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

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.