Reduced Periovulatory Estradiol Peak in Premenstrual Dysphoric Disorder (PMDD)

It is presently thought that the levels of sex hormones in women with PMDD are not implicated in the etiology of the condition. However, the periovulatory subphase has largely been overlooked in research to date. The present study implemented a refined study methodology, involving collection of blood samples at 8 key menstrual cycle timepoints, following which the data is realigned, as the original visits are inherently misaligned, and imputed, because the realignment causes some datapoints to be set to missing. Study participants did not take any medications, had a negative urine drug test, and did not have DSM-5 defined anxiety or depression. Their symptom ratings were collected daily across two menstrual cycles, following which they were classified as PMDD (n=9), or healthy (n=13). The participants’ estradiol levels, collected at the 8 clinic visits, were measured using ultra-performance liquid chromatography tandem mass spectrometry. Relative to the original data, realignment of study visits resulted in better-defined estradiol and LH periovulatory peaks. No group differences were identified regarding: (1) demographic characteristics, (2) periovulatory luteinizing hormone (LH), and (3) estradiol at the early and mid-follicular, as well as early, mid-, and late luteal subphase. In contrast, the PMDD group showed a markedly reduced periovulatory estradiol peak (p=0.0049). The present talk will describe the study’s findings in the context of periovulatory inflammation and estradiol’s anti-inflammatory properties, as well as highlight a validated methodology for studying menstrual cycle trajectories, which involves realignment of study visits based on serum LH levels.