Does PMS cause anxiety. Why do some people experience anxiety before their period. What are the differences between PMS and PMDD. How can you manage premenstrual anxiety symptoms. What treatments are available for severe PMS and PMDD.

The Link Between PMS and Anxiety: Unraveling the Mystery

Premenstrual syndrome (PMS) affects a significant portion of menstruating individuals, with anxiety being a common symptom. But what exactly is the connection between PMS and anxiety? Let’s explore this relationship and uncover the underlying factors at play.

PMS occurs in 30-80% of people who menstruate, with symptoms ranging from mild to severe. Anxiety before a period can be attributed to hormonal fluctuations that occur during the menstrual cycle, particularly in the luteal phase. This phase begins after ovulation and typically lasts for 14 days, ending when menstruation starts.

During the luteal phase, estradiol and progesterone levels peak, which can impact mood and emotional well-being. These hormonal changes may trigger anxiety symptoms in some individuals, especially those prone to mood disorders or with existing mental health conditions.

Key Factors Contributing to Premenstrual Anxiety:

• Hormonal fluctuations
• Changes in serotonin levels
• Existing mental health conditions
• Stress and lifestyle factors

It’s important to note that while PMS can cause anxiety, not everyone experiences the same symptoms or severity. Some individuals may have no signs of PMS, while others may develop more severe symptoms indicative of premenstrual dysphoric disorder (PMDD).

PMDD: When PMS Symptoms Become Severe

Premenstrual dysphoric disorder (PMDD) is a more severe condition that shares similarities with PMS but can significantly impact an individual’s quality of life. How does PMDD differ from PMS, and why do some people develop this condition?

While researchers are still working to fully understand the causes of PMDD, it’s believed that hormonal fluctuations play a crucial role. Additionally, changes in serotonin levels may contribute to the development of anxiety and persistent depressive disorder symptoms associated with PMDD.

Common PMDD Symptoms:

• Severe mood swings
• Intense feelings of anxiety or depression
• Irritability and anger
• Difficulty concentrating
• Fatigue and sleep disturbances
• Physical symptoms similar to PMS, but more intense

Is there a connection between PMDD and other mental health conditions? Indeed, research suggests that individuals who experience PMDD are more likely to also have anxiety or depression. This highlights the importance of comprehensive mental health care for those dealing with severe premenstrual symptoms.

Distinguishing Between PMS, PMDD, and PME

Understanding the differences between PMS, PMDD, and premenstrual exacerbation (PME) is crucial for proper diagnosis and treatment. How do these conditions differ, and why is accurate identification important?

PMS involves a combination of emotional and physical symptoms that occur after ovulation during the luteal phase. PMDD is characterized by more severe symptoms that significantly impact daily life. PME, on the other hand, refers to the worsening of symptoms of a pre-existing mental health condition during the luteal phase.

Conditions That May Experience PME:

• Generalized anxiety disorder
• Major depressive disorder
• Schizophrenia
• Alcohol use disorder
• Eating disorders

Distinguishing between these conditions can be challenging for healthcare providers, but accurate diagnosis is essential for providing appropriate treatment and care. If you’re experiencing severe premenstrual symptoms, it’s important to consult with a healthcare professional who can assess your individual situation and provide personalized recommendations.

Natural Remedies for Managing Premenstrual Anxiety

For those experiencing mild to moderate premenstrual anxiety, several home remedies and lifestyle changes can help alleviate symptoms. What natural approaches can be effective in managing anxiety related to PMS?

Effective Home Treatments for PMS-Related Anxiety:

1. Regular exercise: Engaging in aerobic activities has been shown to reduce PMS symptoms effectively.
2. Prioritizing sleep: Aim for 8 hours of quality sleep per night to support overall well-being.
3. Avoiding smoking: Studies indicate that smokers are more likely to develop PMS and PMDD.
4. Practicing relaxation techniques: Yoga, meditation, deep breathing exercises, and massage can help reduce stress and anxiety.
5. Maintaining a healthy diet: Focus on nutrient-rich foods and avoid excessive caffeine, alcohol, and salt intake.

Can dietary changes impact premenstrual anxiety? While more research is needed, some studies suggest that certain nutrients may help alleviate PMS symptoms. Consuming foods rich in calcium, magnesium, and vitamin B6 may be beneficial. Additionally, some individuals find relief by reducing their intake of refined sugars and processed foods.

It’s important to note that while these natural remedies can be helpful, they may not be sufficient for everyone, especially those with severe symptoms or PMDD. In such cases, medical intervention may be necessary.

Medical Treatments for Severe PMS and PMDD

When home remedies and lifestyle changes aren’t enough to manage premenstrual anxiety and other severe symptoms, medical treatments may be recommended. What options are available for those dealing with severe PMS or PMDD?

