Advertising on the portal

PMS symptoms treatment. Premenstrual syndrome: symptoms of PMS in women, causes and treatment

Most women experience strong sensitivity, mood swings, sudden outbursts of anger. But such behavioral features are not always explained only by the subtleties of character. In fact, the psychological state of women very much depends on menstrual cycle .

Premenstrual syndrome (this condition is also called for short PMS) is a complex set of disorders that appear in a woman in the days before the onset of menstruation. All these symptoms disappear immediately after menstruation begins, or stop in the first days of menstruation. IN in this case we're talking about O metabolic-endocrine , psycho-emotional And vegetative-vascular violations.

Statistics show that up to 80% of all women on the planet know from their own experience what PMS is. As a rule, this syndrome is observed in women aged 20 to 40 years. But in most cases, women develop light form premenstrual syndrome, so they do not turn to specialists with complaints. But still in some cases over time PMS symptoms become more pronounced. Therefore, for those women who feel worsening unpleasant symptoms Before menstruation every month, you should definitely consult a doctor to prevent the situation from worsening in the future.

Why does PMS occur?

To today The causes of premenstrual syndrome have not been precisely determined. But there are still suggestions that the manifestation of premenstrual syndrome is a consequence of a sharp jump in the level in the female body in last days menstrual cycle.

In addition, among the causes of PMS, cyclical monthly levels of certain substances in a woman’s brain are called. Among these substances are endrophins that have a direct impact on a person’s mood.

To some extent, the manifestation of premenstrual syndrome also depends on an incorrect approach to nutrition: as a result, fluid is retained in the body, the breasts become very sensitive, and fatigue is observed, which may be associated with a lack of vitamin B6 in the body. cause a headache palpitations, can provoke magnesium deficiency in the body. There is also an unproven opinion that a genetic predisposition leads to the manifestation of premenstrual syndrome.

Symptoms of premenstrual syndrome

Symptoms of PMS manifest themselves in women in completely different ways: for some, this condition passes relatively calmly, while others experience the days before menstruation very violently. But diagnosing this condition allows the time of occurrence of such signs: they always appear for a certain period before the onset of menstruation.

PMS in women can manifest itself as periodic occurrence panic attacks, depressive state, , states of anxiety. Sometimes PMS leads to menstrual dysfunction.

Signs of premenstrual syndrome occur 2-10 days before the first day of menstruation. Premenstrual syndrome can occur in different ways. Thus, there are three different variants of PMS, each of which has certain characteristics.

At first option development of PMS symptoms this state do not progress over time. They usually occur in the second half monthly cycle and stop when menstruation occurs.

At second option As the disease progresses, PMS symptoms disappear only when menstruation stops completely. Over the years, the intensity of symptoms increases.

At third option During the course of PMS, the symptoms of the disease only intensify over the years. The signs disappear only a few days after menstruation has stopped.

The manifestations of premenstrual syndrome in different women can be completely different. This condition is characterized by tearfulness, manifestations of irritability, high sensitivity to strong smells and sounds, and discomfort in the mammary glands. As a rule, in young women, PMS manifests itself as tearfulness and depressive state, and adolescents may experience outbursts of aggressiveness. In addition to the feeling of discomfort, other changes may also appear in the mammary glands. In particular, they feel painful areas, compactions appear that can be felt. In addition, during PMS, a woman may experience swelling in her face, legs, fingers, and sweating.

At home, a woman can carry out it on her own, or wait until the time when menstruation should occur.

Diet, nutrition for premenstrual syndrome

List of sources

  • Radzinsky V.E., Fuks A.M., Toktar L.R. et al. Gynecology: textbook. M.: GEOTAR-Media, 2014;
  • Kulakov V.I., Prilepskaya V.N., Radzinsky V.E. et al. Guide to outpatient care in obstetrics and gynecology. M.: GEOTAR-Media, 2007;
  • Aganezova N.V. Premenstrual syndrome: biological and psychosocial predictors of pathogenesis, clinical picture, rationale complex therapy. Doctoral dissertation, 2011;
  • Ledina A.V. Premenstrual syndrome: epidemiology, clinical picture, diagnosis and treatment. Abstract of doctoral dissertation, 2014;
  • Gynecological endocrinology. Ed. Serov V.N., Prilepskaya V.N., Ovsyannikova T.V., Moscow, 2004.

