Many women experience psychological changes during the luteal phase of their menstrual cycle. The late luteal (premenstrual) phase, when symptoms become most severe, is characterized by declining levels of ovarian progesterone. In female rats, withdrawal from prolonged dosing with progesterone leads to upregulation of α4 and δ subunits of the GABA A receptor in several brain regions. During the oestrous cycle of the rat, the natural fall in progesterone that occurs in late dioestrus is associated with a parallel increase in expression of α4, β1 and δ GABA A receptor subunits in neurones in the periaqueductal grey matter (PAG), suggesting that new receptors of the α4β1δ composition have been formed. Recombinant α4β1δ receptors display a low EC 50 for GABA, which is consistent with activation by extracellular levels of GABA. They are also likely to be located extrasynaptically and to carry tonic currents. In the PAG, a region involved in mediating panic-like anxiety, α4, β1 and δ GABA A receptor subunits are located principally on GABAergic interneurones. On-going GABAergic neuronal activity normally limits and controls the excitability of the panic circuitry. During late dioestrus, when expression of α4, β1 and δ subunits on GABAergic interneurones is upregulated, the increase in tonic current would be expected to lead to a reduction in the activity of the GABAergic population. Thus the panic circuitry would become intrinsically more excitable. It is suggested that during the menstrual cycle in women, plasticity of GABA A receptor subunit expression in brain regions such as the PAG, which are involved in mediating anxiety behaviour, may underlie some of the changes in mood that occur during the premenstrual period. The concept of a link between mood changes and the female reproductive organs is not new. Although Hippocrates had proposed peregrinations of the uterus as the underlying cause of hysterical behaviour in women, it was not until the advent of the twentieth century advances in endocrinology that the link between gonadal hormonal status and mood changes in women was demonstrated unequivocably. The recognition that steroid metabolites of progesterone were neuroactive and could pass through the blood-brain barrier further strengthened the link between female hormones and behaviour. Recent studies of progesterone-linked plasticity of GABA A receptor subunit expression are now beginning to offer an insight into the underlying causes of premenstrual symptoms and related hormone-linked disease states.
Premenstrual symptomsPremenstrual syndrome (PMS) describes a constellation of psychological and somatic symptoms that appear in the latter half of the menstrual cycle in women. They include depression, irritability, anxiety, aggression, avoidance of social activity, breast tenderness and bloating (Steiner, 1997). Typically, the symptoms appear gradually during the luteal phase, worsen during the late luteal phase and have remitted by the end of the menstrual flow. Most women of reproductive age experience one or m...