(Premenstrual tension syndrome)

Premenstrual syndrome (PMS) is associated with irritability, anxiety, mood swings, depression, edema, chest pain and headache, occurring 7-10 days before the onset of menses and then stop within hours. The diagnosis is made by the clinic, often based on daily record of symptoms. Treatment depends on the symptoms and includes diet, drugs and counseling.

Approximately 20-50% of women of childbearing age have PMS; about 5% suffer from a severe form of the so-called. premenstrual dysphoric disorder.

Premenstrual syndrome (PMS) is associated with irritability, anxiety, mood swings, depression, edema, chest pain and headache, occurring 7-10 days before the onset of menses and then stop within hours. The diagnosis is made by the clinic, often based on daily record of symptoms. Treatment depends on the symptoms and includes diet, drugs and counseling. Approximately 20-50% of women of childbearing age have PMS; about 5% suffer from a severe form of the so-called. premenstrual dysphoric disorder. Etiology The cause is unknown. Possible causes or factors include multiple endocrine factors (z. B. hypoglycemia, other changes in carbohydrate metabolism, hyperprolactinemia, fluctuating estrogen and progesterone levels in the blood, abnormal responses to estrogens and progesterone, aldosterone, or ADH excess) A genetic predisposition serotonin deficiency possibly magnesium and calcium deficiency estrogens and progesterone, as well as too much aldosterone or ADH can temporarily cause fluid retention. Since women are particularly affected by PMS have reduced levels of serotonin and SSRI (increase serotonin) occasionally relieve the symptoms of PMS, it is believed that a lack of serotonin in the development is involved. Magnesium and calcium deficiency may be involved. Symptoms and signs type and intensity of symptoms vary from woman to woman and from cycle to cycle. The symptoms last from a few hours to ? 10 days; They usually disappear after the onset of menses. Stress or during perimenopause, the symptoms may increase. For women in perimenopause they can to stop after menses. The most common symptoms include irritability, anxiety, restlessness, anger outbursts, insomnia, lack of concentration, lethargy, depression and extreme tiredness. Water retention cause edema, transient weight gain and swelling and pain of the breasts. Pelvic pain or pressure and back pain may occur. Some women, especially the younger ones, suffer from dysmenorrhea at the onset of menses. Other non-specific symptoms may be headache, dizziness, paresthesia in the extremities, fainting, palpitations, constipation, nausea, vomiting and appetite changes. Acne and eczema are also possible. Already-existing skin conditions may worsen as respiratory diseases (eg. As allergies, infections) or eyes (eg. As visual disturbances, conjunctivitis). Premenstrual dysphoric disorder (PMDD) Some women have severe PMS symptoms that occurs on a regular basis and only in the second half of the menstrual cycle; the symptoms end with or shortly after menses. The mood is down considerably, and it is complaining of anxiety, irritability and emotional lability. Suicidal thoughts may be present. The interest in daily activities is greatly reduced. In contrast to the PMS, the symptoms in PMDD is so strong that the daily routine or the general condition is impaired. PMDD is highly distressing, disabling and is often undiagnosed. Tips and risks A PMD should be considered in women with non-specific, but severe symptoms before the menses into consideration. Diagnosis For PMS description of symptoms by the patient In PMDD clinical criteria PMS is diagnosed on the basis of physical ailments (eg. As bloating, weight gain, breast tenderness, swelling of hands and feet). Women should be asked to keep a diary of their symptoms. Physical examination and laboratory tests are not helpful. On suspicion of PMDD women should evaluate their daily symptoms over ? 2 cycles to assess whether symptoms are severe regularly. For the diagnosis of PMDD have ? 5 of the following symptoms most of the time in the week before menstruation and the symptoms have during the week diminish or disappear after menstruation. The symptoms must have at least one of the following included: Significant mood swings (. Eg sudden sadness) Marked irritability or anger or increased interpersonal conflicts. Pronounced depressive condition, feelings of hopelessness or thoughts about missing self-esteem Significant anxiety, tension, or a nervous feeling addition, there must be ? 