Blunted Cortisol Response to Acute Psychosocial Stress in Women With Premenstrual Dysphoric Disorder

Abstract

Background: Despite being considered a stress-related condition, it is not known whether the hypothalamic-pituitary-adrenal (HPA) axis is dysfunctional in response to acute psychosocial stress in premenstrual dysphoric disorder (PMDD). This is problematic because many women with PMDD report that they are not able to control their stress levels, and a blunted cortisol output has been identified in women with related psychiatric conditions, such as anxiety and depression. The present study is a part of the Premenstrual Hormonal and Affective State Evaluation (PHASE) project, and it aimed to characterize the cortisol trajectory in response to an acute psychosocial stress challenge.

Methods: Women with PMDD and healthy controls with confirmed ovulatory cycles underwent the Trier Social Stress Test (TSST) procedure in the mid-late luteal phase of the menstrual cycle, throughout which we collected serum samples of cortisol that we analyzed using ultra-performance liquid chromatography tandem mass spectrometry.

Results: The linear mixed model analysis indicated a significant time*diagnosis interaction (P = .008) such that women with PMDD displayed significantly lower serum cortisol levels at +40 through +90 minutes from the time of stress induction.

Conclusion: This is the first study to show that women with PMDD have a blunted cortisol response to psychosocial stress. Combined with our earlier finding showing a greater parasympathetic nervous system withdrawal on heart oscillations in PMDD during acute stress, these and other results show that the dysregulated processing of stress in PMDD may be captured using objective study measures.

Keywords: HPA axis; Premenstrual dysphoric disorder; cortisol; menstrual cycle.

Figure 1.

The effect of time and diagnosis on serum cortisol. Considering the baseline, PMDD participants had lower cortisol levels at +40 (P ≤ .01), +50 (P ≤ .01), +65 (P ≤ .01), and +90 (P ≤ .01) minutes from the start of TSST relative to the healthy controls. The intervals represent confidence intervals for the predicted values. PMMD, premenstrual dysphoric disorder; TSST, Trier Social Stress Test.