Zespół napięcia przedmiesiączkowego
Rokowania, prognozy i postęp choroby

Zespół napięcia przedmiesiączkowego (PMS) dotyka 20-32% kobiet w wieku rozrodczym, a jego cięższa forma, przedmiesiączkowe zaburzenie dysforyczne (PMDD), występuje u 3-8% kobiet premenopauzalnych. Rokowanie zależy od nasilenia objawów, leczenia i indywidualnych predyspozycji, przy czym PMS ma stabilny przebieg kliniczny z nawrotami po zaprzestaniu terapii, chyba że dojdzie do owariektomii lub menopauzy. Czynniki ryzyka obejmują m.in. 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. Etiologia wiąże się z nadwrażliwością na cykliczne zmiany estrogenów i progesteronu. Nieleczony PMS znacząco obniża jakość życia, wpływa na relacje interpersonalne, produktywność i zwiększa ryzyko dystresu seksualnego oraz samobójstw, szczególnie u kobiet z zaburzeniami nastroju.

  1. Zespół napięcia przedmiesiączkowego (PMS) – Rokowanie
    1. Naturalny przebieg zespołu napięcia przedmiesiączkowego
    2. Czynniki ryzyka wpływające na rokowanie
    3. Wpływ PMS na jakość życia i funkcjonowanie
    4. Ryzyko samobójcze
    5. Skuteczność leczenia i jej wpływ na rokowanie
    6. Podtypy PMS i ich rokowanie
    7. Zalecenia dotyczące dalszych badań
    8. Postępowanie w przypadkach opornych na leczenie
    9. Znaczenie właściwej diagnozy dla rokowania
    10. Kolejne rozdziały

Zespół napięcia przedmiesiączkowego (PMS) – Rokowanie

Zespół napięcia przedmiesiączkowego (PMS) stanowi istotny problem zdrowotny, który dotyka od 20 do 32% kobiet w wieku rozrodczym, podczas gdy jego cięższa postać – przedmiesiączkowe zaburzenie dysforyczne (PMDD) – występuje u 3-8% kobiet premenopauzalnych. Rokowanie w zespole napięcia przedmiesiączkowego jest zależne od wielu czynników, w tym nasilenia objawów, zastosowanego leczenia oraz indywidualnych predyspozycji pacjentki.12

Naturalny przebieg zespołu napięcia przedmiesiączkowego

PMS charakteryzuje się stabilnym przebiegiem klinicznym. Podatne na ten zespół kobiety zazwyczaj doświadczają tych samych objawów o podobnym nasileniu pod koniec każdego cyklu menstruacyjnego przez wiele lat. Objawy PMS mają tendencję do nawracania po zaprzestaniu leczenia, z wyjątkiem sytuacji gdy dochodzi do owariektomii lub menopauzy.12

U kobiet w okresie okołomenopauzalnym objawy PMS zazwyczaj ulegają zmniejszeniu nawet bez wprowadzenia leczenia. Jednakże pacjentki, które doświadczały PMS lub PMDD, są bardziej narażone na wyraźne objawy związane z menopauzą, takie jak uderzenia gorąca.3

Czynniki ryzyka wpływające na rokowanie

Badania wskazują na kilka kluczowych czynników ryzyka, które mogą wpływać na przebieg i rokowanie w zespole napięcia przedmiesiączkowego. Do głównych zalicza się:

  • Wiek menarche (pierwszej miesiączki) – współczynnik częstości (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
  • Spożywanie kofeiny więcej niż trzy razy w tygodniu

4

Etiologia PMS i PMDD nie jest jednoznacznie określona, ale postuluje się, że kobiety z tymi zaburzeniami wykazują zwiększoną wrażliwość fizjologiczną na normalnie cykliczne poziomy estrogenu i progesteronu, co prowadzi do nasilenia objawów.5

Wpływ PMS na jakość życia i funkcjonowanie

Nieleczony PMS może znacząco wpływać na różne aspekty życia kobiety. Obciążenie związane z chorobą może być znaczne – kobiety z PMS mają wyższe wskaźniki nieobecności w pracy, wyższe wydatki medyczne oraz niższą jakość życia związaną ze zdrowiem.67

PMS i PMDD negatywnie wpływają na:

  • Relacje interpersonalne
  • Obecność w pracy
  • Produktywność
  • Koszty opieki zdrowotnej i jej wykorzystanie

8

Objawy PMS mogą stać się na tyle nasilone, że uniemożliwiają normalne funkcjonowanie. Szczególnie niepokojący jest wpływ na życie seksualne – nieleczony PMS może prowadzić do wyższego poziomu dystresu seksualnego, co z kolei może powodować problemy w związkach i nasilać problemy psychologiczne.910

Ryzyko samobójcze

Istnieje udokumentowany związek między PMS a zwiększonym ryzykiem samobójczym u kobiet wrażliwych na zmiany hormonalne. Wskaźnik samobójstw u kobiet z depresją jest znacznie wyższy w drugiej połowie cyklu menstruacyjnego. Z tego powodu zaburzenia nastroju u kobiet z PMS wymagają właściwego rozpoznania i leczenia.1112

Skuteczność leczenia i jej wpływ na rokowanie

Większość kobiet leczonych z powodu objawów PMS uzyskuje dobrą poprawę. Leczenie ukierunkowane na konkretne objawy jest zazwyczaj skuteczne. Brak sukcesu w leczeniu farmakologicznym ciężkich objawów często wskazuje na błędną diagnozę.1314

Leczenie PMS i PMDD koncentruje się na łagodzeniu objawów fizycznych i psychicznych. Wiele stosowanych leków oddziałuje na aktywność hormonalną organizmu poprzez hamowanie owulacji, podczas gdy inne wpływają na stężenie neuroprzekaźników, takich jak serotonina, norepinefryna czy dopamina w mózgu.15

Skuteczność poszczególnych metod leczenia

Selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI) są leczeniem pierwszego rzutu w przypadku ciężkich objawów PMS i PMDD. Badania wskazują, że SSRI prawdopodobnie zmniejszają ogólne objawy przedmiesiączkowe oceniane przez same pacjentki z PMS i PMDD. Leczenie SSRI jest prawdopodobnie bardziej skuteczne, gdy jest podawane w sposób ciągły niż tylko w fazie lutealnej cyklu.161718

SSRI i inhibitory wychwytu zwrotnego serotoniny i noradrenaliny (SNRI) mogą wymagać podawania przez 3-4 tygodnie, aby wpłynąć na objawy depresji, jednak objawy PMS wydają się poprawiać szybciej.19

Doustne środki antykoncepcyjne zapewniają korzyści w leczeniu zarówno fizycznych, jak i psychicznych objawów PMS lub PMDD. Jednak niewiele danych potwierdza skuteczność doustnych środków antykoncepcyjnych w leczeniu PMS.2021

Agoniści GnRH takie jak goserelin (Zoladex), histrelin (Vantas), leuprorelina (Lupron) i nafarelina (Synarel), ze względu na hamowanie funkcji jajników, były stosowane poza wskazaniami w celu zmniejszenia ciężkich objawów fizycznych PMS i PMDD.22

Terapia poznawczo-behawioralna może poprawić objawy PMS i PMDD.23

Podtypy PMS i ich rokowanie

Badania wskazują, że różne podtypy PMS mogą mieć odmienne rokowanie i odpowiedź na leczenie. Rozpoznania PMS i PMDD wykazują podobną odpowiedź na leczenie sertraliną (SSRI), podczas gdy podtypy oparte na objawach mają znacząco różne odpowiedzi na to leczenie:

  • Podtyp mieszany (objawy psychologiczne i fizyczne) – znacząca poprawa po leczeniu SSRI
  • Podtyp psychologiczny – znacząca poprawa po leczeniu SSRI
  • Podtyp fizyczny – brak znaczącej poprawy w porównaniu z placebo

24

Większość kobiet zgłasza zarówno objawy psychologiczne, jak i fizyczne, kwalifikując się do podtypu mieszanego, niezależnie od diagnozy PMS czy PMDD. Możliwym czynnikiem braku odpowiedzi na SSRI może być dominacja objawów fizycznych, które są mniej zbadane niż objawy psychologiczne zespołu.25

