Randomised trial, 2012
Is the stress hormone system different in women with premenstrual dysphoria?
The stress hormone system (HPA axis) functions normally in women with PMD, just like in women without it. This suggests PMD may have a different biological cause than depression. Progesterone increased stress hormones more than estradiol.
What they did
43 women (18 with confirmed PMD and 25 without) received Lupron to suppress the ovaries for 6 months. After 3 months of ovarian suppression, they received either estradiol (100-micrograms patch daily) or progesterone (200 mg twice daily suppositories) for 5 weeks each in a crossover design. Dexamethasone-suppression and CRH stimulation tests and 24-hour urine cortisol were measured.
What they found
HPA axis function was similar in PMD women compared to those without PMD. Progesterone significantly increased cortisol secretion compared to estradiol (P less than 0.01) and urinary free cortisol (P less than 0.01). Progesterone also increased ACTH (plasma hormone) compared to the hypogonadal state (P less than 0.05).
What it means for you
Women with PMD do not have abnormal stress hormone systems like women with depression do. This suggests PMD may have a different biological cause than depression. Progesterone has a bigger effect on stress hormones than estradiol in all women. This is a carefully controlled study using ovarian suppression, but the sample size is small to moderate.
18
Women with PMD studied
25
Control women without PMD
6 months
Study duration with Lupron
About the study
- Original title
- ACTH and cortisol response to Dex/CRH testing in women with and without premenstrual dysphoria during GnRH agonist-induced hypogonadism and ovarian steroid replacement
- Authors
- Lee EE, Nieman LK, Martinez PE et al.
- Journal
- The Journal of clinical endocrinology and metabolism
- Year
- 2012
- Study design
- Randomised trial
- What was tested
- GnRH agonist (Lupron) for ovarian suppression followed by estradiol or progesterone replacement in a crossover design
- Open access
- Yes
- Read the paper
- doi.org/10.1210/jc.2011-3451
Topics
Related studies
Cohort study, 2022
What are PMS and PMDD and how should they be diagnosed and treated?
Review, 2004
How should doctors diagnose and treat PMS and PMDD?
Study, 2026
What treatments work for PMDD?
Cohort study, 2022
How common are suicidal thoughts and self-harm in people with PMDD?
Review, 2012
Is depression linked to hormonal changes during the menstrual cycle, pregnancy, and menopause?
Study, 2003
Does the stress response system work differently in women with PMS across the menstrual cycle?