PMS as a process of negotiation: Women’s experience and management of premenstrual distress

The experiences and psychological impact of living with premenstrual disorders: a systematic review and thematic synthesis

Introduction

As the psychological impact and decreased quality of life experienced by women living with a Premenstrual Disorder (PMD) has been reported in the literature, the aim of this systematic review and thematic synthesis was to explore a) their experiences and the psychological impact of PMDs, specifically Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), and b) their perceived support needs.

Method

Six databases were searched for publications reporting on qualitative studies, since the database inception. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed.

Results

Seventeen papers reporting on 479 women met the inclusion criteria: ten focused on PMS, six on PMDD and one on PMS and PMDD combined. Two main PMD themes were identified: 1) controlled by PMDs, which had three subthemes, and 2) a women and life left broken, with five subthemes.

Conclusion

Women's accounts revealed that experiences of PMDs were intense, life changing and life-controlling. Women were left holding the responsibility of understanding and managing their own condition, whilst advocating for themselves in a healthcare setting in which their condition has been little understood. Consequently, women developed coping strategies to lead a functional life, and experienced changes to their sense of self. Clinical recommendations included the need for professionals working with women in crisis, to assess for PMDs and signpost towards specialist services.

Menstrual and psychosocial characteristics associated with high-risk of premenstrual dysphoric disorder among university students: a cross-sectional study

Up to 92 percent of Chinese women of reproductive age have pre-menstrual syndrome (PMS). The severe form of PMS (i.e. pre-menstrual dysphoric disorder [PMDD]) negatively affects women's everyday functioning and reproductive health. This study examined the relationships between menstrual, psychosocial characteristics and the risk of PMDD among young Chinese women. A cross-sectional online survey was conducted among Chinese university students in Hong Kong. Logistic regression was used to compute adjusted odds ratio (aOR) for the association of high-risk PMDD with menstrual and psychosocial characteristics. A total of 541 Chinese university students were recruited. Approximately 53 percent of female students were at high risk of developing PMDD. The high-risk PMDD group was significantly associated with a heavy volume of menstrual flow (aOR = 2.17, 95 percent CI 1.06-4.45), irregular menstrual cycle (1.72, 1.17-2.52), high dysmenorrhea (2.80, 1.95-4.04) and older ages of menarche (0.67, 0.45-0.98) in the menstrual characteristics. In the psychosocial characteristics, high-risk PMDD was significantly associated with symptoms of anxiety (2.19, 1.48-3.32) and depression (2.22, 1.48-3.32), high loneliness (1.94, 1.34-2.79) and low resilience (2.21, 1.52-3.23) levels. Additionally, resilience had a potential moderating effect on the associations between the high risk of PMDD and anxiety, depression and loneliness. The development and delivery of interventions that can enhance resilience and manage psychological distress would be beneficial for young Chinese women's reproductive health.

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.

How Do Elite Female Athletes Cope with Symptoms of Their Premenstrual Period? A Study on Rugby Union and Football Players' Perceived Physical Ability and Well-Being

Women's participation in sports has recently grown worldwide, including in sports typically associated with men (e.g., rugby and football). Similarly, literature on female athletes has increased, but how they cope with premenstrual (PM) physical and affective symptoms remains a poorly studied topic. Our study aimed to explain which coping strategies elite female rugby and football players use during their PM period to maintain perceived physical ability (PPA) and well-being. A mediation model analysis considering coping strategies (i.e., avoiding harm, awareness and acceptance, adjusting energy, self-care, and communicating) as independent variables, PPA and well-being as dependent variables, and PM physical and affective symptoms and PM cognitive resources as mediators was run on the data collected via an anonymous online survey. A dysfunctional impact of avoiding harm (indirect) and adjusting energy (both direct and indirect) and a functional indirect influence of awareness and acceptance, self-care, and communicating as coping strategies were found on PPA and well-being during the PM period. As predicted, PM physical and affective symptoms as mediators reduced PPA and well-being, while PM cognitive resources enhanced them. These results may inform practitioners on how to support elite female athletes' PPA and well-being by knowing and reinforcing the most functional PM coping strategies for them.

