Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder

Abstract

Objective Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol (E2) and progesterone (P4) have been implicated in the pathophysiology of menstrually related mood disorder (MRMD). However, no prospective studies have investigated psychosocial risk factors for sensitivity to hormone effects on mood in MRMD. Using a repeated measures approach and multilevel models, we tested the hypothesis that a history of abuse provides a context in which within-person elevations of E2 and P4 prospectively predict daily symptoms. Method 66 women with prospectively-confirmed MRMD recruited for a trial of oral contraceptives provided 1 month of baseline hormone and mood data prior to randomization. Lifetime physical and sexual abuse experiences were assessed. Across one cycle, women completed daily measures of symptoms and provided blood samples on 5 days across the menstrual cycle. Current E2 and P4 were centered within person (CWP) such that higher values represented cyclical elevations in hormones. Results Rates of physical (27%) and sexual (29%) abuse were high, consistent with previous work documenting a link between trauma and MRMD. In women with a history of physical abuse, cyclical increases in P4 predicted greater mood and interpersonal symptoms on the three days following that sample. In women with a history of sexual abuse, cyclical increases in E2 predicted greater anxiety symptoms on the three days following that sample. Conclusions Results inform further inquiry into the role of severe life stressors and stress response systems in MRMD. We discuss areas for future research on the psychosocial and physiological pathways through which abuse may influence the link between hormones and symptoms.

Menstrual Cycle Changes in Vagally-Mediated Heart Rate Variability Are Associated with Progesterone: Evidence from Two Within-Person Studies

“…Individuals affected by PMDD are therefore ascribed hormone sensitivity [59]. Previous research traced inter-individual differences in hormone sensitivity (indicated by the emergence of PMDD symptoms) back to, for example, traumatic experiences in the woman's biography [60][61][62][63]. In the light of the present work, the question is whether intra-individual fluctuations of HRV across the cycle may be a physiological marker of hormone sensitivity (comparable to traumatic experiences as a biographical marker).…”

Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS)

“…Expert diagnoses (coauthor DR) of MRMD made prior to the development of the C-PASS (on the basis of identical data) were available for the majority of our sample (193 women; 96.5%). Because the DRSP summed total score demonstrates inadequate reliability of change 17 , descriptive statistics for single items are considered.…”

Premenstrual Disorders: A Primer and Research Agenda for Psychologists

“…However, another study in a sample of patients with prospectively-diagnosed PMDD found that the strength of the daily link between progesterone levels and symptoms was stronger in patients with histories of trauma exposure, suggesting a possible influence of trauma on the severity (rather than the occurrence) of luteal phase symptoms in PMDD (Eisenlohr-Moul et al, 2016). In addition to historical trauma exposure, current stress may increase risk for PMDD symptoms.…”