Obstetrician-gynecologist, highest category, endocrinologist, ultrasound diagnostics doctor, specialist in the field of aesthetic gynecology Make an appointment

Obstetrician-gynecologist, specialist in the field modern methods evidence-based gynecology Make an appointment

Obstetrician-gynecologist, endocrinologist, candidate of medical sciences Make an appointment

Obstetrician-gynecologist, ultrasound diagnostics doctor, candidate of medical sciences, specialist in the field of aesthetic gynecology Make an appointment

What is PMS (premenstrual syndrome)

Premenstrual syndrome (abbreviated as PMS, or as it is sometimes mistakenly called “postmenstrual syndrome”) is a complex set of negative symptoms that occurs in women in the days leading up to menstruation. Premenstrual syndrome (PMS) can manifest itself in a number of neuropsychic, metabolic-endocrine or vegetative-vascular disorders, and the symptoms of PMS are individual for each patient.

According to statistics, premenstrual syndrome (PMS) affects, according to various sources, from 50 to 80% of all women on the planet. Many of them are in a fairly mild form, in which there is no need to see a doctor. However, you need to be aware that PMS can progress over time and under the right circumstances, so if you experience any pain or nervous disorders before menstruation, try to prevent the situation from worsening.

It happens that changes in a woman’s well-being or behavior occur after the onset of menstruation. Since this happens after 2-3 weeks, many people mistakenly call it postmenstrual syndrome.

In general, according to the information of our doctors medical center, PMS most often affects women aged 20 to 40 years; cases of premenstrual syndrome occurring together with the onset of menarche are less common, and even less common in the premenopausal period.

1Array ( => Pregnancy => Gynecology) Array ( => 4 => 7) Array ( => https://akusherstvo.policlinica.ru/prices-akusherstvo.html =>.html) 7

Symptoms of PMS (premenstrual syndrome)

Gynecologists and specialists in this field say that there are about 150 symptoms of premenstrual syndrome (PMS), which, moreover, occur in different combinations. However, the most common of them are the following: slight weight gain, pain in the lumbar region and pelvic organs, bloating, nausea, hardening and tenderness of the mammary glands, increased fatigue, irritability, insomnia or, in some cases, on the contrary, excessive drowsiness.

Most young women say that in the days leading up to menstruation, they often experience not only physical, but also emotional and psychological discomfort. Many experience seizures unjustified aggression, inappropriate behavioral reactions, tearfulness, and rapid mood swings may be observed. At the same time, it has been noticed that some women unconsciously experience fear of the onset of PMS and menstruation, and therefore become even more irritable and withdrawn, even before the onset of this period.

At one time, studies were conducted aimed at elucidating the effect of PMS on a woman’s activity and ability to work. Their results turned out to be very disappointing. Thus, the last few days of the menstrual cycle account for about 33% of cases. acute appendicitis, 31% of acute viral infections and respiratory diseases, about 25% of women are hospitalized during this period. 27% of women during postmenstrual syndrome begin to take tranquilizers or some other drugs that affect the neuropsychic state, which also negatively affects both their future health and ability to work.

As noted by the gynecologist of our medical center "Euromedprestige" Fedor Nikolaevich Usatenko, in clinical practice There are four most common forms of premenstrual syndrome. The first form of postmenstrual syndrome is neuropsychic, characterized by weakness, tearfulness, depression or, conversely, excessive and unreasonable irritability and aggression. Moreover, the latter, as a rule, predominates among young girls, while slightly older women are more often susceptible to depression and melancholy.

The edematous form of PMS is characterized by hardening, swelling and tenderness of the mammary glands, swelling of the face, legs and hands, and sweating. With this form of PMS, sensitivity to odors is sharply expressed, changes are possible taste sensations. Many women suffering from this type of premenstrual syndrome believe that the cause similar conditions in respiratory or viral infections and seek help from a therapist. Meanwhile, the gynecologists at our medical center recommend that you carefully monitor yourself and, if symptoms occur exclusively before the onset of menstruation, visit a gynecologist. In this case, only he will be able to prescribe the appropriate treatment for you.

The third form of PMS is called cephalgic. With this form of PMS, a woman experiences headaches, nausea, sometimes vomiting, and dizziness. About a third experience heart pain and a depressed psychological state. If a cranial x-ray is performed in this situation, you can see an increase in the vascular pattern in combination with hyperostosis (overgrowth of the bone layer). In addition, the amount of calcium in a woman’s body changes, which can lead to fragility and brittle bones.


And finally, the last, so-called crisis form of postmenstrual syndrome (PMS), manifests itself in the appearance of adrenaline crises, which begin with a feeling of squeezing under the chest and are accompanied by a significantly increased heart rate, numbness and coldness of the arms and legs. Frequent and copious urination may occur. In addition, half of the women say that during such crises they experience a very heightened fear of death, which negatively affects their mental and emotional state.

