Premenstrual syndrome – a set of pathological symptoms that occur a few days before menstruation and disappear in its first days. Premenstrual syndrome is mainly manifested by changes in the function of the CNS, vascular and metabolic and endocrine disorders.
Etiology and pathogenesis. There are many theories explaining the complex pathogenesis of premenstrual syndrome. Hormonal theory suggests that its development is associated with an excess of estrogen and progesterone deficiency during the 2nd phase of the menstrual cycle. The theory of “water intoxication” explains the cause of premenstrual syndrome changes in the system of renin-angiotensin-aldosterone and high levels of serotonin. Activation of the renin-angiotensin system increases serotonin and melatonin levels. In turn, serotonin and melatonin interact with the angiotensin system according to the feedback principle. Estrogens can also cause sodium retention and body fluids by increasing the production of aldosterone.
The theory of prostaglandin disorders explains the many different symptoms of premenstrual syndrome by changing the balance of prostaglandin Er. Its increased expression is noted in schizophrenia due to a change in brain arousal processes.
The main role in the pathogenesis of premenstrual syndrome is played by the disruption of the metabolism of neuropeptides (serotonin, dopamine, opioids, noradrenaline, etc.) in the central nervous system and related peripheral neuroendocrine processes. In recent years, much attention has been paid to the peptides of the intermediary lobe of the pituitary gland, in particular to the melanostimulating hormone.
This hormone when interacting with β-endorphin can contribute to a change in mood. Endorphins increase the level of prolactin, vazospressin and inhibit the action of prostaglandin E in the intestine, resulting in the engorgement of the mammary glands, constipation, and bloating.
The development of premenstrual syndrome is promoted by stress, neuroinfection, complicated childbirth and abortion, especially in women with congenital or acquired inferiority of the hypothalamic-pituitary system.
The clinical picture of premenstrual syndrome includes irritability, depression, tearfulness, aggressiveness, headache, dizziness, nausea, vomiting, pain in the heart area, tachycardia, breast swelling, swelling, flatulence, thirst, shortness of breath, fever . Neuropsychiatric manifestations of premenstrual syndrome are reflected not only in complaints, but also in inappropriate behavior of patients.
Depending on the prevalence of certain symptoms, they release the neuropsychiatric, edematous, cephalgic and crisis forms of premenstrual syndrome. The clinical picture of the neuropsychiatric form of premenstrual syndrome is dominated by irritability or depression (depression prevails in young women, and aggressiveness is noted in transitional age), as well as weakness and tearfulness. The edematous form of premenstrual syndrome is manifested by pronounced nagging and tenderness of the mammary glands, swelling of the face, legs, fingers, abdominal distention. Many women with an edematous form have sweating, increased sensitivity to odors.
Cephalgic form of premenstrual syndrome is clinically manifested. intense throbbing headache radiating to the eyeball. Headache accompanied by nausea, vomiting; BP does not change. In ‘/ 3 patients with the cephalgic form of premenstrual syndrome, depression, pain in the region of the heart, sweating, and numbness of the hands are observed.
The sympathetic-adrenal crises are inherent in the critical form of premenstrual syndrome. The crisis begins with an increase in blood pressure, there is a feeling of constriction behind the sternum, the fear of death, increased heart rate. Crises usually arise. In the evening or at night, they can be triggered by stress, fatigue, or an infectious disease. Crises often end in plentiful urination. Depending on the number, duration, and intensity of symptoms, mild and severe premenstrual syndrome occurs. With mild premenstrual syndrome, 3 symptoms are observed, 1–2 of them are significantly expressed. Symptoms appear 2 days before the onset of menstruation. In severe premenstrual syndrome, 5 to 12 symptoms occur 3 to 14 days before menstruation, and 2 to 5 of them are pronounced.
Diagnosis of premenstrual syndrome is associated with certain difficulties due to the variety of clinical symptoms. Identifying premenstrual syndrome contributes to an adequate patient interview, in which you can detect the cyclical nature of the pathological symptoms that occur in premenstrual days.
In all clinical forms of premenstrual syndrome, it is advisable to perform EEG and REG of cerebral vessels. These studies show the functional impairment of various brain structures. In women with the neuropsychiatric form of premenstrual syndrome, violations are detected mainly in the diencephalic-limbic region. In an edematous form, EEG indices indicate an increase in the activating effects of non-specific structures on the cerebral cortex. EEG changes in the cephalgic form of premenstrual syndrome are the result of blocking the activating systems of the brainstem. In the form of a crisis, changes in EEG reflect dysfunction of the upper vein and diencephalic formations. On the roentgenogram of the skull, it is possible to reveal the pathological digital impressions of the cranial vault due to an increase in intracranial pressure, as well as the pathology of the Turkish saddle.
In the case of the cephalgic form of premenstrual syndrome, sometimes pronounced radiographic changes in the bones of the cranial vault and the Turkish saddle are found: a combination of vascular pattern enhancement and hyperostosis or calcification of the pineal gland. Neurological manifestations depend on the localization of calcification sites. Hyperostosis of the dura mater of the Turkish saddle and in the parietal region is accompanied by signs of dysfunction of the midbrain reticular formation in combination with stem neurological manifestations. Hyperostosis of the frontal bone causes signs of simultaneous damage to the cerebral cortex and hypothalamic structures.
The hormonal status of patients with premenstrual syndrome reflects some features of the functional state of the hypothalamic-pituitary-ovarian-adrenal system. Thus, in an edematous form of premenstrual syndrome, progesterone levels are lowered and serotonin levels in the blood are increased; in the neuropsychiatric form, the level of prolactin and histamine is elevated, in the case of cephalgic, the content of serotonin and histamine is increased, and in the case of crisis form, the level of prolactin and serotonin in phase 2 of the menstrual cycle.
The use of other additional diagnostic methods depends on the form of premenstrual syndrome. When edematous form shows the measurement of diuresis, the study of renal excretory function. Soreness and swelling of the mammary glands are an indication for breast ultrasound and mammography in the 1st phase of the menstrual cycle for the differential diagnosis of mastodynia and mastitis. A neurologist, a psychiatrist, a therapist, an endocrinologist, an allergist are attracted to the examination of patients.