Emotional interference and attentional processing in premenstrual syndrome

Premenstrual syndrome is associated with differences in heart rate variability and attentional control throughout the menstrual cycle: A pilot study

INTRODUCTION

Most persons with an active menstrual cycle suffer from a range of aversive symptoms (e.g. reduced ability to concentrate) in the days before their menstruation - the premenstrual syndrome (PMS). Biological and cognitive mechanisms of PMS are poorly understood. It has been shown that vagally mediated heart rate variability (vmHRV), a physiological marker of self-regulation, decreases during the PMS-affected cycle phase (luteal phase) only in individuals with high PMS symptomology. This study investigates the specific associations between vmHRV, PMS symptomology and cognitive self-regulation (attentional control).

METHODS

In this between-subject study, participants completed an vmHRV baseline measurement through electrocardiography, a reaction time paradigm to measure attentional control (modified attention network test revised, ANT-R) and filled out a questionnaire regarding impact of PMS as well as current menstrual phase.

RESULTS

Mixed Model analysis showed interactions effects in the hypothesized direction. VmHRV was decreased during the luteal phase only in individuals with higher PMS. Analogously, performance in the Executive Functioning of the ANT-R task was reduced in the luteal compared to the follicular phase only in individuals with increased PMS symptoms. No effects were found in the Orienting Network Score.

DISCUSSION

The results point in the direction of associations between vmHRV, PMS and self-regulation. This could hint at common underlying mechanisms. Further research, however, must be conducted to examine causal pathways to confirm these associations.

Association between physical activity and risk of premenstrual syndrome among female college students: a systematic review and meta-analysis

BACKGROUND

This study aimed to analyze the relationship between physical activity and the risk of premenstrual syndrome among college students.

METHODS

Eligible studies were searched from the PubMed, Web of Science, and Embase databases. The link between physical activity and the risk of premenstrual syndrome was evaluated using odds ratio (OR) and 95% confidence interval (CI). The heterogeneity of the included studies was tested and their sources were explored by subgroup analysis. A sensitivity analysis was performed to assess the effect of a single study on the pooled results. The included studies were evaluated for publication bias. Five moderate-quality studies were included in this meta-analysis.

RESULTS

Physical activity levels were negatively associated with risk of premenstrual syndrome among college students (OR [95%CI] = 1.46 [1.09, 1.96], P = .011). The pooled results were not influenced after being stratified by the study region and whether multi-factor correction was performed or not. Publication bias was not observed in the included studies.

CONCLUSION

A high level of physical activity is dramatically associated with a reduced risk of premenstrual syndrome among female college students.

Women with more severe premenstrual syndrome have an enhanced anticipatory reward processing: a magnetoencephalography study

Laboratory studies reveal that young women with premenstrual syndrome (PMS) often exhibit decreased reward processing during the late luteal phase. However, studies based on the self-reports find opposite results (e.g., higher craving for high-sweet-fat food). These differences may lie in the difference between the stimulus used and measuring the different aspects of the reward. The present study was designed to expand previous work by using a classic monetary reward paradigm, simultaneously examining the motivational (i.e., reward anticipation, "wanting") and emotional (i.e., reward outcome, "liking") components of reward processing in women with high premenstrual symptoms (High PMS). College female students in their early twenties with High PMS (n = 20) and low premenstrual symptoms (Low PMS, n = 20) completed a monetary incentive delay task during their late luteal phase when the premenstrual symptoms typically peak. Brain activities in the reward anticipation phase and outcome phase were recorded using the magnetoencephalographic (MEG) imaging technique. No group differences were found in various behavioral measurements. For the MEG results, in the anticipation phase, when High PMS participants were presented with cues that predicted the upcoming monetary gains, they showed higher event-related magnetic fields (ERFs) than when they were presented with neutral non-reward cues. This pattern was reversed in Low PMS participants, as they showed lower reward cue-elicited ERFs than non-reward cue-elicited ones (cluster mass = 2560, cluster size = 891, p = .03, corrected for multiple comparisons), mainly in the right medial orbitofrontal and lateral orbitofrontal cortex (cluster mass = 375, cluster size = 140, p = .03, corrected for multiple comparisons). More importantly, women with High PMS had an overall significantly higher level of ERFs than women with Low PMS (cluster mass = 8039, cluster size = 2937, p = .0009, corrected for multiple comparisons) in the bilateral precentral gyrus, right postcentral gyrus, and left superior temporal gyrus (right: cluster mass = 410, cluster size = 128, p = .03; left: cluster mass = 352, cluster size = 98, p = .05; corrected for multiple comparisons). In the outcome phase, women with High PMS showed significantly lower theta power than the Low PMS ones for the expected non-reward feedback in the bilateral temporal-parietal regions (cluster mass = 47620, cluster size = 18308, p = .01, corrected for multiple comparisons). These findings reveal that the severity of PMS might alter reward anticipation. Specifically, women with High PMS displayed increased brain activities to reward-predicting cues and increased action preparation after the cues appear.