2 of the following conditions: Decreased interest in daily activities, possibly to social withdrawal leads difficulty concentrating Low energy or fatigue Significant changes in appetite overeating or specific food cravings have insomnia or Hyperinsomnie feeling of being overwhelmed or loss of control PMS accompanying physical complaints (eg. as breast tenderness, edema) In addition, should the symptoms most of the time the past 12 months have been present, and symptoms be so strong that the daily activities and general condition are impaired. Patients with depressive symptoms will be assessed on a Depression Inventory or referred to a specialist for psychological or psychiatric evaluation. Treatment General measures Occasionally administration of SSRIs or hormone treatment PMS can be difficult to treat. There are no treatment that is effective for all women; few patients are completely healed by a single treatment. Thus, patience and empirical therapy trials are needed. General measures Treatment depends on the symptoms and begins with adequate rest and sleep, regular exercise and relaxation measures. Regular exercise can have a positive effect on bloating and irritability, anxiety and insomnia. Some women also benefit from yoga. A dietary changes-more protein, less sugar, consume complex carbohydrates and eat more frequent smaller meals-can help, as well as therapy, avoiding stress activities, relaxation training, light therapy, sleep adjustment and cognitive behavioral therapy. It can also be tried, certain foods and beverages (eg. As cola, coffee, hot dogs, chips, canned food) to avoid and increasingly others to consume (eg. As fruit, vegetables, dairy, high-fiber foods, lean meat, calcium and vitamin D-rich foods). The positive effects of dietary supplements have not been set. Drugs NSAIDs can help relieve pain and dysmenorrhea. SSRIs (eg., Fluoxetine, 20 mg po 1 times / day) are the drugs of choice for reducing anxiety, irritability and other emotional symptoms, especially if stress is inevitable. Effectively relieve PMS and PMDD symptoms. Continuous dosing is more effective than intermittent dosage. SSRIs seem to be more effective than the others. Clomipramine, which is given over a whole or half a cycle, acting as effective against emotional symptoms such as nefazodone, a serotonin-norepinephrine reuptake inhibitor (SNRI). Anxiolytics can be effective, but they are rarely given because of their dependency or addiction potential. Buspirone, which may be added during the cycle or during the late luteal phase, helps the symptoms of PMS and PMDD alleviate. The adverse effects include nausea, headache, anxiety and dizziness. Some women respond well to hormonal manipulation. Options include Oral contraceptives Progesterone vaginal suppositories as (200-400 mg 1 time / day) An oral progestin (z. B. micronized progesterone 100 mg at bedtime) for 10 to 12 days before menses A long-acting progestin ( z. B. take 200 mg medroxyprogesterone in every 2-3 months) women who choose to use an oral contraceptive for birth control, can drospirenone and ethinyl estradiol. However, the risk of venous thromboembolism may be increased. In rare cases, a GnRH agonist (eg. As leuprolide, goserelin or 3.75 mg in 3.6 mg sc 1 time / month) with strong or refractory symptoms with a low dose progestin combination preparation (z. B. oral Estradiol optionally 0.5 mg transdermal patch plus micronized progesterone 100 mg at bedtime) to minimize cyclic variations. Fluid retention often speaks to a reduced sodium intake and taking a diuretic (eg., Spironolactone 100 mg po 1 times / day), just before symptoms are expected. However, minimizing fluid retention and taking a diuretic not eliminate the other symptoms completely and possibly ineffective. Bromocriptine and MAO inhibitors are not useful. Surgical procedures For severe symptoms, a bilateral oophorectomy relieve symptoms because it thus no longer comes to a menstrual cycle; HRT is then displayed to about an age of 51 years (when menopause usually occurs). Summary The PMS symptoms may be non-specific and vary from woman to woman. PMS is diagnosed solely on the basis of symptoms. With strong and debilitating symptoms of PMDD should (this is often undiagnosed) are thought; the patient should record the symptoms for ? 2 cycles. To make the diagnosis PMDD, the clinical criteria must be met. Usually, the treatment consists of an empirical therapy in order to identify the most effective treatment option for the patient.

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