Premenstrual Syndrome ( PMS) Biological/Psychosocial???

Premenstrual Syndrome (PMS)

Biological/Psychosocial???

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 SxBloating Irritability

Breast tenderness Anxiety

Cramps Depression

GnRH

FSH LH

EstrogenProgesterone

Anterior Pituitary

Ovaries

Hypothalamus

Results in…

Sx’s

Premenstrual Syndrome

Over 70 years of research! Controversial concept Known etiology?

You tell me!!!

Etiological Hypotheses

Linkage of Sx with a specific phase of menstrual cycle Biological etiology

Proposed mechanisms Thyroid dysfunction, serotonin dysregulation, endocrine

dysfunction

Biological Basis…

Sx related to hormone levels Abnormal

High Low

FSH, LH Estrogen Progesterone

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 Sx’s

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

Biological Basis cont…

These findings suggests… A strong a link between PMS and circulating

hormone levels

Question

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

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

Conclusion

Ovarian hormones and perhaps LH as determining factors in premenstrual symptomology

Abnormal levels E, P, or combination of the two remains unclear…

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

Conclusions

Learned expectancies play an important role in determining premenstrual experiences

Reflecting cultural stereotypes rather than actual premenstrual experiences

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

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 women’s perception of events surrounding normal cyclic changes

Colored by psychological traits, social contexts, and learned expectancies (Anson, 1999; Woods, Mitchell & Lentz, 1995).

Simply Put….

Fluctuations in hormones set the stage

The extent to which events are perceived as negative is largely dependent upon learned expectancies