Patterns of premenstrual syndrome in collegiate women: A cross-sectional study

Premenstrual syndrome (PMS) has a wide variety of symptoms. The classification of these symptoms into several patterns is useful for more effective tailor-made treatment. Therefore, our study aimed to examine the patterns of PMS by analyzing multiple factors to identify the characteristics of each pattern. This is a cross-sectional study. A total of 165 women (18.9 ± 1.0 years) were investigated by using of questionnaire about PMS, nutrition, physical activity, and other lifestyle traits. Then, the factor analysis was performed to classify the premenstrual symptoms, that is, the pattern of PMS. Additionally, logistic regression analysis was performed to identify the characteristics of each pattern, adjusted for age, body mass index, sleep duration, and caffeine intake. As the result, PMS was classified into 3 patterns. The type related to psychological symptoms such as depression, physiological symptoms, such as abdominal pain, and intermingled type, were labeled as affected, somatic, and mixed types, respectively. From the result of logistic regression analysis, self-rating depression scale scoring was marginally associated with affective type (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.99-1.16), physical activity was significantly associated with the mixed type (OR: 1.13, 95% CI: 1.00-1.28), and physical activity (OR: 1.20, 95% CI: 1.05-1.36) and some nutrients (OR: 0.56-1.00) were significantly associated with the somatic type. Understanding PMS and management of these complicated symptoms has been difficult. From the results of this study, the complicated symptoms were categorized into simpler patterns. Our findings may contribute to the understanding and possible management adjusted for each categorized case of PMS.

The effect of a social network-based cognitive behavioral therapy intervention on the severity of premenstrual syndrome symptoms: a protocol of a randomized clinical trial study

Background

Premenstrual syndrome (PMS) is one of the most widespread menstrual disorders in women of reproductive age. This recurrent syndrome is a combination of physically, mentally, or behaviorally disturbing changes occurring during the secretory phase of the menstrual cycle. The aim of this study is to determine the effect of a cognitive-behavioral therapy-based educational intervention using social networks on PMS in female health center employees in Rudbar, Iran.

Methods/design

A randomized superiority controlled trial will be conducted involving 140 female employees of health centers affiliated with the Guilan University of Medical Sciences, Rudbar. The study involves a block size of 4 and 6 in a randomly varied order, 140 women who meet all the inclusion criteria will be randomly and equally divided into 2 groups: the intervention and the control groups. Those in the former group will receive a cognitive-behavioral therapy-based treatment for eight consecutive weeks on the social network platform WhatsApp; however, those in the control group will not be offered any treatment except usual care practices (unprotocolized usual care). The study’s primary outcome is the severity of PMS symptoms, and the secondary outcomes include general self-efficacy, work-related quality of life, the impact of PMS on daily life, coping with the symptoms, and experiencing anxiety and depression at the beginning of the study to identify people with PMS. A daily record of the symptoms will be completed for two consecutive months by all female employees aged 20–45 years who wish to participate in the study. According to the initial screening, those with moderate to severe PMS will be included. We will use the MLwin software for the analyses. All questionnaires will be completed by both groups immediately and 8 weeks after the termination of the treatment. The data will be analyzed using linear mixed-effects modeling with random intercepts and slopes.

Discussion

It is anticipated that the findings of the present study may demonstrate the effectiveness of the cognitive behavioral therapy intervention on the severity of PMS symptoms that could guide healthcare providers in opting for suitable treatment alternatives for the syndrome.

Ethics and dissemination

The research proposal is approved by the Human Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1399.252). The results of this intervention trial will be submitted for publication in a peer-reviewed research journal.

Trial registration

Iranian Registry of Clinical Trials IRCT20180218038789N4. Registered prospectively on October 28, 2020

Mapping the abject: Women's embodied experiences of premenstrual body dissatisfaction through body-mapping

Women's body shame and body dissatisfaction increase in the premenstrual phase of the cycle, associated with premenstrual distress. However, the meaning and consequences of premenstrual body dissatisfaction remain underexplored. The aim of this study was to explore how women who report premenstrual body dissatisfaction construct and experience their bodies, using qualitative arts-based methods. Four hundred and sixty women completed online open-ended survey questions and 16 women took part in body-mapping and an interview. Thematic analysis identified three major themes: construction of the premenstrual body as abject, manifested by positioning of the body and self as fat, leaking and dirty; self-policing and self-regulation through increased scrutinising and concealment of the premenstrual body; and resistance of cultural constructions of idealised femininity. These findings emphasise the need to acknowledge changes in body dissatisfaction across the menstrual cycle, and the implication for women's feelings about the self. Internalisation of negative constructions of the female body plays a role in women's experience of premenstrual change and distress. There is a need for further research to examine the role of body management behaviours in premenstrual body dissatisfaction and distress.

Mindfulness Training Intervention With the Persian Version of the Mindfulness Training Mobile App for Premenstrual Syndrome: A Randomized Controlled Trial

Premenstrual syndrome (PMS) is a common problem for women of reproductive age, affecting various aspects of their lives. While various in-person psychotherapeutic interventions, including Mindfulness therapy, have yielded promising results in reducing PMS symptoms, due to the COVID-19 Pandemic, psychotherapists are providing their services via online methods. Therefore, the present study is the first one worldwide to examine whether smartphone-based Mindfulness training can reduce symptoms of PMS and improve the quality of life in women with PMS. We recruited 80 Iranian women (aged 25-45) with PMS through online advertising who were randomly allocated into two groups of 40. The intervention group underwent two online introductory group sessions followed by 8 weeks of Mindfulness practice, while the control group received no intervention. Before and after the intervention, participants completed the 12-Item Short-Form Health Survey and the Premenstrual Symptoms Screening (PSST) questionnaires. Data were analyzed using the Analysis of Covariance (ANCOVA). Following the intervention, the mean scores of PMS symptoms were significantly lower in the intervention group than in the control group (p < 0.001; η² = 0.18). Likewise, the quality of life score was significantly higher in the intervention group (p < 0.001; η² = 0.14). Our results indicated that the smartphone-based Mindfulness training intervention could be an effective treatment modality for women with PMS symptoms, especially during the COVID-19 Pandemic, which has posed limitations for in-person therapies.

