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Westermark V, Yang Y, Bertone-Johnson E, Bränn E, Opatowski M, Pedersen N, Valdimarsdóttir UA, Lu D. Association between severe premenstrual disorders and change of romantic relationship: A prospective cohort of 15,606 women in Sweden. J Affect Disord 2024; 364:132-138. [PMID: 39147145 DOI: 10.1016/j.jad.2024.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/05/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Premenstrual disorders (PMDs) affect women's quality of life, yet the impact on romantic relationships remains unclear. This study aimed to examine the association between severe PMDs and relationship disruption and initiation. METHODS We conducted a prospective cohort study of 15,606 women during 2009-2021 in Sweden. PMDs were assessed with the modified Premenstrual Symptom Screening Tool at baseline (one-time retrospective self-report), while relationship status was obtained from national population registers during follow-up. Poisson regression was employed to assess the risk of relationship change. RESULTS At baseline (mean age 33.5 years), 1666 (10.6 %) women met the criteria for severe PMDs. All women were followed for 9.1 years on average for any change of relationship status. Among married/cohabiting women, PMDs were positively associated with relationship disruption (Incidence risk ratio, IRR =1.21, 95 % CI: 1.01-1.43, p = 0.03). A more pronounced association was suggested for premenstrual dysphoric disorder (IRR = 1.22, 95 % CI: 1.01-1.45, p = 0.03) than severe premenstrual syndrome (IRR = 1.01, 95 % CI: 0.43-1.96, p = 0.98) and among women without depression/anxiety (IRR = 1.21, 95 % CI: 1.00-1.47, p < 0.05) than among those with (IRR = 0.99, 95 % CI: 0.61-1.54 p = 0.96) and IRR = 1.01, 95 % CI: 0.57-1.72, p = 0.97). Among single women, a null association was found between PMDs and relationship initiation (IRR = 1.05, 95 % CI: 0.95-1.15, p = 0.32). LIMITATIONS PMDs were not assessed using prospective symptom charting. CONCLUSIONS Married/cohabiting women with probable severe PMDs have an increased risk of relationship disruption. PMDs were not associated with relationship initiation in single women. Healthcare professionals should recognize relationship challenges in women with severe PMDs, and they may require support to maintain healthy relationships.
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Affiliation(s)
- Veronika Westermark
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Yihui Yang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Emma Bränn
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marion Opatowski
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nancy Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Donghao Lu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Pedro AO, Brandão JDP, de Oliveira Silva SB, Lapa MG, Castilho VC. Impact of age on premenstrual syndrome prevalence and severity: A population-based survey in Brazil. Int J Gynaecol Obstet 2024. [PMID: 39319606 DOI: 10.1002/ijgo.15895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/17/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE To evaluate the relationship between premenstrual disorders (PMD) and age, we analyzed the prevalence and severity of psycho-emotional and physical symptoms in a representative sample of Brazilian women. METHODS This observational and retrospective study analyzed data from Brazilian women aged 20-49 years from five regions of the country who reported premenstrual symptoms. Participants completed a premenstrual symptom screening questionnaire and self-reported the presence and severity of their symptoms. Among 23 104 women reporting does premenstrual symptoms, 38.91% (n = 8990) experienced PMD caused functional impairment. Finally, 5121 participants agreed to complete the adapted version of the screening questionnaire. RESULTS The age group distribution was 20-29 (46.7%), 30-39 (38.3%), and 40-49 years (15%). The most prevalent and severe physical symptom was acne/oily skin in participants aged 20-29 years and headache in women aged 30-49 years. Regarding psycho-emotional symptoms, the most prevalent was anxiety/tension in women aged 20-29 years and 40-49 years and irritability/anger in those aged 30-39 years. Irritability/anger was the most severe symptom in all groups. CONCLUSION PMD significantly impacts the quality of life of Brazilian women with varying intensity. Physical symptoms associated with PMD vary with age, while psycho-emotional symptoms, particularly irritability/anger and anxiety, were intense in Brazilian women of reproductive age. These findings inform early diagnosis and individualized treatment approaches for PMD, addressing the needs of women.
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Affiliation(s)
- Adriana Orcesi Pedro
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
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Yoshimi K, Inoue F, Odai T, Shirato N, Watanabe Z, Otsubo T, Terauchi M, Takeda T. Practical diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder by psychiatrists and obstetricians/gynecologists in Japan. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e234. [PMID: 39149567 PMCID: PMC11325828 DOI: 10.1002/pcn5.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 06/30/2024] [Accepted: 07/28/2024] [Indexed: 08/17/2024]
Abstract
Aim To investigate and compare the diagnoses and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) from the perspectives of psychiatrists and obstetricians/gynecologists (OB/GYNs) in Japan. Methods Between December 2021 and February 2022, a web-based survey was conducted among the members of the Japanese Association of Neuro-Psychiatric Clinics. Data from 262 psychiatrists who responded to the aforementioned survey were compared with data from 409 OB/GYNs from a survey conducted in 2021 among members of the Japanese Society of Obstetrics and Gynecology. Results Overall, 79.8% of psychiatrists and 97.3% of OB/GYNs were involved in practicing PMS/PMDD diagnosis and treatment. Most psychiatrists believed that PMS should be treated by OB/GYNs (74.4%) and PMDD by psychiatrists (75.6%). Only vague medical interviews were conducted by 86.6% of psychiatrists, and only 9.7% maintained a two-cycle symptom diary. Psychiatrists mostly prescribed selective serotonin/serotonin and noradrenaline reuptake inhibitor (SSRI/SNRI) continuous dosing (91.1%), followed by Kampo medicines, especially Kamishoyosan (73.3%); only 2.8% chose oral contraceptive pills, unlike OB/GYNs, while SSRI continuous (32.8%) and luteal phase dosing (20.6%) and Kampo medicine (42.1%) were the most common first-line treatments. Lifestyle guidance was prescribed by 63.6% of psychiatrists, followed by cognitive behavioral therapy (13.8%) and the symptom diary observation method (11.1%), which were similar to OB/GYNs' choices. Conclusions Many Japanese psychiatrists and OB/GYNs do not base PMS/PMDD diagnoses on prospective monitoring methods using specific diagnostic criteria and therefore do not provide evidence-based treatment. Moreover, a tendency of being biased toward treatments in which the department specialized was observed.
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Affiliation(s)
- Kana Yoshimi
- Division of Women's Health, Research, Institute of Traditional Asian Medicine Kindai University Osaka Japan
- Department of Psychiatry Kyowakai Hannnan, Hospital Osaka Japan
| | - Fumi Inoue
- Division of Women's Health, Research, Institute of Traditional Asian Medicine Kindai University Osaka Japan
| | - Tamami Odai
- Department of Women's Health Tokyo Medical and Dental University Tokyo Japan
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology Showa University School of Medicine Tokyo Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine Tokyo Women's Medical University Adachi Medical Centerr Tokyo Japan
| | - Masakazu Terauchi
- Department of Women's Health Tokyo Medical and Dental University Tokyo Japan
| | - Takashi Takeda
- Division of Women's Health, Research, Institute of Traditional Asian Medicine Kindai University Osaka Japan
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Jespersen C, Lauritsen MP, Frokjaer VG, Schroll JB. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev 2024; 8:CD001396. [PMID: 39140320 PMCID: PMC11323276 DOI: 10.1002/14651858.cd001396.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a combination of physical, psychological and social symptoms in women of reproductive age, and premenstrual dysphoric disorder (PMDD) is a severe type of the syndrome, previously known as late luteal phase dysphoric disorder (LLPDD). Both syndromes cause symptoms during the two weeks leading up to menstruation (the luteal phase). Selective serotonin reuptake inhibitors (SSRIs) are increasingly used as a treatment for PMS and PMDD, either administered in the luteal phase or continuously. We undertook a systematic review to assess the evidence of the positive effects and the harms of SSRIs in the management of PMS and PMDD. OBJECTIVES To evaluate the benefits and harms of SSRIs in treating women diagnosed with PMS and PMDD. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase and PsycINFO for randomised controlled trials (RCTs) in November 2023. We checked reference lists of relevant studies, searched trial registers and contacted experts in the field for any additional trials. This is an update of a review last published in 2013. SELECTION CRITERIA We considered studies in which women with a prospective diagnosis of PMS, PMDD or LLPDD were randomised to receive SSRIs or placebo. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We pooled data using a random-effects model. We calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for premenstrual symptom scores, using 'post-treatment' scores for continuous data. We calculated odds ratios (ORs) with 95% CIs for dichotomous outcomes. We stratified analyses by type of administration (luteal phase or continuous). We calculated absolute risks and the number of women who would need to be taking SSRIs in order to cause one additional adverse event (i.e. the number needed to treat for an additional harmful outcome (NNTH)). We rated the overall certainty of the evidence for the main findings using GRADE. MAIN RESULTS We included 34 RCTs in the review. The studies compared SSRIs (i.e. fluoxetine, paroxetine, sertraline, escitalopram and citalopram) to placebo. SSRIs probably reduce overall self-rated premenstrual symptoms in women with PMS and PMDD (SMD -0.57, 95% CI -0.72 to -0.42; I2 = 51%; 12 studies, 1742 participants; moderate-certainty evidence). SSRI treatment was probably more effective when administered continuously than when administered only in the luteal phase (P = 0.03 for subgroup difference; luteal phase group: SMD -0.39, 95% CI -0.58 to -0.21; 6 studies, 687 participants; moderate-certainty evidence; continuous group: SMD -0.69, 95% CI -0.88 to -0.51; 7 studies, 1055 participants; moderate-certainty evidence). The adverse effects associated with SSRIs were nausea (OR 3.30, 95% CI 2.58 to 4.21; I2 = 0%; 18 studies, 3664 women), insomnia (OR 1.99, 95% CI 1.51 to 2.63; I2 = 0%; 18 studies, 3722 women), sexual dysfunction or decreased libido (OR 2.32, 95% CI 1.57 to 3.42; I2 = 0%; 14 studies, 2781 women), fatigue or sedation (OR 1.52, 95% CI 1.05 to 2.20; I2 = 0%; 10 studies, 1230 women), dizziness or vertigo (OR 1.96, 95% CI 1.36 to 2.83; I2 = 0%; 13 studies, 2633 women), tremor (OR 5.38, 95% CI 2.20 to 13.16; I2 = 0%; 4 studies, 1352 women), somnolence and decreased concentration (OR 3.26, 95% CI 2.01 to 5.30; I2 = 0%; 8 studies, 2050 women), sweating (OR 2.17, 95% CI 1.36 to 3.47; I2 = 0%; 10 studies, 2304 women), dry mouth (OR 2.70, 95% CI 1.75 to 4.17; I2 = 0%; 11 studies, 1753 women), asthenia or decreased energy (OR 3.28, 95% CI 2.16 to 4.98; I2 = 0%; 7 studies, 1704 women), diarrhoea (OR 2.06, 95% CI 1.37 to 3.08; I2 = 0%; 12 studies, 2681 women), and constipation (OR 2.39, 95% CI 1.09 to 5.26; I2 = 0%; 7 studies, 1022 women). There was moderate-certainty evidence for all adverse effects other than somnolence/decreased concentration, which was low-certainty evidence. Overall, the certainty of the evidence was moderate. The main weakness was poor reporting of study methodology. Heterogeneity was low or absent for most outcomes, although there was moderate heterogeneity in the analysis of overall self-rated premenstrual symptoms. Based on the meta-analysis of response rate (the outcome with the most included studies), there was suspected publication bias. In total, 68% of the included studies were funded by pharmaceutical companies. This stresses the importance of interpreting the review findings with caution. AUTHORS' CONCLUSIONS SSRIs probably reduce premenstrual symptoms in women with PMS and PMDD and are probably more effective when taken continuously compared to luteal phase administration. SSRI treatment probably increases the risk of adverse events, with the most common being nausea, asthenia and somnolence.
