It is presently not known whether endogenous neuroactive steroid hormone trajectories across the menstrual cycle are distinguishable in women with premenstrual dysphoric disorder (PMDD). To improve the rigor in this area of research, we implemented a validated study methodology, involving blood sample collection at 8 key menstrual cycle timepoints, following which the study data is realigned so that all women are compared at the same biological window (i.e., menstrual cycle subphase). Using liquid chromatography-mass spectrometry (LC-MS), we analyzed serum levels of nine steroid hormones previously implicated in the etiology of PMDD, including allopregnanolone. Other than progesterone (p ≤ 0.001), none of the steroid hormones displayed significant changes across menstrual cycle subphases when comparing participants with PMDD to the healthy controls. A thorough investigation of the progesterone trajectory showed that its left shift in the luteal phase (e.g., earlier rise in progesterone) exposes women with PMDD to a higher periovulatory progesterone and a more acute withdrawal in the late luteal subphase. Results of the present study indicate that the largely overlooked brief periovulatory subphase should be thoroughly examined in PMDD and agree with prior conclusions that rapid progesterone withdrawal associates with the development of negative affect.

目前尚不清楚月经周期中的内源性神经活性类固醇激素轨迹在患有经前烦躁症（PMDD）的女性中是否可区分。为了提高这一研究领域的严谨性，我们实施了经过验证的研究方法，包括在 8 个关键月经周期时间点采集血液样本，随后重新调整研究数据，以便所有女性在同一生物窗口（即月经周期）进行比较。循环子阶段）。我们使用液相色谱-质谱法 (LC-MS) 分析了先前与经前抑郁症病因有关的九种类固醇激素的血清水平，其中包括四氢孕酮。将患有经前抑郁症的参与者与健康对照者进行比较时，除了黄体酮 (p ≤ 0.001) 外，没有任何类固醇激素在月经周期的各个子阶段表现出显着变化。对黄体酮轨迹的彻底研究表明，黄体期左移（例如，黄体酮较早升高）使患有经前抑郁症的女性面临更高的排卵期黄体酮水平，并在黄体亚期晚期出现更严重的退缩。本研究的结果表明，在 PMDD 中应彻底检查被广泛忽视的短暂的围排卵亚阶段，并同意先前的结论，即快速黄体酮戒断与负面情绪的发展相关。