Management of Cardio-metabolic Features in Women Diagnosed with Premenstrual Syndrome

Abstract

PM (premenstrual syndrome) management starts from establishing the diagnostic that embraces a combination of self - reported accuses with cyclic menstrual appearance in addition to exclusion of other causes like thyroid and psychiatric conditions which may actually overlap in some individuals, thus a clear multi-disciplinary distinction is mandatory. Multiple mechanisms are involved in PM as hormonal pathways concerning ovarian-associated sex steroids, neuroendocrine elements, central neurotransmitters, anomalies of uterine-chemokine-brain-axis; genetic and epigenetic studies on PM still have conflicting results. New data suggested that PM is associated with cardiometabolic conditions like high blood pressure (HBP) or obesity which also independently of PM affect a great number of people in certain populations including at young age. Our purpose is to focus on cardio-metabolic features in PM. This is a narrative review. Recent data suggests that approximately one in ten PM females associates HBP. Despite baseline normal values of arterial pressure, the menstrual cycle-related symptoms correlates with higher BP (mean, systolic, diastolic) during luteal phase versus follicular phase. Monthly variability of BP is correlated with PM symptoms via arterial stiffness and estrogens effects on reninangiotensin system. In PM positive females diagnosed with refractory HBP, BP improves if SSRI are added, SSRIs representing the first line therapy in traditional PM management. One study found PM to be associated with a risk of developing HBP (hazard ratio of 1.4, CI 95%: 1.2-1.6), independent of age, smoking status and body mass index. In terms of PM and glucose profile, there is limited amount of published data. A few small sample size studies revealed glucose and insulin differences among PM females during menstrual cycle phases. Food behavior changes are part of PM. PM seems more frequent among obese individuals, but not all studies agree. Whether PM females are prone to cardio-metabolic comorbidities or they are incidental due to high prevalence in general reproductive female population of both conditions is still on open subject. But understating the cardio-metabolic features in PM is essential nowadays as modern society is oriented to a better management of conditions that impair the quality of life.