Question: What Causes Premenstrual Syndrome?
Answer: The causes of PMS are not completely understood at this time. However, significant progress has been made during the last decade in understanding the characteristics of the underlying causes of premenstrual syndrome. While the amount of sex steroids such as estrogen, progesterone, and testosterone is normal in women with PMS, researchers believe there may be an underlying difference in function and structure of cells relevant to the normal fluctuation that occurs in any one or more of these sex hormones. The most likely cause involves the chemical reactions to changes that entail the central nervous system and mediated neurotransmitter connections with the sex hormones. Impairment of the physiological regulatory mechanism that transmits the nerve impulses which involve serotonin is considered the most likely theory. Of several studies that support this theory, a well-designed study reported in Neuorpsychopharmacology 1995; 12:167—176 (Level II-2) found that women who have severe PMS responded better to serotonin reuptake inhibitors or SSRIs such as Prozac than to noradrenergic antidepressants such as Ludiomil or maprotiline. Because not all women with premenstrual syndrome respond to this type of treatment, researchers recognize that other causes are almost certainly involved.
Reference: ACOG Practice Bulletin Number 15, 2000
