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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-142-144
Khodjaeva Nodira Vakhidovna, Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan,
external degree candidate.
E-mail: nadira202@mail.ru Khaidarova Feruza Alimovna, MD, Republican Specialized Scientific and Practical Medical Center of Endocrinology under the Ministry of Health of the Republic of Uzbekistan,
therapeutic work director.
E-mail:alimovna@mail.ru
Estradiol-progesterone correlation as a marker of severity of premenstrual syndrome
Abstrct: The level of estradiol in the luteal phase of menstrual cycle was significantly higher in women with severe course of PMS compared to patients from other groups. During PMS, a correlation relation between the level of estradiol (r=0,87; P<0,0001), estradiol-progesterone correlation (r=0,81; P<0,0001) and degree of severity of PMS in the luteal phase of menstrual cycle was observed.
Keywords: premenstrual syndrome, estradiol, progesterone, correlation estradiol/progesterone.
Premenstrual syndrome (PMS) is a complicated complex of In some researches, the formation of PMS is related to the ac-
symptoms cyclically appearing in women in luteal phase of menstru- tivity of neuro-active metabolites of progesterone, including those, al cycle and is characterized by various neuro-psychotic, vegeto-vas- which are produced spontaneously in the CNS [2; 3; 9]. Also, it is cular and metabolic-endocrine disorders, which reduce professional noted that women with clearly expressed deficit of progesterone in and household working capacity and level of social adaptation. luteal phase of the cycle showed no disposition to PMS. PMS is not
There are numerous theories about pathogenesis of PMS. One observed during anovulatory cycles, when relative hyperestrogen-of the key theories is the hormonal theory of PMS, according to ism is developed. The authors reckon that PMS can be the result of which, the disease is determined by the disruption of the correla- disruption of the balance of estrogens and progesterone [1]. tion of estrogens and progesterone during luteal phase of menstrual Goal of research: to study estradiol-progesterone correlation in
cycle [3; 5]. Estrogens affect the receptors in the limbic system of the women with PMS depending on the degree of disease severity. brain, which determines the appearance of a range of symptoms in Materials and methods: 129 women aged 18 to 40 with com-
the phsyco-emotional sphere [1; 5]. plaints about somatic and/or psycho-emotional symptoms appear-
Estradiol-progesterone correlation as a marker of severity of premenstrual syndrome
ing before menstruation were examined. The mean age was 28,8 ± 6,19 years old (95% CI 27,8-29,9). The control group consisted of 26 women of same age with the absence of clinical manifestations of PMS. Depending on the degree of severity of disease, the patients were divided into 3 groups. The group with light degree included 66 (51,2%) women; with medium degree of severity — 43 (33,3%) and severe degree — 20 (15,5%) women. PMS diagnosis was established on the basis of complaints and anamnesis.
The research of the levels of estradiol and progesterone in the blood serum was done by radio-immune method with the sets made by «Beckman Coulter» on the meters «Gamma-12» and «Strangt 300» at the laboratory of RSSRMCE.
Table 1. - Level of steroid sex hormones in women
The obtained data was processed with the help of the package of applied programs StatSoft Statistica 6.0. and Biostat. The odd ration (OR) and 95% confidence interval (95% CI) were calculated with the use oflogistic regression. The significance of differences of the indicators was evaluated with the help of non-parametric criterion x2 (Pearson's test). The quantitative indicators were presented in the form of a median (Me) and 25 and 75 percentiles (IQR). The differences between groups were considered statistically significant at p=0,05.
Results. Conducted studies showed that regardless the degree of severity of disease, the level of estradiol and progesterone in the follicular phase differed from the control group insignificantly (Table 1.).
