Regulation of the excitation / inhibition balance during the menstrual cycle in healthy women and women with PMDD

Premenstrual syndrome (PMS) is frequently observed in healthy women of reproductive age: shortly before the start of menstruation, women experienced unpleasant physical sensations, mood swings, and appetite changes. However, such cyclical changes can also take extremely severe forms, leading to disability, and, in some cases, to suicide [1]. This severe form of PMS – premenstrual dysphoric disorder (PMDD) – is observed in 2-6% of women of reproductive age [2]. The importance of PMDD research has been recognized in western countries (https://www.bbc.com/future/article/20191213-pmdd-a-little-understood-and-often-misdiagnosed-condition). Unfortunately, in Russia this problem attracts unfairly little attention.

PMS and PMDD are associated with fluctuations in sex hormones - primarily progesterone - during the menstrual cycle [3]. There is evidence that an abnormal sensitivity of neural cells to this hormone can lead to sharp changes in the balance of neural excitement and inhibition (E/I balance) in the brain structures and, as a result, to emotional instability and other behavioral manifestations.

Herein, we investigate how the E/I balance changes during the menstrual cycle in healthy women in those with PMDD. To assess the E/I balance we plan to use magnetoencephalogram (MEG); in particular MEG parameters based on the modulation of fast oscillations of brain electromagnetic activity ('gamma oscillations') by excitatory drive to the visual cortex [4-7].

This study will help to understand the mechanisms of normal cyclic changes in the E/I balance in women, and identify markers of the E/I unbalance, which that can be used to diagnose PMDD and monitor its treatment.

Figure 1. 'Gamma response' of the cortex to visual stimulation in one subject in the follicular (F) and luteal (L) phases of the menstrual cycle.

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