Ovarian steroid addback increases symptom severity in women with PMDD

Ovarian hormone suppression gets rid of symptom cyclicity in women with premenstrual dysphoric disorder (PMDD), reports a study. In addition, ovarian steroid addback results in the emergence of symptoms in those with PMDD but not in healthy comparison women.

In this study, 34 women with PMDD and 76 healthy participants completed a daily rating form during three hormone conditions, namely ovarian suppression induced by the gonadotropin-releasing hormone agonist leuprolide, leuprolide plus estradiol addback, and leuprolide plus progesterone addback.

The authors then compared the affective and somatic symptom scores during the last 8 of 12 weeks of leuprolide alone with scores during the first 4 weeks of estradiol addback and the first 4 weeks of progesterone addback.

Significant main effects of diagnosis and diagnosis-by-hormone interactions were noted for affective symptoms (ie, anxiety, sadness, irritability, mood swings). This indicated a significant increase in symptom severity scores during estradiol addback and progesterone addback relative to leuprolide treatment alone.

Women with PMSS had significantly higher symptom scores during each addback than healthy participants. The PMDD cohort also showed greater severity in physical symptoms, bloating, and food cravings regardless of hormone conditions. Furthermore, breast pain severity increased during estradiol addback compared with leuprolide alone and progesterone.

“In PMDD, irritability and mood swings are tied more closely to progesterone than estradiol,” the authors said. “Despite the replication of this hormone-related behavioral phenotype in PMDD, the mechanisms underlying the presumed alteration in steroid signaling require further characterization.”