Common Medical Treatments for PMDD:

• Hormonal birth control
• Selective serotonin reuptake inhibitors (SSRIs)
• Anti-anxiety medications
• Light therapy
• Benzodiazepines (e.g., alprazolam)
• Hormone interventions using gonadotropin-releasing hormone agonists

How do these treatments work to alleviate symptoms? Hormonal birth control can help regulate menstrual cycles and hormone levels, potentially reducing the severity of PMS and PMDD symptoms. SSRIs work by increasing serotonin levels in the brain, which can improve mood and reduce anxiety. Anti-anxiety medications may provide short-term relief for acute symptoms.

It’s crucial to work closely with a healthcare provider to determine the most appropriate treatment plan, as each individual’s needs and response to treatment may vary. In some cases, a combination of therapies may be recommended for optimal symptom management.

Tracking and Managing Premenstrual Anxiety

One effective strategy for managing premenstrual anxiety is to track symptoms over time. How can symptom tracking help individuals better understand and cope with their PMS-related anxiety?

By keeping a detailed record of emotional and physical symptoms throughout the menstrual cycle, individuals can identify patterns and potential triggers. This information can be invaluable when discussing treatment options with healthcare providers and developing personalized coping strategies.

Benefits of Symptom Tracking:

• Identifying patterns in symptom occurrence and severity
• Recognizing potential triggers (e.g., stress, diet, sleep patterns)
• Evaluating the effectiveness of treatments and lifestyle changes
• Providing accurate information to healthcare providers
• Empowering individuals to take an active role in managing their health

What tools can be used for symptom tracking? Many individuals find success using smartphone apps designed specifically for tracking menstrual cycles and associated symptoms. These apps often provide features such as mood tracking, physical symptom logging, and the ability to generate reports for healthcare providers.

Alternatively, a simple journal or diary can be an effective tool for recording symptoms, emotions, and potential triggers. The key is to be consistent in tracking and to include as much relevant information as possible.

Seeking Support and Building a Care Team

Dealing with premenstrual anxiety and related symptoms can be challenging, but it’s important to remember that support is available. How can individuals build a strong support system and care team to manage their PMS or PMDD symptoms effectively?

Key Components of a Comprehensive Care Team:

• Primary care physician
• Gynecologist or reproductive health specialist
• Mental health professional (e.g., therapist, psychiatrist)
• Nutritionist or dietitian
• Support groups or peer counseling

Why is a multidisciplinary approach important? PMS and PMDD can affect various aspects of an individual’s life, including physical health, mental well-being, and daily functioning. A diverse care team can address these different facets and provide comprehensive support.

In addition to professional support, many individuals find comfort and valuable insights through support groups or online communities dedicated to PMS and PMDD. These platforms can offer a space to share experiences, coping strategies, and emotional support with others who understand the challenges of premenstrual symptoms.

Remember that seeking help is a sign of strength, not weakness. If you’re struggling with premenstrual anxiety or other severe symptoms, don’t hesitate to reach out to healthcare providers and support networks for assistance.

Empowering Yourself: Education and Advocacy

Understanding PMS, PMDD, and their relationship to anxiety is an important step in managing symptoms and improving quality of life. How can individuals empower themselves through education and advocacy?

Staying informed about the latest research and treatment options can help individuals make informed decisions about their health care. Additionally, sharing experiences and raising awareness about PMS and PMDD can help reduce stigma and promote better understanding of these conditions.

Ways to Empower Yourself and Others:

• Stay up-to-date on current research and treatment options
• Share your experiences with trusted friends and family members
• Participate in awareness campaigns or support organizations
• Advocate for improved research and healthcare policies
• Encourage open conversations about menstrual health and mental well-being

By taking an active role in your health and contributing to broader conversations about PMS and PMDD, you can not only improve your own well-being but also help others who may be struggling with similar challenges.

Remember that everyone’s experience with PMS and anxiety is unique. What works for one person may not work for another, so it’s essential to be patient and persistent in finding the right combination of treatments and coping strategies that work best for you.

As research in this field continues to evolve, new insights and treatment options may emerge. Stay connected with your healthcare providers and support network to ensure you have access to the most current information and care strategies available.

Why it happens and tips for relief

Anxiety before a period can be a sign of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). It may result from hormonal changes. Existing mental health conditions can also worsen at this time.

PMS and PMDD can cause varying levels of physical symptoms, as well as mental ones. These conditions occur due to hormone level changes around the time of a period.

This article discusses why anxiety can occur or worsen before a period and what treatment options exist.

People may experience anxiety before a period due to PMS and PMDD.

Discover more about anxiety in our dedicated hub.

PMS

Anxiety is a symptom of PMS, which affects 30–80% of people who have periods.

The severity of PMS symptoms can vary. Some people experience no signs of PMS. Others, on the other hand, can develop severe symptoms, which may be a sign of PMDD.

Other psychological symptoms of PMS may include:

• irritability
• fatigue
• changes in appetite
• mood swings
• loss of interest in sex
• difficulties with memory or concentration
• sleeping too much or too little

Physical symptoms may include:

• swollen and tender breasts
• constipation or diarrhea
• cramping
• bloating
• headaches
• backaches
• a lower tolerance for light or noise

PMDD

PMDD is a more severe condition that causes symptoms similar to PMS.