CLINICAL TRIAL REGISTRATION

https://fa.irct.ir/trial/59924, identifier: IRCT20180607040000N2.

"Extreme emotions" - the impact of reproductive life events for women living with bipolar disorder

Little is known about how women with bipolar disorder construct and experience reproductive life events across the lifespan. We analyzed qualitative data from 29 semi-structured interviews with women aged 22-63 years (reproductive, menopause and post-menopause phases) using thematic analysis through a social constructionist framework. Themes of "Losing a sense of self-agency and self-worth" contained accounts of feeling out of control because of both bipolar disorder and reproductive life events. "Building a sense of personal autonomy and positive self-image" included accounts of acceptance and management of mood change over time, particularly for women in menopause and post-menopause life phases.

Views of Dutch general practitioners about premenstrual symptoms: A qualitative interview study

Background

General practitioners (GPs) encounter women suffering from premenstrual symptoms. Often women with premenstrual problems experience little understanding from GPs. Views of GPs will influence their approach to these women and their care. Insight into these views is lacking but could help in designing educational programmes for GPs.

Objectives

To explore the views of Dutch GPs towards aetiology, diagnostic process, and preferred treatment of premenstrual symptoms.

Methods

In 2017, we conducted a qualitative, semi-structured, interview survey among 27 GPs, varying in age, gender, and practice setting.

Results

Important themes emerged from the interviews: ‘no need for a symptom diary,’ ‘PMS defined as illness’ exclusively in case of disruption of normal functioning, and ‘symptomatic treatment’ as preferred approach. Most GPs considered PMS to be a physiological phenomenon, with taking history as an adequate diagnostic tool. Almost all GPs regarded a normal cyclical hormonal cycle as causal; many also mentioned the combination with personal sensitivity. Some pointed to a dividing line between physiological condition and illness if women could not function normally in daily life. Lastly, the approach GPs preferred was focussing on relieving symptoms of individual patients. In addition to explaining the hormonal cycle and lifestyle advice, all GPs advocated oral contraceptives, and if necessary psychological support. GPs expressed negative feelings about prescribing antidepressants.

Conclusion

GPs considered physiological changes and personal sensitivity as aetiological factors. We recommend more training to improve GPs knowledge and more insight into the burden of women with PMS. A symptom diary is an essential diagnostic tool for GPs.

Association between Childhood Maltreatment History and Premenstrual Syndrome

Childhood maltreatment history has known relationships with various mental and physical diseases; however, little is known about its association with premenstrual syndrome (PMS). In this study, we investigated the association between childhood maltreatment history and PMS among young women in Japan. In a Japanese city, we approached 3815 women aged 10–60 years who visited a gynecology clinic and one general practice clinic. A questionnaire on childhood maltreatment history and PMS was administered to them. We observed that women with histories of childhood maltreatment demonstrated a significantly increased risk of PMS compared with those without such histories (odds ratio: 1.47, 95% confidence interval: 1.20–1.81). Particularly, women with childhood physical or emotional abuse demonstrated a stronger association with PMS, whereas other forms of childhood maltreatment (emotional neglect, witnessing of intimate-partner violence, or sexual abuse) were not associated with PMS. Our results illustrate that childhood maltreatment may be a risk factor for PMS.

“I feel fat and ugly and hate myself”: Self-objectification through negative constructions of premenstrual embodiment

The body is central to women’s construction of premenstrual change as premenstrual syndrome (PMS), and to experiences of premenstrual distress. Embodied change, such as bloating or breast tenderness, can act as a marker of PMS. Within biomedical models, PMS is located within the body. Women’s dissatisfaction with their bodies is also reported to be higher in the premenstrual phase of the cycle. What is absent from this analysis is the meaning and experience of embodied change, in the context of broader constructions of femininity and embodiment. In this paper, we adopt a feminist material-discursive theoretical framework to examine the role of premenstrual embodiment in women’s premenstrual distress, drawing on open-ended survey responses and interviews with 83 women who self-diagnose as “PMS sufferers”. We theorize premenstrual body hatred as subjectification, wherein women take up cultural discourse associated with idealized femininity and the stigmatization of the fat body, resulting in self-objectification, distress and dehumanization. However, women can resist negative cultural constructions of premenstrual embodiment. We describe the impact of psychological therapy which increases awareness of emotional and embodied change, resulting in greater acceptance of the premenstrual body and self-care, serving to reduce premenstrual distress and self-objectification.

