经前期综合征

一、定义和描述经前期综合征(PMS)定义缺乏主观标准,是以排卵后期出现身体、情感、认识和习惯上的紊乱并在接近经期时迅速消失为特征的一组异常情况。PMS的重要特点是症状有周期性、定时性。 PMS有150多种症状,又可分为二组:机体性的和精神性的。机体的症状有肿胀感,乳房胀痛,盆腔疼痛,头疼,自感体重增加,皮肤异常,大便习惯改变。精神症状有急躁、易怒,情绪低落或不稳定,抑郁,焦虑精力不集中,紧张,嗜睡、失眠、食欲和性欲的改变、心绪不宁及喊叫。     

经前期综合征影响因素研究进展

经前期综合征（premenstrual syndrome,PMS）是指反复在黄体期出现周期性的以躯体和精神症状为特征的综合征,月经来潮后,症状自然消失。伴有严重情绪不稳定的PMS称为经前焦虑性障碍( pre-menstrual dysphoric disorder, PMDD),美国《精神疾病诊断与统计手册》第五版（DSM-5）将其作为抑郁症的一个亚型。PMS由于没有明确的生理诊断依据,各研究者使用的评价方法、研究设计和研究对象不同,发病率报道不一,有报道高达50％的育龄妇女都曾经历过,其中PMDD的患病率在3％~8％;约旦妇女的PMS和PMDD患病率分别为80.2％和10.2％,高于多数文献;东亚PMDD的患病率(1.3%~2.8%) 低于西方(3%~8%)。按照DSM-5关于PMDD的诊断标准,绝经前妇女符合PMDD诊断标准的比例少于10%。PMS的病因尚不清楚,可能与卵巢激素变化、神经递质改变、精神心理因素等有关。本文对PMS的影响因素综述如下。     

口服避孕药治疗经前期综合征的研究进展

经前期综合征(premenstrual syndrome,PMS)是指月经来潮前周期性出现影响妇女日常生活和工作的躯体、精神及行为的一组症候群,发病率较高,目前病因尚不明确。其治疗主要包括非药物治疗和药物治疗。口服避孕药(oral contraceptive,OCP)由于其特殊性质近来被考虑应用于治疗PMS。第三代孕激素屈螺酮的出现让OCP治疗PMS出现曙光,研究表明含屈螺酮的OCP可以显著改善PMS症状,包括躯体、精神、行为症状,其效果优于其他OCP,且缩短OCP无激素间隔可能效果更好。     

育龄妇女经前期综合征的发生情况及影响因素

目的了解育龄妇女经前期综合征的发生情况及影响因素。方法以问卷调查的形式,调查了北京市１５～４９岁的育龄妇女４５４例。结果经前期综合征的发生率为３０．４％,轻度占６１．６％,中度占３４．１％,重度占４．３％;经前期综合征发生率较高的症状为易激动,其次依次为抑郁、焦虑、腹胀腹泻、注意力不集中、嗜睡等;文化程度高、对生活有压力感、痛经、讨厌月经、有抑郁情绪者的经前期综合征发生率高于文化程度低、对生活无压力感、无痛经和无抑郁情绪者（Ｐ＜０．０５）。结论经前期综合征是育龄妇女较常见的疾病,应引起医务工作者的关注,并应针对妇女生理特点采取综合性干预措施。     

中重度经前期综合征症状表现形式分析

目的 观察和分析中重度经前期综合征(PMS)的症状表现形式.方法 对2007年北京协和医院通过在医院张贴告示招募的月经正常、总体健康、符合PMS初筛问卷的女性,前瞻填写两个连续周期月经症状日记(PMSdiary,PMSD),确诊67例患有中重度经前期综合征.分析其症状的时间表现形式、症状的周期变异、症状发生的严重程度及频率.结果 PMSD中的各项症状得分和所有症状总分的平均值均在经前第7天到经期第3天较高,且在月经的前2或1d最高(P相似文献   

克罗米芬治疗经前期综合征的临床研究

经前期综合征(PMS)的重要表现是经前期一系列的不适和情绪异常变化，对育龄妇女的身心健康有不同程度的影响。其发生率为30％～40％。目前PMS的病因尚不清楚，治疗方法很多。国外有应用拘橼酸克罗米芬(CC)治疗PMS的报道，国内应用CC治疗不孕症及月经不调等方面研究较多，尚未见应用CC治疗PMS的报道，现将我们应用CC     

