Premenstural tension syndrome
It is acyclical disorder in the luteal phase of the menstrual cycle ,involving behavioral ,psychological and physical changes result in loss of work or social impairment.It mostly occurs in women over 30 years of age.
Symptom:
The symptoms are varied and non specific.Somatic symptom,include bloated feeling of distension or pelvic engorgement,which proceed the period by aweek or 10 days.
It is characterized by premenstrual discomfort in the lower abdomen and back and in the breasts.
Behavioral and emotional manifestation include emotional hypersensitivity,accompanied by varying degrees of irritability,depression,anxiety,tension,mood swings and other emotional disturbances and headache,some women notice deterioration in their concentration,violent and antisocial behavior,mastalgia,fatigue,irritability,depression.
Weight gain due to salt and water retention.
Other symptom include food cravings,craving sweets or salt,fatigue,feeling of being overwhelmed,abdominal cramping,nausea.
Etiology:
It is probably multifactorial,etiological theories include estrogen excess,progesterone deficiency,hyperprolactinemia ,hypoglycemia and increased activity of aldosteron.
Declinig level of serotonin in platelets and whole blood in the late luteal phase of menstrual cycle result in mood changes ,irritability and depression.
Progesteron to estrogen imbalance contributes significantly to retention of water and fluid ,it supports feeling of being bloated and can cause atransient weight gain.
Excess estrogen has been linked to nervousness and irritability.
Decreased dopamine as acontributor also ,subclinical levels of both magnesium and vitamin B6
Abnormal thyroid function can result in breast tenderness and
Proper thyroid function is essential to menstruation and cellular function of the ovaries .
Increased activity of anterior pituitary from hypothyroidism causes the anterior pituitary to release excess amount of prolactin causing prolactinoma,the true effect of hyperprolactinemia on PMS are inconclusive.
TREATMENT:
Non pharmacological treatment:
Reassurance and simple psychotherapy will help.
Support groups,relaxation and stress management,reflexology therapy,aerobic exercise,encourage to eat well balanced diet(low sodium and fat,high fiber,adequate protein,avoid caffeine containing drinks).
Vitamins B are important for controlling PMS.
B5 known as stress vitamin ,work with other B vitamin in complex to abate feeling of being over whelmed or irritable.
B6 acts as anti-inflammatory ,dopamine co factor and as co-enzyme in the production of serotonin.
Magnesium is responsible for phosphorylization of vitamin B.
Magnesium is responsible in assisting nerve conduction ,muscle function and bioavailability of vitamin B.
Deficiencies can activate PGE2 and PGF2 alpha.
Essential fatty acids(omega 3 and 6) act as anti inflammatory .
Blood sugar imbalance ,if the patient does not cosume enough sugar,gluconeogenesis occur and adrenalin is released leading to anxiety ,heart pounding and symptoms of fear.
Medical treatment:
1-Some women obtain symptomatic relief with diuretic,chlorothiazide 500mg orally 3 times daily in the premenstrual week.
2-PG synthesis inhibitor may improve fatigue,headache,general ache and pain and general mood symptoms.
3-for emotional and affective symptoms anti depressant offer agood first line approach.
Mild tranquilizer e.g.diazepam.
4-Bromocriptin if mastalgia is aproblem.
5-Hormonal treatment:since PMS is associated with cyclical ovarian activity,pharmacological suppression of hypothalamopituitary-ovarian axis should offer alogical approach to therapy.
Progesteron give the best results(northisteron 5mg bd or dydrogesteron 10mg bd from day 15-25).
Estrogen has been used to suppress ovulation(cocp used to suppress ovulation).
6-Danazol,suppress gonadotrophin secretion and abolished cyclical ovarian function(unwanted androgenic effect such as weight gain ,hirsutism and acni).
7-GnRH(unwanted menopausal side effects and long term and term risk of osteoporosis )
8-selective serotonin reuptake inhibitors.
Surgery:
For women with sever PMS that have not responded to medical treatment hysterectomy and bilater salpingo oopherectomy.
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