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Premenstrual syndrome - Causes

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of premenstrual syndrome (PMS).

Alternative Names

PMS

Causes:

Researchers are still uncertain about the causes of premenstrual syndrome. Fluctuations in gonadal hormones (progesterone or estrogen) and brain chemicals may play a role although their exact significance is unclear. Hormonal levels seem to be the same in women whether or not they have premenstrual syndrome. It is possible that women with premenstrual syndrome are somehow more responsive to these changing levels of hormones.

The Hypothalamic-Pituitary-Adrenal (HPA) System

The hypothalamic-pituitary-adrenal (HPA) system controls reproduction, appetite, and feelings of well-being. The HPA is also involved in regulating the stress response. A number of reproductive hormones and neurotransmitters (chemical messengers in the brain) play important and complicated interrelated roles in the activity of the HPA system. Disruptions in these chemicals may be important in PMS and premenstrual dysphoric disorder (PMDD).

Reproductive hormones. The two important female hormones, progesterone and estrogen, are at their highest levels during the premenstrual period. An abnormal response to progesterone, more so than estrogen, may be the primary factor in PMS.
Neurotransmitters. Each hormone is involved in the regulation of two neurotransmitters, serotonin and gamma-aminobutyric acid (GABA). These brain chemicals have properties that appear to protect against PMS symptoms.
Stress hormones. Stress hormones include cortisol and norepinephrine.

The exact roles and relationships of any of these substances in PMS or premenstrual dysphoric disorder (PMDD) are still unclear. Evidence increasingly suggests that cyclic fluctuations in some of these hormones -- not whether they are high or low -- may be the important factors in premenstrual problems.

Other Factors

Calcium and Magnesium. Calcium and magnesium help nerve cells to communicate and blood vessels to widen and narrow. Imbalances in these minerals may contribute to PMS.

Resources

www.womenshealth.gov -- National Women's Health Information Center
www.acog.org -- American College of Obstetricians and Gynecologists

References

Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol. 2007 Feb;20(1):3-12.

Brown J, O' Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD001396.

Jarvis CI, Lynch AM, Morin AK. Management strategies for premenstrual syndrome/premenstrual dysphoric disorder. Ann Pharmacother. 2008 Jul;42(7):967-78. Epub 2008 Jun 17

Kwan I and Onwude JL. Premenstrual syndrome. BMJ Clinical Evidence. Web publication date: 01 May 2007.

Lentz GM. Primary and secondary dysmenorrheal, premenstrual syndrome, and premenstrual dysphoric disorder. Etiology, diagnosis, management. In: Katz VL, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby; 2007:chap 36.

Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006586.

Yonkers KA, O'Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008 Apr 5;371(9619):1200-10.

Reviewed last on: 8/4/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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