Premenstrual syndrome

Premenstrual syndrome (PMS) is characterized by irritability, anxiety, emotional lability, depression, swelling, pain in the mammary glands, headaches. These symptoms occur 7-10 days before menstruation and end a few hours after its onset. The diagnosis is based on the clinical manifestations of the disease. Treatment is symptomatic with the prescription of the correct diet and medications.

Premenstrual tension syndrome (premenstrual syndrome) is a complex of neuropsychic, vegetative-vascular and endocrine-metabolic disorders that occur in the second half of the disrupted menstrual cycle and quickly regress in the first days of menstruation. Its development is typical in conditions of insufficiency of the 2nd or both phases of the cycle.

Most women find that their mental state or physical health is affected by their menstrual cycle, worsening before their period. Symptoms may be severe one month and very mild the next, probably due to external factors. Symptoms tend to increase after age 30-40; combined contraceptive pills are effective. In 3% of women, symptoms associated with their periods are so severe that they interfere with their normal life: this is premenstrual syndrome (PMS) or premenstrual tension (PMT).

Premenstrual syndrome is a cyclic symptom complex that occurs in the premenstrual period (2–10 days before menstruation) and is characterized by somatic, neuropsychic, vegetative-vascular and metabolic-endocrine disorders, negatively affecting a woman’s usual way of life and alternating with a period of remission (lasting at least 7–12 days) associated with the onset of menstruation.

Premenstrual tension syndrome is the most severe form of premenstrual syndrome, which is characterized by severe bouts of anger, irritability and is accompanied by internal tension.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Causes of premenstrual syndrome

The clinical manifestations of PMS are caused by multiple endocrine factors (e.g., hypoglycemia, changes in carbohydrate metabolism, hyperprolactinemia, fluctuations in circulating estrogen and progesterone levels, abnormal responses to estrogen and progesterone, excessive production of aldosterone or antidiuretic hormone (ADH)). Estrogens and progesterone cause fluid retention by producing increased amounts of aldosterone or ADH.

Premenstrual Syndrome - Causes

[ 6 ], [ 7 ], [ 8 ], [ 9 ]

Symptoms of premenstrual syndrome

The type and intensity of symptoms vary from cycle to cycle in each woman. Symptoms may last from a few hours to 10 days or more. Symptoms usually end with the onset of menstruation. In perimenopausal women, symptoms may persist until the end of menstruation. The most common symptoms are irritability, anxiety, agitation, anger, insomnia, decreased concentration, drowsiness, depression, and severe fatigue. Fluid retention causes edema, transient weight gain, breast tenderness, and pain. Pelvic pain and tension, and lower back pain may occur. Some women, especially younger women, experience dysmenorrhea when menstruation begins. Other nonspecific symptoms include headache, dizziness, paresthesia of the extremities, fainting, palpitations, constipation, nausea, vomiting, and changes in appetite. Acne and neurodermatitis may also occur. Deterioration of the skin (due to allergies or infections) and eyes (e.g. visual impairment, conjunctivitis) may occur.

Premenstrual Syndrome - Symptoms

Diagnosis of premenstrual syndrome

Ask the patient to keep a diary of symptoms and events. If premenstrual syndrome is present, symptoms will be most severe in the days leading up to the onset of menstruation, will subside after the onset of menstruation, and will be free of any of the symptoms listed above for at least a week after the onset of menstruation. The diary may reveal other problems, such as mental health problems (which may be worse before the onset of menstruation) or menstrual disorders.

The diagnosis is based on taking into account typical manifestations of the disease (depression or asthenovegetative syndrome, headaches, discomfort, swelling, bloating and pain in the lower abdomen, engorgement and soreness of the mammary glands), their temporal connection with the premenstrual period and rapid regression of clinical symptoms upon the onset of menstruation.

Premenstrual syndrome - Diagnosis

[ 10 ], [ 11 ], [ 12 ], [ 13 ]

Treatment of premenstrual syndrome

Treatment is symptomatic, beginning with adequate rest and sleep and regular exercise.

Dietary changes are necessary: increasing protein intake, decreasing sugar intake, using B-complex vitamins (especially pyridoxine), increasing magnesium in the diet, and reducing stress may also help. Fluid retention can be reduced by decreasing sodium intake and administering diuretics (eg, hydrochlorothiazide 25-50 mg orally once a day in the morning) immediately before symptoms appear. However, reducing fluid retention does not help all symptoms disappear and may have no effect. Selective serotonin inhibitors (eg, fluoxetine 20 mg orally once a day) are prescribed to reduce anxiety, irritability, and other emotional symptoms, especially if stress cannot be avoided.

Hormonal therapy is effective for some women. The drugs of choice are oral contraceptives (eg, norethindrone 5 mg once daily), progesterone in the form of vaginal suppositories (200-400 mg once daily), an oral progestin (eg, microdosed progesterone 100 mg at bedtime) for 10-12 days before the onset of menstruation, or a prolonged-release progestin (eg, medroxyprogesterone 200 mg intramuscularly every 2-3 months). In severe cases of premenstrual syndrome and the absence of an effect from treatment, gonadotropin-releasing hormone agonists are prescribed (for example, leuprolide intramuscularly at 3.75 mg once a month, goserelin at 3.6 mg subcutaneously once a month) with the simultaneous administration of low-dose estrogens and progestins (for example, estradiol 0.5 mg once a day plus microdose progesterone at 100 mg before bedtime). The use of these drugs can reduce cyclic fluctuations. The use of spironolactone, bromocriptine and monoamine oxidase inhibitors (MAO) is not recommended.

Premenstrual Syndrome - Treatment

ICD-10 code

N94.3 Premenstrual tension syndrome.