Mood changes and physical complaints during the normal menstrual cycle in healthy young women

What Pre-clinical Rat Models Can Tell Us About Anxiety Across the Menstrual Cycle in Healthy and Clinically Anxious Humans

PURPOSE OF REVIEW

Anxiety symptoms increase during the peri-menstrual phase of the menstrual cycle in people with anxiety disorders. Whether this reflects a heightened variant of normal menstrual-related changes in psychological states experienced by healthy (i.e. non-anxious) people is unknown. Moreover, menstrual-related change in anxiety symptoms is a poorly understood phenomenon, highlighting a need for pre-clinical models to aid mechanistic discovery. Here, we review recent evidence for menstrual effects on anxiety-like features in healthy humans as a counterpart to recent reviews that have focused on clinically anxious populations. We appraise the utility of rodent models to identify mechanisms of menstrual effects on anxiety and offer suggestions to harmonise methodological practices across species to advance knowledge in this field.

RECENT FINDINGS

Consistent with reports in clinical populations, some evidence indicates anxiety symptoms increase during the peri-menstrual period in healthy people, although null results have been reported, and these effects are heterogeneous across studies and individuals. Studies in rats show robust increases in anxiety during analogous phases of the oestrous cycle. Studies in female rats are useful to identify the evolutionarily conserved biological mechanisms of menstrual-related changes in anxiety. Future experimental approaches in rats should model the heterogeneity observed in human studies to increase alignment across species and advance understanding of the individual factors that increase the propensity to experience menstrual-related changes in anxiety.

Tracking Sleep, Temperature, Heart Rate, and Daily Symptoms Across the Menstrual Cycle with the Oura Ring in Healthy Women

Background and Objective

The ovulatory menstrual cycle is characterized by hormonal fluctuations that influence physiological systems and functioning. Multi-sensor wearable devices can be sensitive tools capturing cycle-related physiological features pertinent to women’s health research. This study used the Oura ring to track changes in sleep and related physiological features, and also tracked self-reported daily functioning and symptoms across the regular, healthy menstrual cycle.

Methods

Twenty-six healthy women (age, mean (SD): 24.4 (1.1 years)) with regular, ovulatory cycles (length, mean (SD): 28.57 (3.8 days)) were monitored across a complete menstrual cycle. Four menstrual cycle phases, reflecting different hormone milieus, were selected for analysis: menses, ovulation, mid-luteal, and late-luteal. Objective measures of sleep, sleep distal skin temperature, heart rate (HR) and vagal-mediated heart rate variability (HRV, rMSSD), derived from the Oura ring, and subjective daily diary measures (eg sleep quality, readiness) were compared across phases.

Results

Wearable-based measures of sleep continuity and sleep stages did not vary across the menstrual cycle. Women reported no menstrual cycle-related changes in perceived sleep quality or readiness and only marginally poorer mood in the midluteal phase. However, they reported moderately more physical symptoms during menses (p < 0.001). Distal skin temperature and HR, measured during sleep, showed a biphasic pattern across the menstrual cycle, with increased HR (p < 0.03) and body temperature (p < 0.001) in the mid- and late-luteal phases relative to menses and ovulation. Correspondingly, rMSSD HRV tended to be lower in the luteal phase. Further, distal skin temperature was lower during ovulation relative to menses (p = 0.05).

Conclusion

The menstrual cycle was not accompanied by significant fluctuations in objective and perceived measures of sleep or in mood, in healthy women with regular, ovulatory menstrual cycles. However, other physiological changes in skin temperature and HR were evident and may be longitudinally tracked with the Oura ring in women over multiple cycles in a natural setting.

Estrogen, the Peripheral Immune System and Major Depression – A Reproductive Lifespan Perspective

Major depression is a significant medical issue impacting millions of individuals worldwide. Identifying factors contributing to its manifestation has been a subject of intense investigation for decades and several targets have emerged including sex hormones and the immune system. Indeed, an extensive body of literature has demonstrated that sex hormones play a critical role in modulating brain function and impacting mental health, especially among female organisms. Emerging findings also indicate an inflammatory etiology of major depression, revealing new opportunities to supplement, or even supersede, currently available pharmacological interventions in some patient populations. Given the established sex differences in immunity and the profound impact of fluctuations of sex hormone levels on the immune system within the female, interrogating how the endocrine, nervous, and immune systems converge to impact women’s mental health is warranted. Here, we review the impacts of endogenous estrogens as well as exogenously administered estrogen-containing therapies on affect and immunity and discuss these observations in the context of distinct reproductive milestones across the female lifespan. A theoretical framework and important considerations for additional study in regards to mental health and major depression are provided.

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

LEARNING OBJECTIVE

After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health.

ABSTRACT

A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

The Effect of the Menstrual Cycle and Oral Contraceptive Cycle on Muscle Performance and Perceptual Measures

Most reproductive-aged women are exposed to fluctuating female steroid hormones due to the menstrual cycle or oral contraceptive use. This study investigated the potential effect of the menstrual cycle and combined monophasic oral contraceptive cycle on various aspects of muscle performance. Thirty active females (12 with a natural menstrual cycle, 10 taking a high-androgenicity oral contraceptive and 8 taking a low-androgenicity oral contraceptive), aged 18 to 30 years, were tested three times throughout one menstrual or oral contraceptive cycle. Counter-movement jumps, bilateral hop jumps, handgrip strength, isometric knee extensor strength and isokinetic knee flexion and extension were assessed. Perceptual ratings of fatigue, muscle soreness, pain and mood were recorded. Most variables showed no significant changes over the menstrual or oral contraceptive cycle. However, for the menstrual cycle group, isokinetic knee flexion at 240° s⁻¹, and time of flight in bilateral hopping and counter movement jumps showed better results during the mid-luteal phase compared with the late follicular phase. For the high-androgenicity oral contraceptive group, isokinetic knee flexion at 240° s⁻¹ was significantly higher in the late hormone phase compared with the early hormone phase. For the low-androgenicity oral contraceptive group, time of flight for the counter-movement jumps was lower in the late hormone phase compared with the early hormone phase. The findings indicate that faster and explosive aspects of muscle performance may be influenced by endogenous and exogenous female hormones.

