Premenstrual Syndrome (PMS)

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Premenstrual Syndrome (PMS)

• Biological/Psychosocial???

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General Definition

• A cyclic recurrence of physical, ?, and
  behavioral Sx 5-10 days before the onset of
  menses (Marvàn Cotes-Iniestra, 2001).
• Biological Sx Affective Sx
• Bloating Irritability
• Breast tenderness Anxiety
• Cramps Depression

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Hypothalamus
GnRH
FSH LH
Anterior Pituitary
Estrogen Progesterone
Ovaries
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Results in
Sxs
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Premenstrual Syndrome

• Over 70 years of research!
• Controversial concept
• Known etiology?
• You tell me!!!

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Etiological Hypotheses

• Linkage of Sx with a specific phase of menstrual
  cycle
• Biological etiology
• Proposed mechanisms
• Thyroid dysfunction, serotonin dysregulation,
  endocrine dysfunction

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Biological Basis

• Sx related to hormone levels
• Abnormal
• High
• Low
• FSH, LH
• Estrogen
• Progesterone

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Biological Basis cont

• Seippel Bäckström
• Hormone levels and Sx severity in PMS patients
  (Daily sampling and questionnaires)
• High levels of luteal phase estrogen related to
  severity of negative premenstrual Sxs

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Biological Basis cont

• Hammerback, Damber, Bäckström
• Hormone levels and Sx severity in PMS patients
• More (-) Sx associated with higher luteal phase
  levels of E P,
• More specifically, lowest scores for () mood
  with higher E

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Biological Basis cont

• These findings suggests
• A strong a link between PMS and circulating
  hormone levels

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Question

• If ovarian hormones are the culprits, then
  removing them or decreasing their levels should
  be beneficial

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Biological Basis cont

• Mortola, Girton, Fischer
• Treatment of PMS with GnRH agonist
• Negative consequences (hypoestrogenism)
  associated with GnRH agonist treatment alone
• Exogenous E P replacement
• 75 improvement in Sx reporting

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Conclusion

• Ovarian hormones and perhaps LH as determining
  factors in premenstrual symptomology
• Abnormal levels
• E, P, or combination of the two remains unclear

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Psychosocial Etiologies

• Learned Expectancies surrounding menstruation
  acquired through socialization
• Ruble
• ? who thought they were PM report more Sx
• Marván Cortés-Iniestra
• Prevalence estimates affect retrospective ratings
  
• PMS as a Culture-specific disorder

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Conclusions

• Learned expectancies play an important role in
  determining premenstrual experiences
• Reflecting cultural stereotypes rather than
  actual premenstrual experiences

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The Debate...
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Biological or Psychosocial?
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In the end

• Problems with both approaches to studying PMS
• Inclusion criteria
• Inconsistencies
• Retrospective nature of studies
• Ss know that study is about PMS therefore
  expectations come into play
• May account for placebo effects

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Is it Bio or ?? ? Probably both.

• Ovarian hormones are required for Sx to occur
  (Schmidt et al., 1998)
• Expectations play an important role
• A premenstrual Experiential State-Change occurs
  that affects womens perception of events
  surrounding normal cyclic changes
• Colored by ? psychological traits, social
  contexts, and learned expectancies (Anson, 1999
  Woods, Mitchell Lentz, 1995).

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Simply Put.

• Fluctuations in hormones set the stage
• The extent to which events are perceived as
  negative is largely dependent upon learned
  expectancies