Premenstrual syndrome

Therapeutic selection for abnormal uterine bleeding with ovulatory dysfunction: a cross-sectional study in Chinese women

OBJECTIVE

To investigate the therapeutic selection of abnormal uterine bleeding with ovulatory dysfunction (AUB-O) among Chinese women and analyze the impact of various factors.

METHODS

This was a cross-sectional study involving 3527 patients with AUB-O diagnosed by local doctor between 14 and 55 years old. Questionnaire compiled according to the Chinese AUB-O treatment guidelines was used to collect the demographic and therapeutic information.

RESULTS

The patients were divided into the juvenile group, the reproductive group, and the senior group. The results showed that irregular menstruation (37.6-46.3%), dysmenorrhea (29.9-44.4%), and heavy menstrual bleeding (16.7-32.2%) were the main symptoms in Chinese AUB-O patients. Most of the patients chose to seek help in the Department of General Gynecology (78.6-90.7%). Among the therapeutic options, combined oral contraceptives (COCs) met the treatment expectations with high acceptance among patients (36.6%-52.2%).

CONCLUSION

This study underscores the crucial need to fortify the endocrine diagnostic proficiency of doctors within the Department of General Gynecology. Furthermore, it also indicates that implementing clinical medication education programs for patients could facilitate their correct selection of appropriate therapeutic strategies for AUB-O.

Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome

INTRODUCTION

Premenstrual syndrome (PMS) affects nearly half of women worldwide and is associated with sleep disturbances, though the specific relationship between PMS and nightmares remains underexplored. Clinical observations suggest a potential link, leading this study to investigate whether women with PMS experience more frequent or intense nightmares compared to those without PMS.

METHODS

We conducted a prospective case series of seven women experiencing nightmares, all of whom participated in weekly imagery rehearsal therapy (IRT) over 1-month. Each participant completed the daily record of severity of problems (DRSP) to assess PMS symptoms and kept daily dream diaries throughout one menstrual cycle, tracking nightmare frequency, intensity, and emotional valence. The nightmare severity index (NSI) was administered at the beginning and end of the study. Descriptive analysis was used for the dream metrics, and the Wilcoxon signed-rank test was employed to assess changes in NSI scores.

RESULTS

Women with PMS exhibited an increase in nightmare frequency during the premenstrual phase, but no formal statistical comparisons were made between PMS and non-PMS groups regarding dream frequency or intensity. A significant reduction in NSI scores (p = 0.03) was observed across the entire sample, though this effect was not significant in the PMS subgroup.

CONCLUSIONS

This case series is the first, to our knowledge, to provide detailed longitudinal data indicating that nightmare frequency may fluctuate across the menstrual cycle and could be more pronounced in women with PMS. While IRT effectively reduced nightmare severity overall, its specific impact on nightmares in women with PMS requires further research in larger studies.

Association between maternal overprotection and premenstrual disorder: a machine learning based exploratory study

BACKGROUND

Premenstrual disorder (PMD), which includes premenstrual syndrome and premenstrual dysphoric disorder, has a complex pathogenesis and may be closely related to emotional cognition and memory. However, the mechanisms underlying these associations remain unclear. Therefore, this study used machine learning to explore the roles of various factors that are not typically considered risk-factors for PMD.

METHODS

A predictive model for PMD was constructed using a dataset of questionnaire responses and heartrate variability data collected from 60 participants during their follicular and luteal phases. Based on the Japanese version of the Premenstrual Symptom Screening Tool, the binary objective variable (PMD status) was defined as "PMD" for moderate-to-severe premenstrual syndrome and premenstrual dysphoric disorder and other conditions as "non-PMD." The contribution of each feature to the predictive model was assessed using the Shapley Additive exPlanations (SHAP) model-interpretation framework.

RESULTS

Of the 58 participants (providing 117 data points), 17 (34 data points) were in the PMD group and 41 (83 data points) were in the non-PMD group. The area under the receiver operating characteristic curve was 0.90 (95% confidence interval: 0.82-0.98). Among the top 20 features with the highest SHAP values, six were associated with maternal bonding. Four of the six mother-related characteristics were associated with overprotection.

CONCLUSIONS

Based on these findings, parental bonding experiences, including maternal overprotection, may be associated with the presence of PMD.

Women with premenstrual syndrome exhibit high interoceptive accuracy, but low awareness, with parasympathetic rebound responses from stress

Premenstrual syndrome (PMS) is characterized by emotional or physical discomfort that occurs specifically during the luteal phase. However, women with PMS typically do not exhibit abnormalities in serum sex hormone levels or structural anomalies, making it challenging to identify distinct pathological findings unique to PMS. Instead, they may exhibit hypersensitivity to fluctuations in sex hormone levels within the normal range. This study involved experiments conducted in the late luteal phase. The pre-stress baseline state evaluated the effects of PMS on interoception using the Heartbeat Counting Task (HCT) and the Multidimensional Assessment of Interoceptive Awareness (MAIA), and the effects on emotional states using a questionnaire assessing subjective emotions in the late luteal phase. The results indicated that the "PMS group" scored higher on the HCT compared to the "without PMS group," while their MAIA scores were lower. Additionally, the PMS group reported experiencing more negative and stressful states. The findings suggest that women with PMS demonstrate high accuracy in but lower awareness of interoception. This mismatch between "accuracy" and "awareness" may indicate a maladaptive state regarding mental health. The stress-related analysis examined whether the effects of stress on exacerbating PMS include impacts on interoception and the autonomic nervous system (ANS). States before baseline, immediately after, and during stress recovery were evaluated. The results revealed that women in the PMS group exhibited more pronounced negative and stressful states; they showed higher scores on the HCT, with scores progressively increasing as the task was repeated. Regarding ANS indices, no main effect of group was observed, but parasympathetic activity increased during the recovery period compared to the pre-stress baseline. In the degree of changes in parasympathetic activity from the baseline to post-stress and recovery periods, a group-by-time interaction effect was observed. These findings suggest that the PMS group may experience a prolonged rebound effect during the recovery phase following induced stress. In conclusion, women with PMS exhibit a discrepancy between high interoceptive accuracy and low awareness of their sensations. This may contribute to heightened discomfort and suggest that vulnerability to stress, mediated by the parasympathetic nervous system, exacerbates factor for PMS symptoms.

Cardiac Autonomic and Affective Reactivity to Laboratory Stressors across the Menstrual Cycle: A Systematic Review

Fluctuations in steroid sex hormones are associated with altered cardiac autonomic and affective functioning across the female lifespan. The neuroendocrine pathways which modulate sex hormone changes during the menstrual cycle have reciprocal interactions with the autonomic nervous system, an integral system for self-regulation and stress response. Cardiac autonomic activity is often imbalanced among individuals with mental and physical health conditions. However, it is unclear whether variations in female-typical sex hormones across the menstrual cycle significantly alter cardiac autonomic and affective stress reactivity, which may underlie menstrual-related mood and psychosomatic symptoms. The present systematic review aims to address this gap by characterizing patterns of cardiac autonomic activity at baseline, and cardiac autonomic and affective reactivity to laboratory stress tasks across the menstrual cycle in reproductive-aged women. The review was preregistered (https://doi.org/10.17605/OSF.IO/B2Y5Q) and conducted in line with PRISMA guidelines. Twenty studies and 28 records were identified and discussed. The study found modest support for increased cardiac sympathetic activation at baseline and in response to stress, and greater affective reactivity within the luteal phase of the menstrual cycle. These results expand upon prior research demonstrating cardiac autonomic imbalance and affective vulnerability within the luteal phase to show that these patterns also influence stress reactivity. Additionally, the review aims to identify notable methodological limitations and gaps within this body of literature and suggests areas of future research to clarify the role of cardiac autonomic and affective processes in steroid sex hormone-related symptomatology.

Effect of a psychoeducation program based on cognitive-behavioral psychodrama techniques on premenstrual syndrome symptoms: a randomized controlled trial

Premenstrual syndrome is characterized by physical and psychological symptoms that negatively affect daily functioning. This study investigated the effect of a psychoeducation program based on cognitive-behavioral psychodrama techniques on premenstrual syndrome symptoms. This study utilized a 2 × 2 pretest-posttest, experimental-control group research design. The sample consisted of 32 participants randomized into experimental (n = 16) and control (n = 16) groups. The experimental group participated in a seven-session psychoeducation program based on cognitive-behavioral psychodrama techniques. Data were collected using a personal information questionnaire and the Premenstrual Syndrome Scale (PMSS). The experimental group demonstrated a significantly lower median posttest PMSS total and 'depressive affect', 'fatigue', 'irritability', 'depressive thoughts', 'changes in appetite' and 'changes in sleeping habits' subscale scores than the pretest score (p < .05). Moreover, the experimental group had a significantly lower median posttest 'anxiety' score than the control group (p = .021). A psychoeducational program based on cognitive-behavioral and psychodrama techniques can be used as an effective therapeutic intervention to relieve or managing premenstrual symptoms.

