Improved understanding of the role of female sex hormones on the drivers and symptoms of premenstrual dysphoric disorder (PMDD) may shed light on the complex interactions between sex hormones and mood, potentially helping to explain the increased prevalence of mood disorders in women.
Most women are unaffected by the hormonal changes of the menstrual cycle, however approximately 20% of women experience premenstrual syndrome (PMS), or premenstrual dysphoric disorder (PMDD), a more severe form of PMS. The latter affects roughly 5% of women of reproductive age, and is categorised as a mood disorder characterised by functionally impairing or distressing mood, and physical symptoms in the luteal phase of the menstrual cycle (second half of cycle). Symptoms typically improve after menstruation has begun, and there is an absence of symptoms in the post-menstrual week. Hallmark mood symptoms include mood fluctuations, irritability, anxiety, tension, and depression.
PMDD is moderately heritable, however to date, no genetic marker has consistently been associated with the disorder, nor have abnormalities in levels of sex hormones been found.
Professor Inger Sundström Poromaa, Professor of Obstetrics and Gynaecology at the Department of Women's and Children's Health, Uppsala University, Sweden presented findings from neuroimaging studies in patients with PMDD at the 26th ECNP Congress. The results suggested that brain activity across the menstrual cycle is different between healthy controls and women with PMDD, highlighting the importance of hormone fluctuations in this disorder.
Fifteen women with PMDD underwent neuroimaging using functional magnetic resonance imaging (fMRI) in the late follicular and late luteal phases of their menstrual cycle. Women completed an emotional processing task related to anxiety control. A total of 14 controls received the same battery of neuroimaging tests and results were compared between the two groups.
Specifically, results showed that when women with PMDD were exposed to emotional processing, they showed higher activation of the amygdala region of the brain in the follicular phase, relating to impaired anxiety control compared to healthy controls.
The increased amygdala activation in response to emotional stimuli in the follicular phase was highly correlated with the very low, follicular phase, progesterone concentrations. "Our interpretation is that PMDD women are indeed hyper-responsive to even low progesterone levels, and that the amygdala successively habituates to the increasing luteal phase progesterone levels."
However, in some patients with PMDD, enhanced emotional responses, due to amygdala activation, were also seen in the luteal phase. "In addition, patients with PMDD who also have high scores of anxiety, display increased emotion-induced amygdala reactivity in the luteal phase too."
In addition, Professor Sundström Poromaa also found that amygdala reactivity in PMDD is differently influenced by the content of the emotional stimuli. Women with PMDD displayed increased amygdala reactivity to social stimuli as compared to non-social stimuli in the luteal phase.
Effectively, these results suggest that although PMDD women clinically only have anxiety in the luteal phase, the anxiety mechanisms may be different in the early and late luteal phase. "Clearly they have an amygdala that is easily activated once progesterone levels start to increase in the early luteal phase. The higher amygdala activity in the follicular phase may also be a more general vulnerability mark in PMDD women," explained Professor Sundström Poromaa.
Furthermore, the researchers found that women with PMDD who were carriers of the BDNF Val66Met risk genetic mutation had lower activation of the fronto-cingulate cortex region in the luteal phase, suggesting difficulty with control of anxiety by the brain.
Professor Sundström Poromaa explained why their research was particularly important for many women during reproductive years. She noted that anxiety and depression disorders were twice as common in women, and major depressive disorder was the leading cause of disease burden in 15 to 44-year-old women. "The sex bias for depressive disorders is not evident until after puberty, and this suggests a possible role for sex hormones in the manifestation of increased risk for these disorders in women."
"PMDD is an important disorder in this context as it may be used to disentangle the complex interactions between sex hormones and mood, ultimately helping us to understand the female preponderance for mood disorders," she added.
The research conducted by the Uppsala group may also have implications for women with anxiety and depressive disorders who require oral contraception.
"To date, very little emphasis has been put into evaluating the best possible hormonal contraception, with no or positive impact on mood, in women suffering from anxiety and mood disorders. Ongoing clinical trials with low-dose estrogen oral contraceptives will shed light on their usefulness in women with mood disorders."
Finally, while women with PMDD may benefit from serotonin antidepressant treatment, many women discontinue treatment or request treatments that better target the hormonal causes of the disorder. The research of Professor Sundström Poromaa and her team may aid in developing new treatment strategies for affected women.
Explore further: Impaired melatonin secretion may play a role in premenstrual syndrome
Provided by European College of Neuropsychopharmacology
Medical Xpress on facebook
Related Stories
Impaired melatonin secretion may play a role in premenstrual syndrome
Dec 19, 2012
A new study by Douglas Mental Health University Institute researchers shows altered body rhythms of the hormone melatonin in Premenstrual dysphoric disorder (PMDD) women with insomnia. This finding may help explain some of ...
Severe PMS may last longer than thought
Mar 05, 2012
(HealthDay) -- For years, women with the severe form of premenstrual syndrome known as premenstrual dysphoric disorder (PMDD) were told that their symptoms should subside the day menstruation begins.
