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Chapter 7. PREMENSTRUAL TENSION SYNDROME

7.1. GENERAL INFORMATION

ICD-10 Code

N94.3 Premenstrual tension syndrome.

Synonyms

Premenstrual syndrome, cyclic syndrome, premenstrual dysphoric disorder.

General Information

This is a complex of abnormal symptoms arising 2-3 (or more) days before the period no less than in two menstrual cycles in the row, each time presenting with the same emotional, vegetative, vascular, metabolic and endocrine disorders. Cyclic changes in the mood and physical conditions alternate with times of remission which set on with the start of menses and last for no less than 7-12 days.

Epidemiology

Some symptoms of indisposition prior to the period are noted by 75% of women, but in fact only 25% of them have PMS. The predominance of PMS in the population varies from 5 to 40% (about 25% on average). PMS predominance is not related to socioeconomic cultural or ethnic features but is higher in menstruating women of older ages. For instance, among women aged 19-29 PMS is noted in 20%; among women aged 30-40 it is seen in 47%, and among women aged 40-49 the predominance of PMS is as high as 55%.

Etiology and Pathogenesis

Etiology and pathogenesis are not understood well enough. Development of PMS is promoted by:

• dysfunction of central components of reproductive system regulation;

• disorder of sex steroid hormone metabolism;

• disorder of regulation in the hypothalamic-pituitary-ovarian axis;

• activation of renin-angiotensin-aldosterone system;

• hyperprolactinemia in the second phase of menstrual cycle;

• disorder of mineralocorticoid metabolism;

• elevated prostaglandin production;

• reduced level of endogenous opioid peptides;

• disorder of biogenic amine metabolism and/or circadian rhythm in the body;

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