What causes premenstrual syndrome and premenstrual dysphoric disorder, and how common are they?

Premenstrual disorders remain one of the most prevalent pathologies in women all over the world. The core disorders – premenstrual syndrome (PMS) and premenstrual dysphoric disorder – predominate in women of reproductive age. Also, there are four variants of premenstrual disorders – premenstrual exacerbation, premenstrual disorders due to nonovulatory ovarian activity, progestogen-induced premenstrual disorders, premenstrual disorders with absent menstruation. Recently, the prevalence of any premenstrual disorder is up to 87% in female population.In this article some mechanisms that are involved in the pathogenesis of PMS are presented. The fluctuations of different hormones (namely, estradiol, progesterone, testosterone, etc.) and not normal response of the central nervous system to such variations can lead to psychological changes. Serotonin, serotonin transporter, gamma amonibutyric acid are involved in the mechanisms of mood disorders. Genetic factor is studied in different woman’s reproductive diseases. Gene polymorphism of SERT, COMT, MAOA, BDNF, ESR1 and ESR2 genes were studied most often in PMS development. One of the subtypes of premenstrual disorders is premenstrual exacerbation, when clinical manifestations of underlying diseases are expressed more before menstruation. Special attention is paid to the association of metabolic syndrome, overweight, obesity with premenstrual syndrome. There is a negative impact of these diseases of the regulation of menstrual cycle processes – early menarche onset, abnormal uterine bleeding (irregular periods, heavy menstrual bleeding or amenorrhea), hyperandrogenism, low concentration of sex steroid-binding globulin. It was found that the frequency of PMS in overweight and obese women is almost twice higher than in normal weight women. Women with metabolic syndrome who suffer from PMS have poor sleep quality, they are more depressive and anxiety. The most common association of gene between obesity, diabetes mellitus and PMS is related to angiotensin converting enzyme gene and its I/D polymorphism, however, the results of such relationship are controversial. It is very important the for different medical professionals to understand the manifestations of premenstrual disorders and prescribe to the patients not only medicament treatment, but also perform for them psychological support and give recommendations about lifestyle changes.

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