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Kibralew G, Demilew D, Koye S, Yitayih S, Kelebie M, Melkam M, Tadesse G, Fentahun S, Nakie G, Wassie YA, Amare T. Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia. Front Psychiatry 2024; 15:1362118. [PMID: 38988740 PMCID: PMC11234160 DOI: 10.3389/fpsyt.2024.1362118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Background Premenstrual dysphoric disorder (PMDD) is the most prevalent but neglected psychiatric disorder, with somatic symptoms that are severe enough to markedly affect usual daily activities and have a negative impact on mental health and quality of life by affecting female patients' behavior and cognition. Studies regarding premenstrual dysphoric disorder and associated factors among high school students in low- and middle-income countries are limited. Therefore, the aim of this study was to assess the prevalence and associated factors of PMDD among high school students, and this is pivotal in further investigation. Methods A school-based cross-sectional study was conducted from March 25 to April 17, 2023 using a simple random-sampling technique to select a sample of 564 participants. Premenstrual dysphoric disorder was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Self-administered standardized questionnaires were used to collect data. Result A total of 548 study participants participated, with a 97.2% response rate. The prevalence of premenstrual dysphoric disorder among high school students was found to be 33.03% (95%CI: 29.20-37.09). In a multivariable analysis, irregular menstruation cycle (AOR = 4.242, 95%CI = 2.182-8.246), depression (AOR = 5.272, 95%CI = 2.779-10.002), having greater than 4 days of menstruation bleeding duration (AOR = 2.138, 95%CI = 1.105-4.138), and high perceived stress (AOR = 3.468, 95%CL = 1.217-9.880) were the factors significantly associated with premenstrual dysphoric disorder. Conclusion The overall prevalence of PMDD which was one-third among high school students was high. Moreover, long duration of menstruation bleeding, depressive symptoms, irregular menstruation cycle, and high perceived stress were significant factors in PMDD. Therefore, it needs early screening and intervention in primary healthcare settings, especially for those who have high perceived stress, having depression, having a long duration of menstruation bleeding, and having an irregular menstruation cycle, so as to have good academic achievement and psychological wellbeing.
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Affiliation(s)
- Getasew Kibralew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demeke Demilew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Selam Koye
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Sewbesew Yitayih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mulualem Kelebie
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing School of Nursing, College of Medicine and Health, Science, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Stevenson B, Gavrilidis E, Malik Y, Kulkarni J. (S)-S-adenosylmethionine in the treatment of pre-menstrual disorders in adult women: A protocol for an open-label pilot study. Contemp Clin Trials Commun 2024; 39:101297. [PMID: 38590512 PMCID: PMC10999483 DOI: 10.1016/j.conctc.2024.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
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.
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Affiliation(s)
- Brendan Stevenson
- The Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
| | - Emorfia Gavrilidis
- The Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
| | - Yasmin Malik
- The Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
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Hantsoo L, Sajid H, Murphy L, Buchert B, Barone J, Raja S, Eisenlohr-Moul T. Patient Experiences of Health Care Providers in Premenstrual Dysphoric Disorder: Examining the Role of Provider Specialty. J Womens Health (Larchmt) 2022; 31:100-109. [PMID: 33978482 PMCID: PMC8785767 DOI: 10.1089/jwh.2020.8797] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Premenstrual dysphoric disorder (PMDD) is a severe mood disorder that affects ∼5% of menstruating individuals. Although symptoms are limited to the luteal phase of the menstrual cycle, PMDD causes significant distress and impairment across a range of activities. PMDD is under-recognized by health care providers, can be difficult to diagnose, and lies at the intersection of gynecology and psychiatry. Thus, many patients are misdiagnosed, or encounter challenges in seeking care. The aim of this study was to examine patients' experiences with different health care specialties when seeking care for PMDD symptoms. Methods: We examined data from the 2018 Global Survey of Premenstrual Disorders conducted by the International Association for Premenstrual Disorders (IAPMD). Patients rated their health care providers (general practitioners, psychiatrists, gynecologists, psychotherapists) in three key areas related to treatment of premenstrual mood complaints: interpersonal factors, awareness and knowledge of PMDD, and whether the patient was asked to track symptoms daily. Intraclass correlations examined between- and within-person variance. Multilevel regression models predicted ratings on each provider competency item, with ratings nested within individuals to examine the within-patient effect of provider type on outcomes. Results: The sample included 2,512 patients who reported seeking care for PMDD symptoms. Regarding interpersonal factors, psychotherapists were generally rated the highest. On awareness and knowledge of PMDD, gynecologists and psychiatrists were generally rated the highest. Gynecologists were more likely than other providers to ask patients to track symptoms daily. Conclusions: These findings suggest that different providers have different strengths in assessing and treating PMDD. Further, graduate and medical training programs may benefit from increased curricular development regarding evidence-based evaluation and treatment of PMDD.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Address correspondence to: Liisa Hantsoo, PhD, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2105, USA
| | - Husna Sajid
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura Murphy
- International Association for Premenstrual Disorders, Boston, Massachusetts, USA
| | - Brett Buchert
- International Association for Premenstrual Disorders, Boston, Massachusetts, USA
| | - Jordan Barone
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sabina Raja
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
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Premenstrual Symptoms and Work: Exploring Female Staff Experiences and Recommendations for Workplaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073647. [PMID: 33807463 PMCID: PMC8036722 DOI: 10.3390/ijerph18073647] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
Most women experience some premenstrual symptoms during their reproductive years. Yet, this is an under-researched health issue, particularly in the context of work. This study aimed to: (i) understand the prevalence and severity of premenstrual symptoms experienced by working females, and their association with key work outcomes; (ii) explore factors that may be influencing these symptoms and their severity; and (iii) examine how organizations might help staff with premenstrual symptoms that may be impacting their working lives. An online, anonymous survey collected quantitative and qualitative data from 125 working women in the UK. Over 90% of the sample reported some premenstrual symptoms; 40% experienced premenstrual symptoms moderately or severely. Higher symptom severity was significantly (p < 0.05) associated with poor presenteeism, intention to reduce working hours, and higher work absence (time off work, being late, leaving early). Moderate/severe symptoms were significantly associated with several individual-related variables: lower perceived general health, higher alcohol consumption, poorer sleep quality, anxiety, depression, hormonal contraception, and using fewer coping approaches towards premenstrual symptoms (avoiding harm, adjusting energy levels); and work-related variables: poorer work–life balance, lower levels of psychological resilience, higher perceived work demands, less control over work. Disclosure of premenstrual symptoms and sickness absence because of premenstrual symptoms was very low, typically because of perceptions of appropriateness as a reason for work absence, gender of line managers (male), and it being a personal or embarrassing topic. Staff with moderate to severe premenstrual symptoms were statistically more likely to disclose reason for absence than those with milder symptoms. Recommendations and suggestions for employers and line managers include the need to train staff to improve knowledge about women’s experience of premenstrual symptoms, to be able to communicate effectively with women and to provide tailored support and resources for those who need it. Implications for future research, policy and practice are discussed.
