PMS and PMDD Flashcards
(11 cards)
What is PMS?
American College of Obstetricians and gynaecologists diagnostic criteria is as follows for PMS. Need to have at least one symptom before the period.
AFFECTIVE
* Depression
* Angry outburst
* Irritability
* Anxiety
* Confusion
* Social withdrawal
SOMATIC
* Breast tenderness
* Abdominal bloating
* Headache
* Swelling of extremities
What are the symptoms of PMS?
90 % of women experience some symptoms of PMS.
At least 150 symptoms!!
Many women do sympton tracking, they do prospective daily monitoring of symptoms over at least three menstrual cycles.
Symptoms follow ovulation, and usually clear up once menstruation has started, or soon
after.
What are the causes of PMS?
When is it PMS, and when is it PMDD?
* Ovarian steroid fluctuations
* CNS neurotransmitters
* Genetic predisposition
* Social expectations
Many theories about what causes PMS and how it involves the Hypothalamus, Thyroid, Pineal Gland & Pituitary Gland
There is a high density of receptors in the brain that regulate emotions; sex hormones affect these receptors.
Progesterone receptors
PMS might be from abnormal response to normal hormonal levels.
Or stress hormones might block progesterone receptors, plus… oestrogen needed for
priming the receptors
What is the link between hormones and neurotransmitters?
“Neurostransmitters very much affect mood, and those in turn can be affected by levels of hormones plus many other things. Progesterone and oestrogen has a wide range of effects on neurotransmitters, glutamate, GABA, dopamine, serotonin
As ovarian hormones fluctuate during cycle so do those neurotransmitters
Lets look at GABA receptors - GABA has a trasnquilising affect
* One of the progesterone metabolites, allopregnanolone. has high affinity for the GABA receptors - it has a sedative effect, and suppresses glutamate response, so progesterone has normally anxiolytic, analgesic, sedative, anaesthetic effects.
* Severity of mood symptoms might be/ can be related to the allopregnanolone serum concentrations in an inverted U-shaped curve.
* A little/Low levels or progesterone, are calming, but very high levels can cause anxiety
* Levels more commonly arising at ovulation, then fall as progesterone levels fall in late luteal phase.
Allopregnanolone and stress
* However - progesterone not same effect on all women, some have excessive sensitivity, and normal levels cause anxiety.
* Chronic stress can lead to lower levels of allopregnanolone, and the chronic stress can cause a blunted allogprenalaone response to acute stress.
* Study confirms altered sensitivity to allopregnanolone in pmdd patients.”
What is the link with serotonin?
Serotonin
* Lowering of serotonin levels in the body can give rise to PMS-like symptoms (mood, sleep,
eating behaviour, depression, suicide, aggression)
* SSRIs shown to be effective, but not in all women
* Serotonin receptor concentration varies with changes in oestrogen and progesterone levels- during the whole month cycle.
What is the link with endorphins?
Endorphins are natural opiates in the brain,
and elicit a sense of wellbeing.
* Endorphins high-> LH low.
* High level endorphins are normal stress response, and tend to suppress the hpa axis,
decreasing therefore LH secretion.
What is the link with Melatonin and Cortisol?
Melatonin also has an impact
* Women with PMDD exhibit disturbances
in circadian rhythms, and decreased levels of melatonin in the luteal phase
* Melatonin is derived from serotonin;
* This may explain effectiveness of SSRIs as well as beneficial effects of tryptophan rich foods.
Cortisol
There is a lack of consistent evidence for cortisol dysregulation in PMS/PMDD - stress response is an important aspect related to PMS however
What is the link with Aldosterone?
Aldosterone - fluid retention
* Magnesium deficiency - low magnesium levels and high progesterone is associated with elevated aldosterone levels
* Stress might increase aldosterone
What is the link with Latent Hyperprolactinaemia?
Prolactin is linked to latent Hyperprolactinaemia
* Oestrogen increases prolactin secretion
* Low thyroid function related to higher prolactin levels
* Low Dopamine levels; lead to elevation of prolactin.
* Studies show women with PMS shown to release prolactin levels at greater physiological amounts in response to stressful situations
How do nutrients impact?
Nutrients might also impact
* Fluctuations of calcium regulating hormones
across menstrual cycle with evidence of
vitamin D def.
* B vitamins, required to synthesize
neurotransmitters. B 6 normalises low intracellular magnesium levels, B6 deficiency leads to increase tissue sensitivity to
oestrogen.
* Iron needed for conversion of tryptophan into 5-hydroxytryptophan, low iron levels to be associated with a higher risk of postpartum depression.
* There is an interaction between alcohol and GABA receptors, low dose alcohol, resulted in decreasing peripheral allopregnenolone levels (so anxiety increases, explains how
alcohol increases PMS symptoms).
* Exercise itself has a big impact on hormones: decreases levels of prolactin, oestradiol and progesterone
What is the orthodox treatment for PMS?
Treatment
* SSRIs
* Anxiolytics
* Oral contraceptives, transdermal oestrogens
* Induce medical menopause, with HRT to prevent side effects.
* Bromocriptine for breast swelling
* Analgesics
* Prostaglandin related treatments, e.g. Mefenamic acid, naproxen
We commonly see this in a herbal clinic - GPs can only prescribe SSRIs which some feel are heavy duty but they cannot use evening primrose oil or similar.
