OBJECTIVE Premenstrual dysphoric disorder (PMDD) symptoms are eliminated by ovarian suppression and stimulated by administration of ovarian steroids, yet they appear with ovarian steroid levels indistinguishable from those in women without PMDD. Thus, symptoms could be precipitated either by an acute change in ovarian steroid levels or by stable levels above a critical threshold playing a permissive role in expression of an underlying infradian affective "pacemaker." The authors attempted to determine which condition triggers PMDD symptoms. METHOD The study included 22 women with PMDD, ages 30 to 50 years. Twelve women who experienced symptom remission after 2-3 months of GnRH agonist-induced ovarian suppression (leuprolide) then received 1 month of single-blind (participant only) placebo and then 3 months of continuous combined estradiol/progesterone. Primary outcome measures were the Rating for Premenstrual Tension observer and self-ratings completed every 2 weeks during clinic visits. Multivariate repeated-measure ANOVA for mixed models was employed. RESULTS Both self- and observer-rated scores on the Rating for Premenstrual Tension were significantly increased (more symptomatic) during the first month of combined estradiol/progesterone compared with the last month of leuprolide alone, the placebo month, and the second and third months of estradiol/progesterone. There were no significant differences in symptom severity between the last month of leuprolide alone, placebo month, or second and third months of estradiol/progesterone. Finally, the Rating for Premenstrual Tension scores in the second and third estradiol/progesterone months did not significantly differ. CONCLUSIONS The findings demonstrate that the change in estradiol/progesterone levels from low to high, and not the steady-state level, was associated with onset of PMDD symptoms. Therapeutic efforts to modulate the change in steroid levels proximate to ovulation merit further study.

中文翻译：

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卵巢抑制后的经前烦躁不安症状：由卵巢类固醇水平的变化而非连续稳定水平触发。

目的经卵巢抑制可消除经前烦躁不安（PMDD）症状，并通过给予卵巢类固醇激素可刺激经前烦躁不安症状，但与没有PMDD的女性相比，这些现象与卵巢类固醇激素水平无明显区别。因此，症状可能是由于卵巢类固醇水平的急性变化或高于临界阈值的稳定水平而加剧的，该阈值在潜在的红外线情感“起搏器”的表达中扮演了允许的角色。作者试图确定哪种情况会触发PMDD症状。方法该研究包括22名30至50岁的PMDD妇女。12名在GnRH激动剂诱导的卵巢抑制作用2-3个月后出现症状缓解的妇女（亮丙瑞林），然后接受1个月的单盲（仅参与者）安慰剂治疗，然后接受3个月的雌二醇/孕激素持续联合治疗。主要结局指标为经前紧张度观察者评分以及在诊所就诊时每2周完成一次自我评分。对混合模型采用多元重复测量方差分析。结果与单独使用亮丙瑞林的最后一个月，安慰剂月以及第二个月和第三个月相比，在雌二醇/孕酮联合使用的第一个月中，经前紧张等级的自我和观察者得分均明显提高（有症状）。雌二醇/孕酮。单独使用亮丙瑞林的最后一个月，安慰剂一个月或雌二醇/孕酮的第二个月和第三个月之间，症状严重程度无显着差异。最后，第二个月和第三个月雌二醇/孕酮对经前紧张度的评分没有显着差异。结论研究结果表明，雌二醇/孕酮水平从低到高而不是稳态水平的变化与PMDD症状的发作有关。调节排卵期附近类固醇水平变化的治疗工作值得进一步研究。结论研究结果表明，雌二醇/孕酮水平从低到高而不是稳态水平的变化与PMDD症状的发作有关。调节排卵期附近类固醇水平变化的治疗工作值得进一步研究。结论研究结果表明，雌二醇/孕酮水平从低到高而不是稳态水平的变化与PMDD症状的发作有关。调节排卵期附近类固醇水平变化的治疗工作值得进一步研究。