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July 14, 2007
PMS? All in your head - or hormones?
For some women PMS is more than a minor annoyance, in 5-8% categorized as a more severe condition, PMDD or “premenstrual dysphoric disorder”. Although antidepressants can be helpful, new research suggests hormonal treatments may be equally effective. Researchers believe that PMDD mood symptoms are related to progesterone and estrogen elevations approximately 2 weeks subsequent to ovulation (during the so-called late luteal phase of the monthly cycle). Looking at placebo-controlled studies, links were found between levels of progesterone and excitability of the amygdala (a part of the brain involved in processing of environmental stimuli and subsequent emotional responses). Functional MRI studies utilizing exogenously administered progesterone to healthy women revealed decreased communication between the amygdala and the fusiform gyrus (a part of the brain involved in higher order processing of emotionally laden stimuli); and an increased activation of the amygdala and dorsal anterior cingulate gyrus (a more rudimentary brain region activated during evaluation of stimuli that is perceived as “threatening”)
Potential evolutionary antecedents/ potential benefits of premenstrual emotion sensitivity and perhaps amplification; are still speculative. Although I did have a male professor tell me his wife gave him her prempro once, instead of his cardiac medication; his only response was that he felt “warm and fuzzy—more maternal inside”, adding that he had an unusual urge to use psychotherapy with his patients rather than prescribe medication. Although we could all use some help with the kids from time to time; for now, I think we should probably avoid slipping progesterone into our husband’s coffee -- tempting as it may be.
Citations:
Joan Arehart-Treichel
Brain Imaging Suggests Origin of Premenstrual Dysphoric Disorder
Psychiatric News, Sep 2007; 42: 13 - 20.
Studd, J. Ovariotomy for menstrual madness and premenstrual syndrome--19th century history and lessons for current practice. Gynecologic Endocrinology, 2006 Aug; 21(8)
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
