Premenstrual Syndrome - a set of cyclically recurring symptoms of physical and psycho-emotional condition of the woman shortly before the start of the next menstruation.The incidence of PMS is in the range of 5-40% and increases with age. Young not overcome three decades abroad, patients does not exceed 20%, but after thirty years, every second woman experiences PMS.
Significant causes of PMS is unknown, so to speak of predisposing factors of this disease.Among them there are hormonal, metabolic, endocrine, and neuropsychiatric abnormalities.
Premenstrual syndrome can safely be called "state-mystery" becausevirtually none of genital pathology is not seen so many symptoms on the part of many body systems.However, all of the owners of state has expressed a hormonal imbalance.
Despite the variety of clinical symptoms and the degree of severity of premenstrual syndrome is closely related to the menstrual cycle, namely its second phase.1-2 weeks before the next menstruati
severity of pathological symptoms of premenstrual syndrome and ambiguous, therefore emit light, does not take great physical and psychological discomfort, shape, and heavy, which prevents observe the rhythm of life.
Diagnosis of premenstrual syndrome can not be called easy, as the pathology involved in the formation of all the most important systems of the body, and the number of possible symptoms of approaching 150. Often, the patient initially treated to a neurologist, internist, endocrinologist and other specialists.If, during the first phase of the cycle abnormalities in the organs and systems is observed, caused by a failure to correlate with premenstrual syndrome.
Among women, there is an erroneous opinion that any deviation from the usual state of the body on the eve of menstruation due to the presence of premenstrual syndrome.The majority of women are often the harbingers of menstruation breast enlargement, increased appetite and excessive emotionality, but these symptoms may be a normal variant.These symptoms are not always repeated regularly before each menstruation, and anecdotal.
In fact, the diagnosis confirms the presence of a certain number of symptoms that recur regularly associated with menstruation and go after it.The diagnosis of premenstrual syndrome can be established only after excluding the presence of mental health specialist.
volume of laboratory and instrumental studies determined form of the disease and the degree of its manifestation.All patients assigned a laboratory study of hormonal status, EEG and additional inspections under the leading symptoms of the disease.
Therapy PMS has no clear diagrams and a list of essential drugs.Special tablet premenstrual syndrome does not exist.The treatment consists of several stages and is a sequential elimination of all existing violations.The key to successful treatment is correct hormonal ovarian function and biphasic ovulatory menstrual cycles.
Premenstrual syndrome in the absence of adequate therapy is often transformed into a pathological climax.
Causes of premenstrual syndrome
There are several assumptions about the causes of premenstrual syndrome, but each theory explains the development of pathological processes in one or more body systems and can not establish a uniform trigger, linking all the changes together.
changes of mental and emotional status of the patient on the eve of menstruation is associated with violations of the proper ratio of estrogen and progesterone.The resulting hyperestrogenia and reducing the concentration of progesterone increases the lability of the nervous system.
hormonal dysfunction is considered one of the most likely impetus for the development of premenstrual syndrome, so its development correlate with abortion, removal or ligation of the fallopian tubes, abnormal pregnancy and childbirth incorrect hormonal contraception.
changes in the breast stimulates the hormone prolactin.With its abundant breasts nagrubayut and become overly sensitive.
violations of water-salt balance and the subsequent development of edema is due to delays in the tissues of water and sodium by the kidneys.
Shortage of some vitamins (zinc, magnesium, B6, and calcium), disruption of the endocrine glands, underweight and many other abnormalities can also participate in the development of PMS.
Premenstrual syndrome is closely associated with the state of psycho-emotional sphere.First of all it affects women with high mental stress, experiencing frequent stress and overwork.Among residents of large cities suffering from premenstrual syndrome more than the occupants of the countryside.
The presence of a genetic predisposition to the development of premenstrual syndrome.
infrequent menstrual syndrome in adolescents is associated with hormonal dysfunction and neurological disorders.The disease can occur with the first menstruation or a few months later.
Signs and symptoms of premenstrual syndrome
number of symptoms associated with premenstrual syndrome, is extremely high, so we can say that no two women have the same symptoms of this disease.However, there is a list of symptoms that are more common than others.If they are divided on the membership of the body's systems, there are several forms of clinical implementation of premenstrual syndrome:
- psychovegetative (sometimes called neurodevelopmental) form.It includes symptoms of a malfunction of the psycho-emotional sphere and nervous system.There are irritability, touchiness, tearfulness, heightened sensitivity to smells and sounds, as well as flatulence and / or constipation.Patients complain of sleep disturbances, fatigue, numbness of the limbs.In adult women is more common depression and premenstrual syndrome in adolescents is different manifestation of aggression.
- edematous form.Develops against the background of temporary changes in renal function, they retain sodium and excess water accumulates in the tissues, including the mammary glands.The patient had marked swelling of the face, in the area of legs and hands, a small weight gain and breast tenderness.Because stromal edema breast compressed nerves and they appear discomfort or pain.
- cephalgic form.Expressed headache (often migraine), dizziness, nausea and vomiting.
- krizovoe form.A complex of symptoms associated with kidney damage, cardiovascular and digestive systems.Marked tachycardia, hypertension, chest pain and panic attacks - "panic attacks."This form is characteristic of premenopausal patients (45-47 years).
- atypical forms.As the name is different from the usual symptoms of the disease: asthma attacks during the premenstrual period, raising the temperature to 38 ° C, vomiting, and headache.
- mixed form.It features the simultaneous combination of several forms of premenstrual syndrome.Preference is given to the joint manifestation psychovegetative and edematous forms.
premenstrual syndrome, is prolonged, some women able to worsen, so there are several stages of its development:
- Compensated stage.Premenstrual syndrome is expressed only slightly over the years and is not progressing.All are symptoms appear immediately after menstruation.
