Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder

Ju-Yu Yen; Huang-Chi Lin; Pai-Cheng Lin; Tai-Ling Liu; Cheng-Yu Long; Chih-Hung Ko

doi:10.3390/ijerph16224352

Reproductive Endocrinology · Ovarian Hormones

Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder

Yen JY, Lin HC, Lin PC, Liu TL, Long CY, Ko CH

Published November 7, 2019 International journal of environmental research and public health, 16(22)

DOI 10.3390/ijerph16224352 PMID 31703451 PMC PMC6888463

RRM Academy Synopsis

Women with PMDD had lower early luteal estrogen than controls

Women with premenstrual dysphoric disorder (PMDD) had lower estrogen early in the luteal phase. The study compared 63 women with PMDD and 53 controls. Early estrogen and progesterone together were linked to later symptom severity.

Key Findings

The PMDD group had significantly lower estrogen than controls in the early luteal phase (p < 0.001) and in the late luteal phase (p = 0.026).
Across the 63 women with PMDD and 53 controls, progesterone levels showed no significant difference between groups.
In the study's statistical model, early luteal estrogen and progesterone interacted in their association with late luteal PMDD severity. The interaction term and early luteal progesterone were each significantly associated with severity.
Among women with lower early luteal estrogen, women with PMDD had significantly higher early luteal progesterone than controls. Among women with higher estrogen, the groups did not differ.

Interpretation

The study is an observational comparison of volunteers recruited through campus advertisements. It shows associations and cannot show that low estrogen causes PMDD symptoms. Each woman gave blood twice in one cycle. The authors placed the luteal phases by counting from the last period and used no ovulation test or LH measurement. The authors note that weekly symptom ratings mean memory bias could not be prevented. Strict criteria excluded many candidates, leaving a small sample. Women taking psychotropic or gonadotropic medication were excluded. The authors call for further mechanistic studies.

RRM Context

The authors report that PMDD symptoms disappear in cycles without ovulation and during pregnancy. That ties the condition to ovulation and the hormones after it. Restorative reproductive medicine treats the ovulatory cycle as the unit of care. Timing luteal hormones requires the ovulation date, which cycle charting can supply.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective/Introduction

The dynamics of ovarian hormone fluctuations during the luteal phase of the menstruation cycle were previously suggested to contribute to the development of premenstrual dysphoric disorder (PMDD) symptoms, but adequate empirical evidence has not been obtained from hormone concentration studies. We prospectively evaluated estrogen and progesterone levels in the early luteal (EL) and late luteal (LL) phases in women with PMDD and the association of these levels with PMDD symptom severity.

Methods

63 women with PMDD and 53 controls without such severe symptoms were evaluated for the estrogen and progesterone levels, and PMDD severity in the EL and LL phases.

Results

The results demonstrated that the women with PMDD had a lower EL-phase estrogen level than the controls. Covariant analysis demonstrated that the interaction term between EL-phase estrogen and EL-phase progesterone level was associated with PMDD severity. Among women with lower EL estrogen levels, higher EL-phase progesterone was observed among the women with PMDD versus controls. These results suggest that low EL-phase estrogen level could moderate the provoking effect of EL progesterone in women with PMDD. Overall, these data suggest a possible role of estrogen and progesterone in the development of PMDD symptoms.

Topics

Reproductive Endocrinology › Ovarian Hormones › Estrogen · Menstrual Cycle › Premenstrual Disorders › Premenstrual Dysphoric Disorder · Diagnostics › Hormone Testing › Timing of Testing

Ju-Yu Yen, Huang-Chi Lin, Pai-Cheng Lin, Tai-Ling Liu, Cheng-Yu Long, Chih-Hung Ko

J Yen, H Lin, P Lin, T Liu, C Long, C Ko

PMID 31703451 31703451 DOI 10.3390/ijerph16224352 10.3390/ijerph16224352 Yen et al. 2019, Yen 2019

Keywords

PMDD, estrogen, luteal, progesterone, prospective, women

Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder

Women with PMDD had lower early luteal estrogen than controls

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States

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Keywords