PREMENstrual TENSION SYNDROME (PREMENSTRUAL SYNDROME)

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Premenstrual Syndrome (Premenstrual Tension), in which important psychological complaints are added to physical complaints, is observed in 20-30% of women. Physical complaints in this table; It can be summarized as migraine and other headaches, fainting, dizziness, tension and edema in the breasts, palpitations, nausea, abdominal bloating, constipation and diarrhea, decrease in urine, acne, joint and muscle pain. Psychological complaints can be listed as depression, restlessness, tension, sudden emotional changes, anger, uncontrolled shouting, aggression, panic attack, irritability, social collapse, negative changes in memory and concentration, and changes in sexual desire. These complaints significantly affect women's social and business life. For this reason, patients turn to physicians for medical help.

The most severe form of this group is Premenstrual Dysphoric Disorder. It is seen in about 5% of women. Complaints seriously affect a person's social and business life. The main findings are as follows; A significant depressive psychological state, irritability, emotional instability, anger, reluctance towards daily activities, restlessness, appetite changes, excessive sleep or insomnia and physical complaints can be listed. The presence of five findings, provided that at least one of the first three of these complaints is present, allows the diagnosis to be made.

In the formation of the disease; Hormones secreted during normal ovarian functions and changes in intermediate substances occurring in the brain are held responsible. Estrogen hormone and serotonin effects are the main substances investigated. Post-ovulation blood serotonin levels of women with premenstrual tension were found to be lower than other women.

Diagnosis: Before the patient presents with these complaints, a detailed history is taken and a general and gynecological examination is performed. Underlying thyroid disease, hyperprolactinemia, ovarian cyst, myoma, pelvic infection, endometriosis The presence of diseases such as is investigated. There is no laboratory test to diagnose the disease. In premenstrual tension, it is important for the person to have a complaint-free period for at least one week every month. Patients who apply with these complaints are recorded daily for 2 or 3 months, which of the mentioned complaints they experience. It is learned whether the complaints affect work, school, social and other relationships. Premenstrual tension is diagnosed in people who do not have any other underlying disease, who have the above complaints recurring periodically, and who are determined to be free of complaints for at least one week in each menstrual month.

Treatment:

1- Patient education and self-administered precautions:

Education is the most important step in the treatment of premenstrual tension. The woman is given information about her menstrual cycle, hormonal changes, and her own body anatomy, and is helped to understand the disease.

Exercise performed 3-4 times a week will contribute to the reduction of complaints.

Learning to cope with stress and relaxation techniques also help the treatment.

Patients are advised to change their eating habits. Salt, coffee and refined carbohydrate (sugar) intake is reduced. Although it is stated that the intake of vitamin B6, E, calcium and magnesium reduces complaints, there is no proven scientific data on this subject.

2- Drug treatment:

Birth control pills are the first drugs used in treatment. The patient has premenstrual syndrome painful menstruation (dysmenorrhea) If there is excessive menstrual bleeding (menorrhagia) and the person wants birth control, these drugs should be preferred. However, it does not show the expected improvement only in patients with premenstrual syndrome and predominant psychological symptoms. It may even worsen psychological symptoms.

Antidepressant drugs are quite effective in severe forms of the disease. Especially the fluoxetine group is recommended. These medications can be taken continuously or only during periods of tension. In cases where the feeling of distress predominates, anxiolytic drugs (buspirone, alprezolam) can be given. Low doses of diuretics may be recommended in patients with prominent edema.

In cases where the above treatments are insufficient, treatments that suppress the functions of the ovaries (gonadotropin-releasing hormone derivatives) may be given. They create artificial menopause in women. Although these medications are very effective in eliminating physical symptoms, they are not as effective in eliminating psychological symptoms. It is recommended that these drugs be used with caution, as some serious side effects may occur when used for longer than 6 months.

3- Surgery:

It may be recommended for patients who have tried all medical treatment options but have not received any results, whose disease is severe and who are approaching menopause. Surgeries to remove bilateral ovaries (bilateral oophorectomy) or to remove the uterus along with the ovaries (hysterectomy) can be performed. Since the surgery option is irreversible, it should be used as a last resort. In patients for whom surgery is decided, artificial menopause should be created before the operation and it should be tested to see how much the patient will benefit from the surgery.

As can be seen from the information above, premenstrual tension syndrome can sometimes make a woman's life miserable. Treatment takes a long time in these patients. For this reason, the patient's close cooperation with his physician and his openness to cooperation play an important role in the success of the treatment.