How does PMS cause anxiety. What are the main symptoms of PMS-related anxiety. Which treatment options are available for managing PMS anxiety. How can lifestyle changes help alleviate PMS-induced anxiety symptoms.

Understanding the Link Between PMS and Anxiety

Premenstrual syndrome (PMS) affects a significant portion of individuals who menstruate, with anxiety being a common symptom. The relationship between PMS and anxiety is complex, involving hormonal fluctuations and potential exacerbation of existing mental health conditions. To better comprehend this connection, it’s crucial to examine the underlying mechanisms and differentiate between PMS and its more severe counterpart, premenstrual dysphoric disorder (PMDD).

The Prevalence of PMS-Related Anxiety

PMS affects approximately 30-80% of menstruating individuals, with varying degrees of severity. Anxiety is one of the psychological symptoms that can manifest during the premenstrual period. The wide range in prevalence highlights the diverse experiences of those affected by PMS, emphasizing the importance of individualized approaches to management and treatment.

Hormonal Fluctuations and Anxiety

The menstrual cycle is characterized by hormonal changes, particularly during the luteal phase. This phase, which begins after ovulation and typically lasts 14 days, is associated with peak levels of estradiol and progesterone. These hormonal fluctuations are believed to play a significant role in the development of PMS symptoms, including anxiety.

Can hormonal changes directly cause anxiety? While researchers have not fully elucidated the exact mechanisms, evidence suggests that the fluctuations in hormone levels during the menstrual cycle can influence neurotransmitter activity, particularly serotonin. Serotonin, a key neurotransmitter involved in mood regulation, may be affected by these hormonal shifts, potentially contributing to the onset of anxiety symptoms.

Distinguishing Between PMS and PMDD

While PMS and PMDD share similar symptoms, PMDD is considered a more severe condition. Understanding the distinctions between these two disorders is crucial for accurate diagnosis and appropriate treatment.

PMS: Symptoms and Characteristics

PMS encompasses a range of emotional and physical symptoms that occur during the luteal phase of the menstrual cycle. Common psychological symptoms include:

• Anxiety
• Irritability
• Mood swings
• Fatigue
• Changes in appetite
• Difficulties with memory or concentration

Physical symptoms may include:

• Swollen and tender breasts
• Cramps
• Bloating
• Headaches
• Backaches
• Gastrointestinal issues

PMDD: A More Severe Form of Premenstrual Distress

PMDD is characterized by more intense symptoms that can significantly impact daily functioning. In addition to the symptoms associated with PMS, individuals with PMDD may experience:

• Severe mood swings
• Intense feelings of sadness or hopelessness
• Extreme anxiety or tension
• Persistent irritability or anger
• Loss of interest in usual activities
• Difficulty concentrating
• Fatigue or low energy
• Changes in appetite or food cravings
• Sleep disturbances
• Feeling overwhelmed or out of control

Do individuals with PMDD have a higher likelihood of experiencing anxiety or depression? According to the Office on Women’s Health (OWH) and the Anxiety and Depression Association of America (ADAA), people diagnosed with PMDD are indeed more likely to experience concurrent anxiety or depression. This underscores the importance of comprehensive mental health evaluations for those presenting with severe premenstrual symptoms.

The Role of Serotonin in PMS-Related Anxiety

Serotonin, a neurotransmitter crucial for mood regulation, may play a significant role in the development of anxiety and depressive symptoms associated with PMS and PMDD. Research suggests that serotonin levels fluctuate during the menstrual cycle, potentially contributing to the mood changes observed in some individuals.

Serotonin Fluctuations and Symptom Severity

How do changes in serotonin levels affect PMS symptoms? While the exact mechanisms are not fully understood, it is believed that the fluctuations in serotonin during the menstrual cycle may contribute to the severity of mood-related symptoms, including anxiety. This connection between serotonin and PMS symptoms has implications for treatment approaches, particularly the use of selective serotonin reuptake inhibitors (SSRIs) in managing PMDD.

Premenstrual Exacerbation: When Existing Conditions Worsen

For some individuals, the premenstrual period can lead to an exacerbation of preexisting mental health conditions, a phenomenon known as premenstrual exacerbation (PME). This distinction is important, as it can impact treatment strategies and overall management of symptoms.