Effects of a social-media-based support on premenstrual syndrome and physical activity among female university students in South Korea

Introduction: This study examined the effects of social-media-based support on premenstrual syndrome (PMS) and physical activity among female South Korean university students.Methods: This quasi-experimental study with an equivalent-control-group pretest-posttest design randomly assigned 64 female students with PMS to the experimental or control group. The experimental group received social-media-based support through a smartphone application, text messaging, and e-mail for one menstrual cycle between September and December, 2016. Descriptive and inferential statistics included a Chi-square test and independent and paired t-tests.Results: Significant differences emerged between the experimental and control groups in total PMS scores (p = .003), 14 premenstrual symptoms, and physical activity (p = .010).Conclusions: Female university students with PMS experienced decreased premenstrual symptoms and increased physical activity with social-media-based support, which could be an efficacious, accessible, and widely available nursing intervention to manage PMS and physical activity.

Menstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls

STUDY OBJECTIVE

To determine the cross-sectional characteristics of menstruating girls, dysmenorrhea, and the frequencies of related problems.

DESIGN

Descriptive, cross-sectional study.

SETTING

Randomly selected primary, junior, and high schools in the city center of Kayseri.

PARTICIPANTS

Two thousand female adolescents of ages between 9 and 18 years.

MAIN OUTCOME MEASURES

We used a questionnaire addressing the epidemiological characteristics of menstruation, such as age at menarche, duration of menstrual intervals, average days of bleeding, and any menstrual problems and their frequencies.

RESULTS

This study consists of a sufficient number of participants from all age groups. Of the participant (n = 2000) girls, 63.7% (n = 1274) had started menstruating. The mean age at menarche was 12.74 (±1.03) years. With a prevalence of 84.8% (n = 1080), dysmenorrhea was the most prevalent menstrual problem and the average pain score was 5.87 (±2.45). Of the menstruating girls, 34% (n = 439) used painkillers, the most commonly used was acetaminophen; during their period the prevalence of nonmedical methods to relieve pain was 35.2%; the rate of seeking medical help for dysmenorrhea was 9.3% (n = 119). In menstruating participants, 90.8% discussed their menstrual problems with their mothers. The rate of school absenteeism in menstruating girls was 15.9% in general and 18% in those with dysmenorrhea.

CONCLUSION

Problems related to menstruation are common in adolescents and these problems affect their social life. In adolescent girls, the most common menstrual problem is dysmenorrhea and it affects school performance and attendance. Girls with menstrual problems showed a low rate of seeking medical help.

Treatment of premenstrual syndrome: Appraising the effectiveness of cognitive behavioral therapy in addition to calcium supplement plus vitamin D

Premenstrual syndrome (PMS) consists of repetitious physical and psychological symptoms. The symptoms occur during the luteal phase of the menstrual period and cease when the menstrual period starts. This study included pre-test and post-test experiments between a control group and a test group. The statistical population involved 40 females, chosen based on multistage cluster sampling. The participants were then divided into four groups to undergo treatment with calcium supplement plus vitamin D together with cognitive behavioral therapy (CBT), and were screened with the Premenstrual Syndrome Screening Test (PSST). The pre-test and post-test scores in the PSST, the General Health Questionnaire (GHQ-28), and Bell's Adjustment Inventory (BAI) were used as assessment tools (p < .05). According to the parameters of PMS symptoms, when evaluating the pre-test and post-test scores, the overall score of each individual in the experimental group was improved and a significant effect for the combination of calcium supplement plus vitamin D together with CBT was observed in comparison to the post-test control group. A comparison of multivariate analysis of covariance (MANCOVA) results collected from the pre-test and post-test scores revealed that the method of treatment was beneficial for PMS, adjustment, and general health.

Exploring premenstrual dysphoric disorder (PMDD) in the work context: a qualitative study

This study aims to explore women's experience of premenstrual dysphoric disorder (PMDD) in the workplace, and identify if organizations can do anything to help. Analysis of 15 semi-structured interviews, using an inductive thematic analysis approach, revealed the most common symptoms women experience at work include difficulty in concentrating, self-doubt, paranoia, fatigue, tearfulness, a heightened sensitivity to the environment and people, outbursts, and finding social interaction particularly difficult during this premenstrual "episode" phase. It is these symptoms that contribute to observed presenteeism and absenteeism in the work context. After symptoms disappear (with onset of menstruation), women reported feelings of guilt and engage in over-compensatory behaviors such as working longer hours and taking work home during the remainder of the menstrual cycle (i.e. post-episode phase). Women alternate between these phases every month, which over time, accumulate and have additional consequences. Women are leaving the workforce through voluntary and/or involuntary turnover, sometimes giving up on careers entirely. The interviews also highlighted that organizations need greater awareness and support mechanisms in place for helping female employees with this condition. These findings could be of interest and have relevance to researchers, employers, policymakers, and health professionals.

