Cardiovascular Autonomic Profile in Women With Premenstrual Syndrome

Abstract

Introduction: The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle. Since many symptoms could be related to the autonomic nervous system, we hypothesized that the sympathetic nervous system is perturbed in PMS. Methods: The cardiovascular autonomic profile of nine women with PMS (30.4 ± 2.5 years) were compared to that of nine healthy controls (30 ± 2.5 years) during their early follicular (EF) and LL phases of the menstrual cycle. Plasma norepinephrine (NE) concentrations, power spectral analysis of heart rate and systolic blood pressure (BP), and baroreflex sensitivity (BRS) were assessed during recumbency and a head-up tilt (HUT). Cardiovascular responsiveness to α1- and β-adrenoreceptor agonists (phenylephrine and isoproterenol, respectively) were also assessed. Results: In the LL phase, the plasma NE concentrations in women with PMS during recumbency and a HUT were lower than those in women without PMS [180 ± 30 vs. 320 ± 50 pg/ml; p = 0.04 (recumbent), and 480 ± 70 vs. 940 ± 180 pg/ml: p = 0.02 (HUT)]. In the LL phase, the dose of phenylephrine required to increase systolic BP by 15 mmHg in women with PMS was significantly greater than that in women without PMS (202 ± 30 μg vs. 138 ± 20 μg; p = 0.02). Sympathetic and vagal cardiac control indices were comparable in the two groups in the menstrual phases. In women with PMS, the value of LF _SBP in the LL phase was lower than that in the EF phase (0.98 ± 0.2 vs. 1.77 ± 0.4 mmHg², p = 0.04). The increase in LF _SBP in women with PMS in the LL phase during HUT was greater than that in the controls, 5.2 ± 0.9 vs. 3.1 ± 0.5 mmHg², p = 0.045, and this increase was associated with a significant decrease in BRS. Conclusion: In women with PMS without psychogenic symptoms, the sympathetic control of their circulation is not dominant during the LL phase of their menstrual cycle.

Keywords: autonomic nervous system; baroreflex sensitivity; head-up tilt test; premenstrual syndrome; spectral analysis.

FIGURE 1

Plasma norepinephrine concentration in women without premenstrual syndrome (PMS; CON) and with PMS in a recumbent position (A, Upper panel) and the change in plasma norepinephrine levels during a 60° head-up tilt (B, Lower panel) in the early follicular and late luteal phases of the menstrual cycle. A mixed model of two-way ANOVA for repeated measures was used to assess the significance of menstrual phase–group interaction and menstrual phase effect. Bonferroni’s test was used for post hoc analysis. ^∗p < 0.05, paired data between the menstrual phases EF and LL into each group, ^#p < 0.05, unpaired data between the two groups in each menstrual phase.

FIGURE 2

Responses of women without premenstrual syndrome (CON) and with PMS to graded intravenous boluses of phenylephrine (selective α1-adrenoceptor agonist), as represented by the PHE₁₅ value (A, Upper panel): the phenylephrine dose which increased the systolic blood pressure by 15 mmHg (A, Upper panel), and isoproterenol (β-adrenoceptor agonist), as represented by the ISOP₁₅ value (B, Lower panel): the isoproterenol dose which increased the heart rate by 15 beats/minute in the early follicular and late luteal phases of the menstrual cycle. A mixed model of two-way ANOVA for repeated measures was used to assess the significance of menstrual phase–group interaction and menstrual phase effect. Bonferroni’s test was used for post hoc analysis. ^∗p < 0.05, paired data between the menstrual phases EF and LL into each group.