Menstrually-related mood disorders and postpartum depression: Convergent aspects in aetiology

Females diagnosed with Menstrually-related mood disorders (MRMDs) have more risk to develop postpartum depression (PPD). There are overlapping symptoms between MRMDs and PPD such as anxiety, depressed mood, irritability, that can contribute to a lower quality of life. MRMDs and PPD share components in their etiology such as dramatic hormonal oscillations, and alterations in Hypothalamus-Pituitary-Adrenal (HPA) axis activity that may impair GABAergic neurotransmission. As well, stressful events that impact HPA regulation may play an important role in the etiology of MRMDs and PPD. Here we review common hormone fluctuations across the menstrual cycle and pregnancy/postpartum to identify shared pathways that could contribute to greater sensitivity in people with MRMDs and PPD. This review summarizes hormone sensitivity, HPA axis activity and neurosteroids effects on GABAergic transmission and the potential role of chronic stress in developing MRMDs and PPD. In addition, other potential etiopathological factors, such as serotonin and the immune system, are discussed. Investigating the etiopathology of MRMDs and PDD will help to better understand the complexity of factors involved in these disorders that affect females across the reproductive years.

Association of preconception premenstrual disorders with perinatal depression: an analysis of the perinatal clinical database of a single Japanese institution

BACKGROUND

Recent studies have identified premenstrual disorders (PMDs) as a risk factor for postpartum depression. However, routine screening for preconception PMDs is not yet common in Japan. This study investigated the association between preconception PMDs and perinatal depression in a single tertiary care setting.

METHODS

We analyzed data from pregnant women who gave birth at Kyoto University Hospital between April 2020 and October 2023. The Premenstrual Symptoms Screening Tool was administered at the first postconception visit to retrospectively assess PMD status before the current pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was administered during pregnancy and one month postpartum as a prospective measure of perinatal depression. EPDS cutoff values were set at 12/13 during pregnancy and 8/9 at one month postpartum.

RESULTS

Of the 781 women analyzed, 53 had preconception PMD. Univariate and multivariate logistic regression analyses revealed that preconception PMD was associated with an EPDS score of ≥ 13 during pregnancy, with a crude odds ratio (OR) of 5.78 (95% confidence interval [CI]: 2.70-11.75) and an adjusted OR of 3.71 (95% CI: 1.54-8.35). For an EPDS score of ≥ 9 at 1 month postpartum, the crude OR was 3.36 (95% CI: 1.79-6.12) and the adjusted OR was 2.16 (95% CI: 1.04-4.35).

CONCLUSIONS

Our findings indicate that preconception PMDs are a significant risk factor for both depression during pregnancy and postpartum depression. These results support the implementation of preconception PMD screening during antenatal checkups as a preventive measure and to identify women in need of early mental health care.

Relationship Between Psychological Stress Scores and Urinary 5-HT Levels Over Time Under Psychological Stress

Background

Biomarkers for psychological stress have been examined and the "gut-microbiota-brain axis" is currently attracting attention. An intervention study reported improvements in both the intestinal environment and psychological stress. However, the relationship between psychological stress scores and urinary 5-hydroxytryptamine (u-5-HT), produced by enterochromaffin cells in the intestinal tract, has not yet been investigated over time in healthy subjects under psychological stress. Therefore, the present study examined the relationship between subjective psychological stress (depression and anxiety) scores and u-5-HT levels over time in healthy women.

Methods

The effects of the objective structured clinical examination (OSCE), considered to be a uniform source of psychological stress, on u-5-HT levels were assessed in 16 third-year female medical university students (21.3 ± 2.1 years old) in Japan with a normal menstrual cycle. A self-administered questionnaire consisting of Zung's Self-rating Depression Scale (SDS) and State-Trait Anxiety Inventory (STAI) was used to evaluate subjective stress 1 month, 1 week, and 1 day before and 1 week after the OSCE. Pearson's product-momentum correlation coefficient was used to calculate the correlation coefficient between u-5-HT levels, STAI, and SDS for each examined period.

Result

On the day before the OSCE, u-5-HT levels correlated with SDS and STAI (SDS: r = .524, P = .037, State-Anxiety: r = -.718, P = .002).

Conclusion

A correlation was observed between subjective psychological stress scores and u-5-HT levels in healthy women under psychological stress.

Clinical characteristics of female long COVID patients with menstrual symptoms: a retrospective study from a Japanese outpatient clinic

PURPOSE

To elucidate the impact of long COVID on menstruation and mental health, medical records of patients with long COVID were evaluated.

METHODS

Symptoms of long COVID, QOL, mental health, and related endocrine data were compared between two groups with and without menstrual disturbances.

RESULTS

Of 349 female patients who visited our clinic between February 2021 and March 2023, 223 patients with long COVID (aged 18-50 years) were included. Forty-four (19.7%) of the patients had menstrual symptoms associated with long COVID. The patients with menstrual symptoms were older than those without menstrual symptoms (42.5 vs. 38 years). The percentage of patients with menstrual symptoms was higher during the Omicron phase (24%) than during the Preceding (13%) and Delta (12%) phases. Cycle irregularity was the most frequent (in 63.6% of the patients), followed by severe pain (25%), heavy bleeding (20.5%), perimenopausal symptoms (18.2%), and premenstrual syndrome (15.9%). Fatigue and depression were the most frequent complications. Scores for fatigue and for QOL were significantly worse in long COVID patients with menstrual symptoms. Results of endocrine examinations showed significantly increased cortisol levels in patients with menstrual complaints.

CONCLUSION

Long COVID has an impact on menstrual conditions and on QOL related to menstrual conditions.

The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): a systematic review

BACKGROUND AND PURPOSE

Premenstrual dysphoric disorder (PMDD) is a debilitating illness that affects 3-8% of women worldwide. There are multiple factors underlying the aetiology of PMDD, ranging from neuroendocrine changes to psychosocial factors such as exposure to trauma. This systematic review aims to assess the prevalence of traumatic exposure in women with PMDD.

METHODS

A literature search of MEDLINE, EMBASE and PsycInfo was conducted following PRISMA guidelines. Of the 369 studies identified for abstract and full-text screening, 27 were included for review and 16 studies for the quantitative calculation of average prevalence and 95% confidence intervals. Data extracted included study details, sampling details, demographic details, type of traumatic exposure reported, diagnostic tools used, the prevalence of PMDD (total) and the prevalence of self-reported traumatic exposure in PMDD patients.

RESULTS

The reported prevalence of traumatic exposure in PMDD ranged from 18.03 to 90.5%. Using a random effects model, the pooled prevalence was 61% (95%CI, 46-74%). The level of heterogeneity (I2) was 95%, showing considerable variability in the data. Amongst only those studies with a control group, it was shown that those with PMDD are 1.99 times more likely to have a history of traumatic exposure than those without PMDD.

CONCLUSION

Our findings suggest that a history of traumatic exposure is highly represented in women living with PMDD. Trauma exposure may be a risk factor for PMDD and could inform this condition's aetiology. A trauma-informed approach should be considered when assessing and managing women presenting with PMDD.

Women with Premenstrual Dysphoric Disorder experiences of suicidal thoughts and behaviours: a mixed methods study

Background

Women with Premenstrual Dysphoric Disorder (PMDD) experience debilitating psychological symptoms during each luteal phase of their menstrual cycle. Although women's increased risk of suicidal thoughts and attempts to end their lives has been highlighted, little is as yet known about women's own narratives. Therefore, this study aimed to explore the prevalence and the experiences of self-harm, suicidal thoughts and attempts in women with PMDD.

Method

In this mixed methods study, women's experiences of living with PMDD were captured via an online survey exploring risk and via semi-structured interviews with questions informed by survey results. Data were analysed using descriptive statistics and reflexive thematic analysis.

Results

Over 3,600 women completed the survey between January and March 2020 and 14 women were subsequently interviewed in 2022. The survey revealed that just under half of women had deliberately harmed themselves during a PMDD crisis, 82% had suicidal thoughts on one or more occasions during their luteal phase, and 26% of women had attempted to end their own life. Three main themes, which related to suicidal ideation in the context of PMDD, were generated from the interview data: 1) personal relationships and social connections affected by PMDD, 2) the increase in suicidal experiences caused by diagnosis delays and 3) self-worth damaged by PMDD.

Conclusion

Women living with PMDD are at high risk of self-harm, suicidal thoughts and attempts to end their lives each month, narratives highlighted the damaging impacts PMDD had on relationships. Risk was increased by delays in appropriate medical support and women reported internalising their experiences as their problem.