Being a mother with multiple sclerosis: Negotiating cultural ideals of mother and child

Multiple sclerosis can impact affected women’s experiences of motherhood through physical and cognitive impairment. This study examined how women construct and experience motherhood while living with multiple sclerosis. Twenty mothers diagnosed with multiple sclerosis took part in semi-structured interviews. Transcripts were analysed using theoretical thematic analysis, drawing on feminist poststructuralist theory to organise and interpret themes. Two main themes were identified: “Performing motherhood in the context of MS” and “Bringing up a ‘good’ child”. “Performing motherhood in the context of MS” comprises the subthemes, “The self-sacrificing mother: Negating women’s needs”, “The unreliable mother: Adjusting day-to-day mothering practices”, and “Resisting discourses of idealised motherhood”. “Bringing up a ‘good’ child”, comprises the subthemes, “The damaging mother: Fear of harming the child” and “The good mother: Caring and building resilience in the child”. Women positioned themselves as failing to be good mothers, because of limitations to their mothering, and fear of damaging children. Focusing on building children’s emotional resilience functioned to restore constructions of “good” mothering. Acknowledging how Western cultural ideals influence women’s experience of mothering when living with chronic illness is important. Health professionals can provide support by addressing women’s feelings of failure as mothers and supporting communication with children.

"Is it menopause or bipolar?": a qualitative study of the experience of menopause for women with bipolar disorder

Background

Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions.

Methods

Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework.

Results

Themes identified included ‘Constructions of mood change: menopause or bipolar disorder?’,‘ Life events, bipolar disorder and menopause coming together’; ‘Treatment choices for mood change during menopause’.

Conclusions

The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0467-y) contains supplementary material, which is available to authorized users.

Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial

DESIGN

A randomised control trial (RCT) was conducted to examine the efficacy of couple-based cognitive behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait-list control.

METHODS

Triangulation of quantitative and qualitative outcome measures evaluated changes pre-post intervention. Eighty three women were randomly allocated across three conditions, with 63 completing post-intervention measures, a retention rate of 76%.

RESULTS

Repeated measures analysis of variance found a significant time by group interaction identifying that women in the two CBT conditions reported lower total premenstrual symptoms, emotional reactivity/mood, and premenstrual distress, in comparison to the wait list control. Significantly higher active behavioural coping post-intervention was found in the couple condition than in the one-to-one and wait list control groups. Qualitative analysis provided insight into the subjective experience of PMDs and participation in the intervention study. Across groups, women reported increased awareness and understanding of premenstrual change post-intervention. A larger proportion of women in the CBT conditions reported reduction in intensity and frequency of negative premenstrual emotional reactivity, increased communication and help-seeking, increased understanding and acceptance of embodied change, and the development of coping skills, post-intervention. Increased partner understanding and improved relationship post-intervention was reported by a greater proportion of participants in the CBT conditions, most markedly in the couple condition.

CONCLUSION

These findings suggest that one-to-one and couple CBT interventions can significantly reduce women's premenstrual symptomatology and distress, and improve premenstrual coping. Couple based CBT interventions may have a greater positive impact upon behavioural coping and perceptions of relationship context and support. This suggests that CBT should be available for women reporting moderate-severe PMDs, with couple-based CBT offering additional benefits to a one-to-one modality.

Relationships among Menstrual Attitude, Premenstrual Distress, and Premenstrual Coping in Korean College Women

PURPOSE

This paper presented a descriptive study which aimed to identify the relationship among menstrual attitude, premenstrual distress and premenstrual coping in Korean college women and to propose fundamental data for the development of guidelines for effective management of premenstrual distress.

METHODS

The data were collected from 111 college women and analyzed using descriptive statistics, t-tests, ANOVA and Pearson's correlation coefficients.

RESULTS

The mean score of premenstrual coping was 3.25±0.60 out of 5 points. The 'Awareness and Acceptance of Premenstrual Change' score was highest and the 'Avoiding Harm' score was lowest. Menstrual attitude was significantly related to premenstrual distress (r=.37 p<.001) and the awareness and acceptance style of premenstrual coping (r=-.21. p=.021). And premenstrual distress was significantly related to the self-care coping style of premenstrual coping (r=.30, p=.001), the adjusting energy coping style of premenstrual coping (r=.45, p<.001) and the avoiding harm coping style of premenstrual coping (r=.48, p<.001).

CONCLUSION

Results of this study support that positive attitude about menstruation is necessary for the effective management of premenstrual distress. Also, premenstrual coping programs that consider the level of premenstrual distress will be needed for college women.

