Premenstrual syndrome: A modern view on the problem

Most women of reproductive age (about 80%) experience premenstrual symptoms, which indicate the approaching menstruation and are of little clinical significance, since they do not affect the quality of life. However, some women experience severe physical and/or psychological symptoms before menstruation, which, if left untreated, can lead to a reduced quality of life. The exact etiology and pathogenesis of premenstrual syndrome (PMS) remain unclear. Despite the fact that PMS etiology remains unknown, there are some theories and studies supporting them that inappropriate inflammatory response and oxidative stress may be considered as the causes of occurrence of PMS. Symptoms of premenstrual syndrome can be nonspecific and individual for each specific woman, the diagnosis is made only on the basis of symptoms, pathognomonic hormonal disorders do not exist. Rarely, the symptoms are expressed to an extreme degree and disrupt the ability to work and the rhythm of a woman’s life, then premenstrual dysphoric disorder (PMDD) should be assumed, which is often underestimated, and the patient should be recommended to record her symptoms for ≥2 cycles. Usually, the treatment of premenstrual syndrome involves a combination of various methods in order to determine the most effective in each individual case: treatment includes lifestyle changes, micronutrient support, herbal medicine, pharmacotherapy. Drospirenone-containing combined oral contraceptives are first line for PMS and PMDD. Herbal medicines are used as maintenance therapy. Transdermal estradiol and cyclical gestogens in phase 2 of the menstrual cycle can be used as second line hormonal therapy.

1. Kaye SL. An Overview of Premenstrual Voice Syndrome: Definition, Treatment, and Future Trajectories. Med Probl Perform Art. 2020;35(1):59–65. https://doi.org/10.21091/mppa.2020.1008.

2. Wittchen HU, Becker E, Lieb R, Krause P. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med. 2002;32(1):119–132. https://doi.org/10.1017/s0033291701004925.

3. Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. J Womens Health. 2009;18(1):31–39. https://doi.org/10.1089/jwh.2008.0932.

4. Ledina AV, Prilepskaya VN, Akimkin VG. Premenstrual Syndrome: Prevalence and the Main Manifestations (the Results of Epidemiological Studies). Epidemiologiya i Vaktsinoprofilaktika. 2014;(2):66–71. (In Russ.) Available at: https://med-click.ru/uploads/files/docs/predmenstrualnyy-sindromrasprostranennost-i-osnovnye-proyavleniya-rezultaty-epidemiologicheskogoissledovaniya.pdf.

5. Yakovleva EB, Babenko OM, Pilipenko ON. Premenstrual syndrome. Emergency Medicine. 2014;(3):159–163. (In Russ.) Available at: https://elibrary.ru/skcwrz.

6. Prokopenko NA, Shaposhnikova VV. Modern view on the problem of premenstrual syndrome. Young Scientist. 2016;(13):54–55. (In Russ.) Available at: https://moluch.ru/archive/117/30670/.

7. Rapkin AJ, Mikacich JA. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Opin Obstet Gynecol. 2008;20(5):455–463. https://doi.org/10.1097/GCO.0b013e3283094b79.

8. Roomruangwong C, Matsumoto AK, Michelin AP, de Oliveira Semeão L, de Lima Pedrão JV, Moreira EG et al. The role of immune and oxidative pathways in menstrual cycle associated depressive, physio-somatic, breast and anxiety symptoms: Modulation by sex hormones. J Psychosom Res. 2020;135:110158. https://doi.org/10.1016/j.jpsychores.2020.110158.

9. Purnawati J, Sinrang AW, Jusuf EC, Limoa E, Ahmad M, Usman AN. Nutrition, Mental Status and Level of 8-Hydroxy-2-Deoxyguanosine (OHDG) Urine as Predictors of Premenstrual Syndrome (PMS) in Adolescent Girls. Int J Curr Res Rev. 2020;12(23):7–13. https://doi.org/10.31782/IJCRR.2020.122315.

10. Bertone-Johnson ER, Ronnenberg AG, Houghton SC, Nobles C, Zagarins SE, Takashima-Uebelhoer BB et al. Association of Inflammation Markers with Menstrual Symptom Severity and Premenstrual Syndrome in Young Women. Hum Reprod. 2014;29:1987–1994. https://doi.org/10.1093/humrep/deu170.

