Zespół napięcia przedmiesiączkowego – Rokowania, prognozy i postęp choroby

Zespół napięcia przedmiesiączkowego
Rokowania, prognozy i postęp choroby

Zespół napięcia przedmiesiączkowego (PMS) to złożone zaburzenie występujące w fazie lutealnej cyklu miesiączkowego, charakteryzujące się objawami somatycznymi, behawioralnymi i psychologicznymi, które ustępują po rozpoczęciu menstruacji. Nasilenie objawów jest zmienne, a tylko 36% kobiet z rozpoznaniem PMS spełnia kryteria rok później. Czynniki ryzyka obejmują m.in. późny wiek menarche (PR = 0,77, 95% CI: 0,63-0,96), ujemną grupę krwi Rh (PR = 4,43, 95% CI: 1,95-10,08), umiarkowaną lub ciężką depresję (PR = 2,81, 95% CI: 1,24-6,36) oraz spożycie kofeiny >3 razy w tygodniu. PMS może znacząco obniżać jakość życia, prowadząc do absencji w pracy, zaburzeń relacji i zwiększonego ryzyka samobójstwa, szczególnie w podtypie PMDD, który dotyczy 3-30% kobiet i wymaga intensywnej interwencji klinicznej.

Prognoza zespołu napięcia przedmiesiączkowego (PMS)

Naturalny przebieg PMS i przewidywanie występowania objawów
Odpowiedź na leczenie i rokowanie
Implikacje funkcjonalne i jakościowe
Rozpowszechnienie i rozpoznanie PMS
Podtypy i zróżnicowanie odpowiedzi na leczenie
Czynniki związane z leczeniem i poszukiwaniem pomocy medycznej
Znaczenie diagnostyczne i terapeutyczne
Kolejne rozdziały

Prognoza zespołu napięcia przedmiesiączkowego (PMS)

Zespół napięcia przedmiesiączkowego (PMS) to stan charakteryzujący się występowaniem niepokojących objawów fizycznych, behawioralnych i psychologicznych w fazie lutealnej cyklu miesiączkowego (około tygodnia przed menstruacją), które ustępują lub znacznie zmniejszają się z początkiem miesiączki. Prognoza dla pacjentek z zespołem napięcia przedmiesiączkowego jest zróżnicowana i zależy od wielu czynników, w tym nasilenia objawów, stosowanego leczenia oraz indywidualnych predyspozycji.¹²

Naturalny przebieg PMS i przewidywanie występowania objawów

Zespół napięcia przedmiesiączkowego to schorzenie, które może utrzymywać się przez wiele lat aż do menopauzy. Objawy PMS mają tendencję do powtarzania się w każdym cyklu owulacyjnym, choć ich nasilenie i częstotliwość mogą się zmieniać w czasie. Badania wykazują, że nasilenie i utrzymywanie się objawów zazwyczaj podlega wahaniom. Interesujące jest, że tylko 36% kobiet, które otrzymały diagnozę PMS, w dalszym ciągu spełniało kryteria diagnostyczne rok później.³⁴

Objawy PMS zwykle nawracają po zaprzestaniu leczenia, z wyjątkiem przypadków po owariektomii (usunięciu jajników) i menopauzie. Badania sugerują, że kobiety, które doświadczały PMS, wydają się mieć większe ryzyko wystąpienia objawów menopauzalnych związanych z wahaniami hormonalnymi.⁵⁶

Na wystąpienie i nasilenie objawów PMS wpływ mają różne czynniki ryzyka. Badania wykazały, że kobiety, które przybrały na wadze lub doświadczyły stresującego wydarzenia w ciągu ostatniego roku, częściej otrzymują diagnozę PMS. Dodatkowo, późniejszy wiek menarche (PR = 0,77, 95%CI: 0,63-0,96), posiadanie ujemnej grupy krwi Rh (PR = 4,43, 95%CI: 1,95-10,08), umiarkowana lub wyższa depresja (PR = 2,81, 95%CI: 1,24-6,36) oraz spożycie kofeiny więcej niż trzy razy w tygodniu są statystycznie związane z występowaniem PMS lub PMDD (premenstrual dysphoric disorder – przedmiesiączkowe zaburzenia dysforyczne).⁷⁸

Odpowiedź na leczenie i rokowanie

Większość kobiet leczonych z powodu objawów PMS uzyskuje dobrą poprawę. Celem leczenia jest złagodzenie objawów, ponieważ etiologia PMS i PMDD nie jest do końca poznana.⁹¹⁰

Leki wpływające na poziom serotoniny, takie jak selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI), są lekami pierwszego wyboru w leczeniu ciężkiego PMS lub PMDD. Badania wskazują, że leczenie SSRI prawdopodobnie zmniejsza nasilenie objawów przedmiesiączkowych u kobiet z PMS i PMDD. Co ważne, terapia SSRI jest prawdopodobnie bardziej skuteczna, gdy jest stosowana ciągle, niż gdy jest podawana tylko w fazie lutealnej cyklu.¹¹¹²

