Premenstrual syndrome: symptoms, diagnostics, phytotherapy (clinical lecture)

Abstract

Premenstrual syndrome is a symptom complex characterized by repeated physical, psycho-emotional, behavioral symptoms that develop into the luteal phase of the cycle (2-14 days before menstruation) and disappear with its onset. The basis of the PMS diagnosis is the cyclical nature of pathological symptoms. The PMS diagnosis is established in accordance with ICD-10 criteria based on the analysis of frequency and severity of symptoms over two menstrual cycles. Differential diagnostics of PMS, and especially its most severe form - premenstrual dysphoric disorder, should be carried out first of all with various mental diseases, because in its clinical picture often it is psychoneurological symptomatology that prevails. It is necessary to exclude major depression, dysthymic conditions, generalized anxiety, panic disorder, bipolar diseases. Similar symptoms may have anaemia, autoimmune diseases, hypothyroidism, diabetes, convulsive conditions, endometriosis, chronic fatigue syndrome, and so on. The article notes the need for a comprehensive examination aimed at identifying gynecological and associated extragenital pathology with the involvement of related specialists. The existing recommendations for treatment of PMS, confirmed by randomized controlled studies, demonstrate the effectiveness of not only combined oral contraceptives, but also non-hormonal therapy, including phytopreparation containing the extract of Vitex sacred. Their application has yielded very positive results both in randomized controlled trials and in real clinical practice. At the same time, PMS therapy should take into account the state of general and reproductive health of women, concomitant diseases, tolerance of treatment, etc. These principles should be the basis for prevention, diagnosis and treatment of women with PMS.