Premenstrual syndrome (PMS)

Premenstrual syndrome, or PMS considered to be cyclical changes in a woman's body, manifested in numerous, diverse painful changes. Women complain sharp emotional lability, nausea, vomiting, skin itching, pain in the heart, palpitation, depressed mental state. Objectively marked swelling of the face and hands, various skin rashes, painful engorgement, flatulence. Menstrual function or normal, or disturbed by type hypomenstrual syndrome. All numerous complaints cycle for 4-14 days before menstruation and disappear in the first half of the menstrual cycle. It is believed that the primary link in breaking the chain of neurohumoral regulation of menstrual function is the hypothalamic-pituitary system.
Treatment of premenstrual syndrome consists of the following points: sedatives (andaxin or trioxazin 1-2 tablets a day); regulation of water-salt metabolism (appointed 10% solution of ammonium chloride on 1 table. L. 3 times a day for 14 days before menstruation); regulation of violation of ovarian function, hormone therapy (treatment appoints gynecologist) after the detailed examination; anti-inflammatory therapy in the detection of inflammatory process in the reproductive system; allergic manifestations appointed diphenhydramine, suprastin 1 tablet 1-2 times a day. Treatment should be conducted cyclically during the three periods of the menstrual cycle.

Premenstrual syndrome includes complaints of women on breast engorgement and heaviness in them, a feeling of heaviness in the lower abdomen, in some vegetative disorders, irritability, easy fatigue, headaches. These disorders usually begin in the second phase of the cycle, i.e. 7-10 days before the onset of menstruation and the beginning of its end. Premenstrual syndrome is more common in women with unstable nervous system, full-bodied, often in the age close to menopause; with menopause complaints cease.
Happen and objective changes in a woman's body: body weight in the premenstrual period increased by 500 - 1500 m; often there dermatitis, swelling vocal cords, acrocyanosis. Sometimes there is a low level of secretion of progesterone and reduced secretion of 17-ketosteroids; therefore, we can assume that the basis of the pathogenesis of premenstrual syndrome lie benefit of estrogen-progesterone violations. Basically premenstrual syndrome is caused, apparently, with deviations of functions of the hypothalamus, as evidenced by the observed these women flatulence, reduced excretion of progesterone (as a result of insufficient allocation of luteinizing hormone), the delay of water body (due to increased formation of antidiuretic hormone) and the coming of vegetative disorders.
Treatment of premenstrual syndrome is the appointment of progesterone in the second phase of the menstrual cycle; more efficient use of testosterone (also in the second phase of the menstrual cycle) - 25 mg 1 time per 2-3 days. In addition, prescribed diet with restriction of chlorides; apply ammonium chloride, which has diuretic properties.

