Sleep, premenstrual mood disorder, and women’s health

Premenstrual Symptoms Risk Factors Among Newly Graduated Nurses in Shift Work: A Prospective Longitudinal Study

PURPOSE

The premenstrual symptoms (PMSs) are a common health issue affecting women of reproductive age and are associated with various physiological, psychological, and situational factors. Newly graduated nurses, when suddenly exposed to excessive workloads and shift work, may experience disturbances such as sleep disorders, fatigue, depression, and stress. These factors are related to PMS, and their occurrence varies. Therefore, this study aimed to understand the changes in PMS and its risk factors among newly graduated nurses across shift work periods, and investigate the longitudinal relationships between PMS and its risk factors based on the theory of unpleasant symptoms.

METHODS

This study constituted a secondary data analysis and employed a prospective longitudinal design. Newly graduated nurses were assessed three times: before starting shift work, six months after initiating shift work, and 18 months thereafter. Physiological (age, body mass index, alcohol consumption, dietary behavior), psychological (sleep quality, fatigue, depression, stress, life satisfaction), and situational (social support) factors were included as PMS-related factors.

RESULTS

PMS worsened six months after the initiation of shift work compared with those before, and this aggravation persisted even after 18 months of shift work (p < .001). Age (p = .043), sleep quality (p = .004), and fatigue (p < .001) were associated with PMS. An interaction between time and depression that affected PMS was observed (p = .021).

CONCLUSION

Newly graduated nurses need to pay attention to the exacerbation of PMS after initiating shift work. Interventions to improve sleep quality and reduce fatigue are crucial for novice nurses, irrespective of shiftwork duration. Additionally, it is important to assess depressive symptoms before starting shift work and implement early interventions. Furthermore, the need for interventions addressing depression escalates with the increase in shiftwork duration.

The behavioral and physiological correlates of affective mood switching in premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD), a more severe manifestation of premenstrual syndrome (PMS), is characterized by emotional, behavioral, and physical symptoms that begin in the mid-to-late luteal phase of the menstrual cycle, when estradiol and progesterone levels precipitously decline, and remit after the onset of menses. Remotely monitoring physiologic variables associated with PMDD depression symptoms, such as heart rate variability (HRV), sleep, and physical activity, holds promise for developing an affective state prediction model. Switching into and out of depressive states is associated with an increased risk of suicide, and therefore, monitoring periods of affective switching may help mitigate risk. Management of other chronic health conditions, including cardiovascular disease and diabetes, has benefited from remote digital monitoring paradigms that enable patients and physicians to monitor symptoms in real-time and make behavioral and medication adjustments. PMDD is a chronic condition that may benefit from real-time, remote monitoring. However, clinical practice has not advanced to monitoring affective states in real-time. Identifying remote monitoring paradigms that can detect within-person affective state change may help facilitate later research on timely and efficacious interventions for individuals with PMDD. This narrative review synthesizes the current literature on behavioral and physiological correlates of PMDD suitable for remote monitoring during the menstrual cycle. The reliable measurement of heart rate variability (HRV), sleep, and physical activity, with existing wearable technology, suggests the potential of a remote monitoring paradigm in PMDD and other depressive disorders.

Biological rhythms in premenstrual syndrome and premenstrual dysphoric disorder: a systematic review

BACKGROUND

Women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) typically experience a range of psychological and physiological symptoms that negatively affect their quality of life. Disruption in biological rhythms, including alterations of the sleep-wake cycle, have been implicated in PMS/PMDD, though literature is still growing to substantiate these findings. The objective of this study is to systematically review the available literature on biological rhythms disruption in PMS/PMDD.

METHODS

A literature search was conducted on four databases (Pubmed, Embase, Medline, and Web of Science) on December 3rd, 2021. This search yielded a total of 575 articles that assessed the relationship between biological rhythms and PMS/PMDD/premenstrual symptoms.

RESULTS

After the exclusion of irrelevant articles and hand-searching references, 25 articles were included in this systematic review. Some studies showed that women with PMS/PMDD present lower melatonin levels, elevated nighttime core body temperature, and worse subjective perception of sleep quality when compared to women without PMS/PMDD. Other biological rhythms parameters showed either no differences between groups (wrist actimetry) or conflicting results (objective sleep parameters, cortisol, prolactin, and thyroid stimulating hormone).

CONCLUSION

Current research demonstrates that women with PMS/PMDD experience lower melatonin levels, higher body temperature, and worse subjective perception of sleep quality. This review outlines some possible mechanisms behind these findings and proposes recommendations for future research. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020149921.

Premenstrual syndrome and lifestyle: Development and validity of a Premenstrual Syndrome Quality-Of-Life Scale

BACKGROUND

Premenstrual Syndrome significantly affects young women's quality of life, encompassing psychological and clinical symptoms. The aim of this study is to develop a comprehensive and reliable Premenstrual Syndrome Quality of Life Scale and identify factors that affect women's quality of life.

