What Are the Symptoms of Premenstrual Syndrome?

Premenstrual Syndrome (PMS) refers to a series of physical and emotional discomfort symptoms that women show in the late menstrual cycle (luteal phase D14-D28). The symptoms are not related to mental and medical diseases and are in the follicular phase. Relieve, after spontaneous menstrual cramps, to return to the state without any symptoms. Premenstrual syndrome is a disease of women caused by a combination of physical and psychosocial factors. The main goals of treatment are to alleviate or eliminate physical and psychological symptoms, reduce the impact on individual daily life, interpersonal communication, and quality of life, and minimize the side effects of treatment as much as possible.

Zhang Xingli

(Deputy Chief Physician)

Department of Geriatrics, Beijing Huilongguan Hospital

Western Medicine Name: Premenstrual syndrome

English name: Premenstrual Syndrome, PMS

Introduction to premenstrual syndrome disease

Premenstrual Syndrome (PMS) refers to a series of physical and emotional discomfort symptoms that women show in the late menstrual cycle (luteal phase D14-D28). The symptoms are not related to mental and medical diseases and are in the follicular phase. Relieve, after spontaneous menstrual cramps, to return to the state without any symptoms. Its main manifestations are a series of symptoms such as irritability, irritability, insomnia, tension, depression, and headache, breast tenderness, and facial edema, which can affect women's normal life in severe cases. From the clinical symptoms of premenstrual syndrome, the disease is one of the higher incidence of women of childbearing age. At the same time, premenstrual syndrome is a women's disease caused by a combination of physical and psychosocial factors.

Severe premenstrual syndrome: The current definition of severe premenstrual syndrome is inconsistent. However, in recent studies, this diagnostic criterion has been basically unified and has been used to diagnose this series of severe premenstrual symptoms (premenstrual restlessness and mental disorders) with multiple manifestations-with at least 5 symptoms Based on, it also includes one of the 4 core psychological symptoms (from a table containing 17 physical and psychological symptoms. These 17 symptoms are: depression, helplessness and guilt, anxiety / stress, emotional instability, irritability / Persistent anger, decreased interest, lack of concentration, fatigue, hyper appetite, sleep disturbances, lack of control or vulnerability, poor ability to assist, headache, pain, edema / weight gain, convulsions, breast tenderness) Aggravated in the early stage, and reduced or disappeared after menstruation ^[1] .

/ Premenstrual syndrome incidence / prevalence

95% of women of childbearing age have had symptoms of PMS, of which 5% are severe enough to be known as PMS.

Causes of PMS

It may be caused by hormones and other neuroendocrine factors or high sensitivity to progestin, or it may be caused by insufficient serotonin secretion. Socio-psychological factors have a certain impact on the occurrence of premenstrual syndrome, but related research is insufficient ^[2] .

Premenstrual syndrome treatment

Premenstrual syndrome treatment goals

Alleviate or eliminate physical and psychological symptoms, reduce the impact on individual daily life, interpersonal communication, and quality of life; and minimize the side effects of treatment as much as possible ^[3] .

Premenstrual syndrome treatment

1. Anxiolytics / non-selective serotonin reuptake inhibitors: Non-selective serotonin reuptake inhibitors / antidepressants and anxiolytics can significantly relieve premenstrual syndrome than placebo, but some women Treatment discontinuation due to drug side effects. Benefits: Most studies suggest that anxiolytics / non-selective serotonin reuptake inhibitors can significantly relieve one or more symptoms. Harm: Adverse reactions such as drowsiness, nausea, anxiety, and headache in most trials affected patient compliance. Alprazolam causes drowsiness and a relatively low rate of nausea and headache. Common side effects of antidepressants include dry mouth, fatigue, nausea, and dizziness.

2. Bromocriptine: The side effects of bromocriptine are mainly nausea.

3. Massage therapy: There is insufficient evidence for the effect of massage therapy on women's PMS.

4. Cognitive-behavioral therapy: Studies have shown that cognitive-behavioral therapy can significantly relieve premenstrual symptoms compared with the control group. Relaxation, walking activities, self-monitoring, education, and cooperative skills all alleviate women's symptoms. The therapy has the benefits of long-term treatment, and cognitive behavioral therapy may be more suitable for more active patients.