The Office on Women’s Health (OWH) says researchers do not fully understand why some people develop PMDD and others do not. However, similarly to PMS, fluctuations in hormone levels may play a role.

The OWH also indicates that serotonin levels may play a part in the development of anxiety and persistent depressive disorder symptoms. Similarly to other hormones, serotonin levels change during the menstrual cycle.

The OWH and the Anxiety and Depression Association of America (ADAA) both indicate that people who experience PMDD are likely to also experience anxiety or depression.

Other symptoms of PMDD may include:

• feeling overwhelmed
• an increased depressed mood
• severe mood swings
• sensitivity to rejection
• more severe irritability and anger
• social withdrawal
• sudden tearfulness or sadness

Learn more about the differences between PMS and PMDD here.

PMS is a combination of emotional and physical symptoms that people experience after ovulation during the luteal phase. The luteal phase begins after ovulation and typically lasts for 14 days. It ends when a person’s period, known as the menstrual phase, begins.

The OWH notes that researchers do not fully understand why anxiety occurs before a period, but it may occur due to changing hormone levels. According to research, the luteal phase corresponds with peak levels of estradiol and progesterone.

PMDD and premenstrual exacerbation (PME) are similar conditions with similar symptoms.

The International Association for Premenstrual Disorders characterizes PMDD as experiencing severe physical and emotional symptoms that begin during the luteal phase. Symptoms will subside within a few days after the period begins.

PME refers to the worsening of the symptoms of a preexisting mental health condition, such as generalized anxiety disorder, during the luteal phase.

Other conditions that can prompt PME effects include:

• major depressive disorder
• suicidal tendencies
• schizophrenia
• alcohol use disorder
• eating disorders

Doctors may have difficulty telling the two conditions apart. The correct diagnosis is important for a person to receive the necessary treatment and care.

Treatment depends on the severity of anxiety and other symptoms a person may experience.

Home treatments

A person can try several strategies to help reduce anxiety and other symptoms of PMS. These include:

• Regular exercise: Studies show that aerobic exercise can effectively reduce PMS symptoms.
• Sleep: People should aim for 8 hours of sleep per night.
• Avoiding smoking: A 2019 study found that those who smoke are more likely to develop PMDD and PMS.

If possible, people can also try relaxation techniques, such as yoga, massage, meditation, and breathing exercises.

Additionally, people will benefit from eating a healthful diet and avoiding alcohol, caffeine, and salt.

Learn more about what to eat during a period here.

Medical treatments

If home remedies and treatments are not helping with symptoms of anxiety, a person should contact a doctor about additional medical treatments and therapies.

According to the OWH, common treatments for PMDD include:

• using hormonal birth control
• taking selective serotonin reuptake inhibitors (SSRIs)
• taking antianxiety medications

Some medical professionals may also recommend:

• light therapy
• benzodiazepine alprazolam (Xanax)
• hormone intervention using gonadotropin-releasing hormone agonists

A person may not be able to prevent anxiety caused by PMS, but they may be able to help lessen their symptoms, such as lack of sleep, or exposure to stressors.

For example, people can track their anxious feelings in a diary or app. Doing this may help people identify certain lifestyle patterns or triggers behind their PMS symptoms.

Learn more about journaling for anxiety here.

Creating a regular sleep schedule and improving the quality of a person’s sleep environment can help them fall asleep faster and get better quality of sleep.

Learn more about sleep routines and sleep hygiene here.

In some people, home treatment may be enough to reduce the symptoms of anxiety related to PMS or PMDD.

If a person’s anxiety or other symptoms associated with PMS interfere with their daily life and activities, they should seek guidance from a doctor. A doctor can recommend additional treatment options or prescribe medication that may help.

It is possible that a person will not receive the correct diagnosis due to the similarities between PMDD and PME.

If the treatments are not working or become less effective, a person should contact a doctor about adjusting their treatment and ensuring they have the correct diagnosis.

Anxiety before a person’s period is a common symptom of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Researchers do not fully understand the difference between people’s experiences with the symptoms, but generally, they believe it is due to fluctuations in hormone levels.

A person should contact a doctor if they experience anxiety before their period or if the steps taken to treat their anxiety are not working or are working less effectively. A proper diagnosis can help a person more effectively treat their symptoms.

Can You Help?: New England Women’s Healthcare: OBGYNs

The days and weeks leading up to your period can be absolute torture, especially if you suffer from premenstrual syndrome (PMS). 

This condition causes you to crave certain foods, have mood swings, and feel downright terrible. PMS may also cause you severe anxiety, which could be a sign of a more serious problem.

At New England Women’s Healthcare, our board-certified OB/GYN specialists offer treatments when you can’t handle your PMS symptoms. Our team is compassionate and knowledgeable, providing you with a quick diagnosis and treatment so you can say goodbye to your unwanted PSM symptoms.

