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Today, the term premenstrual syndrome (PMS = Pre Mestrual Syndrome) indicates a rather complex and heterogeneous set of biological and psychological alterations extremely variable from one case to another, but always with a very precise temporal localization with respect to the cycle menstrual.
It is also important to assess the nature of the symptoms, their severity, and the type of basic symptoms, already present in the follicular phase, to which the premenstrual syndrome overlaps.
How Much is Widespread?
About 80% of women will experience more or less unpleasant symptoms near the menstrual flow. Approximately, in 10-40% of women, these disorders will have some repercussions on their working activity and on their lifestyle, while only in 5% of women of reproductive age will be able to configure the typical picture of premenstrual syndrome. The most important role for the diagnosis of PMS is played by the severity of the symptoms that occur in the premenstrual phase and the extent of their remission after the menstrual flow.
Symptoms
To learn more: Symptoms Premenstrual syndrome
The symptoms, which usually appear 7 to 10 days before the start of the flow, are extremely variable and difficult to assess in their entity; they range from depression to breast tenderness, from headache to abdominal swelling, from edema (swelling) of the extremities (legs and less frequently arms) to the instability of behavior. In some patients they become progressively worse while in others they reach peaks of considerable intensity interspersed with periods of well-being.
Premenstrual syndrome can occur at any time during a woman's reproductive life; most commonly appears in later years, and in those patients who report a history of long periods of natural menstrual cycles, ie without the use of oral contraceptives. Mostly it does not manifest itself in an acute way, but the symptoms undergo a progressive worsening with the passing of the years.
Complications
Premenstrual syndrome can have social and marital repercussions. In fact, in the most serious cases, poor work performance can occur up to absenteeism, alterations in sexual desire, social isolation. Exceptionally, women affected by this syndrome are responsible for psychotic behavior (suicide, etc.) or even for criminal acts. Precisely because of this possibility, the premenstrual syndrome is recognized by the legislation of some countries (England, France) as a mitigating condition.
Is it serious?
Usually the syndrome does not disappear by itself but by changing the lifestyle or using some form of therapy.
There are no data on the behavior of the syndrome at the time of passage towards menopause, but it seems that the approaching end of menstruation can positively influence it. There is no evidence to show that premenstrual syndrome begins or worsens after a pregnancy, nor that its frequency increases after tubal ligation. Little information exists about the influence of inheritance on the syndrome, although some data would seem to prove the existence of genetic factors.
Causes
Although numerous hypotheses have been advanced, the factors involved in the origin of the various disorders related to premenstrual syndrome are not known with certainty. Among the various theories proposed, they received the greatest support:
- The hormonal one, consisting of an altered estrogen-progesterone ratio due to a progesterone deficiency in the lutein phase (the second half of the cycle);
- That of an altered hydro-saline (water-salt) alteration caused by the excess or defect of various hormones that have an action on the hydro-electrolytic balance: estrogen and progesterone, antidiuretic hormone (ADH or vasopressin), prolactin, aldosterone;
- That of thyroid dysfunction, based on the finding that some women with premenstrual syndrome have clear or subclinical signs of hypothyroidism and that in these patients the administration of thyroid hormones determines an improvement of the premenstrual syndrome;
- That of vitamin B6 deficiency, based on the relationships between the levels of this vitamin and some endocrine functions;
- That of hypoglycemia, based on the similarities existing between the classical picture of premenstrual syndrome and that of the hypoglycemic condition, and on the demonstration that sex hormones are able to influence glucose metabolism;
- The deficiency of prostaglandins E1, which are substances involved in the perception of pain;
- The psychosomatic one, which is based on psychological, behavioral and social considerations, and on the finding of an association, even if not frequent, of the premenstrual syndrome with real psychiatric pathologies.
It is important, however, to keep in mind that to date it has not been possible to demonstrate differences in the circulating levels of the various hormones (including estrogens, progesterone, testosterone, FSH, LH, prolactin) during the menstrual cycle between women with premenstrual syndrome and those without; the same applies to the substances involved in the regulation of hydroelectric metabolism such as aldosterone. No differences were recorded even with respect to weight gain.
More recently, theories have been put forward that are based on the proven fact that the sex hormones produced by the ovaries modulate the response to stress. Therefore, it is thought that, in the onset of premenstrual syndrome, during the luteinic phase, there is a reduction in the concentrations of endogenous opioids, ie those "well-being" hormones that are normally produced by the body (eg endorphins, or the serotonin ), and that this causes an increase in psychological stress.
