Premenstrual Syndrome (PMS) and Premenstrual Dysophoric Disorder (PMDD)

Tueré D. BrannumPathophysiology Project

What is PMS/PMDD? Premenstrual Syndrome (PMS) is classified as a symptom or a series

of symptoms of physical and/or emotional changes that women experience about a week or two before their period begins for that month.

It is a condition that is ignited in women by the hormonal modifications which normally occur right after ovulation in the luteal phase of menstruation (when the ovary releases an egg) (Matsumoto, et.al).

When symptoms (such as depression) are noted as more severe and frequent, the condition is known as Premenstrual Dysphoric Disorder (PMDD).

All studies within my research indicate that the exact cause of PMS is

unknown.

Who is affected by PMS/PMDD? PMS has been reported to affect women between the ages of 30-

45 years old. However, women who are categorized as being in their reproductive years (ages before 30) can also be candidates. Some women over 45 have reported experiencing PMS symptoms as well.

In an early epidemiological study of PMS and premenstrual dysphoric disorder (PMDD), 92% of women experienced some form of PMS at some point in time.

In the same study, it showed that “less than 10% [of women] experienced symptoms that were severe or [of a] disabling nature” (p. 264, Bahamondes, et. al). This would be classified as PMDD.

Some Symptoms of PMS/PMDD Bloating Cramps Acne Irritability Depression Anxiety Headaches Nausea Breast Tenderness Cravings

The Pathogenesis of PMS A decrease in the synthesis of serotonin (an important neurotransmitter)

during the luteal phase and a change in the amount of estrogen and progesterone have been noticeable contributing factors in those who are experiencing PMS and PMDD. › Serotonin – serotonin is produced with the help of tryptophan. It is interesting

that serotonin cannot “cross the blood-brain barrier” and therefore is separated and housed in both the Central Nervous System (CNS) and the peripheral system (Namkung, J. et. al).

› In the CNS, serotonin is produced in the brainstem as well as the hypothalamus. Since it functions as a neurotransmitter in the CNS, it is the regulator of mood (Merens et al., 2007; Young and Leyton, 2002), sleep-wake behavior (Monti, 2011) and food intake (Lam et al., 2010)” (Namkung, J., et.al).

› 90% of serotonin is produced in the “gut and pineal gland” in the peripheral system. (Namkung, et.al)

What causes the decrease in serotonin?

Pathogenesis, cont. Those who have high levels of stress, poor exercise habits and poor

nutritional habits are potential candidates for PMS and PMDD.

This is a really good animation that briefly explains the pathogenesis of PMS:

https://www.videum.com/video/pms-1/#.WDzhLDaa3IU Here is a clip provided by youtube.com

The Pathophysiology of PMS During the luteal phase of the cycle, when estrogen and

progesterone levels may not be evenly distributed, serotonin levels may also be altered.

In the study provided by Firoozi (et. al. p. 39), during the luteal phase of a menstrual cycle, lower levels of serotonin, B-endorphin and game amino butaricacid (GABA) displayed negative mood symptoms and emotional reactions in women.

What physiological changes lead up to the development of this disease?

Another study suggests that a malfunctioning of the hypothalamic-pituitary-adrenal axis (HPA) “which leads to defect in adrenal hormone secretion, nutritional defects and environmental factors are the main factors for PMS” (

Remedies/Treatments Due to the vitamin and mineral deficiency during the menstrual cycle, one should

increase their intake of calcium, magnesium, vitamin D, vitamin B6 and vitamin E. Over indulging in alcohol and caffeine can heighten PMS symptoms.

There are over the counter medicines or hormonal drugs that can be prescribed to help minimize PMS symptoms. Prescriptions such as selective serotonin reuptake inhibitors (SSRIs). According to Shah, N. (et. al) SSRIs are “currently considered the most effective pharmacologic class for the treatment of symptoms related to severe PMS and PMDD”.

Home remedies can be of assistance:› Healthy nutrition› Increasing vitamins and minerals› Exercise › An understanding support system› Counseling and therapy can help with the mental troubles that PMS and PMDD

can cause.

Remedies/Treatments, cont.

Natural Remedies› B6, Magnesium, Calcium› Primrose oil

How does PMS integrate with this course?

In this course, we have learned “how the body responds to disease and adverse circumstances” (Module 1, Overview ISCI647b). We covered how the major body systems can be compromised, as well as how they operate when compromised. The female reproductive system can function as normal, however there can be adverse reactions in other areas.

The 3 systems that PMS closely integrated with in this course were the:

Reproductive System – (female reproduction processes introduce a dynamics of hormones)

Endocrine System – (i.e. thyroid imbalance (hormone synthesis))

Nervous System – (i.e. depression, anxiety, headaches, etc.)

THE BIG PICTURE: Does PMS make sense as an adaptive

response?

Is this based on theory, evidence or both?

Optional Extras:CRAMPS

PMS

Self-check:

ReferencesDirekvand-Moghadam, A., Sayehmiri, K., et. al. (2014). Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. 2014 Feb; 8(2): 106–109. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972521/

Firoozi, R., Kafi, M., Salehi, I., and Shirmohammadi, M. (2012). The Relationship between Severity of Premenstrual Syndrome and Psychiatric Symptoms. Iranian J Psychiatry 7:1, Winter 2012.

Imai, A., Ichigo, S., Matsunami, K., Tagi, H. (2015). Premenstrual syndrome: management and pathophysiology. Clinical And Experimental Obstetrics & Gynecology [Clin Exp Obstet Gynecol] 2015; Vol. 42 (2), pp. 123-8.

Matsumoto, T. (et.al).(2007). Altered autonomic nervous system activity as a potential etiological factor of premenstrual syndrome and premenstrual dysphoric disorder. Retrieved November 2016 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253548/

Namkung, J., Hail, K. (et.al).(2015). Peripheral Serotonin: a New Player in Systemic Energy Homeostasis. Mol 2015 Dec 31; 38(12): 1023–1028. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696992/

Nikam, S., MayuraChavan, Sharma, PH. (2014). Premenstrual Syndrome-Causes, Symptoms, Diagnosis and Treatment. International Journal of Pharmaceutical, Chemical & Biological Sciences. Oct-Dec2014, Vol. 4 Issue 4, p829-833. 5p.

Shah, N., Jones, J.B., Aperi, J. et.al. (2008). Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Obstet Gynecol. 2008 May; 111(5): 1175–1182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670364/

VanMeter, K. and Hubert, R. (2014). Gould's Pathophysiology for the Health Professions. Ch. ISBN: 978-1-4557-5411-3

References