The Premenstrual Syndrome: A Study Of Its Diagnosis And Pathogenesis

Abstract

The premenstrual syndrome (PMS), with its characteristic combination of mental and physical symptoms recurring in the luteal phase of each menstrual cycle and disappearing after the onset of the menstruation, has during recent decades attracted the interest of many researchers. However, the lack of a commonly accepted definition and way to diagnose PMS has led to contradictory results in attempts to establish the etiology of PMS, which still is obscure, and to find ways to treat the complaints.In this study of 82 patients, a diagnostic procedure for PMS was developed, based on prospective daily ratings of symptoms, statistical criteria and non‐parametric statistics. Three subgroups of subjects were identified: group 1, the pure PMS group, with significant symptom cyclicity and all symptoms concentrated to the luteal phase; group 2, the PMS aggravation group, with significant cyclicity but with negative symptoms also appearing prior to ovulation; group 3, the non‐PMS group, i.e. those who do not suffer from menstrually related symptoms.The three subgroups were investigated concerning possible distinguishing demographic factors, and medical and psychiatric anamnesis. The only significant difference found was a lower frequency of pathological scores for neuroticism in the Eysenck Personality Inventory and of a previous psychiatric history in group 1.Among 124 women seeking help for PMS, 8 were found who had one ovulatory and one spontaneously occurring anovulatory cycle. In the ovulatory cycles, a typical symptom cyclicity was evident. In the anovulatory cycles this cyclicity disappeared and the symptoms abated, indicating the importance of a corpus luteum in precipitating PMS.The role of hormonal variations was also studied in 22 postmenopausal women receiving either estradiol only, or estradiol/progestagen sequential therapy. When the progestagen was added to the treatment in the latter group, a PMS‐like syndrome was induced–but not in the “estradiol only” group.To further test the role of ovulation‐anovulation in the pathogenesis of PMS, 26 PMS patients were given the GnRH agonist buserelin in a dose of 400 μg daily intranasally in a double‐blind cross‐over study, versus placebo. Though an appreciable placebo effect was noted, the active drug gave significantly better symptom relief. In the last cycle during medication with active drug 19 of the remaining 23 patients showed a non‐cyclic pattern in their symptoms; thus they no longer had PMS.In each of 18 carefully diagnosed PMS patients the varying effects of hormone concentrations on the severity of symptoms were investigated in two cycles. The results show that in cycles with higher serum concentrations of progesterone–and particularly estradiol–the patients also had more severe symptoms, which contradicts earlier theories of PMS being due to a lack of progesterone.