Abstract
Introduction: The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle. Since many symptoms could be related to the autonomic nervous system, we hypothesized that the sympathetic nervous system is perturbed in PMS.Methods: The cardiovascular autonomic profile of nine women with PMS (30.4 ± 2.5 years) were compared to that of nine healthy controls (30 ± 2.5 years) during their early follicular (EF) and LL phases of the menstrual cycle. Plasma norepinephrine (NE) concentrations, power spectral analysis of heart rate and systolic blood pressure (BP), and baroreflex sensitivity (BRS) were assessed during recumbency and a head-up tilt (HUT). Cardiovascular responsiveness to α1- and β-adrenoreceptor agonists (phenylephrine and isoproterenol, respectively) were also assessed.Results: In the LL phase, the plasma NE concentrations in women with PMS during recumbency and a HUT were lower than those in women without PMS [180 ± 30 vs. 320 ± 50 pg/ml; p = 0.04 (recumbent), and 480 ± 70 vs. 940 ± 180 pg/ml: p = 0.02 (HUT)]. In the LL phase, the dose of phenylephrine required to increase systolic BP by 15 mmHg in women with PMS was significantly greater than that in women without PMS (202 ± 30 μg vs. 138 ± 20 μg; p = 0.02). Sympathetic and vagal cardiac control indices were comparable in the two groups in the menstrual phases. In women with PMS, the value of LFSBP in the LL phase was lower than that in the EF phase (0.98 ± 0.2 vs. 1.77 ± 0.4 mmHg2, p = 0.04). The increase in LFSBP in women with PMS in the LL phase during HUT was greater than that in the controls, 5.2 ± 0.9 vs. 3.1 ± 0.5 mmHg2, p = 0.045, and this increase was associated with a significant decrease in BRS.Conclusion: In women with PMS without psychogenic symptoms, the sympathetic control of their circulation is not dominant during the LL phase of their menstrual cycle.
Highlights
The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle
Our findings on changes in plasma NE concentrations in two different phases of the menstrual cycle are in agreement with those of Blum et al Previously, we reported that plasma renin activity and plasma aldosterone levels are increased during the LL phase of the menstrual cycle of women with PMS and these increases could account for their increased fluid retention (Rosenfeld et al, 2008)
We found that vagal and sympathetic cardiac control were comparable in the two groups of women when they were recumbent and during a 60◦ head-up tilt (HUT). de Zambotti et al (2013) reported that cardiac autonomic control and cardiac vagal tone are similar in the early follicular (EF) and LL phases of the menstrual cycle of women with and without PMS
Summary
The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle. Women with PMS can have different profiles of cyclic symptoms, which characteristically appear in the late luteal (LL) phase of the menstrual cycle and subside within a few days after the onset of menstruation (Halbreich et al, 1993; Redei and Freeman, 1995). The second group includes a variety of somatic symptoms, which can be arbitrarily separated into two subgroups, volume-related and sympathetic-related (Rosenfeld et al, 2008; Ismaili et al, 2016). Investigations into PMDD have focused on the syndrome’s psycho-behavioral profile, while partially neglecting the pathophysiology of the somatic symptoms. Cases in which significant somatic symptoms present together with mild to moderate behavioral and affective symptoms are usually diagnosed as PMS and treated by gynecologists (Biggs and Demuth, 2011)
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