Differentiating PME from PMDD

PME refers to the worsening of symptoms associated with preexisting mental health conditions during the luteal phase of the menstrual cycle. Conditions that may be subject to PME include:

• Generalized anxiety disorder
• Major depressive disorder
• Bipolar disorder
• Schizophrenia
• Eating disorders
• Substance use disorders

Is it challenging to distinguish between PMDD and PME? Indeed, healthcare providers may find it difficult to differentiate between these two conditions due to the overlap in symptoms. Accurate diagnosis is crucial for determining the most appropriate treatment approach, as management strategies may differ depending on whether an individual is experiencing PMDD or PME of an existing condition.

Effective Strategies for Managing PMS-Related Anxiety

Managing anxiety associated with PMS or PMDD often requires a multifaceted approach, combining lifestyle modifications with medical interventions when necessary. By implementing a comprehensive management plan, many individuals can experience significant relief from their symptoms.

Lifestyle Modifications and Self-Care Techniques

Several lifestyle changes and self-care strategies can help alleviate PMS-related anxiety:

1. Regular exercise: Engaging in aerobic activities has been shown to effectively reduce PMS symptoms.
2. Adequate sleep: Aim for 8 hours of quality sleep per night to support overall mental health and resilience.
3. Stress reduction techniques: Incorporate practices such as yoga, meditation, deep breathing exercises, or progressive muscle relaxation.
4. Dietary adjustments: Focus on a balanced diet rich in whole grains, fruits, vegetables, and lean proteins. Consider reducing salt, caffeine, and alcohol intake.
5. Smoking cessation: Research indicates that individuals who smoke are more likely to develop PMS and PMDD.
6. Symptom tracking: Keep a diary or use a mobile app to track symptoms, helping identify patterns and potential triggers.

Medical Interventions for Severe Symptoms

When lifestyle modifications alone are insufficient, medical treatments may be necessary, particularly for individuals with PMDD or severe PMS symptoms. Common medical interventions include:

• Hormonal birth control: Can help regulate menstrual cycles and alleviate symptoms.
• Selective Serotonin Reuptake Inhibitors (SSRIs): Effective in managing mood-related symptoms, including anxiety.
• Anti-anxiety medications: May be prescribed for short-term symptom relief.
• Light therapy: Some individuals may benefit from exposure to bright light to help regulate mood.
• Hormone therapy: In severe cases, gonadotropin-releasing hormone agonists may be considered.

Are there specific SSRIs that are more effective for PMDD? While various SSRIs have shown efficacy in treating PMDD, some studies suggest that fluoxetine, sertraline, and paroxetine may be particularly effective. However, the choice of medication should be made in consultation with a healthcare provider, taking into account individual factors and potential side effects.

The Importance of Individualized Treatment Approaches

Given the wide range of experiences and symptom severity among individuals with PMS-related anxiety, it’s crucial to emphasize the importance of personalized treatment plans. What works for one person may not be as effective for another, highlighting the need for a flexible and adaptive approach to management.

Collaborative Care and Support Systems

Effective management of PMS-related anxiety often involves collaboration between healthcare providers, mental health professionals, and the individual experiencing symptoms. Building a strong support system, including friends, family, and support groups, can also play a crucial role in coping with the challenges associated with PMS and PMDD.

Ongoing Research and Future Directions

As our understanding of PMS, PMDD, and their relationship to anxiety continues to evolve, ongoing research is exploring new treatment modalities and management strategies. From investigating the potential benefits of nutraceuticals to exploring the role of genetics in symptom susceptibility, the field of premenstrual disorders is dynamic and continually advancing.

Empowering Individuals Through Education and Awareness

Increasing awareness and education about PMS-related anxiety is crucial for destigmatizing these experiences and empowering individuals to seek appropriate care. By fostering open conversations about menstrual health and its impact on mental well-being, we can create a more supportive environment for those affected by PMS and PMDD.

Breaking Down Barriers to Care

What obstacles do individuals face when seeking help for PMS-related anxiety? Common barriers include lack of awareness, stigma surrounding menstrual and mental health issues, and limited access to specialized care. Addressing these challenges through public health initiatives, improved healthcare provider education, and increased accessibility to mental health services is essential for ensuring that individuals receive the support and treatment they need.

The Role of Advocacy and Support Groups

Support groups and advocacy organizations play a vital role in providing resources, fostering community, and driving research efforts in the field of premenstrual disorders. These groups can offer valuable peer support, educational materials, and platforms for sharing experiences and coping strategies.

By combining evidence-based treatments, personalized care approaches, and increased awareness, individuals experiencing PMS-related anxiety can find effective ways to manage their symptoms and improve their overall quality of life. As research in this field continues to advance, we can look forward to even more targeted and effective interventions for those affected by PMS and PMDD.

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.