5. Danazol: It seems very obvious that Danazol can alleviate premenstrual symptoms. Many women who insist on treatment have some symptoms cured by Danazol.

6. Dietary supplementation: Calcium supplementation can significantly relieve overall symptoms, including breast tenderness, edema, dizziness, and abdominal cramping pain, compared to placebo.

7. Diuretics: Many symptoms of PMS are generally believed to be the result of fluid retention! Therefore diuretics are widely used, but in most women with PMS. We have not found conclusive evidence of fluid retention.

8. Endometrial resection: Endometrial resection for women with more menstruation can relieve symptoms of PMS, but the effect on women with PMS alone is not clear.

10. Luteinizing hormone-releasing hormone analogues (GnRH analogues: cloth containing Ruilin, getonin, leuprolide). Continuous use of luteinizing hormone-releasing hormone analogues for more than 6 @ months will bring bone The danger of loosening limits its long-term use.

11. Hysterectomy with or without double ovariectomy: Almost all premenstrual symptoms disappear completely after hysterectomy with double ovariectomy. Unless there is a gynecological problem, surgery is rarely used.

12. Laparoscopic double ovariectomy: estrogen replacement therapy and progesterone cycle therapy are usually used after double ovariectomy to prevent endometrial hyperplasia and endometrial cancer. Progesterone can again induce symptoms of PMS.

13. Low-dose estrogen: Estrogen can relieve premenstrual symptoms. In order to avoid endometrial hyperplasia and adenocarcinoma, it is necessary to give progestin for 12 days every 28 days, but in some women progestin may induce PMS. In order to avoid this circulating effect, progestin should be given locally (Use IUD or progestin gel with levonorgestrel). The side effects are breast tenderness, nausea, weight gain, headache, and changes in the menstrual cycle. Transdermal patch tests also have sensitive skin and pigmentation side effects.

14. Non-steroidal anti-inflammatory drugs: Compared with placebo, non-steroidal anti-inflammatory drugs are beneficial for alleviating a series of premenstrual symptoms.

15. Oral contraceptives: There is insufficient evidence that oral contraceptives improve premenstrual symptoms compared to placebo. Some women have severe PMS symptoms when they first started using oral contraceptives.

16. Progestogens (synthetic progesterone-like drugs): There is insufficient evidence to compare the effects of progestins with placebo.

17. Vit B6: There is insufficient evidence for the effect of Vit B6 in treating premenstrual stress.

18. Reflexology: Reflexology has a certain effect in relieving symptoms. Reflexology includes a method of artificial pressure on specific reflex areas of the body.

19. Relaxation therapy: Muscle relaxation therapy and reading leisure magazines can significantly alleviate physical symptoms. Muscle relaxation therapy and massage therapy have improved compared with the initial symptoms. Most people use relaxation therapy as a complementary treatment to other treatments.

20. Selective serotonin reuptake inhibitors: Selective serotonin reuptake inhibitors can significantly improve premenstrual symptoms. Sertraline, fluvoxamine, and paroxetine have significant effects, and venlafaxine is considered to be a serotonin and norepinephrine reuptake inhibitor ^[4-5] .

Premenstrual Syndrome Treatment by Motherland Medicine for Premenstrual Syndrome

In ancient Chinese medicine, there were no names of premenstrual syndrome, but there were discussions such as "premenstrual fever" and "premenstrual irritability". Modern Chinese medicine and gynecology often refer to such symptoms collectively as "the evidences before and after menstruation." Its clinical manifestations are numerous and complicated, such as headache, fever, vomiting, oral cavity, edema, cough and asthma. Another example is postmenstrual diarrhea, convulsions, hiccups, blue lips, swelling, pruritus, etc., although rare, but seen in ancient books and modern clinical. According to the ancient people's knowledge combined with modern clinical reality, it is currently believed that the reason for the onset of various syndromes before and after menstruation with the menstrual cycle is closely related to changes in Qi and blood deficiency and physical fitness during menstruation.

