Severe PMS Linked with Chronic Hormone Disorder
March 3, 2000 (Atlanta) -- Women with a severe form of premenstrual syndrome
are more sensitive to pain and are more likely to have chronically lower levels
of beta-endorphins, the body's natural painkilling hormones, according to a new
study. Called premenstrual dysphoric disorder (PMDD), it affects millions of
women in their reproductive years.
For women with PMDD, emotional symptoms like severe depression,
irritability, and anxiety profoundly interfere with their lives during the
second half of the menstrual cycle. "These women also suffer from many
severe physical symptoms -- migraine, headache, backache, bloating,
cramping," lead author Susan S. Girdler, PhD, tells WebMD. Girdler is
assistant professor of psychiatry at the School of Medicine at the University
of North Carolina at Chapel Hill.
"It's a very severe disorder, yet it's not taken seriously by
doctors," Girdler says. "The vast majority of PMDD women coming into my
clinic to some extent want to be validated. When I first began this research, I
was shocked. Some women have full-blown panic attacks, are afraid to leave
their houses, have suicidal thoughts. It continues to be a very misunderstood
disorder, yet it's a very important issue for women."
Results of Girdler's small study, which focused just on pain sensitivity,
were presented at the American Psychosomatic Society annual meeting this week.
While a preliminary study had suggested that women with PMDD have increased
pain sensitivity three to seven days before menstruation, Girdler's study
showed that the sensitivity extended into all phases of the PMDD woman's
Hers is the first study to measure blood levels of beta-endorphins while
testing pain sensitivity. It supports a growing body of research suggesting
that PMDD is a chronic disorder that causes abnormal levels of many hormones,
including beta-endorphins, at all times of the month. "It suggests that
something happens premenstrually, that elevated sex hormones during that week
contribute to symptom expression," says Girdler.
Girdler's study used a tourniquet/blood pressure cuff, which has been proven
effective in gauging pain sensitivity, she says. The women were tested during
two phases: the premenstrual phase, and the week after menstruation began.
The study involved 54 women, including 27 with PMDD and 27 who did not have
it. The average age was 35. During the 20-minute test, pressure was gradually
increased until the woman expressed pain, then it was continued until the woman
could no longer tolerate it. Before the cuff was deflated, women were asked to
rate how unpleasant and how intense the pain was.
"We found that the PMDD women were significantly more sensitive to the
pain test," Girdler tells WebMD. "They had significantly lower
threshold levels and tolerance times. They couldn't endure the test nearly as
long as the control group, regardless [of] what phase they were in [in] their
menstrual cycle. They also rated the test procedure as being significantly more