Premenstrual symptoms getting on your nerves?
Dec 20, 2007
For some women premenstrual syndrome (PMS) is a minor monthly annoyance, but for others, more severe symptoms seriously disrupt their lives. However despite the number of women affected, science has yet to offer a full explanation ...
Depression affects how women with PMDD respond to stress, pain
Mar 30, 2010
As science slowly, but continually, unravels the causes of disorders, it increasingly teases apart biological threads that, when spooled together, begin to take on the warp and weft of separate disorders.
First significant genetic finding in severe PMS, or PMDD
Oct 02, 2007
The first significant genetic finding in premenstrual dysphoric disorder (PMDD) has now been reported. PMDD is a very severe form of the more commonly known premenstrual syndrome, or PMS. PMDD is heritable, affects 5-8% ...
Recommended for you
GABA inverse agonist restores cognitive function in Down's syndrome
24 seconds ago
A selective GABA inverse agonist has restored cognitive function in a mouse model of Down's syndrome (DS) and has the potential to benefit humans, French researchers have revealed.
Enzymatic pathway common to drugs of abuse could lead to new treatment options
18 minutes ago
The extracellular-signal regulated kinase (ERK) pathway plays a role in multiple drug addictions and appears to modulate neuronal plasticity through epigenetic mechanisms, say French scientists.
Glutamatergic agents show promise for mood and anxiety disorders
19 minutes ago
Glutamergic agents may one day be used as a novel treatment for mood and anxiety disorders, new research presented at the 26th ECNP Congress suggests.
Food addiction a step closer to formal diagnostic status—or not?
20 minutes ago
Food addiction is not yet recognised as a mental disorder but certain obese individuals clearly display addictive-like behaviour towards food. To achieve a formal diagnostic status, 'food addiction' requires a stronger evidence ...
Work seems life threatening to people suffering from stress
36 minutes ago
Stress causes today more cases of prolonged absence from work due to sickness. Work and identity are more closely knit together than ever before, and therefore work becomes a matter of life and death to the person suffering ...
Is the human brain capable of identifying a fake smile?
46 minutes ago
Human beings follows others' state of mind From their facial expressions. "Fear, anger, sadness, and surprise are quickly displeasure inferred in this way," David Beltran Guerrero, researcher at the University ...
User comments
© Medical Xpress 2011-2013, Phys.org network
Improved understanding of the role of female sex hormones on the drivers and symptoms of premenstrual dysphoric disorder (PMDD) may shed light on the complex interactions between sex hormones and mood, potentially helping to explain the increased prevalence of mood disorders in women.
Most women are unaffected by the hormonal changes of the menstrual cycle, however approximately 20% of women experience premenstrual syndrome (PMS), or premenstrual dysphoric disorder (PMDD), a more severe form of PMS. The latter affects roughly 5% of women of reproductive age, and is categorised as a mood disorder characterised by functionally impairing or distressing mood, and physical symptoms in the luteal phase of the menstrual cycle (second half of cycle). Symptoms typically improve after menstruation has begun, and there is an absence of symptoms in the post-menstrual week. Hallmark mood symptoms include mood fluctuations, irritability, anxiety, tension, and depression.
PMDD is moderately heritable, however to date, no genetic marker has consistently been associated with the disorder, nor have abnormalities in levels of sex hormones been found.
Professor Inger Sundström Poromaa, Professor of Obstetrics and Gynaecology at the Department of Women's and Children's Health, Uppsala University, Sweden presented findings from neuroimaging studies in patients with PMDD at the 26th ECNP Congress. The results suggested that brain activity across the menstrual cycle is different between healthy controls and women with PMDD, highlighting the importance of hormone fluctuations in this disorder.
Fifteen women with PMDD underwent neuroimaging using functional magnetic resonance imaging (fMRI) in the late follicular and late luteal phases of their menstrual cycle. Women completed an emotional processing task related to anxiety control. A total of 14 controls received the same battery of neuroimaging tests and results were compared between the two groups.
Specifically, results showed that when women with PMDD were exposed to emotional processing, they showed higher activation of the amygdala region of the brain in the follicular phase, relating to impaired anxiety control compared to healthy controls.
The increased amygdala activation in response to emotional stimuli in the follicular phase was highly correlated with the very low, follicular phase, progesterone concentrations. "Our interpretation is that PMDD women are indeed hyper-responsive to even low progesterone levels, and that the amygdala successively habituates to the increasing luteal phase progesterone levels."
However, in some patients with PMDD, enhanced emotional responses, due to amygdala activation, were also seen in the luteal phase. "In addition, patients with PMDD who also have high scores of anxiety, display increased emotion-induced amygdala reactivity in the luteal phase too."