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Affiliation(s)
- Cecilie Jespersen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Mette Petri Lauritsen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Mental Health Services, Capital Region of Copenhagen, Brondby, Denmark
| | - Jeppe B Schroll
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Herlev, Denmark
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Lin J, Nunez C, Susser L, Gershengoren L. Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses. Front Psychiatry 2024; 15:1410813. [PMID: 39176230 PMCID: PMC11338788 DOI: 10.3389/fpsyt.2024.1410813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Premenstrual exacerbation of an existing psychiatric disorder refers to the worsening of symptoms inherent to the condition during the premenstrual phase. Research consistently indicates that hormonal fluctuations during the menstrual cycle present a unique period of vulnerability for the onset or exacerbation of psychiatric symptoms, impacting diagnosis, risk assessment, and treatment. This review sought to elucidate the phenomenon of premenstrual exacerbation and its impact across a spectrum of psychiatric illnesses, including mood, anxiety, psychotic, obsessive-compulsive, personality, and trauma-related disorders. Despite the expanded research in recent years on premenstrual dysphoric disorder and premenstrual syndrome, premenstrual exacerbation remains underexplored and poorly defined. This review offers significant contributions to the diagnosis and management of psychiatric conditions, advocating for heightened awareness and novel treatment approaches in the context of premenstrual exacerbation.
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Affiliation(s)
- Jenny Lin
- Department of Psychiatry, New York University, New York, NY, United States
| | - Christine Nunez
- Department of Psychiatry, New York University, New York, NY, United States
| | - Leah Susser
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, United States
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Takeda T, Yoshimi K, Kai S, Inoue F. The Japanese Version of the Daily Record of Severity of Problems for Premenstrual Symptoms: Reliability and Validity Among the General Japanese Population. Int J Womens Health 2024; 16:299-308. [PMID: 38435757 PMCID: PMC10907499 DOI: 10.2147/ijwh.s450300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose The validity and reliability of the Japanese version of the Daily Record of Severity of Problems (DRSP-J) have already been confirmed in a population with premenstrual symptoms. This study aimed to assess the validity and reliability of the DRSP-J in the general population. Patients and Methods We analyzed data from 113 Japanese women with regular menstrual cycles who applied to participate in an ongoing study. Participants were recruited regardless of the severity of premenstrual symptoms, and their menstrual cycles were monitored using the DRSP-J for two cycles. Reliability was examined using Cronbach's α, a measure of internal consistency, and test-retest reliability. Structural validity was assessed using a principal component analysis (PCA). The Hospital Anxiety and Depression Scale (HADS) and EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) were used to examine concurrent validity. The agreement between the clinical diagnoses based on the diagnostic criteria for premenstrual syndrome/premenstrual dysphoric disorder and that based on the DRSP-J score was examined using the kappa coefficient. Results Cronbach's α for DRSP-J total score was 0.96. The DRSP-J total score showed high test-retest reliability. The PCA showed a two-factor model describing "Mood" and "Behavior/Physical" symptoms. The DRSP-J total score was highly correlated with the HADS total and EQ-5D-5L scores. The classification of "moderate to severe premenstrual syndrome" and "premenstrual dysphoric disorder" by clinical methods and the criteria based on the DRSP-J were in good agreement (kappa values = 0.78). Conclusion The DRSP-J is a reliable and valid measure of premenstrual symptoms in the general Japanese population, including those with few or no symptoms.
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Affiliation(s)
- Takashi Takeda
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Kana Yoshimi
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Sayaka Kai
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Fumi Inoue
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
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Carlini SV, Lanza di Scalea T, McNally ST, Lester J, Deligiannidis KM. Management of Premenstrual Dysphoric Disorder: A Scoping Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:81-96. [PMID: 38694162 PMCID: PMC11058916 DOI: 10.1176/appi.focus.23021035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account. Reprinted from Int J Womens Health 2022; 14:1783-1801, with permission from Dove Medical Press Ltd. Copyright © 2022.
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Affiliation(s)
- Sara V Carlini
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA (Carlini); Departments of Psychiatry & Behavioral Sciences and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA (Lanza di Scalea); Department of Obstetrics and Gynecology, Katz Institute for Women's Health, Queens, NY, USA (McNally); Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA (Lester); Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA (Deligiannidis)
| | - Teresa Lanza di Scalea
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA (Carlini); Departments of Psychiatry & Behavioral Sciences and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA (Lanza di Scalea); Department of Obstetrics and Gynecology, Katz Institute for Women's Health, Queens, NY, USA (McNally); Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA (Lester); Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA (Deligiannidis)
| | - Stephanie Trentacoste McNally
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA (Carlini); Departments of Psychiatry & Behavioral Sciences and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA (Lanza di Scalea); Department of Obstetrics and Gynecology, Katz Institute for Women's Health, Queens, NY, USA (McNally); Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA (Lester); Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA (Deligiannidis)
| | - Janice Lester
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA (Carlini); Departments of Psychiatry & Behavioral Sciences and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA (Lanza di Scalea); Department of Obstetrics and Gynecology, Katz Institute for Women's Health, Queens, NY, USA (McNally); Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA (Lester); Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA (Deligiannidis)
| | - Kristina M Deligiannidis
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA (Carlini); Departments of Psychiatry & Behavioral Sciences and Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA (Lanza di Scalea); Department of Obstetrics and Gynecology, Katz Institute for Women's Health, Queens, NY, USA (McNally); Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA (Lester); Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA (Deligiannidis)
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Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. Obstet Gynecol 2023; 142:1516-1533. [PMID: 37973069 DOI: 10.1097/aog.0000000000005426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To provide recommendations for the management of premenstrual syndrome and premenstrual dysphoric disorder, collectively referred to as premenstrual disorders, based on assessment of the evidence regarding the safety and efficacy of available treatment options. An overview of the epidemiology, pathophysiology, and diagnosis of premenstrual disorders also is included to provide readers with relevant background information and context for the clinical recommendations. TARGET POPULATION Reproductive-aged adults and adolescents with premenstrual symptoms. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on the following evidence-based treatment options for premenstrual disorders, with an acknowledgement that many patients may benefit from a multimodal approach that combines several interventions: pharmacologic agents (hormonal and nonhormonal), psychological counseling, complementary and alternative treatments, exercise and nutritional therapies, patient education and self-help strategies, and surgical management. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence. Based on review of extrapolated data from adult populations and expert consensus, it was determined that the recommendations also apply to adolescents, with a few exceptions that are noted in the Clinical Practice Guideline.
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Labots-Vogelesang MS, Kooiman-Andringa R, Teunissen TAM, Lagro-Janssen ALM. Perspectives of Dutch women on premenstrual disorder. A qualitative study exploring women's experiences. Eur J Gen Pract 2023; 29:2166033. [PMID: 36714999 PMCID: PMC9888467 DOI: 10.1080/13814788.2023.2166033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Women presenting with Premenstrual Disorder (PMD) to general practitioners (GPs) experience problems with their biopsychosocial functioning. PMD is a disorder consisting of physical and/or mood-based symptoms cyclically occurring with a significant impairment of daily life. Little is known about the symptoms and coping strategies of women with PMD and their experiences with their GPs. OBJECTIVES This present study aimed to improve understanding of the perspectives of women with PMD, their coping strategies and their expectations of the GP. DESIGN Qualitative study with semi-structured interviews. SETTING In 2017, Dutch women with symptoms of premenstrual disorder were recruited through local newspapers in the town of Nijmegen and the North-Holland region and via social media. After checking the inclusion and exclusion criteria, we interviewed 20 women (between 27 and 49 years of age). The interviews took place at a location of the interviewees' preference. RESULTS PMD symptoms can strongly influence the quality of women's lives. Three themes emerged from our analysis: feelings of having two separate female identities, PMD as a life-controlling condition and different coping strategies. Most women used an active coping strategy. Women with PMD need recognition from their GPs and knowledge of proper treatment. CONCLUSION PMD symptoms can have a high impact on daily life. Women with PMD expressed their need for acknowledgement and a personalised approach from their GP. Greater awareness and knowledge among GPs may be helpful in this.
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Affiliation(s)
- Marijke S. Labots-Vogelesang
- Gender and Women’s Health Unit, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rachel Kooiman-Andringa
- Gender and Women’s Health Unit, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Theodora A. M. Teunissen
- Gender and Women’s Health Unit, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands,CONTACT Theodora A. M. Teunissen Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Centre, P.O. Box 9101, Geert Grooteplein Noord 21, Nijmegen6525EZ, the Netherlands
| | - Antoine L. M. Lagro-Janssen
- Gender and Women’s Health Unit, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
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Maranho MCDMF, Guapo VG, de Rezende MG, Vieira CS, Brandão ML, Graeff FG, Lovick T, Del-Ben CM. Low doses of fluoxetine for the treatment of emotional premenstrual syndrome: a randomized double-blind, placebo-controlled, pilot study. Psychoneuroendocrinology 2023; 157:106360. [PMID: 37572412 DOI: 10.1016/j.psyneuen.2023.106360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION The neuroactive metabolite of progesterone, allopregnanolone (ALLO), has been implicated in premenstrual syndrome (PMS) physiopathology and preclinical studies suggested that low doses of fluoxetine increase the ALLO brain concentration. OBJECTIVES To assess which low dose of fluoxetine (2 mg/d, 5 mg/d or 10 mg/d), administered exclusively during the luteal phase of menstrual cycle, has a potential effect for preventing or mitigating emotional PMS symptoms. METHODS In this randomized, double-blind, placebo-controlled pilot study, we followed 40 women (mean age = 29.7 +/- 7.4 years) with emotional PMS, during two menstrual cycles: cycle 1, without pharmacological intervention; and cycle 2, with pharmacological intervention. Participants took capsules, on average, seven days preceding the likely date of menses. We assessed the severity of PMS symptoms in both cycles using the Daily Record of Severity of Problems scale (DRSP). RESULTS There was an increase in the DRSP scores during the late luteal phase of cycle 1, confirming the diagnosis of emotional PMS. Low doses of fluoxetine (5 mg/d: 33.5%; 10 mg/d: 48.4%) reduced DRSP total score in the day before menses (day-1) at cycle 2 compared with day-1 at cycle 1. Fluoxetine 10 mg/d had the most consistent decline in emotional PMS symptoms; 70% of the participants reported a reduction greater than 40% in the DRSP score. CONCLUSIONS Low doses of fluoxetine, which may have no or few effect on the serotonergic system, but may interfere in the progesterone metabolization, seem to have some potential to mitigate emotional PMS symptoms. While the 10 mg/d of fluoxetine had the best performance on reducing emotional PMS symptoms, the 5 mg/d dose also seems to have some effect on emotional PMS symptoms. Further larger studies will help establish the lowest effective dose of flouxetine for PMS treatment.
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Affiliation(s)
- Maria Clara de Morais Faleiros Maranho
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Internal Medicine, Barão de Mauá University Center, Ribeirão Preto, Brazil
| | - Vinicius Guandalini Guapo
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcos Gonçalves de Rezende
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcus Lira Brandão
- Neuropsychopharmacology Laboratory, FFCLRP, University of São Paulo, Ribeirão Preto, SP, Brazil; Institute of Neuroscience and Behavior - IneC, Ribeirão Preto, SP, Brazil
| | | | - Thelma Lovick
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Takeda T, Yoshimi K, Inoue F, Odai T, Shirato N, Watanabe Z, Otsubo T, Terauchi M. Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study. TOHOKU J EXP MED 2023; 261:95-101. [PMID: 37612076 DOI: 10.1620/tjem.2023.j059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Fumi Inoue
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Tamami Odai
- Department of Women's Health, Tokyo Medical and Dental University
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine, Tokyo Women's Medical University Adachi Medical Center
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Mahmoodi M, Farajkhoda T, Nadjarzadeh A, Zareei Mahmoodabadi H. Online positive-oriented counseling, taking vitamin D3 tablet, online lifestyle modification training on premenstrual syndrome: a 3-armed randomized clinical trial. Sci Rep 2023; 13:16631. [PMID: 37789181 PMCID: PMC10547791 DOI: 10.1038/s41598-023-43940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/30/2023] [Indexed: 10/05/2023] Open
Abstract
Lack of absolute treatment for premenstrual syndrome (PMS), its cyclic nature, considerable prevalence (70-90%), and its mental and physical burden imply necessity of effectiveness comparison of various treatments. Although antidepressant and hormonal drugs are well-known medications for PMS, in affected women who can't tolerate, or don't have compatibility or compliance with these drugs, other effective treatments have always been important concern. This study aimed to compare effectiveness of online positive-oriented counseling, taking vitamin D3 tablet, and online lifestyle modification training on alleviating PMS. 3-armed parallel randomized clinical trial was performed on 84 20-40-year-old eligible women with PMS. 84 women were randomly ( www.random.org/sequenc ) allocated into three groups, but data of 77 women (1, n = 25) online positive-oriented counseling group (6 sessions), (2, n = 27) vitamin D3 tablet group (one vitamin D3 tablet weekly for 6 weeks), and (3, n = 25) online lifestyle training group (6 sessions) were analyzed. Vitamin D3 was measured at baseline, week6 and fallow up week10. Primary outcome variable PMS was measured with Premenstrual Symptoms Screening Tool (PSST) at baseline, week 6, and follow-up week 10. Primary outcome satisfaction with intervention method was measured using satisfaction scale at week 6 and follow-up week 10. ANOVA, Repeated Measures, and Paired samples t-test were used for statistical analysis. There was no statistically significant difference in PMS at baseline between three groups respectively (33 ± 5.8, 34.1 ± 7.1, & 35.2 ± 6.4, P = 0.500). However, at follow-up week 10, there was statistically significant difference between three groups (22.3 ± 4.3, 25.4 ± 6.5, & 31.8 ± 6.5; P < 0.001), with greatest improvement in online positive-oriented counseling group (P < 0.001). Satisfaction differed significantly among three groups at week 6 (51 ± 6.8, 46.4 ± 12, & 42.3 ± 6.3, P = 0.001) and follow-up week 10 (55.7 ± 11.6, 51.4 ± 12; & 43 ± 3.3, P < 0.001), with most satisfaction in positive-oriented counseling group (P < 0.001). All three interventions alleviated PMS, but online positive-oriented counseling was more effective and satisfying. Superiority of positive-oriented counseling implies mechanism of adaptation, better relationships, forgiveness, self-mood-regulation, and feasibility of its skills that could be continued individually by women after counseling completion. It is recommended health providers, health policymakers and managers support use of these interventions in treatment program and clinical guidelines.Trial registration: RCT registration number: IRCT20191231045967N1, Registration date:11/02/2020, Registration timing: prospective (IRCT | Survey the effect of vitamin D3 tablet intake, positivism group consulting with changing in life style in the treatment of premenstrual syndrome in women).