1. Liver depression and qi stagnation type: premenstrual breast tenderness, like induration or lumps, lower abdominal pain and two threats, irritability or irritability, or mental depression, good sigh, or even mania, insomnia, or severe headache, Or the limbs are swollen, the moss is thin and white, and the pulse strings or strings are slippery. Governing Law: Shugan Qi. Recipe: Chaihu Shugan Powder with flavor. 15g of Bupleurum, 20g of white scallion, 10g of scallion shell, 10g of chuanxiong, 15g of fragrant apricot, 10g of licorice, 10g of tangerine peel, 15g of turmeric. Breast tenderness is mainly plus Lulutong 15g, Wang Buliu 15g; breast tenderness with nodules plus orange core 15g, prunella 15g, pangolin 15g; if the liver stagnation and fire caused dizziness and headache, reduce fragrance, Add 15g chrysanthemum, 15g chrysanthemum, 15g crocus, and 30g vermiculite. If you have swollen limbs, you can add Zelan 15g, Zexie 15g, betel nut 15g. If you are restless, add magnet 30g, amber 25g, and stone iris 15g.

2, blood stasis type: severe menstrual headache during the premenstrual period, or pain in the waist and knee joints, reduced heat pain, severe cold pain, or fever, abdominal pain or swelling in the limbs, which is easy to follow, often accompanied by low menstrual flow Or it is not smooth, the color is dark and dark, the tongue is dark or the sharp edges have petechiae, and the pulse is astringent. Governing method: regulating qi and activating blood, dissolving blood stasis and clearing collaterals. Recipe: Xuefu Zhuyu Decoction. 15g of peach kernel, 15g of safflower, 10g of chuanxiong, 15g of radix chinensis, 10g of achyranthes bidentata, 15g of Bupleurum chinense, 15g of husk, 10g of licorice root, 20g of motherwort, 20g of angelica, 15g of habitat, 15g of salvia miltiorrhiza. If the limbs are swollen, add 15g of Zeeran, 15g of Alisma, 15g of big belly skin; if the body pain is obvious, add Guizhi 159, 15g of blood of chicken blood.

3. Blood deficiency type: dizziness and headache during menstrual period or postmenstrual period, less palpitation, fatigue, or body numbness, soft limbs, or fever, cold and spontaneous sweating, less gas, lazy words, or frequent rubella, itchy skin, The complexion is dull, the skin is dull, the amount of menstruation is small, the color is pale, the tongue is red, the coat is white, and the veins are weak. Governing Law: Yiqi Yangxue. Recipe: Bazhenchang. 25g of cooked land, 15g of white peony, 20g of angelica, 10g of chuanxiong, 10g of codonopsis, 15g of atractylodes, 10g of Yunling, 10g of licorice. If the person has itching and rubella, 20g of Shouwu, 15g of windproof, 15g of Jingqi.

4. Spleen Deficiency Type: Suffering from swollen limbs on the face, reduced abdominal distension, loose stools, or dizziness before and after menstruation, chest tightness and general discoloration, heavy menstrual flow, pale color, thin red tongue, white fur, slippery pulses Or calm. Governing method: spleen warming Yangyang water. Recipe: Lingguizhugan Decoction. Poria 20g, Guizhi 15g, Self-operated 25g, Licorice 10g, Astragalus 20g. For those who have experienced diarrhea, add 25g of yam, 15g of lentils, 15g of lotus seed meat, 15g of coix seed; if puffiness is the main, add diarrhea 15g, Morinda officinalis 15g, 15g of Poria, 15g of self-protection.

