Abstract
Premenstrual syndrome (PMS), including the severe subtype premenstrual dysphoric disorder (PMDD), DSM-5 category, represents a challenging combination of hormonal, environmental and neuroendocrine dysfunctions with menstrual cycle-related pattern. Controversies around the role of daily stress and associated anomalies of hypothalamic-pituitary-adrenal axis are related to the fact that stress is all the time, not just a fluctuating element. This is a narrative review on PMS/PMDD and cortisol profile. 46 articles are cited (between 2009 and 2020). PMD/PMDD underlines multiple imbalances and anomalies of the cortisol levels or its secretory pattern may be a few of them, despite the fact that multiple controversies are still present and most of studies are of limited statistical power. Women with PMS may have higher levels of cortisol in relationship to stress independently of the cycle phase, also a delay of CAR (cortisol awakening response) peak and a delayed cortisol slope during day time. It does not seem that CAR pattern is related to the phases of menstrual cycle. CAR anomalies may be associated with pain perception disturbances in PMS females. The most modern area of interest is related to allopregnanolone, a progesterone metabolite with neuroactive profile. The diurnal serum baseline cortisol and the values of cortisol after dexamethasone suppression test may be similar between patients with PMS and without, but the females with PMS that have higher allopregnanolone associate blunted values of cortisol during the night versus control (without PMS) and versus women with low allopregnanolone levels, thus proving a suboptimal response to stress. Allopregnanolone modules GABA receptors on a paradoxical manner inducing anxiety and irritability during luteal phase on women with a specific predisposal configuration of GABA receptor as those confirmed with PMDD. Overall, PMS/PMDD impairs the quality of life, thus the more we understand about its pathogeny, the easier it gets to control it.
Highlights
Premenstrual syndrome (PMS), including the severe subtype premenstrual dysphoric disorder (PMDD), DSM-5 category, represents a challenging combination of hormonal, environmental and neuroendocrine dysfunctions with menstrual cycle-related pattern [1,2,3]
A study from 2019 on 61 women with PMDD and a similar number of control subjects evaluated subjective reactivity to stress during luteal phase in addition to assays of salivary cortisol and cortisol awakening response (CAR) showed higher levels of cortisol in relationship to stress independently of the cycle phase, a delay of CAR peak and a cortisol slope during day time which was more flatted than control [2]
One study of 59 females with PMS showed that salivary CAR increased during the premenstrual phase and not during the menses while salivary cortisol is positively correlated with estradiol, respective progesterone, and pain perception is more severe when ovarian steroids are low [10]
Summary
Premenstrual syndrome (PMS), including the severe subtype premenstrual dysphoric disorder (PMDD), DSM-5 category, represents a challenging combination of hormonal, environmental and neuroendocrine dysfunctions with menstrual cycle-related pattern [1,2,3]. PMDD, a severe, luteal phase-related impairment of emotional and physical status with suggestive symptoms, displays the complete remission once the menstruation is present, as well as having in common with PMS some uncertainties related to the actual underling contributor pathways like serotonin, GABA (acid gama-aminobutiric), reproductive steroids, and other brain circuits [1,4].
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