Sex differences in sleep and influence of the menstrual cycle on women's sleep in junior endurance athletes

Previous research shows that female athletes sleep better according to objective parameters but report worse subjective sleep quality than male athletes. However, existing sleep studies did not investigate variations in sleep and sleep stages over longer periods and have, so far, not elucidated the role of the menstrual cycle in female athletes' sleep. To address these methodological shortcomings, we investigated sex differences in sleep and sleep stages over 61 continuous days in 37 men and 19 women and examined the role of the menstrual cycle and its phases in 15 women. Sleep was measured by a non-contact radar, and menstrual bleeding was self-reported. Associations were investigated with multilevel modeling. Overall, women tended to report poorer subjective sleep quality (p = .057), but objective measurements showed that women obtained longer sleep duration (p < .001), more light (p = .013) and rapid eye movement sleep (REM; hours (h): p < .001, %: p = .007), shorter REM latency (p < .001), and higher sleep efficiency (p = .003) than men. R2 values showed that sleep duration, REM and REM latency were especially affected by sex. Among women, we found longer time in bed (p = .027) and deep sleep (h: p = .036), and shorter light sleep (%: p = .021) during menstrual bleeding vs. non-bleeding days; less light sleep (h: p = .040), deep sleep (%: p = .013) and shorter REM latency (p = .011) during the menstrual than pre-menstrual phase; and lower sleep efficiency (p = .042) and more deep sleep (%: p = .026) during the follicular than luteal phase. These findings indicate that the menstrual cycle may impact the need for physiological recovery, as evidenced by the sleep stage variations. Altogether, the observed sex differences in subjective and objective sleep parameters may be related to the female athletes' menstrual cycle. The paper provides unique data of sex differences in sleep stages and novel insights into the role of the menstrual cycle in sleep among female athletes.

Bumpy and Smoother Pathways of Puberty Hormone Change: A Novel Way to Define Gonadal Hormone Trajectories in Adolescents

CONTEXT

The study of gonadal hormone effects on adolescent wellbeing has been limited by logistical challenges. Urine hormone profiling offers new opportunities to understand the health and behavioral implications of puberty hormones.

OBJECTIVE

To characterize pubertal change in urinary testosterone and estradiol among male and female adolescents, respectively.

DESIGN

Three-year prospective cohort study.

SETTING

Australian regional community.

PARTICIPANTS

282 (163 male) normally developing adolescents aged 11.8 ± 1.0 years at baseline.

MAIN OUTCOME MEASURE

Quarterly urine measurements of testosterone and estradiol (mass spectrometry); annual anthropometric assessment and Tanner stage (TS) self-report.

RESULTS

Two-class sigmoidal and quadratic growth mixture models (centered on age at TS3) were identified as best-fit for describing testosterone (male) and estradiol (female) change. Classes 1 (male: 63%; female: 82%) and 2 (male: 37%; female: 18%) were respectively named the "stable" and "unstable" trajectories, characterized by different standard deviation of quarterly hormone change and magnitude of hormone peaks and troughs (all P < 0.001). Compared with class 1 (stable), class 2 males were taller at baseline (154 vs 151 cm), reported earlier and faster TS progression (P < 0.01), and showed higher serum testosterone levels at baseline and 3 years (P ≤ 0.01). Class 2 females exhibited smaller height and weight gains over the 3 years and had higher baseline serum estradiol (249 vs 98 pmol/L; P = 0.002) than class 1.

CONCLUSIONS

Adolescents showed 2 distinct urinary gonadal hormone trajectories, characterized by stability of change over time, which were not associated with consistent anthropometric differences. Results provide a methodology for studying gonadal hormone impacts on other aspects of biopsychosocial wellbeing. Identification of potential "at-risk" hormone groups would be important for planning supportive interventions.

The influence of ovulation on postural stability (Biodex Balance System) in young female

The purpose of this study was to examine the influence of ovulation (OV) on dynamic balance in young female. Thirty-two eumenorrheic healthy women participated in Biodex Balance System (BBS) test for postural stability and a limit of stability menstrual cycle. BBS was tested in the menses (MS), OV, and luteal phase (LP). The limits of stabilities (total, forward-left, forward-right, backward-left, and backward-right) were significantly higher in the OV (total, 61.44±14.77; forward-left, 67.50± 15.17; forward-right, 69.50±14.43; backward-left, 64.00±20.32; and back-ward-right, 69.06±13.59) than in the MS (total, 55.44±14.63; forward-left, 60.00±15.98; forward-right, 62.17±9.78; backward-left, 57.83±19.09; and backward-right, 57.28±13.73). Furthermore, the LP (65.11±13.79) was a significantly higher limit of stability than MS (57.28±13.73) during back-ward-right. The present study showed that estrogen negatively influences postural stability. The postural sway in limits of stabilities (total, forward-left, forward-right, backward-left, and backward-right) were significantly the greatest in the OV. Since there is a different postural stability between MS, OV, and LP, this should be taken into account when devising training programs to avoid risk factor of fall and joint injury.

Stress-Induced Chronic Visceral Pain of Gastrointestinal Origin

Visceral pain is generally poorly localized and characterized by hypersensitivity to a stimulus such as organ distension. In concert with chronic visceral pain, there is a high comorbidity with stress-related psychiatric disorders including anxiety and depression. The mechanisms linking visceral pain with these overlapping comorbidities remain to be elucidated. Evidence suggests that long term stress facilitates pain perception and sensitizes pain pathways, leading to a feed-forward cycle promoting chronic visceral pain disorders such as irritable bowel syndrome (IBS). Early life stress (ELS) is a risk-factor for the development of IBS, however the mechanisms responsible for the persistent effects of ELS on visceral perception in adulthood remain incompletely understood. In rodent models, stress in adult animals induced by restraint and water avoidance has been employed to investigate the mechanisms of stress-induce pain. ELS models such as maternal separation, limited nesting, or odor-shock conditioning, which attempt to model early childhood experiences such as neglect, poverty, or an abusive caregiver, can produce chronic, sexually dimorphic increases in visceral sensitivity in adulthood. Chronic visceral pain is a classic example of gene × environment interaction which results from maladaptive changes in neuronal circuitry leading to neuroplasticity and aberrant neuronal activity-induced signaling. One potential mechanism underlying the persistent effects of stress on visceral sensitivity could be epigenetic modulation of gene expression. While there are relatively few studies examining epigenetically mediated mechanisms involved in visceral nociception, stress-induced visceral pain has been linked to alterations in DNA methylation and histone acetylation patterns within the brain, leading to increased expression of pro-nociceptive neurotransmitters. This review will discuss the potential neuronal pathways and mechanisms responsible for stress-induced exacerbation of chronic visceral pain. Additionally, we will review the importance of specific experimental models of adult stress and ELS in enhancing our understanding of the basic molecular mechanisms of pain processing.

Negative affect is unrelated to fluctuations in hormone levels across the menstrual cycle: Evidence from a multisite observational study across two successive cycles

BACKGROUND

Female sex hormones may play a crucial role in the occurrence of cycle-related mood disorders. However, the literature is inconsistent and methodologically stringent observational studies on the relationship between sex hormones and negative affect are lacking.

METHODS

In this longitudinal multisite study from Hannover, Germany, and Zurich, Switzerland, we examined oestrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone serum levels in association with negative affect as measured with the Positive and Negative Affect Schedule (PANAS). Negative affect and hormone assays were collected at four consecutive time points comprising menstrual, pre-ovulatory, mid-luteal and premenstrual phase across two cycles (n=87 and n=67 for the first and second cycles). The Beck Depression Inventory (BDI) was assessed once prior to the first cycle and included as a secondary measure.

