Liisa Hantsoo is a clinical psychologist and an assistant professor at the Department of Psychiatry & Behavioral Sciences at the School of Medicine. Hantsoo conducts clinical research in sex-specific mood disorders like premenstrual dysphoric disorder (PMDD) and postpartum depression in addition to providing cognitive behavioral therapy to patients having significant premenstrual mood issues or post-partum or pregnancy-related depression and anxiety. In an interview with The News-Letter, Hantsoo explained one of her current studies along with her thoughts on the changing landscape of reproductive health.
One study Hantsoo is working on is funded by a two-year long NIH R21, which investigates hormone changes throughout an individual’s menstrual cycle, particularly in patients with PMDD. PMDD is a severe form of premenstrual syndrome (PMS). Symptoms mostly occur a week before menstruation and include increased depression, anxiety, irritability, fatigue and lapsed concentration. Physical symptoms may include bloating and weight gain.
“There's a real range… 5% of people who have periods will have PMDD… My patients and study participants describe [the disorder] like this roller coaster where they'll have two or three weeks every month where they feel fine, they feel like themselves, and then they have a week or two [before their period] where they say, ‘I feel like a different person. I feel really down, or I feel really irritable.’ And then [their period] starts and [they say] ‘I feel like myself again.’ It's an interesting disorder, because on one hand, it's cut and dry: it's very tied to the menstrual cycle. We see this very clear on and off pattern,” she said.
Hantsoo aims to explore this regulation at the molecular level. Hormones of interest for the study include the neurosteroids estradiol and progesterone that not only play crucial roles in reproduction but also protect neurons and regulate neurotransmitters. One specific progesterone metabolite is allopregnanolone, which modulates GABAA receptors that reduce neuron activity, and may cause sedative effects.
“We think that it's possible in women who have premenstrual mood changes, there is some issue with either the way those [ovarian] hormones are shifting across the late luteal phase, which is that week or so prior to menstruation, or the way that the hormones might be interacting with these receptors… We wanted to trace what the levels looked like of these neuroactive steroid hormones, and then also the GABAA receptors that they interact with,” Hantsoo explained.
Participants included people with and without PMS symptoms. Their blood was collected every other day during the week before their period and sent to a collaborator at University of Illinois, Chicago. There, molecules of interest like isomers of progesterone metabolites and neuroactive steroids were qualitatively and quantitatively measured through gas chromatography-mass spectrometry.
“The nice part about [the frequency of the blood collection] was it gave us this really detailed picture of what these hormones are doing. This is letting us test the hypothesis that perhaps there are differences in the pattern of what the neuroactive steroids are doing. So for instance, right before someone's period, in the few days before you'll start to have a decrease in things like allopregnanolone. Maybe the rate of decline could be different in people who do versus don't have PMS,” Hantsoo said.
Hantsoo also discussed one of the challenges of PMDD: the difficulty of diagnosing the disorder. She explained that to properly provide a clinical diagnosis, the individual needs to track their symptoms every single day for two full menstrual cycles for the provider to observe a possible pattern of the symptoms’ starting date and length. The time-consuming nature of this activity might act as a barrier to receiving care, particularly in individuals that might not have the time and energy everyday.
Another difficulty in diagnosing PMDD is related to menstruation not being taken seriously in popular culture, Hantsoo noted. The severe symptoms might be considered as normal to some people, therefore not brought up to their doctor. The stigma that surrounds discussion about menstruation and related disorders also contributes to the issue.
“There's almost a double stigma to it, or double taboo. It involves not only mental health but also involves the menstrual cycle…People with PMDD can face really upsetting [reactions]. [PMDD] is just like things like major depression or generalized anxiety disorder or panic disorder -- it's a mental health diagnosis. To joke about it or minimize it, or say, oh, ‘that person is just PMS-ing’ can really feel minimizing to people who have that diagnosis. [To] really respect the diagnosis is to not brush it off,” Hantsoo said.
However, Hantsoo highlighted the increasing awareness of such disorders. She touched upon social media as a method of sharing experiences related to reproductive health.
“Social media can make people feel more comfortable opening up about that. If they see other people posting ‘I'm struggling with these symptoms,’ they may be more comfortable opening up themselves, being like, ‘Okay, this is a thing.’ Because what I've seen clinically is that patients often feel kind of isolated. They might be the only person they know who has these PMS symptoms, and they might feel really isolated because of that… This might be really comforting, and I'm hoping that that awareness continues to grow.”
