--- title: Why do women get PMS and PMDD? | Niyora description: PMS and PMDD happen because the brain responds very sensitively to normal changes in estrogen and progesterone during the menstrual cycle. Several brain syste url: https://niyora.com/research/papers/premenstrual-syndrome-and-premenstrual-dysphoric-disorder-as-centrally-based-2022/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Why do women get PMS and PMDD? Study, 2022 # Why do women get PMS and PMDD? PMS and PMDD happen because the brain responds very sensitively to normal changes in estrogen and progesterone during the menstrual cycle. Several brain systems control mood and are affected. Early or limited evidence Review article, not a study of specific people ## What they did This is a review of research on what causes PMS and PMDD and how the brain and hormones are connected. ## What they found PMS and PMDD involve the brain being extra sensitive to estrogen and progesterone changes. A brain chemical that forms from progesterone may affect a brain system called GABA that helps control mood. Problems with serotonin and brain inflammation may also play a role. Treatments that work include birth control pills and antidepressants. Researchers are testing new treatments that affect progesterone and GABA systems in the brain. ## What it means for you PMS and PMDD are not simple hormone imbalances. They happen because the brain responds differently to normal hormone changes. This explains why different treatments work for different women. This is a review of what we already know, not new research findings. ## About the study Original title Premenstrual Syndrome and Premenstrual Dysphoric Disorder as Centrally Based Disorders Authors Rossella Elena Nappi, Laura Cucinella, David Bosoni et al. Journal Endocrines Year 2022 Study design Study What was tested Discusses birth control, serotonin medications, and experimental treatments Open access Yes Read the paper [doi.org/10.3390/endocrines3010012](https://doi.org/10.3390/endocrines3010012) Original abstract Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) encompass a variety of symptoms that occur during the luteal phase of the menstrual cycle and impair daily life activities and relationships. Depending on the type and severity of physical, emotional or behavioral symptoms, women of reproductive age followed for at least two prospective menstrual cycles may receive one of the two diagnoses. PMDD is the most severe form of PMS, predominantly characterized by emotional and behavioral symptoms not due to another psychiatric disorder. PMS and PMDD are common neuro-hormonal gynecological disorders with a multifaceted etiology. Gonadal steroid hormones and their metabolites influence a plethora of biological systems involved in the occurrence of specific symptoms, but there is no doubt that PMS/PMDD are centrally based disorders. A more sensitive neuroendocrine threshold to cyclical variations of estrogens and progesterone under physiological and hormonal therapies is present. Moreover, altered brain sensitivity to allopregnanolone, a metabolite of progesterone produced after ovulation potentiating GABA activity, along with an impairment of opioid and serotoninergic systems, may justify the occurrence of emotional and behavioral symptoms. Even neuro-inflammation expressed via the GABAergic system is under investigation as an etiological factor of PMS/PMDD. Pharmacological management aims to stabilize hormonal fluctuations and to restore the neuroendocrine balance. The rationale of suppressing ovulation supports prescription of combined hormonal contraception (CHC). Its effect on mood is highly variable and depends on biochemical characteristics of exogenous steroids and on type and severity of symptoms. Hormonal regimens reducing the estrogen-free interval or suppressing menstruation seem better choices. Psychoactive agents, such as serotonin reuptake inhibitors (SSRIs), are effective in reducing the symptoms of PMS/PMDD and may be prescribed continuously or only during the luteal phase. Novel therapeutic approaches include inhibition of progesterone receptors in the brain, i.e., with ulipristal acetate, reduced conversion of progesterone with dutasteride, and modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone. Reproduced under CC-BY. ## Topics [Premenstrual syndrome (PMS)](https://niyora.com/research/topics/condition-pms/)[Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[SSRIs and antidepressants](https://niyora.com/research/topics/treatment-ssri/)[Oral contraceptives and drospirenone](https://niyora.com/research/topics/treatment-hormonal-contraceptives/)[Estradiol, progesterone and hormone therapy](https://niyora.com/research/topics/treatment-hormone-therapy/)[Neurosteroids (allopregnanolone)](https://niyora.com/research/topics/treatment-neurosteroids/)[Pregnancy and postpartum](https://niyora.com/research/topics/comorbidity-postpartum/) Research tells you what helps on average. Niyora helps on the day it hits. Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor. ## Related studies Randomised trial, 2017 Does Sepranolone reduce symptoms of severe premenstrual syndrome (PMDD)? Survey study, 2022 What causes PMS and PMDD and what new treatments are being studied? Study, 2026 What treatments work for PMDD? Randomised trial, 2024 Does sertraline change brain chemicals in people with PMDD, and does this relate to symptom improvement? Case-control study, 2025 Do certain hormone-related brain chemicals predict how bad premenstrual depression and anxiety will be? Non-randomised trial, 2024 Does luteal phase sertraline treatment affect stress hormones and inflammation in PMDD? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