11. Azizieh FY, Alyahya KO, Dingle K. Association of self-reported symptoms with serum levels of vitamin D and multivariate cytokine profile in healthy women. J Inflamm Res. 2017;10:19–28. https://doi.org/10.2147/JIR.S127892.

12. Foster R, Vaisberg M, Bachi ALL, dos Santos JMB, de Paula Vieira R, Luna-Junior LA et al. Premenstrual Syndrome, Inflammatory Status, and Mood States in Soccer Players. Neuroimmunomodulation. 2019;26(1):1–6. https://doi.org/10.1159/000494559.

13. Halbreich U. The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology. 2003;28(Suppl. 3):55–99. https://doi.org/10.1016/s0306-4530(03)00097-0.

14. Jahanfar S, Lye MS, Krishnarajah IS. The heritability of premenstrual syndrome. Twin Res Hum Genet. 2011;14(5):433–436. https://doi.org/10.1375/twin.14.5.433.

15. Prasad D, Wollenhaupt-Aguiar B, Kidd KN, de Azevedo Cardoso T, Frey BN. Suicidal Risk in Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Systematic Review and Meta-Analysis. J Womens Health. 2021;30(12):1693–1707. https://doi.org/10.1089/jwh.2021.0185.

16. Baker LJ, O’Brien PM. Premenstrual syndrome (PMS): a peri-menopausal perspective. Maturitas. 2012;72(2):121–125. https://doi.org/10.1016j.maturitas.2012.03.007.

17. Sander B, Gordon JL. Premenstrual Mood Symptoms in the Perimenopause. Curr Psychiatry Rep. 2021;23(11):73. https://doi.org/10.1007/s11920-021-01285-1.

18. Andreeva EN, Absatarova YuS. Premenstrual syndrome: a review of the literature. Gynecology. 2019;21(2):38–43. (In Russ.) Available at: https://gynecology.orscience.ru/2079-5831/article/view/33475/ru_RU.

19. Fernández MDM, Saulyte J, Inskip HM, Takkouche B. Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis. BMJ Open. 2018;8(3):e019490. https://doi.org/10.1136/bmjopen-2017-019490.

20. Bertone-Johnson E, Hankinson S, Willett W, Johnson SR, Manson JE. Adiposity and the development of premenstrual syndrome. J Womens Health. 2010;19(11):1955–1962. https://doi.org/10.1089/jwh20102128.

21. Hashemi S, Ramezani Tehrani F, Mohammadi N, Rostami Dovom M, Torkestani F, Simbar M et al. Comparison of Metabolic and Hormonal Profiles of Women With and Without Premenstrual Syndrome: A Community Based Cross-Sectional Study. Int J Endocrinol Metab. 2016;14:e28422. https://doi.org/10.5812/ijem.28422.

22. Perkonigg A, Yonkers K, Pfister H, Lieb R, Wittchen HU. Risk factors for premenstrual dysphoric disorder in a community sample of young women: the role of traumatic events and posttraumatic stress disorder. J Clin Psychiatry. 2004;65(10):1314–1322. https://doi.org/10.4088/jcp.v65n1004.

23. Graze K, Nee J, Endicott J. Premenstrual depression predicts future major depressive disorder. Acta Psychiatr Scand. 1990;81(2):201–205. https://doi.org/10.1111/j.1600-0447.1990.tb06479.x.

24. Ledina AV, Prilepskaya VN. Premenstrual Syndrome. Towards The Clinical And Diagnostic Criteria. Farmateka. 2012;(12):13–17. (In Russ.) Available at: https://pharmateca.ru/ru/archive/article/8507.

25. Reid RL, Soares CN. Premenstrual Dysphoric Disorder: Contemporary Diagnosis and Management. J Obstet Gynaecol Can. 2018;40(2):215–223. https://doi.org/10.1016/j.jogc.2017.05.018.

26. Artymuk NV, Marochko KV, Marochko TYu, Tachkova OA. Modern ideas about premenstrual syndrome. Literature review. Mother and Baby in Kuzbass. 2021;(1):32–37. (In Russ.) Available at: https://mednauki.ru/index.php/MD/article/view/535/0.

27. Unanyan AL, Arakelov SE, Polonskaya LS, Guriev TD, Morozova VD. Premenstrual syndrome: diagnosis and treatment. Farmateka. 2014;(12):40–45. (In Russ.) Available at: https://pharmateca.ru/ru/archive/article/30019.

