Symptoms
Premenstrual syndrome is a syndrome occurring in women with psychological and physical symptoms that occur in the run-up to menstruation (luteal phase) and disappear at the beginning of menstruation. It is not the menstrual symptoms that occur during menstruation. Depression, anger, irritability, anxiety, confusion, lack of concentration, insomnia, increased appetite, craving for sweets, tightness in the breasts, meteorism, headaches, oedema especially in the face / eyelids, indigestion, acne, back pain, abdominal cramps The symptoms begin before the onset of menstruation (luteal phase) and may worsen as menstruation approaches. After menopause, the symptoms usually disappear. The course of PMS can vary greatly from woman to woman. Up to 30% of women suffer from PMS. In about 3-8%, the symptoms become so severe that they have consequences in the family, interpersonal and professional spheres. PMS occurs mainly in women over 30 years of age.
Causes
The exact causes of PMS are not known. In the past, it was thought that only an imbalance between progestins and estrogens was responsible for its development. Today, however, it is generally agreed that an interaction of several factors contributes to the symptoms. Endocrine factors (hypoglycemia, changes in carbohydrate metabolism, hyperprolactinemia, fluctuating progesterone and estrogen levels, increased ADH or aldosterone levels), messenger substances in the brain (serotonin) and other endogenous substances (prostaglandins), stress, heredity, and nutrition are considered to be important influencing factors. Normally, a balancing of fluctuating hormone concentrations takes place during a female cycle. If this balancing does not take place, impairments such as PMS may develop.
Risk factors
Risk factors include stress, increased age, malnutrition, genetic predisposition, and depression.
Diagnosis
Diagnosis results from descriptions of symptoms under medical care. The diagnosis is considered confirmed when other diseases can be excluded as the cause of the complaints.
Differential diagnosis
Menstrual cramps, endogenous depression, anemia, anorexia or bulimia, endometriosis, hypothyroidism, perimenopause.
Nonpharmacologic treatment
Before considering drug therapy, the patient should have tried nonmedication measures. If this has not improved symptoms, a switch to drug therapy is indicated. Healthy lifestyle:
- Healthy diet
- Reduce stress (relaxation exercises, autogenic training), psychotherapy.
- Sports
- Enough sleep
- Salt consumption with moderation, this can reduce fluid retention and associated chest pain.
Surgery:
- Removal of the uterus; controversial because irreversible and associated with risks.
Other:
- Recommendations to eat less chocolate or drink alcohol have not yet been scientifically studied. Drinking less coffee is said to help against insomnia and nervousness.
Drug treatment
The type of therapy depends on the patient’s particular symptoms. Non-steroidal anti-inflammatory drugs and analgesics:
Herbal medicines:
- Monk’s pepper, black cohosh and St. John’s wort (see below).
Food supplementation with vitamins and minerals:
- Substances used include calcium, tryptophan, vitamin E, vitamin A, vitamin B6 and magnesium.
Antidepressants:
- Antidepressant therapy with SSRIs (Selective Serotonin Reuptake Inhibitors) has been shown to significantly improve the quality of life of severely affected women. Therefore, they are considered the standard of care in the treatment of PMS. When treated with SSRIs, symptom relief usually occurs after three menstrual cycles.
Oral contraceptives Diuretics:
- Spironolactone relieves breast pain and the feeling of tightness in the breast.
Antianxiety agents and sedatives:
- Benzodiazepines are antianxiety and sedative agents. However, they should not be used or should be used with restraint because of the adverse effects, development of tolerance, and potential for dependence.
- GnRH agonists: there is little evidence for the therapeutic benefit of GnRH agonists. Only a small alleviation of behavioral symptoms is observed. The risk-benefit ratio of such therapy is rather unfavorable.
- Progesterone used to be widely used but is no longer recommended because studies have failed to show a beneficial effect.
Herbal therapy
The various phytopharmaceuticals are well established in the treatment of PMS. For optimal effect, they should be used for several months. Monk’s pepper:
- Monk’s pepper extract has been shown to have dopaminergic and prolactin-lowering effects. As a result of prolactin reduction, increased dopamine levels decrease. Its inhibitory effect on the release of GnRH fades and FSH and LH release normalizes.
Black cohosh
- Black cohosh extract has been shown to have a weak estrogenic effect (binding to estrogen receptor) and dopaminergic effect.
St. John’s wort:
- For mood disorders
Prevention
For prevention, a PMS calendar, which is kept over time to record correlations with the course of the cycle, can be helpful. Such a calendar is composed of the categories of symptoms, correlations with other factors such as diet, sleep, physical activity, etc., and assessment of each day. Keeping a PMS calendar allows the patient to develop a sense of the critical days and adjust her daily routine accordingly.