Mood symptoms and gut function across the menstrual cycle in individuals with premenstrual syndrome

Gastrointestinal (GI) symptoms such as bloating, constipation, and nausea are common in the days before menstruation, experienced by as many as 73 % of menstruating individuals. Mood may influence the link between menstrual cycle and GI symptoms, with prior studies indicating that even among healthy controls, GI symptoms worsen premenstrually and are associated with worsening mood. Associations between GI symptoms and mood are poorly understood among those with premenstrual syndrome (PMS), a cluster of mood and/or physical symptoms that occur in the week before menses affecting roughly 20 % of menstruators. Our primary aim was to examine associations between GI symptoms and mood symptoms across the menstrual cycle, in those who do and do not report PMS using a menstrual tracking app. We hypothesized that GI symptoms would be reported more frequently in the luteal phase than follicular phase, and that frequency of GI symptoms would be positively associated with mood symptoms in those with PMS. We analyzed data from 33,628 menstrual cycles across 32,241 participants, including n = 27,897 controls (29,137 menstrual cycles) and n = 4344 PMS participants (4491 menstrual cycles). GI symptoms were reported significantly more frequently in the luteal phase than the follicular phase in both control and PMS groups (p < 0.001). Mood symptoms were significantly positively associated with GI symptoms in both groups, in both follicular and luteal phases (p < 0.001). Results suggest that premenstrual GI symptoms are a common issue, and additional work is needed to explore associations between mood and GI symptoms in the context of the menstrual cycle.

The Global Burden of Gynecological Diseases from 1990 to 2019

INTRODUCTION

Gynecological diseases ranked second among new cases of noncommunicable diseases in women of reproductive age in 1990 and 2019 globally. The aim of this study was to estimate the disease burden of gynecological diseases and describe their trends in women of all ages from 1990 to 2019.

METHODS

Using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), authors examined the incidence, disability-adjusted life years, and deaths from gynecological diseases by age in 204 countries and territories worldwide from 1990 to 2019. Analyses were conducted in 2022.

RESULTS

Globally, the age-standardized incidence rate and age-standardized disability-adjusted life year rate (ASDR) of gynecological diseases decreased by -0.176% and -0.245%, respectively from 1990 to 2019. Low socioeconomic development index countries had the highest age-standardized incidence rate and ASDR in 2019. The age-specific incidence rate of gynecological diseases in women aged 15-29 years increased from 1990 to 2019, and the 20-24-year age group increased the greatest by 0.21%. Polycystic ovary syndrome and other types of benign disorders contributed to the major increase.

CONCLUSIONS

Although the disease burden of gynecological diseases decreased slightly between 1990 and 2019 globally, it remained highest in low socioeconomic development index countries. The disease burden in 20-24-year age group exhibited the fastest growth, with polycystic ovary syndrome and other types of benign disorders playing a significant role. Urgent and effective measures should be taken to target different age groups, types of gynecological disease, and regions with high disease burdens.

Vitex agnus castus Extract Ze 440: Diterpene and Triterpene's Interactions with Dopamine D2 Receptor

Pre-clinical studies suggest that extracts prepared from the fruits of Vitex agnus castus (VAC) interact with dopamine D2 receptors, leading to reduced prolactin secretion. In previous experiments, dopaminergic activity was mostly evaluated using radioligand binding assays or via the inhibition of prolactin release from rat pituitary cells. Diterpenes featuring a clerodadienol scaffold were identified as major active compounds, but no conclusive data regarding their potency and intrinsic activity are available. Utilising advances in chromatography, we re-examined this topic using HPLC-based tracking of bioactivity via microfractionation of the VAC extract Ze 440. Using a cAMP-based assay, we measured dopaminergic activity in CHO-K1 cells that overexpress the human D2 receptor. Six diterpenes were isolated from two active HPLC microfractions. Viteagnusin I emerged as the most potent diterpene (EC50: 6.6 µM), followed by rotundifuran (EC50: 12.8 µM), whereas vitexilactone was inactive (EC50: >50 µM). Interestingly, triterpenes were also identified as active, with 3-epi-maslinic acid being the most active compound (EC50: 5.1 µM). To better understand these interactions at the molecular level, selected diterpenes and triterpenes were analysed through molecular docking against D2 receptor structures. Our data show that the dopaminergic activity of VAC diterpenes seems to depend on the configuration and on ring substitution in the side chain. This study also highlights for the first time the dopaminergic contribution of triterpenes such as 3-epi-maslinic acid.

Impact of premenstrual tension syndrome on academic performance among female university students from the United Arab Emirates: A cross-sectional study

Background and Aim

Premenstrual tension syndrome can vary in type and severity among females, potentially affecting their academic performance. This study aims to examine the prevalence and severity of premenstrual tension syndrome symptoms in female university students and their impact on academics.

Methods

A cross-sectional descriptive study was conducted among female university students from Ras Al Khaimah, UAE over 6 months, from January 1, 2022 to June 30, 2022. The updated premenstrual tension syndrome self-rating scale questionnaire was used to assess the prevalence and severity of symptoms. A total of 251 respondents were included in the study. The chi-square test was used to determine the association between PMT and academic performance.

Results

The results showed that 78.9% of the participants experienced premenstrual tension syndrome, with 16.3% of them reporting premenstrual dysphoric disorder. The majority of participants reported mild to moderate symptoms, with anxiety and depressed mood being the most common psychological symptoms. In terms of behavioral symptoms, physical symptoms and feeling overwhelmed were the most prevalent. Furthermore, 90% of participants reported a negative impact on their academic performance, with paying attention in class being the most affected. The study also found that PMT disorder had a significant impact on physical activities and extracurricular activities.

Conclusions

Our study showed a high prevalence of premenstrual disorders among female students and their influence on physical activity and extracurricular participation. The study highlights the importance of implementing therapies for PMT syndrome and providing support to improve academic performance and overall quality of life.

The association between occupational stress, sleep quality and premenstrual syndrome among clinical nurses

OBJECTIVE

Premenstrual Syndrome is also known as premenstrual tension syndrome because of the pronounced premenstrual mental and emotional anomalies. This study focuses on the association between occupational stress, sleep quality and premenstrual syndrome in clinical nurses and the mediating role of sleep quality.

METHODS

A cross-sectional study was conducted to measure occupational stress, sleep quality and premenstrual syndrome in 415 clinical nurses using the Chinese Nurses Stressor Scale, the Pittsburgh Sleep Quality Index Scale, and the Premenstrual Syndrome Scale. SPSS was used to explore the relationship between the variables, and AMOS was used to explore the mediating role between the variables.

RESULTS

Nurses' occupational stress positively predicted PMS (β = 0.176, p < 0.001), and the regression coefficients for sleep quality were significantly different for both paths of nurses' occupational stress (β = 0.665, p < 0.001) and PMS (β = 0.261, p < 0.001). The mediation effect accounts for 49.57% of the total effect.

CONCLUSION

This study revealed a notably high incidence of PMS among clinical nurses in China, with occupational stress and sleep quality significantly correlated with PMS. Sleep quality played an intermediary role between occupational stress and PMS. Consequently, managers should prioritize addressing occupational stress, mitigating PMS symptoms, enhancing nurses' health and nursing quality, and preventing nursing risks through mental health support and improving sleep quality.

Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses

Premenstrual exacerbation of an existing psychiatric disorder refers to the worsening of symptoms inherent to the condition during the premenstrual phase. Research consistently indicates that hormonal fluctuations during the menstrual cycle present a unique period of vulnerability for the onset or exacerbation of psychiatric symptoms, impacting diagnosis, risk assessment, and treatment. This review sought to elucidate the phenomenon of premenstrual exacerbation and its impact across a spectrum of psychiatric illnesses, including mood, anxiety, psychotic, obsessive-compulsive, personality, and trauma-related disorders. Despite the expanded research in recent years on premenstrual dysphoric disorder and premenstrual syndrome, premenstrual exacerbation remains underexplored and poorly defined. This review offers significant contributions to the diagnosis and management of psychiatric conditions, advocating for heightened awareness and novel treatment approaches in the context of premenstrual exacerbation.

Diagnostic and therapeutic use of oral micronized progesterone in endocrinology

Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality.

Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion

Background

Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation.

Purpose

To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores.

Results

Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020).

Conclusion

HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.

ShuYu capsule alleviates emotional and physical symptoms of premenstrual dysphoric disorder: Impact on ALLO decline and GABAA receptor δ subunit in the PAG area

Premenstrual dysphoric disorder (PMDD) is a severe subtype of premenstrual syndrome in women of reproductive age, with its pathogenesis linked to the heightened sensitivity of type A γ -aminobutyric acid receptors (GABAAR) to neuroactive steroid hormone changes, particularly allopregnanolone (ALLO). While a low dose of fluoxetine, a classic selective serotonin reuptake inhibitor, is commonly used as a first-line drug to alleviate emotional disorders in PMDD in clinical settings, its mechanism of action is related to ALLO-GABAA receptor function. However, treating PMDD requires attention to both emotional and physical symptoms, such as pain sensitivity. This study aims to investigate the efficacy of ShuYu capsules, a traditional Chinese medicine, in simultaneously treating emotional and physical symptoms in a rat model of PMDD. Specifically, our focus centres on the midbrain periaqueductal grey (PAG), a region associated with emotion regulation and susceptibility to hyperalgesia. Considering the underlying mechanisms of ALLO-GABAA receptor function in the PAG region, we conducted a series of experiments to evaluate and define the effects of ShuYu capsules and uncover the relationship between the drug's efficacy and ALLO concentration fluctuations on GABAA receptor function in the PAG region. Our findings demonstrate that ShuYu capsules significantly improved oestrous cycle-dependant depression-like behaviour and reduced stress-induced hyperalgesia in rats with PMDD. Similar to the low dose of fluoxetine, ShuYu capsules targeted and mitigated the sharp decline in ALLO, rescued the upregulation of GABAAR subunit function, and activated PAG neurons in PMDD rats. The observed effects of ShuYu capsules suggest a central mechanism underlying PMDD symptoms, involving ALLO_GABAA receptor function in the PAG region. This study highlights the potential of traditional Chinese medicine in addressing both emotional and physical symptoms associated with PMDD, shedding light on novel therapeutic approaches for this condition.