METHODS

A methodological and descriptive study was conducted to develop a Premenstrual Syndrome Quality of Life Scale in three phases. Initially, a literature review and qualitative interviews were conducted to generate an item pool. In the second phase, the validity and reliability of the scale were tested. Exploratory Factor Analysis, Confirmatory Factor Analysis were used to confirm the validity and Cronbach's Alpha coefficient was calculated for reliability. In the final phase, the psychometric properties of the scale were evaluated.

RESULTS

A 28-item scale was developed in phase one. In Phase two 260 women were participated. Factor analysis confirmed the scale's validity with a KMO measure of 0.837 and significant Bartlett's Sphericity Test (p < 0.000). Confirmatory factor analysis indicated a good fit for the scale. Reliability analysis showed high reliability for the overall scale and subscales. Phase three included 212 participants diagnosed with premenstrual syndrome. There are no significant correlations between age, menarche age, and overall PMS Quality-of-Life scores. However, higher PMS severity and urban living negatively impact quality of life (p < 0.05).

CONCLUSIONS

The Premenstrual Syndrome Quality of Life Scale provides a holistic assessment of premenstrual syndrome impact on women's lives, addressing physical, emotional, and social dimensions.

Knowledge, attitude, and practice toward sleep disorders and sleep hygiene among perimenopausal women

This cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) toward sleep disorders and sleep hygiene among perimenopausal women, who were enrolled in Dezhou region of Shandong Province between July and September 2023. A total of 720 valid questionnaires were collected (mean age: 51.28 ± 4.32 years old), and 344 (47.78%) reported experiencing insomnia. The mean scores for knowledge, attitude, practice, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) were 15.73 ± 7.60 (possible range: 0-36), 29.35 ± 3.15 (possible range: 10-50), 28.54 ± 4.03 (possible range: 10-50), and 6.79 ± 1.90 (possible range: 0-10), respectively. Path analysis showed that knowledge had direct effects on attitude (β = 0.04, 95% CI 0.01-0.07, P = 0.001), and DBAS (β = 0.04, 95% CI 0.02-0.05, P < 0.001). Knowledge had direct effects (β = 0.11, 95% CI 0.08-0.15, P < 0.001) and indirect (β = 0.02, 95% CI 0.00-0.03, P = 0.002) effect on practice. Moreover, attitude also had a direct impact on practice (β = 0.34, 95% CI 0.25-0.43, P < 0.001). In conclusion, perimenopausal women exhibited insufficient knowledge, negative attitude, inactive practice toward sleep disorders and sleep hygiene, and unfavorable DBAS, emphasizing the need for targeted healthcare interventions.

LSD increases sleep duration the night after microdosing

Microdosing psychedelic drugs at a level below the threshold to induce hallucinations is an increasingly common lifestyle practice. However, the effects of microdosing on sleep have not been previously reported. Here, we report results from a Phase 1 randomized controlled trial in which 80 healthy adult male volunteers received a 6-week course of either LSD (10 µg) or placebo with doses self-administered every third day. Participants used a commercially available sleep/activity tracker for the duration of the trial. Data from 3231 nights of sleep showed that on the night after microdosing, participants in the LSD group slept an extra 24.3 min per night (95% Confidence Interval 10.3-38.3 min) compared to placebo-with no reductions of sleep observed on the dosing day itself. There were no changes in the proportion of time spent in various sleep stages or in participant physical activity. These results show a clear modification of the physiological sleep requirements in healthy male volunteers who microdose LSD. The clear, clinically significant changes in objective measurements of sleep observed are difficult to explain as a placebo effect. Trial registration: Australian New Zealand Clinical Trials Registry: A randomized, double-blind, placebo-controlled trial of repeated microdoses of lysergic acid diethylamide (LSD) in healthy volunteers; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381476 ; ACTRN12621000436875.

The impact of COVID-19 on menstrual cycle's alterations, in relation to depression and sleep disturbances: a prospective observational study in a population of medical students

BACKGROUND

The sars-Cov-2 pandemic has determined psychological stress, particularly in the young population of medical students. We studied the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students.

METHODS

293 female students at the Faculty of Medicine and Psychology of the Sapienza University of Rome (23.08 years old ± 3.8) were enrolled. In March 2021, one year after quarantine, a personal data sheet on menstrual cycle, examining the quality of the menstrual cycle during the pandemic, compared to the previous period. Concomitantly, the Beck Depression Inventory and the Impact of Event Scale have been administered. A Pearson chi-square test was assessed to evaluate the difference between the characteristics of the menstrual cycle and the scores obtained with the questionnaires.