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Zhao S, Wu W, Kang R, Wang X. Significant Increase in Depression in Women With Primary Dysmenorrhea: A Systematic Review and Cumulative Analysis. Front Psychiatry 2021; 12:686514. [PMID: 34421672 PMCID: PMC8374105 DOI: 10.3389/fpsyt.2021.686514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
Women with primary dysmenorrhea are vulnerable to develop a depressive disorder, which is a common form of psycho-disturbance. However, clinical findings are inconsistent across studies, and the evidence has not been previously synthesized. This study aims to investigate whether primary dysmenorrhea is associated with a higher risk of depression via a cumulative analysis. Four electronic databases were systematically searched for the eligible studies. The combined effect was assessed by analyzing the relative risk (RR) and standard mean differences (SMD) with a 95% confidence interval (CI). This cumulative analysis was registered on the PROSPERO (ID: CRD42020169601). Of 972 publications, a total of 10 studies involving 4,691 participants were included. Pooled results from six included studies showed that primary dysmenorrhea was associated with a significant depressive disorder (RR = 1.72, 95%CI: 1.44 to 2.0, P < 0.001; heterogeneity: I 2 = 0%, P = 0.544). In addition, synthesis results from two studies provided the BDI scores suggested that dysmenorrhea had significantly higher scores when compared to non-dysmenorrhea (SMD = 0.47, 95% CI: 0.31-0.62, P < 0.001; heterogeneity: I 2 = 0%, P = 0.518). However, in the two studies providing the PROMIS T-Score, the pooled result showed that there was no significant difference between women with dysmenorrhea and those without dysmenorrhea (P = 0.466). The overall quality of the evidence in our study was judged to MODERATE. The present study has confirmed the positive relationship between primary dysmenorrhea and depression. Social supports and medical help from pain management physicians or psychologists are important interventions for women with dysmenorrhea-suffering depressive disorder.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, China
| | - Weizhou Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Ran Kang
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Xiaolan Wang
- Reproductive Center of Medicine, The First Affiliated Hospital of University of South China, Hengyang, China
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Roomruangwong C, Sirivichayakul S, Carvalho AF, Maes M. The uterine-chemokine-brain axis: menstrual cycle-associated symptoms (MCAS) are in part mediated by CCL2, CCL5, CCL11, CXCL8 and CXCL10. J Affect Disord 2020; 269:85-93. [PMID: 32217347 DOI: 10.1016/j.jad.2020.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine associations between chemokines and menstrual cycle associated symptoms (MCAS). METHODS Forty-one women completed the Daily Record of Severity of Problems (DRSP) rating scale during 28 consecutive days of the menstrual cycle. MCAS is diagnosed when the total daily DRSP score during the menstrual cycle is > 0.666 percentile. We assayed plasma CCL2, CCL5, CCL11, CXCL8, CXCL10, EGF, IGF-1, and PAI-1 at days 7, 14, 21 and 28 of the menstrual cycle. RESULTS CCL2, CCL5, CCL11 and EGF are significantly higher in women with MCAS than in those without. Increased CCL2, CXCL10, CXCL8, CCL11 and CCL5 levels are significantly associated with DRSP scores while CCL2 is the most significant predictor explaining 39.6% of the variance. The sum of the neurotoxic chemokines CCL2, CCL11 and CCL5 is significantly associated with the DRSP score and depression, physiosomatic, breast-craving and anxiety symptoms. The impact of chemokines on MCAS symptoms differ between consecutive weeks of the menstrual cycle with CCL2 being the most important predictor of increased DRSP levels during the first two weeks, and CXCL10 or a combination of CCL2, CCL11 and CCL5 being the best predictors during week 3 and 4, respectively. DISCUSSION The novel case definition "MCAS" is externally validated by increased levels of uterus-associated chemokines and EGF. Those chemokines are involved in MCAS and are regulated by sex hormones and modulate endometrium functions and brain neuro-immune responses, which may underpin MCAS symptoms. As such, uterine-related chemokines may link the uterus with brain functions via a putative uterine-chemokine-brain axis.
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Affiliation(s)
- Chutima Roomruangwong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Sirivichayakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Andre F Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; IMPACT Strategic Research Center, Deakin University, Geelong, Australia.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Center, Deakin University, Geelong, Australia.
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7
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Roomruangwong C, Carvalho AF, Comhaire F, Maes M. Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains. Front Psychol 2019; 10:2446. [PMID: 31736837 PMCID: PMC6831719 DOI: 10.3389/fpsyg.2019.02446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is unknown whether lowered steady state levels of sex hormones coupled with changes in those hormones during the menstrual cycle are associated with premenstrual syndrome (PMS). OBJECTIVE To examine associations between levels of progesterone and oestradiol during the menstrual cycle and PMS considering different diagnostic criteria for PMS. METHODS Forty-one women aged 18-45 years with a regular menstrual cycle completed the Daily Record of Severity of Problems (DRSP) for all 28 consecutive days of the menstrual cycle. Blood was sampled at days 7, 14, 21, and 28 to assay oestradiol and progesterone. RESULTS We developed a new diagnosis of peri-menstrual syndrome, which is characterized by increased DRSP severity in pre and post-menstrual periods and increased scores on the major DRSP dimensions, i.e., depression, physio-somatic symptoms, breast tenderness and appetite, and anxiety. This new diagnosis performed better than classical diagnoses of PMS, including that of the American College of Obstetricians and Gynecologists (ACOG). Lowered steady state levels of progesterone, when averaged over the menstrual cycle, together with declining progesterone levels during the luteal phase predict severity of peri-menstrual symptoms. Steady state levels of oestradiol and declining oestradiol levels during the cycle are also related to DRSP severity although most of these effects appeared to be mediated by progesterone. CONCLUSION A significant increase in menstrual-cycle related symptoms can best be conceptualized as "peri-menstrual syndrome" and may result from insufficient progesterone production (relative corpus luteum insufficiency), which, in part may result from lowered oestradiol production indicating suboptimal pre-ovulatory follicular development.
