How are PMS and stress connected, and what is the role of stress dysfunction in PMS?

Premenstrual syndrome (PMS) encompasses a range of emotional, physiological, and behavioral symptoms that occur during the luteal phase of the menstrual cycle (MC) and resolve with the onset of menstruation. These symptoms, which can include fatigue, physical pain, anxiety, irritability, and depression, significantly affect women's daily lives and overall well-being. In severe cases, PMS can progress to premenstrual dysphoric disorder (PMDD), profoundly impairing quality of life. Despite its prevalence, the neural mechanisms underlying PMS-particularly those related to stress-are not fully understood.This review aims to explore the complex interactions between PMS and stress, with a focus on the hormonal pathways involved. We propose that abnormal stress coping styles and stress reactivity patterns, collectively referred to as stress dysfunction, are crucial factors influencing women's vulnerability to PMS. We examine the relationship between PMS and stress from four perspectives: (1) PMS shares neuroendocrine metabolic circuits based on hormonal fluctuations with stress reactivity systems; (2) there is comorbidity between PMS and stress-related disorders; (3) PMS itself may act as a stressor, potentially creating a negative feedback loop that exacerbates symptoms; and (4) biofeedback training used for stress disorders may be effective in treating PMS. By providing a detailed analysis of stress-related hormonal changes and their effects on PMS, this review offers new insights into the physiological processes underlying PMS. Understanding these interactions may inform the development of targeted interventions and improve the quality of life for women affected by PMS.

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