No explicit link has firmly been established between PCOS and premenstrual dysmorphic disorder or PMDD,[1] an extreme form of PMS with significant mental and physical impairments in the week leading up to menses, the onset of a period, and then improvement in or absence of symptoms in the intervening weeks.[2]
However, individuals with PCOS have a significantly increased likelihood of having autism and/or attention deficit hyperactivity disorder or ADHD. While only 3-9% of the population experience PMDD,[3] one study found that 46% of women with ADHD and 92% of those with autism have a diagnosis of PMDD.[4]
In this article we explore the potential link between PCOS and PMDD.
A typical menstrual cycle relies on a complex interplay of chemicals over a cycle of around 28 days and comprised of four key phases:[5]
Menses: the uterus sheds its lining if pregnancy hasn’t occurred from day 1 of the cycle for a typical period of 3-7 days;
Follicular: overlapping with menses and lasting for 10-14 days, the lining of the uterus is restored and follicles in the ovaries grow to produce (usually) a single mature egg or ovum;
Ovulation: at roughly day 14, an eggs is released; and
Luteal: from day 15-28 the egg travels to the uterus and, if fertilized by a sperm, implants into the uterine wall.
As the luteal phase comes to a close leading up to menstruation, individuals may experience a range of physical and emotional symptoms associated with both PMS and PCOS:[6]
Fatigue, insomnia and frequent napping;
Bloating;
Cramps;
Breaking out or acne;
Breast tenderness;
Headaches;
Mood changes, including irritability, anxiety and/or depression;
Difficulty concentrating
Changes in appetite, including cravings and/or increased/decreased appetite; and
Diminished interest in activities, including sex.
Individuals with PMDD experience an extreme form of PMS with more severe expression of these emotional and physical symptoms.[7] PMDD can even be associated with suicidal feelings.[8]
There are several similarities through which PCOS and PMDD may share underlying mechanisms or through which PCOS may exacerbate PMS symptoms:
Elevated levels of allopregnanolone (ALLO),[9] a very small molecule or metabolite produced when the body breaks down the progesterone hormone, are associated with both PMDD and PCOS.[10],[11] This is related to increased sensitivity to ALLO through the Gamma-aminobutyric acid-A (GABAA) receptors,[12],[13] neurotransmitters or signaling molecules that reduce the level of neuronal activity by reducing the transmission of signals between neurons.[14]
Alterations to grey matter volume, either in terms of absolute volume in the case of PCOS[15] or asymmetry between the volume in left and right hemisphere of the brain in the case of PMDD.[16],[17]
Individuals with PCOS may experience a more significant burden of PMS symptoms due to the irregular and unpredictable nature of their cycles.
Other risk factors for PMDD may include:[18]
Family history of PMDD or PMS;
Personal or family history of other mental health disorders including depression, post-partum disorder or other mood disorders;
Lower level of educational attainment; and
Use of tobacco.
Reviewed by Sonia Kalra, CEO of NatureMary, biologist and advocate for women’s health
PARTNER SPOTLIGHT
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Sources
[1] https://ada.com/conditions/premenstrual-dysphoric-disorder-pmdd/
[2] https://www.additudemag.com/pmdd-autism-adhd/#footnote6
[3] https://www.additudemag.com/pmdd-autism-adhd/#footnote6
[4] https://www.sciencedirect.com/science/article/abs/pii/S0022395620311134?via%3Dihub
[5] https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle
[6] https://my.clevelandclinic.org/health/diseases/24288-pms-premenstrual-syndrome
[7] https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
[8] https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
[9] https://www.researchgate.net/publication/275665591_Women_with_polycystic_ovary_syndrome_have_elevated_serum_concentrations_of_and_altered_GABA_A_receptor_sensitivity_to_allopregnanolone
[10] https://www.acs.org/molecule-of-the-week/archive/a/allopregnanolone.html
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231988/?_kx=jJxDde4-6THbrwFbgRIVkZTM_h7TMGni3B4Lw3KtYWo.Tw6sBY
[12] https://www.researchgate.net/publication/275665591_Women_with_polycystic_ovary_syndrome_have_elevated_serum_concentrations_of_and_altered_GABA_A_receptor_sensitivity_to_allopregnanolone
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231988/?_kx=jJxDde4-6THbrwFbgRIVkZTM_h7TMGni3B4Lw3KtYWo.Tw6sBY
[14] https://www.ncbi.nlm.nih.gov/books/NBK526124/
[15] https://www.tandfonline.com/doi/full/10.1080/09513590.2022.2106475
[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200862/?_kx=jJxDde4-6THbrwFbgRIVkZTM_h7TMGni3B4Lw3KtYWo.Tw6sBY
[17] https://pubmed.ncbi.nlm.nih.gov/15050374/
[18] https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
Complications – Menstrual Health