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Affiliation(s)
- Chutima Roomruangwong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - André F. Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Frank Comhaire
- Endocrinology and Metabolic Disease, Ghent University Hospital, Ghent, Belgium
- Fertility Clinic, Aalter, Belgium
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria
- IMPACT Research Center, Deakin University, Geelong, VIC, Australia
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Weise C, Kaiser G, Janda C, Kues JN, Andersson G, Strahler J, Kleinstäuber M. Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:16-29. [PMID: 30783069 DOI: 10.1159/000496237] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Given the high prevalence of clinically relevant premenstrual symptoms and the associated impairment, there is a need for effective treatments. Initial evidence suggests cognitive-behavioural therapy (CBT) as an effective treatment for premenstrual dysphoric disorder (PMDD). The aim of the current randomized clinical trial was to evaluate an Internet-based CBT (iCBT) to reduce the burden of PMDD. METHODS In all, 174 women with PMDD were recruited via newspaper articles, flyers, and social media. They were randomized to a treatment group (TG; n = 86) or waitlist control group (CG; n = 88). Women of the TG received an 8-week therapist-guided iCBT. Data were assessed before and after treatment/waiting, and 6 months after intervention with prospective symptom diaries and questionnaires in the premenstrual phase. Treatment effects and moderators were analysed using hierarchical linear modelling. RESULTS Significant time × group interaction effects on functional impairment and psychological impairment, impact on everyday life, symptom intensity, and symptom disability in favour of the TG indicated the efficacy of the treatment. Follow-up assessments demonstrated treatment effects to be stable until 6 months after treatment. Additionally, significant interactions with moderator variables were found. In the TG, higher levels of active coping and lower levels of support-seeking coping were associated with stronger improvement in interference in everyday life and symptom intensity. In addition, lower levels of perceived stress were associated with stronger improvement in functional impairment. CONCLUSION The iCBT was highly effective in reducing the burden of PMDD. It appears to be particularly important to address coping styles and stress management in the treatment.
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Affiliation(s)
- Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany,
| | - Gudrun Kaiser
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Carolyn Janda
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Johanna N Kues
- Department for Anaesthesiology and Intensive Care, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jana Strahler
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
| | - Maria Kleinstäuber
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany.,Department of Psychological Medicine, Dunedin Medical School, University of Otago, Dunedin, New Zealand
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Abstract
PURPOSE OF REVIEW Risk for suicidal behavior may fluctuate across the menstrual cycle. Here, we use the RDoC framework to review potential mechanisms by which the cycle may increase acute suicide risk. RECENT FINDINGS The menstrual cycle impacts the majority of RDoC constructs linked to suicide risk, particularly among hormone-sensitive women, such as those with premenstrual dysphoric disorder or premenstrual exacerbation of a psychiatric disorder. Despite this, there are no published studies examining suicidal ideation, planning, or behavior longitudinally across the cycle. More work is needed to understand how hormone sensitivity may relate to both trait and state suicide risk. Intensive multilevel investigations of cyclical hormone effects on suicide risk through specific RDoC mechanisms are suggested. This is a fertile research area and may provide key insights regarding the mechanisms of acute suicide risk.
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Affiliation(s)
- Sarah A Owens
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, Women's Mental Health Research Program, University of Illinois at Chicago, 912 S Wood St., South Tower, Room 335, Chicago, IL, 60612, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Song JA, Lee MK, Min E, Kim ME, Fike G, Hur MH. Effects of aromatherapy on dysmenorrhea: A systematic review and meta-analysis. Int J Nurs Stud 2018; 84:1-11. [PMID: 29729556 DOI: 10.1016/j.ijnurstu.2018.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Menstrual pain is not a disease, but it is a problem that periodically makes women uncomfortable during menstrual cycles. There has been a continuing effort to alleviate menstrual cramps in the medical field. Aromatherapy, one of the alternative complementary therapies, has been used as a way to alleviate menstrual cramps, but there is still little evidence of how to use it. Therefore, in this study, we tried to find and provide the evidence of relieving effects of menstrual cramps. DESIGN This study involved a systematic review and meta-analysis. The study was to identify the effects of aromatherapy on menstrual pain through a systematic review of the relevant literature from Korea and abroad and a meta-analysis of the data from studies meeting our inclusion criteria. DATA SOURCES We obtained articles published in English from PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL), and we also obtained articles by searching the Korean databases Research Information Service System (RISS), DBPIA, and Korean Studies Information Service System (KISS). REVIEW METHODS A systematic review was performed on all searchable articles published form inception to October 17, 2016, using the international and Korean databases noted above. The search terms used was ((aromatherapy OR aroma* OR essential oil) AND (dysmenorrhea OR menstrual pain)). Articles were selected for analysis from among the retrieved articles based on the key questions and the inclusion and exclusion criteria using a PRISMA flow diagram. The 21 articles entire texts were reviewed and qualitatively analyzed while seven articles were quantitatively analyzed using RevMan software ver. 5.3. RESULTS In a comparison between the experimental groups, which received an aromatherapy intervention, and the control groups, which received no treatment of any kind, the dysmenorrhea score in the experimental group decreased by 2.67 points (mean difference -2.67), showing a statistically significant difference(Z = 7.79, p < .001, Higgins I2 = 0%). Compared to the placebo group, which received a placebo oil treatment, the dysmenorrhea score in the experimental group decreased by 1.71 points (mean difference, -1.71), showing a statistically significant difference (Z = 4.51, p < .001), but high heterogeneity (Higgins I2 = 81%). CONCLUSIONS Aromatherapy was an effective intervention for reducing dysmenorrhea. However, because the analysis showed that the aroma intervention methods were diverse and that the basis for the intervention methods was weak, the possibility of randomization bias was high.
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Affiliation(s)
- Ji-Ah Song
- Department of Nursing, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
| | - Mi-Kyoung Lee
- College of Nursing, Eulji University, 77 Gyeryong-ro 771 beon-gil, Jung-gu, Daejeon, 34824, Republic of Korea.
| | - Eunsil Min
- Department of Nursing, DaeJeon Institute of Science and Technology, 100 Hyechon-ro, Seo-gu, Daejeon, 302-715, Republic of Korea.
| | - Mi-Eun Kim
- Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju-si, Jeollabuk-do, 55069, Republic of Korea.
| | - Geraldine Fike
- Department of Nursing, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA, 92407-2393, United States.
| | - Myung-Haeng Hur
- College of Nursing, Eulji University, 77 Gyeryong-ro 771 beon-gil, Jung-gu, Daejeon, 34824, Republic of Korea.
