Rising Estrogen Levels Trigger Premenstrual Dysphoria

Peter Forster Uncategorized

New research suggests that rising estrogen and progesterone levels trigger premenstrual dysphoria symptoms.

“Although the mechanisms underlying the mood-destabilizing effects of ovarian steroids in PMDD remain to be better characterized, as does the source of susceptibility to this trigger, our findings provide a new target for interventions,” Peter Schmidt, M.D., chief of the Section on Behavioral Endocrinology at the National Institute of Mental Health, and colleagues reported.

This discovery came from an assessment of 22 women with PMDD, aged 30 to 50, who were given monthly injections of leuprolide to suppress the production of ovarian hormones. Following two to three months of leuprolide alone, 12 of 22 women reported PMDD symptom remission (as determined by self-reported improvement confirmed by Rating for Premenstrual Tension scale scores <5 and the absence of symptom cyclicity on the Daily Rating Form). Women who responded to leuprolide then received one month of placebo followed by three months of estradiol/progesterone replacement therapy.

The women receiving estradiol/progesterone reported a rise in some PMDD symptoms during the first month of therapy, but there were no significant differences in symptom severity during the subsequent months when plasma levels of these sex hormones were stable, Schmidt and colleagues reported.

“[O]ur findings suggest that there is a ‘half-life’ of the affective state that is triggered, following which it remits,” Schmidt and colleagues wrote. “[T]reatment strategies to attenuate or eliminate the change in estradiol and progesterone (or their metabolites) could effectively target the hormonal trigger in this condition.”


Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable LevelsPeter J. Schmidt, Pedro E. Martinez, Lynnette K. Nieman, Deloris E. Koziol, Karla D. Thompson, Linda Schenkel, Paul G. Wakim, and David R. Rubinow. American Journal of Psychiatry 2017