RESULTS

A statistically significant association between menstrual alterations and stress during pandemic had been found. The onset of depressive symptoms and sleep disturbances was observed in 57.1% and in 58.1% of young women with cycle's alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, premenstrual syndrome had a significant correlation with both depression and sleep disturbances. The pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea.

CONCLUSIONS

The pandemic affected the menstrual cycle as well as the depressive symptoms and sleep. Practical implications of the study lead to the development of strategies for psychological intervention during the pandemic experience, in order to help medical trainees, with specific attention to women's needs. Future studies should analyze the impact of other types of social stress events, on sleep, depression and the menstrual cycle beside the pandemic.

Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study

Introduction

Menstruation-related symptoms (MRSs) significantly impact women's health and contribute to economic burdens worldwide. Current interventions, primarily pharmacological ones, have limitations and side effects that underscore the need for alternative management strategies. This study explores the association between MRSs and lifestyle factors, specifically physical activity and sleep timing across menstrual cycle phases, to inform non-pharmacological intervention development.

Methods

Fourteen female students from Ritsumeikan University, Japan, with regular menstrual cycles (25-38 days), not on hormonal treatment or engaged in shift work, participated in this observational study. Using a Fitbit Inspire 2, total daily energy expenditure (TDEE) and sleep timing were monitored over a complete cycle. Menstrual cycle phases were defined based on ovulation day, predicted using home luteinizing hormone tests. Participants completed daily electronic questionnaires rating MRSs using a modified menstrual distress questionnaire. Data were analyzed using a generalized linear mixed model with a gamma distribution and logarithmic link function, examining the relationship of TDEE and the midpoint of sleep time (MS time) with MRS severity.

Results and discussion

The following observations were noted: first, MRS severity, except for behavioral change symptoms, significantly increased during the menstrual and luteal phases compared to the follicular phase. Second, delayed MS time was associated with reduced pain, concentration symptoms, water retention, and negative affect during the menstrual phase and reduced negative affect during the luteal phase. Finally, an increase in TDEE was associated with reduced concentration symptoms, autonomic reaction symptoms, and negative affect during the menstrual and luteal phases and reduced water retention only during the luteal phase. This study provides insights into the relationship between MRSs and TDEE/MS time, suggesting potential non-therapeutic approaches for symptom management, though further research is needed to substantiate these findings for practical applications.

Sleep Quality in Women with Premenstrual Syndrome Is Associated with Metabolic Syndrome-Related Variables

In this study, we examined whether metabolic syndrome (MetS)-related variables are simultaneously affected by sleep quality, premenstrual syndrome (PMS) and dietary consumption. In this cross-sectional study, data for 307 premenopausal women were available. The results showed that women experiencing PMS had significantly lower sleep quality and were more depressed and anxious (p < 0.001 for all). After the subjects were divided into groups according to PMS, the effect of sleep quality on MetS-related variables or MetS components significantly differed; only among women who experienced PMS were poor sleepers significantly higher in waist circumference (p = 0.018) and diastolic blood pressure (p = 0.012) than good sleepers. Among the MetS components, abdominal obesity in women with poor sleep quality was approximately three (16.9% vs. 3.0%, p= 0.020) times more common than in those with good sleep quality. However, these findings were not observed among those who did not experience PMS. Poor sleepers among women experiencing PMS consumed 2.8 times more alcoholic drinks than good sleepers (p = 0.006). The MetS-related variables in Korean women experiencing PMS are associated with sleep quality, and these associations may be modified by dietary habits.

Characteristics of menstrual cycle disorder and saliva metabolomics of young women in a high-temperature environment

Objective: Menstrual disorders induced by high-temperature environments, can seriously damage women's reproductive health and workability. The regulation mechanism underlying it is not yet to be elucidated. Saliva is an information-rich biological fluid that can reflect systemic diseases. Here, we investigated the characteristics of menstrual cycle disorders and saliva metabolomics to provide a deeper insight of the regulation mechanism of young women in high-temperature environments. Methods: Women from high and normal temperature areas of China were selected and divided into two groups-high-temperature (H group) and control (C group). A questionnaire survey was conducted in summer (July) to investigate the incidence rate of menstrual disorders, characteristics of the disorders, and factors influencing the risk of these disorders in different regions. Metabolomics was applied to analyze the characteristics of the salivary metabolites and neurotransmitters in the two groups of women with menstrual disorders. Results: The incidence rate of menstrual disorders was significantly higher in the H group than that in the C group (p < 0.05). High-temperature environment, stress, and sleep quality were identified as critical factors associated with menstrual disorders. Non-targeted saliva metabolomics identified 64 significantly different metabolites between two groups, which mainly enriched in metabolic pathways such as carbohydrate metabolism, membrane transport, digestive system, and nucleotide metabolism (p < 0.05). N-acetylneuraminic acid, MYO, and tyramine may be candidate markers for early diagnosis of menstrual disorders in high temperature environments. Metabolites may be involving in the acute-phase response during an inflammatory process, to affecting the reproductive system by influencing the HPA axis loop. Regulations about oocyte membrane production and the luteal functions would be exerted in menstrual disorders. Targeted metabolomics of neurotransmitters revealed increased expression of histamine (HA) and glutamine and decreased expression of 5-hydroxyindole acetic acid (5-HIAA) (p < 0.05). Conclusion: Menstrual disorder characteristics induced by high temperature environments were specific. Anxiety, sleep quality and temperature feeling were the key factors to the menstrual disorder. endocrine regulation mechanism and inflammatory reactions might contribute to the development of menstrual disorders through influencing the formation of the follicular cell membrane.