As noted by specialists from our medical center, the crisis form of PMS is the most severe and requires mandatory medical intervention. Moreover, it does not arise on its own, but is a consequence of the untreated previous three forms. Therefore, for any negative symptoms and deterioration general condition health in the days preceding menstruation, it is best to consult a gynecologist, since only he will be able to determine how serious the situation is and prescribe the necessary treatment.

gastroenterology diagnostic complex - 5,360 rubles

ONLY IN MARCHsaving - 15%

1000 rubles ECG recording with interpretation

- 25%primary
doctor's appointment
therapist on weekends

980 rub. initial appointment with a hirudotherapist

appointment with a therapist - 1,130 rubles (instead of 1,500 rubles) "Only in March, on Saturdays and Sundays, appointments with a general practitioner with a 25% discount - 1,130 rubles, instead of 1,500 rubles (diagnostic procedures are paid according to the price list)

Causes of PMS (premenstrual syndrome)

For several decades, medical scientists have been trying to figure out the causes and factors that lead to the occurrence of premenstrual syndrome. Today, there are several theories, but none of them can explain all the symptoms that accompany PMS.

The most complete theory so far is the hormonal theory, according to which premenstrual syndrome is a consequence of an imbalance of estrogen< и прогестерона в организме женщины. Наиболее обоснованной в рамках этой теории является точка зрения, говорящая о гиперэстрогении (избытке эстрогенов). Действие этих гормонов таково, что в большом количестве они способствуют задержке жидкости в организме, что, в свою очередь, вызывает отеки, набухание и болезненность молочных желез, головную боль, обострение сердечно-сосудистых проблем. Кроме того, эстрогены могут скапливаться в лимбической системе организма, влияющей на нервно-эмоциональное состояние женщины. Отсюда — депрессивные или агрессивные состояния, раздражительность и т.п.


Another theory, the theory of water intoxication, suggests that PMS symptoms occur when water-salt metabolism fluids in the body. In addition, there is an opinion that PMS is a consequence of vitamin deficiency, in particular, a lack of vitamins B6, A, magnesium, calcium, and zinc. However, this has not yet been fully tested in practice, although in some cases vitamin therapy gives a positive result in the treatment of PMS. Also, some doctors talk about a genetic factor in the development of premenstrual syndrome.

At our medical center "Euromedprestige", gynecologists and gynecological endocrinologists are of the opinion that the basis of premenstrual syndrome is not one reason, but a combination of them, and for each woman they can be individual. Therefore, before prescribing treatment, our doctors conduct a comprehensive mini-examination in order to make the most accurate diagnosis.

Treatment of PMS (premenstrual syndrome)

The direction of treatment for premenstrual syndrome (PMS) is largely determined by individual characteristics female body and the symptoms that the patient experiences. Common to all forms of PMS is the advice to keep a menstrual calendar, and, if possible, write down your feelings in the days before menstruation. This clearly shows whether a woman has PMS or whether the causes of the malaise lie in another, non-gynecological disorder.

At our medical center, doctors practice complex treatment of premenstrual syndrome, including the use of sex hormones, vitamins, and other medicines as needed, as well as special diet and physical therapy. The last two methods are recommended in any case, whatever the symptoms. Drug therapy is prescribed by the doctor at his own discretion.

1Array ( => Pregnancy => Gynecology) Array ( => 4 => 7) Array ( => https://akusherstvo.policlinica.ru/prices-akusherstvo.html =>.html) 7

Hormonal theory of PMS

Let's talk a little about what medications are prescribed to women suffering from premenstrual syndrome (PMS). Firstly, these are synthetic analogues natural hormones gestagens, which helps restore hormonal balance and eliminates the manifestations of PMS. They have been used for quite a long time, since about the 50s of the twentieth century, and remain popular to this day, as they are effective in most cases. Rarely, but still there are situations in which gestagens are not recommended due to individual characteristics woman's hormonal system. Therefore, before prescribing treatment, the specialists of our medical center "Euromedprestige" first conduct a study on tests functional diagnostics, and also examine the level of hormones in the patient’s blood. All this allows us to draw a conclusion about the possibility of using gestagens for the treatment of PMS. If there are contraindications, the doctor selects another treatment using other medications.

PMS treatment vitamin preparations usually includes the use of vitamins A and E in combination. A series of approximately 15 injections is performed. In addition, at the discretion of the specialist and on the basis of analysis, magnesium, calcium or vitamin B6 preparations, which activate estrogen metabolism and prevent their accumulation, can be prescribed for the treatment of PMS.

