Premenstrual syndrome

Signs of premenstrual syndrome (PMS)

Symptoms of premenstrual syndrome begin to develop 2-14 days before menses, while with the beginning of menses most of the symptoms usually resolve or significantly decrease. Symptoms of PMS are extremely manifold – over 120 symptoms are known to develop at various time periods before menses.

There are 6 clinical forms of premenstrual syndrome with characteristic symptoms:

  1. Edematous form: the main symptoms include swelling of shins, digits, face, other symptoms include acne, itching, pain and breast engorgement, slight weight gain, increased sweating, myalgias, abdominal distention and pain, fatigue;
  2. Psychovegetative form: the main symptoms are proneness to conflict, resentful temper, irritability, tearfulness, sleeplessness or drowsiness, fatigue, forgetfulness, increased fatigability, numbness sensations in the hands, depression or sudden onsets of anger, decreased libido, increased sensitivity to odors and sounds, constipations or meteorism. It should be noted that in younger females of child-bearing age premenstrual syndrome may often cause onsets of depression;
    and adolescent girls are often arises aggressive behavior;
  3. “Crisis form” may include sense of pressure in the chest, onsets of rapid heart beating, increased blood pressure and sense of impending doom. Other possible symptoms may include panic attacks. Such a form of premenstrual syndrome is more specific for pre-menopausal period (45-47 years). Most of the patients with crisis form of PMS exhibit signs of concurrent disorders in the gastrointestinal tract, kidneys or cardiovascular system.
  4. Cephalgic form: characterized by the predominance of headache over other symptoms - irritability, dizziness, fainting, nausea, vomiting. Headaches may occur spontaneously with possible swelling and facial redness;
  5. Atypical forms: atypical (non-typical) symptoms of premenstrual syndrome may involve fever up to 38°С, ulcerative lesions of the palatine and oral mucosa, periodic onsets of bronchial asthma (onsets of asthma-like suffocating feeling during the menses and before), “menstrual migraine” (developing migraine symptoms during menses).
  6. Mixed forms: includes cases of symptom combinations typical for various forms of premenstrual syndrome. It is important to note that mixed forms present in overwhelming majority of the cases.

With all this the most common mixed form is the combination of edematous and psychovegetative forms of premenstrual syndrome. One way or another, the most common complaints in overwhelming majority of the cases include the consequences of multiple swelling of tissues and organs.

Unfortunately, it is not common for women to seek medical advice due to premenstrual syndrome. It is partially explained by the widespread opinion that premenstrual syndrome  is a norm. .
In fact it is not so.  If PMS symptoms are left with no medical attention, they surely progress year after year. The severity and duration of the symptoms will increase.

Besides, multiple advertisement of analgesics and spasmolytics promote its widespread use as self-treatment. Using such medications provides only temporary relief of the premenstrual syndrome symptoms, but without proper treatment the disease may become decompensated, which is why the patient needs to visit the gynecologist as soon as possible.


So far the exact factors and causes of developing PMS are not absolutely clear.

However, most authors lean to the opinion that its occurrence and severity may be promoted by previous neuroinfections, stresses, multiple abortions, surgeries and traumas along with many other gynecological and general disorders which may serve as a background for the premenstrual syndrome.

An opinion is widespread that the reasons defining the course of PMS are changes in the hormonal background during the menstrual cycle.
On this assumption, the basic theories of the development of premenstrual syndrome are constructed



Thus, one of the most popular theories says that the essential cause of the premenstrual syndrome is the changes of the estrogen/progesterone ratio in the second half of the cycle. Estrogen excess promotes water retention in tissues and organs, swelling, breast engorgement, which, in turn, promotes pain.

The effect of estrogens with regard to the brain include neuro-emotional changes – aggression or depression, tearfulness, irritability, proneness to conflict etc.

Other theory says that PMS is associated with increased levels of prolactin hormone that induces water and sodium retention in the organism with further swelling of the breast tissues.

Besides, in the progression of PMS a significant contribution has been proven for so-called prostaglandins – substances produced by the tissues of the organism and taking part in the regulation of such pathologic processes, as inflammation, pain and swelling. Increased tissue concentrations of prostaglandins promote the development of headaches, alimentary disorders, vascular reactions followed by the development of tissue swelling.

Some investigators suggest that PMS is caused by a combination of factors individual for each clinical case.

Whatever the reasons of premenstrual syndrome developing are – most investigators share the opinion that all of the reasons promote the development of interstitial swelling and pain, which in most cases pre-determine the main complaint of PMS.


Risk factors of developing premenstrual syndrome

Using complex statistical studies, the following main risk factors of developing PMS were determined:

  • Caucasian race
  • Chronic stresses and stress induced depressions;
  • Living in big cities
  • Intellectual labour
  • Iodine deficiency
  • Unbalanced diet
  • Late labor (older than 30 y/o)
  • Absence of pregnancies or, on the contrary – frequent pregnancies
  • Previous miscarriages and abortions
  • Gestational toxicosis
  • Adverse effects of oral contraceptive pills
  • Previous gynecological surgeries
  • Chronic inflammatory diseases of the female urogenital system
  • Genital candidosis (vaginal moniliasis )
  • Brain traumas and infections
  • Endocrine diseases
  • Insufficient physical activity