Associations among social jetlag, sleep-related characteristics, premenstrual symptoms, depression, and body mass index of female nursing students

PURPOSE

This study aimed to identify the predictors of female nursing students' body mass index (BMI), including social jetlag.

DESIGN AND METHODS

This secondary data analysis of a cross-sectional survey conducted in 2015 included data of 304 female undergraduate nursing students. A hierarchical regression analysis was performed to identify the predictors of BMI.

FINDINGS

Social jetlag was the most potent predictor of BMI, followed by premenstrual symptoms and sleep quality.

PRACTICE IMPLICATIONS

This study presents foundational data for developing interventions for social jetlag management as a strategy to prevent obesity in female nursing students by identifying factors predicting BMI.

Effects of exogenous melatonin on sleep and circadian rhythms in women with premenstrual dysphoric disorder

We previously found normal polysomnographic (PSG) sleep efficiency, increased slow-wave sleep (SWS), and a blunted melatonin secretion in women with premenstrual dysphoric disorder (PMDD) compared to controls. Here, we investigated the effects of exogenous melatonin in five patients previously studied. They took 2 mg of slow-release melatonin 1 h before bedtime during their luteal phase (LP) for three menstrual cycles. At baseline, patients spent every third night throughout one menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analog scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual Symptoms (PRISM), and ovarian plasma hormones. Participants also underwent two 24-hour intensive physiological monitoring (during the follicular phase and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration. In the intervention condition compared to baseline, we found increased urinary aMt6 (p < 0.001), reduced objective sleep onset latency (p = 0.01), reduced SWS (p < 0.001), and increased Stage 2 sleep (p < 0.001). Increased urinary aMt6 was correlated with reduced SWS (r = -0.51, p < 0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p = 0.01). Ovarian hormones were comparable between the conditions (p ≥ 0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p = 0.02) and the PRISM (p < 0.001). These findings support a role for disturbed melatonergic system in PMDD that can be partially corrected by exogenous melatonin.

Investigation of the Relationship between Premenstrual Syndrome, and Childhood Trauma and Mental State in Adolescents with Premenstrual Syndrome

PURPOSE

This study was aimed at investigating the relationship between premenstrual syndrome (PMS), and childhood trauma and mental state in adolescents with PMS.

DESIGN AND METHODS

This descriptive study was conducted with 702 students between September 2020 and November 2020. An Information Form, the PMS Scale, the Childhood Trauma Questionnaire (CTQ) and Symptom Checklist (SCL)-90 were used as the data collection tools.

RESULTS

The mean scores the participants with PMS obtained from the Symptom Checklist (SCL)-90 and Childhood Trauma Questionnaire (CTQ) were higher than were those obtained by the participants without PMS. The Pearson correlation analysis revealed a positive and weak statistically significant relationship between the PMS Scale, and SCL-90 and CTQ.

CONCLUSIONS

The results of the study demonstrated that adolescents with PMS suffered from childhood traumas and mental problems more.

Intermittent Fasting, Dietary Modifications, and Exercise for the Control of Gestational Diabetes and Maternal Mood Dysregulation: A Review and a Case Report

Gestational diabetes mellitus (GDM) is a common pregnancy-related condition afflicting 5-36% of pregnancies. It is associated with many morbid maternal and fetal outcomes. Mood dysregulations (MDs, e.g., depression, distress, and anxiety) are common among women with GDM, and they exacerbate its prognosis and hinder its treatment. Hence, in addition to early detection and proper management of GDM, treating the associated MDs is crucial. Maternal hyperglycemia and MDs result from a complex network of genetic, behavioral, and environmental factors. This review briefly explores mechanisms that underlie GDM and prenatal MDs. It also describes the effect of exercise, dietary modification, and intermittent fasting (IF) on metabolic and affective dysfunctions exemplified by a case report. In this patient, interventions such as IF considerably reduced maternal body weight, plasma glucose, and psychological distress without any adverse effects. Thus, IF is one measure that can control GDM and maternal MDs; however, more investigations are warranted.