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Affiliation(s)
- Maryam Mahmoodi
- International Campus of Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahmineh Farajkhoda
- Reproductive Health & Clinical Psychologist, Research Center for Nursing and Midwifery Care, Non-communicable Diseases Institute, Department of Midwifery, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Azadeh Nadjarzadeh
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Taim BC, Ó Catháin C, Renard M, Elliott-Sale KJ, Madigan S, Ní Chéilleachair N. The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review. Sports Med 2023; 53:1963-1984. [PMID: 37389782 DOI: 10.1007/s40279-023-01871-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes. OBJECTIVE To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist. RESULTS Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8-85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality. DISCUSSION MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms. TRIAL REGISTRATION This review has been registered in the PROSPERO database (CRD42021268757).
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Affiliation(s)
- Bernadette Cherianne Taim
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland.
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland.
| | - Ciarán Ó Catháin
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
| | - Michèle Renard
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
| | - Kirsty Jayne Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, 99 Oxford Road, M1 7EL, Manchester, UK
| | - Sharon Madigan
- Sport Ireland Institute, Dublin, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Niamh Ní Chéilleachair
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
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Jaholkowski P, Shadrin AA, Jangmo A, Frei E, Tesfaye M, Hindley GFL, Haram M, Rahman Z, Athanasiu L, Bakken NR, Holen B, Fominykh V, Kutrolli G, Parekh P, Parker N, Rødevand L, Birkenæs V, Djurovic S, Frei O, O’Connell KS, Smeland OB, Tesli M, Andreassen OA. Associations Between Symptoms of Premenstrual Disorders and Polygenic Liability for Major Psychiatric Disorders. JAMA Psychiatry 2023; 80:738-742. [PMID: 37163253 PMCID: PMC10173094 DOI: 10.1001/jamapsychiatry.2023.1137] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 05/11/2023]
Abstract
Importance Premenstrual disorders are heritable, clinically heterogenous, with a range of affective spectrum comorbidities. It is unclear whether genetic predispositions to affective spectrum disorders or other major psychiatric disorders are associated with symptoms of premenstrual disorders. Objective To assesss whether symptoms of premenstrual disorders are associated with the genetic liability for major psychiatric disorders, as indexed by polygenic risk scores (PRSs). Design, Setting, and Participants Women from the Norwegian Mother, Father and Child Cohort Study were included in this genetic association study. PRSs were used to determine whether genetic liability for major depression, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, and autism spectrum disorder were associated with the symptoms of premenstrual disorders, using the PRS for height as a somatic comparator. The sample was recruited across Norway between June 1999 and December 2008, and analyses were performed from July 1 to October 14, 2022. Main Outcomes and Measures The symptoms of premenstrual disorders were assessed at recruitment at week 15 of pregnancy with self-reported severity of depression and irritability before menstruation. Logistic regression was applied to test for the association between the presence of premenstrual disorder symptoms and the PRSs for major psychiatric disorders. Results The mean (SD) age of 56 725 women included in the study was 29.0 (4.6) years. Premenstrual disorder symptoms were present in 12 316 of 56 725 participants (21.7%). The symptoms of premenstrual disorders were associated with the PRSs for major depression (β = 0.13; 95% CI, 0.11-0.15; P = 1.21 × 10-36), bipolar disorder (β = 0.07; 95% CI, 0.05-0.09; P = 1.74 × 10-11), attention deficit/hyperactivity disorder (β = 0.07; 95% CI, 0.04-0.09; P = 1.58 × 10-9), schizophrenia (β = 0.11; 95% CI, 0.09-0.13; P = 7.61 × 10-25), and autism spectrum disorder (β = 0.03; 95% CI, 0.01-0.05; P = .02) but not with the PRS for height. The findings were confirmed in a subsample of women without a history of psychiatric diagnosis. Conclusions The results of this genetic association study show that genetic liability for both affective spectrum disorder and major psychiatric disorders was associated with symptoms of premenstrual disorders, indicating that premenstrual disorders have overlapping genetic foundations with major psychiatric disorders.
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Affiliation(s)
- Piotr Jaholkowski
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexey A. Shadrin
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Andreas Jangmo
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Evgeniia Frei
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markos Tesfaye
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Guy F. L. Hindley
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Marit Haram
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Zillur Rahman
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lavinia Athanasiu
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nora Refsum Bakken
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Børge Holen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vera Fominykh
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gleda Kutrolli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pravesh Parekh
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nadine Parker
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Viktoria Birkenæs
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Oleksandr Frei
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
| | - Kevin S. O’Connell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav B. Smeland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
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Ma S, Song SJ. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2023; 6:CD006586. [PMID: 37365881 PMCID: PMC10289136 DOI: 10.1002/14651858.cd006586.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a common problem. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. Combined oral contraceptives (COC), which provide both progestin and oestrogen, have been examined for their ability to relieve premenstrual symptoms. A combined oral contraceptive containing drospirenone and a low oestrogen dose has been approved for treating PMDD in women who choose combined oral contraceptives for contraception. OBJECTIVES To evaluate the effectiveness and safety of COCs containing drospirenone in women with PMS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group trial register, CENTRAL (now containing output from two trials registers and CINAHL), MEDLINE, Embase, PsycINFO, LILACS, Google Scholar, and Epistemonikos on 29 June 2022. We checked included studies' reference lists and contacted study authors and experts in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCT) that compared COCs containing drospirenone with placebo or with another COC for treatment of women with PMS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were effects on premenstrual symptoms that were prospectively recorded, and withdrawal due to adverse events. Secondary outcomes included effects on mood, adverse events, and response rate to study medications. MAIN RESULTS We included five RCTs (858 women analysed, most diagnosed with PMDD). The evidence was very low to moderate quality; the main limitations were serious risk of bias due to poor reporting of study methods, and serious inconsistency and imprecision. COCs containing drospirenone and ethinylestradiol (EE) versus placebo COCs containing drospirenone and EE may improve overall premenstrual symptoms (standardised mean difference (SMD) -0.41, 95% confidence interval (CI) -0.59 to -0.24; 2 RCTs, N = 514; I2 = 64%; low-quality evidence); and functional impairment due to premenstrual symptoms in terms of productivity (mean difference (MD) -0.31, 95% CI -0.55 to -0.08; 2 RCTs, N = 432; I2 = 47%; low-quality evidence), social activities (MD -0.29, 95% CI -0.54 to -0.04; 2 RCTs, N = 432; I2 = 53%; low-quality evidence), and relationships (MD -0.30, 95% CI -0.54 to -0.06; 2 RCTs, N = 432; I2 = 45%; low-quality evidence). The effects from COCs containing drospirenone may be small to moderate. COCs containing drospirenone and EE may increase withdrawal from trials due to adverse effects (odds ratio (OR) 3.41, 95% CI 2.01 to 5.78; 4 RCT, N = 776; I2 = 0%; low-quality evidence). This suggests that if you assume the risk of withdrawal due to adverse effects from placebo is 3%, the risk from drospirenone plus EE will be between 6% and 16%. We are uncertain of the effect of drospirenone plus EE on premenstrual mood symptoms, when measured by validated tools that were not developed to assess premenstrual symptoms. COCs containing drospirenone may lead to more adverse effects in total (OR 2.31, 95% CI 1.71 to 3.11; 3 RCT, N = 739; I2 = 0%; low-quality evidence). This suggests that if you assume the risk of having adverse effects from placebo is 28%, the risk from drospirenone plus EE will be between 40% and 54%. It probably leads to more breast pain, and may lead to more nausea, intermenstrual bleeding, and menstrual disorder. Its effect on nervousness, headache, asthenia, and pain is uncertain. There was no report of any rare but serious adverse effects, such as venous thromboembolism in any of the included studies. COCs containing drospirenone may improve response rate (OR 1.65, 95% CI 1.13 to 2.40; 1 RCT, N = 449; I2 not applicable; low-quality evidence). This suggests that if you assume the response rate from placebo is 36%, the risk from drospirenone plus EE will be between 39% and 58%. We did not identify any studies that compared COCs containing drospirenone with other COCs. AUTHORS' CONCLUSIONS COCs containing drospirenone and EE may improve premenstrual symptoms that result in functional impairments in women with PMDD. The placebo also had a significant effect. COCs containing drospirenone and EE may lead to more adverse effects compared to placebo. We do not know whether it works after three cycles, helps women with less severe symptoms, or is better than other combined oral contraceptives that contain a different progestogen.
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Affiliation(s)
- Siyan Ma
- Women's Health, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Sae Jin Song
- Women's Health, Te Whatu Ora Counties Manukau, Auckland, New Zealand
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Tuygar-Okutucu F, Cimilli-Senocak G, Ceyhun HA, Ozcan H. Association of menopausal symptoms and menopausal quality of life with premenstrual syndrome. Malawi Med J 2023; 35:95-100. [PMID: 38264163 PMCID: PMC10731529 DOI: 10.4314/mmj.v35i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background Premenstrual symptoms at reproductive age resemble menopausal symptoms and have symptomatic commonalities. We hypothesized that women with previous premenstrual syndrome may be more prone to develop menopausal symptoms and aimed to investigate the association of menopausal symptoms and menopausal quality of life with premenstrual symptoms. Methods The study included 120 postmenopausal women. We evaluated the current menopausal symptoms with menopause rating scale (MRS) and quality of life with menopause-specific quality of life scale (MSQoL), previous premenstrual symptoms with premenstrual syndrome scale (PMSS) retrospectively and compared the associations statistically. Results According to retrospective PMSS, participants were divided into two groups; with and without premenstrual syndrome (PMS). PMS group included 29 (24.2%) participants and 91 (75.8%) participants were in group without PMS. Sociodemographic characteristics of groups were similar. Somatic and psychological symptoms were higher in MRS of PMS group. Evaluating the MSQoL; psychosocial and physical symptoms were impaired in the PMS group. Vasomotor, urogenital and sexual symptoms were similar in both groups. Conclusion Premenstrual and menopausal symptoms were related in terms of somatic, and psychosocial symptoms but not in vasomotor, urogenital, and sexual symptoms. It seems that women with previous premenstrual symptoms are more likely to develop menopausal symptoms in some ways. However, a prospective longitudinal study may be needed for more conclusive results.
