Study on Inflammatory Markers in Premenstrual Syndrome (Emphasis on ESR, TLCand C-Reactive Protein Levels) in South Indian Women View PDF

^*Sai Anirudh Athaluri
Medicine, Rangaraya Medical College, Andhra Pradesh, India

^*Corresponding Author:

Sai Anirudh Athaluri
Medicine, Rangaraya Medical College, Andhra Pradesh, India
Email:saiathaluri@gmail.com

Published on: 2022-12-28

Abstract

Aim: This study aims to study the role of inflammation as a key contributor to the pathophysiology of PMS, which is still undefined to this day; by studying serum levels of inflammatory markers in women with Premenstrual syndrome (PMS) symptoms and women without PMS symptoms at a different point of their menstrual cycle. This study also sheds light on the significance of correlates such as BMI, onset age of menarche, type of lifestyle etc on the severity of PMS symptoms.

Methods: 100 South Indian women chosen as per the above-mentioned subject inclusion criteria were made to fill out a questionnaire with questions regarding common symptoms of PMS and whether they have experienced those symptoms in the late-luteal phase or not. Women who answered yes to most questions were asked to grade the severity of said symptoms as mild, moderate and severe. Their clinical correlates such as height and weight were measured to calculate BMI. Other factors such as age at menarche, current pulse, blood pressure and type of lifestyle (active, slightly active or sedentary) were also noted. In the last 7-10 days of their menstrual cycle, their samples were collected for analysis of their ESR, TLC and C reactive protein levels. Statistical graphical analysis of the results attained with consideration of age and other correlates was done to gauge the relevancy of the correlation of inflammatory markers in PMS diagnosis, onset, and degree of symptom severity.

Results: There was a significant rise of inflammatory marker levels i.e., ESR (Z= -8.651 at p <0.001), TLC (Z= -6.614, p <0.001) and CRP (Z= -7.743, p <0.001) in PMS subjects over women in the control group, when analyses were done using the Wilcoxon signed ranks test. However, the inflammatory markers studied did not seem to affect symptom severity as the relationship between the degree of severity of symptoms and inflammatory marker levels were not statistically significant. But the correlates BMI (W = 896.500, p = 0.019) and onset age of menarche (W = 984.500, p = 0.030) significantly seemed to influence PMS symptom severity when statistical significance was assessed via Wilcoxon-Mann-Whitney U Test, with the median BMI (Kg/m2) and mean onset age of menarche being highest in the severe category of the degree of PMS symptoms experienced.

Conclusions: There is a role played by inflammation in causing PMS or its symptoms (owing to the rise of levels of inflammatory markers such as ESR, TLS and CRP in PMS) but the inflammatory markers studied did not seem to affect symptom severity. However, the correlation between BMI and the onset age of menarche seemed to influence PMS symptom severity. While the type of lifestyle lived by the woman did not directly influence symptom severity, it was found to have a significant influence on BMI and onset age of menarche; thus, indirectly influencing PMS symptom severity. The findings of this study also pave way for further studies to shed light on the role of lectin in influencing PMS symptom severity, as well as the significance of the onset age of menarche in various other studies of female reproductive or menstrual physiology.

Keywords

Premenstrual Syndrome, Inflammatory Markers, Women

Introduction

Premenstrual syndrome (PMS) is a condition associated with a group of consistently occurring symptoms, some of which include irritability, bloating, oedema, decreased ability to concentrate, depression, headache and constipation; which usually occur during the last 7-10 days of the menstrual cycle, corresponding to the secretory or luteal the phase of the menstrual cycle. These symptoms have conventionally been attributed to salt and water retention.

However, it is rather unlikely that this or any of the other hormonal alterations that occur in the late luteal phase are responsible, because the duration and severity of the symptoms are not modified if the luteal phase is terminated early. Several studies have shown that the effects of antidepressant fluoxetine, which is a serotonin reuptake inhibitor, and the benzodiazepine alprazolam produces symptomatic relief, and so do GnRH-releasing antagonists in doses that suppress the pituitary ovarian axis. Hence, the pathophysiology of PMS remains undefined to this day [1].

Moreover, as of now, there are no unique lab findings that facilitate an easy diagnosis of PMS. Currently, doctors attribute particular symptoms to PMS if it is a part of the predicted menstrual pattern [2]. Henceforth, it is seemingly apparent that PMS isn’t always effectively diagnosed.

Chronic inflammation, however, has been deemed a manifestation of depression and other important psycho-somatic aspects associated with PMS, paving way for research to establish a definite detection of PMS via inflammatory markers [3]. This inflammation occurs when cytokine production remains active in cells. Cytokines are hormonelike molecules that act generally in a paracrine fashion to regulate immune responses, enabling inflammation. They are secreted not only by lymphocytes but also by endothelial and endometrial cells to facilitate vascularisation and tissue repair after periodic endometrial shedding [4]. Related studies done on women in western countries on inflammatory markers in depression to date have only taken subjects with either reference BMI of 20.5 or a cut-off BMI as 25 which is considerably different from the Indian ideal which is 23, as dictated by the American Diabetes Association as the threshold cut-off for Asian ethnicity people [3,5, and 6]. The subjects of said studies have reported being on a protein-rich diet, which is contrary to the current South Indian scenario (carbohydrate-rich diet which is an attribute of rice consumption). Also, the parameters of this particular study haven’t been evaluated before collectively. With this sufficient pre-requisite knowledge, we intend to evaluate how inflammatory markers are correlated with PMS and its effective clinical diagnosis.