The most common hormone imbalance responsible for PMS and PMDD is due to inadequate production of progesterone, and the metabolites of progesterone.

Low Progesterone Premenstrual Symptoms
The most common hormone imbalance responsible for PMS and PMDD is due to inadequate production of progesterone, and the metabolites of progesterone. As mentioned in the previous article, the premenstrual part of the cycle is when progesterone levels drop form the very high luteal levels back to the follicular levels. If the follicular levels are low, then when the levels drop the drop will be more severe. Now remember, 60% of a woman’s progesterone comes from her adrenal glands. So, if adrenal production of progesterone is low, then follicular levels of progesterone will be low. That is what causes PMS – the severe drop of progesterone from the high luteal to lower than normal follicular progesterone levels.
Research has revealed that in most cases, PMS and PMDD appear to be caused by an inadequate adrenal gland production of progesterone and its metabolite allopregnanolone [1, 2, 3]. Diminished concentrations of allopregnanolone in women with PMS may lead to decreased adaptation to stress and results various mood symptoms of the disorder, such as anxiety, tension, and feeling out of control [4]. The following list shows premenstrual symptom that often occur with decreased progesterone and progesterone metabolites:
Signs of Premenstrual Decreased Progesterone and Progesterone Metabolites

Feeling out of control
Heart Palpitations
Gastrointestinal symptoms
Menstrual Cramps

While allopregnanolone is produced as a metabolite of progesterone, the adrenal glands also produce allopregnanolone directly [5]. It is the decreased production of allopregnanolone specifically by the adrenal gland that is causing the PMS and PMDD. [1] Normal allopregnanolone production is maintained and stimulated by adrenocorticotropic hormone (ACTH). The ability of the adrenal glands to create allopregnanolone is important for stress adaptation, including the stress of hormonal changes that occur with the menses. Allopregnanolone levels are also affected by serotonin levels, indicating that the neuro-endocrine response is also involved in endogenous production.
Allopregnenolone levels are decreased if alcohol is consumed during the late luteal phase (the few days before the period starts). Therefore, it may be best to avoid drinking alcohol right before the menses starts. [6]
It is the decreased ability of the adrenal glands to respond to ACTH and directly create allopregnanolone that needs to be addressed. While bioidentical HRT like exogenous progesterone may increase allopregnanolone that is produced as a breakdown product of progesterone, it does not support the normal adrenal production of allopregnanolone. Furthermore, exogenous progesterone may suppress the monthly cycle. Most important is the fact that the inability of the adrenal glands to create endogenous progesterone and allopregnanolone, as needed – to help the body respond to day-to-day stressors – indicates that the best course of action is the restore proper adrenal gland function. Restoration before replacement is especially important in younger women who are looking at years of hormone replacement therapy if they cannot restore normal adrenal gland function.
Before taking progesterone, women can actually restore the ability of the adrenal glands to make its own progesterone & allopregnanolone with proper amounts of herbs Bupleurum, Coleus and other progestogenic herbs in the progesterone supporting formulation, ProgestoMend™.
It is best to use ProgestoMend™ for a couple of months before trying to determine if androgen excess should be considered. Progesterone and its metabolites play an important role in “controlling” or balancing the effects of androgens such as testosterone. After restoring the ability of the adrenal glands to make progesterone & allopregnanolone, signs of androgen excess often resolve.

However, if excessive testosterone and androgen excess symptoms persist, it may be best to take measures to address high testosterone premenstrual symptoms.

[1] Lombardi I, Luisi S, Quirici B, Monteleone P, Bernardi F, Liut M, Casarosa E, Palumbo M, Petraglia F, Genazzani AR. Adrenal response to adrenocorticotropic hormone stimulation in patients with premenstrual syndrome. Gynecol Endocrinol. 2004 Feb;18(2):79-87. PMID: 15195499
[2] Eriksson E, Sundblad C, Lisjo P, Modigh K, Andersch B. Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls. Psychoneuroendocrinology. 1992 May-Jul;17(2-3):195-204. PMID: 1438645
[3] Monteleone P, Luisi S, Tonetti A, Bernardi F, Genazzani AD, Luisi M, Petraglia F, Genazzani AR. Allopregnanolone concentrations and premenstrual syndrome. Eur J Endocrinol. 2000 Mar;142(3):269-73. PMID: 10700721
[4] Rapkin AJ, Morgan M, Goldman L, Brann DW, Simone D, Mahesh VB. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol. 1997 Nov;90(5):709-14.
[5] Genazzani AR, Lombardi I, Borgioli G, di Bono I, Casarosa E, Gambacciani M, Palumbo M, Genazzani AD, Luisi M. Adrenal function under long-term raloxifene administration.Gynecol Endocrinol. 2003 Apr;17(2):159-68. PMID: 12737677
[6] Nyberg S, Andersson A, Zingmark E, Wahlström G, Bäckström T, Sundström-Poromaa I. The effect of a low dose of alcohol on allopregnanolone serum concentrations across the menstrual cycle in women with severe premenstrual syndrome and controls. Psychoneuroendocrinology. 2005 Oct;30(9):892-901. PMID: 15979810.