Diet also plays an important role in the treatment of premenstrual syndrome. It is based on the fact that a woman should consume food that contains enough large number fiber. The approximate ratio of proteins, fats and carbohydrates should be 15%, 10% and 75%. It is worth limiting beef, as some types contain artificial estrogens, and reducing the amount of fat consumed due to the fact that they can negatively affect the liver and cause fluid retention in the body. Excess proteins are also not recommended, as they increase the body's need for mineral salts, which can interfere with water-salt metabolism.

The theory of water intoxication in postmenstrual syndrome

Besides food, rich in fiber, a woman suffering from PMS can be advised to eat more vegetables, fruits, and drink herbal teas and juices, especially carrot and lemon. But drinks containing caffeine should be avoided, as this component can increase irritability, anxiety and sleep disturbances. The same applies to alcohol, but its effect is even more negative, since it directly affects the liver, reducing its ability to process hormones, and thus estrogens accumulate in the body.

Physiotherapy is also quite effective for premenstrual syndrome (PMS). The woman is offered therapeutic aerobics or special hydrotherapy< в сочетании с массажем. Доказано, что physical exercise can relieve stress and balance the hormonal system. However, you should not get involved in sports such as weightlifting, boxing, etc. Too strong physical activity Not only do they not treat, but they also aggravate premenstrual syndrome (PMS). Gynecologists at our medical center recommend that women suffering from PMS engage in sports such as jogging, walking, and cycling on level ground at low speed. First, of course, you should consult a doctor who will select the best exercise regimen.

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 occurrence of premenstrual symptoms. Severe forms PMS is 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 drug 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 sexual 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 substances involved in the pathogenesis of PMS is serotonin. Reduction of serotonin-dependent transmission in the brain nerve impulses leads to the emergence of emotional and behavioral symptoms characteristic of 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: disorders emotional sphere, somatic disorders and symptoms associated with changes in general well-being.

Depending on the predominance of certain clinical manifestations PMS has four forms:

  • 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 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.

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 monthly similar symptoms. The most common psycho-emotional manifestations of PMS are increased fatigue, irritability, anxiety, feelings of internal tension, sharp changes moods. TO 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 have difficulty performing daily work already morning hours. At the same time in evening time days, sleep disturbances appear.

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 limbs. 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. 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 necessary element diagnostic search. For this purpose they are used as menstrual calendars symptoms, and visual analogue scales (VAS), 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 symptom, 1 - mild symptom severity, 2 - moderate severity symptoms, 3 — high degree severity of the symptom. 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, reliable and reliable method obtaining information about PMS symptoms in a particular patient. It is a segment 10 cm long, at the beginning of which the point is “complete absence of a symptom”, 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 follicular phase menstrual cycle, L — symptom severity 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 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. A consultation with a psychiatrist allows you to rule out mental illnesses that may be hidden under the guise of PMS. For severe headaches, dizziness, tinnitus, and visual impairment, an MRI of the brain and assessment of the condition of the fundus and visual fields are indicated. In a crisis form that occurs with an increase blood pressure(BP), required differential diagnosis with pheochromocytoma (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 work and rest schedules, night sleep duration of 7-8 hours, exclusion of psycho-emotional and physical overload, mandatory physical activity moderate intensity. Positive result Walking, jogging, cycling are provided. 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, headache, i.e. with symptoms associated with fluid retention in the body, it is advisable to recommend limiting consumption 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, 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 the patient if mental symptoms PMS. 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 amount 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 psychoemotional and somatic manifestations PMS such as breast engorgement and swelling. 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 shortening the menstrual cycle, sexual disorders, the need 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 as mastalgia, pain in the lower parts belly. 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. Minor positive influence The use of progesterone was established 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 positive action for 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 plasma levels of 17 b-estradiol. 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. Daily dose 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, a positive impact was 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 aHRH is limited by possible side effects similar to the manifestations climacteric syndrome, as well as the development of osteoporosis. At the same time, with the simultaneous use of aGRH and estrogen-gestagen drugs for replacement therapy, estrogen-dependent PMS symptoms did not occur, while gestagen-dependent PMS symptoms persisted. This observation imposes restrictions on the use of drugs containing sex steroids during therapy with GnRH in women suffering from PMS.