Leki SSRI mogą wymagać podawania przez trzy do czterech tygodni, aby wpłynąć na objawy depresji. Jednakże, objawy PMS wydają się poprawiać szybciej. Badania wykazały, że odpowiedź na leczenie sertraliną może się różnić w zależności od podtypów objawów. Większość kobiet odczuwa dyskomfort zarówno z powodu objawów psychologicznych, jak i fizycznych, i należy do podtypu z mieszanymi objawami, niezależnie od diagnozy PMS czy PMDD.¹³¹⁴

Chociaż zarówno diagnoza PMS, jak i PMDD miały podobną i znaczącą odpowiedź na leczenie sertraliną, podtypy oparte na objawach reagowały różnie na leczenie SSRI. Powszechne objawy PMS, takie jak tkliwość piersi i obrzęk/wzdęcia, uległy poprawie, ale większość objawów fizycznych nie reagowała na sertralinę. To sugeruje, że klinicyści powinni dokładnie ocenić indywidualne objawy każdej pacjentki, aby określić, które objawy są dominujące i czy są one ciężkie.¹⁵

Jeśli chodzi o doustne środki antykoncepcyjne, dane nie potwierdzają jednoznacznie ich skuteczności w leczeniu PMS. Przegląd Cochrane z 2012 roku dotyczący doustnych środków antykoncepcyjnych zawierających drospirenon ocenił pięć badań z udziałem 1920 kobiet. Wyniki wykazały, że tabletka łączona z drospirenonem zmniejszyła upośledzenie produktywności i funkcjonowania społecznego u kobiet z PMDD, ale nie było wystarczających dowodów na korzyści dla osób z PMS.¹⁶¹⁷

Implikacje funkcjonalne i jakościowe

Zespół napięcia przedmiesiączkowego może mieć istotny wpływ na codzienne funkcjonowanie kobiety i jakość jej życia. PMS jest klasyfikowany według nasilenia jako łagodny, umiarkowany lub ciężki. W łagodnych przypadkach codzienne aktywności kobiety są ledwie dotknięte, podczas gdy w ciężkich przypadkach jakość życia może być znacznie upośledzona.¹⁸

Badania pokazują, że choroba może być znaczna – kobiety z PMS mają wyższy wskaźnik absencji w pracy, wyższe wydatki medyczne i niższą jakość życia związaną ze zdrowiem. Objawy PMS mogą stać się na tyle poważne, że uniemożliwiają normalne funkcjonowanie.¹⁹²⁰

Nieleczony PMS prawdopodobnie wpłynie na życie seksualne, prowadząc do wyższego poziomu stresu seksualnego, co z kolei może prowadzić do problemów w związkach i większej liczby problemów psychologicznych. Istnieją również dowody łączące PMS ze zwiększonym ryzykiem samobójstwa u kobiet wrażliwych na hormony. Wskaźnik samobójstw u kobiet z depresją jest znacznie wyższy w drugiej połowie cyklu miesiączkowego, co podkreśla znaczenie diagnozy i leczenia zaburzeń nastroju.²¹²²

Rozpowszechnienie i rozpoznanie PMS

Zaburzenia przedmiesiączkowe dotykają do 12% kobiet. We francuskm badaniu z udziałem 2800 kobiet, około 12% spełniało kryteria diagnostyczne PMS, a 4% zgłaszało ciężkie objawy. W innym badaniu, według skali oceny przedmiesiączkowej Carolina, 11,6% badanej próby (95% CI: 8,2-15,7%) spełniało kryteria diagnostyczne PMS lub PMDD.²³²⁴

Dokładne rozpoznanie jest kluczowe dla właściwego leczenia. Historia kliniczna ma kluczowe znaczenie dla diagnozy PMS lub PMDD. Amerykańskie Kolegium Położników i Ginekologów sugeruje diagnozowanie PMS na podstawie prospektywnych dzienników objawów; wiele kobiet będzie miało objawy fazy nielutealnej zgodne z innymi zaburzeniami medycznymi lub psychologicznymi.²⁵

Prospektywne kwestionariusze są najdokładniejszym sposobem diagnozowania PMS i PMDD, ponieważ stwierdzono, że pacjentki znacznie przeceniają cykliczny charakter objawów, podczas gdy w rzeczywistości są one nieregularne lub po prostu nasilone podczas cyklu lutealnego. Ustalenie czasu występowania objawów jest niezbędne podczas oceny PMS i PMDD. Objawy muszą wystąpić w fazie lutealnej i ustąpić wkrótce po rozpoczęciu menstruacji.²⁶²⁷