Emotional interference and attentional processing in premenstrual syndrome

BACKGROUND AND OBJECTIVES

Premenstrual syndrome (PMS) is characterized by menstrual cycle-related affective, behavioral, and/or somatic symptoms. By applying the emotional Stroop task (EST) the current study examined if changes in processing emotional information, which have been demonstrated in affective disorders, are also present in PMS.

METHODS

Via online screening, telephone interviews, and daily records over two months 55 women for the PMS group (on the basis of the specific inclusion criteria and a prospectively confirmed PMS) and 55 'non-PMS' controls were recruited. All participants completed three emotional Stroop tasks (EST) with neutral and negative word, picture, and facial stimuli, during the follicular and luteal phase of the menstrual cycle.

RESULTS

Mixed 2 × 2 univariate analyses of variance and post-hoc comparisons showed primarily a greater emotional Stroop effect with respect to picture and facial stimuli in the luteal menstrual cycle phase in women with PMS, compared to the control group. No significant group differences were observed for word stimuli. With respect to the facial stimuli, a kind of paradox effect was revealed (Stroop facilitation) in the PMS group.

LIMITATIONS

This study provides important information regarding cognitive processes in women suffering from PMS that have to be interpreted in the light of the following limitations: a limited representativeness of the sample, the determination of menstrual cycle phases based on symptom diaries but not hormone levels, and a limited interpretability of our results as causal relationships.

CONCLUSIONS

Our findings are in line with the assumption that alterations in cognitive-emotional processes are associated with PMS. Further research on the etiology of PMS should focus more on cognitive-emotional processing and its interaction with biological changes relating to the menstrual cycle.

A Qualitative Study on Negative Emotions Triggered by Breastfeeding; Describing the Phenomenon of Breastfeeding/Nursing Aversion and Agitation in Breastfeeding Mothers

Background:

Breastfeeding aversion and agitation (BAA) while breastfeeding is anecdotally known to occur in some women who breastfeed while pregnant or those who tandem feed a newborn and a toddler. However, it is a little-researched area and the paucity of published literature around BAA reveals a significant gap in the literature.

Materials and Methods:

This study presents the findings and responses of 694 women who filled in an anonymous survey questionnaire that collected data on their basic demographics and their experiences with breastfeeding. It uses thematic and inductive content analysis, with qualitative interpretive description to present the findings.

Results:

The findings of this study shed light on an experienced phenomenon of aversion and agitation whilst breastfeeding, which varies in form, severity, and duration. It is characterised by feelings of anger or rage, a skin crawling sensation and an urge to remove the suckling infant, but can also be feelings of agitation and irritability whilst the infant is latched. A number of mothers who experience aversion still continue to breastfeed, but have feelings of guilt and shame while also experiencing confusion around those feelings.

Conclusions:

BAA is a phenomenon that occurs in some women who breastfeed, whereby breastfeeding triggers negative emotions. The reason women experience it is not clearly known. Research is needed to understand its cause, triggers, and strategies to minimise the experience in breastfeeding mothers.

Emotion Dysregulation of Women with Premenstrual Syndrome

The aim of the current study was to test whether women with premenstrual syndrome (PMS) had difficulties in emotion regulation. In Study 1, we investigated the relationship between the habitual use of emotion-regulation strategies and the severity of PMS (n = 230). The results showed that the severity of PMS was negatively associated with the habitual use of reappraisal, but positively associated with the habitual use of suppression. In Study 2, we first investigated the difference in the spontaneous use of suppression versus reappraisal between women with (n = 42) and without PMS (n = 42) when watching sad film clips. Then we instructed some participants (PMS group = 20, healthy group = 21) to use reappraisal to regulate their emotions induced by a second sad film clip, and the other participants were asked to watch the second film clip freely (PMS group = 22, healthy group = 21). The results showed that there was no significant difference between participants with and without PMS in the self-reported spontaneous use of emotion-regulation strategies. For participants with PMS, increases in spontaneous suppression use were associated with increases in skin conductance level (SCL), while this association was not found among participants without PMS.

Premenstrual symptom clusters and women's coping style in Korea: happy healthy 20s application study

INTRODUCTION

The purpose of this study was to identify premenstrual symptom clusters; and to explore the differences in and effectiveness of coping strategies among symptom cluster groups.

METHODS

Using the happy healthy 20s smartphone application, 349 women with premenstrual symptoms participated in the study. Premenstrual symptoms and health outcomes such as perceived health, depressive feelings, quality of life, suicidal ideation/attempts and coping strategies were explored. Factor analysis and silhouette analysis were used to identify premenstrual symptom clusters. Analysis of variance was used to explore the differences among symptom clusters in health outcomes and coping strategies.

