Hypothalamic, pineal and pituitary factors in the premenstrual syndrome.

Most women experience some changes in bodily sensations and mood prior to the onset of menstrual flow. In some women the number and severity of the symptoms justify regarding these changes as a disorder, the premenstrual syndrome (PMS). Theories of the etiology of PMS have focused almost exclusively on abnormalities of estrogen, progesterone and prolactin secretion. Examination of the possible etiology of individual symptoms occurring in PMS suggests a common etiology involving abnormal fluctuations in brain levels of serotonin, gamma-aminobutyric acid (GABA) and interrelated neuroendocrine processes. Estrogen feedback may be a factor in the excessive fluctuations, particularly of serotonin. Danazol, an antiestrogen, can damp estrogen feedback effects and proved effective in most women treated in a small, uncontrolled trial. Future research should focus on central and peripheral neuroendocrine changes.