RESULTS

Mean negative affect scores did not significantly fluctuate across both cycles and there was in particular no symptom increase premenstrually. No sex hormone consistently related to repeated measures of negative affect across two consecutive cycles. The BDI sum-score assessed at baseline was not related to hormone levels across the first cycle.

CONCLUSIONS

This is the first multisite longitudinal study on the association between negative affect and sex hormone levels encompassing two consecutive menstrual cycles. Negative affect did not fluctuate across the cycle and there was no direct and uniform association between sex hormones and self-reported negative affect. These findings suggest that moderators such as personality traits and epigenetics should be considered in future research.

Neurobiology of early life stress and visceral pain: translational relevance from animal models to patient care

BACKGROUND

Epidemiological studies show that females are twice as likely to receive a diagnosis of irritable bowel syndrome (IBS) than their male counterparts. Despite evidence pointing to a role for sex hormones in the onset or exacerbation of IBS symptoms, the mechanism by which ovarian hormones may predispose women to develop IBS remains largely undefined. On the other hand, there is a growing body of research showing a correlation between reports of early life stress (ELS) and the diagnosis of IBS. Current treatments available for IBS patients target symptom relief including abdominal pain and alterations in bowel habits, but are not directed to the etiology of the disease.

PURPOSE

To better understand the mechanisms by which sex hormones and ELS contribute to IBS, animal models have been developed to mirror complex human experiences allowing for longitudinal studies that investigate the lifelong consequences of ELS. These preclinical models have been successful in recapitulating ELS-induced visceral pain. Moreover, in female rats the influence of cycling hormones on visceral hypersensitivity resembles that seen in women with IBS. Such studies suggest that rodent models of ELS may serve as pivotal tools in determining (i) the etiology of IBS, (ii) novel future treatments for IBS, and (iii) improving individualized patient care. The current review aims to shed light on the progress and the challenges observed by clinicians within the field of gastroenterology and the preclinical science aimed at addressing those challenges in an effort to understand and more efficiently treat functional gastrointestinal disorders (FGIDs) in both children and adults.

Individual differences in self-reported difficulty sleeping across the menstrual cycle

The effect of menstrual cycle phase on sleep has been studied for decades; however, individual differences in the associations between sleep and menstrual phase have not been well studied. In addition, the associations between changes in sleep and other physiological and psychological factors that vary as a function of menstrual phase have not been thoroughly assessed. This study explored individual differences in daily self-reports of difficulty sleeping across the menstrual cycle, as well as associations between daily changes in difficulty sleeping and psychological/vegetative and somatic symptoms. Participants (n = 213 females, mean age = 21.29 ± 4.01 years) completed daily online questionnaires assessing` sleep, psychological and physical symptoms for two menstrual cycles. Two patterns of menstrual cycle-related self-reported difficulty sleeping emerged in addition to women who showed no cyclical change in self-reported difficulty sleeping: a perimenstrual increase and a mid-cycle increase. All psychological/vegetative symptoms and some of the somatic symptoms showed significant associations with self-reported difficulty sleeping. These findings highlight the importance of examining individual differences in sleep across the menstrual cycle and the significant contribution of a wide range of menstrual cycle-related psychological/vegetative and somatic symptoms.

Prevalence and Predictors of Cyclic and Noncyclic Affective Change

The prevalence of cyclic and week-to-week affective change was prospectively assessed over two consecutive menstrual cycles in a nonclinical sample of 101 employed women. Although 40% perceived themselves to have premenstrual syndrome (PMS), none showed a recurrent pattern of marked premenstrual affective change. Marked affective change was as likely to occur in the postmenstrual as the premenstrual phase. Weekly marked change was as prevalent as cyclic change. Although social health (perceived quantity and quality of interpersonal relationships) and subjective stress consistently predicted both cyclic and weekly affective states, the contribution of social health was 10 times greater than that of stress. The role of social health requires further examination, as does the widespread misuse of the PMS label to account for occasional changes in affect.

The impact of menstrual cycle-related physical symptoms on daily activities and psychological wellness among adolescent girls

Associations between perimenstrual physical and psychological symptoms have not been adequately studied among adolescent girls. The purpose of the present study was to test a mediation hypothesis postulating that perimenstrual disengagement from daily activities would mediate the association between physical symptoms and psychological symptoms. A non-clinical sample of N = 208 Italian adolescent girls (age M = 16.68 years) completed a 95-item online retrospective questionnaire regarding perimenstrual symptoms, and how these symptoms affect their daily activities. Structural Equation Modeling was used to test the mediation hypothesis. Results showed that physical and psychological symptoms were strongly associated. More importantly, results supported the hypothesis that perimenstrual disengagement from daily activities mediates the association between physical symptoms and psychological symptoms, but only for depressed mood and cognitive symptoms. This study provides support for a novel theoretical framework linking diverse aspects of menstrual cycle change. Longitudinal research is needed to replicate these findings.

Stress-induced visceral pain: toward animal models of irritable-bowel syndrome and associated comorbidities

Visceral pain is a global term used to describe pain originating from the internal organs, which is distinct from somatic pain. It is a hallmark of functional gastrointestinal disorders such as irritable-bowel syndrome (IBS). Currently, the treatment strategies targeting visceral pain are unsatisfactory, with development of novel therapeutics hindered by a lack of detailed knowledge of the underlying mechanisms. Stress has long been implicated in the pathophysiology of visceral pain in both preclinical and clinical studies. Here, we discuss the complex etiology of visceral pain reviewing our current understanding in the context of the role of stress, gender, gut microbiota alterations, and immune functioning. Furthermore, we review the role of glutamate, GABA, and epigenetic mechanisms as possible therapeutic strategies for the treatment of visceral pain for which there is an unmet medical need. Moreover, we discuss the most widely described rodent models used to model visceral pain in the preclinical setting. The theory behind, and application of, animal models is key for both the understanding of underlying mechanisms and design of future therapeutic interventions. Taken together, it is apparent that stress-induced visceral pain and its psychiatric comorbidities, as typified by IBS, has a multifaceted etiology. Moreover, treatment strategies still lag far behind when compared to other pain modalities. The development of novel, effective, and specific therapeutics for the treatment of visceral pain has never been more pertinent.

Evidence for gender differences in cognition, emotion and quality of life in Parkinson's disease?

