PMS symptoms occur during the luteal phase of the menstrual cycle. This phase is characterized by increased production of progesterone and estradiol, the body's main form of estrogen, by the corpeus luteum. The increase of estrogen and progesterone during the first four to five days of the luteal phase promotes endometrial and fallopian tube secretions that allow for proper nourishment and implantation of a fertilized ovum.

One theory is that PMS reflects "corpus luteum insufficiency," which creates a progesterone deficiency during this phase of the menstrual cycle. Many women report relief of symptoms through progesterone therapy, and this is backed by clinical evidence which suggests that progesterone metabolites may act as anti-anxiety agents in reducing mood swings and anxiety associated with PMS.1 Another possibility is that progesterone treatment improves symptoms by reducing luteal phase fluid retention.2

Progesterone is metabolized in the brain into a sedative-like substance called 3alpha,5alpha-THP, which can reduce anxiety and promote increased activity of gamma-aminobutyric acid, an important amino acid which modulates the activity of brain neurotransmitters linked to depresssion and seizures. For this reason, "symptoms of premenstrual syndrome (PMS), such as anxiety and seizure susceptibility, are associated with sharp declines in circulating progesterone."3

The progesterone deficiency theory for PMS has been challenged by some researchers, however. Some studies have observed a positive correlation between progesterone levels and PMS symptoms, and found a negligible effect--or even a worsening of symptoms--after initiation of progesterone therapy.4,5

One possible explanation for these conflicting results may lie in the biochemical individuality of each woman. Certainly, indiscriminately treating women suffering from PMS for a progesterone deficiency without knowing whether such a deficiency exists could yield contradictory treatment results. This underscores the importance of careful evaluation of baseline bioavailable hormone levels before embarking on replacement therapy.

High or low levels of estrogen are also implicated in the etiology of PMS. A common finding in women with PMS is estradiol excess during the luteal phase. A recent study by Swedish researchers reveals that the severity of PMS symptoms correlates with levels of estradiol during the luteal phase of the menstrual cycle.6 In addition to an increase in negative mood symptoms such as depression, anxiety, tension, and irritability, this study showed higher luteal-phase estradiol levels associated with increased headaches, swelling and breast tenderness.

On the other hand, because optimal levels of estrogen are crucial for the healthy function of important brain neurotransmitters that guard against depression, extreme deficiencies of estrogen during the luteal phase are associated with a relatively rare type of PMS characterized primarily by depression.7-9

Many believe, however, that rather than isolated progesterone or estradiol imbalances, it is the relative balance between these two hormones over the entire menstrual cycle that is most important to evaluate in women with PMS. Some health experts have linked the combination of low progesterone and high estradiol, for example, with a form of PMS characterized by anxiety, irritability, mood swings, and nervousness.8 Other researchers point to the combination of elevated estrogen with elevated progesterone in the luteal phase as a possible synergistic cause of PMS symptoms.10

Because scientific research has associated so many different patterns of female hormone imbalances with PMS, a comprehensive evaluation of sex hormone activity over the complete menstrual cycle is crucial for establishing the specific needs of each woman and for carefully monitoring hormone therapy.

The Female Hormone Profile analyzes bioavailable levels of progesterone, testosterone and ß-estradiol over 28 days using 11 saliva samples.

The comprehensive version of this test includes analysis of the hormones melatonin, DHEA, and cortisol, for a more complete picture of how endocrine function may be influencing female reproductive health.

The Women's Hormonal Health Assessment provides a focused overview of hormonal balance in both pre- and post-menopausal women, using a single serum sample to evaluate dynamics of sex steroid metabolism that can profoundly affect a woman's health throughout her lifetime.

Related Information: PMS and Adrenocortex Stress; PMS and Melatonin.

Call to set up a nutritional consultation so that tests can be performed and a comprehensive strategy of lifestyle, dietary modification and nutrient supplementation can be implemented to aid you in reversing this disorder.

For an appointment, contact our office at: 800-956-7083 or 818 707-3126.

Dr. Rispoli, Ph.D., L.Ac. has had a clinical practice for over 20 years. Her programs work because she is so thorough in testing and providing a nutritional approach. Remember that the body can heal itself if given the proper nutrients.

References
1 Baker ER, Best RG, Manfredi RL, Demers LM, Wolf GC. Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome. J Assist Reprod Genet 1995;12(3):205-9.
2 Watanabe H, Lau DC, Guyn HL, Wong NL. Effect of progesterone therapy on arginine vasopressin and atrial natriuretic factor in premenstrual syndrome. Clin Invest Med 1997;20(4):211-23.
3 Smith SS, Gong QH, Hsu FC, Markowitz RS, French-Mullen JM, Li X. GABA(A) receptor alpha4 subunit suppresssion prevents withdrawal properties of an endogenous steroid. Nature 1998;392(6679):926-30.
4 Redei E, Freeman EW. Daily plasma estradiol and progesterone levels over the menstrual cycle and their relation to premenstrual symptoms. Psychoneuroendocrinol 1995;20(3):259-67.
5 Tiemstra JD, Patel K. Hormonal therapy in the management of premenstrual syndrome. J Am Board Fam Pract 1998;11(5):378-81.
6 Seippel L, Backstrom T. Luteal -phase estradiol relates to symptom severity in patients with premenstrual syndrome. J Clin Endocrinol Metab 1998;83(6): 1988-1993.
7 Hammarback S, Damber JE, Backstrom T. Relationship between symptom severity and hormone changes in women with premenstrual syndrome. J Clin Endocrinol Metab 1989;68(1):125-130.
8 Pizzorno J, Murray MT. Encyclopedia of Natural Medicine. Rocklin (CA):Prima Publishing, 1998.
9 Fink G, Sumner BE, Rosie R, Grace O, Quinn JP. Estrogen control of central neurotransmission: effect on mood, mental state, and memory. Cell Mol Neurobiol 1996;16(3):325-44.
10 Hammarback S, Damber JE, Backstrom T. Relationship between symptom severity and hormone changes in women with premenstrual syndrome. J Clin Endocrinol Metab 1989 68(1):125-130.