In addition, Professor Sundström Poromaa also found that amygdala reactivity in PMDD is differently influenced by the content of the emotional stimuli. Women with PMDD displayed increased amygdala reactivity to social stimuli as compared to non-social stimuli in the luteal phase.
Effectively, these results suggest that although PMDD women clinically only have anxiety in the luteal phase, the anxiety mechanisms may be different in the early and late luteal phase. "Clearly they have an amygdala that is easily activated once progesterone levels start to increase in the early luteal phase. The higher amygdala activity in the follicular phase may also be a more general vulnerability mark in PMDD women," explained Professor Sundström Poromaa.
Furthermore, the researchers found that women with PMDD who were carriers of the BDNF Val66Met risk genetic mutation had lower activation of the fronto-cingulate cortex region in the luteal phase, suggesting difficulty with control of anxiety by the brain.
Professor Sundström Poromaa explained why their research was particularly important for many women during reproductive years. She noted that anxiety and depression disorders were twice as common in women, and major depressive disorder was the leading cause of disease burden in 15 to 44-year-old women. "The sex bias for depressive disorders is not evident until after puberty, and this suggests a possible role for sex hormones in the manifestation of increased risk for these disorders in women."
"PMDD is an important disorder in this context as it may be used to disentangle the complex interactions between sex hormones and mood, ultimately helping us to understand the female preponderance for mood disorders," she added.
The research conducted by the Uppsala group may also have implications for women with anxiety and depressive disorders who require oral contraception.
"To date, very little emphasis has been put into evaluating the best possible hormonal contraception, with no or positive impact on mood, in women suffering from anxiety and mood disorders. Ongoing clinical trials with low-dose estrogen oral contraceptives will shed light on their usefulness in women with mood disorders."
Finally, while women with PMDD may benefit from serotonin antidepressant treatment, many women discontinue treatment or request treatments that better target the hormonal causes of the disorder. The research of Professor Sundström Poromaa and her team may aid in developing new treatment strategies for affected women.
Explore further: Impaired melatonin secretion may play a role in premenstrual syndrome
Provided by European College of Neuropsychopharmacology
Medical Xpress on facebook
Related Stories
Impaired melatonin secretion may play a role in premenstrual syndrome
Dec 19, 2012
A new study by Douglas Mental Health University Institute researchers shows altered body rhythms of the hormone melatonin in Premenstrual dysphoric disorder (PMDD) women with insomnia. This finding may help explain some of ...
Severe PMS may last longer than thought
Mar 05, 2012
(HealthDay) -- For years, women with the severe form of premenstrual syndrome known as premenstrual dysphoric disorder (PMDD) were told that their symptoms should subside the day menstruation begins.
Premenstrual symptoms getting on your nerves?
Dec 20, 2007
For some women premenstrual syndrome (PMS) is a minor monthly annoyance, but for others, more severe symptoms seriously disrupt their lives. However despite the number of women affected, science has yet to offer a full explanation ...
Depression affects how women with PMDD respond to stress, pain
Mar 30, 2010
As science slowly, but continually, unravels the causes of disorders, it increasingly teases apart biological threads that, when spooled together, begin to take on the warp and weft of separate disorders.
First significant genetic finding in severe PMS, or PMDD
Oct 02, 2007
The first significant genetic finding in premenstrual dysphoric disorder (PMDD) has now been reported. PMDD is a very severe form of the more commonly known premenstrual syndrome, or PMS. PMDD is heritable, affects 5-8% ...
Recommended for you
GABA inverse agonist restores cognitive function in Down's syndrome
24 seconds ago
A selective GABA inverse agonist has restored cognitive function in a mouse model of Down's syndrome (DS) and has the potential to benefit humans, French researchers have revealed.
Enzymatic pathway common to drugs of abuse could lead to new treatment options
18 minutes ago
The extracellular-signal regulated kinase (ERK) pathway plays a role in multiple drug addictions and appears to modulate neuronal plasticity through epigenetic mechanisms, say French scientists.
Glutamatergic agents show promise for mood and anxiety disorders
19 minutes ago
Glutamergic agents may one day be used as a novel treatment for mood and anxiety disorders, new research presented at the 26th ECNP Congress suggests.
Food addiction a step closer to formal diagnostic status—or not?
20 minutes ago
Food addiction is not yet recognised as a mental disorder but certain obese individuals clearly display addictive-like behaviour towards food. To achieve a formal diagnostic status, 'food addiction' requires a stronger evidence ...
Work seems life threatening to people suffering from stress
36 minutes ago
Stress causes today more cases of prolonged absence from work due to sickness. Work and identity are more closely knit together than ever before, and therefore work becomes a matter of life and death to the person suffering ...
Is the human brain capable of identifying a fake smile?
46 minutes ago
Human beings follows others' state of mind From their facial expressions. "Fear, anger, sadness, and surprise are quickly displeasure inferred in this way," David Beltran Guerrero, researcher at the University ...
User comments
© Medical Xpress 2011-2013, Phys.org network
0 comments:
Post a Comment