Kovács Zoltán, Hegyi Gabriella, Szőke Henrik
1 Róbert Magánkórház, Szülészeti Osztály Budapest Magyarország.
2 Pécsi Tudományegyetem, Egészségtudományi Kar, Egészségtudományi Doktori Iskola Pécs Magyarország.
Orv Hetil. 2022 Jun 26;163(26):1023-1031. doi: 10.1556/650.2022.32496.
Premenstrual syndrome (PMS) is one of the most common problems for women of reproductive age. The physical, mental and behavioural symptoms recur during the luteal phase of the cycle in daily life and cause a deterioration in the quality of life, affecting the patient's social, work and family relationships. Symptoms typically disappear spontaneously within a few days after the onset of menstruation. The onset and severity of PMS are determined by the cyclical functioning of the hypothalamic-pituitary-ovarian axis and the combined presence of other physiological (e.g., chronobiological and circadian) and psychological stressors, which interact with each other. The diagnosis of PMS and premenstrual dysphoric disorder (PMDD) is based on the following criteria, as recommended by the International Society for Premenstrual Disorders (ISPMD): in PMS, the woman has 1-4 symptoms, which may be physical, behavioural or affective/psychological, or at least five symptoms, which may be physical or behavioural. However, if a woman has 5 or more symptoms, and one of these is affective (e.g., irritability, mood swings, anger) in addition to physical or behavioural symptoms, a more accurate diagnosis of PMDD can be made. Since, in addition to the general and gynecological history, the prospective scales (e.g., Prospective record of the impact and severity of menstrual symptoms - PRISM; Daily record of severity of problems - DRSP) completed daily by the physician are helpful in confirming the diagnosis of PMS and PMDD, it is important to take into account the severity of symptoms, the woman's plans for conception or contraceptive needs, her other associated medical conditions, her response to previous treatment methods, and her history of other medical conditions when formulating a treatment plan. Therapeutic options include regular aerobic exercise, stress relief, cognitive behavioural therapy, drug treatments (selective serotonin reuptake inhibitors - SSRIs, combined oral estrogen-progestin contraceptives - COCs, GnRH agonists), -depending on the severity of PMS and PMDD.
经前综合征（PMS）是育龄女性最常见的问题之一。在日常生活中，身体、心理和行为症状会在月经周期的黄体期反复出现，导致生活质量下降，影响患者的社交、工作和家庭关系。症状通常在月经开始后的几天内自行消失。PMS的发作和严重程度由下丘脑 - 垂体 - 卵巢轴的周期性功能以及其他生理因素（如时间生物学和昼夜节律）和心理压力源的共同存在决定，这些因素相互作用。根据国际经前疾病协会（ISPMD）的建议，PMS和经前烦躁障碍（PMDD）的诊断基于以下标准：在PMS中，女性有1 - 4种症状，可能是身体、行为或情感/心理方面的，或者至少有5种身体或行为症状。然而，如果女性有5种或更多症状，并且其中之一是情感方面的（如易怒、情绪波动、愤怒），同时伴有身体或行为症状，则可以更准确地诊断为PMDD。由于除了一般病史和妇科病史外，医生每天完成的前瞻性量表（如月经症状影响和严重程度前瞻性记录 - PRISM；问题严重程度每日记录 - DRSP）有助于确诊PMS和PMDD，因此在制定治疗计划时，考虑症状的严重程度、女性的受孕计划或避孕需求、她的其他相关医疗状况、她对先前治疗方法的反应以及她的其他病史非常重要。治疗选择包括定期有氧运动、缓解压力、认知行为疗法、药物治疗（选择性5-羟色胺再摄取抑制剂 - SSRIs、复方口服雌激素 - 孕激素避孕药 - COCs、GnRH激动剂），具体取决于PMS和PMDD的严重程度。