A number of gender differences have been documented in the incidence and symptomatology of the second most common age-related neurodegenerative disorder, idiopathic Parkinson's disease (PD). Overall, previous reports suggest a less frequent incidence and a more benign phenotype in women mainly in Western populations, which is thought to be mediated by estrogens in particular in early stages of the disease. Not only motor symptoms seem to underlie gender effects, but also non-motor symptoms such as psychiatric and cognitive impairments, which can often precede motor manifestation. However, reliable results for gender differences in PD in particular of cognitive function and emotion processing, having a major impact on quality of life, are lacking. Moreover, studies investigating gender effects in PD in these areas have revealed highly heterogeneous results. The present review summarizes findings of currently available studies on gender effects on neuropsychological tests covering major cognitive domains, emotion processing as well as quality of life in patients with PD. Overall, the occurrence of cognitive impairment in PD seems to be associated with male gender, though inconsistent results were shown in cognitive screening tests. Regarding emotion recognition, men with PD were found to be less accurate than women with PD at identifying fearful expressions, whereas vice versa results appeared in healthy subjects. Lower quality of life and greater disability were reported by women compared to men with PD, which corresponds with the results in healthy subjects. Several disease-specific mediators as well as the question of a general gender and age-related effect as observed in healthy individuals are discussed. Increased knowledge on possible gender effects in PD would provide an enhanced insight in underlying pathological mechanisms, and has potential implications for the diagnosis and treatment of PD.

Gastrointestinal symptoms before and during menses in healthy women

Background

Little is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses.

Methods

We recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms.

Results

Of 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01).

Conclusions

Emotional symptoms occurring in conjunction with GI symptoms are common perimenstrually, and as such may reflect shared underlying processes that intersect brain, gut, and hormonal pathways.

Comparisons of the sleep quality, daytime sleepiness, and sleep cognitions of Caucasian Australians and Zimbabwean and Ghanaian black immigrants

Studying sleep differences across different ethnic groups is not only important for our understanding of sleep but may lead to the development of new, culturally appropriate interventions. Perceptions of sleep quality, daytime sleepiness, and sleep cognitions (beliefs and attitudes) were investigated in a community sample of Caucasian Australians and Black immigrants currently resident in Australia from Zimbabwe (Black Zimbabwean) and Ghana (Black Ghanaian). A sample of a total of 176 participants including Caucasian Australian ( n = 58), Black Zimbabwean ( n = 59), and Black Ghanaian ( n = 59), aged between 18 and 60 years was surveyed. Groups were matched on age and gender, with a strong predominance of professional occupations in all groups in the final sample and no significant socio-economic status differences between groups. Participants completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Dysfunctional Beliefs and Attitudes about Sleep, and the Short Form-36 Health Survey. After matching participants on age, gender, and socio-economic status, no statistically significant group differences were found on sleep quality, daytime sleepiness, and physical health. However, significant group differences were found on beliefs and attitudes about sleep with Black Zimbabwean and Black Ghanaian participants, attributing sleep difficulties more to physical than psychological phenomena compared to Caucasian Australian participants.

Treatment of irritable bowel syndrome: sex and gender specific aspects

Patients with functional gastrointestinal disorders constitute the majority of patients seeking healthcare for gastrointestinal symptoms in primary and secondary care. Of these disorders irritable bowel syndrome (IBS) is one of the most common and affects 10-20% in the Western world. IBS is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. Sex and gender aspects are important in understanding differences between men and women in their risk and experience of IBS. Relative to men, women are diagnosed more frequently with IBS. Female patients are more likely to be constipated, complain of abdominal distension and of certain extracolonic symptoms. Given the variability of IBS, the most successful treatment will be comprehensive, involving multiple strategies. Efficacy, safety and tolerability are important in the evaluation of IBS therapies, as patients are likely to require long-term treatment. Laxatives, antidiarrheals or antispasmodics are common in the treatment of IBS but the majority of patients receive antispasmodics followed by prokinetic agents. In treatment of IBS there appears to be a greater clinical response to serotonergic agents developed for IBS in women compared to men. There is an absence of drugs licensed specifically for the treatment of IBS. Further studies with novel agents are needed, to evaluate new approaches to IBS management including gender specific behavioral therapies and better characterization of patient subgroups with regard to drug therapy so that personalized therapy can be tested.

Gender differences in aging: cognition, emotions, and neuroimaging studies

Gender and aging moderate brain-behavior relationships. Advances in neuroscience enable integration of neurobehavioral, neuroanatomic, and neurophysiology measures. Here we present neurobehavioral studies thai examine cognitive and emotion processing in healthy men and women and highlight the effects of sex differences and aqinq. Neuroanatomic studies with maqnetic resonance imaging (MRI) indicate that the progressive decrease in brain volume affects froniotemporal brain regions in men more than in Vi/omen, Functional imaging methods suggest sex differences in rate of blood flow, pattern of glucose metabolism, and receptor activity. The role of ovarian hormones is important in elucidating the observed relationships. A life span perspective on gender differences through the integration of available methodologies will advance understanding healthy people and the effects of brain disorders.

The role of ovarian steroid hormones in mood

Fluctuations in ovarian hormones across the menstrual cycle have long been considered a determinant of mood in women. The majority of studies, however, use menstrual cycle phase as proxy for hormone levels. We measured ovarian hormone levels directly in order to examine the relationship between daily hormone levels and mood in non-help-seeking women. Participants (n=19) provided daily information about their positive and negative moods, and collected their first morning-voided urine for 42days, which was analyzed for estrogen and progesterone metabolites (E1G and PdG). The independent contributions of daily E1G, PdG, stress, physical health, and weekly social support, were calculated for 12 daily mood items, and composite measures of positive and negative mood items, using linear mixed models. E1G or PdG contributed to few mood items: E1G measured 2days prior contributed negatively to the model for Motivation, while E1G measured 3days prior contributed negatively to Getting Along with Others, and E1G measured 4days prior contributed negatively to Anxiety. PdG, measured the same day and 1day prior, contributed positively to the models of Irritability, and PdG measured 5days prior contributed positively to Difficulty Coping. By contrast, the variables stress and physical health contributed significantly to all the mood items, as well as both composite positive and negative mood measures. These findings demonstrate that, compared to stress and physical health, ovarian hormones make only a small contribution to daily mood. Thus, fluctuations in ovarian hormones do not contribute significantly to daily mood in healthy women.

Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis

OBJECTIVES

Irritable bowel syndrome (IBS) is thought to be commoner in women. However, no systematic review has confirmed whether this is the case, or assessed whether any proposed female preponderance remains stable according to geography and criteria used to define IBS. Nor has effect of gender on subtype of IBS been examined systematically.

METHODS

MEDLINE, EMBASE, and EMBASE Classic were searched (up to October 2011) to identify population-based studies reporting prevalence of IBS in adults (≥15 years) according to gender, and defined using symptom-based criteria, or questionnaire. The prevalence of IBS in women and men was extracted for all studies, and according to study location and diagnostic criteria used, and compared using odds ratios (ORs) with 95% confidence intervals (CIs). Prevalence of each subtype of IBS, according to predominant stool pattern, was compared in women and men with IBS.

