Association and Timing of Changes in Emotion Regulation and Mood along the Menstrual Cycle in Women with Premenstrual Syndrome

Premenstrual dysphoric disorder (PMDD) is characterized by the recurrence of major psychiatric symptoms in the final week before the onset of menses, which severely impact womens quality of life. The etiology of PMDD, or more generally premenstrual syndrome (PMS) including subclinical forms, is not well understood and both biological and psychological models have been postulated. In the current manuscript we explore the role of emotion regulation ability for the emergence of premenstrual symptoms. Specifically, we were interested whether difficulties in emotion regulation in women with PMS/PMDD persisted as a trait across all cycle phases or were specific to the symptomatic premenstrual phase. We also explored for the first time, whether difficulties in emotion regulation already emerged during the high progesterone mid-luteal phase. 105 women aged 18 to 35 years completed a trait questionnaire on difficulties in emotion regulation, as well as two state measures of emotion regulation during three cycle phases (mid-follicular, mid-luteal, premenstrual). PMS/PMDD was prospectively confirmed across two menstrual cycles in 54 women, while the remaining 51 were assigned to the control group. Our results confirm previous findings that women with PMS/PMDD subjectively report more difficulties in emotion regulation on a trait scale. However, these difficulties were not confirmed in any of the state measures employed in the current study. Furthermore, difficulties in emotion regulation did not account for premenstrual symptom severity in a mediation analysis. This raises the question, whether difficulties in emotion regulation underly premenstrual symptoms or the perception of impaired emotion regulation arises as a consequence of untreated PMS/PMDD. Noteworthy, we were also able to demonstrate via Bayesian analyses, that mood worsening in the premenstrual phase is not a universal occurrence and absent in healthy controls. Taken together these findings highlight the importance of adequate diagnosis and treatment of PMDD.