Life stress plays a major role in women with PMS, and women undergoing negative or stressful life experiences are much more likely to report PMS symptoms.1-3 These stressors can include personal conflicts at work or at home, health problems, aging, and other factors. One controlled study noted that women with PMS reported more total negative life events than women without premenstrual symptoms,4 and a recent large-scale survey found that women with PMS scored nearly four times higher on stress scale measurements tests than other women.5

Researchers also have observed that women with more severe PMS often have a disrupted stress arousal and response pattern, and this difference can play a role in their symptoms.6,7 DHEA and cortisol are two important hormones secreted by the adrenal glands that play a critical role in helping the body adapt to stress.

Cortisol primes the body in response to stress, increasing energy, blood flow, glucose production and other important parameters. However, too much cortisol can create many health problems. Investigators monitoring hormonal stress responses in women with PMS have found these women may show cortisol imbalances associated with their turmoil symptoms, as an offshoot of impaired stress regulation.8 In fact, one Dutch researcher reported that a difference in cortisol levels was an important factor that distinguished women with premenstrual symptoms from those who remained free of any troublesome symptoms.9

High cortisol during the luteal phase of the menstrual cycle has also been linked with fluid retention.7 The shunting of metabolic pathways toward cortisol synthesis can cut off the body's normal production of progesterone, resulting in a progesterone deficiency. An interesting case study in the literature describes a woman with depressive symptoms whose condition worsened after being treated with progesterone or adreno-corticotropin-releasing hormone (ACTH). Testing revealed that this woman had elevated cortisol levels, which were brought back to normal using hormone therapy, resulting in the complete elimination of her symptoms for over eight years.10

However, just as both low and high cortisol levels have been linked to different etiologies of depression (low secretion linked to lethargy and indifference, and high levels linked to insomnia and anxiety) so too are cortisol deficiencies implicated in certain types of PMS. A team of investigators from the Department of Psychiatry at Edinburgh University reported that women with premenstrual depressive symptoms had lower evening cortisol levels in the premenstrual phase than women without mood symptoms. This suggests a possible etiology for depression-related PMS similar to that asssociated with Seasonal Affective Disorder, in which the body's stress center, the hypothalamic-pituitary-axis, exhibits a chronically underactive stress response.11

While no studies have been done on the specific effects of dehydroepiandrostrone (DHEA) on premenstrual syndrome, this hormone plays an important role in stress response by balancing the physiological effects of cortisol.

The Adrenocortex Stress Profile is a noninvasive salivary hormone analysis that measures cortisol activity over the course of an entire day, and includes a DHEA assay.

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 and visit our web site www.completehealthinstitute.com go to lab tests and click on appropriate test for information.

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 Siegel JM, Johnson JH, Sarason IG. Life changes and menstrual discomfort. Human Stress 1979;5:41-46.
2 Harrison WM, Rabkin JG, Endicott J. Psychiatric evaluation of premenstrual changes. Psychosomatics 1985;26:789-799.
3 Rosen LN, Moghadam Lz, Endicot J. Psychosocial correlates of premenstrual dysphoric subtypes. Acta Psychiatr Scand 1988;77:446-453.
4 Schmidt PJ, Hoban MC, Rubinow DR. State dependent alterations in the perception of life events in premenstrual syndrome (PMS). Paper presented at the 2nd International Symposium: Premenstrual, postpartum and menopausal mood disorders, Kiawah Island, Charleston, SC, September 11, 1987.
5 Deuster PA, Adera T, South-Paul Jeannette. Biological, social and behavioral factors associated with premenstrual syndrome. Arch Fam Med 1999;8:122-128.
6 Woods NF, Lentz M, Mitchell, Heitkemper M, Shaver J. PMS after 40: persistence of a stress-related symptom pattern. Res Nurs Health 1997;20(4):329-40.
7 Woods NF, Lentz MJ, Mitchell, Shaver J, Heitkemper M. Luteal phase ovarian steroids, stress arousal, premenses perceived stress, and premenstrual symptoms. Res Nurs Health 1998;21(2):129-142.
8 Cahill CA. Differences in cortisol, a stress hormone, in women with turmoil-type premenstrual symptoms. Nurs Res 1998;47(50):278-84.
9 Van Goozen SH, Frijda NH, Wiegant VM, Endert E, Van de Poll NE. The premenstrual phase and reaction to aversive events: a study of hormonal influence on emotionality. Psychoneuroendocrinol 1996;21(50):479-97.
10 Crammer JL. Premenstrual depression, cortisol and oestradiol treatment. Psychol Med 1986;16(20):451-5.
11 Odber J, Cawood EH, Bancroft J. Salivary cortisol in women with and without premenstrual mood changes. J Psychosom Res 1998;45(6):557-68.