RESULTS

Of the 390 papers evaluated, 56 studies containing 188,229 subjects were eligible. The OR for IBS in women, compared with men, in all studies was 1.67 (95% CI: 1.53-1.82). Prevalence of IBS was not significantly higher in women, compared with men, in South Asian, South American, or African studies. The OR was highest with the Rome I criteria (1.99; 95% CI: 1.76-2.25), and lowest with the Rome II criteria (1.40; 95% CI: 1.24-1.59). Women with IBS were more likely to exhibit the constipation-predominant subtype (OR: 2.38; 95% CI: 1.45-3.92), and less likely to meet criteria for the diarrhea-predominant subtype (OR: 0.45; 95% CI: 0.32-0.65) than men with IBS.

CONCLUSIONS

Prevalence of IBS appeared modestly higher in women, and this remained relatively stable according to geography and criteria used to define its presence. However, among individuals with IBS, subtypes varied according to gender.

Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?

BACKGROUND

An increase in gastrointestinal (GI) symptoms, including bowel discomfort, abdominal pain/discomfort, bloating, and alterations in bowel patterns, has been reported during premenses and menses menstrual cycle phases and the perimenopause period in women with and without irritable bowel syndrome (IBS).

OBJECTIVE

This article reviews the literature related to one possible physiological mechanism-declining or low ovarian hormone levels--that may underlie the occurrence or exacerbations of abdominal pain/discomfort at times of low ovarian hormones (menses, menopause) in women with or without IBS.

METHODS

To identify English-only review and data-based articles, PubMed was searched between January 1980 and September 2008 using the following terms: irritable bowel syndrome, functional gastrointestinal disorders, gastrointestinal motility, immune, pain, hyperalgesia, menstrual cycle, menopause, pregnancy, estrogen, estradiol (E(2)), and progesterone. Studies in animals and in humans were included; drug trials were excluded.

RESULTS

From our review of the literature, 18 papers were identified that were related either to the mechanisms accounting for menstrual cycle fluctuations (n = 12) or to the impact of menopausal status on symptoms of IBS (n = 6). One study reported that visceral pain sensitivity was significantly higher during menses than at other menstrual cycle phases in women with IBS (P < 0.05). Other menstrual cycle phase-linked symptoms, dysmenorrheal symptoms (cramping pain) in particular, were more intense in women with IBS. Animal studies have shed some light on the relationship of ovarian hormones to GI sensorimotor function.

CONCLUSION

The increase in GI symptoms around the time of menses and early menopause occurs at times of declining or low ovarian hormones, suggesting that estrogen and progesterone withdrawal may contribute either directly or indirectly. This review highlights the need for confirmatory preclinical and clinical studies to unravel the role of ovarian hormones in women with IBS.

Meta-analysis: do irritable bowel syndrome symptoms vary between men and women?

BACKGROUND

Studies suggest that sex and gender-related differences exist in irritable bowel syndrome (IBS), but data is often conflicting.

AIM

To evaluate gender differences and the effect of menstrual cycle and menopausal status on IBS symptoms.

METHODS

We performed a systematic review of MEDLINE to search for studies comparing IBS symptoms between gender, menstrual cycle phases and menopausal states in IBS and/or healthy individuals. We performed meta-analyses to compare the relative risk (RR) of individual IBS symptoms between men and women.

RESULTS

Twenty-two studies measured gender differences in IBS symptoms. Women were more likely to report abdominal pain (RR = 1.12, 95% CI: 1.02, 1.22) and constipation-related symptoms (RR = 1.12, 95% CI: 1.02, 1.23) than men (all P < 0.05). However, men with IBS were more likely to report diarrhoea-related symptoms than women with IBS (RR = 0.84, 95% CI: 0.75, 0.94, P < 0.05). A systematic review of 13 studies demonstrated that both IBS and healthy women reported increased IBS symptoms during menses vs. other phases. There were insufficient data to determine the effect of menopause and hormone supplementation on IBS symptoms.

CONCLUSIONS

In the general and IBS populations, gender differences in IBS symptoms exist, although these differences are modest. Studies suggest that female sex hormones influence the severity of IBS symptoms, but more studies are needed.

Ovulation disturbances and mood across the menstrual cycles of healthy women

We examined the cyclicity of negative mood relative to ovulation and ovulation disturbances in Menstrual Cycle Diary(c) data collected daily during a 1-year study of ovulation, exercise, and bone change. A validated quantitative basal temperature-based methodology was used to determine the onset of the luteal phase. 'Feeling depressed', 'feeling anxious', and 'feeling angry/frustrated' were scored on a scale of 0 (absent) to 4 (very intense). Mood scores were examined over two 15-day intervals centered on either ovulation/midpoint, or on the onset of flow. Data were available from 765 cycles of 62 healthy and initially ovulatory women with a mean age of 33.9 +/- 5.4 years. Of 739 cycles that could be classified, 532 (72%) were normally ovulatory, 185 (25%) were ovulatory with a short (<10 day) luteal phase, and 22 (3%) were anovulatory. Minor cyclic mood changes were present in both ovulatory and anovulatory menstrual cycles. In anovulatory cycles, mood tended to be more variable but less negative, with a time course that differed from that in ovulatory cycles. Mood scores did not differ based on luteal phase length or with hormone levels. Patterns and mechanisms of mood change in very symptomatic women appear to be essentially amplifications of normal experiences.

Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome

In the United States, more women than men seek health-care services for symptoms of irritable bowel syndrome (IBS). A number of explanations are given for this gender difference including the higher rates of somatic non-gastrointestinal symptoms and increased psychological distress reported by women with IBS. However, these gender differences are found in studies that rely on retrospective recall with little attention to age or reproductive status. The purpose of the current analysis was to prospectively compare the frequency (days/month of moderate to severe based on a daily diary) of somatic, gastrointestinal (GI), and psychological distress symptoms, in menstruating women (N = 89) and postmenopausal women (N = 66) to men (N = 32) with IBS. In addition, the correlation between daily symptoms and daily report of overall health was evaluated. Postmenopausal women reported significantly more GI pain/discomfort symptoms, especially bloating and abdominal distension, than men, however these differences are greatly attenuated when age is controlled for. Both postmenopausal and menstruating women reported significantly more somatic symptoms (especially joint pain and muscle pain) than men with IBS. The effect was stronger in postmenopausal women, whose somatic symptoms were also higher than menstruating women (P = 0.014). Fatigue and stress were higher in women than men but anxiety and depression were not. All three types of symptoms were strongly correlated with self-rating of health, both across and within-person. Gender-related differences in GI and somatic symptoms are apparent in persons with IBS, more strongly in postmenopausal women. The presence of somatic symptoms in postmenopausal women with IBS may challenge clinicians to find suitable therapeutic options.

