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

: HPA axis (Hypothalamic - Pituitary - Adrenal, HPA) dysfunction determines the formation or deterioration of stress-related emotional disorders. 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 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 findings suggested that the persistent changes of the HPA axis and blunted reactivity of HPA axis to pressure might be pathological mechanisms of PMS. Future research should focus on stress regulation strategies to improve PMS.