Premenstrual Syndromes : PMS and PMDD - Rutuja :: The site ...

100 THE PREMENSTRUAL SYNDROMES
significant effect on prefrontal cortical activation
during cognition.
Functional magnetic resonance imaging (fMRI)
studies evaluating cognition have suggested little
change in the location of activation across phases of the
cycle, although some have found greater activation
during high levels of estrogen or estrogen and progesterone.
One study utilized a word-stem completion
task, a mental rotation task, and a simple motor task
(Table 11.1). 8 There were no differences between male
and female subjects when females were scanned during
the low estrogen phase, but during the periovulatory
phase of high estrogen, women exhibited a marked
increase in activation of cortical areas involved in the
cognitive tasks, but not the motor task. Similarly, the
luteal phase was marked by greater recruitment of
brain regions involved in a semantic decision task than
the early follicular phase. 9 Another study involving
rhyme identification did not find differences in the
regions that were activated during the follicular and
luteal phases. 10 It is difficult in the absence of behavioral
effects to determine whether increased activation
during relatively high levels of estradiol and progesterone
is the result of their direct effects on cognition or
a result of other influences on the BOLD (blood oxygenation
level dependent) signal, such as vascular
effects. 11 Even when differences in activation exist in
cognitive tasks of interest and not simple control tasks,
it is possible that differences in cerebral vasculature in
the regions activated by the control task may influence
findings. 8 Thus, precise control conditions are required
to evaluate changes in brain activation during cognition
that coincide with changes in ovarian steroid levels.
Studies have also evaluated changes in affective processing
across the menstrual cycle in healthy women by
comparing activation to emotional vs neutral stimuli.
These data may be useful in identifying abnormalities
in women with PMDD. One study reported increased
activation in several cortical and subcortical regions,
including areas of the brainstem, hippocampus,
Table 11.1 Functional magnetic resonance imaging studies examining menstrual cycle effects on cognition
and affective processing
Study Sample Findings/comments
Veltman et al10 8 healthy women scanned twice; No differences across phase in the regions
early follicular and mid-luteal phases activated during a rhyming task
Dietrich et al8 6 healthy women scanned twice; early Tasks: word-stem completion, mental rotation
and late follicular phases and simple motor. Activation areas larger during
high estrogen, particularly during cognitive tasks
Fernandez et al9 12 healthy women scanned twice; Activation areas larger during high hormones for
early follicular and mid-luteal phases a semantic but not perceptual task
Goldstein et al12 12 healthy women scanned twice; early Increases activation in response to unpleasant
and late follicular phases visual stimuli during the early follicular phase
(presumed low hormones) in several regions of
interest; hormone levels were not obtained to
verify phases of interest
Protopopescu et al16 12 healthy women scanned twice; Increased medial orbitofrontal cortex (OFC)
follicular and late luteal phases activation during response inhibition to negative
words premenstrually, but increased lateral OFC
activation postmenstrually; variation in hormone
levels was not of interest
Amin et al15 14 healthy women scanned twice; Increased activation in regions of interest during
early follicular and mid-luteal phases response inhibition to positive words in the
luteal phase. Activation correlating with luteal
phase estradiol level was dissociated by valence