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Journal of the Society for Gynecologic Investigation, Vol. 3, No. 2, 93-98 (1996)
DOI: 10.1177/107155769600300210

Decreased Central Opioid Activity in Premenstrual Syndrome: Luterinizing Hormone Response to Naloxone

Andrea J. Rapkin, MD

Department of Obstetrics and Gynecology, UCLA School of Medicine; Neuropsychiatrick Institute, Los Angeles, California; Department of Obstetrics and Gynecology, University of Southern, California and Women's Hospital, Los Angeles, California; Department of Physiology and Endocrinology, Medical College of Georgia, Augusta, Georgia; Department of Obstetrics and Gynecology, University of Utah, 50 North Medical Drive, Room 2B200, Salt Lake City, UT 84132

Donna Shoupe, MD

Anthony Reading, PhD

K. Kevin Daneshgar

Linda Goldman, RNP

Yvonne Bohn

Darrell W. Brann, PhD

Virenda B. Mahesh, PhD

Department of Obstetrics and Gynecology, UCLA School of Medicine; Neuropsychiatrick Institute, Los Angeles, California; Department of Obstetrics and Gynecology, University of Southern, California and Women's Hospital, Los Angeles, California; Department of Physiology and Endocrinology, Medical College of Georgia, Augusta, Georgia

Objective: To evaluate central opioid activity in women with prespectively documented premenstrual syndrome (PMS) and control women in the mid- and late luteal phases of the menstrual cycle.

Methods: Blood was collected every 15 minutes 1 hours before (0800) and 2 hours after treatment (0900-1100). The treatment was administered in a randomized fashion and consisted of naloxone 1 or 4 mg or placebo, and blood was assayed for luteinizing hormone (LH). Baseline estradiol, progesterone, and prolactin were measured at 0800 and 0900 hours.

Results: There was a significant increase in LH area under the curve and mean LH in response to naloxone in the midluted phase in the controls (P < .001). The PMS subjects did not display a significant increase in LH concentration in response to naloxone in the midluteal phase. There were no significant LH response to naloxone in either group in the late luteal phase. There were no significant difference in estradiol, progesterone, or prolactin concentrations or estrogen to progesterone ratios between groups.

Conclusion: Control women have on enhanced central opioid tone during the midluteal phase that diminishes and becomes minimal in the late luteal phase of the menstrual cycle. In contrast, women with PMS have a loss of central opioid tone during the midluteal phase as indicated by the loss of LH response to naloxone. This attenuated central opioid tone in women with PMS as compared with asymptomatic control women may play a role in the pathophysiology of PMS.

Key Words: PMS • central opioid activity • LH response to naloxone


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