Biochemical hypotheses of premenstrual tension syndrome

Abstract

EDITORIALBiochemical hypotheses of premenstrual tension syndrome 1 As information has evolved concerning the incidence of cyclical emotional changes preceding the onset of menses, the premenstrual tension syndrome (PMT) has gained increased attention in both the lay and professional literature. Although there has been some disagreement as to the exact nature, the time of occurrence, or even the existence of PMT (Koeske, 1981), there is considerable consensus that the PMT syndrome indeed exists (Janowsky et al. 1966(Janowsky et al. , 1967(Janowsky et al. , 1969(Janowsky et al. , 1973. Steiner et al. (1980) and Halbreich & Endicott (1982) have now operationalized psychodiagnostic criteria for PMT which can allow separate studies to attain diagnostic consensus more accurately.Several methodological problems in PMT research have limited exploration of how premenstrual physiology might influence mood. A major problem has been the strong reliance on the use of correlative techniques. Many hormones,, electrolytes, neurotransmitters and somatic parameters change within the menstrual cycle, and a tradition has existed for assuming the aetiological importance of a favourite correlate which changes premenstrually. Although such correlations are a reasonable place to start, it may be naive to believe that temporal correlations necessarily imply aetiology.Another problem in PMT research is the general assumption that circulating ovarian-linked hormones as such are of fundamental significance in triggering and sustaining premenstrual emotional symptoms. It is equally possible that central neurotransmitters, neuromodulators, and neuroendocrine mechanisms control the onset and intensity of PMT, and that peripheral ovarian and other hormonal changes are merely simultaneous epiphenomena, and/or are driven by the above central influences, but do not actually exert behavioural effects.The use of retrospective reports in PMT research has caused additional problems, with exaggerated incidences being reported, probably due to societal expectations (Koeske, 1981; Parlee, 1973;Sommer, 1978). In contrast, the incidence of PMT symptoms reported usually is relatively low in prospective PMT studies. Thus, many subjects who report PMT do not show symptoms in actual experiments. Also, since the intensity of PMT may vary from month to month (Green, 1982), such variation may introduce serious inconsistencies and variance problems into research studies. One recent step forward in this area has been the administration of repeated mood and behavioural ratings to prospective subjects over several cycles to screen for and document cyclic emotional changes before a given subject is used in a specific PMT study.Also, there is some evidence that the stress of the experimental method itself may influence and confound studies exploring menstrual cycle-behavioural relationships (Koeske, 1981;Parlee, 1982). Conversely, a major impediment to understanding and treating PMT has been its remarkable sensitivity to treatment by placebo. Many promising aetiol...

“Female Preponderance” of Depression in Non-clinical Populations: A Meta-Analytic Study

“…The change in gender difference with age is not consistent with the biological or evolutionary theories. A biological account of gender difference, which suggests that the influence of female hormones as the cause ( Janowsky and Rausch, 1985 ), is not consistent with the similar gender difference in the level of depressive symptoms in the middle-age and the older adult groups. We would expect female hormone levels to be different in these two periods of the human lifespan.…”

“…Second, the biological susceptibility theory is based on the observation that clinical depression tends to be associated with events in the female reproductive cycle. Thus, the effect of female hormones has been proposed as a potential cause for the observed gender difference in depression ( Janowsky and Rausch, 1985 ). Third, evolutionary psychologists have noted that males tend to value physical appearance more than females when choosing a partner.…”

Psychophysiological responses in women reporting severe premenstrual symptoms.

“…However, the pattern of change has proved inconsistent, with reports of greater autonomic reactivity in the follicular than in the luteal phases (3), the reverse effect (4), or only slight differences between the phases (5)(6)(7). Studies related to PMS have usually involved experimental testing during the premenstrual period rather than earlier portions of the luteal phase, since it has been suggested that central nervous system disturbances may lead to alterations of autonomic control and reactivity to stress (8,9). Yet investigations specifically focusing on this phase have also failed to identify robust patterns of response (10)(11)(12)(13).…”

Effects of Expectations and Bodily Sensations on Self-Reports of Premenstrual Symptoms

“…Most studies bearing on the bodily sensations hypothesis have revealed mixed results. Although several literature reviews have concluded that fluctuating levels of ovarian hormones are not associated with the experience of premenstrual symptoms (Abplanalp, 1983;Clare, 1985;Gannon, 1985;Green, 1982;Janowsky, 1985;Rubinow & Roy-Byrne, 1984), a few studies have found a temporal association between hormonal changes and symptom experience Hammarback, Damber, & Backstrom, 1989;Schechter, Bachmann, Vaitukaitis, Phillips, & Saperstein, 1989). In addition, although some research findings suggest that women with prospectively confirmed reports of menstrually related mood disorder do not differ from asymptomatic control women in the amount or pattern of hormone secretion throughout the menstrual cycle (Rubinow et al, 1988;Sondheimer, Freeman, Scharlop, & Rickels, 1985), other research has found differences in estrogen and pregnanediol levels between PMS patients and controls (Dennerstein, Spencer-Gardner, Brown, Smith, & Burrows, 1984).…”