Gas and Bloat in Female Patients after Antireflux Procedures: Analysis of 934 Cases

BACKGROUND

Antireflux procedures (ARPs) are effective treatments for GERD. However, variation in objective and patient-reported outcomes persists. Limited evidence and anecdotal experience suggest that patient sex may play a role. The objective of this study was to compare outcomes after ARPs between male and female patients.

STUDY DESIGN

We performed a retrospective review of a prospectively maintained database at a single institution. All patients who underwent an ARP for GERD were included. Demographic, clinical, and patient-reported outcomes data (GERD health-related quality of life [HRQL] and reflux symptom index), and radiographic hernia recurrence were collected and stratified by sex. Univariable and multivariable logistic and mixed-effects linear regression were used to control for confounding effects.

RESULTS

Between 2009 and 2022, 934 patients (291 men and 643 women) underwent an ARP. Reflux symptom index, GERD-HRQL, and gas and bloat scores improved uniformly for both sexes, though female patients were more likely to have higher gas and bloat scores 1 year postprocedure (mean ± SD 1.7 ± 1.4 vs 1.4 ± 1.3, p = 0.03) and higher GERD-HRQL scores 2 years postprocedure (6.3 ± 8.1 vs 4.7 ± 6.8, p = 0.04). Higher gas and bloat scores in women persisted on regression controlling for confounders. Hernia recurrence rate was low (85 patients, 9%) and was similar for both sexes. A final intraprocedural distensibility index 3 mm 2 /mmHg or more was significantly associated with a 7 times higher rate of recurrence (95% CI 1.62 to 31.22, p = 0.01).

CONCLUSIONS

Although patients of either sex experience symptom improvement and low rate of recurrence after ARPs, women are more likely to endorse gas and bloat compared with men. Final distensibility index 3 mm 2 /mmHg or more carries a high risk of recurrence. These results may augment how physicians prognosticate during consultation and tailor their treatment in patients with GERD.

Green gram soup and barley porridge as dietary interventions for management of premenstrual syndrome in adolescent girl: A case report

Women suffer from various conditions related to menstrual cycle due to changing lifestyle, bad food habits, physical and mental stress. Pre Menstrual Syndrome (PMS) is a combination of physical and emotional symptoms that many women get one or two weeks before the start of their menstrual period. In the present study, 14 years old female patient having symptoms-lower abdominal pain, backache, breast tenderness, constipation, pimples, tiredness and unexplained anger typically in luteal phase from last 4 months, was diagnosed with mild to moderate symptoms of PMS. After proper analysis, she was suggested to consume light to digest dietary articles advised in classical texts for minimizing specific symptoms during menstruation.Thus Green gram Soup and Barley porridge was prescribed to her as lunch and dinner respectively for first three days of menstruation cycle for continuous 6 cycles. It is observed that consumption of these dietary products during the menstruation time period assisted to minimize the symptoms of PMS. This illustrates that there is a wide scope to explore the ayurvedic dietary regimen recommended during menstruation which can be used more rationally to suit menstrual disorders.

Modelling and Preliminary Clinical Validation of Home-based Menstrual Neuromodulation Therapy

Primary dysmenorrhea (PD), characterised by chronic pelvic pain during menstruation, significantly impairs the quality of life for many women. This paper presents a modelling and clinical validation study of the novel Nettle™ device for at-home transcranial direct current stimulation (tDCS) for alleviating PD symptoms. Specifically, we aimed to investigate the electric field patterns induced by Nettle™ and its immediate efficacy in reducing menstrual pain and improving functionality. Finite element method (FEM) simulations, using realistic head models, assessed the electric field distribution, targeting key brain regions involved in pain processing. A single-centre triple-blinded, sham-controlled study involving 34 women was conducted to compare the effects of active and sham tDCS. Results demonstrated a clinically meaningful decline in menstrual pain symptoms in the active group, with medium effect sizes for both pain reduction (Cohen's d=0.53) and functionality (Cohen's d=0.47), based on Nettle™'s protocol focused on the electric field within the medial prefrontal cortex. Limitations include the use of generalised brain models and small sample size, highlighting the need for further research with comprehensive modelling and larger clinical trials to validate and understand the effects of Nettle™ as a menstrual neuromodulation therapy. Clinical Relevance- This study underscores Nettle™'s potential as a non-invasive, cost-efficient intervention for PD, with implications for broader applications in women's health.

Menstrual cycle tracking in professional volleyball athletes

Introduction

The menstrual cycle may affect well-being and physical performance of elite female athletes by interfering with the function of multiple physiological systems. The aim of this study was to characterize the symptoms of the menstrual cycle and their frequency in elite female volleyball players.

Methods

Twenty professional female volleyball players were instructed to track their menstrual symptoms over the course of the first German national league season using the FitrWoman® tracking app. The app recorded the cycle length, duration, and intensity of the period as well as the occurrence and frequency of frequent cycle symptoms. The reported symptoms were then categorized into four categories (frequently, sometimes, rare, never) in order to create an individual Menstrual Symptom index (MSi) for each athlete.

Results

The most frequently occurring symptoms among all players without hormonal contraception (non-HC; n = 15) were "stomach cramps" (n = 15), "sleep disturbances" (n = 11), and "tiredness" (n = 11). The average number of symptoms counted per cycle was 11.8 (±17.7) and the average calculated MSi within the team was 12.9 (±10.7) points for non-HC users. The HC players (n = 4) also regularly experienced symptoms such as "sleep disturbances" or "tendered breasts". The most common symptoms "stomach cramps" and "disturbed sleep" occurred more frequently during menstruation, while symptoms such as "bloating", "cravings" or "tendered breasts" did also peak before menstruation.

Discussion

Menstrual cycle symptoms can be highly individual within a professional sports team. The calculation of the MSi seems to be a simple and accessible method to describe and overview the intensity and prevalence of symptoms in top female athletes in sports games.

Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019

STUDY QUESTION

What is the burden of premenstrual syndrome (PMS) at the global, regional, and national levels across 21 regions and 204 countries and territories?

SUMMARY ANSWER

Over the past few decades, the global prevalent cases of PMS have grown significantly from 652.5 million in 1990 to 956.0 million in 2019, representing a 46.5% increase.

WHAT IS KNOWN ALREADY

PMS, which affects almost half of reproductive women worldwide, has substantial social, occupational, academic, and psychological effects on women's lives. However, no comprehensive and detailed epidemiological estimates of PMS by age and socio-demographic index (SDI) at global, regional, and national levels have been reported.

STUDY DESIGN, SIZE, DURATION

An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of PMS by age and SDI across 21 regions and 204 countries and territories has been performed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The prevalence and YLD of PMS from 1990 to 2019 were retrieved directly from the Global Burden of Diseases (GBD) 2019 study. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels.

MAIN RESULTS AND THE ROLE OF CHANCE

Globally, the prevalent cases of PMS increased by 46.5% from 652.5 million in 1990 to 956.0 million in 2019; in contrast, however, the age-standardized prevalence rate was approximately stable at 24 431.15/100 000 persons in 1990 and 24 406.51/100 000 persons in 2019 (AAPC, 0[95% CI: -0.01 to 0.01]). Globally, the YLD was 8.0 million in 2019 and 5.4 million in 1990, with a sizable increase over the past 30 years. The age-standardized YLD rate was stable (AAPC 0.01, P = 0.182), at 203.45/100 000 persons in 1990 and 203.76/100 000 persons in 2019. The age-standardized burden estimates were the highest in the low-middle SDI regions and the lowest in the high SDI regions. Peaks in burden rate estimates were all observed in the 40-44 years age group. Regional age-standardized burden estimates were the highest in South Asia and the lowest in Western Sub-Saharan Africa. The national age-standardized burden estimates were the highest in Pakistan and the lowest in Niger.

LIMITATIONS, REASONS FOR CAUTION

The accuracy of the results depended on the quality and quantity of the GBD 2019 data. Fortunately, the GBD study endeavoured to retrieve data globally and applied multiple models to optimize the completeness, accuracy, and reliability of the data. In addition, the GBD study took the country as its basic unit and neglected the influence of race. Further study is warranted to compare differences in PMS burden associated with race. Finally, no data are available on the aetiology and risk information related to PMS, which might help us to better understand the trends and age distribution of PMS and help local governments formulate more detailed policies and comprehensive interventions.