What is PMS?

PMS is a common problem among women. It occurs a week or so before your period and leads to a variety of uncomfortable symptoms. These symptoms can range from mild to severe, and interfere with your daily life.

This condition is the result of the significant change in your hormones leading up to your menstrual cycle. These changes bring on a wide range of symptoms, including:

• Fatigue
• Breast tenderness
• Abdominal bloating
• Headaches
• Mood swings
• Crying or emotional outbursts
• Sleep changes
• Depression or anxiety
• Change in your libido

There’s also a correlation between the emotional symptoms and chemical changes in your brain.

Serotonin is a crucial neurotransmitter that plays a role in your mood. If you have insufficient amounts of serotonin, it could contribute to symptoms like mood swings and depression or anxiety during PMS.

Could your anxiety be PMDD?

If you suffer from severe anxiety before your period, it could be more than just PMS. When you have the symptoms of PMS along with anxiety and depression, you may be dealing with premenstrual dysphoric disorder (PMDD).

PMDD is a much more severe form of PMS. It causes many of the same symptoms, but it adds the extra issues of severe anxiety and depression. PMDD is often serious enough to interfere with your daily activities.

While PMS does have an impact on your mood, PMDD causes severe bouts of anxiety and intense irritability. You may also feel extremely depressed or even suicidal with PMDD.

The symptoms of PMDD typically clear up within a few days of your period starting, but while the symptoms are around, your life is turned upside down.

How PMDD is managed

The team at New England Women’s Healthcare offers prompt evaluation and treatment when you’re suffering from severe anxiety and PMDD. You don’t have to live with the undesirable symptoms of PMDD, and our team is there every step of the way.

After the team evaluates your symptoms and determines that the anxiety is related to PMDD, they form a treatment plan to help you overcome this issue. There are many treatments available for PMDD, some of which include:

• Antidepressants
• Hormonal birth control
• Anti-anxiety medications
• Relaxation techniques
• Over-the-counter medications
• Exercise
• Diet changes, including decreased intake of caffeine and sugar

The team takes all of your symptoms into account when forming a treatment plan for your PMDD or PMS. If your anxiety is severe, antidepressants or anti-anxiety medications are combined with other treatments to ease your discomfort.

Lifestyle changes are also key as your period approaches. Eating a healthy diet and incorporating exercise helps you manage anxiety and depression related to PMDD. Stress management is also an important aspect of treating this condition.

If your PMS symptoms lead to anxiety, don’t hesitate to call one of our offices in Wilmington or Woburn, Massachusetts, to schedule a consultation. You may also request an appointment on our webpage.

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Premenstrual syndrome: neurological aspects | Kurushina O.V., Miroshnikova V.V., Barulin A.E.