Thus, GHRH agonists have high efficiency 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 effect of the drug on the renin-angiotensin-aldosterone system prevents fluid retention in the woman’s body and, thus, may have healing effect with 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 taking which 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 causing positive influence for 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 secretion 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 COCs 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 minimum quantity possible side effects, most of which self-limit 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

Premenstrual syndrome (PMS) is a complex complex of somatic and mental disorders, which appear 2-14 days before menstruation and, as a rule, completely disappear after it begins. Thus, PMS develops in the second, luteal phase of the menstrual cycle. You can also find other names for this condition: premenstrual tension syndrome, cyclic syndrome, premenstrual illness.

PMS in one form or another occurs in 3 out of 4 menstruating women aged 15 to 49 years.

PMS appears especially often at the end of the 3rd and beginning of the 4th decade. Typically, PMS symptoms are characterized by periodicity: they are more pronounced in some months and may disappear in others.

Symptoms of premenstrual syndrome traditionally divided into two groups:

Emotional and behavioral: tension and anxiety; mood swings, irritability, fits of anger or crying; depressed mood, changes in appetite (from complete absence to a pronounced feeling of hunger), sleep disturbances (insomnia) and concentration, the desire to isolate oneself from others, increased sensitivity to sounds and smells.

General somatic: headache, feeling of fullness in eyeballs, pain in the heart area, general weakness, weight gain due to fluid retention, bloating, nausea, engorgement of the mammary glands, pain in the joints and muscles, numbness in the hands, loose stools or constipation.

Symptoms of PMS can appear in various combinations and are characterized by: varying intensity, in connection with which a distinction is made between mild (3–4 symptoms) and severe (5–12 manifestations) forms of PMS. Sometimes emotional and behavioral disorders of PMS deprive a woman of her ability to work; in such cases they talk about premenstrual dysphoria. According to another classification, compensated, subcompensated and decompensated stages of PMS are distinguished. In the first case, the disease does not progress, in the second, the severity of symptoms increases over the years, and in the third, after the cessation of menstruation, the manifestations of PMS persist for an increasingly longer time.

Depending on the prevalence of certain symptoms, PMS is divided into four forms: neuropsychic(emotional and behavioral symptoms predominate - see above), edematous(swelling of the face, legs, fingers, engorgement of the mammary glands comes to the fore), cephalgic(severe headache, nausea, vomiting, dizziness) and crisis(in the form of attacks, palpitations, a feeling of fear of death, increased blood pressure, and numbness of the extremities predominate). Dividing PMS into these forms allows you to choose the most effective treatment.

Accurate causes of PMS unknown, but factors contributing to the development of this condition have been identified. Frank, who described this syndrome in 1931, believed that it was caused by excess estrogen. Later, it was suggested that progesterone decreases in the second phase of the menstrual cycle. There is no doubt that the manifestations of PMS depend on cyclical fluctuations of hormones. This is evidenced by the disappearance of the syndrome during pregnancy and menopause. Fluctuations in serotonin (a neurotransmitter) in the brain are responsible for changes in a person's mood. It is believed that an insufficient amount of it can contribute to the development of premenstrual depression, sleep disturbances, changes in appetite, and general weakness. Proponents of the “water intoxication” theory point to changes in the renin-angiotensin-aldosterone system, which plays a role in important role during development hypertension. Many researchers consider primary neuro-hormonal disorders in the area of ​​two very important structures of the brain - the hypothalamus (considering PMS as a manifestation of hypothalamic syndrome) and the pituitary gland (the leading role is assigned to melanostimulating hormone and its interaction with endorphins).

Difficult childbirth, abortion, stressful situations, infectious diseases, especially neuroinfections, overwork serve as trigger factors in the development of PMS. More often, this syndrome occurs in women with existing diseases. internal organs. It has been noted that a lack of vitamins and microelements in food against the background of increased consumption of salty foods, coffee and alcohol also contributes to the development of PMS. The disease is more often observed in representatives of mental work. The hereditary nature of the disease can be traced.

Diagnosis of premenstrual syndrome

The symptoms of PMS are numerous. Therefore, patients often turn to a therapist and a neurologist. The treatment appears to be successful. This is explained by the fact that after menstruation the symptoms of the disease disappear. Then comes disappointment due to the resumption of symptoms. The cyclical nature of the manifestations suggests PMS and serves as a reason to refer the patient to a gynecologist. Many experts recognize the following criteria for diagnosing PMS: cyclicality (recurrence) of symptoms that occur in the luteal (second) phase (2-14 days before menstruation) and their absence for at least 7 days of the follicular (first) phase; symptoms must interfere with quality of daily life.

