It is a disorder that occurs about 7-10 days before menstruation and disappears a few hours after the onset of menstruation, is characterized by nervousness, emotional instability, anxiety, depression and possible headaches, edema and mastalgia. The exact frequency is unknown but it is estimated that 30% of women have any symptoms before menstruation, and that 10% have significant symptoms that affect their daily activities.

What causes it?

Premenstrual syndrome appears to be related to changes in the levels of estrogens and progesterone. Estrogen and progesterone can cause transient fluid retention, which seems to explain some of the symptoms of this syndrome.

What are the symptoms?

The type of symptoms and their intensity vary from woman to woman and cycle to cycle. In many women the symptoms are significant but short-lived and do not disable, in others the patient can not perform its normal activity.

Symptoms last from a few hours up to 10 days or more and usually cease with the onset of menstruation, but in perimenopausal women, symptoms may persist during menstruation and after it. With the onset of menstruation, many women Premenstrual Syndrome is replaced by dysmenorrhea. The essential dysmenorrhea is more common in teens and tends to decrease with age.

The most common symptoms are irritability, depression, fatigue, drowsiness, headache, edema in legs, abdomen or breasts, increased appetite, weight gain, nervousness, lack of control, agitation, anger, insomnia, difficulty concentrating, lethargy, depression and severe fatigue.

Symptoms related to fluid retention are edema, transient increase in weight, oliguria and breast tension and pain. Neurological and vascular symptoms include headache, dizziness, syncope, numbness in the limbs, easy bruising and heart palpitations. Epilepsy may worsen.

Gastrointestinal symptoms include constipation, nausea, vomiting, changes in appetite. There may be heavy or pelvic pressure and back pain. Problems can also arise from the skin as acne, neurodermatitis and sometimes aggravation of other skin disorders. Breathing problems (eg., Allergies and infection) and ocular (eg, visual disturbances and conjunctivitis) may worsen.

What is your treatment?

Firstly it is important to reassure the patient. Counseling may help women and their partners to cope with the condition and activities of women should be modified to reduce stress. The explanation of the physiological mechanism of the cycle, changes in lifestyle, proper scheduling of sleep, a balanced diet, sometimes enough to reduce the symptoms of this syndrome.

The practice of sport, such as aerobic exercise, increase levels of neurotransmitters such as serotonin and is a good therapy for this syndrome.

Treatment consists of symptomatic relief.

Water retention may be relieved by reducing sodium intake and using a diuretic, beginning immediately before the time at which the symptoms are usually noted. Spironolactone is the only diuretic that has shown some efficacy in reducing fluid retention.

Hormone manipulation is effective in some cases.

Oral contraceptives are often used in treatment but their effectiveness is limited. Some women respond positively but instead other unresponsive and even worse.

Possible regimens include anovulatory; progesterone vaginal suppositories (200-400 mg / d) or injection (5-10 mg im, oily form) for 10-12 days before menstruation, long-acting progestin (eg. , im medroxyprogesterone acetate 200mg every 2-3 months) or a GnRH agonist (eg, leuprolide or goserelin im 3.75 mg 3.6 mg im per month) with estrogens and progestins in low doses to eliminate changes cyclical.

You can use tranquilizers (eg a benzodiazepine) in patients with irritability, nervousness and lack of control, especially when they can not change the determinant of stress environment.

In some women may be useful dietary change (eg. By increasing and decreasing protein carbohydrates).

Selective inhibitors of serotonin reuptake (eg., Fluoxetine 20 mg / day po or sertraline 50 mg / day po) are the most effective drugs in the treatment of psychological and physical symptoms of premenstrual syndrome.

It has been shown that vitamin supplements improve symptoms of the syndrome.