- subcompensated stage.Significantly severe symptoms of the disease limits the ability to work and the patient continued to worsen with time.
- Decompensated stage of premenstrual syndrome at different degrees of severity of symptoms that pass in a few days after menstruation.
Impaired ability to lead a normal life and work, regardless of the severity of symptoms and their duration always points to the severity of the disease and is often associated with mental disorders.Changes psycho-emotional sphere can be so pronounced that the patient is not always control their behavior, 27% of women have committed crimes diagnosed premenstrual syndrome.
number of pathological symptoms forming premenstrual syndrome patients, not equivalent, so to distinguish between light and heavy severity of the disease.The presence of three or four symptoms of the leading value only -dvuh one of them points to a mild form of the disease.About severe form of the disease is the appearance of symptoms in 5- 12 obligatory expression of two or five of them.
Unfortunately, there is a perception that premenstrual syndrome is common to all women, without exception, and that it should not become the reason for seeking medical attention.The popularization of medical knowledge in the media allows women to purchase their own drugs premenstrual syndrome in a free pharmacy network.Self-medication can not cure the illness, but it can eliminate or ease its symptoms, creating the illusion of healing.Any decisions on their own tablets for PMS can not replace a full-fledged comprehensive treatment.
diagnosis of premenstrual syndrome
diagnosis of premenstrual syndrome is not always obvious.The disease has many symptoms neginekologicheskogo nature, so often initially treated patients to an endocrinologist, neurologist and other specialists.Most patients visit the years related professionals and unsuccessfully trying to cure non-existent extragenital pathology.
only diagnostic criterion in such cases is the close relationship existing pathological symptoms of the approaching menstruation and cyclical recurrence.
is also necessary to take into account the characteristics of the individual patient psihoemotsonalnogo warehouse, as each woman has their own criteria for evaluating their condition.
To correctly navigate among a large number of possible symptoms and distinguish them from other states, there are several clinical diagnostic criteria:
- initial psychiatric report on the absence of mental illness in the case of heavy psychological and emotional symptoms.
- Cyclical rise and subside the symptoms according to the phases of the menstrual cycle.
diagnosis of PMS is put only if the patient has at least five of the following clinical signs, one of them has to be among the first four:
- Emotional instability: frequent changes of mood, tearfulness unmotivated, negative mood.
- aggressive or depressed, depression.
- Unmotivated anxiety and emotional stress.
- Feeling hopeless, worsening of mood.
- Indifference to events happening around them.
- Fatigue and weakness.
- impaired concentration: forgetfulness, inability to concentrate on something specific.
- Change in appetite.Often, women with bulimia in the survey identify premenstrual syndrome.
- Change the normal rhythm of sleep: the patient can not sleep at night because of anxiety and emotional stress or experiencing constant desire to sleep during the day.
- headaches or migraines, swelling, bloating and breast tenderness, joint and / or muscle pain (sometimes very expression), a small weight gain.
definite diagnosis of PMS is installed in conjunction with the patient.It is proposed to conduct "diaries" and fix it all, symptoms for several menstrual cycles.
Laboratory diagnosis helps to identify the nature of hormonal disorders.It determines the level of prolactin, progesterone and estradiol.Research carried out in the second half cycle, and the results correlate with form of the disease.Reduced levels of progesterone is inherent in the edematous form of the disease, and high prolactin levels detected in patients with psychovegetative, cephalgic or krizovoe form of the disease.
for headaches, tinnitus, dizziness, blurred vision and other symptoms of cerebral differential diagnosis is carried out with space-occupying lesions in the brain.It is shown that computed tomography (CT) or magnetic resonance imaging of the brain (MRI).
When expressed neuropsychiatric abnormalities carried electroencephalography confirming cyclical changes in the brain.
edematous form of premenstrual syndrome requires the differential diagnosis of kidney disease, as well as with the pathology of the breast.We study the function of the kidneys by a laboratory (urine tests, monitoring of urine output) and instrumental (ultrasound) diagnosis.Mammography exclude mastodynia and mastopathy.
predmestrualnogo syndrome diagnosis help the gynecologist to put related professionals, to exclude the presence of "their" disease.Therefore, the list of diagnostic procedures can significantly increase due to additional methods prescribed by other doctors.
opinion that premenstrual syndrome in varying degrees of severity is available to all women, really true, but it becomes a disease if its accompanying symptoms regularly disrupt normal life and bring the physical and mental suffering.
treatment of premenstrual syndrome
Mechanisms of premenstrual syndrome are closely related to the menstrual cycle and those with psychosomatic processes that accompany it.Therefore, the total elimination of premenstrual symptoms can only be subject to completion of the menstrual function.However, with a properly chosen treatment strategy fails to relieve patient suffering from a painful monthly and transform a mild illness.
Therapy premenstrual syndrome always long (not less than three to six months) and is directed to all parts of the pathological process, depending on the shape and extent of its expression.Unfortunately, often after the end of therapy the illness returned, and came back to look for new approaches to the treatment of the disease.
Typically, patients with premenstrual syndrome have expressed emotional and neurological disorders related to attitude to his condition.To the healing process to be successful, you need a positive attitude, so the first step in treatment is a detailed conversation in which the doctor tells about the disease and explains the treatment policy, and recommends necessary changes lifestyle: diet, necessary physical activity, avoiding harmfuland other habits.
of drugs for PMS are selected according to the list of symptoms that accompany it.Uses:
- Psychotropic and sedatives for the elimination of neuropsychiatric disorders.
- Hormonal drugs are used to restore hormonal balance necessary.Can be used progestins (Utrozhestan, Duphaston), monophasic contraceptives (Yarina, Logest, Jeanine).