premenstrual syndrome
Introduction
Introduction to premenstrual syndrome Women of childbearing age have repeated symptoms of mental, behavioral and physical conditions 7 to 14 days before menstruation (ie during the luteal phase of the menstrual cycle). The symptoms disappear immediately after menstruation, due to the mental and emotional disorders of the disease. To highlight, in the past it was named "premenstrual tension", "premenstrual tension syndrome". In recent years, the symptoms of this disease have been widely spread. In addition to mental and neurological symptoms, several organs and systems are involved, including a variety of organic and functional symptoms. Therefore, they are collectively called premenstrual syndrome (premenstralsyndrome). , PMS). However, some scholars have highlighted the symptoms of emotional abnormalities and proposed the term "lateluteal phasedysphoric disorder" (LLPDD) as a branch of PMS. basic knowledge Proportion of the disease: the incidence of the disease in certain age groups (23% of women over 30 years old) Susceptible people: more common in women aged 25-45 Mode of infection: non-infectious Complications: headache, insomnia, depression
Cause
Causes of premenstrual syndrome
Endorphin theory (20%):
Since changes in endorphin levels can affect mental and neurological factors, intravenous endorphin can increase prolactin concentrations. Animal experiments have also shown an increase in vasopressin after endorphin administration. While the endorphin inhibitor sodium ketone can change the secretion of luteinizing hormone after endorphin receptor, and -endorphin changes with the menstrual cycle, it is proposed that the premenstrual tension syndrome is the luteal phase. The peptide concentration is changed.
Proportion of estrogen and progesterone imbalance (25%):
It can be caused by relatively high estrogen levels and relatively insufficient progesterone levels; it may also be caused by abnormalities in tissue sensitivity to progesterone. Under normal circumstances, progesterone promotes the excretion of sodium and water in the distal renal tubules, while estrogen retains sodium and water through the renin, angiotensin II, and aldosterone systems. Therefore, the imbalance of estrogen and progesterone may cause weight gain and other signs. .
Insufficient vitamin B6 (18%):
Vitamin B6 promotes excessive estrogen clearance and eases mood and behavior. Lack of vitamin B6 may cause premenstrual syndrome.
Mental factors (15%):
Some patients have prominent mental symptoms, mood swings, and mental stress can make the original symptoms worse.
(1) Causes
It can be related to the balance of neurotransmitter-neuroendocrine system, hormone changes, water, sodium retention, and mental factors. Although the cause of PMS is still not clear, but through in-depth research in recent years, the cause of PMS may be caused by E2, progesterone and/or their metabolites in the corpus luteum. Due to their cyclical changes, they are mediated by neurotransmitters (they include -EP, 5-Sr, and even gamma-aminobutyric acid, the adrenergic nervous system), which affect the function of certain regions of the brain. Intracranial dysfunction, resulting in numerous, multi-system symptoms.
Peripheral blood ovarian steroid hormone levels in the PMS patients are still in the normal range, but it does not reflect the level of the central nervous system, its impact on the central nervous system is still different from healthy women.
(two) pathogenesis
1. Neurotransmitter - neuroendocrine system balance disorder:
Endophage (-endorphin, -EP) theory: normal menstrual cycle -EP begins to rise before ovulation and lasts until the next menstrual period. The -EP of the luteal phase of PMS patients was significantly lower than that of the normal control group. The use of the endorphin inhibitor sodium chromone (na1axone) can produce symptoms similar to PMS.
In the luteal phase, abnormalities in -EP or sensitivity to -EP are the main causes of a series of neuroendocrine changes that cause various manifestations of PMS.
Serotonin (Sr) theory: It is indicated that 5-HT is related to the occurrence of PMS. In the pre-menstrual phase, the Sr energy system of PMS patients is defective, and the responsiveness to stimulation is mutated. PMS can be effectively treated using a drug that releases 5-HT or blocks its resorption.
2. Hormone changes:
Progesterone deficiency: PMS often occurs during ovulation cycles, and progesterone levels in the luteal phase or a change in the E/P ratio can lead to PMS.
Progesterone is insufficient to cause excessive estrogen, resulting in imbalance of electrolyte balance, increased extracellular fluid, headache, edema, irritability, and bloating.
Prolactin (PRL) excretion increased: PRL's regulation of osmotic pressure is significant in animals but not in humans, and may only act on the mammary gland, affecting the balance of local osmotic pressure to make the breasts swell and tender. Women with high PRL have few symptoms of PMS. The use of bromocriptine treatment only reduces breast symptoms, but the effect on other symptoms is not significant, so there is still no reliable and strong evidence for the increase in PRL discharge.