Premenstrual syndrome (synonym premenstrual tension) - unwell before menstruation, taking the form of the disease.
Premenstrual syndrome is characterized neuropsychiatric, vegetative-vascular and metabolic disorders that occur for 3-14 days before menstruation and endangered immediately or in the first days of its appearance.
PMS occurs, according to various authors, 36-95% of menstruating women. The townspeople, especially in women of intellectual labour, premenstrual syndrome occurs more often than women engaged in physical labor. More than 1/3 menstruating women resort to various medical means due to deterioration of health before menstruation, and 1/4 needs medical help. Premenstrual syndrome often occurs after childbirth and abortions, experienced mental stress. Sometimes the occurrence of premenstrual syndrome coincides with menarche.
The pathogenesis of PMS are not well understood. There are several theories.
Supporters of the hormonal theory believe PMS the result of violation of the ratio of estrogen and progesterone. Some authors find in the second half of the cycle absolute or relative giperestrogenia with hypoglycaemia, while others find the hypoestrogenia. The increase in estrogen causes a delay of sodium, which leads to the extracellular fluid retention and edema. The decrease in progesterone further contributes to the appearance of edema. Progesterone, having natriyureticeski effect, increases diuresis. When hypolycaena fluid accumulate in the tissues. Swelling cause a sensation of bloating, pain in the milk glands; swelling of the brain tissue explain irritability, headaches. Excess estrogen cause hypoglycemia (estrogens increase tolerance to the sugar), hypoglycaemia explain not uncommon for premenstrual syndrome bouts of fatigue and weakness.
Some authors consider that the basis of the pathogenesis of PMS is water retention (theory of water intoxication), as evidenced by the increasing weight in the premenstrual period, high antidiuretic activity serum of patients and the emergence expressed edemas. Swelling and cause mnogovektornosti premenstrual syndrome.
Supporters allergic theory of the cause of PMS consider Allergy to own hormones. For the proof of allergic status with PMS injected intradermally net hormones. Sharply positive reaction in the second phase of the cycle indicates allergies to their own hormones. Consider that one of sensitizing factors is genital infection, which result in perverse reaction to its own hormones.
Is very widespread and theory, which gives primary importance to the violation of the autonomic nervous system. According to this theory PMS is caused by a lowering of the threshold of excitability of the sympathetic nervous system. In this regard, the normal physiological, and even more pathological effects lead to painful reactions. "A change in the autonomic system causes for the second time hormonal balance and allergic condition.
We can assume that PMS is caused by the violation of the functional state of the upper governing centers. The occurrence of premenstrual syndrome after mental stress, infections, abortion and childbirth along with polimorfnogo symptoms of PMS allows to believe that the hypothalamus is the primary link in violation of the chain complex neuroendocrine regulation. Violations in the hypothalamus result in a change in the exchange steroid hormones, water-salt metabolism, carbohydrate, and so on, and this is reflected in the premenstrual syndrome.
Clinic PMS is characterized by the cyclical nature of the disease, i.e., his appearance in the second phase of the cycle, with the disappearance of basically all symptoms immediately after the onset of menstruation and individuality of expression syndrome.
Clinically for premenstrual syndrome characterized by a combination of emotional tension, vegetative-vascular manifestations, impaired water-salt exchange under different ovarian function.
For 3-14 days before menstruation appear diverse and numerous complaints of irritability, depression, fatigue, insomnia, headache and dizziness, nausea, vomiting, pain in the heart, sometimes fever, nasal bleeding, decreased hearing and vision, chills, allergic rashes. These complaints reach the peak the day before or on the first day of menstruation, and improvement of health comes sometimes only by the end of menstruation. The clinical picture is noteworthy emotional tension. In the first half of a woman's cycle, as a rule, is sustained, communicative, with good health and a friendly attitude towards others. In the second half of the cycle appear irritability, suspiciousness, increased reaction to minor events, hypochondriac thoughts, loss of health with high demanding to others, often aggressive towards its close, there is the fear of fatality. Characteristically, with the onset of menstruation patients themselves are critical of their behaviour in the premenstrual period.
Violation of water-salt metabolism is expressed in the swelling of the face, hands and feet, which is accompanied by the increase in weight, sometimes significant,up to 2-3 kg Immediately after the onset of menstruation weight begins to decline. About fluid show a negative urine output in the second phase of the cycle, and accelerated "volturna sample". Simultaneously with the appearance of edema is often changed the exchange of electrolytes with a decrease in potassium and increasing chloride in the blood in some patients.
The function of the ovaries during PMS is different. Along with pronounced ovulatory cycles are hypolycaena and anovulation, with both Hyper-and with hypoestrogenia. Menstruation usually not changed, sometimes become more scarce or abundant in retained their rhythm.


Treatment. The most rational is therapy, combining psychotherapy, soothing, dioretiki, hormones and vitamins. With all patients, it is recommended conducting interviews to explain the treatability of the disease and the removal of fear of mental illness. To relieve emotional tension use tranquilizers (trioxazin or phrenolon 1-2 tablets per day) for 10 to 14 days before menstruation, it is better to assign soothing 2-3 days before the onset of symptoms.
Water-salt metabolism regulate the admission of 10% solution of ammonium chloride (1 tbsp. spoon 3 times a day daily) or gipotiazida (on 12,5-25 mg / day 2-3 times a week). Diuretics appoint 14 days before menstruation in combination with a daily intake of potassium 1 g 3-4 times a day (in order to prevent gipokaliemii).
In severe edematous form of PMS apply progesterone (8 days before menstruation for 6 days).
In cases of violation of ovarian function when hypolycaena and anovulation with giperestrogenia prescribe progesterone 8 days before menstruation by 5 to 10 mg for 6 days; if anovulation with hypoestrogenia - cyclical hormone therapy (estrogen 5 000 - 10 000 IU at 8, 10, 12, 14, 16 and 18-th day of the cycle in a 28-day cycle, followed by the appointment of progesterone from the 20th to the 25th day of the cycle).
After 40 years in the second phase of the cycle shown the appointment of androgens - 10 - 20 mg methyltestosterone a day for 8-10 days before menstruation, preferably in combination with gestagena (15 mg pregnina 3 times a day for 6 days 8 days before menstruation).
In allergic manifestations in the second phase of the cycle appoint diphenhydramine (0.05 g) or suprastin (0,025 g) 1-2 tablets a day.
Given the regulating effect of vitamin E on the neuroendocrine system, it is used in the second phase of the cycle, along with vitamin a, which has anti-allergic activity and is peripheral estrogen antagonist.
Cm. also the Menstrual cycle.