Introduction For a significant number of women, the monthly shedding of the inner lining of the uterus is barely noticeable beyond the need for sanitary protection and the vague lower abdominal discomfort. This may the reason behind the temptation to overlook the powerful effects of sex steroid hormone, notably progesterone.
In about 3 - 9% of women, the days surrounding the menstrual bleeding are laced with many psychological complaints, deserving a psychiatric classification. These symptoms affect the individual, her family and relationships. In its most severe form, it is referred to as Premenstrual Dysphoric disorder (PMDD). It is dominated by psychological complaints such as depressive symptoms, irritability, anxiety, aggression, inability to concentration and the feeling of being out of control.
Interestingly, there are no objective tests for premenstrual syndrome (PMS). Rather the hallmark of diagnosis is based on completing a chart that demonstrates the relationship between the symptoms and menstruation. It is important not to forget that quite a number of women with PMS have another underlying problem such as peri-menopause, Thyroid disorder, Migraine, drug and alcohol abuse as well as psychiatric problems such as personality disorder and anxiety.
Etiology It hardly a straightforward topic as it involves a multiplicity of factors revolving round genetic predisposition, environmental factors and psychological factors. Some women appear to be unusually sensitive to the cyclic variation in progesterone levels. The absolute levels are similar with non-sufferers. Also women have no PMS before puberty, during pregnancy and at menopause.
The heightened sensitivity maybe due to the action Estrogen, which exhibits clear a effect on several neurotransmitters in the brain such as Serotonin, Acetycholine, Norepinephrine and Dopamine. It a well recognized fact serotonin plays a vital role in regulating mood, sleep, sexual activity and appetite.
Treatment options The first aspect is the manipulation of Serotonin levels in the brain. This is achieved by using drugs referred to as Selective Serotonin Re-uptake Inhibitors (SSRI) such as Fluxetine (Sarafem), which increases the levels of serotonin.
The other option is the suppression of the function of the ovary. This eliminates the hormonal fluctuations that precipitate this disorder. This can be achieved with numerous hormonal medications. They include; Estrogen, Danazol, Gonadotropin Releasing Hormone analogue. Surgical intervention may be necessary in some cases. This involves the removal of the ovaries, the major source of the sex steroid hormone.
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