PMS signals higher risk for hypertension

Women with moderate-to-severe premenstrual syndrome (PMS) had a 40% higher risk of developing hypertension over the following 20 years compared to women with few menstrual symptoms, according to a new study published online November 24, 2015 in the American Journal of Epidemiology.

Risk for hypertension was highest in the women under age 40, researchers found. In this age group, women with PMS had a three-fold higher risk of developing hypertension compared to women without PMS.

“To my knowledge, this is the first large long-term study to suggest that PMS may be related to risk of chronic health conditions in later life,” said lead author Elizabeth Bertone-Johnson, ScD, Associate Professor in the Department of Epidemiology in the School of Public Health and Health Sciences at the University of Massachusetts Amherst, in Amherst, MA.

In this study, Dr. Bertone-Johnson and colleagues prospectively evaluated women from the Nurses’ Health Study II, including 1,257 women with clinically significant PMS and 2,463 age-matched control participants with few menstrual symptoms. The researchers assessed PMS symptoms using a modified Calendar of Premenstrual Experiences, which included palpitations, nausea, forgetfulness, dizziness, hot flashes, insomnia, depression, acne, and cramping.

The researchers then followed the participants for new diagnoses of hypertension. Over the next 6 to 20 years, 342 women with PMS and 541 women without PMS reported hypertension. After adjusting for known risk factors—including body mass index, pack-years of cigarette smoking, physical activity, alcohol use, postmenopausal hormone use, oral contraceptive use, and family history of hypertension—women with PMS had a 40% increased risk for hypertension compared to women without PMS.

Hypertension is on the rise among women, the researchers noted, so new interventions are needed to identify women at high risk. In light of these findings, the researchers recommended that “women with PMS should be screened for adverse changes in blood pressure and future risk of hypertension.”

Their results also showed that hypertension risk was not increased in women with PMS who had a higher intake of the B vitamins thiamine and riboflavin. This finding matches a study that the researchers published in 2011 in which they found that women with high dietary intake of thiamine and riboflavin had 25% to 35% lower risk of developing PMS.

Results from the current study are “consistent with these findings, and suggest that improving B vitamin status in women with PMS may both reduce menstrual symptom severity and lower hypertension risk,” the authors wrote.