Perceived Sleep Quality and Sleepiness in South African University Students

Little is known about the sleep habits of South African students. The objectives in this study were to evaluate sleep habits and daytime behaviours of South African university students and to examine possible factors associated with their sleep quality and daytime sleepiness. Nine hundred and eighty-six undergraduate students completed a questionnaire about their sleep and lifestyle habits over the previous month, and their fatigue-related driving history. Sleep habits were similar for male and female students, although male students went to bed later and had fewer night-time awakenings. Black students went to bed significantly later than white and Asian students and woke earlier than white students during the week; consequently they were more likely to have a shorter time in bed than white students. Black students were more likely to nap than white students, possibly to supplement their overall sleep amount. Sleep quality and daytime sleepiness were not influenced by gender or ethnicity. Twenty percent of the students reported having ever fallen asleep while driving and 2% reported having had a fatigue-related accident; these findings have implications for road safety. Eighteen percent of the students reported poor sleep quality, although few students (4%) had consulted a doctor about a sleeping problem. Logistic multiple regression modeling revealed that poor sleep quality was associated with the following factors: long sleep onset latency; night-time awakenings; late bed times; use of sleep medication; not getting enough sleep; and low energy. Based on the Epworth Sleepiness Scale, 44% of the students had a high propensity for daytime sleepiness, which was associated with not getting enough sleep, consuming more caffeinated beverages, daytime napping, and having no/little energy. Daytime sleepiness and associated factors in South African students need to be investigated further and it is recommended that students be better informed about sleep problems and their consequences. First-line help-professionals such as psychologists, doctors, and healthcare workers should be better trained to support students with sleep problems.

Irritable bowel syndrome: does gender matter?

In industrialized parts of the world, women seek health care services for irritable bowel syndrome (IBS) more frequently than men. The role of gender in IBS is likely multifactorial involving inherent physiological differences in gonadal hormones, stress reactivity, and inflammatory responses, as well as sociocultural differences in response to pain and/or bowel pattern changes. This mini-review in particular addresses gender differences in visceral sensitivity, motility, and autonomic nervous system balance as potential factors contributing to gender differences in IBS presentation.

Ovulatory shifts in human female ornamentation: near ovulation, women dress to impress

Humans differ from many other primates in the apparent absence of obvious advertisements of fertility within the ovulatory cycle. However, recent studies demonstrate increases in women's sexual motivation near ovulation, raising the question of whether human ovulation could be marked by observable changes in overt behavior. Using a sample of 30 partnered women photographed at high and low fertility cycle phases, we show that readily-observable behaviors - self-grooming and ornamentation through attractive choice of dress - increase during the fertile phase of the ovulatory cycle. At above-chance levels, 42 judges selected photographs of women in their fertile (59.5%) rather than luteal phase (40.5%) as "trying to look more attractive." Moreover, the closer women were to ovulation when photographed in the fertile window, the more frequently their fertile photograph was chosen. Although an emerging literature indicates a variety of changes in women across the cycle, the ornamentation effect is striking in both its magnitude and its status as an overt behavioral difference that can be easily observed by others. It may help explain the previously documented finding that men's mate retention efforts increase as their partners approach ovulation.

Menstrual cycle influences on pain and emotion in women with fibromyalgia

OBJECTIVE

This study examined the influence of the menstrual cycle on pain and emotion in women with fibromyalgia (FM) as compared with women with rheumatoid arthritis (RA) and to healthy controls.

METHODS

One hundred and twenty-five premenopausal women (21-45 years old) participated in this study (57 with FM, 20 with RA, and 48 controls). Pain and emotion assessments were conducted during the follicular and the luteal phases of the menstrual cycle.

RESULTS

Women with FM experienced more pain, menstrual symptoms, and negative affect than did women with RA and the controls. All women reported less positive affect during the luteal phase, although this pattern was more pronounced in women with FM and RA than in controls.

CONCLUSION

Although FM pain did not vary across the menstrual cycle, these results point to the importance of considering the lower level and cyclical nature of positive affect when studying women with chronic pain.

Effects of disordered eating and obesity on weight, craving, and food intake during ad libitum smoking and abstinence

Although there is empirical support for the association between smoking, disordered eating, and subsequent weight gain upon smoking cessation, there have been no prospective studies to track changes in eating patterns during smoking abstinence and explore underlying biobehavioral processes. To help fill these gaps, we recruited four groups of women (N=48, 12/group) based on presence vs. absence of obesity and on low vs. high risk of severe dieting and/or binge-eating to participate in a laboratory study of eating in the context of ad libitum smoking and smoking abstinence. Participants [mean age 31.3 years; Fagerstrom Test of Nicotine Dependence (FTND) 4.3; smoking rate 18.7 cigarettes/day] completed two sessions: one after ad libitum smoking, the other after 2 days' smoking abstinence, in counterbalanced order. After a half-day's restricted eating, participants watched a video, with measured amounts of preselected preferred food available throughout. Cigarettes were available during the ad libitum smoking session. High-risk women weighed more after 2 days' abstinence than during the ad libitum smoking condition, whereas low-risk women did not differ across conditions. Nicotine craving changed significantly more in anticipation of nicotine deprivation for high-BMI women than their low-BMI counterparts. Caloric intake was marginally attenuated during abstinence for low-BMI compared with high-BMI participants (P<.10), an effect primarily accounted for by differences in protein intake (P<.10). These findings suggest that low-BMI women may be less prone to weight gain during early abstinence, possibly because they compensate for metabolic changes induced by nicotine washout by eating less. Craving increases experienced by high-BMI women during abstinence under conditions of food deprivation may contribute to difficulty quitting in these women.

The effect of the menstrual cycle on electrophysiological and behavioral measures of memory and mood

Event-related potentials (ERPs) were compared between the menses and ovulatory phase of the menstrual cycle in response to visually presented words, some of which were repeated as part of direct and indirect memory tasks. Twelve spontaneously cycling women were tested during the menses and ovulatory phases. For the direct task, participants had to discriminate between new words and those repeated after a mean of six trials. In the indirect task, subjects were required to discriminate between target and nontarget words. Some of the nontarget words were repeated after a mean of six trials. The ERP repetition effect mean amplitude was significantly greater in response to repeated words at both cycle phases but did not differ across the cycle. P300 amplitude was significantly greater during menses than the ovulatory phase. We conclude that context updating mechanisms as indexed by the P300 are sensitive to cyclic hormonal fluctuations.

Self-reported sleep across the menstrual cycle in young, healthy women

OBJECTIVE

To establish the association between subjective sleep and phase of the menstrual cycle in healthy, young, ovulating women.

METHODS

Twenty-six women (mean age: 21 years) who did not suffer from any menstrual-associated disorders, and in whom we had detected ovulation, completed daily questionnaires about their sleep over 1 month.