不同个性中国女大学生经前期综合征的症状及其应对方式研究

目的探讨不同个性类型女大学生经前期综合征(premenstrualsyndrome,PMS)相关症状及其应对方式的差异,为不同个性女大学生经前期综合征制定个体化干预方案提供科学依据。方法通过多阶段分层整群随机抽样的方法,抽取中国不同地区12所大学,72个班2508名女大学生为调查对象,采用艾森克人格问卷、月经症状量表以及月经应对方式量表进行调查。资料分析利用SPSSWindowsProgram18.0进行单向分类-方差分析。结果不同个性女大学生经前期综合征的症状总分之间,差异有统计学意义(F=53.38,P<0.001)。不同个性女大学生的PMS症状6个领域即疼痛、注意力下降、行为改变、自主神经反应、钠水潴留、否定情绪反应分数之间,差异亦均有统计学意义(P<0.001)。内向稳定型和外向稳定型、内向不稳定型和外向不稳定型分数之间差异无统计学意义(P>0.05),但内向稳定型、外向稳定型分别与内向不稳定型、外向不稳定型分数进行比较,不稳定型得分高,差异有统计学意义(P均<0.001)。不同个性女大学生PMS各种应对方式即一般应对方式、积极行为应对方式、积极认知应对方式、消极应对方式的分数之间,差异均有统计学意义(P<0.001)。内向稳定型分别和内向不稳定型、外向稳定型、外向不稳定型分数比较差异有统计学意义(P均<0.001)。结论不同个性女大学生的PMS相关症状及其应对方式存在差异,应根据不同个性类别给予针对性的干预方案,为女大学生个体化性健康教育程序的制定提供可靠的理论依据。     

心外科ICU护士职业压力调查及应对措施

目的：探讨心外科ICU护士职业压力与应对措施。方法：对心外科ICU护士的职业压力特征进行调查,本文主要从本科ICU的护理工作性质、工作环境以及特殊职业危害等几个方面进行了分析。结果：提出从实施人性化管理、帮助护士提升自身修养以及建立心理支持系统等几方面制定应对职业压力的措施。结论：只有在更好地缓解职业压力的情况下,心外科ICU护士的生活质量方可得以改善,并为提高护理质量创造基础条件。     

螺内酯治疗经前期综合征的观察性研究

目的：观察螺内酯治疗经前期综合征（PMS）的疗效。方法：60例PMS患者随机分为螺内酯组（观察组,30例）及维生素B6组（对照组,30例）,并给予相应药物治疗;治疗前后分别使用焦虑自评量表（SAS）及抑郁自评量表（SDS）对患者焦虑及抑郁进行评分,并比较患者血浆醛固酮、血钾、血钠及尿量变化。结果：治疗前上述指标组间差异均无统计学意义（均P〉0.05）;治疗后观察组的SAS评分显著低于对照组,差异有统计学意义（P〈0.05）,但SDS评分组间差异无统计学意义。治疗后观察组醛固酮及血钠水平较治疗前明显降低,且明显低于对照组（P〈0.05或P〈0.01）;治疗后观察组尿量较治疗前增加,差异有统计学意义（P〈0.01）,且明显多于对照组（P〈0.01）,但2组治疗后的血钾水平差异无统计学意义。结论：螺内酯对PMS患者具有较理想的抗焦虑作用,并且可以改善体液代谢紊乱,其疗效优于维生素B6。     

Association between premenstrual syndrome and alexithymia among Turkish University students

Premenstrual syndrome (PMS) is a heterogeneous disorder, which includes physical, cognitive, affective and behavioral symptoms. The aim of this study was to determine the factors affecting PMS and the relationship between PMS and alexithymia. The research was performed with 308 students. Data were collected using a demographic questionnaire, the Toronto alexithymia scale (TAS-20) and a premenstrual assessment form (PAF). The prevalence of PMS in our sample was 66.6%. The contributing factors to PMS were having a history of psychiatric treatment and having a smoking habit (p?p?p?≤?0.001). Further studies are needed to determine the probable role of alexithymia in the pathogenesis of PMS.     

Management of premenstrual syndrome

Premenstrual syndrome is one of the most common gynaecological ailments. Despite its prevalence and perhaps because of its heterogeneity in symptoms, more than half the women are undiagnosed and poorly managed. There have been multiple medical, surgical and alternative therapies evaluated and this provides a summary of the evidence and a practical management strategy to be implemented in women with this condition.     

Treatment of moderate to severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women

Objectives.?To assess efficacy of the extract of Vitex agnus castus (VAC, BNO 1095) in the treatment of Chinese women suffering from moderate to severe premenstrual syndrome (PMS).

Methods.?It was a prospective randomised double-blind placebo-controlled study conducted in Chinese women. Eligible patients were randomly assigned into VAC or placebo group. Symptoms were documented with a daily rating scale with four symptom factors (negative affect, water retention, food cravings and pain).

Results.?Sixty-seven patients were enrolled and randomly assigned to receive one tablet of VAC or placebo once a day. The premenstrual syndrome diary (PMSD) sum score decreased from 29.38?±?7.63 score points at baseline to 4.28?±?5.76 at the 3rd cycle in the treatment group, while it decreased from 28.76?±?8.23 to 11.79?±?11.78 in the placebo group. All the four symptom factor scores were significantly reduced by the 3rd treatment cycle. There was significant difference in PMSD sum score, score of negative affect and water retention between two groups at cycle 3 (P?<?0.05). PMSD sum scores decreased 60% was defined as efficacy, and the efficacy rate in treatment group was significantly higher than that in placebo group at the 3rd treatment cycle.