Estrogen metabolism is affected in patients with liver disease, and premenstrual syndrome is often prone to occur.
However, in recent years, many studies have not found abnormalities in the production and metabolism of ovarian hormones in patients with PMS. The average level of ovarian carcass in patients with PMS did not differ from normal. PMS patients have normal reproductive function, which does not affect fertility and can also prove that their ovarian hormones are in a normal equilibrium state.
Clinically, the application of vitamin B6 treatment can promote the metabolism of excessive estrogen in the liver, enhance the monoamine biosynthesis of the brain, regulate behavior and mood, and improve symptoms. Therefore, it is considered that vitamin B6 deficiency may be the pathogenesis factor of PMS. One.
3, water, sodium retention:
Excessive aldosterone levels cause systemic fluid retention and are often used to explain the formation of PMS. The 5-HT change in patients with PMS increases the corticosteroids in the pituitary gland, and increases the aldosterone and angiotensin II secreted by the adrenal gland, thereby affecting electrolyte metabolism and causing sodium retention.
However, some studies have found that patients with PMS have unstable vascular regulation. Increased capillary permeability leads to redistribution of fluids in the body, causing bloating and breast tenderness.
4. Mental factors:
Many scholars have suggested that psychosocial factors cause physical and mental dysfunction. Parker comprehensively agrees with many scholars that personality and environmental factors are extremely important for the occurrence of PMS symptoms. The presence of symptoms reflects the unresolved conflicts in the patient's heart. Tracing the patient's life history, there are often more obvious emotional stimulation, such as childhood unfortunate experience and trauma, parental family disharmony, poor academic performance, loss of love, etc., may be important factors in the emergence of pre-menstrual changes. Some patients have prominent mental symptoms, and the mental symptoms often exacerbate the original symptoms.
Prevention
Premenstrual syndrome prevention
In daily life, you should avoid unnecessary mental stimulation, eat less salt, have regular life, and participate in some recreational activities and sports activities, which can significantly reduce or even disappear the symptoms. For more serious symptoms, under the guidance of a doctor. Take benzophenone and other sedative drugs or progesterone, androgen, etc. to treat.
Eat less meals before menstruation, and use fruit as a snack to avoid eating sugar, candy and irritating foods. Make sure that the daily diet includes 1 tablespoon of cold pressed vegetable oil because they are rich in omega-3 series and -6. A range of fatty acids, multivitamin supplements and a variety of mineral supplements.
It is very important to educate family members about the health of the disease, so that the family members of the patient can understand the regularity of the disease and the expected onset time, understand and tolerate and prevent the patient from premature behavioral errors, and help adjust the pre-menstrual family activities. Reduce environmental stimuli and minimize the patient's loss of control.
Complication
Premenstrual syndrome complications Complications, headache, insomnia, depression
For the series of abnormal signs that occur periodically, it is more common in women aged 25-45. It is often caused by family disharmony or work stress. Symptoms appear in 1-2 weeks before menstruation, and quickly disappeared to disappear after menstruation.
The main symptoms can be classified into three categories:
1 physical symptoms: manifested as headache, breast pain, abdominal fullness, limb edema, weight gain, motor coordination function decreased;
2 psychiatric symptoms: irritation, anxiety, depression, emotional instability, fatigue and changes in diet, sleep, and sexual desire;
3 behavior change: lack of concentration, low efficiency, accidental tendency, prone to criminal behavior or suicidal intentions.
Symptom
Symptoms of premenstrual syndrome Common symptoms Dysmenorrhea Weight gain Breast pain Dizziness Diarrhea Dizziness Anorexia Water retention fatigue Insomnia
1. The relationship between symptoms and menstruation
The symptoms of typical premenstrual syndrome often begin 7 to 10 days before menstruation, gradually worsening, until the last 2 to 3 days before menstruation is the most serious, the symptoms disappear within 4 days after the start of the tide, and another uncommon situation, namely menstruation There are two periods of severe symptoms that are not connected in the cycle. One is before and after ovulation, and then goes through an asymptomatic period. Symptoms appear again one week before menstruation, which is a special type of PMS.
2. Symptom characteristics and grouping
Premenstrual syndrome involves 150 kinds of symptoms, which can be divided into two major categories, the spirit and the body. Each type can have more than one subgroup, with varying degrees of severity.
(1) Mental symptoms:
1 Anxiety: For mental stress, mood swings, irritability, impatience and loss of patience, micro-trivial things can cause emotional impulses and even quarrels, crying, not self-control.