RESULTS

The women reported a lower sleep quality over the 3 premenstrual days and 4 days during menstruation, compared to the mid-follicular and early/mid luteal phases. Total sleep time, sleep onset latency, number and duration of awakenings, and morning vigilance were not affected by the menstrual cycle.

CONCLUSION

The normal, ovulatory cycle is associated with changes in the perception of sleep quality but not sleep continuity in healthy, young women. The temporal relationship of sleep complaints with menstrual phase should be considered in the evaluation of sleep disorders, particularly insomnia, in women.

Whose voice? Whose experiences? Women's qualitative accounts of general and private discussion of premenstrual syndrome

Little is known about the disparity between public perceptions of premenstrual syndrome (PMS) and how women perceive PMS. In this interview study the perceptions 17 healthy women have about the discussion on PMS are described. Qualitative and quantitative content analysis of the interviews resulted in three main categories: (i) Turning women's experiences against them, (ii) PMS as a silent part of everyday life and (3) Symptoms and experiences reported: public instability, private discomfort. These categories contain statements from the participants ascertaining that men talk negatively about PMS, the media portray PMS negatively, other women's premenstrual experiences are more negative than their own experiences and they do not need to discuss their experiences although they find it important to increase positive public discussion. The conclusions are that (i) the public voice on PMS is based on negative male stereotypical views about PMS and that women participate in constructing and sustaining that view through their own descriptions of other women; (ii) through media and health education, women and men should be made aware of whose voice rules in public discussion; (iii) to educate and change the public discourse on PMS is a challenge that the caring professions must take.

Differential subjective effects of D-amphetamine by gender, hormone levels and menstrual cycle phase

Estrogen and progesterone interact with monoamines in ways that suggest the potential modulation of responses to psychoactive drugs by endogenous steroids, both between menstrual phases and between the sexes. The present study assessed the subjective and physiological effects of a single dose of D-amphetamine (AMPH; 15 mg oral) in healthy, normally cycling women (n=13), who received amphetamine and placebo (PL) during both the follicular and luteal phases of a single menstrual cycle, and in healthy men (n=7). Females reported greater amphetamine-induced subjective stimulation [Addiction Research Center Inventory (ARCI)-A, ARCI-MBG; Drug Effects Questionnaire (DEQ) Feel Drug, Feel High, Want More] during the follicular phase than the luteal phase. Within the follicular phase, the magnitude of individuals' AMPH-induced stimulation was positively associated with baseline (predrug) salivary estradiol [r=+.55-.78; Profile of Mood States (POMS) Vigor, Positive Mood, Elation], and negatively associated with salivary progesterone [r=-.66-.68; POMS Friendliness; Subjective States Questionnaire (SSQ) Pleasant Sedation]. Sex differences also emerged. Males reported feeling greater AMPH-induced stimulation (ARCI-A, ARCI-MBG; DEQ Feel Drug, Want More) than females in the luteal phase. Thus, higher levels of estrogen and lower levels of progesterone are associated with greater subjective stimulation after AMPH in women, and these hormonal influences contribute to sex differences in amphetamine responding.

Smoking behavior, dysphoric states and the menstrual cycle: results from single smoking sessions and the natural environment

A 2-way factorial repeated measures design examined the effects of menstrual cycle phase and smoking on: 1) smoking behavior, 2) mood state, 3) nicotine withdrawal symptomatology, and 4) menstrual symptomatology. Female smokers, aged 20-39, were followed for two consecutive menstrual cycles with two data collection sessions per cycle, which were conducted in the University's General Clinical Research Center (GCRC). Participants were randomly assigned to order of smoking condition, which included: 1) smoking ad libitum, and 2) 24-hour abstinence prior to data collection. Data were collected in the mid-to-late follicular (MLF) phase (between days 6 through to 11) and the four days prior to menses in late luteal (LL) phase. Participants completed the Profile of Mood States and Menstrual Symptom Severity List and recorded daily cigarette smoking rate in the natural environment during MLF and LL phases. Nicotine boost and carbon monoxide (CO) boost were measured and the Shiffman-Jarvick Tobacco Withdrawal Questionnaire was administered during GCRC data collection sessions. Results indicated that subjects smoked more cigarettes per day during the LL phase and CO boost was greater during MLF. No difference was noted in nicotine boost by condition or phase. No difference in mood state was noted by either condition or phase. Withdrawal symptomatology and craving for cigarettes were increased after 24 hours of abstinence. No difference was noted in menstrual symptoms by condition or phase. Further investigations are still needed to characterize the importance of cycle phase in the design of smoking cessation interventions for women of reproductive age.

The relationship between psychological distress and gastrointestinal symptoms in women with irritable bowel syndrome

BACKGROUND

Individuals with irritable bowel syndrome (IBS) are reported to experience more symptoms compatible with psychopathologic disorders, abnormal personality traits, and psychological distress. Conversely, individuals with psychiatric disorders report higher levels of gastrointestinal (GI) symptoms compatible with IBS. Thus, psychological distress may contribute to GI symptoms in individuals with IBS.

OBJECTIVES

To examine psychological distress in women with IBS, women with similar GI symptoms but not diagnosed (IBS nonpatients, IBS-NP), and asymptomatic Control women.

METHODS

The women (N=97) were interviewed, completed questionnaires, and maintained daily diaries for 2 months. Across-women and within-woman analyses were used to calculate the results.

RESULTS

The IBS and IBS-NP groups had a higher percentage of lifetime psychopathology and recalled psychological distress. At least 40% of the women in the IBS and IBS-NP groups had positive relationships between daily psychological distress and daily GI symptoms.

CONCLUSIONS

Psychological distress is an important component of the IBS symptom experience and should be considered when treatment strategies are designed.

Reflex control of autonomic function induced by posture change during the menstrual cycle

This study was designed to determine whether autonomic regulation induced by posture changes varies during the menstrual cycle. Heart rate variability (HRV) was analyzed in women with normal menstrual cycles (n = 10, age range 20-37 years) during 3 min periods of controlled frequency breathing (15 breaths/min) in supine followed by sitting positions. In a supine or sitting position, high frequency (HF) components of HRV, which reflects only parasympathetic activity, were significantly high in the follicular phase compared with those in the menstrual phase, suggesting that parasympathetic nerve activity increases in this phase. Following the change of position to sitting from supine, the HF component decreased significantly in the menstrual, ovulatory and luteal phases, but not the follicular or premenstrual phase. After changing the position to sitting, the low to high frequency component ratio, which reflects the balance of autonomic nerve activities, was increased significantly in the menstrual, luteal and premenstrual phases, indicating that sympathetic nerve activities in these phases became predominant by the sitting position. These results suggest that parasympathetic nerve activity is predominant in the follicular phase, resulting in an impairment of baroreflex caused by posture changes. Moreover, baroreflex control of the sympathetic component, not the parasympathetic component, increases in the premenstrual phase, while the reflex response of the sympathetic component is less in the ovulatory phase compared with the menstrual or luteal phase. We concluded that baroreflex regulation of autonomic functions induced by changing positions is modified during the menstrual cycle. A difference of a balance of ovarian hormones may be responsible for these changes of autonomic functions during the menstrual cycle.