The gynecologist must perform vaginal and rectal examination pelvis, carefully examines the patient’s complaints, taking into account her lifestyle and previous diseases. A patient diary (calendar), which records the dates of onset and disappearance of symptoms, as well as the dates of menstruation, can be of significant benefit. If necessary, the concentration of hormones in the blood is determined, and the content of progesterone is determined in both phases of the menstrual cycle. X-rays of the skull, sella turcica and cervical spine spine, electroencephalography, electrocardiography, mammography (in the first phase of the cycle), consultation with an ophthalmologist (fundus condition), neurologist, and in some cases a psychiatrist. Additional tests help rule out others gynecological diseases and choose the most rational therapy.

Treatment of premenstrual syndrome start with normalizing nutrition and changing lifestyle. To get rid of flatulence and a feeling of fullness in the stomach, you need to eat often and in small portions. Limiting salty foods reduces fluid retention. The most beneficial carbohydrates are found in fruits, vegetables and whole grains. It is better to cover the need for calcium through dairy products, but not food additives. Avoid drinking drinks containing alcohol and caffeine. Dieting is especially important in the second phase of the menstrual cycle. There is evidence of a significant reduction in the risk of PMS when consuming increased amounts of B vitamins, but only from food sources. Physical exercise and visits required gym. Useful brisk walking on fresh air, swimming, skiing, etc. Activities physical culture and exercise should be done regularly. Massage and yoga classes are shown, which will teach you to relax your muscles and breathe deeply and correctly. You need to set aside enough time for sleep.

Oral contraceptives inhibit ovulation, stabilize the concentrations of sex hormones in the blood and, thus, alleviate the symptoms of PMS. In connection with hyperestrogenism (estrogens promote fluid retention), the administration of progestogens (a group of hormones derived from progesterone), for example, duphaston, utrozhestan, which are prescribed for 10 days from the 16th day of the menstrual cycle, is indicated. Lately To eliminate the symptoms of PMS, a new unique progestogen drospirenone, which is a derivative of spirolactone (a diuretic), is used. Therefore, it prevents sodium and water retention in the body and prevents estrogen-induced effects such as weight gain and breast engorgement. Drospirenone is especially effective for the edematous form of PMS.

Antidepressants (serotonin reuptake inhibitors) - fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and others - are very effective in eliminating emotional and behavioral disorders PMS and especially in cases of premenstrual dysphoria. These drugs can be prescribed two weeks before the onset of menstruation. For this purpose, tranquilizers (Rudotel) and antipsychotics (Sonapax) are also prescribed. For cephalgic and other forms of PMS, the prescription of drugs that improve metabolic processes in the brain, for example, nootropil and aminalon.

Nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) relieve symptoms such as breast engorgement and headache.

Of the diuretics, preference is given to veroshpirone (aldosterone antagonist), which is prescribed 4 days before the onset of symptoms (the patient’s diary helps determine the date), and continues until menstruation.

This information is provided for informational purposes only and should not be used for self-treatment.

Remember that manifestations of PMS cannot be tolerated, because they often worsen the quality of life and lead to loss of ability to work. Lifestyle changes and drug therapy are effective in treating this disease.

Premenstrual syndrome is a symptom complex that is characterized by neuropsychic, metabolic-endocrine and vegetative-vascular disorders that occur in the second phase of the menstrual cycle (about 3-10 days) and cease either at the beginning of menstruation or immediately after their completion.

Other names for premenstrual syndrome (PMS) are premenstrual illness, premenstrual tension syndrome, or cyclic illness.

As a rule, PMS is diagnosed in women after 30 years of age (occurs in 50% of the fairer sex), while in young and at a young age it is familiar to only every fifth woman.

Species

Depending on the predominance of certain manifestations, 6 forms of premenstrual illness are distinguished:

  • neuropsychiatric;
  • edematous;
  • cephalgic;
  • atypical;
  • crisis;
  • mixed.

Based on the number of manifestations, their duration and intensity, there are 2 forms of PMS:

  • light. 3-4 signs appear 3-10 days before menstruation, and the most pronounced of them are 1-2;
  • heavy. 5-12 signs appear 3-14 days before menstruation, and 2-5 of them, or all 12, are maximally expressed.

But, despite the number of symptoms and their duration, in case of decreased performance, they speak of a severe course of PMS.

Stages of PMS:

  • compensated. Symptoms appear on the eve of menstruation and disappear with their onset, while the symptoms do not intensify over the years;
  • subcompensated. There is a progression of symptoms (their number, duration and intensity increase);
  • decompensated. A severe course of PMS is observed; over time, the duration of the “light” intervals decreases.