Monitorowanie cyklu jest skuteczną metodą rejestrowania i wykrywania objawów PMS. Poprzez ciągłe rejestrowanie miesięcznych objawów i ich nasilenia, można identyfikować wzorce i przewidywać wystąpienie objawów. Dla umiarkowanych do ciężkich objawów, należy skonsultować się z lekarzem w celu zbadania innych możliwych przyczyn i omówienia możliwych alternatywnych terapii.²⁸

Podtypy i zróżnicowanie odpowiedzi na leczenie

Identyfikacja dominujących objawów pacjentki i ich nasilenia jest ważna dla zindywidualizowanego leczenia i możliwej odpowiedzi na selektywne inhibitory wychwytu zwrotnego serotoniny. Nasilenie objawów było ważnym czynnikiem w obserwowanej poprawie.²⁹

Potrzebne są dalsze badania podtypów PMS i ich odpowiedzi na inne leki, jak również porównania SSRI z doustnymi środkami antykoncepcyjnymi lub innymi terapiami hormonalnymi w leczeniu zaburzeń przedmiesiączkowych. Długoterminowi użytkownicy często potrzebują hormonalnej terapii dodatkowej, aby przeciwdziałać wielu hipoestrogenowym efektom, które mogą powodować nawrót objawów PMS.³⁰³¹

Spironolakton znacząco poprawił objawy tkliwości piersi, wzdęć, przyrostu masy ciała i obniżonego nastroju w porównaniu z placebo, i lekarze mogą rozważyć jego stosowanie jako opcję farmakologiczną w leczeniu objawów PMS.³²

W kontekście subtypu najcięższego PMS – przedmiesiączkowych zaburzeń dysforycznych (PMDD) – dotyczy on około 3% do 30% kobiet. Jest to poważny stan, który wymaga intensywnej interwencji klinicznej, a kobiety mogą doświadczyć ekstremalnych wahań nastroju, ostrego rozdrażnienia, a nawet myśli samobójczych.³³

Czynniki związane z leczeniem i poszukiwaniem pomocy medycznej

Mimo rozpowszechnienia i wpływu PMS na życie kobiet, nie wszystkie poszukują pomocy medycznej. W jednym z badań tylko 83 (48,0%) uczestniczek szukało leczenia z powodu PMS. Analiza regresji logistycznej wykazała, że przeciętna długość jednego cyklu miesiączkowego (COR=0,20(0,070-0,569)) i upośledzenie wyników akademickich (AOR=0,345(0,183-0,653)) były istotnie związane odpowiednio z diagnozą PMS i korzystaniem z leczenia PMS.³⁴

Średnia liczba dni na każdą miesiączkę wpływa na rozwój PMS, a upośledzenie wyników akademickich wpływa na stosowanie protokołów leczenia PMS. Znaczące jest odkrycie, że zaburzenia preedmiesiączkowe wykazują negatywny wpływ na relacje, obecność w pracy, produktywność oraz koszty i wykorzystanie opieki zdrowotnej.³⁵³⁶

W odniesieniu do diagnozy i narzędzi, w badaniu stwierdzono, że na podstawie C-PASS jako złotego standardu, PSST (Premenstrual Symptoms Screening Tool) wykazał dobrą ważność w roli testu przesiewowego z wysoką czułością (80,0%; 95% CI 63,1-91,6%), swoistością (76,8%; 95% CI 71,2-81,7%), niezwykle wysoką negatywną wartością predykcyjną-NPV (97,2%; 95% CI 93,3-98,7%), ale niską pozytywną wartością predykcyjną-PPV (31,1%, 95% CI 21,8-41,7%).³⁷

Znaczenie diagnostyczne i terapeutyczne

Poprawne rozpoznanie i odpowiednie leczenie mają kluczowe znaczenie dla prognozy PMS. Zespół napięcia przedmiesiączkowego można zdiagnozować, jeśli pacjentka zgłasza co najmniej jeden z afektywnych i somatycznych objawów w ciągu pięciu dni przed miesiączką w każdym z trzech poprzednich cykli miesiączkowych.³⁸

Diagnozowanie PMS może być trudne, ponieważ nie ma konkretnych testów. Opiera się głównie na objawach i ich regularnym miesięcznym nawracaniu. Efektywną metodą rejestrowania i wykrywania objawów PMS jest monitorowanie cyklu. Poprzez ciągłe rejestrowanie miesięcznych objawów i ich nasilenia, wzorce mogą być identyfikowane, a wystąpienie objawów przewidywane.³⁹

W przypadku umiarkowanych do ciężkich objawów, zaleca się konsultację z lekarzem w celu zbadania innych możliwych przyczyn i omówienia możliwych alternatywnych terapii. Lekarze powinni dokładnie ocenić indywidualne objawy każdej pacjentki, aby ustalić, które objawy są dominujące i czy są one ciężkie.⁴⁰⁴¹

