مورفولوژی تخمدان در بی قراری پیش از قاعدگی

Ovarian cyclicity is a prerequisite for premenstrual dysphoria (PMD), as illustrated by the fact that this condition is effectively eliminated by ovariectomy or by treatment with a GnRH agonist. Despite the possibility of differences in ovarian function between women with and without PMD, no study comparing ovarian morphology in these two groups has ever been published. Fifty-two women were recruited for this study; 26 had premenstrual dysphoria, fulfilling criteria slightly modified from those of the premenstrual dysphoric disorder, and 26 were asymptomatic age-matched controls. Ovarian morphology was assessed using transvaginal 7 MHz ultrasonography on day 5 after the start of menses, and venous blood was sampled for hormone analysis on days 3 and 8, the expected day of ovulation, and day −4 of the menstrual cycle. There were no significant differences between the groups with respect to the prevalence of polycystic ovaries (PCO), the total number of follicles, the total ovarian volume or serum levels of androgen hormones. In addition, serum free testosterone levels in late premenstrual phase showed an inverse association to premenstrual symptoms of irritability and a similar inverse association trend to symptoms of depressed mood. Unexpectedly, the prevalence of ovaries with fewer than five antral or growing follicles was significantly higher in women with PMD than in controls (p = 0.016). While the results do not support a role for PCO or androgen hormones in eliciting late luteal phase irritability, the possible relationship between oligofollicular ovaries and PMD deserves further study.

A severe form of premenstrual syndrome, characterized by mood symptoms appearing regularly in the luteal phase of the menstrual cycle, and disappearing after the onset of menses, is referred to as premenstrual dysphoric disorder (PMDD) (if the diagnosis has been made using criteria presented in DSM-IVTR) (Yonkers et al., 2008), or premenstrual dysphoria (PMD)(which is a somewhat broarder term) (Eriksson et al., 2002; Landen and Eriksson; 2003). While many regard irritability and anger as the cardinal symptoms of this condition (Angst et al., 2001, Hartlage and Arduino, 2002, Landen and Eriksson, 2003, Pearlstein et al., 2005 and Steiner et al., 2011) depressed mood, tension and affect lability are also common complaints. Ovarian cyclicity is a prerequisite for premenstrual symptoms to occur, as illustrated by the fact that such symptoms are effectively eliminated by ovariectomy (Casper and Hearn, 1990, Casson et al., 1990 and Cronje et al., 2004) or by treatment with a GnRH agonist (Muse et al., 1984, Bancroft et al., 1987, Hammarback and Backstrom, 1988 and Wyatt et al., 2004). Although some authors have reported differences between women with and without PMD with respect to serum levels of estradiol (Backstrom et al., 1976, Watts et al., 1985, Seippel and Backstrom, 1998 and Blum et al., 2004), progesterone (Backstrom et al., 1976, Watts et al., 1985 and Blum et al., 2004), or testosterone (Eriksson et al., 1992, Eriksson et al., 1994 and Lombardi et al., 2004) the weight of the available evidence does not support such a relationship, and suggests that it is the responsiveness of the target organs, including the brain, to the influence of these hormones, rather than ovarian activity, that differentiates women with and without PMD (Dougherty et al., 1997, Bloch et al., 1998 and Schmidt et al., 1998). However, no formal comparison of the ovarian morphology of women with and without PMD has been published to date, and differences in ovarian function between these groups cannot, therefore, be excluded. The polycystic ovary syndrome (PCOS) (Souter et al., 2004, Norman et al., 2007 and Diamanti-Kandarakis, 2008) is a condition characterized by (i) oligo- and/or anovulation, (ii) clinical and/or biochemical signs of hyperandrogenism, and (iii) polycystic ovaries; two of these three criteria have to be met for the diagnosis (Rotterdam PCOS Consensus Workshop Group, 2004). Whereas PCOS has a reported prevalence of between 6.5 and 8% in an unselected population of women of fertile age, polycystic ovaries (PCO), not necessarily interfering with menstrual cyclicity, are considerably more common; the prevalence of this condition varies between 17 and 27% in most Western countries (Farquhar et al., 1994, Botsis et al., 1995, Lakhani et al., 2002 and Hart et al., 2004). Numerous studies suggest that PCOS is associated with an increased risk of mood symptoms, including depressed mood, anxiety and aggression (Himelein and Thatcher, 2006, Barnard et al., 2007, Hollinrake et al., 2007, Mansson et al., 2008, Benson et al., 2009, Jedel et al., 2009, Deeks et al., 2010 and Dokras et al., 2011), elevated androgen levels is one (but not the only) possible mediator. Whereas there may not be comorbidity between PCOS causing anovulation, as per the definition, and PMD, we speculated that the possibility of an association between PMD and the milder variant of this condition, i.e. PCO, was worth exploring, especially since (i) a negative association between androgen levels and mood in fertile women has recently gained considerable support (Baischer et al., 1995, Bromberger et al., 2010 and Roepke et al., 2010), (ii) some (Eriksson et al., 1992, Eriksson et al., 1994 and Lombardi et al., 2004) but not all (Backstrom and Aakvaag, 1981, Watts et al., 1985 and Bloch et al., 1998) workers have found higher androgen levels in women with PMD than in those without, and (iii) recent studies have suggested that an oral contraceptive displaying anti-androgenic properties may be effective in PMD (Rapkin, 2008). The primary aim of this study was therefore to compare women with PMD and symptom-free age-matched controls with respect to ovarian morphology type, ovarian volume and the number of ovarian follicles using transvaginal ultrasonography. A secondary aim was to investigate differences in serum levels of androgen hormones between the groups. Further, in a post hoc analysis, to test these androgen levels for associations to self-rated premenstrual symptoms of irritability and depressed mood.