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Hardy C, Hardie J. Exploring premenstrual dysphoric disorder (PMDD) in the work context: a qualitative study. J Psychosom Obstet Gynaecol 2017. [PMID: 28635534 DOI: 10.1080/0167482x.2017.1286473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
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.
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Affiliation(s)
- Claire Hardy
- a Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Jenna Hardie
- b Department of Psychology , Northumbria University , Newcastle upon Tyne , UK
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Fisher C, Sibbritt D, Hickman L, Adams J. A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: a focus upon prevalence, patterns and applications of use and users' motivations, information seeking and self-perceived efficacy. Acta Obstet Gynecol Scand 2016; 95:861-71. [PMID: 27185060 DOI: 10.1111/aogs.12921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/09/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Complementary and alternative medicine (CAM) is used for treating cyclic perimenstrual pain and discomfort. This critical review examines women's reported CAM use, its perceived effectiveness and information relating to women's attitudes, behaviors, motivations and patterns of CAM use in its treatment. MATERIAL AND METHODS An extensive search of the main medical databases EBSCO, CINAHL, Medline, AMED and SCOPUS, as well as additional hand searches, was conducted. Papers included were confined to those that had been peer-reviewed, written in English and that contained original research into CAM use for cyclic perimenstrual pain and discomfort among adult women. RESULTS CAM, particularly herbal medicine, nutritional supplements and massage, is widely used for a range of cyclic perimenstrual pain and discomfort symptoms. A large number of CAM modalities are adopted, often simultaneously and with little professional oversight. Women's assessment of efficacy of different CAM modalities is positive, though the majority of users are self-prescribing apparently without professional guidance. Although the uptake of CAM for cyclic perimenstrual pain and discomfort is widespread, few empirical data are available regarding which women are using CAM, their motivations for doing so and, importantly, the sources through which women receive information about CAM. CONCLUSIONS This review highlights the extensive use of (often self-prescribed) CAM in a number of countries to alleviate the widespread symptoms of cyclic perimenstrual pain and discomfort. An understanding of all health care use by women with perimenstrual pain and discomfort is vital to help ensure safe, effective and coordinated health care that can lead to optimal patient outcomes.
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Affiliation(s)
- Carole Fisher
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Louise Hickman
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Nillni YI, Rohan KJ, Mahon JN, Pineles SL, Zvolensky MJ. The role of anxiety sensitivity in the experience of menstrual-related symptoms reported via daily diary. Psychiatry Res 2013; 210:564-9. [PMID: 23910240 PMCID: PMC6605776 DOI: 10.1016/j.psychres.2013.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
The current study examined the interactive effects of Anxiety Sensitivity (AS) and menstrual cycle phase in the experience of menstrual-related symptoms. Participants were 55 community women who completed prospective tracking of menstrual-related symptoms across at least one full menstrual cycle using the Daily Record of Severity of Problems (DRSP) and completed the Menstrual Distress Questionnaire (MDQ) once in their premenstrual and follicular cycle phases. Results revealed that women with higher levels of AS reported greater menstrual-related symptoms, regardless of cycle phase, as compared to women with lower levels of AS. These findings suggest that AS may be an important psychological factor involved in the experience of psychological and somatic symptoms across the menstrual cycle. Results are consistent with previous literature documenting the role of AS in menstrual-related symptoms as well as in other physical health conditions.
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Affiliation(s)
- Yael I. Nillni
- University of Vermont, Burlington, VT, USA,National Center for PTSD, Women′s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA,Correspondence to: National Center for PTSD, Women′s Health Sciences Division, Veteran′s Affairs Boston Healthcare System, 150 South Huntington Ave.(116B-3), Boston, MA 02130, USA. Tel.: +1 857 364 4637; fax: +1 857 364 4515., , (Y.I.Nillni)
| | | | | | - Suzanne L. Pineles
- National Center for PTSD, Women′s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | - Michael J. Zvolensky
- University of Houston, Houston, TX, USA,MD Anderson Cancer Center, Houston, TX, USA
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Cirillo PC, Passos RBF, Bevilaqua MCDN, López JRRA, Nardi AE. Bipolar Disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder Comorbidity: A Systematic Review. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:467-79. [DOI: 10.1016/j.rbp.2012.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/25/2012] [Indexed: 10/27/2022]
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[Premenstrual symptomatology, somatization and physical anhedonia]. Encephale 2012; 39:432-8. [PMID: 23095596 DOI: 10.1016/j.encep.2012.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/25/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Physical (headache, abdominal pain, e.g.), emotional (irritability, diminution of self-esteem, e.g.) and/or behavioral disturbances (fatigue, decrease of libido, e.g.) appear frequently during the premenstrual phase of menstrual cycles. Of moderate to severe intensity, these varied symptoms sometimes hinder the usual personal, social and/or professional functioning by generating significant suffering. Thus, premenstrual syndrome (PS) and premenstrual dysphoric disorder (PDD) are closely related to depressive disorders in many prior studies. In spite of solid links associating depression with premenstrual disorders in the literature, the psychological dimension of the premenstrual symptomatology still remains underestimated. OBJECTIVE The objective of this study is to examine the nature of possible relationships between a moderate premenstrual symptomatology and different modes of information processing with physical and emotional stimuli, such as somatization and physical anhedonia, well-known symptoms of depressive disorders. METHOD One hundred and five students in psychology from the François Rabelais university (France), aged between 18 to 50 years old (M=20.98, SD=3.43), were invited to fill in French versions of the Menstrual Distress Questionnaire [25] (Moos, 1991), the somatization subscale of the Symptom Check-List 90 [26] (Derogatis & Cleary, 1977), and the Physical Anhedonia Scale [28] (Chapman et al., 1976). Pearson correlation coefficients were calculated and a multiple regression analysis was conducted with Statistica software. RESULTS Main results reveal that premenstrual symptomatology is positively related to somatization (r=0.58; P<0.001) and negatively to physical anhedonia (r=-0.27; P<0.05). Physical anhedonia (β=-0.20; P<0.05) and somatization (β=0.55; P<0.001) may take part in the appearance of a premenstrual symptomatology. CONCLUSION These results allow us to enrich our knowledge on the origin and the nature of the premenstrual symptomatology, which would be physiological, psychological and social, in order to adapt and widen the therapeutic options by proposing, in parallel with the specific medical treatments, psychological interventions based on cognitive and behavioral techniques aiming a decentralization and a restructuration of the physical symptoms.