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Materiały źródłowe

#1 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Premenstrual syndrome (PMS) is defined as a condition that manifests in distressing physical, behavioral, and psychological symptoms, despite the absence of organic or underlying psychiatric disease. It occurs regularly during the luteal phase of each menstrual cycle and either disappears or diminishes significantly by the end of menstruation. […] PMS is classified by severity: mild, moderate, or severe. In mild cases, a woman’s daily activities are barely affected, while in severe cases, quality of life can be significantly impaired. The most intense form of PMS, premenstrual dysphoric disorder, affects about 3% to 30% of women. It is a serious condition that requires intensive clinical intervention, and women may experience extreme mood swings, severe irritability, and even suicidal thoughts.
#2 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. […] Symptom relief is the goal for treatment of premenstrual syndrome and premenstrual dysphoric disorder. […] Premenstrual syndrome (PMS) is clinically diagnosed if certain symptoms that impair some facet of a woman’s life occur only during the luteal phase of the menstrual cycle (one week before menstruation), and if other diagnoses that may better explain the symptoms are excluded. […] PMS and PMDD symptoms may recur with each ovulatory cycle until menopause, although the severity and frequency of different symptoms may vary over time. […] PMS and PMDD have been shown to negatively affect relationships, work attendance, productivity, and health care costs and utilization.
#3 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. […] Symptom relief is the goal for treatment of premenstrual syndrome and premenstrual dysphoric disorder. […] Premenstrual syndrome (PMS) is clinically diagnosed if certain symptoms that impair some facet of a woman’s life occur only during the luteal phase of the menstrual cycle (one week before menstruation), and if other diagnoses that may better explain the symptoms are excluded. […] PMS and PMDD symptoms may recur with each ovulatory cycle until menopause, although the severity and frequency of different symptoms may vary over time. […] PMS and PMDD have been shown to negatively affect relationships, work attendance, productivity, and health care costs and utilization.
#4 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Symptom persistence and severity tend to fluctuate. One study found that only 36% of women who were diagnosed with PMS continued to meet the diagnostic criteria one year later. […] Women who gained weight or had a stressful event in the past year are more likely to be diagnosed with PMS. […] Establishing the timing of symptoms is essential when evaluating for PMS and PMDD. Symptoms must occur during the luteal phase and resolve shortly after the onset of menstruation. […] A 2012 Cochrane review of oral contraceptives containing drospirenone evaluated five trials with 1,920 women. […] High drop-out rates were noted in all but one trial. Results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, but there was insufficient evidence of benefit for those with PMS. […] Long-term users often need hormone add-back therapy to counteract many of their hypoestrogenic effects, which may cause a return of PMS symptoms.
#5 Premenstrual Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560698/
Symptoms of PMS can mostly recur after stopping the treatment, except after oophorectomy and menopause.[22] […] Untreated PMS are likely to affect sexual life, thereby leading to a higher level of sexual distress, which can, in turn, lead to relationship problems and more psychological issues.[23] There is also evidence that relates the PMS to increased suicidal risk in hormone-sensitive females.[24]
#6 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
The etiologies of PMS and PMDD are not definitive, but several theories are postulated. […] Women who experienced PMS appear to have greater risk of menopausal symptoms associated with hormonal fluctuations. […] Clinical history is key to the diagnosis of PMS or PMDD. […] The American College of Obstetricians and Gynecologists suggests diagnosing PMS based on prospective symptom diaries; many women will have nonluteal-phase symptoms consistent with other medical or psychological disorders. […] Because the etiology of PMS and PMDD is not clear, symptom relief is the goal of treatment. […] Medications affecting serotonin are first-line pharmacologic treatments for severe PMS or PMDD. […] SSRIs and SNRIs may need to be administered for three to four weeks to affect symptoms of depression; PMS symptoms, however, appear to improve more rapidly.
#7 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Symptom persistence and severity tend to fluctuate. One study found that only 36% of women who were diagnosed with PMS continued to meet the diagnostic criteria one year later. […] Women who gained weight or had a stressful event in the past year are more likely to be diagnosed with PMS. […] Establishing the timing of symptoms is essential when evaluating for PMS and PMDD. Symptoms must occur during the luteal phase and resolve shortly after the onset of menstruation. […] A 2012 Cochrane review of oral contraceptives containing drospirenone evaluated five trials with 1,920 women. […] High drop-out rates were noted in all but one trial. Results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, but there was insufficient evidence of benefit for those with PMS. […] Long-term users often need hormone add-back therapy to counteract many of their hypoestrogenic effects, which may cause a return of PMS symptoms.
#8 Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0278702
We found that age at menarche (PR = 0.77, 95%CI: 0.630.96), having a negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having PMS/PMDD after adjusting for other variables.
#9 Premenstrual syndrome: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/001505.htm
Most women who are treated for PMS symptoms get good relief. […] PMS symptoms may become severe enough to prevent you from functioning normally. […] The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.
