Heart hurts and presses before menstruation: causes of pain and what to do?


PMS is a cyclic symptom complex that occurs due to changes in hormonal levels before and during menstruation. Its manifestations are classified into three large groups: vegetovascular disorders, neuropsychiatric disorders, and metabolic and endocrine dysfunction.

Despite the division of the syndrome into five forms - vascular, neuropsychic, edematous, cephalgic and atypical - most often women have symptoms from several groups that can mutually reinforce each other. For example, puffiness, emotional instability and vascular disorders lead to severe pain in the heart area before menstruation.

The most complete causes of PMS are explained by hormone theory. According to her, the unpleasant symptoms are a consequence of the disproportion of estrogen and progesterone against the background of increasing concentrations of prolactin. Water-salt and genetic theories of the development of premenstrual syndrome are in development, but their acceptance in attention in some cases helps the specialist to help the patient more quickly.

Why does the heart ache during menstruation?

A sharp change in the ratio of the amount of estrogen and progesterone provokes irritability, mood swings and tearfulness. The increase in the number of emotional stress in the presence of cardiac pathologies can turn into an attack of angina. But even in the absence of heart disease, impaired regulation of the functions of the peripheral nerves and over-stimulation of the central nervous system leads to aching pain.

Excess estrogen, which is necessary for the rejection of the endometrium, also explains the water retention in the tissues. According to statistics, swelling is observed in 50% of women. Water retention is most characteristic of those who have a high level of androgens, estrogen and the “happiness hormone” - serotonin, a few days before menstrual bleeding.

Heart pain is manifested not only as a result of swelling of the internal organs, but also because of the engorgement of the mammary glands. Their expanding lobes squeeze the nodes and nerves in the sternum, which provokes pain.

Fluid retention is enhanced by active production of the hormone prolactin. In addition to edema, an excess of this substance explains the increase in blood pressure and tachycardia. Prolactin prolongs the excitation phase in myocardial cells during contraction of the heart, which leads to the emergence of acute pain that appears cyclically.

Pain can also occur in the absence of excessive hormone production. They are caused by prostaglandins - biologically active substances of lipid origin. They are allocated dying cells and create a "beacon" for immunity. The prostaglandins isolated from the rejection of the endometrium cause pain in various human organs and systems: the spleen, the gastrointestinal tract, the heart, the musculoskeletal system.

Soreness in the sternum is most characteristic of the ICP form of crises. When it is marked "panic attack syndrome", manifested by pressure drops, fear of death, abdominal cramps, chills, frequent pulse and heartbeat. The end of the attack is accompanied by the urge to urinate.

With the onset of menstruation, most of the unpleasant effects disappear, but with intense manifestations of 5-12 symptoms at once, heart pain continues during menstruation.

Communication of pain in the heart and the menstrual cycle

The menstrual cycle of the female body is characterized by periodic changes in the tissues and organ systems caused by the gradual increase and decrease in the concentration of sex hormones. There are two phases of the cycle:

  • follicular (from the first day of menstruation to ovulation, 14-15 days), which is characterized by the minimum amount of estrogen and progesterone in the blood. At this time there is a proliferation of the endometrium of the uterus for future implantation of the egg. In the middle of the follicular phase, the level of estrogen begins to rise, which reaches a maximum at the time of ovulation.
  • luteal (from the moment of ovulation until the first day of menstruation) - an increased synthesis of progesterone by the corpus luteum in the ovaries occurs.

The occurrence of cardialgia (pain in the heart) during menstruation, or in the first days after, is associated with a low concentration of estrogen and progesterone. Estrogens provide vasoprotective ("vessel protection") function from the formation of atherosclerotic plaques, which are the basis of coronary heart disease (CHD).

Hormonal action aimed at preventing spasm of the vascular muscles is implemented through the blockade of channels that transport calcium ions inside the muscle fibers for adequate contraction.

In addition, the presence of special estrogen receptors in the heart, which determine the activity of nitrogenogenic synthase, has been proven. The latter is an enzyme that provides the release of nitric oxide, which expands the pathologically constricted vessels of the heart. The low concentration of these substances contributes to myocardial ischemia in stressful situations and the development of cardialgia. Characteristics of pain in the heart after menstruation:

  • long, more than 10 minutes
  • squeezing character
  • accompanied by a panic attack with a lack of air,
  • heart palpitations (frequency of more than 90 beats per minute), a sense of heart failure.

The appearance of pain in the heart in the second phase of the menstrual cycle is a rarer occurrence, since a sufficient amount of estradiol and estriol provides a cardioprotective effect.

What to do when chest discomfort on critical days?

The emergence of intense pain in the heart in any phase of the menstrual cycle is an alarming symptom that requires emergency medical care.

