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Progesterone Levels Linked to Premenstrual Dysphoric Disorder

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Low progesterone levels early in the menstrual cycle have been linked to an increased susceptibility to premenstrual dysphoric disorder (PMDD) according to research presented at the 26th European College of Neuropsychopharmacology Congress held in Barcelona, Spain on October 7, 2013. Professor Inger Sundstrom Poromaa presented her findings on the study involving 29 women, 15 of the women had been previously diagnosed with PMDD and 14 women were control subjects. Results of the study suggested brain activity throughout the menstrual cycle is different between healthy controls and women with PMDD, which indicates hormone fluctuations are important to those with PMDD.

When women were exposed to emotional processing, the women with PMDD showed a greater activity in the amygdala region of the brain during the follicular phase, which indicates impaired anxiety control compared to healthy women. The amygdala is an almond shape mass of nuclei within the temporal lobe of the brain. It is part of the limbic system that is involved in emotion and motivation, with emphasis on survival (fight or flight mechanism). Memories are sorted and categorized by the amygdala for storage in the brain. It is thought the amygdala determines where items are stored in the brain based on the type of emotional response the memory invokes. The amygdala receives input from the eyes, ears and other senses. During the follicular phase, increased amygdala activity during emotional stimuli was correlated with very low progesterone levels.

In the luteal phase, women with PMDD had higher scores of anxiety which also translated to increased emotion-induced amygdala reactivity. This suggested PMDD women only clinically had anxiety in the luteal phase. “Clearly they have an amygdala that is easily activated once progesterone levels start to increase in the early luteal phase. The higher amygdala activity in the follicular phase may also be a more general vulnerability mark in PMDD women,” explained Professor Sundstrom Poromaa.

Women that were carriers of the BDNF Val66Met risk genetic mutation also showed a lower activation of the fronto-cingulate cortex region which suggested anxiety control issues within the brain.
This information is important for many women during their reproductive years, as anxiety and depression disorders are twice as common in women, and major depressive disorder is the leading cause of disease in 15-44 year old women. “To date, very little emphasis has been put into evaluating the best possible hormonal contraception with no or positive impact on mood, in women suffering from anxiety and mood disorders. Ongoing clinical trials with low-dose estrogen oral contraceptives will shed light on their usefulness in women with mood disorders.”

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