Premenstrual syndrome

October 05, 2016

Active substances:
ICD-10:
XIV.N80-N98.N94.3    Premenstrual tension syndrome
Premenstrual syndrome, PMS, obstetrics and gynecology, the ABC of a doctor
Premenstrual syndrome (PMS) is a condition characterized by the presence of physical and / or emotional symptoms that occur within 1-2 weeks before the onset of menstruation.With this syndrome, one in three women experiences one degree or another throughout their lives, which is why a doctor of any specialty should have a representation of the ICP.
The etiology and pathogenesis of PMS are not fully understood. It is believed that a key role in the pathophysiology of this condition is the increase in the concentration of progesterone during the luteal phase of the menstrual cycle. This is supported by the fact that PMS is practically not found in women with anovulatory cycles and after bilateral oophorectomy.
Progesterone and its metabolites disrupt the normal balance of neurotransmitters in the central nervous system. First of all, GABAergic and serotonergic transmissions are affected.
Symptoms and diagnostic criteria for PMS are presented in the table:
Less often are dysmenorrhea, changes in appetite, hot flashes, nausea and a number of other symptoms.
PMS of the most severe course is called premenstrual dysphoric disorder.
Risk factors:
1) PMS in family history.
2) Age. PMS is more often observed in women in the age range of 25-40 years.
3) Stress.
4) Obesity. The results of population studies clearly showed the relationship between the risk of PMS and the body mass index of more than 30.
5) Depression or anxiety disorder in the anamnesis.
Treatment.
In the west, the drugs of the first line are serotonin reuptake inhibitors (fluoxetine, sertraline and others) that restore serotonergic transmission in the central nervous system.
Traditionally, PMS is widely prescribed combined oral contraceptives. From the point of view of pharmacodynamics, their effectiveness is explained by the suppression of ovulation and, as a consequence, a decrease in the production of progesterone. Nevertheless, the data of randomized clinical trials are ambiguous. Apparently, the most effective in PMS contraceptives based on ethinyl estradiol and drospirenone. The latter is an analogue of the diuretic spironolactone, which causes a number of positive pharmacodynamic effects in PMS (see below).
As an anesthetic, prescribe nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen, diclofenac and others). In addition, the appointment of vitamin-mineral complexes containing calcium, magnesium and vitamin D.