"Premenstrual syndrome (PMS) is a set of clinical manifestations appearing the days before the rules to disappear at the beginning of these," explains Prof. Philippe Descamps, a gynecologist-obstetrician at CHU d'Angers *.

On the Sexplique website, the contraceptive and sexuality information service in Quebec, we find this definition: "a set of physical, cognitive and emotional manifestations felt by some women in the 2 to 10 days preceding menstruation and which gradually decrease with arrival of these. The definition of PMS is based on the cyclical character of these manifestations, since these are related to the menstrual cycle . Thus, it is the appearance of a series of events every month, or almost, and with more or less intensity. "

Premenstrual syndrome, a misunderstood female evil ...

According to Pr. Descamps, benign premenstrual syndrome affects 25 to 77% of women and in 5 to 10% of cases, there are severe disorders. All women are concerned when they are in a period of genital activity. He specifies: "the SPM is independent of the parity, the number of previous pregnancies".

The origins of premenstrual syndrome are unknown, he laments. "Its physiopathology is poorly known but it is thought that it is caused by an increase in capillary permeability, that is to say a passage of plasma through the vessel wall ..."

woman cushion stomachache headache © martin-dm / iStockphoto.com

SPM: different symptoms according to each woman

PMS is manifested by disorders, more or less benign, the most common being: breast tenderness, abdominal-pelvic tension with nausea, abdominal bloating, constipation ; as well as neuro-psychic signs such as mood disorders (irritability, fatigability ), decreased intellectual performance, which can lead to behavioral problems .

This is what testifies Caroline, a victim of a PMS in recent years: "the PMS, I did not really believe. I had not noticed anything since my first period at 12 years old. At 24, I had problems with the pill so I stopped her. At 27, I took the pill and that's when I started to feel symptoms of PMS: a week and a half before my period, I felt irritated by everything (...). In those moments, I became susceptible to everything: my friends got drunk, my boyfriend seemed unbearable to me. I knew I was wrong to feel all this, but could not control it. To make matters worse, I felt tired and had insomnia .

And to continue: "At 31 years old today, nothing has changed. I stopped the pill but the effects persisted. Now, I know when I'm going to have my period, it's a slider that I would have done well. "

At first I feel annoyed, then I see everything in black, I'm emotional, I feel fat and ugly.

A syndrome that can appear and disappear at any time

"The diagnosis is clinical with careful questioning," explains Philippe Descamps. We will look for the association of clinical symptoms with their appearance 7 to 10 days before menstruation and their cyclical evolution. The clinical examination is often normal and no biological assessment is necessary to confirm the diagnosis. "

What is important to keep in mind is that PMS can happen at any time, to all women and can also be transient. Nobody is predestined to be a victim, but no one is safe either.

This is the case of Sandrine, who suddenly saw a PMS: "I have never had a premenstrual syndrome so far, except to feel a little tired and in a bad mood a few days before my period - but like a lot of women.

On the other hand, for several months, these are much more important and troublesome symptoms which appeared. After ovulation and especially 10 days before my period, I swell a lot of the lower abdomen , hips and a little chest, I digest and sleep very badly and my moods are roller coasters . It's a pretty unbearable state for me - changing my body and feeling depressed or anxious is frankly painful - but also for those around me.

I made a hormonal assessment that is normal, so nothing explains this sudden syndrome, if it is not ovulation of poor quality at the moment, without reason and without gravity. "

premenstrual syndrome woman pain © markp73 / iStockphoto.com

What treatment for premenstrual syndrome?

First, Professor Philippe Descamps insists on the importance of reassuring patients about the benign nature of this disorder of the menstrual cycle.

However, there is no question of minimizing the suffering of women. Hygienic and dietary rules are put in place: "moderate sodium-water restriction (adapted diet to fight against the retention of water), limitation of fast sugars as well as excitants", explains the gynecologist-obstetrician. So during the SPM, we avoid coffee, tobacco, alcohol ...

We also try to maintain physical activity.

Then, the symptoms are treated on a case-by-case basis: laxatives during constipation, NSAID if there are headaches ... "Sometimes the treatment is accompanied by a local treatment of mastodynies (breast pain) when those they are disabling; then a progesterone gel is applied, "continues Prof. Descamps. In case of significant edema, diuretics are proposed.

Finally, a comprehensive treatment is possible "when the symptoms are severe and disabling in everyday life. Progestin-only hormonal therapy is prescribed in the second part of the cycle or an oestro-progestative pill.

Hormonal problems, difficult cases for medicine

In the case of Sandrine, many treatments have been put in place, with no conclusive result: "I was offered a light diuretic and hormonal progestin treatment for the second part of the cycle, but the symptoms persist despite everything. The frustrating thing is to feel the limits of medicine with regard to hormonal problems. All women are different and have their own problems, which is why it is so complicated for doctors to define an effective treatment for everyone.

So I turned to more natural medicines, such as acupuncture, osteopathy and some plants known to regulate hormonal disorders , but obviously my concern is temporary, so we must wait and hope that passes. "

In the case of SPM, it is important to relativize; the harm remains benign, explains Professor Philippe Descamps, who nevertheless insists on the need to identify the origin of the disorders to address them on a case by case basis.

However, there is nothing to do with other more serious gynecological diseases, such as endometriosis or polycystic ovary syndrome.

* Doctor's author , I still have a question - everything you've always wanted to know about gynecology without ever daring to ask , ed. Larousse, February 2017.