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Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. ACTA ACUST UNITED AC 2012; 18:48-51. [PMID: 22611221 DOI: 10.1258/mi.2012.012013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to review published literature on the types and prevalences of premenstrual disorders and symptoms, and effects of these on activities of daily life and other parameters of burden of illness. The method involved review of the pertinent published literature. Premenstrual disorders vary in prevalence according to the definition or categorization. The most severe disorder being premenstrual dysphoric disorder (PMDD) affects 3-8% of women of reproductive age. This disorder focuses on psychological symptoms whereas global studies show that the most prevalent premenstrual symptoms are physical. Both psychological and physical symptoms affect women's activities of daily life. A considerable burden of illness has been shown to be associated with moderate to severe premenstrual disorders. In conclusion, premenstrual symptoms are a frequent source of concern to women during their reproductive lives and moderate to severe symptoms impact on their quality of lives.
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Affiliation(s)
- Lorraine Dennerstein
- Department of Psychiatry, National Aging Research Institute, The University of Melbourne, Parkville, Victoria 3010, Australia.
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Heinemann LAJ, Minh TD, Heinemann K, Lindemann M, Filonenko A. Intercountry Assessment of the Impact of Severe Premenstrual Disorders on Work and Daily Activities. Health Care Women Int 2012; 33:109-24. [DOI: 10.1080/07399332.2011.610530] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gianfranco C, Vittorio U, Silvia B, Francesco D. Myo-inositol in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol 2011; 26:526-30. [PMID: 22031267 DOI: 10.1002/hup.1241] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Premenstrual dysphoric disorder (PMDD) is a mood disorder disrupting social and/or occupational life of affected women. Premenstrual dysphoric disorder etiology is unknown, although a pivotal role is played by the serotoninergic system. Indeed, one of the most effective treatments is selective serotonin reuptake inhibitors. Several studies have proposed a selective serotonin reuptake inhibitor-like role for myo-inositol, likely due to the fact that myo-inositol is the second messenger of serotonin. In the present study, we aimed to investigate the effect of myo-inositol in the treatment of PMDD. METHODS We used a two-phase clinical trial approach (phase I: placebo washout; phase II: comparisons between treatment and placebo) and treated PMMD patients with two different myo-inositol formulations: powder or soft gel capsules. We decided to test these two formulations because according to the manufacturer, 0.6 g of myo-inositol in soft gel capsule has a pharmacokinetic equivalent to 2 g of myo-inositol in powder. RESULTS Our results showed a significant improvement of three different scales: a reduction in the Daily Symptoms Records scale and an improvement of the Hamilton Depression Rating and Clinical Global Impression-Severity of Illness scales. Results were similar for both formulations. CONCLUSIONS In the present study, by using a new pharmaceutical formulation, we were able to clearly prove the efficacy of myo-inositol in PMDD.
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Nillni YI, Toufexis DJ, Rohan KJ. Anxiety sensitivity, the menstrual cycle, and panic disorder: a putative neuroendocrine and psychological interaction. Clin Psychol Rev 2011; 31:1183-91. [PMID: 21855828 DOI: 10.1016/j.cpr.2011.07.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 02/15/2011] [Accepted: 07/18/2011] [Indexed: 02/06/2023]
Abstract
The 2:1 female-to-male sex difference in the prevalence of panic disorder (PD) suggests that there is a sex-specific vulnerability involved in the etiology and/or maintenance of this disorder. The purpose of this paper is to present a new conceptual model, which emphasizes the interaction between a cognitive vulnerability for PD, anxiety sensitivity, and the effects of progesterone and its metabolite, allopregnanolone, on behavioral and physiological responses to stress during the premenstrual phase. This interaction is proposed to be a potential sex-specific pathway that may initiate and/or maintain panic and anxiety symptoms in women. This review paper presents preliminary evidence from both the human and animal literatures to support this new model. Specific topics reviewed include: psychopathology related to the menstrual cycle, anxiety sensitivity and its relationship to the menstrual cycle, PMS, and PMDD, anxiety-modulating effects of progesterone and its neuroactive metabolite, allopregnanolone, and how results from the neuroendocrine literature relate to psychopathology or symptoms associated with the menstrual cycle.
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Affiliation(s)
- Yael I Nillni
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Ave., Burlington, VT 05405, USA.
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Lete I, Dueñas JL, Serrano I, Doval JL, Martínez-Salmeán J, Coll C, Pérez-Campos E, Arbat A. Attitudes of Spanish women toward premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder: results of a nationwide survey. Eur J Obstet Gynecol Reprod Biol 2011; 159:115-8. [PMID: 21775045 DOI: 10.1016/j.ejogrb.2011.06.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 05/05/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the attitudes of women with premenstrual symptoms in relation to their perception of complaints and request for medical advice. STUDY DESIGN Cross-sectional study of a representative cohort of 2018 Spanish women aged 15-49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. RESULTS A total of 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. The prevalence of moderate or severe premenstrual syndrome (PMS) was 8.9% and the prevalence of premenstrual dysphoric disorder (PMDD) 1.1%. Only 291 (18.7%) women had sought medical advice. The main reason given by 90.6% of symptomatic women for not seeking medical consultation was to consider that symptoms were normal. A total of 175 (60.1%) women received pharmacological treatment (hormonal contraceptives in 95% followed by analgesics in 50% and anti-inflammatory agents in 44%), 20% were not treated because physicians considered that symptoms were not important and would disappear spontaneously, and 12% received only advice to change life style. CONCLUSION Women suffering from PMS or PMDD do not usually seek medical advice and among those seeking medical care, in many cases, an adequate response to their demands is not obtained.
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Affiliation(s)
- Iñaki Lete
- Department of Obstetrics and Gynecology, Hospital Santiago Apóstol, Vitoria-Gasteiz, Spain.
