Is Premenstrual Syndrome a Uterine Inflammatory Disease? Retrospective Evaluation of an Etiologic Approach

DOI: 10.4236/ojog.2015.56044   PDF   HTML   XML   3,652 Downloads   6,105 Views   Citations


Objective: To retrospectively evaluate the efficacy of local uterine antibiotic and anti-inflammatory injections combined with cryotherapy for the treatment of severe Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). To validate the hypothesis of a uterine infectious/inflammatory etiology of PMS/PMDD. Methods: Clinical files of 161 women sequentially treated from September 1995 to April 2005, were collected for study. A subset of 148 patients (mean: 36.7 ± 7.8 years, range: 20.1 - 53.8 years) were eligible for statistical analysis. The ten most relevant PMS symptoms, namely depression, irritability, anxiety, fatigue, headache, edema, breast tenderness, abdominal bloating, pelvic pain and dysmenorrhea, were self-rated before and three menstrual cycles after treatment, using a 0 to 5 scale. The treatment consisted of cervical stromal antibiotic/anti-inflammatory injections combined with intracervical cryotherapy. Scores were compared using non-parametric tests for matched samples. Results: Before treatment, mean severity scores for the 10 symptoms were 3.97 ± 1.17, 4.26 ± 0.88, 3.41 ± 1.23, 3.91 ± 0.94, 3.35 ± 1.71, 2.28 ± 1.69, 2.13 ± 1.63, 4.51 ± 0.63, 2.28 ± 1.30, and 2.28 ± 1.88, respectively. Mean values after treatment were 0.54 ± 0.91, 0.51 ± 0.91, 0.32 ± 0.70, 0.42 ± 0.74, 0.43 ± 0.96, 0.22 ± 0.53, 0.39 ± 0.73, 1.01 ± 0.94, 0.28 ± 0.69, and 0.44 ± 0.92. All tests were statistically significant (p < 0.01). Conclusion: Both PMS physical and psycho-affective symptoms respond to local anti-inflammatory and antibiotic treatment of the uterus, showing a stable improvement after the treatment has ended. The results of this study suggest that the clinical pattern of PMS can be explained as an inflammatory mediated response to uterine infectious or traumatic insults. Further evidence is urgently needed in order to validate this innovative approach for widespread use in severe PMS/ PMDD cases.

Share and Cite:

Lolas-Talhami, J. , Lafaja-Mazuecos, J. and Ferrández-Sempere, D. (2015) Is Premenstrual Syndrome a Uterine Inflammatory Disease? Retrospective Evaluation of an Etiologic Approach. Open Journal of Obstetrics and Gynecology, 5, 305-312. doi: 10.4236/ojog.2015.56044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Doyle, C., Ewald, H.A.S. and Ewald, P.W. (2007) Premenstrual Syndrome: An Evolutionary Perspective on Its Causes and Treatment. Perspectives in Biology and Medicine, 50, 181-202.
[2] Lolas, J. (1995) Síndrome Premenstrual desde una Nueva Perspectiva. Santiago de Chile, Texido, 1-199.
[3] Lete, I., Duenas, J.L., Serrano, I., Doval, J.L., Martínez-Salmeán, J., Coll, C., Pérez-Campos, E. and Arbat, A. (2011) Attitudes of Spanish Women toward Premenstrual Symptoms, Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Results of a Nationwide Survey. European Journal of Obstetrics Gynecology Reproductive Biology, 159, 115-118.
[4] Rapkin, A.J. and Lewis, E.I. (2013) Treatment of Premenstrual Dysphoric Disorder. Women’s Health (London, England), 9, 537-556.
[5] Studd, J. (2012) Severe Premenstrual Syndrome and Bipolar Disorder: A Tragic Confusion. Menopause International, 18, 82-86.
[6] Teatero, M.L., Mazmanian, D. and Sharma, V. (2014) Effects of the Menstrual Cycle on Bipolar Disorder. Bipolar Disorders, 16, 22-36.
[7] Lolas, J. (1993) Síndrome Premenstrual: Un Ignorado Problema de Salud Pública. Revista Médica de Chile, 121, 560-566.
[8] Toth, A., Lesser, M.L., Naus, G., Brooks, C. and Adams, D. (1988) Effect of Doxycycline on Pre-Menstrual Syndrome: A Double-Blind Randomized Clinical Trial. Journal of International Medical Research, 16, 270-279.
[9] Bertone-Johnson, E.R., Ronnenberg, A.G., Houghton, S.C., Nobles, C., Zagarins, S.E., Takashima-Uebelhoer, B.B., Faraj, J.L. and Whitcomb, B.W. (2014) Association of Inflammation Markers with Menstrual Symptom Severity and Premenstrual Syndrome in Young Women. Human Reproduction, 29, 1987-1994.
[10] Heinemann, L.A.J., Minh, T.D., Filonenko, A. and Uhl-Hochgraber, K. (2010) Explorative Evaluation of the Impact of Severe Premenstrual Disorders on Work Absenteeism and Productivity. Women’s Health Issues, 20, 58-65.
[11] Halbreich, U. (2004) The Diagnosis of Premenstrual Syndromes and Premenstrual Dysphoric Disorder—Clinical Procedures and Research Perspectives. Gynecological Endocrinology, 19, 320-334.
[12] Darwish, A.M.M. and Zahran, K.M. (2013) Trichloroacetic Acid Application versus Spray Monopolar Diathermy for Treating Benign Cervical Lesions: A Randomized Controlled Clinical Trial. Journal of Lower Genital Tract Disease, 17, 248-254.
[13] Yang, K., Li, J., Liu, Y., Ma, B., Roberts, H., Tan, J., Tian, J., Wu, T. and Zhang, P. (2007) Microwave Therapy for Cervical Ectropion. Cochrane Database of Systematic Reviews, 4, CD006227.
[14] Antonova, M. (2013) Prostaglandins and Prostaglandin Receptor Antagonism in Migraine. Danish Medical Journal, 60, B4635.
[15] Müller, N., Schwarz, M.J., Dehning, S., Douhe, A., Cerovecki, A., Goldstein-Müller, B., Spellmann, I., Hetzel, G., Maino, K., Kleindienst, N., Moller, H.-J., Arolt, V. and Riedel, M. (2006) The Cyclooxygenase-2 Inhibitor Celecoxib has Therapeutic Effects in Major Depression: Results of a Double-Blind, Randomized, Placebo Controlled, Add-On Pilot Study to Reboxetine. Molecular Psychiatry, 11, 680-684.
[16] Baumeister, D., Russell, A., Pariante, C.M. and Mondelli, V. (2014) Inflammatory Biomarker Profiles of Mental Disorders and Their Relation to Clinical, Social and Lifestyle Factors. Social Psychiatry and Psychiatric Epidemiology, 49, 841-849.
[17] Khandaker, G.M., Pearson, R.M., Zammit, S., Lewis, G. and Jones, P.B. (2014) Association of Serum Interleukin 6 and C-Reactive Protein in Childhood with Depression and Psychosis in young Adult Life: A Population-Based Longitudinal Study. JAMA Psychiatry, 71, 1121-1128.
[18] Shang, Y.-X., Ding, W.-Q., Qiu, H.-Y., Zhu, F.-P., Yan, S.-Z. and Wang, X.-L. (2014) Association of Depression with Inflammation in Hospitalized Patients of Myocardial Infarction. Pakistan Journal of Medical Sciences, 30, 692-697.
[19] Brietzke, E., Stertz, L., Fernandes, B.S., Kauer-Sant’anna, M., Mascarenhas, M., Escosteguy Vargas, A., Chies, J.A. and Kapczinski, F. (2009) Comparison of Cytokine Levels in Depressed, Manic and Euthymic Patients with Bipolar Disorder. Journal of Affective Disorders, 116, 214-217.
[20] Balik, G., Ustüner, I., Kagitci, M. and Sahin, F.K. (2014) Is There a Relationship between Mood Disorders and Dysmenorrhea? Journal of Pediatric and Adolescent Gynecology, 27, 371-374.
[21] Simanek, A.M., Cheng, C., Yolken, R., Uddin, M., Galea, S. and Aiello, A.E. (2014) Herpesviruses, Inflammatory Markers and Incident Depression in a Longitudinal Study of Detroit Residents. Psychoneuroendocrinology, 50, 139-148.
[22] Harrison, N.A., Brydon, L., Walker, C., Gray, M.A., Steptoe, A., Dolan, R.J. and Critchley, H.D. (2009) Neural Origins of Human Sickness in Interoceptive Responses to Inflammation. Biological Psychiatry, 66, 415-422.
[23] Canli, T. (2014) Reconceptualizing Major Depressive Disorder as an Infectious Disease. Biology of Mood & Anxiety Disorders, 4, 10.
[24] Canli, T. (2014) Is Depression an Infectious Disease? TEDxSBU, USA.
[25] Zouboulis, C.C. (2005) Sebaceous Glands and the Prostaglandin Pathway—Key Stones of an Exciting Mosaic. Journal of Investigative Dermatology, 125, x-xi.
[26] Garza, L.A., Liu, Y., Yang, Z., Alagesan, B., Lawson, J.A., Norberg, S.M., Loy, D.E., Zhao, T., Blatt, H.B., Stanton, D.C., Carrasco, L., Ahluwalia, G., Fischer, S.M., FitzGerald, G.A. and Cotsarelis, G. (2012) Prostaglandin D2 Inhibits Hair Growth and Is Elevated in Bald Scalp of Men with Androgenetic Alopecia. Science Translational Medicine, 4, 126ra34.
[27] Dickerson, L.M., Mazyck, P.J. and Hunter, M.H. (2003) Premenstrual Syndrome. American Family Physician, 67, 1743-1752.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.