Premenstrual syndrome, or PMS. How often do we now hear these words from the TV screen or use them in everyday conversations. Sometimes this is an occasion for jokes and ridicule, sometimes it is a way to caustically prick the interlocutor. We are almost used to such a frivolous attitude, non-medical approach to PMS. In fact, this condition is not always manifested in emotional outbursts, incontinence, and aggressive behavior.
From the point of view of medicine, PMS is a syndrome complex characterized by a variety of psychoemotional, neurovegetative, metabolic and endocrine symptoms that manifest themselves 2–14 days before menstruation. Complete disappearance of symptoms is observed with the onset of menstruation, and relief persists for at least 7 days, so that there is an asymptomatic week after the end of menstruation. In addition, premenstrual changes must be confirmed for at least two consecutive menstrual cycles [1].
Officially, the “year of birth” of the diagnosis “premenstrual syndrome” is 1931, when R. Frank published an article “The Hormonal Causes of Premenstrual Tension” in the neurological journal. But it would be wrong to assume that this was the discovery of this disease. Even Hippocrates in his writings described the fluctuations in the mood and behavior of women, depending on the lunar cycle. Mention of cyclical symptoms in women is also found in the Ebers Papyrus, the oldest medical document.
But scientific research into the nature of these states began only in the 20th century. Russian researchers E.I. Landa (1908) and I.V. Voitsekhovsky (1909) demonstrated rhythmic fluctuations in neuropsychic activity in women depending on the phase of the menstrual cycle. It is their works, describing mood changes, depression, lethargy, depression and irritability that appear before menstruation, that can be attributed to the first descriptions of PMS. Subsequently, several works appeared describing endocrine, sexual, and pain disorders in women during this period [2].
Currently, PMS is a multidisciplinary disease and a place where the interests of doctors of various specialties intersect: gynecologists, endocrinologists, neurologists, cardiologists, and many others.
The presence of PMS in women interferes with their professional activities, training, habitual social activity, and disrupts interpersonal relationships. Its peculiarity is clinical polymorphism and a close connection with vegetative, emotional and motivational disorders. Psychological, social and biological factors play a role in the formation of this syndrome. With the progression of the disease, its transformation into a severe menopausal syndrome is possible, which must be taken into account in the treatment of these patients [3].
The prevalence of PMS, according to domestic and foreign researchers, varies from 18 to 92%. This variability is due to the lack of a unified theory of etiopathogenesis, a clear classification of the clinical picture. In the last decade, interest in PMS has increased significantly in connection with new data on its occurrence in early reproductive age. It has been established that the age of the highest vulnerability ranges between 25 and 35 years, i.e. women of working age suffer, which further emphasizes the medical and social significance of this problem [4].
A number of studies have shown that PMS develops more often in women engaged in mental work, in patients with autonomic dystonia syndrome, and is also 4 times more common in women with underweight. This syndrome can occur under the influence of various factors caused by physical or mental overstrain, professional problems, social insecurity, chronic emotional stress. As a result of their own research, the authors demonstrated that the presence in the perinatal period of women’s development of such complications as prolonged labor, intrauterine hypoxia and fetal malnutrition are unfavorable factors for the occurrence of failure of the hypothalamic-pituitary system, subsequently transforming into PMS. In addition, it was found that unfavorable factors are high infectious morbidity at the age of 5 to 7 years, the presence of extragenital diseases in patients (brain injury, ENT diseases, appendectomy at prepubertal age) [2].
Some researchers emphasize that unrealized motherhood can be a provoking factor in the development of PMS.
Pathogenesis
The pathogenesis of PMS is complex and poorly understood, as evidenced by the existence of many theories that claim to explain it.
The first theories of the etiology of PMS were the theories of psychological stress, since the most common symptoms are psycho-emotional disorders. For a long time, PMS was considered the lot of urban women, and especially representatives of intellectual labor, but later this syndrome began to be found in residents of the provinces and third world countries.
With the development of methods for determining hormones in blood plasma, many assumptions have appeared about hormonal imbalance as a leading factor in the etiology of PMS. So, the founder of the hormonal theory R. Frank in 1931 suggested that PMS is caused by an excessive level of estrogen hormones. A number of researchers noted in this disease an increase in the level of 17β-estradiol and a decrease in the level of progesterone in the luteal phase of the cycle. However, along with progesterone deficiency, many authors found normal or even elevated levels of progesterone production in this category of patients [5].
The role of prolactin in the development of this syndrome complex is also ambiguous. For the first time in 1971, Horrobin suggested the possible role of prolactin in the occurrence of PMS. Shortly thereafter, studies appeared showing an increase in the level of prolactin in the luteal phase of the menstrual cycle in patients with this pathology. At the same time, an increase in the level of prolactin did not always lead to the development of PMS.
For a long time there was a theory of “water intoxication” of the occurrence of PMS. Disturbances in the renin-angiotensin-aldosterone system were of no small importance in the genesis of fluid retention in PMS [6].
The theory of psychosomatic disorders has many supporters. It is believed that a large role in the pathogenesis of PMS belongs to the girl’s attitude to menarche, fear of the onset of menstruation due to ignorance, the girl’s attitude to her own psychosocial role, as well as the woman’s dissatisfaction with intimate family life. However, other authors believe that somatic factors are of paramount importance, and mental ones follow the biochemical changes resulting from neurohormonal disorders [7].
With the advent of methods for determining the secretion of prostaglandins, the theory of prostaglandin disorders has become the dominant theory of PMS. Studying the levels of prostaglandins in PMS, Horrobin (1983) concluded that a deficiency of prostaglandin E1 can be clinically manifested by depression, and an excess can lead to affective disorders. The influence of prostaglandin E2 explains migraines, a pronounced neurotic component of PMS in some women, since prostaglandin E2 reduces intracranial and expands extracranial vessels [8].
A number of researchers attach importance to magnesium and vitamin B6 deficiency as a possible causative factor in PMS. Magnesium deficiency can lead to a selective lack of dopamine in the brain, which explains the symptoms of anxiety and irritability. In addition, magnesium deficiency causes hypertrophy of the glomerular zone of the adrenal cortex, which leads to an increase in aldosterone secretion and explains the hyperhydration syndrome [9].
Theories of imbalance of serotonin and γ-aminobutyric acid (GABA) rhythms in the central nervous system and related peripheral neuroendocrine processes have been proposed as universal factors for all types of PMS. In scientific studies of the pathogenesis of PMS, considerable attention is paid to the peptides of the intermedial lobe of the pituitary gland: α-melanostimulating hormone and endogenous opioid peptides – endorphins.
Proponents of the theory of violation of the functional state of the autonomic nervous system (ANS), based on the predominance of the tone of the sympathetic division of the ANS in the 2nd half of the menstrual cycle, believe that the occurrence and development of PMS is a consequence of excessive functional activity of the sympathetic nervous system.
Thus, many theories of the pathogenesis of PMS testify in favor of the fact that provoking factors should be considered not in opposition, but in interrelation and interdependence. The approach to the diagnosis and treatment of this syndrome should be complex.
Clinical picture
Domestic clinicians, depending on the predominance of a certain group of symptoms, conditionally distinguish several clinical forms of PMS: neuropsychic, edematous, cephalgic, and crisis [10].
The clinical picture of the neuropsychic form of PMS is dominated by a variety of psycho-emotional symptoms (irritability, depression, weakness, tearfulness, aggressiveness). If depression prevails in young women with PMS, then aggressiveness is noted in adolescence.