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Leddy MA, Lawrence H, Schulkin J. Obstetrician-Gynecologists and Women's Mental Health: Findings of the Collaborative Ambulatory Research Network 2005–2009. Obstet Gynecol Surv 2011; 66:316-23. [DOI: 10.1097/ogx.0b013e31822785ee] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rocha Filho EA, Lima JC, Pinho Neto JS, Montarroyos U. Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reprod Health 2011; 8:2. [PMID: 21241460 PMCID: PMC3033240 DOI: 10.1186/1742-4755-8-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 01/17/2011] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the effectiveness and safety of polyunsaturated fatty acids for the treatment of the premenstrual syndrome (PMS) using a graded symptom scale and to assess the effect of this treatment on basal plasma levels of prolactin and total cholesterol. Methods A randomized, double-blind, placebo-controlled study was conducted with 120 women with PMS divided into three groups and treated with 1 or 2 grams of the medication or placebo. Symptoms were recorded over a 6-month period using the Prospective Record of the Impact and Severity of Menstruation (PRISM) calendar. Total cholesterol and prolactin levels were measured. Analysis of variance (ANOVA), Pearson's chi-square test, Wilcoxon's nonparametric signed-rank test for paired samples and the Mann-Whitney nonparametric test for independent samples were used in the statistical analysis. Results There were no differences in age, marital status, schooling or ethnicity between the groups. In the group treated with 1 gram of the medication, a significant reduction was found when the median PRISM score recorded in the luteal phase at baseline (99) was compared with the median score recorded in the 3rd month (58) and in the 6th month of evaluation (35). In the 2-gram group, these differences were even more significant (baseline score: 98; 3rd month: 48; 6th month: 28). In the placebo group, there was a significant reduction at the 3rd but not at the 6th month (baseline: 96.5; 3rd month: 63.5; 6th month: 62). The difference between the phases of the menstrual cycle was greater in the 2-gram group compared to the group treated with 1 gram of the medication. There were no statistically significant differences in prolactin or total cholesterol levels between baseline values and those recorded after six months of treatment. Conclusion The difference between the groups using the medication and the placebo group with respect to the improvement in symptomatology appears to indicate the effectiveness of the drug. Improvement in symptoms was higher when the 2-gram dose was used. This medication was not associated with any changes in prolactin or total cholesterol levels in these women.
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Affiliation(s)
- Edilberto A Rocha Filho
- Department of Maternal and Child Healthcare, School of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample. Arch Womens Ment Health 2010; 13:485-94. [PMID: 20449618 DOI: 10.1007/s00737-010-0165-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
The study aimed at assessing the prevalence of premenstrual symptoms and of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in a population-based sample of women of the entire reproductive age range, as well as to analyse predictors of PMS and PMDD in terms of socio-demographic, health status and health behavioural factors. A set of questions on PMS-based on the premenstrual syndrome screening tool developed by Steiner et al., translated into German and piloted-was integrated into the written questionnaire of the 2007 Swiss Health Survey. Weighted prevalence rates and multivariable regression analysis for the outcome variables PMS and PMDD were calculated. A total of 3,913 women aged 15 to 54 years answered the questions on PMS symptoms, and 3,522 of them additionally answered the questions on interference of PMS with life. Ninety one percent of the participants reported at least one symptom, 10.3% had PMS and 3.1% fulfilled the criteria for PMDD. The prevalence of PMS was higher in non-married women, in women aged 35-44 years and in women of the Italian-speaking region of Switzerland. Both PMS and PMDD were strongly associated with poor physical health and psychological distress. Socio-cultural factors seem to determine the prevalence, perception and handling of PMS. Considering the association with poor physical health and high psychological distress, a broader underlying vulnerability in women qualifying for PMDD must be assumed and should be taken into account in clinical management as well as in future research in this field.
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Abstract
As many as 7% of women experience significant social or occupational dysfunction as a result of severe premenstrual mood disturbance. Biological, psychological, and sociocultural factors are implicated in the cause of premenstrual dysphoric disorder, but the interaction between these factors remains to be elucidated. Mental health practitioners can aid women by providing diagnostic clarity and by initiating an integrated step-wise management approach.
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Heinemann LAJ, Minh TD, Filonenko A, Uhl-Hochgräber K. Explorative evaluation of the impact of severe premenstrual disorders on work absenteeism and productivity. Womens Health Issues 2010; 20:58-65. [PMID: 20123176 DOI: 10.1016/j.whi.2009.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 09/11/2009] [Accepted: 09/29/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the effects of premenstrual disorders on work productivity and absenteeism in the multinational Impact study. METHODS Women aged 15-45 years were screened for suspected premenstrual dysphoric disorders (PMDD) and premenstrual syndrome (PMS) and invited to participate in this web-based study. Based on the Daily Record of Severity of Problems (DRSP) questionnaire, symptoms were assessed prospectively over 2 months. Participants were categorized as having no perceived symptoms/mild PMS or moderate-to-severe PMS/PMDD based on a validated algorithm. Work productivity impairment and absenteeism were assessed retrospectively using the Premenstrual Symptoms Screening Tool (PSST) and a modified version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Work productivity impairment was also assessed prospectively over 2 months using the DRSP questionnaire. RESULTS Overall 1,477 women started the study-of these, 822 (56%) completed the study as planned and represent the full analysis set. Employed women with moderate-to-severe PMS/PMDD had higher rate of productivity impairment on the modified version of the WPAI questionnaire (values >/=7) relative to those with no perceived symptoms/mild PMS (adjusted odds ratio, 3.12; 95% confidence interval, 1.75-5.57). Similar outcomes were obtained for impairment of working productivity or efficiency using the PSST scale (value 4). The mean number of days on the DRSP with at least moderate reduction in productivity or efficiency in daily routine was higher for women with moderate-to-severe PMS/PMDD (5.6 vs. 1.1). Women with moderate-to-severe PMS/PMDD had a higher rate of absenteeism (>8hours per cycle; 14.2% vs. 6.0%). CONCLUSION Moderate-to-severe PMS/PMDD seems to be associated with work productivity impairment and increased absenteeism, and thus poses a potential economic burden.
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Affiliation(s)
- Lothar A J Heinemann
- Berlin Center for Epidemiology & Health Research, Invalidenstr. 115, D-10115 Berlin, Germany.
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Choi D, Lee DY, Lehert P, Lee IS, Kim SH, Dennerstein L. The impact of premenstrual symptoms on activities of daily life in Korean women. J Psychosom Obstet Gynaecol 2010; 31:10-5. [PMID: 20146640 DOI: 10.3109/01674820903573920] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the impact of premenstrual symptoms on activities of daily life (ADL) of Korean women, and their knowledge and treatment seeking regarding premenstrual syndromes (PMSs). METHODS A population-based online survey regarding premenstrual symptoms was conducted in 1000 Korean women aged 15-49 years. Symptoms were classified according to their intensity, persistence each cycle, and impairment of ADL. Women's knowledge of PMSs and physician consultations were assessed. RESULTS The approximate prevalence of PMS/premenstrual dysphoric disorder (PMDD) by the WHO's International Classification of Disease (ICD-10), American College of Obstetrics and Gynecology (ACOG), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV[4th edition]) criteria was 98.6, 32.1, and 2.8%, respectively. Among 23 documented symptoms, the most predominant symptoms were joint-muscle-back pain, abdominal pain, and irritability. Physical symptoms were more prevalent than mental symptoms. There was a high correlation between the duration and severity of symptoms. The impact of PMS on ADL and the proportion of women with impaired ADL were significantly associated with the severity of PMS. The proportion of women consulting physicians increased with severity of PMS from 2%, 2.3%, for ICD-10, ACOG PMS to 10.7% for DSM-IV PMDD, respectively. Most of the women (91.5%) had no knowledge regarding terminology pertaining to PMS and PMDD. CONCLUSION PMSs occur frequently and have a significant impact on daily life for a proportion of Korean women. However, Korean women have little knowledge about PMSs and only infrequently consult their physicians.