5. Kidney-yang deficiency type: swollen limbs on the face, soft waist and knees, loose stools, chills, cold limbs, less urine, more menstrual flow, pale color, thin tongue, pale moss, and slow pulse. Governing law: warming the kidneys and helping the Yang water. Recipe: Zhenwu Decoction. 15 g of Atractylodes, 15 g of Poria, 15 g of Aquilaria, 15 g of aconite, 10 g of ginger, 20 g of Morinda officinalis, 10 g of Alisma orientalis, 15 g of imperial grass, 15 g of fairy spleen. If it is mainly edema, add 15g of Fangji, 15g of cinnamon sticks; add 20g of psoralen, 15g of dogwood, 15g of nutmeg and 15g of schisandra.

6, kidney yin deficiency type: menstrual or post-menstrual hot flashes, night sweats, dizziness, waist and knees tenderness, or breast swelling, or mouth erosion, dry mouth and dry throat, or dumb sound, five upset fever, often early months, A small amount of color red, or prolonged menstruation, red tongue, less moss, pulse count. Governing Law: Nourishing the kidney and yin. Recipe: Zuogui Pill. 25g of cooked land, 20g of yam, 15g of dogwood, 15g of wolfberry, 10g of Achyranthes bidentata, 25g of dodder, 15g of staghorn gum, 15g of turtle gum. Upset and insomnia plus 15g of jujube kernels, 15g of ziziren, 25g of keel; those who pass through the oral cavity plus zhimu 15g, cork 15g, schisandra 15g; headaches, wolfberry 20g, chrysanthemum 15g; early menstruation plus privet 15g, drought Lotus grass 15g.

Effects of psychosocial factors of PMS on the occurrence of PMS

Effects of mood in premenstrual syndrome on premenstrual syndrome

Not all women of childbearing age show symptoms of premenstrual syndrome. The reason is also related to women's emotions. Some studies suggest that the severity of PMS is related to emotional factors, which can make symptoms worse when patients are emotionally stressed. Women often experience irritability, depression, or irritability before and during menstruation. These emotional changes can affect endocrine function. The tension directly increases the secretion of aldosterone, which produces edema due to water and sodium storage, so the premenstrual syndrome occurs. Women's fear, anxiety, and fear caused by the abnormal response to menstrual bleeding will increase their susceptibility to premenstrual complaints and maladaptive escape habit, and further evolve into monthly anxiety, depression, physical discomfort and behavior Behavioralincompetence symptoms. Adverse emotions can aggravate and induce women's premenstrual syndrome, and women's premenstrual syndrome can manifest itself through more adverse emotional reactions.

Influence of personality characteristics of PMS on PMS

Women's personality characteristics are also important factors leading to premenstrual syndrome. The prevalence of psychological symptoms during PMS is quite high, even higher than the rate of physical symptoms. The more conservative, quiet, lonely, lying, lack of compassion, hatred, excessive emotion, and irritability, the more severe the clinical symptoms of PMS. The emotional instability and neurotic personality characteristics are closely related to the occurrence of premenstrual syndrome, especially the personality is related to the fixed pattern of brain activity, which in turn affects the activity of the hypothalamus and the hypothalamus-pituitary-ovarian pumping activity is affected. Hormone secretion changes, so the formation of poor personality characteristics can affect the severity of PMS.

Effects of psychological stress on premenstrual syndrome on premenstrual syndrome

The occurrence of premenstrual syndrome is closely related to the level of psychological stress. Women with high stress are most likely to suffer from premenstrual syndrome. Women with excessive psychological stress and high anxiety value are prone to premenstrual syndrome. The cause of psychological stress caused by premenstrual syndrome is endocrine disorders caused by psychological stress, which causes illness.

Effect of psychotherapy for PMS on PMS

There are few researches on the psychological treatment of premenstrual syndrome at present. Some studies believe that through psychological counseling, emotional adjustment, and seeking family support and help, it can help women with premenstrual syndrome to improve. According to women's premenstrual syndrome patients with poor adaptive coping style, psychological intervention should be carried out during treatment, and psychological therapy can be used to help overcome the premenstrual syndrome. The purpose of treatment can be achieved by cultivating good personality and psychological treatment as the main treatment methods. Increasing the effective components of problem-solving coping methods, such as coping skills training, biofeedback training, relaxation training, and rationalized emotional therapy, are very helpful for patients with premenstrual syndrome.