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Affiliation(s)
| | | | - Hacer A Ceyhun
- Department of Psychiatry, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Halil Ozcan
- Ataturk University Medical Faculty, Erzurum, Turkey
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Hantsoo L, Payne JL. Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neurosci Biobehav Rev 2023; 149:105168. [PMID: 37059403 PMCID: PMC10176022 DOI: 10.1016/j.neubiorev.2023.105168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is a severe mood disorder, with affective symptoms that rise and fall in concert with the hormonal fluctuations of the menstrual cycle. PMDD's pathophysiology is poorly understood. This review describes recent research on potential biological contributors to PMDD, with a focus on neuroactive steroids, genetics, neuroimaging and cellular studies. Studies suggest that a key contributor is abnormal central nervous system (CNS) response to fluctuations in neuroactive steroid hormones. Imaging studies are limited but support alterations in serotonergic and GABA transmission. Genetic studies suggest heritability, yet specific genetic contributors have not been characterized. Finally, recent cutting-edge cellular studies indicate an underlying vulnerability to the effect of sex hormones at a cellular level. Overall the findings across studies do not yet fit together into a complete description of the underlying biology of PMDD. It is possible that PMDD consists of biological subtypes, and future research may benefit from a subtyping approach.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway Street, Baltimore, MD 21205, USA.
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
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Studer E, Nilsson S, Westman A, Pedersen NL, Eriksson E. Significance and Interrelationship of the Symptoms Listed in the DSM Criteria for Premenstrual Dysphoric Disorder. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 5:105-113. [PMID: 37711753 PMCID: PMC10499188 DOI: 10.1176/appi.prcp.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 09/16/2023] Open
Abstract
Objective While premenstrual dysphoric disorder (PMDD) as defined in DSM has become an established diagnosis, and a formal indication for drug treatment, the relative impact of the disparate symptoms named in the criteria, and to what extent they indeed constitute parts of one syndrome, remains insufficiently clarified. We have therefore explored the frequency, impact, and inter-relationship of different PMDD symptoms. Method Using a web survey, 10,457 Swedish women of fertile age were asked to retrospectively assess if they experience reduced functioning due to symptoms clearly associated with the premenstrual phase. Those responding affirmatively reported presence, severity, and impact of each symptom named in the PMDD criteria. Result Nine percent reported impairing premenstrual symptoms. Whereas irritability was reported to cause impairment in 77% of those passing the gate questions, somatic symptoms were common but seldom causing impairment. A vast majority reported presence of at least 5 different symptoms, as required to meet the PMDD criteria, but few reported each of 5 different symptoms to be severe or impairing. An analysis of the association between symptoms revealed clear-cut clustering of somatic and mood symptoms, respectively. Conclusion While retrospective account suggested irritability to be the clinically most important premenstrual symptom, some of the complaints named in the PMDD criteria were not or only weakly associated with mood symptoms and also reported to be of limited clinical significance. It is concluded that regarding all symptoms listed in the DSM criteria as clinically relevant manifestations of one and the same syndrome may be questioned.
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Affiliation(s)
- Erik Studer
- Department of PharmacologyInstitute of Neuroscience and Physiology at the Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Staffan Nilsson
- Institute of Mathematical SciencesChalmers University of TechnologyGothenburgSweden
| | - Anna Westman
- Department of PharmacologyInstitute of Neuroscience and Physiology at the Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Elias Eriksson
- Department of PharmacologyInstitute of Neuroscience and Physiology at the Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Naraoka Y, Hosokawa M, Minato-Inokawa S, Sato Y. Severity of Menstrual Pain Is Associated with Nutritional Intake and Lifestyle Habits. Healthcare (Basel) 2023; 11:healthcare11091289. [PMID: 37174831 PMCID: PMC10178419 DOI: 10.3390/healthcare11091289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Recently, the employment rate of women in Japan has steadily increased. Approximately 80% of women experience menstrual pain and premenstrual syndrome (PMS). These symptoms decrease a woman's quality of life and her work productivity, leading to an economic loss. This cross-sectional study of 321 healthy Japanese women aged 20-39 years aimed to clarify the lifestyle-related factors or nutrient intake that might cause menstrual pain. The participants underwent body composition measurements and completed meal survey sheets and lifestyle questionnaires, including menstrual status, exercise, sleep and breakfast consumption. Based on the questionnaire results, participants were divided into two groups according to the severity of menstrual pain, namely, heavy and light. Chi-square and Wilcoxon signed-rank sum tests were used to compare the severity of menstrual pain in the two groups. In the heavy group, the intake of animal proteins, including fish, vitamin D and vitamin B12, was significantly lower (p < 0.05), as was the frequency of breakfast consumption and bathing (p < 0.05). The rate of PMS symptoms was significantly higher in the heavy group (p < 0.05). This study suggests that a lack of animal protein, the accompanying vitamins and fatty acids, and the frequency of breakfast or bathing are associated with the severity of menstrual pain.
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Affiliation(s)
- Yuna Naraoka
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Japanese Center for Research on Woman in Sport, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
| | - Momo Hosokawa
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
| | - Satomi Minato-Inokawa
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
- Laboratory of Community Health and Nutrition, Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama 790-8566, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuichi Sato
- General Incorporated Association Luvtelli, 3-2-14, Nihonbashi, Chou-ku, Tokyo 103-0027, Japan
- Obstetrics and Gynecology, Tatedebari Sato Hospital, Takasaki 370-0836, Japan
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20
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Higuchi T, Ueno T, Uchiyama S, Matsuki S, Ogawa M, Takamatsu K. Effect of γ-tocopherol supplementation on premenstrual symptoms and natriuresis: a randomized, double-blind, placebo-controlled study. BMC Complement Med Ther 2023; 23:136. [PMID: 37118716 PMCID: PMC10148532 DOI: 10.1186/s12906-023-03962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND This randomized, double-blind, placebo-controlled study aimed to investigate the effects of γ-tocopherol (Toc) supplementation on premenstrual symptoms and natriuresis. METHODS We enrolled 51 Japanese women with premenstrual symptoms, particularly those who showed increased symptoms induced by water retention during the luteal phase compared with the follicular phase. Premenstrual symptoms were recorded in the first cycle's postmenstrual follicular phase; physical measurements and urine collection were conducted during the 48-h run-in period. The test supplement, which contained 180 mg of γ-Toc or placebo, was orally administered twice a day for 7 days during the luteal phase of the first and second cycles in a crossover manner. The same evaluation was conducted during the luteal phase, beginning in the morning of the sixth day of supplement administration. RESULTS Compared with placebo intake, γ-Toc intake significantly reduced "fatigue" and "irritability/anger" symptoms. Furthermore, compared with placebo intake, γ-Toc intake significantly reduced the thigh circumference. Regarding the "swelling of the legs" and "heavy legs" symptoms and the thigh circumference, the biphasic trend of increasing and decreasing values in the daytime and morning, respectively, during the follicular phase was not observed at the luteal phase with placebo intake. Contrastingly, γ-Toc intake resulted in significantly lower values in the morning than placebo intake. The mean difference in 24-h urinary sodium excretion between γ-Toc and placebo intake was 10.6 mEq (95% confidence interval (CI): -0.1, 21.4, p = 0.05, power 55%). Plasma γ-Toc and its metabolite γ-carboxyethyl hydroxychroman (CEHC) levels were significantly higher with γ-Toc intake than with placebo intake. There were no significant between-supplement differences in serum electrolyte levels or cumulative urinary potassium excretion. CONCLUSION γ-Toc intake could effectively alleviate certain premenstrual syndrome symptoms, particularly those related to water retention during the luteal phase. Furthermore, the underlying mechanism may involve the diuretic effect of γ-CEHC, which is a γ-Toc metabolite. TRIAL REGISTRATION UMIN000047989; registration date: 10/06/2022, retrospectively registered.
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Affiliation(s)
- Tomoko Higuchi
- Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co., Ltd., 5006-5 Yoshinogari, Kanzaki-Gun, Saga, 842-01, Japan.
| | - Tomomi Ueno
- Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co., Ltd., 5006-5 Yoshinogari, Kanzaki-Gun, Saga, 842-01, Japan
| | - Shigeto Uchiyama
- Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co., Ltd., 5006-5 Yoshinogari, Kanzaki-Gun, Saga, 842-01, Japan
| | - Shunji Matsuki
- Souseikai Sugioka Memorial Hospital (Currently Souseikai Fukuoka Mirai Hospital) Clinical Research Center, Fukuoka, Japan
| | - Mariko Ogawa
- Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kiyoshi Takamatsu
- Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Nabeh OA. New insights on the impact of gut microbiota on premenstrual disorders. Will probiotics solve this mystery? Life Sci 2023; 321:121606. [PMID: 36948390 DOI: 10.1016/j.lfs.2023.121606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
Premenstrual disorders (PMDs) refer to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), where both are characterized by physical and psychological changes occurring in the luteal phase of menstrual cycle. According to the available theories, there is no single accusation succeeded to explain the pathophysiology of PMDs. However, there is emerging evidence for the role of gut microbiota (GM) in PMDs, supported by the diverging impact of GM on our body systems. The direct secretory function of GM and their integration in hormonal, neurotransmitters and bioactive compounds secretion and activity reinforce this speculation. Moreover, the bidirectional relation between GM and steroid hormones and the impact of diet, drugs, and inflammation on both, GM and PMDs incidence and severity justify the need for more studies to determine the actual role of GM in PMDs and the possible potential of probiotics and prebiotics as therapeutic options.
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Affiliation(s)
- Omnia Azmy Nabeh
- Department of Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt; Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
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22
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Yoshimi K, Inoue F, Odai T, Shirato N, Watanabe Z, Otsubo T, Terauchi M, Takeda T. Current status and problems in the diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder from the perspective of obstetricians and gynecologists in Japan. J Obstet Gynaecol Res 2023; 49:1375-1382. [PMID: 36822597 DOI: 10.1111/jog.15618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIM To investigate the current status and problems in the diagnosis and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) from the perspective of obstetricians and gynecologists (OB/GYNs) in Japan, the Japanese Society of Obstetrics and Gynecology (JSOG) conducted a national-wide survey. METHODS An email survey was sent to all JSOG members (16 732) and a web-based survey was conducted using a Google form between September and November 2021. The current status and problems in PMS/PMDD diagnosis and treatment were surveyed in this cross-sectional study. RESULTS In total, 1312 respondents (7.8% of all JSOG members) completed the questionnaire. In terms of diagnoses and treatment, OB/GYN was preferred over psychiatrist for PMS (91.4% vs. 45%); however, no differences were noted for PMDD (76.1% vs. 73.7%). A total of 1267 (96.6%) respondents engaged in routine PMS/PMDD treatment. Regarding the general diagnosis procedure, 84.4% respondents answered "only a vague medical interview," 8.4% kept a two-cycle symptom diary, and 10.3% used a screening questionnaire. The most commonly used medication was oral contraceptive pills (OCPs) (98.1%), followed by the Kampo, traditional Japanese herbal medicines, Kamishoyosan (73.6%). Concerning first-line drugs for treatment, OCPs were the most common (76.8%), followed by Kampo medicine (19.5%); selective serotonin reuptake inhibitors (SSRIs) were less frequently used (2.6%). Regarding first-line drugs among OCPs, 65.1% respondents reported drospirenone-ethinylestradriol use. CONCLUSIONS This study indicates that only a few OB/GYNs practicing PMS/PMDD in Japan use a prospective diary, which is an essential diagnostic criterion for PMS/PMDD. Regarding treatment, SSRIs were used less frequently.