Zalecenia dotyczące dalszych badań

Potrzebne są dalsze badania podtypów PMS i ich odpowiedzi na inne leki, a także porównania SSRI z doustnymi środkami antykoncepcyjnymi lub innymi metodami leczenia hormonalnego zaburzeń przedmiesiączkowych. Takie badania mogłyby doprecyzować rokowanie w różnych podtypach PMS i zoptymalizować strategie leczenia.26

Postępowanie w przypadkach opornych na leczenie

W przypadkach opornych na leczenie, gdy objawy PMS są bardzo nasilone i nie ustępują po standardowej terapii, ostatecznym rozwiązaniem może być indukcja menopauzy poprzez chirurgiczne usunięcie jajników. Jest to jednak metoda ostateczna, stosowana tylko w wyjątkowych sytuacjach.27

Znaczenie właściwej diagnozy dla rokowania

Dokładne ustalenie czasu występowania objawów jest niezbędne przy ocenie PMS i PMDD. Objawy muszą występować w fazie lutealnej i ustępować wkrótce po rozpoczęciu menstruacji. Kwestionariusze prospektywne są najdokładniejszą metodą diagnozowania PMS i PMDD, ponieważ stwierdzono, że pacjentki znacznie przeceniają cykliczność objawów, podczas gdy w rzeczywistości mogą one być nieregularne lub po prostu nasilone w cyklu lutealnym.2829

Według definicji Amerykańskiego Kolegium Położników i Ginekologów (ACOG), PMS to stan, w którym kobieta doświadcza co najmniej jednego objawu afektywnego i jednego objawu somatycznego, które powodują dysfunkcję w funkcjonowaniu społecznym, akademickim lub zawodowym.30

Historia kliniczna jest kluczowa dla diagnozy PMS lub PMDD. Ponieważ etiologia PMS i PMDD nie jest jasna, celem leczenia jest złagodzenie objawów.31

