January 22, 1998

THE NEW YORK TIMES

Research Suggests PMS May Not Be Psychiatric Disorder

By JANE E. BRODY

omen with premenstrual syndrome appear not to have a hormone abnormality but rather respond abnormally to normal ovarian hormones, according to a carefully executed new study that could change the focus of treatment strategies.

The findings call into question the syndrome's psychiatric designation as an emotional disorder, suggesting instead that the symptoms of PMS stem from an aberrant effect on the brain of changes in blood levels of the hormones estrogen and progesterone, which are released monthly in cyclical fashion throughout a woman's childbearing years.

The results of the study, are published in Thursday's issue of The New England Journal of Medicine.

The findings could change how PMS is regarded by the medical profession and the general public. For many years, it was widely considered an emotional weakness or something women made up, prompting many women who were affected to deny that they had a problem. Others viewed it as a gynecological problem even though no specific cause could be found. In 1987, PMS was listed as a psychiatric disorder.

The new study's results "demonstrate clearly a relationship between biology and behavior," .

"In women with premenstrual syndrome," he added, "it's not that the menstrual cycle or the hormones are bad. It's that women with severe PMS respond differently to normal hormone levels. We're beginning to appreciate the complexity and relevance of hormones in human behavior. It's not a simple matter of an excess or a deficiency of hormones."

An accompanying editorial, said that if the new findings were confirmed by further studies, they could lead to the development of a "designer" chemical that would block the hormones' effects on the brain without interfering with their role in maintaining a woman's health and fertility.

Severe symptoms of premenstrual syndrome afflict about 2.5 percent of women of childbearing age and can seriously interfere with a woman's ability to function socially and at work. The symptoms last for about a week before the onset of menstrual bleeding, then abate.

The listing of PMS as a psychiatric disorder indicated that mood changes were its most prominent symptoms. Even though the listing was controversial, it recognized that PMS was a real and potentially disabling problem, although it did not address possible physical roots.

The current manual of psychiatric diagnoses, which calls the syndrome premenstrual dysphoric disorder, lists these possible symptoms:

"Feeling sad, hopeless or self-deprecating; feeling tense, anxious or 'on edge'; marked lability of mood interspersed with frequent tearfulness; persistent irritability, anger and increased interpersonal conflicts; decreased interest in usual activities; difficulty concentrating; feeling fatigued, lethargic or lacking in energy; marked changes in appetite, which may be associated with binge eating or craving certain foods; hypersomnia or insomnia; a subjective feeling of being overwhelmed or out of control, and physical symptoms such as breast tenderness or swelling, headaches or sensations of 'bloating' or weight gain."

Although many women of reproductive age experience one or more premenstrual symptoms to some degree, a diagnosis of PMS is based on the marked presence of at least five of the above symptoms in the last week of each menstrual cycle and their absence at other times.

That ovarian hormones are somehow the cause of premenstrual syndrome was demonstrated more than a decade ago, when several research teams eliminated the symptoms by suppressing the ovaries' ability to produce hormones. That approach, called a medical ovariectomy, usually involved the use of a drug called leuprolide, which blocks the action of messenger hormones from the hypothalamus and pituitary gland that normally prompt the ovaries to release their own hormones.

But this approach is not considered ideal for premenstrual syndrome because it interferes with fertility and causes a chemical menopause, depriving women of the benefits of estrogen to their hearts, bones, brains and other tissues.

 

The new study implicates hormone action that occurs earlier in the cycle, perhaps prior to ovulation.