Females with Diabetes Mellitus Increased the Incidence of Premenstrual Syndrome

Abstract

Background: Premenstrual syndrome (PMS) is a multifactorial disorder caused by hormone and autonomic imbalance. In our study, hyperglycemia-induced insulin secretion increased progesterone secretion and progressive autonomic imbalance. The young patients with diabetes mellitus (DM) revealed hypo-parasympathetic function and hypersympathetic function compared with nondiabetic controls. Young female patients with DM with higher blood sugar and autonomic malfunction may be associated with PMS. However, there is a lack of evidence about DM in females related to PMS. We evaluated female patients with DM who subsequently followed PMS in a retrospective cohort study. Methods: We retrieved data from the National Health Insurance Research Database in Taiwan. Female patients with DM between 20 and 50 years old were assessed by the International Classification of Disease, 9 Revision, Clinical Modification (ICD-9-CM) disease code of 250. Patients who were DM-free females were fourfold matched to the control group by age and disease index date. The ICD-9-CM disease code of 625.4 identified the incidence of PMS followed by the index date as events. The possible risk factors associated with PMS were detected with a Cox proportional regression. Results: DM was a significant risk factor for PMS incidence with an adjusted hazard ratio of 1.683 (95% confidence interval: 1.104–2.124, p < 0.001) in females after adjusting for age, other comorbidities, season, urbanization status of patients and the hospital status of visiting. Conclusion: This study noted an association between DM and PMS in female patients. Healthcare providers and female patients with DM must be aware of possible complications of PMS, aggressive glycemic control, decreased hyperglycemia and autonomic dysfunction to prevent this bothersome disorder.

Emerging Perspectives on the Impact of Diabetes Mellitus and Anti-Diabetic Drugs on Premenstrual Syndrome. A Narrative Review

“…This finding defended the implication of DM in the development of PMS. Contrary, Creţu et al [ 42 ] and Huang et al [ 65 ] described diabetic women with insulin-related hyper-progesterone as being at higher risk for PMS. Regarding the impact of blood glucose level on PMS symptoms, Zarei et al [ 74 ] concluded that hypoglycemia is a stimulating factor of PMS, which is in contrast to Cawood et al [ 63 ] and [ 76 ], who reported some PMS symptoms (like anxiety and food craving) to be correlated to hyperglycemia and not to hypoglycemia.…”

“…It is important to note that hypoglycemia is almost always represented as an acute episode because long-standing hypoglycemia can lead to irreversible brain damage. Through stimulating sympathetic nervous system and catecholamines secretion, hypoglycemia can be manifested with lack of concentration, anxiety, palpitation, nervousness, and irritability that mimic PMS symptoms [ 65 , 72 ]. However, Denicoff et al [ 73 ] concluded that despite the similarities between the symptoms of PMS and hypoglycemia, these two conditions can be effectively distinguished based on their respective spectrum of symptoms.…”

“…SUs have the highest risk of hypoglycemia among the different anti-diabetic drugs. As mentioned before, hypoglycemia associated with catecholamine surge is manifested by PMS-like symptoms [ 65 , 96 ]. Moreover, chlorpropamide, one of the old-generation SUs has the tendency to cause fluid retention due to an anti-diuretic hormone (ADH)-mediated action [ 99 ].…”

“…Although the impact of DM on PMS has been investigated in several studies, the results of those studies are not enough to understand their possible relation. Few studies have considered the possible association between DM and PMS [63][64][65]. Some studies tackled the impact of the different menstrual cycle phases on blood glucose and IR [63,64,[66][67][68][69][70][71][72], while some studies investigated the impact of blood glucose changes on PMS symptoms, but in nondiabetic women [73,74].…”

“…Some studies tackled the impact of the different menstrual cycle phases on blood glucose and IR [63,64,[66][67][68][69][70][71][72], while some studies investigated the impact of blood glucose changes on PMS symptoms, but in nondiabetic women [73,74]. In terms of prevalence, Huang et al [65] noted an association between DM and PMS. In contrast, Machfudhoh et al [75] concluded that children with T1DM have no or only mild PMS.…”