Premenstrual Syndrome and Premenstrual Dysphoric Disorder as Centrally Based Disorders

Abstract

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) encompass a variety of symptoms that occur during the luteal phase of the menstrual cycle and impair daily life activities and relationships. Depending on the type and severity of physical, emotional or behavioral symptoms, women of reproductive age followed for at least two prospective menstrual cycles may receive one of the two diagnoses. PMDD is the most severe form of PMS, predominantly characterized by emotional and behavioral symptoms not due to another psychiatric disorder. PMS and PMDD are common neuro-hormonal gynecological disorders with a multifaceted etiology. Gonadal steroid hormones and their metabolites influence a plethora of biological systems involved in the occurrence of specific symptoms, but there is no doubt that PMS/PMDD are centrally based disorders. A more sensitive neuroendocrine threshold to cyclical variations of estrogens and progesterone under physiological and hormonal therapies is present. Moreover, altered brain sensitivity to allopregnanolone, a metabolite of progesterone produced after ovulation potentiating GABA activity, along with an impairment of opioid and serotoninergic systems, may justify the occurrence of emotional and behavioral symptoms. Even neuro-inflammation expressed via the GABAergic system is under investigation as an etiological factor of PMS/PMDD. Pharmacological management aims to stabilize hormonal fluctuations and to restore the neuroendocrine balance. The rationale of suppressing ovulation supports prescription of combined hormonal contraception (CHC). Its effect on mood is highly variable and depends on biochemical characteristics of exogenous steroids and on type and severity of symptoms. Hormonal regimens reducing the estrogen-free interval or suppressing menstruation seem better choices. Psychoactive agents, such as serotonin reuptake inhibitors (SSRIs), are effective in reducing the symptoms of PMS/PMDD and may be prescribed continuously or only during the luteal phase. Novel therapeutic approaches include inhibition of progesterone receptors in the brain, i.e., with ulipristal acetate, reduced conversion of progesterone with dutasteride, and modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone.

Prevalence and correlates of premenstrual syndrome and premenstrual dysphoric disorder among women aged 18-25 in Turkey

“…The factors confirmed to be the common associated factors for PMS and PMDD in the literature were considered when determining the inclusion and exclusion criteria for the participants. 1,3,9 In this way, it was aimed to focus on associated factors that are not commonly known.…”

“…However, prevalence rates vary widely in different studies and countries depending on the characteristics of participants, personal attitudes, lifestyle, stressors, socio-cultural factors, environmental conditions, and different diagnostic criteria. [3][4][5] Although the meanings attributed to menstruation vary between societies, it is reported that there are many taboos and myths related to this period, especially in low and middle-income countries. Women who faced negative attitudes experience body dysfunction and perceive themselves as "dirty" and as a result, isolate themselves in their work/school and social lives.…”

“…[6][7][8] For diagnosing of PMS, the most commonly used diagnostic criteria are those of American College of Obstetricians and Gynecologists (ACOG). 3,9 ACOG has published 10 diagnostic criteria for PMS. PMS is diagnosed when at least one of the six affective (depression, angry outbursts, anxiety, irritability, confusion, and social withdrawal) and at least one of the four somatic symptoms (breast tenderness, abdominal bloating, headache or swelling of extremities) are experienced in the luteal phase of three consecutive cycles and disappeared within four days of the onset of bleeding.…”

Premenstrual Syndrome Clinical Manifestations Peculiarities in Adolescents

“…Так, в публикациях отмечены следующие явления, возможно, приводящие к развитию ПМС и ПМДР: генетическая теория о полиморфизме генов усвоения и метаболизма триптофана. Результатом такого полиморфизма является низкий уровень серотонина с вытекающими симптомами психоэмоциональных проблем [10]. Заслуживающими внимания являются и другие нейроэндокринные теории: снижение активности рецепторов дофамина, пульсовое ночное повышение пролактина, «неправильное» восприятие прогестерона и его метаболитов в ЦНС, а также длительная дизадаптация к стрессу [10][11][12][13].…”

“…Современные подходы к терапии ПМС/ПМДР ориентированы на подавление овуляции с помощью комбинированных гормональных контрацептивов, что особенно Как же в такой ситуации проявляет свои свойства Vitex Agnus Castus? Одним из первых хорошо изученных и описанных свойств этого растения является снижение уровня пролактина по дофаминергическому механизму (D 2 ) [10,11]. А как проявляется лечебный эффект при нормальных показателях пролактина?…”