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 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. It affects 20 to 32 percent of premenopausal women. Women with premenstrual dysphoric disorder experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. The disorder affects 3 to 8 percent of premenopausal women. […] 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 have been shown to negatively affect relationships, work attendance, productivity, and health care costs and utilization.
  • #1 Premenstrual syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Premenstrual_syndrome
    PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years. […] Treatment for specific symptoms is usually effective. Unsuccessful medical management of severe symptoms frequently indicates misdiagnosis. […] Even without treatment, symptoms tend to decrease in perimenopausal women, and induction of menopause through surgical removal of the ovaries is a treatment of last resort. However, those who experience PMS or PMDD are more likely to have significant symptoms associated with menopause, such as hot flashes.
  • #2 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
    The study aimed to determine potential risk factors associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder. […] 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. […] According to the C-PASS, 11.6% of the study sample (95%CI: 8.215.7%) met the diagnosis of PMS or PMDD. […] 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.
  • #2 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]
  • #3 Premenstrual syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Premenstrual_syndrome
    PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years. […] Treatment for specific symptoms is usually effective. Unsuccessful medical management of severe symptoms frequently indicates misdiagnosis. […] Even without treatment, symptoms tend to decrease in perimenopausal women, and induction of menopause through surgical removal of the ovaries is a treatment of last resort. However, those who experience PMS or PMDD are more likely to have significant symptoms associated with menopause, such as hot flashes.
  • #4 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
    The study aimed to determine potential risk factors associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder. […] 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. […] According to the C-PASS, 11.6% of the study sample (95%CI: 8.215.7%) met the diagnosis of PMS or PMDD. […] 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.
  • #5 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.
  • #6 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 subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. […] 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.
  • #7 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.
  • #8 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. It affects 20 to 32 percent of premenopausal women. Women with premenstrual dysphoric disorder experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. The disorder affects 3 to 8 percent of premenopausal women. […] 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 have been shown to negatively affect relationships, work attendance, productivity, and health care costs and utilization.
  • #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 – 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]
  • #11 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]
  • #12 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.
  • #13 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.
  • #14 Premenstrual syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Premenstrual_syndrome
    PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years. […] Treatment for specific symptoms is usually effective. Unsuccessful medical management of severe symptoms frequently indicates misdiagnosis. […] Even without treatment, symptoms tend to decrease in perimenopausal women, and induction of menopause through surgical removal of the ovaries is a treatment of last resort. However, those who experience PMS or PMDD are more likely to have significant symptoms associated with menopause, such as hot flashes.
  • #15 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #16 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 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. […] The adverse effects associated with SSRIs were nausea, insomnia, sexual dysfunction or decreased libido, fatigue or sedation, dizziness or vertigo, tremor, somnolence and decreased concentration, sweating, dry mouth, asthenia or decreased energy, diarrhoea, and constipation. […] Overall, the certainty of the evidence was moderate.
  • #17 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #18 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.
  • #19 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.
  • #20 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #21 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.
  • #22 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.
  • #23 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #24 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. Mixed and psychological symptom subtypes improved while the physical symptom subtype did not improve significantly. […] A possible factor in non-response to an SSRI may be the role of physical symptoms, which are predominant for many women who seek treatment but are less studied than the psychological symptoms of the syndrome. […] 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. While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. The mixed subtype significantly improved, while the physical subtype did not significantly improve relative to placebo. […] 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.
  • #25 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. Mixed and psychological symptom subtypes improved while the physical symptom subtype did not improve significantly. […] A possible factor in non-response to an SSRI may be the role of physical symptoms, which are predominant for many women who seek treatment but are less studied than the psychological symptoms of the syndrome. […] 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. While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. The mixed subtype significantly improved, while the physical subtype did not significantly improve relative to placebo. […] 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.
  • #26 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. Mixed and psychological symptom subtypes improved while the physical symptom subtype did not improve significantly. […] A possible factor in non-response to an SSRI may be the role of physical symptoms, which are predominant for many women who seek treatment but are less studied than the psychological symptoms of the syndrome. […] 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. While both diagnoses had a similar and significant response to sertraline, symptom-based subtypes responded differentially to SSRI treatment. The mixed subtype significantly improved, while the physical subtype did not significantly improve relative to placebo. […] 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.
  • #27 Premenstrual syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Premenstrual_syndrome
    PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years. […] Treatment for specific symptoms is usually effective. Unsuccessful medical management of severe symptoms frequently indicates misdiagnosis. […] Even without treatment, symptoms tend to decrease in perimenopausal women, and induction of menopause through surgical removal of the ovaries is a treatment of last resort. However, those who experience PMS or PMDD are more likely to have significant symptoms associated with menopause, such as hot flashes.
  • #28 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 subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. […] 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.
  • #29 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #30 Premenstrual Syndrome and Premenstrual Dysphoric Disorder | AAFP
    https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
    The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). […] 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. […] ACOG has defined PMS as a condition in which a woman experiences at least one affective symptom and one somatic symptom that cause dysfunction in social, academic, or work performance. […] Treatment of PMS and PMDD focuses on relieving physical and psychiatric symptoms. Many of the medications used address the body’s hormonal activity through suppression of ovulation, whereas others affect the concentration of neurotransmitters such as serotonin, norepinephrine, or dopamine in the brain. […] SSRIs are first-line treatment for severe symptoms of PMS and PMDD. […] Oral contraceptives provide benefit when treating physical and psychiatric symptoms of PMS or PMDD. […] Cognitive behavior therapy may improve PMS and PMDD symptoms.
  • #31 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 with PMS or PMDD appear to be more physiologically sensitive to and express more symptoms with normal cycling levels of estrogen and progesterone. […] Clinical history is key to the diagnosis of PMS or PMDD. […] 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. […] Few data support the effectiveness of oral contraceptives in treating PMS. […] Because they suppress ovarian function, the GnRH agonists goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), and nafarelin (Synarel) have been tried off-label to reduce severe physical symptoms of PMS and PMDD. […] Irritability and anxiety are common symptoms in women with PMS or PMDD.

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inhibitor wychwytu zwrotnego serotoniny i noradrenaliny estrogen i progesteron przedmiesiączkowe zaburzenie dysforyczne sertralina menarche goserelin histrelin faza lutealna menopauza leuprorelina ryzyko samobójcze terapia poznawczo-behawioralna agonista GnRH zespół napięcia przedmiesiączkowego owariektomia selektywny inhibitor wychwytu zwrotnego serotoniny uderzenie gorąca depresja doustny środek antykoncepcyjny