2 Depression: lack of arrogance, depression, unhappiness, indifference, love to live alone, unwilling to interact with people and participate in social activities, insomnia, lack of concentration, forgetfulness, weakened judgment, fear of losing control, sometimes insanity, paranoia, Suicidal thoughts.
(2) Somatic symptoms: including sodium and water retention, pain and hypoglycemia symptoms.
1 water retention: common symptoms are edema of the hands and feet and eyelids, some feeling breast pain and abdominal fullness, a small number of patients have weight gain.
2 Pain: There may be headache, breast pain, pelvic pain, intestinal fistula and other pain symptoms throughout the body.
A. Premenstrual headache: It is a common complaint, mostly bilateral, but it can also be unilateral headache; the pain is not fixed, usually located in the ankle or occiput, and the symptoms of headache appear in the first few days, accompanied by Nausea and even vomiting, persistent or onset, may be associated with intermittent intracranial edema; easy to be confused with menstrual migraine, the latter often unilateral, dizziness, nausea, etc. in a few minutes or hours before the attack Prodromal symptoms, accompanied by ocular problems (light spots in the field of vision) and other visual impairments and nausea, vomiting, can be identified according to the location of the headache and accompanying symptoms.
B. Breast pain: Before the breast, the breast is full, swelling and pain, with the outer edge of the breast and the nipple as the weight; in severe cases, the pain can be radiated to the armpit and shoulder, which can affect sleep, nipple sensitivity and tenderness during percussion. There is a diffuse solid thickening, but there is no localized lumps, and the symptoms disappear completely after menstruation.
C. Pelvic pain: pelvic bulge and lumbosacral pain occur before menstruation, and lasted until menstrual cramps, related to prostaglandin and pelvic tissue edema congestion, but should be associated with pelvic endometriosis and other organic diseases Caused by dysmenorrhea.
D. Intestinal pain: occasional intestinal pain, may have nausea and vomiting; diarrhea may occur near menstruation.
3 symptoms of hypoglycemia: fatigue, increased appetite, like sweets, headache may also be related to hypoglycemia.
Most women have multiple symptoms of premenstrual syndrome. Severe premenstrual syndrome has psychiatric symptoms, of which anxiety symptoms are mostly, accounting for 70% to 100%. 60% of patients with premenstrual syndrome have breast pain or weight gain. The main complaint; 45% to 50% of patients have symptoms of hypoglycemia, and about 35% of patients have depressive symptoms. This group of patients has a potential threat to life because of suicidal awareness.
Examine
Premenstrual syndrome examination
Vaginal secretions, CA125 examination.
If necessary, do laparoscopic examination, breast infrared fluoroscopy, molybdenum target film and other inspections.
Diagnosis
Diagnosis and diagnosis of premenstrual syndrome
diagnosis
1. Diagnostic criteria
Premenstrual syndrome has neither specific symptoms for diagnosis nor special laboratory diagnostic indicators. The basic elements of diagnosis are to determine the severity of premenstrual symptoms and the relief after menstrual cramps. It belongs to premenstrual syndrome. The identification of severe premenstrual syndrome is based on the degree of impairment of the patient's work, social and daily activities. It is recommended to use the American Psychiatric Association (APA) and the National Mental Health Association (NIMH). Diagnostic criteria.
APA has established an evaluation criteria for premenstrual anxiety symptoms (PMDD) of premenstrual syndrome. The requirement for diagnosis of PMDD is that 5 of the 11 symptoms listed in the table must have severe performance before menstruation, and in menstrual cramps 4 Relief within the day, persists until the 13th day of the cycle without seizures, and exists in 3 consecutive cycles. The 5 symptoms must include at least one psychiatric symptom (such as irritability, mood swing, anxiety or depression); many physical symptoms as a Symptoms, NIMH emphasizes that the diagnosis of premenstrual syndrome must have a condition that the severity of symptoms in the first 5 days is at least 30% higher than the 5 days after the passage, and any medication, hormones, drugs, or alcohol intake history is excluded.
2. Diagnosis method
Mainly rely on understanding the patient's medical history and family, family history, because many patients have emotional disorders and psychiatric symptoms, so pay special attention to this situation, and now the clinical diagnosis is based on the following three key elements: 1 in the first 3 months menstrual cycle There are at least one neurological symptoms such as fatigue, impatience, depression, anxiety, sadness, hypersensitivity, suspicion, emotional instability, etc. and a physical symptom such as breast tenderness, swelling of the extremities, discomfort of abdominal distension, and periodicity. Headache, etc.; 2 symptoms appear repeatedly in the luteal phase of the menstrual cycle, there must be an asymptomatic intermittent period in the late follicular phase, that is, the symptoms disappear at the latest within 4 days after the start of menstruation, at least until the twelfth day of the next cycle Recurrence; 3 the severity of the symptoms is enough to affect the normal life and work of the patient, and those who meet the above 3 can diagnose the PMS.