#10 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
The etiologies of PMS and PMDD are not definitive, but several theories are postulated. […] Women who experienced PMS appear to have greater risk of menopausal symptoms associated with hormonal fluctuations. […] Clinical history is key to the diagnosis of PMS or PMDD. […] The American College of Obstetricians and Gynecologists suggests diagnosing PMS based on prospective symptom diaries; many women will have nonluteal-phase symptoms consistent with other medical or psychological disorders. […] Because the etiology of PMS and PMDD is not clear, symptom relief is the goal of treatment. […] Medications affecting serotonin are first-line pharmacologic treatments for severe PMS or PMDD. […] SSRIs and SNRIs may need to be administered for three to four weeks to affect symptoms of depression; PMS symptoms, however, appear to improve more rapidly.
#11 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
The etiologies of PMS and PMDD are not definitive, but several theories are postulated. […] Women who experienced PMS appear to have greater risk of menopausal symptoms associated with hormonal fluctuations. […] Clinical history is key to the diagnosis of PMS or PMDD. […] The American College of Obstetricians and Gynecologists suggests diagnosing PMS based on prospective symptom diaries; many women will have nonluteal-phase symptoms consistent with other medical or psychological disorders. […] Because the etiology of PMS and PMDD is not clear, symptom relief is the goal of treatment. […] Medications affecting serotonin are first-line pharmacologic treatments for severe PMS or PMDD. […] SSRIs and SNRIs may need to be administered for three to four weeks to affect symptoms of depression; PMS symptoms, however, appear to improve more rapidly.
#12 What are the benefits and risks of treating premenstrual syndrome and premenstrual dysphoric disorder with selective serotonin reuptake inhibitors? | Cochrane
https://www.cochrane.org/CD001396/MENSTR_what-are-benefits-and-risks-treating-premenstrual-syndrome-and-premenstrual-dysphoric-disorder
Selective serotonin reuptake inhibitors treatment probably reduces a woman’s rating of premenstrual symptoms and may be more effective when administered continuously than when administered only in the luteal phase. […] SSRIs probably reduce premenstrual symptoms in women with PMS and PMDD and are probably more effective when taken continuously compared to luteal phase administration. […] SSRIs probably reduce overall self-rated premenstrual symptoms in women with PMS and PMDD. […] SSRI treatment was probably more effective when administered continuously than when administered only in the luteal phase.
#13 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
The etiologies of PMS and PMDD are not definitive, but several theories are postulated. […] Women who experienced PMS appear to have greater risk of menopausal symptoms associated with hormonal fluctuations. […] Clinical history is key to the diagnosis of PMS or PMDD. […] The American College of Obstetricians and Gynecologists suggests diagnosing PMS based on prospective symptom diaries; many women will have nonluteal-phase symptoms consistent with other medical or psychological disorders. […] Because the etiology of PMS and PMDD is not clear, symptom relief is the goal of treatment. […] Medications affecting serotonin are first-line pharmacologic treatments for severe PMS or PMDD. […] SSRIs and SNRIs may need to be administered for three to four weeks to affect symptoms of depression; PMS symptoms, however, appear to improve more rapidly.
#14 Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC3222869/
To estimate response of diagnosis and symptom-based subtypes to sertraline treatment. […] The PMS and premenstrual dysphoric disorder diagnoses improved similarly with sertraline relative to placebo, while symptom-based subtypes had differential responses to treatment. […] The PMS and premenstrual dysphoric disorder diagnoses have similar response to sertraline treatment, but symptom-based subtypes have significantly different responses to this treatment. […] Identifying the patients predominant symptoms, and their severity is important for individualized treatment and possible response to a selective serotonin reuptake inhibitor. […] Symptom severity was an important factor in observed improvement. […] The findings indicate that the majority of women were distressed by both psychological and physical symptoms and were in the mixed symptom subtype, regardless of a PMS or PMDD diagnosis.
#15 Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC3222869/
While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. […] The prevalent PMS symptoms of breast tenderness and swelling/bloating improved, but most physical symptoms did not respond to sertraline. […] This suggests that clinicians carefully evaluate the individual symptoms of each patient to determine which symptoms are predominant and whether they are severe. […] Further studies of PMS subtypes and their responses to other medications are needed, as are comparisons of SSRIs with oral contraceptives or other hormone treatments for premenstrual disorders.
#16 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin, histrelin, leuprolide, and nafarelin have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Spironolactone significantly improved symptoms of breast tenderness, bloating, weight gain, and depressed mood compared with placebo, and physicians may consider it a pharmacologic option for treating PMS symptoms.
#17 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Symptom persistence and severity tend to fluctuate. One study found that only 36% of women who were diagnosed with PMS continued to meet the diagnostic criteria one year later. […] Women who gained weight or had a stressful event in the past year are more likely to be diagnosed with PMS. […] Establishing the timing of symptoms is essential when evaluating for PMS and PMDD. Symptoms must occur during the luteal phase and resolve shortly after the onset of menstruation. […] A 2012 Cochrane review of oral contraceptives containing drospirenone evaluated five trials with 1,920 women. […] High drop-out rates were noted in all but one trial. Results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, but there was insufficient evidence of benefit for those with PMS. […] Long-term users often need hormone add-back therapy to counteract many of their hypoestrogenic effects, which may cause a return of PMS symptoms.