WIDER IMPLICATIONS OF THE FINDINGS

Although the age-standardized prevalence/YLD rate has been stable over the past 30 years, the absolute number of prevalent cases and YLD grew significantly worldwide from 1990 to 2019. Public health-related policies should be implemented to reduce the prevalence and alleviate the symptoms of PMS. Lifestyle changes and cognitive-behavioral therapy are critical in helping to reduce the burden of PMS.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Key Research and Development Program of China (grant number 2022YFC2704100) and the National Natural Science Foundation of China (No. 82001498, No. 82371648). The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Global burden and trends in female premenstrual syndrome study during 1990-2019

PURPOSE

Premenstrual syndrome (PMS) is prevalent worldwide and considered a crucial issue regarding women's health. In the present study, the Global Burden of Disease (GBD) Study 2019 dataset was utilized to assess the distributional trends in PMS burden and prevalence in regional, national, and sociodemographic index (SDI) categories.

METHODS

The analytical methods and approaches used in the 2019 GBD study were adopted to investigate the incidence rates and disability-adjusted life years (DALY) related to PMS in 204 countries or regions. Age-standardized incidence rates (ASIR), 95% uncertainty intervals (95% UI), and annual percentage changes (EAPC) were calculated from the data.

RESULTS

The global incidence and disability-adjusted life years of PMS exhibited a declining trend in the year 2019. Regions with medium-low SDI had the greatest burden of PMS, with the regions of South Asia (ASR = 7337.9 per 10,000) exhibiting the greatest Age-standardized incidence rates, while the high-income North American states presented the fastest upward trends in Age-standardized disability-adjusted life year rates. At the national level, 107 nations exhibited a decreasing trend in PMS incidence ASR, while 97 nations exhibited an increasing trend, with the United States presenting the greatest increase.

CONCLUSIONS

The present study highlighted that even though the global PMS incidence and disability-adjusted life years have decreased from the year 1990 to 2019, PMS remains a prevalent health concern for women worldwide. While addressing preventive measures and treatment, it is also important to consider the regional and national differences in PMS to develop further effective and targeted health policies.

Ovulatory cycle shifts in human motivational prioritisation of sex and food

Previous research on the endogenous effects of ovarian hormones on motivational states in women has focused on sexual motivation. The Motivational Priority Shifts Hypothesis has a broader scope. It predicts a shift from somatic to reproductive motivation when fertile. In a highly powered preregistered online diary study across 40 days, we tested whether 390 women report such an ovulatory shift in sexual and eating motivation and behaviour. We compared 209 naturally cycling women to 181 women taking hormonal contraceptives (HC) to rule out non-ovulatory changes across the cycle as confounders. We found robust ovulatory decreases in food intake and increases in general sexual desire, in-pair sexual desire and initiation of dyadic sexual behaviour. Extra-pair sexual desire increased mid-cycle, but the effect did not differ significantly in HC women, questioning an ovulatory effect. Descriptively, solitary sexual desire and behaviour, dyadic sexual behaviour, appetite, and satiety showed expected mid-cycle changes that were diminished in HC women, but these failed to reach our strict preregistered significance level. Our results provide insight into current theoretical debates about ovulatory cycle shifts while calling for future research to determine motivational mechanisms behind ovulatory changes in food intake and considering romantic partners' motivational states to explain the occurrence of dyadic sexual behaviour.

(S)-S-adenosylmethionine in the treatment of pre-menstrual disorders in adult women: A protocol for an open-label pilot study

Pre-menstrual disorders, including pre-menstrual syndrome and pre-menstrual dysphoric disorder, are highly prevalent disorders in women of reproductive age. Pre-menstrual disorders are associated with debilitating symptoms that onset in the days prior to menses. A complex interplay between hormonal fluctuations, cellular sensitivity, and psychosocial stressors likely underly the pathophysiology of pre-menstrual disorders. Current treatment options include selective serotonin reuptake inhibitors, hormonal therapies, and psychosocial support. There is growing evidence for oestrogen, progesterone, gonadotropin Releasing Hormone analogues and Complementary and Alternative Medicines in treating Pre-menstrual disorders. (S)-S-adenosylmethionine is a complementary and alternative medicine with postulated roles in the treatment of depression, with a rather rapid onset of action and minimal side effect profile. We propose a protocol for investigating the efficacy of (S)-S-adenosylmethionine in the treatment of pre-menstrual disorders. The proposed study is an open label pilot study, that will recruit thirty women between the ages of 18-45 who experience a pre-menstrual disorder. Daily and interval questionnaires will provide a quantification of symptoms across four menstrual cycles (16 weeks). During two consecutive menstrual cycles it is proposed that participants receive oral (S)-S-adenosylmethionine Complex 400 mg three times a day (total daily dose 1200 mg), during the pre-menstrual time-period (14 days prior to menses). Changes in pre-menstrual disorder symptoms between control and treatment cycles will assist in elucidating the clinical efficacy of (S)-S-adenosylmethionine. This study has the potential to support a larger double blinded, placebo controlled randomised control trial and aims to enrich the knowledge surrounding pre-menstrual disorders.

Network structure of complex interactions of premenstrual syndrome and influencing factors in young adult women

BACKGROUND

In the transition phase from adolescence to adulthood, premenstrual syndrome (PMS) occurs more commonly, with a variety of symptoms. The occurrence of PMS may be the result of a combination of demographic, physiological, psychological and sociological factors. This study aimed to identify the central symptoms of PMS, and explored the complex influencing factors especially the one-to-one inter-relationships factors with specific symptoms.

METHOD

This is a cross-sectional study conducted in mainland China. 3458 young adult women were assessed. Using the Premenstrual Syndrome Scale (PSS) to assess the PMS, and PSS score was over 6 divided into PMS group, and vice versa. Influencing factors were assessed by a set of self-reported questionnaire. Network analysis was used to examined the interplay of PMS, whilst also considering the influencing factors of PMS.

RESULTS

In summary, 1479 participants were in PMS group. Anxiety had the highest strength centrality (1.12/1.09), shown higher centrality in the both network. Swelling of the hands or feet also shown higher strength centrality (0.89) in PMS group. PMS is associated with a higher history of dysmenorrhea, and neurotic personality. Neurotic personality - depressed mood/nervousness (0.27/0.23), history of dysmenorrhea - abdominal distension (0.21), had significantly higher weight than other edges in PMS group.

CONCLUSION

Anxiety was the most central symptom in the network, and was closely associated with other symptoms like depressed mood, which provided additional evidence for the centrality of emotional features in PMS. Moreover, the influencing factors of PMS combined demographic, physiological, psychological, and sociological factors. According to the central symptoms and factors affecting the specific PMS symptoms in young adult women, targeted intervention is helpful to prevent and alleviate PMS.

LIMITATION

Cross-sectional design cannot infer the directionality of the associations between variables. All data is self-reported with recall bias and the edge weights across the constructs of influencing factors and PMS were fairly small.

Gonads under stress: A systematic review and meta-analysis on the effects of acute psychosocial stress on gonadal steroids secretion in humans

Animal research has shown that the hypothalamus-pituitary-gonadal (HPG) axis is inhibited by (chronic and/or severe) stress, which can lead to impaired fertility and reproductive functioning, presumably caused by the inhibition of gonadal steroid secretion and in interactions with glucocorticoids. However, what has not been clarified is how acute psychosocial stress modulates gonadal steroid secretion in humans. Here we summarize the experimental research on the acute effects of stress on the secretion of gonadal steroids in humans. A systematic literature search revealed 21 studies (with N=881 individuals) measuring testosterone, progesterone or estradiol in response to a standardized acute laboratory stressor in healthy humans. Both our literature review and quantitative meta-analysis suggest that in humans, acute stress stimulates rather than inhibits HPG axis activity, although there is a considerable heterogeneity in the reported methods and results. Increased gonadal steroids in response to acute stress contrasts with many animal studies reporting the opposite pattern, at least regarding severe and/or chronic stressors. We discuss methodological issues and challenges for future research and hope to stimulate experimental studies within this area. A better understanding of these mechanisms is needed, and may have important implications for health and disease, as well as the modulation of various behaviors by acute stressors.

Peripheral Blood Mononuclear Cell Expression of Cation-Chloride Cotransporter (CCC) Genes in Premenstrual Dysphoric Disorder (PMDD) across the Menstrual Cycle-A Preliminary Study

Premenstrual Dysphoric Disorder (PMDD) is a psychiatric condition characterized by debilitating affective symptomatology in the luteal phase of the menstrual cycle. Based on the previous reports that PMDD may be related to GABAergic cellular dysfunction(s), we assessed whether cation-chloride cotransporter (CCC) gene expression across the menstrual cycle is altered in PMDD. As there are limitations in accessing the human CNS to study CCC-encoding genes, we utilized peripheral blood mononuclear cells (PBMCs) as an alternative model. We first sought to replicate previous reports characterizing CCC gene expression patterns in PBMCs of reproductive age women. We subsequently investigated potential distinct CCC mRNA expression patterns in women with PMDD. We collected blood samples across 8 menstrual cycle visits for PBMC separation/RNA extraction to study mRNA expression of four KCCs (KCC1, KCC2, KCC3, KCC4) and two NKCCs (NKCC1, NKCC2) cotransporters. We mostly replicated the earlier gene expression pattern findings, and found that the expression levels of KCC1 were significantly downregulated during the mid-follicular and periovulatory subphases of the menstrual cycle in women with PMDD. The present study shows that PBMCs is a valid model for studying GABAergic mechanisms underlying PMDD.