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Affiliation(s)
- DooSeok Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Vigod SN, Ross LE, Steiner M. Understanding and treating premenstrual dysphoric disorder: an update for the women's health practitioner. Obstet Gynecol Clin North Am 2009; 36:907-24, xii. [PMID: 19944308 DOI: 10.1016/j.ogc.2009.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Up to 7% of women report premenstrual symptoms severe enough to impair daily function, and are said to suffer from premenstrual dysphoric disorder (PMDD). Although PMDD is predominately regarded as a biologically based condition, sociocultural factors, and particularly life stress, past sexual abuse, and cultural socialization, likely interact with hormonal changes. This integrative model has implications for etiology and treatment of PMDD.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry Women's College Hospital, Room 944C, Ontario, Canada
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Rapkin AJ, Winer SA. Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Rev Pharmacoecon Outcomes Res 2009; 9:157-70. [PMID: 19402804 DOI: 10.1586/erp.09.14] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Premenstrual symptoms are distressing for up to 20% of reproductive-aged women and are associated with impairment in interpersonal or workplace functioning for at least 3-8%. Typical symptoms of premenstrual syndrome and the severe form, premenstrual dysphoric disorder, include irritability, anger, mood swings, depression, tension/anxiety, abdominal bloating, breast pain and fatigue. The symptoms recur monthly and last for an average of 6 days per month for the majority of the reproductive years. For women with premenstrual dysphoric disorder, the symptoms can be as disabling as major depressive disorder. It has been estimated that affected women experience almost 3000 days of severe symptoms during the reproductive years. Until two decades ago, there were no effective treatments for severe premenstrual syndrome. Even in 2000, almost three-quarters of women in the USA with premenstrual disorders either did not seek help or sought treatment unsuccessfully from at least three clinicians for over 5 years. This review will focus on the epidemiology, diagnosis, treatment outcomes, quality of life and burden of illness for premenstrual disorders.
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Affiliation(s)
- Andrea J Rapkin
- Professor of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. J Womens Health (Larchmt) 2009; 18:31-9. [PMID: 19105683 DOI: 10.1089/jwh.2008.0932] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore the experience of reproductive-age women in the French population with premenstrual syndrome (PMS) by estimating perceived symptom prevalence, identifying risk factors, and quantifying the burden of symptoms. This study also assesses the stability of the PMS diagnosis over a 1-year period of follow-up. METHODS The prevalence of reported PMS was estimated from a population-based cohort of 2863 French women interviewed in 2003 and 2004. Multivariate logistic regressions were used to identify risk factors associated with PMS. PMS fluctuation was studied by comparing women's responses in 2003 and 2004. RESULTS Results show that 4.1% of women qualified for severe PMS (six symptoms) and 8.1% qualified for moderate PMS (one to five symptoms), resulting in 12.2% of women who reported PMS symptoms that impacted their daily lives. Risk factors for PMS fell into three categories: hormonal, psychosocial, and physiological, with life stressors and exogenous hormonal exposure exerting the most substantial impact. Results also indicate a high level of intraindividual variation in PMS status over time; among women who qualified for PMS during 1 or both years of the study, 72% demonstrated fluctuation in their PMS status. CONCLUSIONS More women report suffering from distressing premenstrual symptoms than are captured by strict premenstrual dysphoric disorder (PMDD) diagnostic criteria. The impact of PMS symptoms on women appears to fluctuate over time, however, producing greater variability in the syndrome than previously recognized. Clinicians should be mindful of high intraindividual variability in the syndrome when advising patients about long-term management.
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Affiliation(s)
- Julia Potter
- Institut National de la Santé et de la Recherche Médical, Department of Epidemiology, Demography, and Social Sciences, Le Kremlin-Bicetre, France
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Sundstrm-Poromaa I. Action of Progesterone and Progesterone Metabolites in Menstrual-CycleRelated Disorders. Headache 2008. [DOI: 10.1111/j.1526-4610.2008.01201.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yang M, Wallenstein G, Hagan M, Guo A, Chang J, Kornstein S. Burden of premenstrual dysphoric disorder on health-related quality of life. J Womens Health (Larchmt) 2008; 17:113-21. [PMID: 18240988 DOI: 10.1089/jwh.2007.0417] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The purpose of this study was to document the burden of premenstrual dysphoric disorder (PMDD) on health-related quality of life (HRQoL) in comparison to the U.S. general population and specific chronic health conditions. METHODS The disease burden that PMDD placed on HRQoL was estimated by comparing SF-12v2 scores between women who were identified as being at risk for PMDD with those observed in the general U.S. female population. Additional comparisons were made to several chronic health conditions. Regression methods were used to estimate SF-12v2 normative values from the general population sample and statistically adjust them to match age and the presence of disease comorbidity of the PMDD patient group. Significance tests were used to compare the means across samples. RESULTS After adjusting for multiple comparisons, six SF-12v2 scales and two summary measures of PMDD were significantly below the adjusted U.S. general population norms. Both summary measures of PMDD had mean differences greater than 3 points below the norm (threshold for clinical meaningful difference). The burden of PMDD was greater on mental/emotional HRQoL domains than on physical HRQoL. The HRQoL burden of PMDD was (1) greater than that of chronic back pain in bodily pain and mental health (MH) scales and greater than type 2 diabetes and hypertension in bodily pain scale while comparable in all other scales of the three conditions, (2) comparable to osteoarthritis and rheumatoid arthritis in all scales, and (3) less burden than depression in vitality and MH scales and mental component summary measure while comparable in other scales. CONCLUSIONS PMDD is associated with substantial burden on both physical and mental aspects of HRQoL.
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Affiliation(s)
- Min Yang
- QualityMetric Inc., Lincoln, Rhode Island 02865, USA.