Conclusion.?Vitex agnus castus extract BNO 1095 shows effective in treating moderate to severe PMS in Chinese women, especially in symptoms of negative affect and water retention.     

Obesity as a risk factor for premenstrual syndrome

Purpose: To determine the association between obesity and Premenstrual Syndrome (PMS).

Methods: A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18–44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index.

Results: The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI ??30) had nearly a three-fold increased risk for PMS than non-obese women OR?=?2.8 (95% CI?=?1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers.

Conclusion: This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.     

The correlation between neurosteroids and neurotransmitters with liver yang rising and liver qi stagnation types of premenstrual syndrome

Background: To investigate neural-reproductive hormonal basis of liver yang rising (LYR), liver qi stagnation (LQS) premenstrual syndrome (PMS), and to develop standardized diagnostic criteria for PMS.

Methods: HPLC, HPLC-MC, ELISA and radioimmunoassay were used to compare levels of serum hormones, plasma neurotransmitters and neurosteroids between LYR PMS patients, LQS PMS patients and healthy controls (30 subjects in each group).

Results: Of the measures, all three groups exhibited no significant differences during the follicular phase. In contrast, during the luteal phase, LYR PMS testosterone levels tended to be higher than controls, while dopamine and 5-HT of the LYR PMS group were significantly higher. Conversely, γ-aminobutyric acid in the LYR PMS group was significantly lower than controls (p?p?p?p?Conclusion: The decrease in pregnenolone and allopregnenolone, increase in DHEA, DHEA/allopregnanolone and DHEA/pregnenolone during the luteal phase may be one of the biological bases for anger in LYR PMS patients and depression in LQS PMS patients.     

High dose vitamin D supplementation can improve menstrual problems,dysmenorrhea, and premenstrual syndrome in adolescents

Vitamin D has a crucial role in female reproduction, possibly through its effects on calcium homeostasis, cyclic sex steroid hormone fluctuations, or neurotransmitter function. We have assessed the effects of vitamin D supplementation on dysmenorrhea and premenstrual syndrome (PMS) in adolescents. In this study, 897 adolescent girls living in Mashhad and Sabzevar, Iran, received nine high-dose vitamin D supplements (as 50,000?IU/week of cholecalciferol) and were followed up over 9 weeks. We evaluated the effect of vitamin D supplementation on individuals in four categories: those with only PMS; individuals with only dysmenorrhea; subjects with both PMS and dysmenorrhea and normal subjects. The prevalence of PMS after the intervention fell from 14.9% to 4.8% (p?p?相似文献   

Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome

Purpose To further investigate the efficacy of progesterone in the treatment of the symptoms of premenstrual syndrome (PMS).Materials and Methods From an initial cohort of 25 subjects diagnosed with moderate to severe PMS, 17 reproductive age females completed the 7-month, doubleblind, placebo controlled trial using 200-mg vaginal progestone suppositories. Multiple modalities for evaluating symptoms were employed, including the Spielberger self-evaluation rating, the Beck depression inventory, and the Hamilton anxiety scale. In addition, each subject was interviewed by a psychiatrist on a monthly basis; ovulation was determined monthly using a basal body temperature chart; serum hormonal assays included beta endorphin, progesterone, follicle stimulating hormone, luteinizing hormone, estradiol, and prolactin.Results Hormonal assays confirmed no differences between treatment and control groups. Overall scores on all test vehicles were likewise not significantly different between the two groups; however, in the subcategory of nervous symptoms, a significant improvement was found in symptoms relating to tension, mood swings, irritability, anxiety and lack of control.Conclusions Metabolites of progesterone (pregnanolone and allopregnanolone) may play a physiologic role as anxiolytic agents, perhaps modifying mood and anxiety; the current study confirms the utility of twice daily, 200-mg progesterone vaginal suppositories, in the alleviation of some PMS symptoms relating to anxiety and irritability. Further evaluation may be warranted to ascertain which patients in the known heterogeneous PMS population may be most likely to benefit from such treatment.Presented at the 50th Annual Meeting of the American Fertility Society, November 5–10, 1994, San Antonio, Texas.     

Interdisciplinary consensus on management of premenstrual disorders in Switzerland

Premenstrual disorders (PMD) can affect women throughout their entire reproductive years. In 2016, an interdisciplinary expert meeting of general gynecologists, gynecological endocrinologists, psychiatrists and psychologists from Switzerland was held to provide an interdisciplinary algorithm on PMD management taking reproductive stages into account. The Swiss PMD algorithm differentiates between primary and secondary PMD care providers incorporating different levels of diagnostic and treatment. Treatment options include cognitive behavioral therapy, alternative therapy, antidepressants, ovulation suppression and diuretics. Treatment choice depends on prevalent PMD symptoms, (reproductive) age, family planning, cardiovascular risk factors, comorbidities, comedication and the woman’s preference. Regular follow-ups are mandatory.