Premenstrual dysphoric disorder and associated factors among university graduating class female students in Ethiopia: A cross-sectional study

Objectives

Premenstrual dysphoric disorder is a somatopsychic condition that develops about a week before the start of menstruation and is brought on by fluctuating sex steroid levels that follow an ovulatory menstrual cycle. Therefore, this study aimed to assess the magnitude of premenstrual dysphoric disorder and associated factors among Haramaya University graduating class female students, in eastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from 1 to 30 November 2022 among Haramaya University graduating class female students using a simple random sampling technique. The data were cleaned, coded, and entered into the Epi-data 3.01 before being exported and analyzed with Statistical Package of Social Science 20 versions. The premenstrual dysphoric disorder was assessed by the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. To identify associated factors a bivariable logistic regression analysis was conducted to determine the association between each independent variable and the outcome variable. The multivariable logistic regression model includes all variables with a p-value of less than 0.25 in the bivariate logistic regression analysis. The adjusted odds ratio with a 95% confidence interval was computed when the p-value was less than 0.05, which was considered statistically significant.

Results

Out of 282 samples, 274 study participants were involved providing a response rate of 97.2%. The prevalence of premenstrual dysphoric disorders was 64.6% (95% CI: 59.5-70.4). Participants with the irregular menstrual cycle (AOR = 2.24; 95% CI: 1.26-4.34), heavy menstrual flow (AOR = 2.53; 95% CI: 1.84-7.59), moderate menstrual flow (AOR = 2.29; 95% CI: 1.02-5.26), severe menstrual pain (AOR = 5.69; 95% CI: 1.86-7.42) and those who have depressive symptoms (AOR = 2.46, 95% CI: 1.08-5.68) were variables associated with premenstrual dysphoric disorders.

Conclusion

The prevalence of premenstrual dysphoric disorder was relatively high. Severe menstrual pain, menstrual irregularity, heavy menstrual flow, and a history of depression had significant associations with premenstrual dysphoric disorder. It will be better if higher institution administrators design and implement methods to screen and intervene premenstrual dysphoric disorder among female students.

Association between receiving Covid-19 vaccine and menstrual cycle patterns among childbearing women: A cross-sectional study

Background and Aims

Many women reported experiencing abnormalities in their cycle after being vaccinated with Covid-19 vaccination. To understand this issue further, our study aimed to evaluate the menstrual cycle patterns among women of childbearing age after receiving COVID-19 vaccinations.

Methods

A cross-sectional study was conducted to investigate the impact of COVID-19 vaccine on women aged 18 years and above in Saudi Arabia. A self-administered online questionnaire was distributed among participants who had received at least one dose of COVID-19 vaccine. The questionnaire included questions about the participants' demographic characteristics, medical history, and vaccine-related adverse events.

Results

The study included 383 female participants with an average age of 30.8 ± 8.1 years. The majority of participants, 92.7%, were Saudi, and more than half, 51.4%, were single. Of the participants, 78.9% were disease-free, and a majority of 67.9% had no history of Coronavirus Disease 2019 infection. A significant proportion of participants reported postvaccination changes in the menstrual cycle. Specifically, 43.1% reported changes after the first dose, and 38.4% reported changes after the second dose (p = 0.044). The severity of premenstrual symptoms increased from 44 (11.5%) to 113 (29.5%) after the first dose. Reported pain on the (WONG-BAKER) scale was also significantly elevated from 34 (8.9%) to 87 (22.7%) (p < 0.001) after the first dose.

Conclusion

A relatively high prevalence of menstrual cycle irregularities was reported by Saudi vaccinated women, particularly young adults. These findings suggest the need to further research and explore the underlying causes of these irregularities and develop interventions that may help mitigate their impact on women's health. It is also recommended that women who observe long-term changes in their menstrual cycles seek follow-up and consultation with healthcare providers to ensure that any potential health concerns are addressed promptly.

Experts' view on the role of oestrogens in combined oral contraceptives: emphasis on oestetrol (E4)

Introduction

The evolution of contraception has been crucial for public health and reproductive well-being. Over the past 60 years, combined oral contraceptives (COCs) have remained an important part of the contraceptive landscape worldwide; continued development has worked toward maintaining efficacy and improving safety.

Methods

Seven global experts convened to discuss the clinical relevance of the oestrogen in COCs, focusing on the impact of the new oestrogen, oestetrol (E4). Participants then commented through an online forum on the summary content and other participants' feedback. We prepared this report to describe the experts' views, their follow-up from the open forum and the evidence supporting their views.

Results

Ethinylestradiol (EE) and oestradiol (E2) affect receptors similarly whereas E4 has differential effects, especially in the liver and breast. Adequate oestrogen doses in COCs ensure regular bleeding and user acceptability. EE and E4 have longer half-lives than E2; accordingly, COCs with EE and E4 offer more predictable bleeding than those with E2. Oestrogen type and progestin influence VTE risk; E2 poses a lower risk than EE; although promising, E4/DRSP VTE risk is lacking population-based data. COCs alleviate menstrual symptoms, impact mental health, cognition, libido, skin, and bone health.

Conclusion

Oestrogens play an important role in the contraceptive efficacy, bleeding patterns, and overall tolerability/safety of COCs. Recent studies exploring E4 combined with DRSP show promising results compared to traditional formulations, but more definitive conclusions await further research.

A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences

Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants' evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.

Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage

To determine the relationships between luteal-phase steroidal hormonal profile and PMS for a large number of women attending a dedicated fertility clinic. This was a retrospective cross-sectional study on women attending a hospital-based clinic for fertility concerns and/or recurrent miscarriage. All participants were assessed with a women's health questionnaire which also included evaluation of premenstrual symptoms. Day of ovulation was identified based on the peak mucus symptom assessed by the woman after instruction in a fertility awareness-based method (FABM). This enabled reliable timing of luteal-phase serum hormone levels to be taken and analysed. Between 2011 and 2021, 894 of the 2666 women undertaking the women's health assessment had at least one evaluable serum luteal hormone test. Serum progesterone levels were up to 10 nmol/L lower for symptomatic women compared with asymptomatic women. This difference was statistically significant (p < 0.05) for the majority of PMS symptoms at ≥ 9 days after the peak mucus symptom. A similar trend was observed for oestradiol but differences were generally not statistically significant. ROC curves demonstrated that steroid levels during the luteal phase were not discriminating in identifying the presence of PMS symptoms. Blood levels for progesterone were lower throughout the luteal phase in women with PMS, with the greatest effect seen late in the luteal phase.

The bidirectional association between premenstrual disorders and perinatal depression: A nationwide register-based study from Sweden

BACKGROUND

Premenstrual disorders (PMDs) and perinatal depression (PND) share symptomology and the timing of symptoms of both conditions coincide with natural hormonal fluctuations, which may indicate a shared etiology. Yet, there is a notable absence of prospective data on the potential bidirectional association between these conditions, which is crucial for guiding clinical management. Using the Swedish nationwide registers with prospectively collected data, we aimed to investigate the bidirectional association between PMDs and PND.

METHODS AND FINDINGS

With 1,803,309 singleton pregnancies of 1,041,419 women recorded in the Swedish Medical Birth Register during 2001 to 2018, we conducted a nested case-control study to examine the risk of PND following PMDs, which is equivalent to a cohort study, and transitioned that design into a matched cohort study with onward follow-up to simulate a prospective study design and examine the risk of PMDs after PND (within the same study population). Incident PND and PMDs were identified through clinical diagnoses or prescribed medications. We randomly selected 10 pregnant women without PND, individually matched to each PND case on maternal age and calendar year using incidence density sampling (N: 84,949: 849,482). We (1) calculated odds ratio (OR) and 95% confidence intervals (CIs) of PMDs using conditional logistic regression in the nested case-control study. Demographic factors (country of birth, educational level, region of residency, and cohabitation status) were adjusted for. We (2) calculated the hazard ratio (HR) and 95% CIs of PMDs subsequent to PND using stratified Cox regression in the matched cohort study. Smoking, BMI, parity, and history of psychiatric disorders were further controlled for, in addition to demographic factors. Pregnancies from full sisters of PND cases were identified for sibling comparison, which contrasts the risk within each set of full sisters discordant on PND. In the nested case-control study, we identified 2,488 PMDs (2.9%) before pregnancy among women with PND and 5,199 (0.6%) among controls. PMDs were associated with a higher risk of subsequent PND (OR 4.76, 95% CI [4.52,5.01]; p < 0.001). In the matched cohort with a mean follow-up of 7.40 years, we identified 4,227 newly diagnosed PMDs among women with PND (incidence rate (IR) 7.6/1,000 person-years) and 21,326 among controls (IR 3.8). Compared to their matched controls, women with PND were at higher risk of subsequent PMDs (HR 1.81, 95% CI [1.74,1.88]; p < 0.001). The bidirectional association was noted for both prenatal and postnatal depression and was stronger among women without history of psychiatric disorders (p for interaction < 0.001). Sibling comparison showed somewhat attenuated, yet statistically significant, bidirectional associations. The main limitation of this study was that our findings, based on clinical diagnoses recorded in registers, may not generalize well to women with mild PMDs or PND.