In the event of cardiac pain in the first phase of the menstrual cycle (the first 15 days after menstruation), it is necessary to exclude the development of coronary heart disease. The most frequent provocative factor in angina pectoris (one form of CHD) is physical exertion. Cardialgia due to hormonal changes is caused by:

  • emotional shock
  • acute stress factor
  • smoking
  • alcohol intake.

The most effective method of preventing the occurrence of pain is to modify the lifestyle and prevent situations that cause cardialgia.

In order to eliminate the adverse effects of the lability of the nervous system, spasm of smooth muscles of the coronary vessels are used:

  • nitrates (nitroglycerin, Isoket, Nitrosorbit) - drugs that stop angina, restore adequate blood flow through the coronary vessels to the muscle fibers of the heart,
  • calcium channel blockers (pharmadipine, Amlodipine) - used exclusively to eliminate vasospasm,
  • sedatives (Valeriana Extract, Glyced, Novo-Passit) - are used in case of stressful etiology of pain,
  • Cardioprotective drugs (Mildronat, Asparkam, Ritmokor, Corvitin) - substances that increase the resistance of the myocardium to oxygen deficiency.

In addition, regular repetition of episodes of heart pain before the coming months requires a detailed examination of the cardiologist in order to exclude organic heart disease. Also recommended laboratory diagnosis of concentrations of sex hormones in different phases of the menstrual cycle.

Can the heart ache before or during menstruation so that it is not a sign of cardiac pathology?

Acute or pressing pain in the heart can be part of the vegetative or somatic manifestation of PMS. Most often, discomfort in the chest is caused by fluctuations in hormonal levels, problems with the nervous and reproductive systems.

Dishormonal cardiopathy is an insufficiently studied condition, but the links with the cycle have already identified and described the symptoms:

  • Climacteric cardiopathy or cardialgia - occurs due to hormonal changes characteristic of the menopause several years before or after the cessation of menstruation.
  • Characteristic signs: a pressing sensation, pain in the left side of the chest - burning, cutting, piercing. Symptoms can be either short-term or long-term. Occurrence of the described discomfort at night may mistaken for rest angina.
  • The pain can be combined with shortness of breath, a feeling of lack of air.
  • The occurrence of pain syndrome is not associated with physical activity and rest does not eliminate discomfort.
  • Possible loss of consciousness.
  • The pain can be combined with the "tides" - a feeling of heat and increased perspiration. Parasthesia, emotional instability, spasms in the throat, severe headache, dizziness.
  • Vegetative-vascular dystonia, tachycardia are also characteristic. After the attack, there is a noticeable weakness, polyuria, profuse sweating.
  • In rare cases, an attack may be accompanied by the fear of death or a hysterical seizure occurs, accompanied by clonic convulsions.

Similar symptoms are characteristic in adolescence, but more often it does not manifest itself as vividly as before or after menopause.

After the differential diagnosis and screening of cardiac pathologies, treatment is prescribed, which is mainly based on psychotherapy. The essence of the sessions with a specialist is to explain that dyshormonal cardiopathy is not associated with angina and does not threaten health and life.

The use of medicines is necessary only in the case of persistent cardialgia - sedatives are prescribed. In the pubertal period, therapy is not prescribed - the symptoms disappear after the natural establishment of the hormonal background.

Premenstrual syndrome

Premenstrual syndrome is a cyclic complex of symptoms that manifests itself in some girls before menstruation. It is characterized by psychosomatic, vascular and metabolic and endocrine disorders, which are restored at the beginning of a new cycle.

PMS occurs for several reasons: nervous overexcitement, changes in the metabolic processes of the body, disruption of the cardiovascular system, but they are based on one major factor - hormonal alteration.

Psychosomatic manifestations

Psychosomatic disorders during PMS are caused by a decrease in the blood levels of two hormones: estrogen and progesterone. They have a mild sedative, sedative effect. But the number of oxytocin - anesthetic, stimulating active substance - increases, so the nervous system is in constant irritation.

Psychosomatic symptoms are the most "unpleasant", because it manifests itself in the behavior of a woman relative to other people. Aggressiveness and depressiveness increase, irritability, tearfulness, and depression occur.

Many smells, tastes and sounds are perceived by the excited nervous system differently and can cause discomfort. Because of the excitation of the central nervous system, peripheral neurons suffer: a decrease in tactile perception, slight numbness of the limbs, and engorgement of the chest.

Vegetovascular manifestations

Reducing the amount of male sex hormone - testosterone - before menstruation, as well as an increase in prolactin, cause severe edema, change the usual heart rhythm: heartbeat can increase or slow down especially after exercise, alcohol and caffeine. Severe edema increases the amount of circulating blood, so it increases the pressure inside the vessels, and the accumulation of fluid in the tissues of the internal organs leads to squeezing of the nerve endings.