Effects of cognitive emotion regulation strategies on mood and cortisol in daily life in women with premenstrual dysphoric disorder

BACKGROUND

The psychological risk factors of premenstrual dysphoric disorder (PMDD) are not fully understood, but initial evidence points to a potential role of unfavorable cognitive emotion regulation (ER-) strategies. Given the symptom cyclicity of PMDD, ambulatory assessment is ideally suited to capture psychological and physiological processes across the menstrual cycle. Our study examines habitual ER-strategies in women with PMDD and their predictive value for the course of mood and basal cortisol across the cycle in affected women.

METHODS

Women with and without PMDD (n = 61 each) were compared regarding habitual mindfulness, reappraisal, and repetitive negative thinking (RNT). Momentary affect and cortisol output were assessed over two consecutive days per cycle phase (menstrual, follicular, ovulatory, late luteal).

RESULTS

Women with PMDD reported lower mindfulness, less use of reappraisal and stronger RNT than controls (ps < 0.035). In women with PMDD, higher mindfulness and reappraisal and lower RNT predicted decreased negative and increased positive affect across the menstrual cycle (ps < 0.027). However, women using more favorable ER-strategies displayed stronger mood cyclicity, resulting in stronger mood deterioration in the late luteal phase, thereby resembling women with more unfavorable ER-strategies toward the end of the cycle. Lower mindfulness predicted lower cortisol in the menstrual phase.

CONCLUSIONS

Protective ER-strategies seem to be generally linked to better momentary mood in women with PMDD, but do not appear to protect affected women from premenstrual mood deterioration. Habitual mindfulness, in turn, seems to buffer blunted cortisol activity in women with PMDD, especially in the menstrual phase.

Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms

Purpose

To measure the associations of diet, psycological distress, and lifestyle factors with premenstrual symptoms (PMSx) in women in Riyadh, Saudi Arabia.

Patients and Methods

An interview-based, cross-sectional study was conducted on 1831 women aged 18-50 years seen in primary healthcare centers and teaching institutes in Riyadh from December 2015 to June 2016. Question topics included sociodemographics, physical activity, smoking, and dietary habits information. PMSx were assessed using a symptom checklist with 6 domains: anxiety/mood changes; abdominal/back/joint pain; increased appetite/weight gain, breast pain/tenderness, severe headache, and ≥3 PMS symptoms (any). Multivariable logistic regression analyses were conducted to provide adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each PMSx domain.

Results

Except for breast pain, drinking >5 cups of Arabic coffee was associated with increased odds of anxiety/mood [aOR 2.44 (95% CI 1.44, 4.12)], pain [1.83 (1.13, 2.98)], appetite/weight gain [1.66 (1.10, 2.50)], headache [1.57 (1.00, 2.56)] and ≥3 symptoms [1.50 (1.07, 2.11)]. A significant association was noted between sugar intake and anxiety/mood symptoms [1.53 (1.07, 2.19)] and abdominal/back pain symptoms [1.84 (1.17, 2.88)]. Increased severity of psychological distress was associated with all symptom domains: anxiety/mood [2.75 (1.92, 3.94)]; pain [1.45 (0.92, 2.28)]; appetite/weight gain [2.01 (1.53, 2.65)]; breast pain [2.19 (1.68, 2.88)]; headache [1.86 (1.37, 2.54)] and ≥3 symptoms [3.52 (2.49, 4.95)]. Low physical activity was significantly associated with odds of breast pain symptoms [1.29 (1.04, 1.59)]. Smokers were 3.41 (1.19, 9.77) times as likely to report any ≥3 symptoms compared to nonsmokers.