Neuromuscular performance characteristics in elite female athletes

The purpose of this research was to identify possible predisposing neuromuscular factors for knee injuries, particularly anterior cruciate ligament tears in female athletes by investigating anterior knee laxity, lower extremity muscle strength, endurance, muscle reaction time, and muscle recruitment order in response to anterior tibial translation. We recruited four subject groups: elite female (N = 40) and male (N = 60) athletes and sex-matched nonathletic controls (N = 40). All participants underwent a subjective evaluation of knee function, arthrometer measurement of anterior tibial translation, isokinetic dynamometer strength and endurance tests at 60 and 240 deg/sec, and anterior tibial translation stress tests. Dynamic stress testing of muscles demonstrated less anterior tibial translation in the knees of the athletes (both men and women) compared with the nonathletic controls. Female athletes and controls demonstrated more anterior tibial laxity than their male counterparts and significantly less muscle strength and endurance. Compared with the male athletes, the female athletes took significantly longer to generate maximum hamstring muscle torque during isokinetic testing. Although no significant differences were found in either spinal or cortical muscle reaction times, the muscle recruitment order in some female athletes was markedly different. The female athletes appeared to rely more on their quadriceps muscles in response to anterior tibial translation; the three other test groups relied more on their hamstring muscles for initial knee stabilization.

Power spectral analysis of heart rate variability in healthy young women during the normal menstrual cycle

This study investigated the fluctuations of autonomic nervous activities during the menstrual cycle. Twenty college females were tested for cardiovascular reactivity to mental challenge during both follicular and luteal phases across two menstrual cycles. Power spectral analysis of heart rate variability (HRV) was used to examine the autonomic nervous activities. At baseline, although heart rate and blood pressure did not differ across the menstrual cycle, the low-frequency (LF) component in the HRV was higher and the high-frequency (HF) component in the HRV was lower during the luteal phase than during the follicular phase. The LF/HF ratio was also significantly greater in the luteal phase. These data suggest that sympathetic nervous activities are predominant in the luteal phase as compared with follicular phase. In addition, the power spectral analysis of HRV has more sensitivity than heart rate or blood pressure in assessing the slight fluctuations of autonomic nervous activities during the menstrual cycle.

Macronutrient intake, eating habits, and exercise as moderators of menstrual distress in healthy women

The present investigation studied the relationship between symptoms of menstrual distress and macronutrient intake, eating behavior, and exercise in healthy women. Twenty-six normally menstruating women with no complaints of menstrual distress completed a disguised questionnaire on menstrual symptoms and monitored the type and amount of food consumed as well as the type and duration of exercise during a full menstrual cycle. Menstrual cycle phases were determined by the presence of menses, ovarian hormonal assays, and basal temperature monitoring. Reports of pain, water retention, negative affect, behavior change, and arousal were significantly higher (p < .05 or better) in the perimenstruum when compared to the follicular and luteal phases. During the perimenstruum, a higher energy intake of carbohydrate was associated with higher ratings of negative affect (p < .01) and impaired performance/decreased activity (p < .05). Lower energy intake of protein was associated with higher ratings of well being (p < .05). Overeating and dieting behavior were related to greater water retention (p < .01), autonomic reactions (p < .05), and appetite (p < .05). The amount of aerobic exercise in contrast to the intensity was related to lower water retention (p < .01), autonomic reactions (p < .05), and appetite (p < .01). Carbohydrate consumption, eating behavior, and regular exercise are reliably associated with menstrual distress and deserving of experimental evaluation as treatment interventions for menstrual distress.

Preferences for foods with varying levels of salt and fat differ as a function of dietary restraint and exercise but not menstrual cycle

Women commonly report increased cravings for foods high in sugar, fat, and/or salt premenstrually relative to other times during the menstrual cycle. To determine if elevated cravings for foods high in salt and/or fat were related to alterations in food preferences across the menstrual cycle, preference and sensory ratings for air-popped popcorn with varying levels of salt (0.0, 1.5, and 4.0 g) and butter (3.3, 10, and 30 g) added to 30 g of popcorn were assessed in 34 normal-weight, college-aged women for 4 consecutive weeks. Additionally, using the Profile of Mood Scale (POMS), mood states were determined across the menstrual cycle. Dietary restraint, disinhibition, and hunger were assessed using the Three Factor Eating Questionnaire (TFEQ). Neither preference ratings nor ratings of the saltiness or fatness of the popcorn samples varied as a function of the menstrual cycle. Moreover, no differences in mood states were observed across the menstrual cycle. However, preference ratings for the popcorn samples were significantly greater for restrained than unrestrained eaters. Restrained eaters also rated the samples as significantly more salty, and had significantly higher scores on the tension-anxiety and depression-dejection subscale of the POMS than unrestrained eaters. Additionally, preference ratings of women who reported exercising more than 3 h a week were significantly greater than those of women who reported exercising less than 3 h a week. It is hypothesized that the variations in preference ratings observed as a function of dietary restraint and exercise are the result of differences in cognitive beliefs about food, rather than differences in physiological factors.

Symptomatology across the menstrual cycle in smoking and nonsmoking women

Recent studies suggest that both smoking rates and general menstrual symptomatology increase in women premenstrually; however, no study has investigated the changes in menstrual symptomatology and smoking behavior in both smoking and nonsmoking women over an entire menstrual cycle. Thirty premenopausal women completed daily symptom checklists over an entire menstrual cycle. Smokers also recorded their smoking behavior. Results indicated that symptom severity was greatest during menses for both smoking and nonsmoking women. For cigarette consumption, analyses indicated that women smokers appear to smoke more during menses and the luteal phases than ovulation and that variability in smoking was greatest premenstrually. In summary, results indicated that general menstrual symptomatology increases during menses and the late luteal phase and that smoking-deprivation symptomatology increase in both smokers and nonsmokers. This suggests that smokers may have a difficult time quitting during menses or the luteal phase of their cycle.

Menstrual cycle effects on the action of buspirone on food intake in healthy female volunteers

We studied the effect of single doses of the 5-HT(1A) agonist buspirone (10 mg and 20 mg) on food intake during the menstrual cycle of nine healthy women, none of whom were on a contraceptive pill. In a double-blind placebo-controlled trial, subjects were tested over three cycles, receiving one treatment per cycle. Within each cycle, they were tested at two time points; mid-follicular and late luteal. Food intake following 20 mg buspirone was significantly higher in the luteal phase, suggesting the possibility of pre-menstrually enhanced 5-HT receptor sensitivity.