A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos's menstrual distress questionnaire, Beck et al's depression inventory, Spielberger et al's state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.
PMID 3924191 3924191 DOI 10.1136/bmj.290.6482.1617 10.1136/bmj.290.6482.1617
Cite this article
Dennerstein, L., Spencer-Gardner, C., Gotts, G., Brown, J. B., Smith, M. A., & Burrows, G. D. (1985). Progesterone and the premenstrual syndrome: a double blind crossover trial. British medical journal (Clinical research ed.), 290(6482), 1617-1621. https://doi.org/10.1136/bmj.290.6482.1617
Dennerstein L, Spencer-Gardner C, Gotts G, Brown JB, Smith MA, Burrows GD. Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J (Clin Res Ed). 1985;290(6482):1617-1621. doi:10.1136/bmj.290.6482.1617
Dennerstein, L., et al. "Progesterone and the premenstrual syndrome: a double blind crossover trial." British medical journal (Clinical research ed.), vol. 290, no. 6482, 1985, pp. 1617-1621.
CommentThis case fits the criteria for mania listed by the Diagnostic and Statistical Manual of Mental Disorders (3rd edition) and the ninth revision of the International Classification of Diseases.The association of mania and myxoedema must be very rare, and we can find no other reported case. 1-5The two usual psychiatric syndromes seen in myxoedema are, firstly, confusion and cognitive impairment resembling dementia, sometimes with clouding of consciousness; and, secondly, depressed mood with paranoid delusional ideas and often hallucinations.' 2 Irritability and violence are reported only in association with paranoid cases.2Our patient showed no psychiatric disorder until further metabolic disturbance was superimposed on his thyroid deficiency.After surgery he had a mental disturbance which may have been mild hypomania, which suggests that he may have been particularly susceptible to develop a mental disturbance from metabolic abnormality as an expression of his genetic predisposition indicated by the positive family history.We thank Professor J T Silverstone for his help and advice in preparing this report.
Reproductive EndocrinologyMenstrual Cycle
Open Access
Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.
After participating in this activity, learners • Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.