Premenstrual Syndrome (PMS)
Dr. Nelson Soucasaux, Brazilian gynecologist
The symptoms and clinical manifestations that can occur on the days
that precede the coming of menstruation can be included basically into three
1. Psychological signs and symptoms: Increase of nervous tension, anxiety,
irritability, changes in the personality, emotional instability, depression,
as well as increase or reduction of the sexual desire. The symptoms that
will predominate in each woman will obviously depend on the basic psychological
predispositions of each one. All of this is very individualized.
2. Signs and symptoms in the genital apparatus and in the breasts:
Sensation of pelvic discomfort (possibly due to a localized congestion
in the uterus, tubes, ovaries, ligaments and other near structures), uterine
cramps (which can precede the dysmenorrhea or disappear with the beginning
of menstruation), lumbosacral pain (probably due to the reflex pain related
to the areas of metameric projection of the nervous system, but which may
also originate from the inner genitals). Mammary swelling and pain are
very frequent, with an increase in the volume of the breasts, which can
even be greater on one side than on the other - a fact that demonstrates
the importance of the specific reaction of the "target" organs
in relation to the stimuli that cause the hydric retention and the edemas.
3. Extragenital signs and symptoms: Edemas (that only exceptionally
can produce some premenstrual increase of the body weight), sensation of
"swelling" in the lower belly (probably due to an intestinal
accumulation of air by some functional disturbance caused by a congestion
of these organs), sensation of "weight" and fatigue in the legs
(perhaps by a greater venous stasis), diverse symptoms of neurovegetative
origin, as headache, dizziness, nausea, diarrhea, etc. There also can occur
exacerbation of acne and allergic phenomena.
The quantity and the intensity of the presented signs and symptoms vary
greatly from woman to woman and, in the same woman, from cycle to cycle,
in the same way as in accordance with the phases of life, the emotional
conditions and the endocrine variations. As is known, almost all women present
minimal degrees of premenstrual symptoms. The most usually referred to are
mammary swelling and/or painful breasts, sensation of hydric retention,
slight distension of the lower belly, uterine cramps and nervousness. Some
women have only the psychological symptoms.
Among all signs and symptoms that characterize the premenstrual manifestations,
there are subjective and objective ones. Mammary congestion is the most
frequent objective sign and the one that is more easily verified at the
clinical examination. The increase of density and volume of the mammary
parenchyma thickenings and nodules that characterize the functional mastopathies
(or benign functional alterations of the breasts) becomes evident in the
premenstrual phase. Visible edemas in other parts of the body are rare.
It has been proved that the main physio-pathological manifestation responsible
for many premenstrual symptoms is the retention of sodium and water, which
causes edemas and congestive phenomena mainly situated in specific parts
of the female body. Because of this, one of the most widely used clinical
treatments for this disturbance are diuretics that produce sodium excretion.
What remains a mystery and a very controversial subject are the possible
reasons for this retention of water and sodium on the days that precede
menstruation. Attempts to discover specific alterations in the levels of
estrogens and/or progesterone that could characterize women who suffer from
severe premenstrual syndrome have been usually inconclusive. The only obvious
fact is that the intensity of the signs and symptoms increases as the blood
levels of these hormones physiologically fall at the end of each cycle,
triggering the coming of menstruation.
I suppose that in a great number of cases, the physical discomforts
caused by the mentioned liquid accumulation in specific areas of the female
body (mostly in the sexual organs), together with the woman's emotional
problems, can act as an "irritative factor" at the psychical level.
This, in turn, increases the sensibility to the symptoms, and acting through
the psychosomatic pathways can intensify the disturbances. On the other
hand, the emotional disorders related to the many aspects of the female
constitution can be somatized by means of physiological and endocrine alterations
that can cause, through mechanisms not well elucidated yet, this retention
of sodium and water during the premenstrual period.
Many hypotheses, based on detectable alterations in the endocrine physiology
and in other parts of the organism of women who suffer from these premenstrual
manifestations, have been constructed by different researchers in the last
decades, but not one of them was capable, all by itself, of explaining all
of the disturbances. To enter into details about these hypothesis is not
the purpose of this text and, for a detailed analysis of them, I recommend
the reading of my article "Tensão Pré-Menstrual"
("Premenstrual Syndrome")*. In any case, a very curious fact is
the usually quick disappearance of the edemas and of many other premenstrual
symptoms with the beginning of menstruation - that is, with the necrotic
*Soucasaux, Nelson - "Tensão Pré-Menstrual"
("Premenstrual Syndrome") - in: Jornal Brasileiro de Medicina,
vol 53, nº 2, August 1987.
The text above is an excerpt from my book "Novas Perspectivas em
Ginecologia" ("New Perspectives in Gynecology"), published
by Imago Editora, Rio de Janeiro, 1990. For more information on the book,
see page http://www.nelsonginecologia.med.br/novas.htm
from my Web site http://www.nelsonginecologia.med.br .
© Nelson Soucasaux, 1990, 2001
Nelson Soucasaux is a gynecologist especially dedicated to clinical,
preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade
de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the
author of several articles published in medical journals and of the books
"Novas Perspectivas em Ginecologia" ("New Perspectives in
Gynecology") and "Os Órgãos Sexuais Femininos: Forma,
Função, Símbolo e Arquétipo" ("The
Female Sexual Organs: Shape, Function, Symbol and Archetype"), published
by Imago Editora, Rio de Janeiro, 1990, 1993.
© 2001 Harry Finley. It is illegal
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