RESULTS

Three premenstrual symptom clusters were identified: general discomfort, negative affect and turmoil. Three symptom cluster groups experienced different health outcomes in perceived health, depressive feelings, quality of life and suicidal ideation. However, few differences were noted in participants' engagement in coping strategies, frequencies and perceived effectiveness among women with different symptom clusters.

DISCUSSION

Findings of this study support previous reports that women do not receive tailored care for their premenstrual symptoms. Learning about the symptom structure, women's ways of coping, and perceived effectiveness is important in identifying the issues in current premenstrual symptoms management and providing tailored care.

A path analysis of stress and premenstrual symptoms in Korean international and Korean domestic students

AIMS

To identify the relationships between perceived stress, acculturative stress and premenstrual symptoms, among other associated factors (e.g. depressive symptoms, coping self-efficacy, perceived social support) of premenstrual symptoms suggested in the literature by testing the conceptual framework of the 'Stress and Premenstrual Experience Model: Women in Cultural Transition'.

BACKGROUND

Level of perceived stress has been cited as a major influencing factor for women's premenstrual symptoms; however, how these two elements are related, including possible mediators and moderators, remains unclear.

DESIGN

A longitudinal causal-comparative web-based study design.

METHODS

Data collection occurred between November, 2014 - February, 2015. The convenience sampling method was used to recruit 98 Korean international students and 89 Korean domestic students. Weekly surveys were conducted for 10 weeks to capture women's levels of perceived stress, acculturative stress and premenstrual symptoms from two menstrual cycles. The survey data collected during the premenstrual phase was analysed using path analyses.

RESULTS/FINDINGS

The hypothesized pathways based on the conceptual model were partially supported in the study. Depressive symptoms were a partial mediator between perceived stress and premenstrual symptoms and between acculturative stress and symptoms in Korean international students. The perceived social support was a moderator between perceived stress and premenstrual symptoms in Korean domestic students.

CONCLUSION

This study proposes a revised conceptual model that will contribute to the understanding of stress and premenstrual symptom severity in women in the acculturation process and concludes with suggestions and implications for future nursing practice and research.

Hormonal contraceptives: pharmacology tailored to women's health

BACKGROUND

In recent years, several new oral contraceptives have become available. In some ways, they represent an evolution in terms of individualization and compliance on the part of women. The new formulations make it increasingly possible to prescribe a specific hormonal contraceptive on an individual basis.

METHODS

A systematic literature search of PubMed was performed using the following combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptive'. Only English-language papers published between January 2000 and July 2014 were included in our analysis. The present review analyzes all aspects of the choice of oral contraceptives in the different phases of a woman's life in detail.

RESULTS

Regarding the estrogen component, lowering the dose of ethinylestradiol (EE) helped reduce associated side effects. Natural estradiol is now available and represents a valid alternative to EE. And regarding progestins, the dose has changed over time, as well as the endocrine and metabolic characteristics. These are the fruit of much research into improvement of old products (19-nor-progesterone-derived progestins) with androgenic effects and testing of new molecules with improved metabolic neutrality in terms of insulin sensitivity and lipid parameters. New progestins were a genuine turning point because they greatly reduced major side effects, such as water retention, and their anti-androgenic properties made them indicated for all forms of hyperandrogenism associated with acne and mild hirsutism. The associations of estradiol/dienogest and estradiol/nomegestrol acetate are the most suitable contraceptives for women with abundant menstrual bleeding and can increase the number of potential users of hormonal contraception.

CONCLUSION

Progress in the provision of new oral contraceptives has improved the risk/benefit ratio, by increasing benefits and reducing risks. The present challenge is to tailor contraceptives to individual needs in terms of efficacy and protection of reproductive health.

Maternal experiences of embodied emotional sensations during breast feeding: An Interpretative Phenomenological Analysis

OBJECTIVE

the purpose of this study was to explore mothers׳ experiences of embodied emotional sensations during breast feeding and to understand the meaning and consequences that such experiences may have on mothers' sense of self and the relationships they form with their children.

DESIGN

a qualitative design was applied to this study as it was judged as the most appropriate approach to this novel field of enquiry.

SETTING

the study was conducted in United Kingdom using a sample of mothers drawn from five different countries from Europe, America and Australia.

PARTICIPANTS

the sample consisted of 11 mothers who reported experiencing or having experienced negative embodied emotional sensations associated with breast feeding in the past five years.

MEASUREMENTS

semi-structured interviews were conducted with the mothers and interviews were transcribed to enable the process of data analysis. Interpretative Phenomenological Analysis (IPA; Smith et al., 2009a, 2009b) was chosen as a method of data analysis, enabling in depth understanding and interpretation of the meaning of mothers' experiences. IPA was chosen due to its idiographic commitment and particular interest in sense-making, phenomenology and hermeneutics.

