Premenstrual Syndrome and Psychiatric Comorbidities

By Shirmohammadi, Maryam; Arbabi, Mohammad et al. | Iranian Journal of Psychiatry, April 1, 2009 | Go to article overview

Premenstrual Syndrome and Psychiatric Comorbidities


Shirmohammadi, Maryam, Arbabi, Mohammad, Taghizadeh, Ziba, Haghanni, Hamid, Iranian Journal of Psychiatry


Objective: Premenstrual syndrome (PMS) is a common disorder with prevalence rate of approximately 30%; its concurrence with psychiatric symptoms will make it a disabling condition that resists usual treatment.

Objective: This study was enrolled to assess the co-morbidity of PMS and psychiatric disorders in a sample of girls with PMS compared to those without PMS.

Material and method :This study was conducted through a cross sectional method with 362 participants (166 with PMS and 196 healthy girls) who were selected randomly and completed the demographic questionnaire, premenstrual syndrome symptom daily record scale and the symptom checklist 90-revised (SCL-90-R).

Result: According to the result of the independent t test, the mean score of all the psychiatric symptoms in the PMS group was significantly higher than those in healthy group (P<0.001). According to SCL-90-R measurement, most of the participants in the PMS group were categorized as extremely sick for somatization (44%) ,obsessive-compulsive (59%), depression (58.4%), anxiety (64.5%), hostility (47%) and psychoticism (69.3%); most of the participants were diagnosed as having borderline severity of disorders for interpersonal sensitivity (44.6%) and paranoid (42.8%) and most of the respondents with PMS (46.4%) were diagnosed as healthy only for phobic anxiety.

Conclusion: There is a considerable relationship between PMS and different psychiatric symptoms that can complicate the diagnosis of PMS and its treatment for the health care providers. Therefore, all health care providers who are in contact with women in their reproductive age should be sensitive to mental health status in women with PMS.

Keywords: Comorbidity, Pre menstrual syndrome, Psychiatry

Iran J Psychiatry 2009; 4:62-66

The results of comparison between men and women on prevalence of psychiatric disorders reveal that the incidence of psychological disorders in women is approximately twice than that of men (1). The higher prevalence of mood disorders in women can be related to the following factors: genetic vulnerability, more exposure to stressful life events, cultural and social factors. However, above all, we should consider the unique role of neuroendocrin system and fluctuation of steroidal hormones in regulation of neurotransmitters. Circulating steroidal hormones can directly regulate brain function and adjust behavior. In this case, estrogen has a positive regulatory effect on serotonin activity in different ways. Normal fluctuation in balance of estrogen or estrogen- progesterone ratio can result in disturbed serotonergic system activity and provoke mood disorders in susceptible women (2, 3). For example, the sensitivity of neurotransmitter

system, changes due to sudden appearance of higher level of estrogen in puberty and increases the incidence of disturbed behaviors such as moodiness, irritability and conflicts with parents (1). In addition to the role of serotonergic system, the elevated level of nuroepinephrin and decresed level of endogenous opiates during the luteal phase of menstrual cycle have an established role in stimulating mood changes (4). Besides biological sources, there can be a cognitive disturbance in etiology of PMS and associated symptoms. According to this theory, the severity of distress that a woman experiences is induced not only by the physical symptoms, but also by the negative ways she interprets them. These groups of women are more likely to experience anxiety, depression and other mood disturbances (5).

Premenstrual syndrome (PMS) is a recurrent appearance of psychological (e.g. irritability) and physical (e.g. headache) symptoms that occurs during luteal phase of the menstrual cycles and remits shortly after the beginning of menses and during the follicular phase (6). Worldwide, nearly 40% of women during childbearing age have some form of PMS with mild and moderate severity, but only 3-8% have sever psychological manifestation known as Premenstrual Dysphoric Disorder (PMDD)(3). …

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