Redei, E., & Freeman, E. W. (1995). Daily plasma estradiol and progesterone levels over the menstrual cycle and their relation to premenstrual symptoms. Psychoneuroendocrinology, 20(3), 259-267. https://doi.org/10.1016/0306-4530(94)00057-h
Redei E, Freeman EW. Daily plasma estradiol and progesterone levels over the menstrual cycle and their relation to premenstrual symptoms. Psychoneuroendocrinology. 1995;20(3):259-267. doi:10.1016/0306-4530(94)00057-h
Redei, Eva, and Ellen W. Freeman. "Daily plasma estradiol and progesterone levels over the menstrual cycle and their relation to premenstrual symptoms." Psychoneuroendocrinology, vol. 20, no. 3, 1995, pp. 259-267.
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Progesterone levels correlate with symptoms 5 to 7 days later in PMS
Progesterone levels correlated with premenstrual syndrome symptoms recorded 5 to 7 days later in a pilot study of 10 women with confirmed PMS and 8 without. Mean correlations in controls were not significant. From the follicular to the early luteal phase, estradiol was significantly higher in the 4 women with more severe PMS than in the milder subgroup and controls.
Key Findings
Across the cycle, progesterone levels correlated with symptom scores lagged 5 to 7 days in the PMS group, with mean correlations of 0.56, 0.59 and 0.61 (p < .001 with Bonferroni correction).
Mean correlations were not significant in controls. The 5 to 7 day relationship appeared only for progesterone and not for estrogen, ACTH or cortisol.
Progesterone and estradiol levels were consistently, but not significantly, higher across the cycle in women with PMS than in controls (progesterone p = .16).
PMS subgroup 2 (n = 4), with more severe symptoms, had significantly higher estradiol than subgroup 1 (n = 6) and controls from the follicular to the early luteal phase.
Progesterone correlations with lagged symptom scores differed significantly from controls for seven symptoms, including swelling and cramps (r = 0.54 each) and fatigue (r = 0.45).
Interpretation
This pilot study followed 10 women with confirmed PMS and 8 without across one ovulatory menstrual cycle, ages 19 to 36. The authors note this is a small pilot study. They hypothesize that ovulation-dependent progesterone is necessary but not sufficient to cause PMS symptoms. The findings support larger studies of the progesterone-symptom timing relationship.
RRM Context
Restorative reproductive medicine reads the ovulatory cycle as clinical information, and cycle charting records its timing. The authors cite earlier work linking the absence of ovulation to remission of PMS. They call the progesterone rise ovulation-dependent. Daily sampling and daily symptom ratings tie symptoms to timing in the cycle.
Our editorial summary of this paper, not the article's abstract.
Abstract
The present study extends a previous report of lower plasma ACTH levels in women with premenstrual syndrome (PMS) compared with asymptomatic controls. Plasma levels of estradiol and progesterone were measured daily in 10 women with confirmed PMS and 8 asymptomatic women. Daily symptom reports were maintained during the same menstrual cycle. Both estradiol and progesterone levels were consistently, but not significantly, higher throughout the cycle in PMS subjects compared with controls. From the follicular to the early luteal phase, estradiol levels were significantly higher in a previously defined PMS subgroup 2 with more severe symptoms throughout the cycle compared with both the less severe PMS subgroup 1 and controls. Progesterone levels were significantly and positively correlated with PMS symptoms along the entire menstrual cycle, preceding the symptoms by 5-7 days. These preliminary results provide support for the hypothesis that the presence of progesterone at early luteal phase levels is required for PMS symptoms to occur.
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