#18 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Premenstrual syndrome (PMS) is defined as a condition that manifests in distressing physical, behavioral, and psychological symptoms, despite the absence of organic or underlying psychiatric disease. It occurs regularly during the luteal phase of each menstrual cycle and either disappears or diminishes significantly by the end of menstruation. […] PMS is classified by severity: mild, moderate, or severe. In mild cases, a woman’s daily activities are barely affected, while in severe cases, quality of life can be significantly impaired. The most intense form of PMS, premenstrual dysphoric disorder, affects about 3% to 30% of women. It is a serious condition that requires intensive clinical intervention, and women may experience extreme mood swings, severe irritability, and even suicidal thoughts.
#19 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Premenstrual disorders affect up to 12% of women. […] The burden of disease can be high; women with PMS have higher rates of work absences, higher medical expenses, and lower health-related quality of life. […] Prospective questionnaires are the most accurate way to diagnose premenstrual syndrome and premenstrual dysphoric disorder because patients have been found to greatly overestimate the cyclical nature of symptoms, when realistically, they are erratic or simply exacerbated during the luteal cycle. […] Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous menstrual cycles. […] In a study of 2,800 French women, about 12% met the diagnostic criteria for PMS, and 4% reported severe symptoms.
#20 Premenstrual syndrome: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/001505.htm
Most women who are treated for PMS symptoms get good relief. […] PMS symptoms may become severe enough to prevent you from functioning normally. […] The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.
#21 Premenstrual Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK560698/
Symptoms of PMS can mostly recur after stopping the treatment, except after oophorectomy and menopause.[22] […] Untreated PMS are likely to affect sexual life, thereby leading to a higher level of sexual distress, which can, in turn, lead to relationship problems and more psychological issues.[23] There is also evidence that relates the PMS to increased suicidal risk in hormone-sensitive females.[24]
#22 Premenstrual syndrome: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/001505.htm
Most women who are treated for PMS symptoms get good relief. […] PMS symptoms may become severe enough to prevent you from functioning normally. […] The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.
#23 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Premenstrual disorders affect up to 12% of women. […] The burden of disease can be high; women with PMS have higher rates of work absences, higher medical expenses, and lower health-related quality of life. […] Prospective questionnaires are the most accurate way to diagnose premenstrual syndrome and premenstrual dysphoric disorder because patients have been found to greatly overestimate the cyclical nature of symptoms, when realistically, they are erratic or simply exacerbated during the luteal cycle. […] Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous menstrual cycles. […] In a study of 2,800 French women, about 12% met the diagnostic criteria for PMS, and 4% reported severe symptoms.
#24 Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0278702
According to the Carolina Premenstrual Assessment Scoring System, 35 out of 302 students (11.6%; 95%CI: 8.215.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). […] The prominent risk factors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression. […] We found that age at menarche (PR = 0.77, 95%CI: 0.630.96), having a negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having Premenstrual Syndrome or Premenstrual Dysphoric Disorder after adjusting for other variables. […] According to the C-PASS, 11.6% of the study sample (95%CI: 8.215.7%) met the diagnosis of PMS or PMDD. Based on C-PASS as the gold standard, the PSST demonstrated good validity in the role of the screening test with high sensitivity (80.0%; 95% CI 63.191.6%), specificity (76.8%; 95% CI 71.281.7%), extremely high negative predictive valueNPV (97.2%; 95% CI 93.398.7%), but low positive predictive valuePPV (31.1%, 95% CI 21.841.7%).
#25 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
The etiologies of PMS and PMDD are not definitive, but several theories are postulated. […] Women who experienced PMS appear to have greater risk of menopausal symptoms associated with hormonal fluctuations. […] Clinical history is key to the diagnosis of PMS or PMDD. […] The American College of Obstetricians and Gynecologists suggests diagnosing PMS based on prospective symptom diaries; many women will have nonluteal-phase symptoms consistent with other medical or psychological disorders. […] Because the etiology of PMS and PMDD is not clear, symptom relief is the goal of treatment. […] Medications affecting serotonin are first-line pharmacologic treatments for severe PMS or PMDD. […] SSRIs and SNRIs may need to be administered for three to four weeks to affect symptoms of depression; PMS symptoms, however, appear to improve more rapidly.
#26 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Premenstrual disorders affect up to 12% of women. […] The burden of disease can be high; women with PMS have higher rates of work absences, higher medical expenses, and lower health-related quality of life. […] Prospective questionnaires are the most accurate way to diagnose premenstrual syndrome and premenstrual dysphoric disorder because patients have been found to greatly overestimate the cyclical nature of symptoms, when realistically, they are erratic or simply exacerbated during the luteal cycle. […] Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous menstrual cycles. […] In a study of 2,800 French women, about 12% met the diagnostic criteria for PMS, and 4% reported severe symptoms.