28. Zehravi M, Maqbool M, Ara I. Unfolding the mystery of premenstrual syndrome (PMS): an overview. Int J Adolesc Med Health. 2022;35(1):9–13. https://doi.org/10.1515/ijamh-2022-0023.

29. Pal A, Nath B, Paul S, Meena S. Evaluation of the effectiveness of yoga in management of premenstrual syndrome: a systematic review and meta-analysis. Psychosom Obstet Gynaecol. 2022;43(4):517–525. https://doi.org/10.1080/0167482X.2022.2086457.

30. Mohebbi Dehnavi Z, Jafarnejad F, Sadeghi Goghary S. The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study. BMC Womens Health. 2018;18(1):80. https://doi.org/10.1186/s12905-018-0565-5.

31. Cerqueira RO, Frey BN, Leclerc E, Brietzke E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017;20(6):713–719. https://doi.org/10.1007/s00737-017-0791-0.

32. Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a sys tematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(2):150–166. https://doi.org/10.1016/j.ajog.2017.02.028.

33. Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z et al. Vitex agnuscastus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019;47:102190. https://doi.org/10.1016/j.ctim.2019.08.024.

34. Sidorova TN, Levitskaya VM, Okhotina TN, Zhamlikhanova SS. The provision of vitamin D for female students with premenstrual syndrome. Medical and Pharmaceutical Journal “Pulse”. 2019;21(9):12–17. (In Russ.) https://doi.org/10.26787/nydha-2686-6838-2019-21-9-12-17.

35. Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018;34(8):659–663. https://doi.org/10.1080/09513590.2017.1423466.

36. Abdi F, Ozgoli G, Rahnemaie FS. A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstet Gynecol Sci. 2019;62(2):73–86. https://doi.org/10.5468/ogs.2019.62.2.73.

37. Arab A, Rafie N, Askari G, Taghiabadi M. Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. Int J Prev Med. 2020;11:156. https://doi.org/10.4103/ijpvm.IJPVM_243_19.

38. Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev. 2012;(2):CD006586. https://doi.org/10.1002/14651858.CD006586.pub4.

39. de Wit AE, de Vries YA, de Boer MK, Scheper C, Fokkema A, Janssen CAH et al. Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials. Am J Obstet Gynecol. 2021;225(6):624–633. https://doi.org/10.1016/j.ajog.2021.06.090.

40. Green LJ, O’Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome. BJOG. 2017;124(3):e73–e105. https://doi.org/10.1111/1471-0528.14260.

41. Coffee AL, Sulak PJ, Kuehl TJ. Long-term assessment of symptomatology and satisfaction of an extended oral contraceptives regimen. Contraception. 2007;75(6):444–449. https://doi.org/10.1016/j.contraception.2007.01.014.

42. Marjoribanks J, Brown J, O’Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstual syndrome. Cochrane Database Syst Rev. 2013;2013(6):CD001396. https://doi.org/10.1002/14651858.CD001396.pub3.

43. Studd J. Treatment of premenstrual disorders by suppression of ovulation by transdermal estrogens. Menopause Int. 2012;18(2):65–67. https://doi.org/10.1258/mi.2012.012015.

44. Hofmeister S, Bodden S. Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Am Fam Physician. 2016;94(3):236–240. Available at: https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html.

45. Wyatt KM, Dimmock PW, Ismail KM, Jones PW, O’Brien PM. The effectiveness of GnRHa with and without ‘add-back’ therapy in treating premenstrual syndrome: a meta-analysis. BJOG. 2004;111(6):585–593. https://doi.org/10.1111/j.1471-0528.2004.00135.x.

46. Cronje WH, Vashisht A, Studd JW. Hysterectomy and bilateral oophorectomy for severe premenstrual syndrome. Hum Reprod. 2004;19(9):2152–2155. https://doi.org/10.1093/humrep/deh354.

47. Ussher JM, Perz J. Evaluation of the relative efficacy of a couple cognitivebehaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial. PLoS ONE. 2017;12(4):e0175068. https://doi.org/10.1371/journal.pone.0175068.

48. Lustyk MK, Gerrish WG, Shaver S, Keys SL. Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2009;12(2):85–96. https://doi.org/10.1007/s00737-009-0052-y.