ISSN 1671-3710
CN 11-4766/R

心理科学进展 ›› 2023, Vol. 31 ›› Issue (6): 988-1001.doi: 10.3724/SP.J.1042.2023.00988

• 元分析 • 上一篇    下一篇


张婷1, 张珂霖1, 周仁来1,2()   

  1. 1南京大学社会学院心理学系, 南京 210023
    2媒体融合生产技术与系统国家重点实验室, 北京 100803
  • 收稿日期:2022-10-31 出版日期:2023-06-15 发布日期:2023-03-07
  • 通讯作者: 周仁来

HPA axis dysfunction in women with premenstrual syndrome: A meta-analysis based on cortisol levels

ZHANG Ting1, ZHANG Kelin1, ZHOU Renlai1,2()   

  1. 1Department of Psychology, Nanjing University, Nanjing 210023, China
    2State Key Laboratory of Media Convergence Production Technology and Systems, Beijing 100803, China
  • Received:2022-10-31 Online:2023-06-15 Published:2023-03-07
  • Contact: ZHOU Renlai


HPA轴(Hypothalamic-Pituitary-Adrenal, HPA)功能失调是压力相关情绪障碍形成或者恶化的决定因素。为系统评价基线状态和面临环境挑战时经前期综合征(Premenstrual Syndrome, PMS)女性基于皮质醇水平的HPA轴功能失调, 对1990年以来的32项研究(总样本量N = 1280)进行了定量整合, 以期为女性经前期综合征的病因和干预提供参考。结果发现:在基线研究中, PMS女性黄体期的皮质醇含量显著低于普通女性, 且受到皮质醇测量时间的调节作用; PMS女性卵泡期的皮质醇含量与普通女性无显著差异。环境挑战研究的结果与基线研究类似, PMS女性黄体期的皮质醇含量显著低于普通女性, 但卵泡期的皮质醇含量与普通女性无显著差异。该结果提示压力内分泌轴的持久改变和面对压力时的HPA轴反应迟钝是PMS产生的可能病理机制。未来研究应关注应激调节策略来改善PMS的不良反应。

关键词: 经前期综合征, 皮质醇, 下丘脑-垂体-肾上腺轴, HPA轴, 元分析


HPA axis (Hypothalamic - Pituitary - Adrenal, HPA) dysfunction determines the formation or deterioration of stress-related emotional disorders. As a special stress-related disease, premenstrual syndrome (PMS) appears before menstruation and disappears after menstruation. This stable and explosive phenomenon reflects acute stress. On the other hand, the premenstrual discomfort symptoms are considered chronic stress, which may last about 30 years. In order to provide a more comprehensive understanding of the pathological mechanisms of PMS, we relied on two types of the activity patterns of HPA axis, namely activity patterns at the baseline level and activity patterns after experimental manipulations on stress levels. The current meta-analysis study included 32 studies (total sample size N = 1280) from 1990 to 2021. We investigated the difference of cortisol levels in luteal phase and follicular phase between PMS women and controls. In addition, we investigated the moderating roles of the cortisol measurement method, cortisol measurement time, PMS/PMDD sample size, and diagnostic type. Because of age-related changes in female hormone secretion and regional differences in menstruation attitude, we further investigated the moderating roles of age and area.
We found that the cortisol of PMS individuals in the luteal phase was significantly lower than that of the controls at the baseline level. This effect was moderated by the time of cortisol measurement. At follicular stage, there was no significant difference in cortisol content between PMS women and controls. Similarly, in the experimental studies manipulating stress levels, the cortisol content of PMS women in the luteal phase was significantly lower than that of the controls, but the two groups did not differ in the cortisol content of the follicular phase. The moderating roles of cortisol measurement method, PMS/PMDD sample size, diagnostic type, age and area were not significant.
The findings suggested that the persistent changes of the HPA axis and blunted reactivity of HPA axis to pressure might be pathological mechanisms of PMS. The inactivation of the HPA axis at the baseline reflected the lasting change of the neurobiological system due to long-term ineffective activation, while the inactivation of the HPA axis in the experimental studies directly showed blunted reaction to subsequent stressors. Blunted baseline cortisol response may be a risk factor to the development of PMS. Thus, future studies need to further clarify the role of blunted baseline cortisol response on the occurrence of PMS using a longitudinal design.
In addition, the results of the follicular phase were unstable in both the baseline and experimental studies, influenced by depression history and trauma experience.
The study responds to the controversy of the existing research findings on the topic and provides a deeper understanding for the pathological mechanisms of PMS. Based on the findings of this study, the roles of the time effect of cortisol measurement and stress regulation strategies should be considered in future research.

Key words: premenstrual syndrome, cortisol, hypothalamic-pituitary-adrenal, HPA, meta-analysis