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Affiliation(s)
- Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Fumi Inoue
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Tamami Odai
- Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tempei Otsubo
- Department of Psychiatry, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Terauchi
- Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
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23
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Takeda T. Premenstrual disorders: Premenstrual syndrome and premenstrual dysphoric disorder. J Obstet Gynaecol Res 2023; 49:510-518. [PMID: 36317488 DOI: 10.1111/jog.15484] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 02/10/2023]
Abstract
Recently, the term premenstrual disorders (PMDs), which includes premenstrual syndrome and premenstrual dysphoric disorder as a continuum, has been proposed. Although the precise etiology of PMDs remains unknown, the involvement of hormonal fluctuations is clear. The brain transmitters, serotonin and γ-amino butyric acid, also seem to be involved. Serotonin reuptake inhibitors and oral contraceptives are the current mainstay of treatment, but these are insufficient. Even the currently used prospective two-period symptom diary is not widely used in actual clinical practice, creating a major problem of discrepancy between research and clinical practice. In this review, I would like to outline the latest information and problems in the etiology, diagnosis, and treatment of PMDs, with an emphasis on promising new therapies.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University School of Medicine, Osaka, Japan
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24
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Quaglia C, Nettore IC, Palatucci G, Franchini F, Ungaro P, Colao A, Macchia PE. Association between Dietary Habits and Severity of Symptoms in Premenstrual Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1717. [PMID: 36767083 PMCID: PMC9914022 DOI: 10.3390/ijerph20031717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a set of physical, psychological, and emotional symptoms that occur during the luteal phase of the menstrual cycle. The etiopathogenesis of this condition is not fully understood, and several studies suggest a possible role of environmental factors, such as diet. The aim of this work was to investigate the relationship between dietary habits and the occurrence and severity of PMS. METHODS AND RESULTS Forty-seven women were enrolled in the study. Participants were asked to complete the Daily Record of Severity of Problems (DRSP) to diagnose PMS and to complete a three-day food record during the perimenstrual phase. Thirty women completed the study (16 with PMS and 14 controls). An analysis of the food diaries revealed no differences between the women with PMS and the control subjects in terms of total energy intake (1649 vs. 1570 kcal/day), diet composition, and the consumption of macro- or micronutrients, except for copper, whose consumption was higher in women with PMS than in the control subjects (1.27 ± 0.51 vs. 0.94 ± 0.49 mg/d, p < 0.05). CONCLUSIONS The data presented here are very preliminary, and only a significant difference in copper intake was found when comparing women with PMS and controls. Larger studies are needed to better define how diet may contribute to the exacerbation of the psychological and somatic symptoms associated with PMS and whether PMS itself may influence macro- or micronutrient intake by changing dietary habits.
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Affiliation(s)
- Cinzia Quaglia
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Immacolata Cristina Nettore
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Giuseppe Palatucci
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Fabiana Franchini
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Paola Ungaro
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale (IEOS) “Gaetano Salvatore”, Consiglio Nazionale delle Ricerche, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Paolo Emidio Macchia
- Dipartimento di Medicina Clinica e Chirurgia, Scuola di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
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Hromatko I, Mikac U. A Mid-Cycle Rise in Positive and Drop in Negative Moods among Healthy Young Women: A Pilot Study. Brain Sci 2023; 13:105. [PMID: 36672085 PMCID: PMC9856962 DOI: 10.3390/brainsci13010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Clinically oriented studies of mood as a function of the menstrual cycle mainly address the negative moods in the premenstrual phase of the cycle. However, a periovulatory increase in positive emotions and motivations related to reproduction has also been noted. Thus, it has been suggested that the drop in mood during the luteal phase of the menstrual cycle might be a byproduct of elevated positive moods occurring mid-cycle. The aim of this prospective study was to compare both the positive and negative dimensions of mood across the menstrual cycle. A group of 60 healthy, normally cycling women assessed their mood throughout three phases of their menstrual cycles: the early follicular (low estradiol and progesterone), the late follicular (fertile phase; high estradiol, low progesterone) and the mid-luteal phase (high levels of both estradiol and progesterone). Repeated MANOVA evaluations showed a significant increase in positive (friendly, cheerful, focused, active) and a significant decrease in negative (anxious, depressed, fatigued, hostile) dimensions of mood mid-cycle, i.e., during the late follicular phase (η2 = 0.072−0.174, p < 0.05). Contrary to the widespread belief that negative moods are characteristic of the luteal phase (preceding the onset of the next cycle), the post hoc Bonferroni tests showed that none of the mood dimensions differed between the mid-luteal and early follicular phases of the cycle. The results held when controlling for relationship status and order of testing. This pattern of fluctuations is in accordance with the ovulatory-shift hypothesis, i.e., the notion that the emotions of attraction rise during a short window during which the conception is likely.
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Affiliation(s)
- Ivana Hromatko
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, 10000 Zagreb, Croatia
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Takeda T, Yoshimi K, Kai S, Inoue F. Association Between Loneliness, Premenstrual Symptoms, and Other Factors During the COVID-19 Pandemic: A Cross-Sectional Study with Japanese High School Students. Int J Womens Health 2023; 15:655-664. [PMID: 37131359 PMCID: PMC10149082 DOI: 10.2147/ijwh.s400818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/08/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose Adolescence is a period of transition from childhood to adulthood where people are vulnerable to stress. The COVID-19 pandemic continues to cause sustained stress in the population. Since the COVID-19 pandemic, social isolation and loneliness have increased. Loneliness is associated with increased stress, psychological distress, and a higher risk of mental illnesses, such as depression. This study examined the association between loneliness, premenstrual symptoms, and other factors in the era of the COVID-19 pandemic among adolescent females in Japan. Patients and Methods A school-based cross-sectional survey of 1450 adolescent female students in Japan was conducted in mid-December of 2021. Specifically, paper-based questionnaires were distributed in class, and the responses were collected. The Premenstrual Symptoms Questionnaire (PSQ), 6-item Kessler Psychological Distress Scale, 3-item Revised UCLA Loneliness Scale (R-UCLA), and Fear of COVID-19 Scale were used as measurement tools. The prevalence of loneliness was defined as a total R-UCLA score ≥ 6. Results The prevalence of loneliness was 29.0%. The prevalence of serious psychological distress was also high (8.2%), especially in the lonely group (16.0%). Multivariable regression analysis identified the following factors associated with loneliness: second year (odds ratio [OR] 1.53; 95% confidence interval [CI] 1.09-2.14), longer internet use (OR, 1.11; 95% CI, 1.02-1.20), total PSQ score (OR 1.08; 95% CI 1.06-1.11), and psychological distress (OR 1.05; 95% CI 1.01-1.08). Conclusion Adolescent females in Japan showed a high prevalence of loneliness. School year (2nd year), longer periods of internet use, premenstrual symptom severity, and psychological distress were independently associated with loneliness. For clinicians and school health professionals, special concern should be given to the psychological health of adolescent females during the COVID-19 pandemic.
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Affiliation(s)
- Takashi Takeda
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
- Correspondence: Takashi Takeda, Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan, Tel +81-72-366-0221 (Ext. 3393), Fax +81-72-366-6661, Email
| | - Kana Yoshimi
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Sayaka Kai
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Fumi Inoue
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
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27
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Dinh Trieu Ngo V, Bui LP, Hoang LB, Tran MTT, Nguyen HVQ, Tran LM, Pham TT. Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study. PLoS One 2023; 18:e0278702. [PMID: 36701282 PMCID: PMC9879477 DOI: 10.1371/journal.pone.0278702] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/20/2022] [Indexed: 01/27/2023] Open
Abstract
AIM The study aimed to determine potential risk factors associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder. METHODS Three hundred two female student participants who were 18-45 years old completed a questionnaire including demographic characteristics, lifestyle factors, and a Vietnamese Premenstrual Syndrome Screening Tool. We then followed up participants during at least two menstrual cycles using the Daily Record of Severity of Problems. The Premenstrual Syndrome and Premenstrual Dysphoric Disorder diagnosis was established using The Carolina Premenstrual Assessment Scoring System, based on the American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders. RESULTS According to the Carolina Premenstrual Assessment Scoring System, 35 out of 302 students (11.6%; 95%CI: 8.2-15.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). We found that age at menarche (PR = 0.77, 95%CI: 0.63-0.96), having negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having Premenstrual Syndrome or Premenstrual Dysphoric Disorder after adjusting for other variables. CONCLUSION The prominent risk factors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression.
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Affiliation(s)
- Vy Dinh Trieu Ngo
- Tam Anh TP. Ho Chi Minh General Hospital, Ho Chi Minh, Vietnam
- * E-mail: ,
| | - Linh Phuong Bui
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Research Advancement Consortium in Health, Hanoi, Vietnam
| | - Long Bao Hoang
- Research Advancement Consortium in Health, Hanoi, Vietnam
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - My Thi Tra Tran
- Department of Psychiatry, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Huy Vu Quoc Nguyen
- Department of Obstetrics and Gynaecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Linh Manh Tran
- Department of Obstetrics and Gynaecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Tung Thanh Pham
- Research Advancement Consortium in Health, Hanoi, Vietnam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Physiology, Hanoi Medical University, Hanoi, Vietnam
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Carlini SV, Lanza di Scalea T, McNally ST, Lester J, Deligiannidis KM. Management of Premenstrual Dysphoric Disorder: A Scoping Review. Int J Womens Health 2022; 14:1783-1801. [PMID: 36575726 PMCID: PMC9790166 DOI: 10.2147/ijwh.s297062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account.
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Affiliation(s)
- Sara V Carlini
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Teresa Lanza di Scalea
- Departments of Psychiatry & Behavioral Sciences and Women’s Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Janice Lester
- Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Kristina M Deligiannidis
- Departments of Psychiatry, Molecular Medicine, and Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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AlQuaiz A, Albugami M, Kazi A, Alshobaili F, Habib F, Gold EB. Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms. Int J Womens Health 2022; 14:1709-1722. [PMID: 36561605 PMCID: PMC9766474 DOI: 10.2147/ijwh.s387259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To measure the associations of diet, psycological distress, and lifestyle factors with premenstrual symptoms (PMSx) in women in Riyadh, Saudi Arabia. Patients and Methods An interview-based, cross-sectional study was conducted on 1831 women aged 18-50 years seen in primary healthcare centers and teaching institutes in Riyadh from December 2015 to June 2016. Question topics included sociodemographics, physical activity, smoking, and dietary habits information. PMSx were assessed using a symptom checklist with 6 domains: anxiety/mood changes; abdominal/back/joint pain; increased appetite/weight gain, breast pain/tenderness, severe headache, and ≥3 PMS symptoms (any). Multivariable logistic regression analyses were conducted to provide adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each PMSx domain. Results Except for breast pain, drinking >5 cups of Arabic coffee was associated with increased odds of anxiety/mood [aOR 2.44 (95% CI 1.44, 4.12)], pain [1.83 (1.13, 2.98)], appetite/weight gain [1.66 (1.10, 2.50)], headache [1.57 (1.00, 2.56)] and ≥3 symptoms [1.50 (1.07, 2.11)]. A significant association was noted between sugar intake and anxiety/mood symptoms [1.53 (1.07, 2.19)] and abdominal/back pain symptoms [1.84 (1.17, 2.88)]. Increased severity of psychological distress was associated with all symptom domains: anxiety/mood [2.75 (1.92, 3.94)]; pain [1.45 (0.92, 2.28)]; appetite/weight gain [2.01 (1.53, 2.65)]; breast pain [2.19 (1.68, 2.88)]; headache [1.86 (1.37, 2.54)] and ≥3 symptoms [3.52 (2.49, 4.95)]. Low physical activity was significantly associated with odds of breast pain symptoms [1.29 (1.04, 1.59)]. Smokers were 3.41 (1.19, 9.77) times as likely to report any ≥3 symptoms compared to nonsmokers. Conclusion Several potentially modifiable factors, such as diet and stress, were positively associated with PMSx. Thus, we suggest that increasing women's awareness of healthy lifestyles, particularly diet and stress reduction, may help to reduce the occurrence of premenstrual symptoms.
