Premenstrual syndrome: symptoms, causes, and treatment
Everything you need to know about PMS
What is Premenstrual Syndrome
We define the Premenstrual Syndrome (PMS) on the table:
The set of physical, psychological and emotional symptoms which alter, at least slightly, the daily activities and personal relationships of women who suffer from it during the luteal phase. The luteal phase or 2nd phase of the menstrual cycle It covers the period between ovulation and menstruation. The discomfort disappears or is considerably relieved during menstruation or when it ends.
Premenstrual syndrome affects 30-40% of women of reproductive age and 20-32% of premenopausal women in developed countries.
When PMS occurs with a predominance of affective symptoms and significantly interferes with social, work or relationship life, it is called 'emotional dysphoric disorder' (TDE). It accounts for 5-10% of PMS cases.
The prevalence of PMS is difficult to study. This is due to the subjectivity of symptoms and the lack of objective diagnostic tests. Thus, It is difficult to differentiate this syndrome from premenstrual symptoms physiological isolates, with no clear personal, family, cultural or socioeconomic risk factors established.
However, we can relate this syndrome to a decreased quality of life and work performance an increase in the consumption of medical resources. Thus, it can be stated that PMS represents a public health problem important in developed countries.
Premenstrual Syndrome: Causes
The etiology or cause of PMS remains uncertain today. Although there are several theories and the multifactorial origin of this the most likely.
Among the different theories we can highlight the neuroendocrine dysfunction with the alteration of the normal functioning of the hypothalamic-pituitary axis.
The pituitary gland is a small gland located at the base of the brain that regulates hormone production in the adrenal glands and ovaries. The pituitary gland, in turn, is regulated by a brain structure called the hypothalamus.
On the other hand, there are environmental, nutritional and genetic factors which can determine the appearance and severity of this syndrome.
Premenstrual Syndrome: Symptoms
As a consequence of these neuroendocrine changes, the various symptoms of PMS have been linked to alterations in different hormones; as:
- the reduction of progesterone levels,
- relative or absolute increase in estradiol levels,
- increased production of aldosterone,
- increased prolactin levels.
And so on in an almost unlimited way, with the symptoms varying depending on the combination and severity of the alterations that occur between different women and different cycles in the same woman.
On the other hand, vitamin or nutritional deficiencies can affect the synthesis of different hormones and neurotransmitters that modify the development of this syndrome.
The symptoms of PMS are very varied. As we can imagine, given its multifactorial origin and the subjective component of its symptoms. We can divide it into:
Physical symptoms:
The most common symptoms include headaches, mastodynia or breast pain, and joint and muscle pain.
Neurovegetative symptoms:
These are among those that cause the greatest loss of quality of life in patients. Particularly notable are insomnia, the compulsive need to eat certain, generally high-calorie foods, fatigue, and decreased libido.
Nervous system symptoms:
Dizziness, vertigo, and tremors
digestive symptoms:
Nausea or vomiting, diarrhea, abdominal distension.
Hydroelectrolytic symptoms:
Decreased urine output, edema, and fluid retention.
Dermatological symptoms:
Increased oiliness in the hair, acne.
Premenstrual syndrome: diagnosis
The diagnosis of PMS is based primarily on the patient's description of the symptoms. Labeling it as mild, moderate or severe depending on how disabling it is. These symptoms are due repeat at least in two cycles consecutive to be able to make said diagnosis.
There are multiple questionnaires and scales for diagnosing PMS. However, no advantages have been found in using them for diagnosing and classifying patients compared to a detailed clinical history. listening to the patient carefully.
Once diagnosed, there are multiple therapeutic alternatives depending on the severity of the symptoms and the patient's prevailing clinical presentation.
Discover More information about PMS and its symptoms here.
Treatments indicated for treating Premenstrual Syndrome
Among the different treatments, the following stand out:
Hormonal contraceptives
Those containing drospirenone as a progestin have been shown to be more effective. The main reason is that this progestin reduces fluid retention due to its antimineral corticoid effect.
Progesterone
Its usefulness has not been demonstrated.
Danazol
Useful in severe cases, but with significant metabolic and circulatory side effects. Should only be used for short periods of time.
GnRH analogues
They cause many side effects, so their usefulness is limited to very severe cases. They can be combined with hormone therapy to reduce side effects.
Progesterone antagonists
They have not proven their usefulness.
Prolactin antagonists
They have not been shown to be useful in the treatment of PMS, although they do improve mastodynia or breast pain.
Spironolactone
An aldosterone-antagonist diuretic that has proven useful in the second phase of the cycle for controlling some symptoms. These symptoms include fluid retention and bloating.
Antidepressants
They have been shown to be useful in increasing serotonin levels, even when used only during the second phase of the cycle.
Phytotherapy
El VAC (Vitex Agnus Castus), Alone or in combination with multivitamins, it has proven effective in mild PMS. With virtually no significant side effects, it is a valid therapeutic option.
Furthermore, the Evening Primrose Oil It has not been shown to be effective in the treatment of PMS, although it does improve the mastodynia (breast pain) associated with it.
Other tips for treating PMS
Finally, a adequate nutrition and hydration, el moderate exercise and la abstinence from alcohol consumption can improve symptoms in these patients.
Premenstrual Syndrome: Conclusion
In conclusion, we can say that PMS is a major health problem in developed countries. Women who suffer from it experience a significant decrease in their quality of life. For this reason, we recommend that you go to your gynecologist, since once the diagnosis is established with an adequate clinical history, we can establish treatment. This treatment, if not a solution, at least significantly mitigates the symptoms, substantially improving the patient's quality of life.
If you found this article interesting and would like to be seen by a professional expert in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized unit in this area. You can request more information by calling the following numbers: 91 387 51 72/73/74 or make an appointment for an in-person consultation, always with the best specialists.