Altered autonomic nervous system activity as a potential etiological factor of premenstrual syndrome and premenstrual dysphoric disorder

Takahisa Ushiroyama,Tamaki Matsumoto,Tatsuya Hayashi,Toshio Moritani,Tetsuya Kimura

doi:10.1186/1751-0759-1-24

Abstract

BackgroundPremenstrual syndrome (PMS) encompasses a wide variety of cyclic and recurrent physical, emotional, and behavioral symptoms occurring during the late luteal phase of the menstrual cycle and abating shortly following the beginning of menses. Although PMS is widely recognized, its etiopathogenesis is not yet understood. The present study investigates whether the activity of the autonomic nervous system, which plays a vital role in orchestrating physiological homeostasis within the human body, is altered during the menstrual cycle of women with different degrees of premenstrual symptomatology.MethodsSixty-two women in their 20s to 40s with regular menstrual cycles participated in this study. All subjects were examined during the follicular and late luteal phases. Cycle phase was determined by the onset of menstruation and oral temperature and was verified by concentrations of ovarian hormones, estrone, and pregnanediol in a urine sample taken early in the morning. Autonomic nervous system activity was assessed by means of heart-rate variability (HRV) power spectral analysis during supine rest. The Menstrual Distress Questionnaire was used to evaluate physical, emotional, and behavioral symptoms accompanying the menstrual cycle of the subjects. The subjects were categorized in three groups, Control, PMS, and premenstrual dysphoric disorder (PMDD) groups, depending on the severity of premenstrual symptomatology.ResultsNo intramenstrual cycle difference in any of the parameters of HRV was found in the Control group, which had no or a small increase in premenstrual symptoms. In contrast, Total power and high frequency power, which reflect overall autonomic and parasympathetic nerve activity, respectively, significantly decreased in the late luteal phase from the follicular phase in the PMS group. As for the PMDD group, which had more severe symptoms premenstrually, heart-rate fluctuation as well as all components of the power spectrum of HRV were markedly decreased regardless of the menstrual cycle compared to those of the other two groups.ConclusionSeveral theories have been proposed to explain the underlying mechanisms of PMS with its complex web of bio-psycho-social factors. Although causes and consequences continue to elude, the present study provides intriguing and novel findings that the altered functioning of the autonomic nervous system in the late luteal phase could be associated with diverse psychosomatic and behavioral symptoms appearing premenstrually. In addition, when symptoms become more severe (as seen in women with PMDD), the sympathovagal function might be more depressed regardless of the menstrual cycle.

Highlights

Premenstrual syndrome (PMS) encompasses a wide variety of cyclic and recurrent physical, emotional, and behavioral symptoms occurring during the late luteal phase of the menstrual cycle and abating shortly following the beginning of menses
Premenstrual syndrome (PMS) is characterized by the cyclic nature of a collection of psychological, physiological, and/or behavioral symptoms appearing during the late luteal phase of the menstrual cycle and usually disappearing shortly after the onset of menses [1,2]
To scrutinize the potential influence of premenstrual discomfort on autonomic nervous system activity, we first categorized the subjects into two groups based on the increase in scores on the Menstrual Distress Questionnaire (MDQ) from the follicular to the late luteal phase while referring to the findings from our recent study [13], i.e., 28 subjects in the Control group and 23 subjects in the PMS group

Summary

Introduction

Premenstrual syndrome (PMS) encompasses a wide variety of cyclic and recurrent physical, emotional, and behavioral symptoms occurring during the late luteal phase of the menstrual cycle and abating shortly following the beginning of menses. Premenstrual syndrome (PMS) is characterized by the cyclic nature of a collection of psychological, physiological, and/or behavioral symptoms appearing during the late luteal phase of the menstrual cycle and usually disappearing shortly after the onset of menses [1,2]. Epidemiological studies, including those in Japan, have shown that up to 90% of women of childbearing age experience at least some degree of premenstrual symptomatology, with an estimated 3–8% having symptoms severe enough to disrupt everyday life and/or interpersonal relationships and to be classified as premenstrual dysphoric disorder (PMDD) [3,4]. We investigated the extent to which and the manner in which the menstrual cyclicity of autonomic nervous system activity relates to a constellation of diverse symptoms appearing in the late luteal phase

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Results

Discussion

Conclusion