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Affiliation(s)
- AlJohara AlQuaiz
- Princess Nora Bent Abdullah Chair for Women’s Health Research, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Family & Community Medicine, King Saud University Medical city, Riyadh, Saudi Arabia
| | - Muneerah Albugami
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ambreen Kazi
- Princess Nora Bent Abdullah Chair for Women’s Health Research, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Family & Community Medicine, King Saud University Medical city, Riyadh, Saudi Arabia
| | - Fahdah Alshobaili
- Department of Family & Community Medicine, King Saud University Medical city, Riyadh, Saudi Arabia
| | - Fawzia Habib
- Princess Nora Bent Abdullah Chair for Women’s Health Research, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Gynecology & Obstetrics, Taibah University, Madinah al Munawara, Saudi Arabia
| | - Ellen B Gold
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
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Takeda T, Yoshimi K, Kai S, Inoue F. Development and Psychometric Testing of a New Short-Form of the Premenstrual Symptoms Questionnaire (PSQ-S). Int J Womens Health 2022; 14:899-911. [PMID: 35860717 PMCID: PMC9292817 DOI: 10.2147/ijwh.s369151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The Premenstrual Symptoms Questionnaire (PSQ) is a patient-reported outcome measurement tool for premenstrual symptoms. Although the PSQ is a very useful tool with 14 items to screen for a wide variety of premenstrual symptoms, not everyone will respond to all the questions. Fewer questions would be less burdensome on the respondents. We aimed to develop and analyze the psychometric properties of a short-form of the PSQ (PSQ-S). Patients and Methods The study participants were from an earlier study with a sample of 1388 female students. We reanalyzed data collected from 922 students with regular menstrual cycles who completed the PSQ, premenstrual dysphoric disorder (PMDD) scale, Somatic Symptom Scale-8 (SSS-8), and numerical rating scale (NRS) for menstrual pain. First, we selected nine items for the PSQ-S based on the results of the corrected item-total correlation analysis. The PSQ-S was then analyzed for reliability and validity using the classical test theory. Moreover, item response theory was applied to test the psychometric properties of the PSQ-S. Results Cronbach's α for the PSQ-S score was 0.93. Principal component factor analysis revealed a one-factor model. Confirmatory factor analysis showed that the one-factor model was a good fit. The PSQ-S total score was strongly correlated with the PSQ total score, PMDD scale score, and SSS-8 score (r=0.978, 0.854, and 0.648, respectively) and moderately correlated with the NRS (r=0.437). Item response theory analyses showed that the constructs and items of the PSQ-S had satisfactory discrimination, difficulty parameters, item information curves, and test information curves. Receiver operating characteristic curve analysis revealed a cut-off score of ≥22 for suspected premenstrual disorders based on the total PSQ-S score. Conclusion The PSQ-S, consisting of nine items from the PSQ, had sufficient reliability and validity and could be a convenient assessment tool for premenstrual symptoms in routine clinical practice.
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Affiliation(s)
- Takashi Takeda
- Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Japan
| | - Kana Yoshimi
- Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Japan
| | - Sayaka Kai
- Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Japan
| | - Fumi Inoue
- Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Japan
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Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study. PLoS One 2022; 17:e0268466. [PMID: 35622782 PMCID: PMC9140228 DOI: 10.1371/journal.pone.0268466] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/29/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Premenstrual symptoms can negatively impact the quality of life of women through a range of mood, behavioral, and physical symptoms. The association between the microbiota and brain function has been extensively studied. Here, we examined the characteristics of the microbiota in women with premenstrual disorders (PMDs) and the association between premenstrual symptoms and the microbiota. Materials and methods In this single center cross-sectional pilot study, we recruited 27 women reporting premenstrual symptoms and 29 women with no serious premenstrual symptoms. Among them, we further selected 21 women experiencing premenstrual symptoms resulting in interference to their social life (PMDs group) and 22 women with no serious premenstrual symptoms and thereby no interference to their social life (control group). The severity of symptoms was evaluated by a premenstrual symptoms questionnaire (PSQ). Inflammatory markers were analyzed in blood samples, including C reactive protein, soluble CD14, and lipopolysaccharide binding protein. Sequencing of 16S ribosomal ribonucleic acid genes was performed on stool samples. Results Inflammatory markers in blood samples did not differ significantly between the PMDs and control groups. A difference in beta, but not alpha diversity, was detected for the gut microbiotas of the PMDs and control groups. The relative abundance of the Bacteroidetes phylum was lower in the PMDs group. At the genus level, the prevalence was decreased for Butyricicoccus, Extibacter, Megasphaera, and Parabacteroides and increased for Anaerotaenia in the PMDs group, but after false discovery rate correction, these differences were no longer significant. Linear discriminant effect size analysis revealed a decrease in Extibacter, Butyricicoccus, Megasphaera, and Parabacteroides and an increase in Anaerotaenia in the PMDs group. The PSQ total score correlated with Anaerotaenia, Extibacter, and Parabacteroides. Multiple regression analysis showed that Parabacteroides and Megasphaera negatively predicted the PSQ total score. Conclusion The properties of the gut microbiota are associated with premenstrual symptoms.
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Itriyeva K. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Probl Pediatr Adolesc Health Care 2022; 52:101187. [PMID: 35534402 DOI: 10.1016/j.cppeds.2022.101187] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) represent two premenstrual disorders characterized by physical and psychological symptoms that occur in the luteal phase of the menstrual cycle, prior to the onset of menses, and have a negative impact on the psychosocial functioning of affected individuals. PMS, more common than PMDD, affects 20-40% of menstruating women, with common symptoms including fatigue, irritability, mood swings, depression, abdominal bloating, breast tenderness, acne, changes in appetite and food cravings. PMDD, affecting a smaller percentage of women, is characterized by more severe symptoms and is listed as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While the pathophysiology of these premenstrual disorders remains unclear, it has been hypothesized that sensitivity to hormonal fluctuations during the luteal phase of the menstrual cycle, abnormal serotonergic activity, and aberrations in progesterone and the neurotransmitter gamma aminobutyric acid (GABA) may all play a role in these disorders. Treatment of PMS and PMDD is focused on alleviation of symptoms and improvement of functioning and quality of life for affected individuals. The treatment of severe PMS and PMDD typically requires pharmacologic therapy with selective serotonin reuptake inhibitors (SSRIs), oral contraceptive pills (OCPs), gonadotropin-releasing hormone (GnRH) agonists, and non-contraceptive estrogen formulations. Non-pharmacologic treatment with diet, exercise, cognitive behavioral therapy (CBT), certain vitamin and herbal supplements, and acupuncture may additionally be effective for some individuals.
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Affiliation(s)
- Khalida Itriyeva
- Division of Adolescent Medicine, Cohen Children's Medical Center Northwell Health, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra / Northwell, Hempstead, NY, United States.
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Frey BN, Allega OR, Eltayebani M, Syan SK, Mendes-Ribeiro J, Minuzzi L. A DSM-5-based tool to monitor concurrent mood and premenstrual symptoms: the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS). BMC Womens Health 2022; 22:96. [PMID: 35354450 PMCID: PMC8969316 DOI: 10.1186/s12905-022-01678-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite high co-morbidity between premenstrual dysphoric disorder and mood disorders, there is a gap of research-based tools to monitor concurrent premenstrual and mood symptoms. In this study, we developed a new DSM-5-based questionnaire to prospectively monitor concurrent premenstrual and mood symptoms.
Methods Fifty-two females with bipolar or major depressive disorder, ages 16–45, were enrolled in the study. Participants completed two months of prospective symptom charting including the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS) and the Daily Record of Severity of Problems (DRSP). At the end of the prospective charting, participants also completed the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). The MAC-PMSS was correlated with the DRSP, MADRS, HDRS and YMRS. Results All individual items of the MAC-PMSS correlated strongly with the individual DRSP scores (all p < 0.001). The mood section of the MAC-PMSS also significantly correlated with MADRS (r = 0.572; p < 0.01), HDRS (r = 0.555; p < 0.01) and YMRS scores (r = 0.456; p < 0.01). Conclusions The MAC-PMSS is a reliable to tool to measure concurrent mood and premenstrual symptoms in women with mood disorders.
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Affiliation(s)
- Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Olivia R Allega
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Maha Eltayebani
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sabrina K Syan
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Jeronimo Mendes-Ribeiro
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Rezende APR, Alvarenga FR, Ramos M, Franken DL, Dias da Costa JS, Pattussi MP, Paniz VMV. Prevalence of Premenstrual Syndrome and Associated Factors Among Academics of a University in Midwest Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:133-141. [PMID: 35213911 PMCID: PMC9948150 DOI: 10.1055/s-0041-1741456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities. METHODS This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression. RESULTS The prevalence of PMS was 46.9% (95% confidence interval [CI] 44.0-49.8), and of PMDD, 11.1% (95% CI 9.3-13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-to-severe way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1st/2nd semester of college (prevalence ratio [PR] 1.44; 95% CI 1.14-1.80), those who consumed alcohol in the last 30 days (PR 1.23; 95% CI 1.04-1.47), and those who had depression (PR 1.49; 95% CI 1.30-1.71). CONCLUSION Almost half of the university students had PMS and ∼ 11%, PMDD. Physical symptoms were the most common and interfered in a moderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome.
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Affiliation(s)
| | | | - Marcelo Ramos
- Faculdade de Medicina, Universidade de Rio Verde, Goianésia, GO, Brazil
| | - Débora Luiza Franken
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | | | - Marcos Pascoal Pattussi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Vera Maria Vieira Paniz
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
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Bortolato M, Coffey BJ, Gabbay V, Scheggi S. Allopregnanolone: The missing link to explain the effects of stress on tic exacerbation? J Neuroendocrinol 2022; 34:e13022. [PMID: 34423500 PMCID: PMC8800948 DOI: 10.1111/jne.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
The neurosteroid allopregnanolone (3α-hydroxy-5α-pregnan-20-one; AP) elicits pleiotropic effects in the central nervous system, ranging from neuroprotective and anti-inflammatory functions to the regulation of mood and emotional responses. Several lines of research show that the brain rapidly produces AP in response to acute stress to reduce the allostatic load and enhance coping. These effects not only are likely mediated by GABAA receptor activation but also result from the contributions of other mechanisms, such as the stimulation of membrane progesterone receptors. In keeping with this evidence, AP has been shown to exert rapid, potent antidepressant properties and has been recently approved for the therapy of moderate-to-severe postpartum depression. In addition to depression, emerging evidence points to the potential of AP as a therapy for other neuropsychiatric disorders, including anxiety, seizures, post-traumatic stress disorder and cognitive problems. Although this evidence has spurred interest in further therapeutic applications of AP, some investigations suggest that this neurosteroid may also be associated with adverse events in specific disorders. For example, our group has recently documented that AP increases tic-like manifestations in several animal models of tic disorders; furthermore, our results indicate that inhibiting AP synthesis and signalling reduces the exacerbation of tic severity associated with acute stress. Although the specific mechanisms of these effects remain partially elusive, our findings point to the possibility that the GABAergic activation by AP may also lead to disinhibitory effects, which could interfere with the ability of patients to suppress their tics. Future studies will be necessary to verify whether these mechanisms may apply to other externalising manifestations, such as impulse-control problems and manic symptoms.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and ToxicologyCollege of PharmacyUniversity of UtahSalt Lake CityUTUSA
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
| | - Barbara J. Coffey
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral ScienceMiller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Vilma Gabbay
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNYUSA
| | - Simona Scheggi
- Department of Molecular and Developmental MedicineSchool of MedicineUniversity of SienaSienaItaly
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Effect of Garlic ( Allium sativum) Supplementation on Premenstrual Disorders: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9965064. [PMID: 34760020 PMCID: PMC8575623 DOI: 10.1155/2021/9965064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
Background Premenstrual disorders involve physical, behavioral, and mood variations that affect women of childbearing age and interfere with family relationships, household responsibilities, professional duties, and social activities. Objectives Considering the side effects of conventional medications, their use is not recommended except in severe cases of premenstrual disorders. Nowadays, there is a tendency to use traditional and complementary medicine that offers various treatments. The purpose of the current study was to investigate the impacts of garlic as a herbal medicine on the severity of premenstrual symptoms. Methods This study was a double-blind, randomized, controlled trial. After identification of participants with moderate-to-severe PMS through the premenstrual symptoms screening tools questionnaire (PSST), they were randomly assigned to placebo (n = 64) or garlic (n = 65) groups. Each participant received one tablet daily for three consecutive cycles and logged the severity of their symptoms in the PSST questionnaire during the intervention period. Results There was no significant difference between the two groups in the baseline level of premenstrual symptoms before the intervention. After treatment with garlic for three consecutive cycles, the total score of the severity of premenstrual symptoms significantly (P < 0.001) reduced from 34.09 ± 7.31 to 11.21 ± 7.17. In the placebo group, this score changed from 33.35 ± 7.96 to 24.28 ± 7.22. The difference between mean changes in the two groups was 13.78, with a 95% Confidence Interval (CI) of 11.23–16.33. No serious side effects were observed in either group. Conclusion Our findings highlight the potential effect of garlic in reducing the severity of premenstrual symptoms; therefore, the use of garlic can be considered as an alternative therapy in the prevention and treatment of premenstrual disorders.