Causes of premenstrual syndrome

Currently, the causes and mechanism of development of PMS are not well understood.

There are several theories explaining the development of this syndrome, although none of them covers the entire pathogenesis of its occurrence. And if previously it was believed that a cyclic condition is typical for women with an anovulatory cycle, it is now reliably known that patients with regular ovulation also suffer from premenstrual disease.

The decisive role in the occurrence of PMS is played not by the content of sex hormones (this may be normal), but by fluctuations in their levels throughout the cycle, to which the areas of the brain responsible for the emotional state and behavior react.

Hormonal theory

This theory explains PMS by a violation of the proportion of gestagens and estrogens in favor of the latter. Under the influence of estrogens, sodium and fluid are retained in the body (edema), in addition, they provoke the synthesis of aldosterone (fluid retention). Estrogenic hormones accumulate in the brain, which causes neuropsychiatric symptoms; their excess reduces the content of potassium and glucose and contributes to the occurrence of heart pain, fatigue and physical inactivity.

Increased prolactin

Theory of water intoxication

Explains PMS as a disorder of water-salt metabolism.

Among other versions that consider the causes of PMS, one can note the theory of psychosomatic disorders (somatic disorders lead to mental reactions), the theory of hypovitaminosis (lack of vitamin B6) and minerals (magnesium, zinc and calcium) and others.

Predisposing factors for PMS include:

  • genetic predisposition;
  • mental disorders in adolescence and postpartum period;
  • infectious diseases;
  • poor nutrition;
  • stress;
  • frequent climate change;
  • emotional and mental lability;
  • chronic diseases (hypertension, heart disease, thyroid pathology);
  • alcohol consumption;
  • childbirth and abortion.

Symptoms

As already indicated, signs of PMS occur 2-10 days before menstruation and depend on clinical form pathology, that is, from the predominance of certain symptoms.

Neuropsychic form

Characterized by emotional instability:

  • tearfulness;
  • unmotivated aggression or melancholy, reaching the point of depression;
  • sleep disturbance;
  • irritability;
  • weakness and fatigue;
  • periods of fear;
  • weakening libido;
  • thoughts of suicide;
  • forgetfulness;
  • increased sense of smell;
  • auditory hallucinations;
  • and others.

In addition, there are other signs: numbness of the hands, headaches, decreased appetite, bloating.

Edema form

In this case, the following prevail:

  • swelling of the face and limbs;
  • soreness and engorgement of the mammary glands;
  • sweating;
  • thirst;
  • weight gain (and due to hidden edema);
  • headaches and joint pains;
  • negative diuresis;
  • weakness.

Cephalgic form

This form is characterized by a predominance of vegetative-vascular and neurological symptoms. Characteristic:

  • migraine-type headaches;
  • nausea and vomiting;
  • diarrhea (sign high content prostaglandins);
  • palpitations, heart pain;
  • dizziness;
  • odor intolerance;
  • aggressiveness.

Crisis form

Proceeds according to the type of sympathoadrenal crises or “ psychic attacks", which differ:

  • increased blood pressure;
  • increased heart rate;
  • heart pain, although there are no changes on the ECG;
  • sudden attacks fear.

Atypical form

It occurs as hyperthermic (with an increase in temperature to 38 degrees), hypersomnic (characterized by daytime drowsiness), allergic (appearance of allergic reactions, not excluding Quincke's edema), ulcerative (gingivitis and stomatitis) and iridocyclic (inflammation of the iris and ciliary body) forms.

Mixed form

It is distinguished by a combination of several described forms of PMS.

Diagnosis of premenstrual syndrome

  • mental pathology (schizophrenia, endogenous depression and others);
  • chronic diseases kidney;
  • brain formations;
  • inflammation of the spinal cord membranes;
  • arterial hypertension;
  • pathology of the thyroid gland.

With all of these diseases, the patient complains regardless of the phase of the menstrual cycle, while with PMS, symptoms occur on the eve of menstruation.

In addition, of course, the manifestations of PMS are in many ways similar to the signs of pregnancy in early stages. In this case, it is easy to resolve doubts by independently conducting home test for pregnancy or by donating blood for hCG.

Diagnosis of premenstrual tension syndrome has some difficulties: not all women turn to a gynecologist with their complaints; most are treated by a neurologist or therapist.

When making an appointment, the doctor must carefully collect anamnesis and study complaints, and during the conversation, establish the connection of the listed symptoms with the end of the second phase of the cycle and confirm their cyclicity. It is equally important to make sure that the patient does not have mental illness.