The clinical picture of the edematous form of PMS is dominated by painful engorgement of the mammary glands, swelling of the face, legs, hands, bloating, irritability, sweating, itching of the skin, weight gain in premenstrual days.
The main symptom of the cephalgic form of PMS is a headache of a different nature, a number of women have harbingers of a headache in the form of a feeling of anxiety, fear, irritability and excitability. Headache attacks are often accompanied by vegetative manifestations: nausea, blanching of the skin of the face, increased sensitivity to light stimuli, less often – vomiting.
Among the various forms of headache in PMS, menstrual (catamenial) migraine (MM) is especially distinguished. Due to the lack of a clear definition, the recorded frequency of MM varies from 4 to 73%. According to the definition of the International Headache Society, MM is a migraine without aura if 70% of the attacks occur between 2 days before the onset of menstruation and its last day. The definition of Lignieres Smits (1995) is considered the most accurate: “Attacks of ordinary migraine in the period from two days before the onset of menstruation to its last day, provided that there are no headaches on other days of the headache cycle, attacks are regular, observed for at least 12 cycles” [eleven].
The clinical picture of the crisis form of PMS is characterized by vegetative paroxysms of a sympathoadrenal nature (“panic attacks”), which occur acutely, without precursors and are characterized by a paroxysmal increase in blood pressure, acute headache, chills, palpitations, a feeling of fear of death and end with a copious separation of light urine [12].
There are atypical forms of PMS: vegetative-dys-ovarian myocardial dystrophy, hyperthermic, hypersomnic forms, cyclic severe allergic reactions up to Quincke’s edema, ulcerative gingivitis and stomatitis, cyclic “bronchial asthma”, indomitable vomiting, etc.
Since pain syndrome of various severity and localization is a frequent leading complaint of patients, it is advisable to isolate the algic form of PMS.
Diagnostics
The diagnosis of PMS is a diagnosis of exclusion, that is, in the process of diagnostic search, the doctor’s task is to exclude somatic and mental diseases that can worsen before menstruation. A carefully collected history of life and anamnesis of the disease, as well as a complete general somatic and gynecological examination are important. Age is not a significant condition, i.e. any woman in the period from menarche to menopause can experience PMS symptoms. We have proposed an algorithm for diagnosing PMS, which focuses on the leading group of complaints and allows you to identify one or another form of this syndrome.
In addition, the leading role is given to self-diagnosis with a diary of complaints for 3 menstrual cycles. Women are asked to rate complaints using a visual analog scale, with a score of 1 to 10 for each symptom. The presence of significant differences between the number and severity of complaints in the 1st and 2nd half of the menstrual cycle suggests a diagnosis of PMS in this patient.
Treatment
Treatment of PMS should be guided by the severity of symptoms, but most women need to be prescribed medications in combination with non-drug treatments.
There have been many studies on the effectiveness of psychological treatments. These include lifestyle modification (eg, diet modification, relaxation, exercise) as well as specific psychotherapeutic approaches (eg, support groups and cognitive behavioral therapy) [13].
The need to include psychotherapeutic methods is based on the fact that women with PMS can negatively interpret the physiological changes taking place in the body. Repeated anticipation of negative experiences can increase feelings of anxiety and depression, especially against the background of existing psychosocial stressors. Expected somatic changes may disrupt normal coping mechanisms that the patient views as uncontrollable and further increase gloomy moods and anxiety, causing a sense of inevitable loss of control. A vicious circle of negative thoughts and self-deprecating behavior supports a maladaptive response to physiological changes. Using the cognitive behavioral therapy model involves trying to find more adaptive ways to cope with premenstrual changes.
Relaxation training is a useful addition to the therapeutic package of psychotherapeutic techniques. But there is little research evidence to support its effectiveness on its own. Physical exercises were studied more strictly. Women who exercise regularly are less likely to complain before menstruation. With prospective observation for 6 months. in sedentary women, exercise has been shown to have beneficial effects on mood, fluid retention, and breast tenderness. In a randomized controlled trial of women with confirmed PMS, aerobic exercise was also rated positively, with more intense exercise being more effective.
A modification of the diet is recommended: reducing the consumption of foods containing caffeine, alcohol, salt and refined sugar. Frequent consumption of carbohydrate-rich snacks can increase dietary tryptophan, which in turn increases serotonin synthesis. There is emerging evidence of a beneficial effect of increased premenstrual carbohydrate intake on mood and sex drive [14].
The use of various physiotherapeutic methods has also been studied. Along with procedures that reduce the severity of symptoms, such as massage, balneotherapy, pearl and pine baths, endonasal galvanization, mud applications, it is also possible to use transcranial electrical stimulation of endorphin brain structures (TES). Taking into account the multifaceted effect of the procedure, in particular, a positive effect on the ANS, a significant decrease in the intensity of cephalalgia, and an impact on the emotional sphere, it seems promising to use the TES method to correct algic manifestations and neurovegetative disorders in patients with PMS [15].
Pharmacological correction of PMS can be divided into etiological and symptomatic.
All methods of suppressing the natural cyclicity can be attributed to etiological therapy. This difficult type of therapy is the method of choice in the case of severe PMS, in particular in the crisis form, which causes a long-term loss of the patient’s ability to work and leads to a significant deterioration in her health and quality of life.
Suppression of cyclic hormonal and biochemical processes is achieved by the appointment of hormone therapy (agonists of GnRH, antigonadotropins, combined oral contraceptives, gestagens). But one should take into account the fact that long-term blocking of the natural hormonal cycle may lead to the development of side effects (adrenergic, moderately pronounced androgenic and menopausal symptoms) [16].
A milder option for the etiological drug treatment of PMS is combined oral contraceptives containing highly selective third-generation progestogens. It is possible to prescribe drugs under the supervision of a gynecologist in a continuous mode for 3-4 months. nonstop. However, it must be remembered that this group of drugs is ineffective in case of PMS symptoms in women who took these drugs for contraception [17].
Due to the presence of absolute or relative hyperestrogenism in this condition, therapy with gestagens is indicated, which contribute to the normalization of psycho-emotional disorders and reduce fluid retention in the body and are prescribed after examining the patient’s hormonal background [18].
For pathogenetic therapy of the neuropsychiatric form of the disease (especially moderate and severe), antidepressants are used: selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors. The use of tranquilizers may also be useful in the complex treatment of PMS. When choosing a tranquilizer, preference is given to drugs with a vegetative-corrective effect.
Complex therapy regimens traditionally include vitamins A, E, B6 (especially in combination with magnesium).
It should be noted that PMS therapy can be quite long. It is advisable to carry out treatment in cycles of 3-6 months. with a break of 3 months. [19]. Given the lack of knowledge of the pathogenesis of PMS and the lack of a drug that is effective against all symptoms of the disease at the same time, with a variety of cyclic therapy used, a positive result of treatment will depend on the patience of the doctor and the perseverance of the woman herself. The low compliance of this category of patients, the lack of uniform standards for diagnosis and therapy, and the frivolous attitude on the part of society to the very fact of the existence of this medical problem make the treatment of PMS a difficult clinical task for a doctor. But its solution reduces the disability of patients, the percentage of interpersonal conflicts in society and, in general, makes it possible to change the quality of a woman’s life for the better.