#27 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Symptom persistence and severity tend to fluctuate. One study found that only 36% of women who were diagnosed with PMS continued to meet the diagnostic criteria one year later. […] Women who gained weight or had a stressful event in the past year are more likely to be diagnosed with PMS. […] Establishing the timing of symptoms is essential when evaluating for PMS and PMDD. Symptoms must occur during the luteal phase and resolve shortly after the onset of menstruation. […] A 2012 Cochrane review of oral contraceptives containing drospirenone evaluated five trials with 1,920 women. […] High drop-out rates were noted in all but one trial. Results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, but there was insufficient evidence of benefit for those with PMS. […] Long-term users often need hormone add-back therapy to counteract many of their hypoestrogenic effects, which may cause a return of PMS symptoms.
#28 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Diagnosing PMS can be challenging because there are no specific tests. It relies mainly on symptoms and their regular monthly recurrence. An efficient method for recording and detecting PMS symptoms is cycle monitoring. By continuously recording monthly symptoms and their severity, patterns can be identified and the onset of symptoms can be predicted. […] For moderate to severe symptoms, you should consult a doctor to explore other possible causes and discuss possible alternative therapies.
#29 Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC3222869/
To estimate response of diagnosis and symptom-based subtypes to sertraline treatment. […] The PMS and premenstrual dysphoric disorder diagnoses improved similarly with sertraline relative to placebo, while symptom-based subtypes had differential responses to treatment. […] The PMS and premenstrual dysphoric disorder diagnoses have similar response to sertraline treatment, but symptom-based subtypes have significantly different responses to this treatment. […] Identifying the patients predominant symptoms, and their severity is important for individualized treatment and possible response to a selective serotonin reuptake inhibitor. […] Symptom severity was an important factor in observed improvement. […] The findings indicate that the majority of women were distressed by both psychological and physical symptoms and were in the mixed symptom subtype, regardless of a PMS or PMDD diagnosis.
#30 Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC3222869/
While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. […] The prevalent PMS symptoms of breast tenderness and swelling/bloating improved, but most physical symptoms did not respond to sertraline. […] This suggests that clinicians carefully evaluate the individual symptoms of each patient to determine which symptoms are predominant and whether they are severe. […] Further studies of PMS subtypes and their responses to other medications are needed, as are comparisons of SSRIs with oral contraceptives or other hormone treatments for premenstrual disorders.
#31 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Symptom persistence and severity tend to fluctuate. One study found that only 36% of women who were diagnosed with PMS continued to meet the diagnostic criteria one year later. […] Women who gained weight or had a stressful event in the past year are more likely to be diagnosed with PMS. […] Establishing the timing of symptoms is essential when evaluating for PMS and PMDD. Symptoms must occur during the luteal phase and resolve shortly after the onset of menstruation. […] A 2012 Cochrane review of oral contraceptives containing drospirenone evaluated five trials with 1,920 women. […] High drop-out rates were noted in all but one trial. Results showed that the drospirenone combination pill reduced impairments in productivity and social functioning in women with PMDD, but there was insufficient evidence of benefit for those with PMS. […] Long-term users often need hormone add-back therapy to counteract many of their hypoestrogenic effects, which may cause a return of PMS symptoms.
#32 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin, histrelin, leuprolide, and nafarelin have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Spironolactone significantly improved symptoms of breast tenderness, bloating, weight gain, and depressed mood compared with placebo, and physicians may consider it a pharmacologic option for treating PMS symptoms.
#33 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Premenstrual syndrome (PMS) is defined as a condition that manifests in distressing physical, behavioral, and psychological symptoms, despite the absence of organic or underlying psychiatric disease. It occurs regularly during the luteal phase of each menstrual cycle and either disappears or diminishes significantly by the end of menstruation. […] PMS is classified by severity: mild, moderate, or severe. In mild cases, a woman’s daily activities are barely affected, while in severe cases, quality of life can be significantly impaired. The most intense form of PMS, premenstrual dysphoric disorder, affects about 3% to 30% of women. It is a serious condition that requires intensive clinical intervention, and women may experience extreme mood swings, severe irritability, and even suicidal thoughts.
#34 Prevalence, impacts and medical managements of premenstrual syndrome among female students: cross-sectional study in college of health sciences, Mekelle University, Mekelle, Northern Ethiopia | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-52