CONCLUSIONS

In this study, we observed a bidirectional association between PMDs and PND. These findings suggest that a history of PMDs can inform PND susceptibility and vice versa and lend support to the shared etiology between both disorders.

The impact of "long COVID" on menstruation in Chinese female college students and the intervention of acupuncture

This study aimed to explore the potential application value of acupuncture in alleviating the impact of long COVID on women's menstrual cycles, by investigating the occurrence of long COVID among female college students, its effects on menstruation, and the intervention of acupuncture. This cross-sectional study surveyed female college students with a history of coronavirus disease 2019 (COVID-19) before April 10, 2023. A questionnaire was used to analyze demographic characteristics, post-COVID sequelaes, duration of symptoms, and treatments received during that period. Among the 731 participants enrolled in the survey, 468 were female undergraduate students who met the analysis criteria. Among them, 85 individuals fit the definition of "Long COVID" (18.16%). Within the group of patients with long COVID, 69 individuals experienced changes in their overall menstrual patterns compared to the 6 months prior to contracting the novel coronavirus (81.18%). Additionally, 17 individuals opted for acupuncture treatment following the onset of COVID-19 (20.00%), which resulted in less impact on their menstrual cycle (41.18% vs 64.71% without receiving acupuncture, OR = 2.62), menstrual period duration (41.18% vs 64.71%, OR = 2.62), menstrual flow (47.06% vs 69.18%, OR = 2.52), and the color of menstrual blood (41.18% vs 63.24%, OR = 2.46) among these patients. Long COVID had a certain impact on menstruation. Acupuncture potentially alleviates the clinical symptoms of long COVID and reduces its impact on women's menstrual cycle, thus having potential therapeutic value in the treatment of long COVID.

Effect of COVID-19 Vaccination on Menstrual Cycle Patterns of Reproductive-age Women: A Multi-centric Observational Study

AIM

The study was conducted to know the impact of COVID-19 vaccination on menstrual cycle patterns and pre- and post-menstrual symptoms in women aged 18-45 years.

BACKGROUND

COVID-19 vaccination was introduced to combat the dreadful impacts of human coronavirus infection. The two indigenously developed COVID-19 vaccines approved for use in India are COVISHIELD and COVAXIN.

OBJECTIVES

To investigate the effects of COVID-19 vaccination on the menstrual cycle, pre- and post-menstrual symptoms and to establish the correlation with the type of vaccine received.

METHODS

Multi-centric observational study conducted in six institutes of national importance in different states of India over one year. A total of 5709 female participants fulfilling inclusion criteria were enrolled. Data about the impact of vaccines (COVISHIELD and COVAXIN) and prior COVID-19 infection on the menstrual cycle and its associated symptoms were obtained using all participants' online and offline interviews.

RESULTS

Of 5709 participants, 78.2% received COVISHIELD and 21.8% COVAXIN. Of the total 5709 participants, 333 (5.8%) developed post-vaccination menstrual disturbances, with 32.7% having frequent cycles, 63.7% prolonged cycles, and 3.6% inter-menstrual bleeding. A total of 301 participants noticed changes in the amount of bleeding, with 50.2% excessive, 48.8% scanty, and 0.99% amenorrhea followed by heavy bleeding. Furthermore, the irregularities of the menstrual cycle (p = 0.011) and length (0.001) were significantly higher in the COVAXIN group (7.2%) as compared to the COVISHIELD (5.3%) group. A total of 721 participants complained of newly developed/worsening pre- and post-menstrual symptoms. These symptoms were significantly higher in the COVISHIELD group (p = 0.031), with generalized weakness and body pains as the main complaints (p = 0.001). No significant difference was observed in the incidence of COVID-19 infection with these vaccines. No significant associations were observed when comparing menstrual abnormalities among those with COVID-19 infection (p > 0.05).

CONCLUSION

COVISHIELD and COVAXIN vaccines were associated with menstrual cycle disturbances and pre-and post-menstrual symptoms in a small proportion of participants, with 94.7% having no change in the amount of bleeding during menstruation post-vaccination. The menstrual irregularities observed were significantly higher with the COVAXIN vaccine. Others: Further, long-term studies are required to confirm that the impact of COVID-19 vaccination on the menstrual cycle may be short-lasting, with no severe effects on women's menstrual health.

Perception of benefits-barriers of exercise, physical activity level, and body awareness in women with premenstrual syndrome

INTRODUCTION

The study aims to investigate the relationship between premenstrual syndrome (PMS) and physical activity, body awareness, and the benefits/barriers to exercise (a), as well as to compare women with and without PMS in relation to these parameters (b).

MATERIALS AND METHODS

Participants were administered The Premenstrual Syndrome Scale (PMSS), International Physical Activity Questionnaire-Short Form (IPAQ-SF), Body Awareness Questionnaire, and The Exercise Benefits/Barriers Scale.

RESULTS

The age range of the participants included in the study was 19-48, with a mean age of 26.45 ± 7.14. A statistically significant difference was found between the women with and without PMS in terms of PMSS score, exercise benefits subscale score, and exercise barriers subscale score (p < 0.05). The results indicated that there was a significant positive correlation between PMSS score and exercise barriers subscale score (p < 0.05). There was a significant positive correlation between IPAQ score and body awareness questionnaire, exercise benefits subscale score, total score of exercise benefits and barriers of scale (p < 0.05). There was a significant negative correlation between IPAQ score and exercise barriers subscale score (p < 0.05). There was a significant positive correlation between body awareness questionnaire score and exercise benefits subscale score, total score of exercise benefits and barriers of scale (p < 0.05). There was a significant negative correlation between body awareness questionnaire score and exercise barriers subscale score (p < 0.05).

CONCLUSION

This study provide valuable insights into the relationship between PMS, physical activity, body awareness, and exercise benefits/barriers among women. By addressing the barriers and benefits to exercise and enhancing body awareness, healthcare professionals can potentially improve women's with PMS overall well-being and encourage them to adopt and maintain a physically active lifestyle.

Prevalence of premenstrual syndrome and its associations with dietary and other lifestyle factors among university female students in Dubai: A cross-sectional study

BACKGROUND

Premenstrual syndrome is a relatively prevalent condition that affects a significant number of menstruating women worldwide. It can range from mild to severe and may interfere with daily activities.

OBJECTIVE

This study aims to investigate the prevalence of premenstrual syndrome and its associated factors among female university students in Dubai.

DESIGN

This study was designed as a cross-sectional study.

METHODS

The analysis for this study involved 217 female university students (aged ⩾18 years old) who completed a self-reported online questionnaire. Participants were recruited through simple random sampling, and the study received ethical approval from the Zayed University Ethical Committee.

RESULTS

All participants reported that they experienced at least one premenstrual syndrome symptom with different levels of severity. The prevalence rate of psychological, physical, and behavioral symptoms was 83.0%, 79.4%, and 76.6%, respectively. The most frequently reported premenstrual psychological symptoms were loss of control (69.6%). Most reported physical premenstrual symptoms included lethargy/fatigue/decreased energy (56.7%); premenstrual syndrome symptoms interfered with participants' daily routines (45.2%). Normal body mass index, no smoking, milk consumption, cruciferous vegetables, fruits, animal foods, fish oil supplements, and no fast-food consumption were all significant factors associated with decreasing premenstrual syndrome.

CONCLUSIONS

Premenstrual syndrome is a common menstrual disorder among university students that interferes with their daily routines. Dietary habits and other lifestyle factors were highly related to premenstrual syndrome. Therefore, health promotion programs are highly recommended to encourage healthy diets and lifestyles for females as early as adolescence at the school level.

Perspectives of Dutch women on premenstrual disorder. A qualitative study exploring women's experiences

BACKGROUND

Women presenting with Premenstrual Disorder (PMD) to general practitioners (GPs) experience problems with their biopsychosocial functioning. PMD is a disorder consisting of physical and/or mood-based symptoms cyclically occurring with a significant impairment of daily life. Little is known about the symptoms and coping strategies of women with PMD and their experiences with their GPs.

OBJECTIVES

This present study aimed to improve understanding of the perspectives of women with PMD, their coping strategies and their expectations of the GP.

DESIGN

Qualitative study with semi-structured interviews.

SETTING

In 2017, Dutch women with symptoms of premenstrual disorder were recruited through local newspapers in the town of Nijmegen and the North-Holland region and via social media. After checking the inclusion and exclusion criteria, we interviewed 20 women (between 27 and 49 years of age). The interviews took place at a location of the interviewees' preference.

RESULTS

PMD symptoms can strongly influence the quality of women's lives. Three themes emerged from our analysis: feelings of having two separate female identities, PMD as a life-controlling condition and different coping strategies. Most women used an active coping strategy. Women with PMD need recognition from their GPs and knowledge of proper treatment.