Then the woman is asked to mark the signs she has from the following list:

  • emotional instability ( crying for no reason, sudden mood changes, irritability);
  • tendency towards aggression or depression;
  • feeling of anxiety, fear of death, tension;
  • low mood, hopelessness, melancholy;
  • loss of interest in her usual way of life;
  • increased fatigue, weakness;
  • inability to concentrate;
  • increased or decreased appetite, bulimia;
  • sleep disturbance;
  • a feeling of engorgement, tenderness of the mammary glands, as well as swelling, headaches, pathological weight gain, pain in muscles or joints.

The diagnosis of “PMS” is established if a specialist ascertains the presence of five signs in the patient, with the obligatory presence of one of the first four listed.

A blood test for prolactin, estradiol and progesterone is required in the second phase of the cycle; based on the results obtained, the expected form of PMS is determined. Thus, the edematous form is characterized by a decrease in progesterone levels. And neuropsychic, cephalgic and crisis forms are characterized by increased prolactin.

Further examinations vary depending on the form of PMS.

Neuropsychiatric

  • examination by a neurologist and psychiatrist;
  • radiography of the skull;
  • electroencephalography (detection functional disorders in the limbic structures of the brain).

Edema

Shown:

  • delivery of the BAC;
  • study of renal excretory function and measurement of diuresis (excreted fluid is 500-600 ml less than consumed);
  • mammography and ultrasound of the mammary glands in the first phase of the cycle in order to differentiate mastopathy from mastodynia (pain in the mammary glands).

Krizovaya

Necessarily:

  • Ultrasound of the adrenal glands (to exclude a tumor);
  • testing for catecholamines (blood and urine);
  • examination by an ophthalmologist (fundus and visual fields);
  • X-ray of the skull (signs of increased intracranial pressure);
  • MRI of the brain (to exclude a tumor).

It is also necessary to consult a therapist and keep a blood pressure diary (to rule out hypertension).

Cephalgic

Conducted:

  • electroencephalography, which reveals diffuse changes electrical activity of the brain (type of desynchronization of cortical rhythms);
  • CT scan of the brain;
  • examination by an ophthalmologist (fundus);
  • X-ray of the skull and cervical spine.

And for all forms of PMS, consultations with a psychotherapist, endocrinologist and neurologist are necessary.

Treatment of premenstrual syndrome

PMS therapy begins with explaining to the patient her condition, normalizing the regime of work, rest and sleep (at least 8 hours a day), eliminating stressful situations, and, of course, prescribing a diet.

Women with premenstrual tension syndrome should adhere, especially in the second phase of the cycle, next diet power supply:

  • Hot and spicy dishes are excluded:
  • salt is limited;
  • a ban is imposed on the consumption of strong coffee, tea and chocolate;
  • the consumption of fats is reduced, and in some types of PMS, animal proteins are reduced.

The main emphasis of the diet is on the consumption of complex carbohydrates: whole grain cereals, vegetables and fruits, potatoes.

In the case of absolute or relative hyperestrogenism, gestagens (Norkolut, Duphaston, Utrozhestan) are prescribed in the second phase of the cycle.

For neuropsychic signs of PMS, it is recommended to take sedatives and mild tranquilizers 2-3 days before menstruation (Grandaxin, Rudotel, phenazepam, sibazon), as well as antidepressants (fluoxetine, amitriptyline). MagneB6 has a good calming, sleep-normalizing and relaxing effect. Herbal teas, such as “Aesculapius” (daytime) and “Hypnos” (at night), also have a sedative effect.

In order to improve cerebral circulation (cephalgic form), nootropil, piracetam, and aminolon are recommended.

In case of edema, diuretics (spironolactone) and diuretic teas are prescribed.

Antihistamines (teralen, suprastin, diazolin) are indicated for atypical (allergic) and edematous forms of PMS.

Cephalgic and crisis forms of PMS require taking bromocriptine in the second phase of the cycle: this drug reduces prolactin levels. Mastodinon quickly relieves pain and tension in the mammary glands, and Remens normalizes the level of hormones in the body.

For hyperprostaglandinemia, non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, diclofenac) are indicated, which suppress the production of prostaglandins.

And, of course, indispensable drugs for PMS are combined oral contraceptives from the monophasic group (Jess, Logest, Janine), which suppress the production of their own hormones, thereby leveling the manifestations of the pathological symptom complex.

The average course of treatment for premenstrual tension syndrome is 3-6 months.

Consequences and prognosis

PMS, for which the woman did not treat, threatens in the future severe course climacteric syndrome. The prognosis for premenstrual illness is favorable.