Myths and truth about PMS – Gazeta.Ru

PMS and menstruation are the same

PMS – premenstrual syndrome – occurs 2-10 days before menstruation. Perhaps those who confuse these terms do not know how the abbreviation stands for. Be that as it may, women, showing a bad mood, often hear in response comments about the onset of menstruation.

Ancient physicians spoke about the “morbid condition” of women before menstruation.

For the first time, the scientific basis for PMS was summed up in 1931 year old gynecologist Robert Frank, linking this condition to a decrease in progesterone levels. True, he noticed the influence of the period before menstruation mainly on behavior – his patients at this time committed “stupid and reckless acts.” Only by the 1960s and 1970s, the British endocrinologist Katharina Dalton put together not only behavioral, but also physical symptoms and found their possible cause – a change in the ratio of hormones in the body.

The widespread dissemination of information about PMS played a cruel joke – during this period, women were almost demonized, considering them absolutely uncontrollable. Thus, Dr. Edgar Berman, a member of the Committee on National Priorities of the Democratic Party of the United States, stated that women are unsuitable for managerial positions due to imbalance due to “out of control hormones.”

PMS is when a woman becomes nervous before her period and cries a lot

PMS has more than 150 possible symptoms, and not all of them are related to mood. They also include changes in eating habits, swelling, bloating, clumsiness, headaches, nausea and vomiting, and even heart pain. Emotional symptoms come to the fore simply because they are noticeable to others.

PMS occurs due to fluctuations in hormones

The causes of PMS have not been fully established to this day. The hormonal theory is the predominant one, but there are other options. So, PMS is associated with a deficiency of calcium and magnesium, a decrease in the level of serotonin (by the way, depression is also associated with it), the body’s susceptibility to hormones (and not their concentration), a lack of vitamin B6, a genetic predisposition, and even an allergic reaction of a woman to her own progesterone. .

“It all depends on the mental state of the woman at any given moment. For example, when everything is calm at work and at home, then, of course, PMS will not be so pronounced,” obstetrician-gynecologist and surgeon Aigul Azimova told Gazeta.Ru. —

I think it’s stupid to attribute everything to hormones. The level of hormones cannot influence the condition of a woman so much.