Premenstrual syndrome (PMS) is used to describe physical, cognitive, affective, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation. […] The prevalence of PMS according to DSM-IV was 37.0%. […] Our study revealed a high prevalence and negative impact of PMS on students of Mekelle University. […] Only 83(48.0%) participants sought medical treatment for their PMS. […] Binary logistic regression analysis revealed average length of one cycle of menstruation (COR=0.20(0.070-0.569) and academic performance impairment (AOR=0.345(0.183-0.653) were significantly associated with the diagnosis of PMS and use of PMS treatments respectively. […] The prevalence of PMS in general is high among health sciences students of Mekelle University with prevalence of 37.0%. […] Average number of days per each menses is found to affect the development of PMS and academic performance impairment is found to affect the use of treatment protocols for PMS.
#35 Prevalence, impacts and medical managements of premenstrual syndrome among female students: cross-sectional study in college of health sciences, Mekelle University, Mekelle, Northern Ethiopia | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-52
Premenstrual syndrome (PMS) is used to describe physical, cognitive, affective, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation. […] The prevalence of PMS according to DSM-IV was 37.0%. […] Our study revealed a high prevalence and negative impact of PMS on students of Mekelle University. […] Only 83(48.0%) participants sought medical treatment for their PMS. […] Binary logistic regression analysis revealed average length of one cycle of menstruation (COR=0.20(0.070-0.569) and academic performance impairment (AOR=0.345(0.183-0.653) were significantly associated with the diagnosis of PMS and use of PMS treatments respectively. […] The prevalence of PMS in general is high among health sciences students of Mekelle University with prevalence of 37.0%. […] Average number of days per each menses is found to affect the development of PMS and academic performance impairment is found to affect the use of treatment protocols for PMS.
#36 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2011/1015/p918.html
Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. […] Symptom relief is the goal for treatment of premenstrual syndrome and premenstrual dysphoric disorder. […] Premenstrual syndrome (PMS) is clinically diagnosed if certain symptoms that impair some facet of a woman’s life occur only during the luteal phase of the menstrual cycle (one week before menstruation), and if other diagnoses that may better explain the symptoms are excluded. […] PMS and PMDD symptoms may recur with each ovulatory cycle until menopause, although the severity and frequency of different symptoms may vary over time. […] PMS and PMDD have been shown to negatively affect relationships, work attendance, productivity, and health care costs and utilization.
#37 Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0278702
According to the Carolina Premenstrual Assessment Scoring System, 35 out of 302 students (11.6%; 95%CI: 8.215.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). […] The prominent risk factors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression. […] We found that age at menarche (PR = 0.77, 95%CI: 0.630.96), having a negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having Premenstrual Syndrome or Premenstrual Dysphoric Disorder after adjusting for other variables. […] According to the C-PASS, 11.6% of the study sample (95%CI: 8.215.7%) met the diagnosis of PMS or PMDD. Based on C-PASS as the gold standard, the PSST demonstrated good validity in the role of the screening test with high sensitivity (80.0%; 95% CI 63.191.6%), specificity (76.8%; 95% CI 71.281.7%), extremely high negative predictive valueNPV (97.2%; 95% CI 93.398.7%), but low positive predictive valuePPV (31.1%, 95% CI 21.841.7%).
#38 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Premenstrual disorders affect up to 12% of women. […] The burden of disease can be high; women with PMS have higher rates of work absences, higher medical expenses, and lower health-related quality of life. […] Prospective questionnaires are the most accurate way to diagnose premenstrual syndrome and premenstrual dysphoric disorder because patients have been found to greatly overestimate the cyclical nature of symptoms, when realistically, they are erratic or simply exacerbated during the luteal cycle. […] Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous menstrual cycles. […] In a study of 2,800 French women, about 12% met the diagnostic criteria for PMS, and 4% reported severe symptoms.
#39 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Diagnosing PMS can be challenging because there are no specific tests. It relies mainly on symptoms and their regular monthly recurrence. An efficient method for recording and detecting PMS symptoms is cycle monitoring. By continuously recording monthly symptoms and their severity, patterns can be identified and the onset of symptoms can be predicted. […] For moderate to severe symptoms, you should consult a doctor to explore other possible causes and discuss possible alternative therapies.
#40 Premenstrual syndrome – PMS
https://daysy.me/learn-more/learn-your-cycle/premenstrual-syndrome/
Diagnosing PMS can be challenging because there are no specific tests. It relies mainly on symptoms and their regular monthly recurrence. An efficient method for recording and detecting PMS symptoms is cycle monitoring. By continuously recording monthly symptoms and their severity, patterns can be identified and the onset of symptoms can be predicted. […] For moderate to severe symptoms, you should consult a doctor to explore other possible causes and discuss possible alternative therapies.
#41 Clinical Subtypes of Premenstrual Syndrome and Responses to Sertraline Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC3222869/
While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. […] The prevalent PMS symptoms of breast tenderness and swelling/bloating improved, but most physical symptoms did not respond to sertraline. […] This suggests that clinicians carefully evaluate the individual symptoms of each patient to determine which symptoms are predominant and whether they are severe. […] Further studies of PMS subtypes and their responses to other medications are needed, as are comparisons of SSRIs with oral contraceptives or other hormone treatments for premenstrual disorders.