In 1982, Dr. Attila Toth from the MacLeod laboratory at Cornell University in New York, published an interesting paper on the use of antibiotics for treating Premenstrual Syndrome. He compared two group of women who had been diagnosed with PMS. He prescribed doxycycline to be taken for a month to the first group, and a placebo to the second group. Patients self-evaluated their symptoms using analog visual scales and a questionnaire on menstruation. The first group symptoms’ improvements were objectively higher than the second group. To reconfirm this phenomenon, the placebo group was later prescribed doxycycline, and the difference initially observed between both groups was replicated. Since it was a 6-month study, it was possible to determine that the improvements were not the result of taking the antibiotic, but they were rather permanent.
Even though Toth, given the cyclic nature of the disease, read the results as a possible ovarian infection that could even alternate the endometrial phases, he could not get close to the physiopathological mechanism. As such, studies related to inflammatory mediators are the key. Many diseases and symptoms have been studied since, such as depression, baldness, migraines, among others. It was Dr. Elizabeth Bertone-Johnson’ study, from the University of Amherst, Massachusetts, in June 2014, the first one to relate inflammatory cytokines with premenstrual syndrome.
Both studies, performed at different times, years apart, concur with the more empiric and deductive vision of Dr. Lolas Talhami’ study, who argues the infectious-inflammatory origin of the disease, primarily at the uterus, but in many occasions related to other organs and pelvic tissue from the female reproductive system. Therefore, mild pelvic inflammatory disease could be another cause of premenstrual syndrome that would explain the failure of a hysterectomy with bilateral adnexectomy as treatment for the syndrome in some cases.
In any case, even though the cause and physiopathology of this complex disease are yet to be clarified, science is closer to its understanding and types of treatments.