premenstrual syndrome, include stressful situations, neuroinfections, complicated childbirth and abortion, various injuries and surgical interventions. A certain role is played by the premorbital background, burdened by various gynecological and extragenital pathologies.

There are many theories of the development of premenstrual syndrome that explain the pathogenesis of various symptoms: hormonal, the theory of “water intoxication”, psychosomatic disorders, allergic, etc.

Historically, the hormonal theory was the first. According to her, it was believed that PMS develops against the background of absolute or relative hyperestrogenism and insufficiency of progesterone secretion. But, as studies have shown, anovulation and corpus luteum deficiency occur with severe clinical symptoms of premenstrual syndrome very rarely. In addition, progesterone therapy was ineffective.

In recent years, prolactin has played a major role in the pathogenesis of premenstrual syndrome. In addition to the physiological increase, hypersensitivity of target tissues to prolactin is noted in the second phase of the cycle. It is known that prolactin is a modulator of the action of many hormones, in particular adrenal hormones. This explains the sodium-retaining effect of aldosterone and the antidiuretic effect of vasopressin.

The role of prostaglandins in pathogenesis has been demonstrated premenstrual syndrome. Since prostaglandins are universal tissue hormones that are synthesized in almost all organs and tissues, impaired prostaglandin synthesis can manifest itself in many different symptoms. Many symptoms of premenstrual syndrome are similar to the condition of hyperprostaglandinemia. Impaired synthesis and metabolism of prostaglandins explain the occurrence of symptoms such as migraine headaches, nausea, vomiting, bloating, diarrhea and various behavioral reactions. Prostaglandins are also responsible for the manifestation of various vegetative-vascular reactions.

The variety of clinical manifestations indicates the involvement in the pathological process of central, hypothalamic structures responsible for the regulation of all metabolic processes in the body, as well as behavioral reactions. Therefore, at present, the main role in the pathogenesis of premenstrual syndrome is given to disturbances in the metabolism of neuropeptides in the central nervous system (opioids, serotonin, dopamine, norepinephrine, etc.) and associated peripheral neuroendocrine processes.

Thus, the development of premenstrual syndrome can be explained by functional disorders of the central nervous system as a result of exposure to unfavorable factors against the background of congenital or acquired lability of the hypothalamic-pituitary system.

The menstrual cycle is actually a regular stress event that can lead to changes in hormone levels and subsequently to various health problems. In such cases, it is recommended to take medications containing vitamins and microelements that will help the woman’s body cope with such stress and prevent complications. For example, “Estrovel Time Factor”, the packaging of which consists of 4 blisters, each of which contains components that help a woman in each of the 4 phases of the menstrual cycle.