Conclusion

Several potentially modifiable factors, such as diet and stress, were positively associated with PMSx. Thus, we suggest that increasing women's awareness of healthy lifestyles, particularly diet and stress reduction, may help to reduce the occurrence of premenstrual symptoms.

Premenstrual syndrome is associated with an altered spontaneous electroencephalographic delta/beta power ratio across the menstrual cycle

Premenstrual syndrome is associated with altered spontaneous brain activity in the late luteal phase, but the fluctuation patterns of brain activity throughout the menstrual cycle have not been revealed. Furthermore, it is also unknown whether the altered spontaneous brain activity during the whole menstrual cycle is further associated with their habitual use of maladaptive emotion regulation strategies. Based on the two reasons, electroencephalogram data and cognitive emotion regulation questionnaire from 32 women with high premenstrual symptoms (HPMS) and 33 women with low premenstrual symptoms (LPMS) were measured in the late luteal and follicular phases. Delta power, theta power, beta power, and the slow/fast wave ratios (SW/FW, including theta/beta power ratio [TBR] and delta/beta power ratio [DBR]) were calculated using both fixed frequency bands and individually adjusted frequency bands (based on the individual alpha peak frequency). The results showed that for the frontal and central DBR, as assessed both with fixed and individualized frequency bands, there was no difference between the two phases of the LPMS group, whereas there was a difference between the two phases of the HPMS group with a higher DBR in the late luteal phase than in the follicular phase. Further correlation results revealed that for women with HPMS in the late luteal phase, the frontal and central DBR values, as assessed both with fixed and individualized frequency bands, were positively correlated with self-blame and rumination. Consequently, HPMS was characterized by a fluctuation across the menstrual cycle in the DBR, which was further associated with maladaptive emotion regulation.

Eye movement pattern of attention bias to emotional stimuli in women with high premenstrual symptoms

BACKGROUND AND OBJECTIVES

Premenstrual Syndrome (PMS) refers to a group of symptoms linked to the menstrual cycle. Women with PMS have cognitive mode of rumination, which leads to their attention bias to emotional stimuli. This study investigated the biases for emotional information in women with high premenstrual symptoms (HPMS) compared with women with low premenstrual symptoms (LPMS).

METHODS

A total of 38 women with HPMS and 44 women with LPMS completed self-report questionnaires and a free viewing task with eye-tracking technology.

RESULTS

The questionnaire results indicate that women in the HPMS group had higher levels of rumination than those in the LPMS group. The eye-tracking results show that women in the HPMS group had an orientation bias towards negative emotional stimuli in the early cognitive process. In the late cognitive process, women in the HPMS group had accelerated attentional disengagement to positive emotional stimuli and difficult attentional disengagement to negative emotional stimuli. Further correlation analysis revealed positive relationships between the scores of initial fixation latency bias of positive pictures in premenstrual phase and the scores of symptom rumination in both groups and between the scores of initial fixation latency bias of positive pictures in premenstrual phase and the scores of brooding in HPMS group.

LIMITATIONS

This study used a retrospective questionnaire to assess the symptoms of PMS.

CONCLUSIONS

Women with HPMS had impaired attentional engagement and disengagement to emotional stimuli compared with women with LPMS, and it may be related to their cognitive mode of rumination.

Patterns of premenstrual syndrome and depression symptoms in Chinese female university students: Results of a latent profile analysis

BACKGROUND

Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach.

METHODS

The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity.

RESULTS

The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude.

LIMITATIONS

Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results.

CONCLUSION

These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.

Association of socio-demographic, dietary and lifestyle factors with Premenstrual Syndrome (PMS) among undergraduate medical students of a tertiary care institute in Ahmedabad, Gujarat

Introduction:

The frequency, as well as the severity of the PMS (Pre-Menstrual Syndrome), varies from female to female based on various socio-demographic, dietary, and lifestyle factors. Nevertheless, the PMS is known to affect day-to-day functioning including interference with school/work productivity, relationships with friends, family, and colleagues. This is especially important for medical students where academic performance is much skillful and demanding.

Methodology:

The inclusion criteria for this cross-sectional survey were female medical students studying in one of the medical colleges of the city, having regular menstrual cycle (in the last three consecutive months) and willing to participate in the research. Students were assigned from each of the four professional years (First, Second, Third, and Final) through random sampling so that the desires sample size was achieved. The study used a pre-designed questionnaire, the “Premenstrual Symptoms Screening Tool (PSST)” (through Google form), that included 14 items assessing premenstrual symptoms of appetite, mood, sleep, anxiety and physical symptoms. It includes functional impairment items in five different domains as well.