All the changes that are taking place are absolutely functional monthly normal. Therefore, both the woman and the doctor need to look at this issue more broadly.”

In addition, in 2016, American experts suggested that the presence of PMS symptoms may be associated with an acute inflammatory process, the biomarker of which is C-reactive protein (CRP). After examining more than 3,000 women, they found that those who complained of sudden mood swings, colic and bloating, back pain, increased appetite and chest pain before menstruation, in most cases, CRP was increased.

“Most women experience some form of PMS symptoms. Recognition of the fact that PMS is associated with an underlying inflammatory process opens up new possibilities for treatment and prevention, ”commented the study editor of the Journal of Women’s Health, where it was posted by Dr. Susan Korstein.

PMS is not normal, it needs to be treated

According to various sources, up to 90% of women experience various symptoms of PMS. At the same time, they do not interfere with most of them from working, studying, playing sports – in a word, leading the same life as outside PMS. After all, women experience periods, and therefore PMS, about 400-450 times in their lives, and over time, the vast majority find how to cope with irritability or pain.

However, 3-8% of women have premenstrual dysphoric disorder, and now it is already a serious problem.

During PMDD, a woman experiences the main symptoms of PMS, mainly related to the emotional state (depressed mood, anxiety and tension, mood lability, irritability, decreased interest in daily activities, decreased concentration, fatigue and weakness, changes in appetite, sleep disturbance, impaired self-control, physical symptoms), but in an extremely pronounced form, preventing them from leading a normal life. Five of them are enough to make a diagnosis.

Oral contraceptives and other hormonal drugs, antidepressants are used to combat PMDD.

In the event that none of the therapy options has helped, doctors have to resort to the most radical measure – the removal of the uterus and ovaries.

Even in an acceptable emotional state, a woman can be seriously annoyed by physiological symptoms. In this case, you should not endure discomfort and you should just consult a doctor.

“Some changes in the premenstrual syndrome are considered abnormal – pronounced pain in the lower abdomen, the inability to live sexually, a very strong reaction of the breast before menstruation. In such cases, an analysis is made for the hormonal status, and the gynecologist-endocrinologist selects therapy to minimize these manifestations, ”explains Azimova.

PMS does not exist, women simply justify their tantrums

PMS is included in the ICD, where it is described as premenstrual tension syndrome – premenstrual tension syndrome. At the same time, apparently, even researchers do not consider it too serious a problem – in the ResearchGate scientific articles database, PMS is devoted to five times less scientific articles than erectile dysfunction. However, the problem may not be so much in scientists as in grant givers.

For example, University of Washington psychologist Kathleen Lastyk was denied funding by for a PMS study. Grantors responded that

PMS is “just a product of our society and culture, a natural process that is presented in a negative light, so given the predictability of menstruation, women feel like they are suffering in front of them.”

Of course, it is impossible to exclude the influence of the “self-fulfilling prophecy” effect, when a woman really winds herself up, thereby intensifying her experiences. Back in the 1970s, researchers found out that if a woman is convinced that her period is coming, she is much more likely to report negative symptoms. However, in order to distinguish between real and “contrived” symptoms, further research is needed.

However, even if we exclude the emotional sphere, it is rather problematic to invent swelling, pain in the abdomen or lower back, breast engorgement, flatulence and skin problems.

Hormones spoil your mood during PMS, and nothing happens on other days

Scientists have long noticed an improvement in the cognitive abilities of women during and after ovulation. In 2014, a team of researchers from Austria and Sweden studied changes in the cognitive functions and emotional state of a woman depending on the phase of the menstrual cycle. It turned out that improved verbal and spatial memory are associated with increased levels of estradiol. With high levels of estrogen and progesterone, emotional memory and the accuracy of emotion recognition improve. Researchers attribute these changes to increased activity in the amygdala, the part of the brain that processes emotions.

Progesterone and estradiol levels rise until the mid-luteal phase – the interval between ovulation and the onset of menstruation.

PMS only affects women

“Male PMS” is not considered a medical problem today, but men also experience fluctuations in hormones that affect their well-being and mood.

In the West there is even a name for this state – manstruation.

Scientists drew attention to the relationship between male mood and hormonal changes back in 1960s. In 2003, Peter Selets, a professor at the Comenius University in Bratislava, published the results of several studies confirming that emotional swings and the appearance of aggression in men are associated with a drop in testosterone levels. Selets found that the duration of the male hormonal cycle is 20–30 days.

Two years later, an American professor of psychology, philosophy and medicine Jed Diamond published the book “Irritable Man Syndrome”. In it, he described the symptoms of “male PMS”, and they are surprisingly similar to female ones – emotional weakness, tearfulness, irritability, memory and concentration impairment, anxiety, decreased libido, unmotivated fatigue and a tendency to depression.