CONCLUSION

PMD symptoms can have a high impact on daily life. Women with PMD expressed their need for acknowledgement and a personalised approach from their GP. Greater awareness and knowledge among GPs may be helpful in this.

Low doses of fluoxetine for the treatment of emotional premenstrual syndrome: a randomized double-blind, placebo-controlled, pilot study

INTRODUCTION

The neuroactive metabolite of progesterone, allopregnanolone (ALLO), has been implicated in premenstrual syndrome (PMS) physiopathology and preclinical studies suggested that low doses of fluoxetine increase the ALLO brain concentration.

OBJECTIVES

To assess which low dose of fluoxetine (2 mg/d, 5 mg/d or 10 mg/d), administered exclusively during the luteal phase of menstrual cycle, has a potential effect for preventing or mitigating emotional PMS symptoms.

METHODS

In this randomized, double-blind, placebo-controlled pilot study, we followed 40 women (mean age = 29.7 +/- 7.4 years) with emotional PMS, during two menstrual cycles: cycle 1, without pharmacological intervention; and cycle 2, with pharmacological intervention. Participants took capsules, on average, seven days preceding the likely date of menses. We assessed the severity of PMS symptoms in both cycles using the Daily Record of Severity of Problems scale (DRSP).

RESULTS

There was an increase in the DRSP scores during the late luteal phase of cycle 1, confirming the diagnosis of emotional PMS. Low doses of fluoxetine (5 mg/d: 33.5%; 10 mg/d: 48.4%) reduced DRSP total score in the day before menses (day-1) at cycle 2 compared with day-1 at cycle 1. Fluoxetine 10 mg/d had the most consistent decline in emotional PMS symptoms; 70% of the participants reported a reduction greater than 40% in the DRSP score.

CONCLUSIONS

Low doses of fluoxetine, which may have no or few effect on the serotonergic system, but may interfere in the progesterone metabolization, seem to have some potential to mitigate emotional PMS symptoms. While the 10 mg/d of fluoxetine had the best performance on reducing emotional PMS symptoms, the 5 mg/d dose also seems to have some effect on emotional PMS symptoms. Further larger studies will help establish the lowest effective dose of flouxetine for PMS treatment.

Correlation of perceived stress with monthly cyclical changes in the female body

Background

Women are liable to stress-related disorders as female sex hormone, estrogen has been indicated to be protective against stress disorders. The hormone level varies with different phases of menstrual cycle. Moreover, postmenopausal women are at risk for stress-related disorders. So this study was done to correlate the different phases of menstrual cycle with the perceived stress in different phases of monthly cycle.

Methods

This study was conducted in the Department of Physiology, Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS), Dehradun. Four hundred girls in the age group of 18-26 years were selected for the study. The Perceived Stress Scale (PSS) questionnaire was circulated via Google forms after briefing them about the study. Informed consent was also taken. The menstrual history of the subjects was enquired by one-to-one interaction. The participants completed the PSS questionnaire twice in the same cycle. Data collected were statistically analyzed, using Independent t-test and Chi-square test and point biserial correlation test.

Result

The analysis showed strong statistical association of PSS with two phases of menstrual cycle. The PSS score was higher in the late luteal and menstrual phase, while it was less in the late follicular phase (P < 0.05). Conclusion: The decreased oestrogen levels in the late luteal & menstrual phase are strongly associated with perceived stress in our study. Hormonal changes in the monthly cycles are related with stress, behavioral shift and many other physical changes in females. This information to the family physicians would be beneficial in counseling the females regarding various changes occurring during the menstrual cycle.

Testosterone and Prolactin Perturbations Possibly Associated with Reduced Levels of β-Arrestin1 in Mononuclear Leukocytes of Women with Premenstrual Dysphoric Disorder

Previously, we reported that a reduction in β-Arrestin1 protein levels in peripheral blood mononuclear leukocytes (PBMC) significantly correlated with the severity of depression symptoms in women with premenstrual dysphoric disorder (PMDD). This study aimed to determine whether the reduced premenstrual β-Arrestin1 protein levels were associated with changes in the regulator for late luteal phase progesterone secretion. The study participants (n = 25) were non-pregnant women between 18 and 42 years of age not taking any antidepressants or receiving therapy and experiencing the luteal phase of menstruation. ELISA determined the β-Arrestin1 protein in PBMC; testosterone and prolactin levels from the plasma were determined by radioimmunoassay. Reduced levels of β-Arrestin1 protein in women with Hamilton Rating Scale for Depression (HAM-D) scores above 19 were observed alongside significantly higher plasma testosterone and prolactin concentrations. Understanding the mechanism underlying the initiation of PMDD will allow for identification of a key perturbed metabolic enzyme that can serve as a target for drug development to ensure the alleviation of PMDD, which has been suggested earlier as a risk factor for developing major depressive disorders.

Neurobiological effects of exercise intervention for premenstrual syndrome

Background

Up to 75%-90% of women have varying degrees of premenstrual syndrome (PMS). Exercises are recognized to be beneficial to regulate the negative emotions associated with PMS; however, the effects of exercise on sadness inhibition have not yet been investigated from the neurobiological perspective.

Purpose

This study examined the effects of a single exercise intervention on the neural mechanisms mediating sadness response inhibition at the cortical level using multichannel event-related potential (ERP) recording in women with PMS.

Methods

Participants performed Go/No-go trials while viewing of sad or neutral images before and after exercise intervention, and changes in the No-go-evoked N200 (N2) ERP component were measured by electroencephalography (EEG) at multiple cortical sites. The associations of PMS Inventory scores with N2 amplitude and latency changes were then examined using Pearson's correlation analysis.

Results

There were no significant differences in N2 latency and response error rate following exercise compared to baseline. However, women with higher PMS Inventory scores (greater symptom severity) demonstrated significantly lengthen N2 latency at the Fz electrode sites during correct sad face No-go trials after exercise (p < 0.05), which was not the case in the pre-exercise baseline. We detected no significant relationship between the PMS score and N2 amplitude, either pre- or post-exercise.

Conclusion

Women with higher PMS severity exhibited longer sad N2 latencies as well as slow down the speed of reaction to negative stimuli by exercise, suggesting that the prefrontal emotion regulation network is involved in PMS symptoms and is sensitive to the beneficial effects of exercise.

Characterization of pathogenic factors for premenstrual dysphoric disorder using machine learning algorithms in rats

We established a methodology using machine learning algorithms for determining the pathogenic factors for premenstrual dysphoric disorder (PMDD). PMDD is a disease characterized by emotional and physical symptoms that occurs before menstruation in women of childbearing age. Owing to the diverse manifestations and various pathogenic factors associated with this disease, the diagnosis of PMDD is time-consuming and challenging. In the present study, we aimed to establish a methodology for diagnosing PMDD. Using an unsupervised machine-learning algorithm, we divided pseudopregnant rats into three clusters (C1 to C3), depending on the level of anxiety- and depression-like behaviors. From the results of RNA-seq and subsequent qPCR of the hippocampus in each cluster, we identified 17 key genes for building a PMDD diagnostic model using our original two-step feature selection with supervised machine learning. By inputting the expression levels of these 17 genes into the machine learning classifier, the PMDD symptoms of another group of rats were successfully classified as C1-C3 with an accuracy of 96%, corresponding to the classification by behavior. The present methodology would be applicable for the clinical diagnosis of PMDD using blood samples instead of samples from the hippocampus in the future.

Limbic self-neuromodulation as a novel treatment option for emotional dysregulation in premenstrual dysphoric disorder (PMDD); a proof-of-concept study

AIM

To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD).

METHODS

We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR).

RESULTS

A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement.

CONCLUSION

Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm.

Psychological, physiological, and biochemical correlations after negative emotional videos in college students with and without premenstrual syndrome

Introduction

Women with premenstrual syndrome (PMS) suffer heavily from emotional problems, the pathogenesis of which is believed to be related to the hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system (ANS) and central nervous system (CNS). We took into account all 3 aspects to observed the psychological, physiological and biochemical correlations under anger and sadness in college students with and without PMS.

Methods

33 students with PMS and 24 healthy students participated in the emotion induction experiment, and were required to fill out self-report scales. Their salivary cortisol (SCort), skin conductivity level (SCL), heart rate variability (HRV), blood pressure (BP) and electroencephalogram (EEG) data were collected at the resting stage and 10-15 minutes after each video.

Results

Compared to healthy controls, students with PMS showed lower SCort level and higher VLF at rest, and no statistic difference in activities of ANS and HPA axis after emotional videos, but different results in EEG in all conditions. The decreases in SBP during angry video, SCort after angry and neutral videos, and increases in θ band power during sad video were moderately correlated with increases in PMS score. No intergroup differences were found in self-report emotions.

Discussion

Students with PMS had lower activity of HPA axis and possibly higher activity of PNS at rest, and different response patterns in CNS in all conditions. Several EEG frequencies, especially θ band, in specific encephalic regions during emotional videos, as well as declined HPA activities in dealing with angry and neutral stressors, in which γ activity in frontal lobe may play a role, showed moderate correlations with more severe PMS.