Results:

The common symptoms seen in the respondents were anger/irritability (Mild n = 76, 46.3%; Moderate to severe n = 68, 41.4%) followed by physical symptoms which included headaches, joint or muscle pain, breast tenderness, gain in weight and bloating. The commonest functional impairment was college/work efficiency or productivity (n = 79, 48.2%). Alcohol and tobacco consumption had a significant association with PMDD. The type of diet did not have significant statistical association with PMS or PMDD.

Conclusion:

The most common symptoms seen were anger/irritability as well as physical symptoms like headache, breast tenderness etc., Factors like sleep, diet, exercise, yoga, alcohol and smoking were assessed.

Neural evidence of dysfunction of reward processing in women with premenstrual syndrome

BACKGROUND

Most studies on the mechanism behind premenstrual syndrome (PMS) have focused on negative emotional overreaction, but little evidence exists regarding the weakening of positive emotions. Given the close relationship between positive emotions and reward processing, the aim of this study is to investigate the dysfunction of reward processing in women with PMS.

METHOD

Seventeen women with PMS and seventeen healthy women were scanned during a card guessing task in the late luteal phase. By selecting bilateral caudate and orbitofrontal cortex (OFC) as seed regions, region-of-interest (ROI) analysis and functional connectivity (psycho-physiological interaction [PPI]) analysis were conducted to compare the difference between two groups. Exploratory whole brain analysis was also conducted to examine the group differences in other reward-related brain regions.

RESULTS

ROI analysis revealed that healthy women showed stronger activation at the bilateral caudate and OFC when gains were contrasted to losses feedback, whereas women with PMS showed no significant difference between these two conditions. Whole brain analysis indicated that healthy women showed stronger activation at the right middle frontal gyrus (MFG) when gains were contrasted to losses feedback, whereas women with PMS showed no significant difference between these two conditions. Furthermore, separate analysis on healthy women revealed significant clusters of greater activation to gains minus losses that included the bilateral caudate, right middle temporal gyrus, and left inferior occipital gyrus; conversely, no significant clusters of activations to gains minus losses were observed in women with PMS. PPI analysis results revealed that women with PMS exhibited lower functional connectivity between the right caudate and the right cerebellum than healthy women when experiencing gains versus losses.

CONCLUSIONS

Our findings provide one of the first evidence that PMS is related to dysfunction in reward processing, which could be associated with the weakening of positive emotions.

Reduced Reward Responsiveness in Women With Moderate - to - Severe Premenstrual Syndrome: Evidence From a Probabilistic Reward Task

Nearly 50% of women of reproductive age worldwide experience premenstrual syndrome (PMS). Women with PMS exhibit low positive affect and low frontal electroencephalography asymmetry scores, both of which are associated with reward processing. These findings suggest that women with PMS may exhibit deficiencies in reward processing. A probabilistic reward task based on signal detection approach was used to assess reward responsiveness in 30 women with moderate-to-severe PMS and 31 controls without PMS. The results revealed that in the late luteal phase, the women with moderate-to-severe PMS exhibited lower response bias and lower hit rate toward more frequently rewarded stimuli (rich stimuli) than the controls. By contrast, the response bias and hit rate did not differ between the two groups in the follicular phase. The group differences still remained after controlling for anhedonic symptoms. Furthermore, trial-by-trial probability analyses revealed that women with moderate-to-severe PMS exhibited a trend of having a higher miss rate for rich stimuli than the controls. In particular, when a rich stimulus was preceded by an infrequently rewarded stimulus (a rewarded lean stimulus), participants in the PMS group exhibited a trend for higher miss rate than those in the control group in the late luteal and follicular phases. However, group differences in the probability analyses were nonsignificant after controlling for anhedonic symptoms. These results provide preliminary evidence that women with moderate-to-severe PMS exhibit dysfunctional reward responsiveness and impaired ability to modulate their behavior as a function of prior reinforcement.

Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE

Premenstrual syndrome (PMS) is a cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life. Little is known about PMS in the United Arab Emirates (UAE). This study aimed to determine the prevalence and severity of PMS among university students in Sharjah, UAE, and clarify its associations with dietary habits, lifestyle behaviors, and anthropometric factors. A cross-sectional study was conducted on female college students at the University of Sharjah, UAE. Data were collected using self-administered questionnaires and anthropometric assessments. Descriptive statistics and multiple logistic regression analyses were performed. Participants were 300 adult university students aged 18-24 years (mean age 20.07 ± 1.53 years). In total, 95% of participants reported at least one PMS symptom during their menstrual period. The prevalence of PMS was 35.3%, with mild symptoms being the most commonly reported. Multiple regression analysis showed that smoking was associated with increased risk of reporting psychological (OR 2.5, 95% CI 1.1-5.8; p < 0.05) and behavioral symptoms (OR 2.2, 95% CI 1.0-4.9; p < 0.05), while high calorie/fat/sugar/salt foods intake was associated with increased risk of reporting physical symptoms (OR 3.2, 95% CI 1.4-7.3; p < 0.05). However, fruit consumption (OR 0.34, 95% CI 0.125-0.92; p < 0.05) was associated with a decreased risk of reporting behavioral symptoms. A high prevalence of PMS was reported among university students, with smoking and high calorie/fat/sugar/salt food consumption identified as strong risk factors for PMS.

Gone in sixty (milli)seconds: Disentangling the effects of location context on attention bias

Attention bias is associated with a broad range of emotional disorders. Because of its transportability, attention bias modification (ABM) training can be administered outside of the laboratory; however, some evidence suggests that ABM training may be less effective when conducted in the individual's natural environment. The aim of this study was to examine factors that might account for the attenuated effects of attentional bias (AB) when assessed remotely. One hundred fifty-eight undergraduate psychology students completed the Emotional Stroop Task on two occasions - once in the laboratory and once remotely. To help disentangle the influences of emotional state and location on attention bias, participants were randomized to view either an emotionally provocative clip or an emotionally neutral clip prior to completing the emotional Stroop task. Results showed evidence of an attentional bias only in the laboratory, among participants in the neutral emotion condition (b = -19.67, P = .008, 95% CI [-34.18, -5.15]). Exploratory analyses revealed that emotion provocation was associated with attentional bias among individuals with greater symptoms of depression, but only remotely (b = -15.70, P = 0.046, 95% CI [-31.15, -0.25]). These findings suggest that caution should be used when conducting attention bias research remotely. Limitations and future directions are discussed.

The menstrual cycle affects recognition of emotional expressions: an event-related potential study

Background: Several studies have investigated the relationship between behavioral changes and the menstrual cycle in female subjects at a reproductive age. The present study investigated the relationship between the menstrual cycle and emotional face recognition by measuring the N170 component of ERPs.

Methods: We measured N170 of twelve women in both follicular phase and late luteal phase who were presented with human facial expressions as stimuli (happy and angry).

Results: In the follicular phase, participants showed a significantly larger response to happy male facial expressions. In the late luteal phase, participants had longer reaction times to all emotional stimuli, and a significantly reduced response to happy faces, especially happy male facial expressions (P<0.001).

Conclusions: Our findings suggest that the menstrual cycle modulates early visual cognitive processing, and highlight the importance of considering the menstrual cycle phase in studies that investigate emotion and cognition.

Subtle persistent working memory and selective attention deficits in women with premenstrual syndrome

As a recurrent, cyclical phenomenon, premenstrual syndrome (PMS) affects a significant proportion of women of the reproductive age, and leads to regular monthly days of functional impairment. Symptoms of PMS include somatic and psychological symptoms, such as headaches, sleep disturbances, social withdrawal and mood changes, during the late luteal phase of the menstrual cycle, which alleviate during the follicular phase. This study investigated neurocognitive functioning in women with moderate to severe PMS symptoms (n=13) compared to women with mild/no PMS (n=27) through administration of a battery of neuropsychological tests during the asymptomatic follicular phase of the menstrual cycle. Relative to women with mild/no PMS symptoms, women with moderate to severe PMS showed significantly poorer accuracy and more errors of omission on the N-0-back, as well as more errors of omission on the N-2-back task, indicating the presence of impairment in selective attention and working memory. This study provides evidence of persistent, subtle working memory and selective attention difficulties in those with moderate to severe PMS during the follicular phase of the menstrual cycle.