Zespół napięcia przedmiesiączkowego i przedmiesiączkowe zaburzenia dysforyczne – problem z pogranicza psychiatrii i ginekologii
Słowa kluczowe:
przedmiesiączkowe zaburzenia dysforyczne, zespół napięcia przedmiesiączkowegoAbstrakt
Wiele kobiet w wieku reprodukcyjnym, w fazie lutealnej cyklu miesiączkowego doświadcza pewnych dolegliwości natury somatycznej i psychicznej. U 20% z nich nasilenie tych objawów jest istotnie kliniczne. Wiele kobiet z tej grupy spełnia kryteria zespołu napięcia przedmiesiączkowego (PMS). Przedmiesiączkowe zaburzenia dysforyczne (PMDD) są bardziej nasiloną i upośledzającą funkcjonowanie formą zespołu napięcia przedmiesiączkowego i występują u 5 do 8% miesiączkujących kobiet. Diagnoza PMS/PMDD powinna być potwierdzona prospektywnie w 2 kolejnych cyklach menstruacyjnych. Istotne jest również wykluczenie innych zaburzeń psychicznych i somatycznych, których objawy mogą ulegać zaostrzeniu w fazie lutealnej cyklu. Nie jest znana dokładna etiologia zespołów przedmiesiączkowych. Wyniki badań sugerują, że czynnikiem predysponującym do wystąpienia PMS/PMDD jest nadmierna wrażliwość na fizjologiczne wahania stężeń hormonów płciowych. Konsekwencją tego zjawiska są prawdopodobnie zaburzenia neurotransmisji serotoninergicznej i gabaergicznej. Istnieje kilka skutecznych opcji terapeutycznych tych zespołów: leki przeciwdepresyjne o serotoninergicznym mechanizmie działania (selektywne inhibitory wychwytu zwrotnego serotoniny, wenlafaksyna i klomipramina), doustne środki antykoncepcyjne zwierające drospirenon oraz agoniści GnRH. Prezentowany artykuł jest krótkim przeglądem aktualnych danych na temat epidemiologii, neurobiologii i metod leczenia PMS/PMDD.
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