Altered autonomic nervous system activity evaluated by heart rate variability among women with severe premenstrual emotional distress

Abstract

OBJECTIVE: Premenstrual syndrome (PMS) describes a range of physical, emotional, and behavioral symptoms occurring during the luteal phase. Although PMS is widely recognized, research has not yet clarified its etiopathogenesis. This study investigated whether autonomic nervous system (ANS) activity—a vital player in orchestrating human homeostasis—changed during the menstrual cycle of women with PMS. We also evaluated personality traits as possible agents affecting susceptibility to PMS.DESIGN: A within- and between-subjects study.MATERIALS AND METHODS: This study involved 71 women with regular menstrual cycles. We examined all subjects during the follicular and luteal phases and assessed resting ANS activity by heart rate variability (HRV) power spectral analysis. The Menstrual Distress Questionnaire (MDQ) evaluated subjects' menstrual cycle symptoms. We administered the Yatabe-Guilford Test and the Alexithymia Scale to assess subjects' personality traits and divided subjects into either Control or PMS group, depending on severity of symptoms.RESULTS: Total MDQ scores increased by 67.6% from the follicular to the luteal phase in the PMS group. Psychological factors (negative affection, behavioral change, and concentration) revealed the most remarkable changes between menstrual phases. Total power and high-frequency power—reflecting overall autonomic and parasympathetic nerve activity, respectively—markedly decreased regardless of menstrual cycle in the PMS group compared to the Control group. None of the subjects expressed the alexithymic trait; the PMS group showed other traits, such as cyclic tendency, lack of cooperativeness, and aggressiveness.CONCLUSIONS: This study suggests decreased ANS activity regardless of menstrual cycle in women with severe premenstrual emotional distress. The study also implies that specific psychosocial features may induce unfavorable mind-body interaction, especially premenstrually. OBJECTIVE: Premenstrual syndrome (PMS) describes a range of physical, emotional, and behavioral symptoms occurring during the luteal phase. Although PMS is widely recognized, research has not yet clarified its etiopathogenesis. This study investigated whether autonomic nervous system (ANS) activity—a vital player in orchestrating human homeostasis—changed during the menstrual cycle of women with PMS. We also evaluated personality traits as possible agents affecting susceptibility to PMS. DESIGN: A within- and between-subjects study. MATERIALS AND METHODS: This study involved 71 women with regular menstrual cycles. We examined all subjects during the follicular and luteal phases and assessed resting ANS activity by heart rate variability (HRV) power spectral analysis. The Menstrual Distress Questionnaire (MDQ) evaluated subjects' menstrual cycle symptoms. We administered the Yatabe-Guilford Test and the Alexithymia Scale to assess subjects' personality traits and divided subjects into either Control or PMS group, depending on severity of symptoms. RESULTS: Total MDQ scores increased by 67.6% from the follicular to the luteal phase in the PMS group. Psychological factors (negative affection, behavioral change, and concentration) revealed the most remarkable changes between menstrual phases. Total power and high-frequency power—reflecting overall autonomic and parasympathetic nerve activity, respectively—markedly decreased regardless of menstrual cycle in the PMS group compared to the Control group. None of the subjects expressed the alexithymic trait; the PMS group showed other traits, such as cyclic tendency, lack of cooperativeness, and aggressiveness. CONCLUSIONS: This study suggests decreased ANS activity regardless of menstrual cycle in women with severe premenstrual emotional distress. The study also implies that specific psychosocial features may induce unfavorable mind-body interaction, especially premenstrually.