with PMS in the follicular phase of menstrual cycle
Indicators Control, n=26 PMS form
light, n=66 medium, n=43 severe, n=20
Follicular phase of MC
Estradiol, pmol/l 278,3; 230,0-327,5 275,7; 243,2-289,3 278,2; 191,0-313,3 287,0; 275,7-298,6
Pc 0,06 0,86 0,99
Pl 0,42 0,12
Pm 0,88
Progesterone, nmol/l 2,14; 1,65-2,83 2,35; 1,79-2,97 1,85; 1,34-3,42 2,24; 1,50-3,21
Pc 0,97 0,96 0,83
Pl 0,94 0,85
Pm 0,84
E/P 127,9; 99,3-180,4 110,4; 79,6-154,1 120,5; 71,5-206,2 129,1; 85,6-184,3
Pc 0,29 0,93 0,79
Pl 0,23 0,23
Pm 0,75
Testosterone, nmol/l 2,11; 1,68-3,14 2,79; 2,10-3,24 2,54; 2,03-3,29 2,87; 2,01-3,32
Pc 0,04 0,07 0,14
Pl 0,90 0,96
Pm 0,90
Cortisol, nmol/l 278,3; 230,0-327,5 278,6; 222,9-330,8 267,9; 230,1-328,3 278,4; 234,5-350,0
Pc 0,89 0,98 0,85
Pl 0,90 0,72
Pm 0,83
Pm 0,59
Remark: E/P - correlation estradiol/progesterone; Pc -; Pl -; Pm - significance with regard to control, light and medium degree of severity of PMS respectively.
At light degree of severity of PMS, the concentration of es- compared to 37,8±5,30 nmol/l in the control group; P=0,39). tradiol (451,5±91,4 pmol/l) in LP is significantly higher than in Women in this group showed significant increase of E/P correlation control group (374,8 ±79,4 pmol/l; P <0,0001), whereas the level (11,8±2,38 compared to 10,2±2,86 in the control group; P=0,02) of progesterone remains practically unchanged (38,9±5,48 nmol/l in the luteal phase of menstrual cycle (Table 2.).
Table 2. - Level of steroid sex hormones in women with PMS in the luteal phase of menstrual cycle
Indicators Control, n=26 PMS form
light, n=66 medium severity, n= 43 severe, n=20
1 2 3 4 5
Luteal phase of MC
Estradiol, pmol/l 361,8; 322,7-401,6 483,6; 372,3-513,1 597,2; 556,8-667,1 740,9; 657,2-866,7
Pc <0,0001 <0,0001 <0,0001
Pl <0,0001 <0,0001
1 2 3 4 5
Pm <0,0001
Progesterone, nmol/l 36,3; 34,1-41,1 38,4; 35,1-41,8 40,1; 37,0-42,6 38,4; 33,5-42,8
Pc 0,39 0,25 0,87
Pl 0,65 0,59
0,44
E/P 9,73; 11,5; 15,0; 19,7;
8,10-11,3 9,99-13,9 13,1-17,2 17,0-21,5
Pc 0,02 <0,0001 <0,0001
Pl <0,0001 <0,0001
Pm <0,0001
Testosterone, nmol/l 2,29; 1,94-2,75 2,71; 2,12-3,20 2,78; 1,99-3,10 2,75; 2,16-3,11
Pc 0,03 0,27 0,04
Pl 0,32 0,96
Pm 0,50
Cortisol, nmol/l 282,8; 218,1-355,0 286,5; 233,3-351,0 285,0; 243,9-353,5 288,3; 225,4-379,3
Pc 0,89 0,58 0,41
Pl 0,63 0,37
Pm 0,59
Remark: E/P — correlation estradiol/progesterone; Pc -; Pl —; Pm of PMS respectively.
The patients with medium degree of severity of PMS showed statistically significant increase of the concentration of estradiol (595,4±99,0 pmol/l; P <0,0001) compared with these indicators in women with light degree of severity and without the manifestation of this disease. The level of progesterone was within the limits of control values (39,4±1,19 nmol/l; P=0,25). The analysis of correlation E/P (15,1±3,96; P <0,0001) in the luteal phase of menstrual cycle showed significant excess compared to the data in both, the control group and the group with light degree of severity of PMS.
In women with the severe course of PMS, the level of estradiol (729,1±141,0 pmol/l; P <0,0001) in the luteal phase of menstrual
— significance with regard to control, light and medium degree of severity
cycle was significantly higher than identical indicators of the patients in other groups. The concentration of progesterone in blood didn't change significantly (38,1±6,83 nmol/l; P=0,87).
Positive correlation relation between the level of estradiol (r=0,71; P<0,05), the indicator E/P and deg ree of severity of PMS (r=0,63; P<0,05) in the luteal phase ofmenstrual cycle was revealed.
Thus, based on the conducted research, one can state that women with PMS show direct correlation dependence between the severity of the course of disease and concentration of estradiol in blood as well as estradiol-progesterone correlation. It provides ground to reckon that E/P is an objective test of the severity of PMS course and efficiency of treatment.
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