Vegetative symptoms of PMS are such manifestations:

  • headache,
  • dull, aching pain in the heart,
  • puffiness
  • a heartbeat that can increase or slow down
  • dizziness due to dysfunction of the cerebral vessels,
  • high blood pressure,
  • nausea.

Exchange-endocrine manifestations

Menstruation requires changes not only in the level of sex hormones. At the end of ovulation, the synthesis and release of adrenal steroid hormones that regulate salt and glucose metabolism slows down. In the body, various ions of salts linger: potassium, sodium, phosphorus and others, and the amount of glucose in the blood does not change smoothly, but in waves.

Due to changes in the functioning of the adrenal glands, metabolic processes inside the body slow down: edema and weakness appear, physical activity decreases, depression appears, and appetite significantly increases due to glucose jumps.

The effect of hormones on pain in the heart

From the foregoing, it becomes clear that heart pains are part of the psychosomatic and vascular manifestations of PMS, and their main cause is a change in the level of hormones in the blood. Different active substances have different types of effects on the work of the heart muscle and heartbeat, so it is worth discussing them in more detail.

Prolactin is an active substance that is produced in the body during and after ovulation to prepare the mammary glands for milk production in the event of fertilization of the egg and the appearance of the fetus. One of the side effects of this hormone is sodium retention.

This condition causes not only edema, due to which blood pressure rises and heartbeat quickens. Another result of sodium retention is the prolongation of the excitation phase in cardiomyocytes during heart contraction. Overexcitation of cells leads to acute, lightning-like pains, which can appear cyclically every 5-10 seconds and quickly pass.

Estrogen and progesterone

Estrogen and progesterone regulate not only the sexual system of the woman, but also normalize the functioning of the nervous system, providing a mild sedative effect in the case of over-stimulation. It is because of the decrease in their level at the end of ovulation negative psychosomatic changes appear, the work of the peripheral nervous system is disturbed.

Before menstruation, the pain in the heart, caused by a change in the amount of estrogen and progesterone, has a dull, dull character. They appear due to the growing excitation of the central nervous system (brain) and the deterioration of the regulation of the peripheral nerve endings in the organs.


Prostaglandins are substances that cause inflammation and pain. They stand out mostly
infected or dying cells. The role of these substances for the immune system is difficult to underestimate, because they are a beacon for defense cells, calling them to the place of death or infection of body tissues.

When the endometrium begins to reject at the beginning of the menstrual period, the cells of the uterine mucosa die and prostaglandins are secreted. This causes pain not only in the genital system, but also in the corpus organs: heart, liver, spleen, intestines.

The heart begins to hurt suddenly, the discomfort has a dull, aching character and lasts for 2-3 minutes, especially if the girl is given complete peace at this time.

PMS development factors

PMS is not manifested in all girls, so it can be assumed that not only hormonal changes, but also other additional factors are involved in the occurrence of premenstrual syndrome:

  • constant nervous tension
  • lack of minerals, especially potassium and calcium,
  • increased physical activity on the background of ovulation and menstruation,
  • poor diet low in fat
  • bad sleep
  • abuse of caffeine and cigarettes.

These factors greatly enhance the effect of hormonal changes, as well as contribute to the development of pain in the area of ​​the heart muscle.

PMS diagnostics

To the question of many girls, why the heart hurts before menstruation or during them, the diagnosis will help to answer. First of all, it is necessary to apply to three doctors: a cardiologist, a neurologist and a gynecologist. The first specialist should check the woman's heartbeat and, if a valve or other parts of the heart are suspected, give an MRI scan.

If the cardiologist does not find any violations “on his part”, then the gynecologist will be able to collect a history of PMS - symptoms that occur in a woman. After that, you need to take a blood test, urine, check the content of different hormones, glucose, prostaglandins, salt ions (which is especially important for strong edema).

Much less often, the problem of heart pain before menstruation is associated with nervous disorders, the increase in manifestations of which is caused by hormonal disturbances. Therefore, it is worth visiting a neurologist, to conduct an external examination, as well as an EEG analysis, which will show the electrical activity of brain neurons.

Treatment of pain in the heart due to different reasons is different. For example, if a patient has a severe swelling, then before the onset of menstruation, she may be prescribed diuretic drugs or herbs that will help normalize the fluid content inside the body. If there is a disturbance in the work of the nervous system, psychotherapy is necessary in the form of sedative medications or homeopathic remedies. The latter are composed of herbal ingredients, and their high efficiency for the most part arises due to the placebo effect.

Если же причиной болей в сердце стало сильное нарушение гормонального фона, то поможет терапия с использованием гормонов: прогестерона и эстрогена. They calm the nervous system, and also reduce arousal.