Typical symptoms often begin 1 week before menstruation, gradually worsening, until the last 2 to 3 days before menstruation is the most serious, and suddenly disappear after menstruation, some patients have a longer time to resolve symptoms, gradually reduce, continue until the beginning of menstruation 3 to 4 The genius disappears completely, and another type that is not common, that is, biphasic, has two stages of severe symptoms that are not connected. One is before and after the ovulation period, and then after an asymptomatic period, the typical symptoms appear one week before menstruation. In the past, it was called interstitial tension. Because its clinical symptoms and pathogenesis are consistent with this disease, it is actually a special type of PMS.
(1) Psychiatric symptoms: including changes in mood, understanding, and behavior. At first, I feel general weakness, fatigue, drowsiness, lethargy, and emotional changes. There are two distinct types: mental stress, physical and mental anxiety, irritability, and illness. Picky, irritating, micro-trivial can cause emotional impulses, even quarrels, crying, can not be self-made; the other becomes slumber, depression, anxiety, sadness or indifference, love to live alone, not willing to Communicating and participating in social activities, attention can not be concentrated, judgment is weakened, and even paranoia, resulting in suicidal awareness.
(two) fluid retention symptoms
1, hand and foot, eyelid edema: more common, a small number of patients significantly increased weight, usually fit clothes become tight and discomfort, and some have abdominal fullness, may be accompanied by nausea, vomiting and other gastrointestinal dysfunction, occasional intestinal fistula , clinical menstrual period can occur diarrhea, frequent urination, due to pelvic tissue edema, congestion, may have pelvic swelling, lumbosacral pain and other symptoms.
2, premenstrual headache: for the more common complaints, mostly bilateral, but can also be unilateral headache, the pain is not fixed, usually located in the ankle or occipital, accompanied by nausea and vomiting, can appear a few days before The peak of menstrual blood appears, the headache is persistent or non-inducing, and the time is on, it may be related to intermittent intracranial edema, and it is easy to be confused with menstrual migraine. The latter is often unilateral, a few minutes before the attack. Or a few hours of dizziness, nausea and other prodromal symptoms, accompanied by vertigo (visual dark spots in the field of vision) and other visual impairment and nausea, vomiting, can be identified according to the location of the headache, the severity of the symptoms and accompanying symptoms.
3, breast pain: often have a full breast, swelling and pain, before the breast lateral edge and nipple parts of the weight, severe pain can be radiated to the armpits and shoulders, can affect sleep, breast sensitivity during percussion, touch Pain, diffuse solid thickening, sometimes touching the granular nodules, but lacking the feeling of limited lumps, completely disappeared after menstruation, reappeared in the next cycle, but the severity of symptoms and signs is not fixed, generally In 2 to 3 years, although it can be cured without treatment, if there is breast lobular hyperplasia, there may be persistent pain throughout the menstrual cycle. Before the exacerbation, the percussion can reach flat, dense areas with dense particles. Unclear, after the menstruation does not fade, check and contrast before and after menstruation, you can find a large change in the size of the mass.
(three) other symptoms
1, appetite changes: increased appetite, most have a desire for sweets or hobby for some salty special foods, while others hate certain foods or anorexia.
2, autonomic nervous system function symptoms: the occurrence of hot flashes due to vasomotor instability, sweating, dizziness, dizziness and palpitations.
3, oily skin, hemorrhoids, libido changes.
Differential diagnosis
It is necessary to identify some organic or psychiatric diseases that cause similar symptoms. See Table 4. Symptoms that do not occur before menstruation are not premenstrual syndrome, but some pre-exacerbated diseases such as migraine, pelvic endometriosis It is also not a premenstrual syndrome. The identification of premenstrual syndrome and psychosis is very important, especially for those who have both diseases. About 30% of patients with premenstrual syndrome have psychosis, more than 50% often With depression, the symptoms associated with depression in these patients are aggravated before menstruation. If the medical history indicates that the patient has a history of mental illness or a high score of psychiatric symptoms in the follicular phase, the patient should be instructed to see a psychiatric department, but one group of patients is not accompanied by a mental illness. Identification by psychological test scale and cortisol secretion rhythm examination and depression.