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Bäckström T, Ekberg K, Hirschberg AL, Bixo M, Epperson CN, Briggs P, Panay N, O'Brien S. A randomized, double-blind study on efficacy and safety of sepranolone in premenstrual dysphoric disorder. Psychoneuroendocrinology 2021; 133:105426. [PMID: 34597899 DOI: 10.1016/j.psyneuen.2021.105426] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/11/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Women with premenstrual dysphoric disorder (PMDD) experience mood symptoms related to the increase in progesterone and the neuroactive steroid allopregnanolone. Our hypothesis is that allopregnanolone is the symptom provoking factor. The rationale for the present study was to treat PMDD patients with the GABAA receptor modulating steroid antagonist, sepranolone (isoallopregnanolone). Patients (n = 206) with PMDD from 12 European centers were randomized in a parallel double-blind study and treated with placebo, sepranolone 10 mg and 16 mg. Patients administered sepranolone subcutaneously every 48 h during the 14 premenstrual days of three consecutive menstrual cycles. After obtaining informed consent, the PMDD diagnosis was confirmed according to DSM-5 and verified with two menstrual cycles of daily symptom ratings using the Daily Record of Severity of Problems (DRSP) scale in an eDiary. Inclusion and exclusion criteria stipulated that the women should be essentially healthy, not pregnant, have no ongoing psychiatric disorder or take interfering medications, and have regular menstrual cycles. The study's primary endpoint was the Total symptom score (Sum21, the score for all 21 symptom questions in the DRSP). In the prespecified statistical analysis the average score of the 5 worst premenstrual days in treatment cycles 2 and 3 were subtracted from the corresponding average score in the two diagnostic cycles. The treatment effects were tested using analysis of variance in a hierarchal order starting with the combined active sepranolone treatments vs. placebo. The prespecified analysis of Sum21 showed a large treatment effect of all three treatments but no statistically significant difference to placebo. However, the ratings of distress showed a significant treatment effect of sepranolone compared to placebo (p = 0.037) and the ratings of impairment showed a trend to greater treatment effect of sepranolone compared to placebo. Many women with PMDD had symptoms during a longer period than the late luteal phase. It has previously been shown that 9 premenstrual days may be more representative for comparison of PMDD symptom periods than the 5 worst premenstrual days. A post hoc analysis was undertaken in the per protocol population investigating the treatment effect during 9 premenstrual days in the third treatment cycle. The Sum21 results of this analysis showed that the sepranolone 10 mg was significantly better than placebo (p = 0.008). Similar significant treatment effects were found for the impairment and distress scores. A significantly larger number of individuals experienced no or minimal symptoms (Sum21 <42 points) with the 10 mg sepranolone treatment compared to placebo (p = 0.020). The results indicate that there is an attenuating effect by sepranolone on symptoms, impairment, and distress in women with PMDD especially by the 10 mg dosage. Sepranolone was well tolerated, and no safety concerns were identified.
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Affiliation(s)
- Torbjörn Bäckström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Sweden.
| | - Karin Ekberg
- Asarina Pharma AB Clinical Research & Development c/o COBIS, Ole Maaloes Vej 3, 2200 Kobenhavn N, Denmark
| | | | - Marie Bixo
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Sweden
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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van Casteren DS, Verhagen IE, van der Arend BWH, van Zwet EW, MaassenVanDenBrink A, Terwindt GM. Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary. Neurology 2021; 97:e1661-e1671. [PMID: 34493613 PMCID: PMC8605615 DOI: 10.1212/wnl.0000000000012723] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/05/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Endogenous and exogenous female sex hormones are considered important contributors to migraine pathophysiology. Previous studies have cautiously suggested that perimenstrual migraine attacks have a longer duration and are associated with higher disability compared to nonperimenstrual attacks, but they showed conflicting results on acute therapy efficacy, pain intensity, and associated symptoms. We compared perimenstrual and nonperimenstrual migraine attack characteristics and assessed premenstrual syndrome (PMS) in women with migraine. METHODS Women with migraine were invited to complete a headache e-diary. Characteristics of perimenstrual attacks and nonperimenstrual attacks were compared. The primary outcome was attack duration. Secondary outcomes were headache intensity, accompanying symptoms, acute medication intake, and pain coping. Mixed effects models were used to account for multiple attacks within patients. PMS was assessed in patients without hormonal contraceptives. Subgroup analyses were performed for women with menstrually related migraine (MRM) and nonmenstrually related migraine (non-MRM) and women with a natural menstrual cycle and women using hormonal contraceptives. RESULTS A representative group of 500 participants completed the e-diary for at least 1 month. Perimenstrual migraine attacks (n = 998) compared with nonperimenstrual attacks (n = 4097) were associated with longer duration (20.0 vs 16.1 hours, 95% confidence interval 0.2-0.4), higher recurrence risk (odds ratio [OR] 2.4 [2.0-2.9]), increased triptan intake (OR 1.2 [1.1-1.4]), higher headache intensity (OR 1.4 [1.2-1.7]), less pain coping (mean difference -0.2 [-0.3 to -0.1]), more pronounced photophobia (OR 1.3 [1.2-1.4]) and phonophobia (OR 1.2 [1.1-1.4]), and less aura (OR 0.8 [0.6-1.0]). In total, 396/500 women completed the diary for ≥3 consecutive menstrual cycles, of whom 56% (221/396) fulfilled MRM criteria. Differences in attack characteristics became more pronounced when focusing on women with MRM and women using hormonal contraceptives. Prevalence of PMS was not different for women with MRM compared to non-MRM (11% vs 15%). DISCUSSION The longer duration of perimenstrual migraine attacks in women (with MRM) is associated with higher recurrence risk and increased triptan use. This may increase the risk of medication overuse and emphasizes the need to develop female-specific prophylactic treatment.
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Affiliation(s)
- Daphne S van Casteren
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Iris E Verhagen
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Britt W H van der Arend
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik W van Zwet
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antoinette MaassenVanDenBrink
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gisela M Terwindt
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications. RECENT FINDINGS Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women.
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Affiliation(s)
- Christine Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Sibel Nayman
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, J5, 68159, Mannheim, Germany
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Takeda T, Kai S, Yoshimi K. Association between Premenstrual Symptoms and Posttraumatic Stress Symptoms by COVID-19: A Cross-Sectional Study with Japanese High School Students. TOHOKU J EXP MED 2021; 255:71-77. [PMID: 34588375 DOI: 10.1620/tjem.255.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
COVID-19 has caused an unprecedented global pandemic. Premenstrual symptoms include mood-related, behavioral, and physical symptoms that are limited to the luteal phase of the menstrual cycle. Psychosocial stress is a risk factor for premenstrual symptoms. The aim of this study was to examine the association between premenstrual symptoms and stress caused by COVID-19. We analyzed data from 871 students with regular menstrual cycles who completed the Premenstrual Symptoms Questionnaire (PSQ), Fear of COVID-19 Scale, and Impact of Event Scale-Revised version (IES-R). The total PSQ score was significantly higher in women with COVID-19-induced posttraumatic stress symptoms (PTSS) than in non-PTSS groups. Compared with pre-pandemic data (2019), the total PSQ score did not change in non-PTSS, but increased in PTSS groups. All symptoms were more severe in PTSS groups than in non-PTSS groups. Compared with 2019, PTSS groups had more severe symptoms for all symptoms except 'physical symptoms' and 'decreased social activity', and non-PTSS groups only exhibited improvements in the 'decreased social activity'. Multiple regression analysis revealed that the IES-R score was a significant exacerbation factor of the total PSQ score, along with age and menstrual pain. This study revealed the association between pandemic-associated PTSS and the severity of premenstrual symptoms.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Sayaka Kai
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
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Yoshimi K, Matsumura N, Takeda T. When and how do adolescent girls in Japan become aware of premenstrual symptoms from menarche? A cross-sectional study among senior high school students. BMJ Open 2021; 11:e045215. [PMID: 34446479 PMCID: PMC8395348 DOI: 10.1136/bmjopen-2020-045215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the interval from menarche to the onset of premenstrual symptoms and its relationship with menarche age. DESIGN Cross-sectional school-based survey. SETTING Urban areas of Sendai, the largest city in northeastern Japan. PARTICIPANTS 1422 female Japanese 10th-12th grade senior high school students participated in the survey. MAIN OUTCOME MEASURES The time of awareness of premenstrual symptoms, and the interval from menarche to the onset of premenstrual symptoms. RESULTS 1290 students had menstruation and completed the whole survey. The median age at menarche was 12 years (IQR: 11-13 years). The prevalence of self-reported premenstrual symptoms was 49%. The median age at which students became aware of premenstrual symptoms was 15 years (IQR: 14-16 years). The median time from the onset of menarche to awareness of premenstrual symptoms was 2 years. This time was negatively correlated with menarche age (ρ=-0.47, p<0.001). A Cox proportional hazards regression analysis revealed that early menarche was significantly associated with a lower cumulative risk of developing premenstrual symptoms (OR: 0.73 (95% CI 0.58 to 0.91)). CONCLUSIONS High school students in Japan began experiencing premenstrual symptoms at around 15 years old, and within 2 years of menarche. This study suggested that social factors other than hormonal factors, such as early menarche, might be associated with the onset of premenstrual symptoms.
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Affiliation(s)
- Kana Yoshimi
- Research Institute of Traditional Asian Medicine, Division of Women's Health, Kindai University Hospital, Osakasayama, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan
| | - Takashi Takeda
- Research Institute of Traditional Asian Medicine, Division of Women's Health, Kindai University Hospital, Osakasayama, Japan
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Zeitoun T, Dehghan Noudeh N, Garcia-Bailo B, El-Sohemy A. Genetics of Iron Metabolism and Premenstrual Symptoms: A Mendelian Randomization Study. J Nutr 2021; 151:1747-1754. [PMID: 33758941 DOI: 10.1093/jn/nxab048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many women of reproductive age experience adverse psychological and physiological premenstrual symptoms. These symptoms may last for most of the reproductive years and can negatively affect the quality of life of many women. Some studies have examined the role of micronutrients in premenstrual symptoms, but the research on iron has been limited. OBJECTIVES The objective of this study was to evaluate the effects of genetic predictors of iron overload and low iron status on premenstrual symptoms using Mendelian randomization. METHODS We examined 254 White females aged 20-29 y from the Toronto Nutrigenomics and Health Study. DNA was isolated from peripheral white blood cells and genotyped for the homeostatic regulatory iron gene (HFE; rs1800562 and rs1799945), transmembrane protease serine 6 (TMPRSS6; rs482026), transferrin receptor 2 (TFR2; rs3811647), and transferrin (TF; rs738584) polymorphisms. Risk of iron overload or low iron status was determined based on combined genotypes. Binomial logistic regressions were carried out to examine the association between genetic risk of iron overload or low iron status and the presence of premenstrual symptoms. RESULTS Compared with participants with typical risk of iron overload, those with an elevated risk of iron overload were less likely to experience premenstrual symptoms of confusion (OR: 0.13; 95% CI: 0.02, 1.00), headaches (OR: 0.28; 95% CI: 0.08, 0.98), and nausea (OR: 0.13; 95% CI: 0.02, 0.99) after adjusting for BMI, age, and vitamin C and calcium intake. No associations were seen with the other symptoms. There were also no associations between low iron status genotypes and premenstrual symptoms. CONCLUSIONS This Mendelian randomization study demonstrates that women with an elevated risk of iron overload may have a lower risk of experiencing some premenstrual symptoms (headache, confusion, and nausea), suggesting that iron status could impact the risk of certain premenstrual symptoms.
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Affiliation(s)
- Tara Zeitoun
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Negar Dehghan Noudeh
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bibiana Garcia-Bailo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Dilbaz B, Aksan A. Premenstrual syndrome, a common but underrated entity: review of the clinical literature. J Turk Ger Gynecol Assoc 2021; 22:139-148. [PMID: 33663193 PMCID: PMC8187976 DOI: 10.4274/jtgga.galenos.2021.2020.0133] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are characterized by somatic and psychologic symptoms that arise at the luteal phase of the menstrual cycle and subside with menstruation. For definitive diagnosis prospectively self-reported symptoms should demonstrate a cyclic pattern and other psychological pathologies and thyroid dysfunction, that may present with similar symptoms, should be excluded. Both entities affect millions of women at reproductive age as the prevalence of PMS is given as 10-98% while PMDD affects 2-8%. Sex steroids and neurotransmitters have a central role in the etiology. The role of vitamins and minerals in the etiology and treatment of PMS and PMDD is open to discussion. Drugs that suppress ovarian sex steroid production, such as combined oral contraceptives or selective serotonin re-uptake inhibitors enhancing central serotonin delivery are used for treatment. Life-style changes and regular exercise also have a positive effect in milder cases. Tricyclic antidepressants and gonadotropin-releasing hormone analogues can be used in selected cases.
