Menstruation and Premenstrual Dysphoric Disorder: Its Impact on Mood

Objetivo: Elucidar as principais hipóteses atuais sobre o transtorno disfórico pré-menstrual (TDPM), a síndrome pré-menstrual (SPM) e a terapia cognitiva comportamental (TCC) como tratamento. Método: Foi realizada uma pesquisa nos bancos de dados PubMed, Cochrane e BIREME (LILACS/BVS), nos idiomas português, espanhol e inglês, no período de 2000 a 2017, utilizando os seguintes descritores: transtorno disfórico pré-menstrual, síndrome prémenstrual e terapia cognitiva comportamental. Resultados: Um total de 107 estudos enquadrou-se nos critérios de inclusão – artigos de revisão da literatura, estudos do tipo corte transversal, estudos do tipo coorte prospectivo e estudo do tipo coorte retrospectivo. Cento e cinco estudos identificaram fatores fundamentais para o desenvolvimento da TDPM – as hipóteses da função ovariana, função hormonal, neurotransmissores, genética e fatores ambientais e vulnerabilidade. Desde 2009, temos estudos sobre a TCC como tratamento de primeira linha. Conclusão: Os fundamentos do TDPM podem ser vistos como uma complexa multiplicidade de fatores. Ainda não há nada conclusivo; futuras pesquisas são necessárias para definir os processos etiopatogênicos do TDPM. A TCC demonstrou sua eficácia como tratamento de primeira linha para SPM e TDPM.

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Brain reactivity during aggressive response in women with premenstrual dysphoric disorder treated with a selective progesterone receptor modulator

Neuropsychopharmacology ◽

10.1038/s41386-021-01010-9 ◽

2021 ◽

Author(s):

Elisavet Kaltsouni ◽

Patrick M. Fisher ◽

Manon Dubol ◽

Steinar Hustad ◽

Rupert Lanzenberger ◽

...

Keyword(s):

Progesterone Receptor ◽

Negative Relationship ◽

Premenstrual Dysphoric Disorder ◽

Aggressive Response ◽

Anterior Cingulate ◽

Reproductive Age ◽

Gonadal Hormone ◽

Dorsal Anterior Cingulate Cortex ◽

Response Condition ◽

Receptor Modulator

AbstractPremenstrual dysphoric disorder (PMDD) is a psychiatric condition characterized by late luteal phase affective, cognitive, and physical impairment. The disorder causes significant suffering in about 5% of women in their reproductive age. Altered sensitivity of cognitive-affective brain circuits to progesterone and its downstream metabolite allopregnanolone is suggested to underlie PMDD symptomatology. Core mood symptoms include irritability and anger, with aggression being the behavioral outcome of these symptoms. The present study sought to investigate the neural correlates of reactive aggression during the premenstrual phase in women with PMDD, randomized to a selective progesterone receptor modulator (SPRM) or placebo. Self-reports on the Daily Record of Severity of Problems were used to assess PMDD symptoms and gonadal hormone levels were measured by liquid chromatography tandem mass spectrometry. Functional magnetic resonance imaging was performed in 30 women with PMDD, while performing the point subtraction aggression paradigm. Overall, a high SPRM treatment response rate was attained (93%), in comparison with placebo (53.3%). Women with PMDD randomized to SPRM treatment had enhanced brain reactivity in the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex during the aggressive response condition. The fronto-cingulate reactivity during aggressive responses depended on treatment, with a negative relationship between brain reactivity and task-related aggressiveness found in the placebo but not the SPRM group. The findings contribute to define the role of progesterone in PMDD symptomatology, suggesting a beneficial effect of progesterone receptor antagonism, and consequent anovulation, on top-down emotion regulation, i.e., greater fronto-cingulate activity in response to provocation stimuli.

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