FINDINGS

three themes were generated reflecting the multifaceted nature of breast feeding experiences (i) 'Breast feeding: An unexpected trigger of intense embodied emotional sensations incongruent with view of self', (ii) 'Fulfilling maternal expectations and maintaining closeness with the child', (iii) 'Making sense of embodied emotional sensations essential to acceptance and coping'.

CONCLUSIONS

breast feeding has the potential to trigger a range of conflicting cognitions and emotions in mothers that may impact on how mothers view themselves and relate to their children.

IMPLICATIONS FOR PRACTICE

increasing awareness about emotional breast feeding experiences and recognising the multifaceted, individual nature of difficulties around breast feeding enables professionals to offer mothers person-centred care and avoid making clinical decisions and recommendations based on inaccurate knowledge.

Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study

BACKGROUND

Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes.

METHOD

This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview.

RESULTS

Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer.

CONCLUSION

The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.

Pathology or source of power? The construction and experience of premenstrual syndrome within two contrasting cases

This research examines the construction and experience of premenstrual syndrome (PMS) in the context of intimate couple relationships, through examination of two contrasting cases analysed using thematic decomposition of narrative interviews. Judith and her male partner pathologised premenstrual change, constructing the premenstrual self as out of control, and the epitome of the ‘monstrous feminine’. Judith reported feeling over-burdened and uncontrollably angry premenstrually, associated with relationship issues and absence of partner recognition or support. In contrast, Sophia normalised premenstrual change, challenging the association between PMS and the construction of woman as deviant or dysfunctional. Sophia reported heightened energy and creativity premenstrually, and engaged in self-care supported by her woman partner. These cases demonstrate that premenstrual distress is an intersubjective experience, with constructions and material practices within relationships providing the context for premenstrual women being positioned as pathological and needing to be contained, or conversely, as sensitive and needing support.

Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study

BACKGROUND AND OBJECTIVES

Premenstrual Syndrome (PMS) is a common health problem in women in reproductive age. The present study aimed to investigate the prevalence of PMS using meta-analysis method.

METHODS

This meta-analysis systematically reviewed the prevalence of PMS. A search was conducted using keywords Premenstrual Syndrome, PMS, prevalence PMS and symptom of PMS in reliable English articles. The initial search 53 articles were available. After review of full-text articles, 17 articles were selected for analysis. Data were combined using meta-analysis (random effects model). Data were analyzed using STATA software, Version 11.1 RESULTS: Overall, 17 studies met our inclusion criteria. The pooled prevalence of PMS was 47.8% (95% CI: 32.6-62.9). The lowest and highest prevalence were reported in France 12% (95% CI: 11-13) and Iran 98% (95% CI: 97-100) respectively. However, meta-regression scatter plot showed an increasing trend in the prevalence of PMS during 1996-2011 but correlation between prevalence of PMS and year of study was not significance (p= 0.797).

INTERPRETATION AND CONCLUSIONS

Considering that different tools have been used in studies and many studies have been designed based on a limited sample, therefore, future research needs to consider the prevalence of PMS in different countries of world.

Ways of coping with premenstrual change: development and validation of a premenstrual coping measure

BACKGROUND

Negative premenstrual change can result in distress for a significant proportion of women. Previous research has suggested that women employ a range of coping strategies and behaviours in order to manage and reduce premenstrual distress. However, as yet there has been no specific scale available to measure premenstrual coping. This research aimed to develop and validate a measure of premenstrual coping which can be used in future investigations of negative premenstrual experience.

METHODS

A sample of 250 women living in Australia, reporting mild to severe premenstrual distress, completed an online survey containing 64 items related to premenstrual coping. The items were generated by reviewing past literature related to premenstrual experience, in particular recent qualitative research on premenstrual coping. A principal components factor analysis with varimax rotation was conducted to determine item clusters that would form a measure. Reliability and validity were tested using calculations of Cronbach alphas, correlational analysis with psychological coping scales and a content analysis of participant reports of coping strategies.

RESULTS

The factor analysis, which involved two principal component analyses, resulted in five factors containing 32 premenstrual coping behaviours. Interpretation of the factor solution drew on empirical and theoretical accounts of premenstrual coping and the emergent factors were labelled Avoiding Harm, Awareness and Acceptance of Premenstrual Change, Adjusting Energy, Self-Care, and Communicating. These factors form the subscales of the Premenstrual Coping Measure (PMCM). The subscales demonstrated acceptable to very good reliability and tests of construct, concurrent and content validity were supportive of sound validity.

CONCLUSIONS

The PMCM provides a valid and reliable scale for quantifying ways of coping specific to negative premenstrual change. Conceptual similarity was found between some coping behaviours and behaviours positioned as symptoms of premenstrual change. Explanations for this overlap may be found in cultural discourses associated with idealised femininity and PMS (premenstrual syndrome). Further psychometric investigation of the PMCM will enhance knowledge of the role of coping with negative premenstrual experience.