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Affiliation(s)
- Berna Dilbaz
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health and Research Center, Ankara, Turkey
| | - Alperen Aksan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health and Research Center, Ankara, Turkey
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Bilir F, Akdemir R, Bilir C. Some, but not all of the premenstrual syndrome symptoms affect the medical exam scores in medical students. Pak J Med Sci 2021; 37:1190-1195. [PMID: 34290806 PMCID: PMC8281196 DOI: 10.12669/pjms.37.4.3931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: This research aims to identify the effects of premenstrual syndrome (PMS) symptoms on the school exam scores in medical students. Methods: This cross-sectional study was designed at Sakarya University School of Medicine The study included medical students who were in the first, second, and third year of class. In this study, there were 193 male and 100 female students. The study investigated how PMS symptoms affected medical student’s exam scores and school success. All exam scores were recorded during the two-consecutive semester so duration of study was one year Results: There were 100 female students, and they had five different committee exams for one year. Female student’s exam scores were significantly higher for four committees and an average score of all year. The mean age of female students was 19.9 ±1.5. Acne, nausea/vomiting, sleeping, abdominal bloating, and prurience change had significantly different exam scores compared to the group without these symptoms. Students with acne had substantially higher exam scores than without acne; inversely, the other four symptoms negatively affected exam scores. Conclusion: Some of the PMS symptoms can be more annoying and should change the quality of life more than the other symptoms, so we should define these symptoms to improve our student’s quality of life and school success.
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Affiliation(s)
- Filiz Bilir
- Filiz Bilir, Department of Medical Education, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ramazan Akdemir
- Ramazan Akdemir, Department of Cardiology and Medical Education, Sakarya University School of Medicine, Sakarya, Turkey
| | - Cemil Bilir
- Cemil Bilir, Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
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Park S, Yoon TW, Kang DR, Chung C. [Prevalence of Menstrual Disorders according to Body Mass Index and Lifestyle Factors: The National Health Insurance Service-National Health Screening Cohort in Korea, 2009~2016]. J Korean Acad Nurs 2021; 50:401-410. [PMID: 32632073 DOI: 10.4040/jkan.20054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was performed to identify the prevalence of menstrual disorders in Korean women based on body mass index (BMI) and lifestyle factors, by utilizing the Korean National Health Insurance Database. METHODS A retrospective observational study design was used for the secondary data analysis. Data of women aged 15 to 49 years who were diagnosed with menstrual disorders were extracted from The National Health Insurance Service-National Health Screening Cohort in Korea from 2009 to 2016. The age-standardized prevalence rate of menstrual disorders was calculated using SAS version 9.4, and a Chi-square test and Cochran-Armitage test were performed. RESULTS In total, 2,219,445 cases were extracted from the database. The prevalence of menstrual disorders significantly increased from 8.6% to 11.6% (Z=135.16, p for trend <.001) over the past eight years. In particular, it was higher in underweight women than in women with normal weight across all years (Z=-4.18~-14.72, p<.001). Moreover, statistically significant differences in the prevalence of menstrual disorders were found to be associated with drinking and smoking in all years and with physical activity levels in part (p<.05~.001). CONCLUSION These findings present compelling evidence on the prevalence of menstrual disorders based on a national database. Since the prevalence of menstrual disorders has steadily increased and differs based on BMI and lifestyle factors, educational and clinical interventions are necessary to promote risk awareness and appropriate behavioral changes among Korean women.
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Affiliation(s)
- SoMi Park
- Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Tae Woong Yoon
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - ChaeWeon Chung
- College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
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Granda D, Szmidt MK, Kaluza J. Is Premenstrual Syndrome Associated with Inflammation, Oxidative Stress and Antioxidant Status? A Systematic Review of Case-Control and Cross-Sectional Studies. Antioxidants (Basel) 2021; 10:antiox10040604. [PMID: 33919885 PMCID: PMC8070917 DOI: 10.3390/antiox10040604] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Premenstrual syndrome (PMS) is a cyclically occurring combination of various symptoms, leading to decreased life quality among approximately 30% of women of childbearing age. PMS etiology remains unknown; however, there are some suggestions that inappropriate inflammatory response and oxidative stress are involved. This study aimed to systematically review case–control and cross-sectional studies investigating inflammation markers, oxidative stress, and antioxidant status among women with PMS and controls. The study protocol was registered with PROSPERO (no. CRD42020178545), and the authors followed the guidelines for performing a systemic review recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). By searching PubMed and Scopus databases (up to 8 January 2021), six case–control studies and five cross-sectional studies of medium or high quality were classified to the review. The systematic review included 652 women with PMS and 678 controls, for whom 36 eligible markers were determined. Limited evidence indicates increased levels of inflammatory parameters and suggests decreased antioxidant status in PMS women. Insufficient data with inconsistent results made it impossible to formulate a firm conclusion on the contribution of oxidative stress in PMS occurrence. To acknowledge the role of inflammation, oxidative stress, and antioxidant status in the pathophysiology of PMS, further research with case–control design and large study groups is needed.
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Takeda T, Kai S, Yoshimi K. Psychometric Testing of the Japanese Version of the Daily Record of Severity of Problems Among Japanese Women. Int J Womens Health 2021; 13:361-367. [PMID: 33833588 PMCID: PMC8020050 DOI: 10.2147/ijwh.s301260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The Daily Record of Severity of Problems (DRSP) is commonly used to assess premenstrual syndrome and premenstrual dysphoric disorder throughout the world. The aim of this study was to assess the validity and reliability of the Japanese version of the DRSP (DRSP-J). MATERIALS AND METHODS We analyzed 324 women with regular menstrual cycles who completed the DRSP-J and the Premenstrual Symptoms Questionnaire (PSQ). They had all applied to participate in an ongoing study for the treatment of their premenstrual symptoms. The DRSP-J was examined for evidence of reliability and validity. To examine reliability, we assessed Cronbach's α, a measure of internal consistency, and test-retest reliability. We assessed structural validity with principal component factor analysis (PCA) and confirmatory factor analysis (CFA). We used PSQ total score to examine concurrent validity. RESULTS Cronbach's α for DRSP total score was 0.97. DRSP total score and individual items showed high test-retest reliability. PCA showed a two-factor model describing mood and behavioral and physical symptoms. CFA showed that the two-factor model derived from the PCA was an acceptably good fit. DRSP total score correlated moderately with PSQ total score (r = 0.42). CONCLUSION The DRSP-J showed reliable and valid measures of premenstrual symptoms in Japanese women.
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Affiliation(s)
- Takashi Takeda
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Sayaka Kai
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kana Yoshimi
- Division of Women’s Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka-Sayama, Osaka, 589-8511, Japan
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Frankel RA, Michels KA, Kim K, Kuhr DL, Omosigho UR, Wactawski-Wende J, Levine L, Perkins NJ, Mumford SL. Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective cohort study. BMC WOMENS HEALTH 2021; 21:49. [PMID: 33530988 PMCID: PMC7851915 DOI: 10.1186/s12905-021-01187-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Background It has been suggested that premenstrual syndrome (PMS) may derive from either elevated oxidative stress or reduced antioxidant vitamin levels in the body; however, these relationships have been minimally studied in a large cohort of healthy women. Our objective was to estimate the association between serum concentrations of antioxidant vitamins (A, C, and E) and markers of oxidative stress (F2-isoprostane) with symptoms and severity of PMS. Methods The BioCycle study was a prospective cohort study following 259 healthy premenopausal women aged 18–44 years for up to 2 menstrual cycles. Frequency/severity of 20 PMS symptoms were assessed via questionnaires 4 times/cycle, and antioxidant vitamins and oxidative stress biomarkers were measured up to 8 times/cycle to correspond with specific cycle phases. Generalized linear models were used to estimate associations between mean antioxidant concentrations and oxidative stress biomarkers with PMS symptoms and severity; linear mixed models were used to evaluate associations with symptom severity scores within groups (e.g. depression, cravings, pain). Results Higher concentrations of serum antioxidant vitamins were largely not associated with prevalence or severity of PMS symptoms. Though a few associations were observed, only associations between mean γ-tocopherol and decreased odds of swelling of the hands/feet survived adjustment for multiple comparisons (OR 0.33, 95% CI 0.16, 0.65, per ug/dL). However, F2-isoprostanes were associated with prevalence and severity of several symptoms specifically related to depression and cravings (depression score β = 0.07, 95% CI 0.02, 0.12, per 10 ug/dL; cravings score β = 0.16, 95% CI 0.10, 0.22, per 10 ug/dL), as well as with classification of PMS severity (OR 1.07, 95% CI 1.01, 1.14, per 10 pg/dL), with these associations surviving adjustment for false discovery rate. Conclusions F2-isoprostanes, but not antioxidant vitamins, were associated with select PMS symptoms, as well as symptom and severity categories. Specific symptom relationships merit further research.
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Affiliation(s)
- Robyn A Frankel
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Kara A Michels
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Keewan Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Daniel L Kuhr
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA.,Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ukpebo R Omosigho
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Lindsay Levine
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Neil J Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD, 20892, USA.
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Rajabi F, Rahimi M, Sharbafchizadeh MR, Tarrahi MJ. Saffron for the Management of Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Adv Biomed Res 2020; 9:60. [PMID: 33457343 PMCID: PMC7792881 DOI: 10.4103/abr.abr_49_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Selective serotonin reuptake inhibitors are among the most common agents have been used for the treatment of the premenstrual dysphoric disorder (PMDD); however, due to the diversity in the outcomes and adverse effects, efforts are in progress to find an agent with maximal efficacy and minimal adverse effects. Saffron is an herbal agent consisted of ingredients shown to act as an antidepressant, pain tranquilizer, and antioxidant. In the current study, it is aimed to assess the efficacy of saffron on PMDD treatment. Materials and Methods: In the current randomized controlled trial, 120 females with the diagnosis of PMDD were randomly allocated to three groups of treatment with fluoxetine (20 mg, twice daily), saffron (15 mg, twice daily) or placebo for 2 weeks in the luteal phase of two menstruation cycles. Daily record of severity of problems (DRSP) and Hamilton questionnaires had been filled before the interventions and then following the treatment cessation. The questionnaires' scores and drug-related adverse effects were compared among the studied groups. Results: Post-intervention assessment of three groups revealed significant improvement in all of the treatment approaches in terms of DRSP and Hamilton assessments (P < 0.001). Although DRSP assessments showed remarkable superiority of saffron to placebo (P = 0.027), Hamilton evaluations showed insignificant differences among the three interventions (P > 0.05). Fluoxetine posed a significantly higher rate of adverse effects as compared to the other agents (P = 0.01). Conclusion: Based on the findings of this study, saffron was an efficacious herbal agent for the treatment of PMDD with minimal adverse effects.
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Affiliation(s)
- Fatemeh Rajabi
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Rahimi
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Sundström-Poromaa I, Comasco E, Sumner R, Luders E. Progesterone - Friend or foe? Front Neuroendocrinol 2020; 59:100856. [PMID: 32730861 DOI: 10.1016/j.yfrne.2020.100856] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/05/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
Estradiol is the "prototypic" sex hormone of women. Yet, women have another sex hormone, which is often disregarded: Progesterone. The goal of this article is to provide a comprehensive review on progesterone, and its metabolite allopregnanolone, emphasizing three key areas: biological properties, main functions, and effects on mood in women. Recent years of intensive research on progesterone and allopregnanolone have paved the way for new treatment of postpartum depression. However, treatment for premenstrual syndrome and premenstrual dysphoric disorder as well as contraception that women can use without risking mental health problems are still needed. As far as progesterone is concerned, we might be dealing with a two-edged sword: while its metabolite allopregnanolone has been proven useful for treatment of PPD, it may trigger negative symptoms in women with PMS and PMDD. Overall, our current knowledge on the beneficial and harmful effects of progesterone is limited and further research is imperative.
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Affiliation(s)
| | - Erika Comasco
- Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Eileen Luders
- School of Psychology, University of Auckland, New Zealand; Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, USA
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