From the Department of Obstetrics and Gynecology at Yeni Yüzyıl University Gaziosmanpaşa Hospital, Dr. Instructor Member Şefik Gökçe gave information about 'Severe menstrual pains'.
Period pain is a normal part of the menstrual cycle. More than half of women experience sometimes mild and sometimes severe pain during menstruation. These pains can periodically force women in their social lives. During this period, women mostly try to cope with emotional states such as depression, fatigue, excessive sleep, decreased interest in the environment, irritability, tension, irritability, sadness, anger and lack of attention.
Premenstrual Syndrome (PMS) is the name given to some mental or physical problems and tensions that start about 1 week before menstruation in the premenstrual period. PMS is a physical and depressive mood such as breast swelling, headache, weakness and weight gain in the late luteal phase, which begins after the ovulation function of the menstrual cycle in women. The picture, which appears with psychological symptoms such as tension, disappears with the onset of menstruation.
For a woman who menstruates approximately 12 times a year, it represents a troubled period of about 3-4 months a year, which is a large number and reduces the person's quality of life. PMS symptoms, which usually begin between the ages of 25-35, are seen in approximately 85% of women. However, in only 5% of them, daily life is seriously affected.
Causes of PMS;
The exact cause of PMS is not clear. Mineral deficiency (magnesium, zinc), Vitamin deficiency (A, B vitamins), Hormonal imbalance (Progesterone deficiency and some other hormonal disorders), Low blood sugar, Excessive fluid retention in the body, Some chemical transmitters in the brain, Suppressed sexual desire, psychological reasons Although listed as the most up-to-date analysis; is the assumption of sensitivity in the central nervous system. According to this assumption, PMS is a hypersensitivity to “normal” changes in hormones rather than a hormonal imbalance. In women who are sensitive to normal changes in hormonal functioning that occur in a cyclical manner depending on the menstrual cycle, these changes trigger PMS-related biochemical events in the central nervous system and other target tissues around it. Serotonin hormone plays the most important role in the processes that lead to the emergence of premenstrual tension symptoms in the central nervous system. Fluctuations of serotonin, a brain chemical thought to play a crucial role in mood states, can trigger PMS symptoms. Studies in women with premenstrual tension syndrome (PMS) have shown many differences in the serotonergic system compared to normal women.
Symptoms of PMS;
PMS can sometimes affect all body systems severely, and in this case, symptoms of every organ may occur, and when it negatively affects the social and business life of women, it can even cause depression in the person. The psychological symptoms of PMS may be depression, feeling of tiredness, excessive sleep, decreased interest in the environment, mood swings, irritability, tension, irritability, sadness, anger, lack of attention. Other symptoms are;
- There may be breast symptoms in the form of maturation, enlargement and severe sensitization of the breasts.
- It causes edema (water retention) and swelling in different parts of the body. During this period, there may be an increase in body weight up to 2-3 kilograms.
- Headache, nausea-vomiting, constipation, diarrhea, increased appetite, excessive thirst, intolerance to alcohol, increased sexual desire, acne (pimples) are other common symptoms.
diagnosis of PMS;
There are no physical findings or laboratory tests to diagnose PMS. If the symptoms are part of the predictable premenstrual pattern, a particular symptom may be attributed to PMS by the doctor. Since diagnosing PMS in every woman who presents with some complaints in the premenstrual period will mean that the woman is exposed to some treatments and their side effects unnecessarily, only those who meet certain criteria are diagnosed with PMS. Women with PMS often self-diagnose and seek medical advice. However, most of these women either have exaggerated premenstrual symptoms or have another disease. A complete gynecological examination and examination should be performed, and the diagnosis should be made with some supportive laboratory tests in order to make the diagnosis and give the treatment correctly. It should be noted that some conditions can mimic PMS, including chronic fatigue syndrome, thyroid disorders, and mood disorders such as depression and anxiety. Tests such as thyroid function testing or mood screening tests may be ordered to make this distinction and help provide a clear diagnosis.
For the diagnosis of premenstrual syndrome, PMS is diagnosed when at least one of the following criteria is observed in the premenstrual period during the last 3 months. PMS symptoms should start 5 days before menstruation and these complaints should go away from the 4th day of menstruation.
- outbursts of anger
- social withdrawal
- breast tenderness
- Swelling in the abdomen
It is not yet possible to find a fully effective drug for PMS. For patients with mild or moderate symptoms, good benefits can be obtained from measures other than drug therapy.
The most important is psychological support. He should know that this may happen in some women, that the symptoms will not get worse, on the contrary, that it will decrease as the age progresses, that the event is a kind of sensitive response of the tissues to hormones, that many women have these symptoms and that it is a disease that can be treated.
Birth control pills: These drugs are especially beneficial in PMS patients who have menstrual irregularity and dysmenorrhea (menstrual pain). However, the use of birth control pills in some women may exacerbate the psychological symptoms of PMS.
Painkillers - anti-inflammatory drugs: These drugs can be useful especially in women who have additional symptoms such as PMS and menstrual pain when taken regularly as soon as the symptoms begin and used until the second-third day of menstruation.
GnRH analogs: These hormone drugs are drugs that completely silence the ovaries and reset the secretion of estrogen and progesterone. After careful evaluation, they must be used under the supervision of a doctor. If they are used for a long time, they may cause serious consequences such as osteoporosis, and if the treatment period will be prolonged, estrogen supplementation is applied.
Hysterectomy (removal of the uterus): When all methods fail in PMS, the uterus is surgically removed along with the ovaries. However, thanks to today's effective drugs, it has become a less applied form of treatment.
Treatment for edema (swelling): Since nicotine stimulates the secretion of ADH (water-holding hormone in the body), smoking should be reduced, and it is best to quit. Sleeping on the left side is beneficial for those with general body edema. Some diuretics may be helpful in the treatment of edema.
Foods: Caffeine (found in coffee, tea, chocolate, cola, and some pain relievers) can worsen PMS-related headaches and breast pains. Since women with PMS develop hypersensitivity to alcohol in the second half of the cycle (after ovulation), drinking alcohol these days may increase PMS symptoms. For those with swelling (edema), smoking should be reduced or stopped. Because nicotine keeps water in the body and stimulates hormonal secretion. Sleeping on the left side is also beneficial for those with general body edema. Salt should be restricted if necessary. Again, red meat should be reduced in the diet and fish, vegetables and fruits should be preferred.
Exercise: Regular exercise reduces the symptoms of PMS. This is probably due to its ability to increase the level of brain endorphins. (Enorphin is the “morphine” secreted from the body and has relaxing and relaxing properties.) Also; It increases the oxygenation of the body. Stress-free healthy and regular life, relaxation techniques, meditation or methods such as yoga are beneficial.
Treatment for mastalgia (breast tenderness): Patients with PMS are diagnosed with mastalgia and a complete breast examination should be performed to reveal other causes of breast pain, such as fibrocystic disease. In the treatment of mastalgia, using a bra that supports the breasts well from the bottom day and night, limiting caffeine intake and not smoking is sufficient for most patients. Reducing fat in foods, using diuretics and vitamins A, B, and E also give positive results in some patients. If necessary, drugs such as danazol and bromocriptine can also be used.
Treatment for mental symptoms: Mental symptoms may be in the form of simple emotional fluctuations or may occur in the form of severe depression. Antidepressant drugs and, if necessary, different drugs can be used depending on the results of the psychiatric evaluation.