Trigger PMS Symptoms -- But Susceptibility
Still a Mystery
article syndicated from NIH
Premenstrual syndrome, or PMS, is an "abnormal response
to normal hormonal changes," report National Institute
of Mental Health (NIMH) researchers David Rubinow, M.D.,
and Peter Schmidt, M.D., in the January 22 New England
Journal of Medicine. "Women with PMS have a specific
susceptibility for mood problems triggered by normal monthly
cycles," said the researchers.
Their study is the first to directly demonstrate the widely assumed--yet heretofore
unproven--link between female sex hormones and PMS symptoms. PMS affects 3 to
7 percent of women, causing mood swings and physical symptoms that can interfere
with work and social life.
Women with a history of the disorder experienced a reprieve from mood problems
when their sex hormones were temporarily turned off, but the PMS symptoms returned
when they were given either estrogen or progesterone, the major female reproductive
hormones. A control group of women without PMS reported no mood shifts during
the same hormonal manipulations.
The researchers compared mood ratings of 10 patients whose PMS responded to leuprolide,
a drug that suppresses sex hormones in both men and women, with those of 15 women
without PMS. The hormones were first removed and then reintroduced one at a time
to reveal whether estrogen or progesterone alone could account for the mood changes.
Each woman was placed on month-long courses of leuprolide alone and leuprolide
in combination with estrogen, progesterone and placebo. Each then rated her own
severity of symptoms nightly on standardized forms that covered various aspects
of mood as well as physical sensations like food craving, hot flushes and breast
pain. Investigators obtained additional ratings, as well as blood for hormone
assays, during biweekly visits to the NIMH clinic.
Within a week or two after either sex hormone was added back, the women with
PMS began suffering typical symptoms of the disorder--sadness, anxiety, bloating,
irritability and impaired function. The control women reported no change. Yet,
the NIMH researchers found no apparent differences between the two groups of
women--both groups had normal menstrual cycles in terms of hormone levels and
"Although the female sex hormones need to be present to trigger PMS symptoms,
the hormones themselves are not the cause of the disorder," said Rubinow.
The researchers are pursuing clues to explain what may cause the susceptibility
to PMS in some women but not others. One possibility now being investigated is
genetic differences in the sensitivity of receptors and related messenger systems
that relay sex hormone signals within cells. Other clues include possible differences
in patients' histories of other mood disorders or in serotonin function.
The NIMH researchers are currently seeking women in the perimenopause, women
with PMS, and men with mid-life depression who might be interested in participating
in ongoing studies aimed at identifying factors responsible for the differential
mood responses to sex hormones.
in the current study were: Linda Adams of NIMH; Merry Danaceau, R.N., NIH Clinical
Center Nursing Department; and Lynnette Nieman, M.D., National Institute on Child
Health and Human Development.
NIMH is a component of the National Institutes of Health, an agency of the
U.S. Department of Health and Human Services.
syndicated from National
Institutes of Health:
EMBARGOED FOR RELEASE - Wednesday, January 21, 1998
- 5:00 PM Eastern Time