EXECUTIVE SUMMARY
New data from the UC Davis Health System in Sacramento indicate that certain premenstrual symptoms, such as mood changes, breast pain, and abdominal cramps, are linked with inflammation. C-reactive protein, a commonly accepted biomarker for inflammation, is elevated within most women with premenstrual symptoms, data indicate.
- Understanding the physiology of premenstrual symptoms could benefit patients and providers: About 80% of women experience premenstrual symptoms, and about 50% of women seek medical care for them.
- Establishing Premenstrual Symptoms As An Inflammatory Condition May Indicate That Such Symptoms May Be A Useful Sentinel Of Future Chronic Disease Risk, Researchers Believe.
New data from the UC Davis Health System in Sacramento indicate that certain premenstrual symptoms, such as mood changes, breast pain, and abdominal cramps, are linked with inflammation.1 C-reactive protein, a commonly accepted biomarker for inflammation, is elevated within most women with premenstrual symptoms, data indicate. Understanding the physiology of premenstrual symptoms could benefit patients and providers: About 80% of women experience premenstrual symptoms, and about 50% of women seek medical care for them.2,3
Even though premenstrual symptoms affect most women, they are rarely studied, possibly because they are considered just a natural part of the menstrual cycle, says Ellen Gold, PhD, professor of epidemiology in the Department of Public Health Sciences at the UC Davis School of Medicine. In particular, very few studies have examined the role of inflammation, even though nonsteroidal anti-inflammatory drugs are one of the most-used treatments for premenstrual symptoms, notes Gold, who served as lead author of the current research.
Gold and her colleagues at UC Davis used data from the Study of Women’s Health Across the Nation (SWAN), a longitudinal, multicenter study of some 3,000 women in midlife from five racial/ethnic groups. Participants were eligible for inclusion in the cohort if they were ages 42–52 and premenopausal or early perimenopausal, had not undergone a hysterectomy or bilateral oophorectomy, were not pregnant, and were not using menopausal hormone therapy or oral contraceptives at baseline. Because Gold serves as one of the SWAN investigators, she had access to extensive health data from the study, including results of blood analyses for an inflammatory marker (C-reactive protein) on a large and diverse group of women. This access allowed the researchers to look at the specific premenstrual symptoms women experienced and whether inflammation was associated with them.
“The results showed that this blood biomarker of inflammation was associated with most premenstrual symptoms, but not headaches, after controlling for a variety of potentially confounding variables,” notes Gold.
Establishing premenstrual symptoms as an inflammatory condition may indicate that those symptoms may be a useful sentinel of future chronic disease risk, notes Elizabeth Bertone-Johnson, ScD, assistant professor of epidemiology at University of Massachusetts, Amherst. C-reactive protein is a biomarker of inflammation that also is associated with increased risk of cardiovascular disease.
“This intriguing possibility also suggests that treatment of premenstrual symptoms with therapies targeting inflammation could have positive impacts on long-term chronic disease risk,” states Bertone-Johnson in an accompanying editorial.4 Bertone-Johnson served as lead author of recent research which indicates that women with moderate-to-severe premenstrual symptoms had a 40% higher risk of developing high blood pressure over the following 20 years compared to women experiencing few menstrual symptoms.5 (Contraceptive Technology Update reported on the data. See the March 2016 article, “Could premenstrual syndrome be a flag for future risk of hypertension?” available at http://bit.ly/29O2Bdq.)
UC Davis also plans to use SWAN data to determine the timing of inflammation relative to premensrual symptoms and the role of hormonal factors. “Our hope is that our work will lead to treatment plans that can be targeted to specific symptoms or groups of symptoms, depending on each woman’s experiences,” notes Gold.
Providers can help ease mild-to-moderate premenstrual symptoms by suggesting changes in lifestyle or diet. Regular aerobic exercise, such as brisk walking, running, cycling, and swimming, may help lessen premenstrual symptoms and reduce fatigue and depression. Relaxation therapy such as breathing exercises, meditation, and yoga, as well as massage therapy, also may help.6
When premenstrual symptoms interfere with daily life, women may decide to seek medical treatment. Treatment will depend on the severity of symptoms; in more severe cases, medication may be indicated. Family planning providers may suggest use of extended cycles of combined oral contraceptives or the contraceptive vaginal ring, levonorgestrel intrauterine contraception, or the contraceptive injection for lessening dysmenorrhea associated with premenstrual symptoms.7
REFERENCES
- Gold EB, Wells C, Rasor MO. The association of inflammation with premenstrual symptoms. J Womens Health (Larchmt) 2016; doi:10.1089/jwh.2015.5529.
- Campbell EM, Peterkin D, O’Grady K, et al. Premenstrual symptoms in general practice patients. Prevalence and treatment. J Reprod Med 1997; 42:637-646.
- Sternfeld B, Swindle R, Chawla A, et al. Severity of premenstrual symptoms in a health maintenance organization population. Obstet Gynecol 2002; 99:1014-1024.
- Bertone-Johnson ER. Chronic inflammation and premenstrual syndrome: A missing link found? J Womens Health (Larchmt) 2016; doi:10.1089/jwh.2016.5937.
- Bertone-Johnson ER, Whitcomb BW, Rich-Edwards JW. Premenstrual syndrome and subsequent risk of hypertension in a prospective study. Am J Epidemiol 2015; 182(12):1000-1009.
- American College of Obstetricians and Gynecologists. Premenstrual syndrome. Accessed at http://bit.ly/1Mf5NLV.
- Nelson AL, Baldwin SB. Menstrual disorders. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th Revised Edition. New York: Ardent Media; 2011.