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Borenstein JE, Dean BB, Leifke E, Korner P, Yonkers KA. Differences in Symptom Scores and Health Outcomes in Premenstrual Syndrome. J Womens Health (Larchmt) 2007; 16:1139-44. [PMID: 17937566 DOI: 10.1089/jwh.2006.0230] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeff E. Borenstein
- Departments of Medicine and Health Services Research, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California
| | | | | | | | - Kimberly A. Yonkers
- Departments of Psychiatry, Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
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Mody I. Extrasynaptic GABAA receptors in the crosshairs of hormones and ethanol. Neurochem Int 2007; 52:60-4. [PMID: 17714830 PMCID: PMC2291573 DOI: 10.1016/j.neuint.2007.07.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 10/23/2022]
Abstract
Gamma-aminobutyric acid (GABA) is the main chemical inhibitory neurotransmitter in the brain. In the central nervous system (CNS) it acts on two distinct types of receptor: an ion channel, i.e., an "ionotropic" receptor permeable to Cl- and HCO3- (GABAA receptors) and a G-protein coupled "metabotropic" receptor that is linked to various effector mechanisms (GABAB receptors). This review will summarize novel developments in the physiology and pharmacology of GABAA receptors (GABAARs), specifically those found outside synapses. The focus will be on a particular combination of GABAAR subunits sensitive to ovarian and adrenal cortical steroid hormone metabolites that are synthesized in the brain (neurosteroids) and to sobriety impairing concentrations of ethanol. These receptors may be the final common pathway for interactions between ethanol and ovarian and stress-related neurosteroids.
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Affiliation(s)
- Istvan Mody
- Department of Neurology NRB1 575D, The David Geffen School of Medicine at UCLA, 635 Charles Young Dr S., Los Angeles, CA 90095, United States.
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Borenstein JE, Dean BB, Yonkers KA, Endicott J. Using the daily record of severity of problems as a screening instrument for premenstrual syndrome. Obstet Gynecol 2007; 109:1068-75. [PMID: 17470584 DOI: 10.1097/01.aog.0000259920.73000.3b] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess symptom ratings on the first day of menses to identify women at high risk of clinically significant premenstrual syndrome (PMS) who should undergo further evaluation. METHODS A cohort of 697 women kept daily symptom ratings using the Daily Record of Severity of Problems (DRSP). The DRSP includes 21 symptom items grouped within 11 domains. DRSP scores on the first day of menses were calculated using the sum of all 21 items (standard method), the sum of the highest rated items within each domain (alternative method), and the sum of seven items derived from modeling. Seventy percent of the study sample was randomly assigned into a model-building set to identify optimal cutoff scores for PMS screening. The remaining 30% comprised a testing set used to compare PMS screening results to a PMS diagnosis based on two cycles of daily DRSP ratings. RESULTS Of the initial study sample, 388 participants (55.7%) completed two cycles of daily ratings. The prevalence of PMS was 30.4%. In the model-building set, the positive and negative predictive values of the 21-item DRSP scores were 53.8% and 83.4% using the standard method and 52.7% and 84.0% using the alternative method. Corresponding values were 55.0% and 84.9% for an abbreviated seven-item DRSP version. These results were confirmed in the testing set. CONCLUSION The DRSP administered on the first day of menses is an acceptable screening instrument to identify women who may have PMS.
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Affiliation(s)
- Jeff E Borenstein
- Departments of Medicine and Health Services Research, Cedars-Sinai Health System and the UCLA School of Medicine, Los Angeles, California, USA.
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Halbreich U, Backstrom T, Eriksson E, O'brien S, Calil H, Ceskova E, Dennerstein L, Douki S, Freeman E, Genazzani A, Heuser I, Kadri N, Rapkin A, Steiner M, Wittchen HU, Yonkers K. Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol 2007; 23:123-30. [PMID: 17454164 DOI: 10.1080/09513590601167969] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Premenstrual syndrome (PMS) encompasses a variety of symptoms appearing during the luteal phase of the menstrual cycle. Although PMS is widely recognized, the etiology remains unclear and it lacks definitive, universally accepted diagnostic criteria. To address these issues an international multidisciplinary group of experts evaluated the current definitions and diagnostic criteria of PMS and premenstrual dysphoric disorder (PMDD). Following extensive correspondence, a consensus meeting was held with the aim of producing updated diagnostic criteria for PMS and guidelines for clinical and research applications. This report presents the conclusions and recommendations of the group. It is hoped that the criteria proposed by the group will become widely accepted and eventually be incorporated into the next edition of the World Health Organization's International Classification of Diseases (ICD-11). It is also hoped that the proposed guidelines for quantification of criteria will be used by clinicians and investigators to facilitate diagnostic uniformity in the field as well as adequate treatment modalities when warranted.
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Affiliation(s)
- Uriel Halbreich
- Departments of Psychiatry and Obstetrics and Gynecology, State University of New York at Buffalo, Buffalo, NY 14214, USA.
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Di Giulio G, Reissing ED. Premenstrual dysphoric disorder: prevalence, diagnostic considerations, and controversies. J Psychosom Obstet Gynaecol 2006; 27:201-10. [PMID: 17225621 DOI: 10.1080/01674820600747269] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Premenstrual dysphoric disorder (PMDD) has been included as a formal diagnosis of a mood disorder in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition in 1994. The ensuing, critical attention has resulted in increased research productivity and clinical recognition of this neglected women's health problem. A decade later, this paper will review the current literature on PMDD focusing on prevalence, biopsychosocial etiological correlates, history of the development of a formal DSM diagnosis, and the controversies surrounding the current classification of PMDD. The authors conclude that PMDD presents a distinct diagnostic entity and that recognition through formal diagnostic criteria serves the important minority of women who suffer from this cyclical mood disorder distinct from premenstrual symptoms and major depression.
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Affiliation(s)
- G Di Giulio
- School of Psychology, University of Ottawa, Ontario, Canada
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Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord 2005; 85:275-82. [PMID: 15780697 DOI: 10.1016/j.jad.2004.10.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 10/20/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of intermittent dosing strategies for the treatment of premenstrual dysphoric disorder (PMDD) highlights the need for detailed empirical data on the onset, duration and pattern of symptom expression in women suffering from PMDD. METHOD Data were analyzed from 276 women who met DSM-IV criteria for PMDD and prospectively charted two menstrual cycles prior to commencing sertraline treatment. The presence and severity of PMDD symptoms were measured using the Daily Record of Severity of Problems (DRSP). RESULTS The most frequent PMDD symptoms (moderate-to-severe for > or = 3 days) included anger/irritability (76%), anxiety/tension (71%), tired/lethargic (58%), and mood swings (58%). Mean DRSP scores peaked at day -2 (2 days prior to the onset of menses), but the within-patient day of onset of PMDD-level symptoms was highly variable, differing from cycle-to-cycle by > or = 4 days in 45% of women. Similarly, the within-patient duration of PMDD symptoms varied from cycle-to-cycle by 3 or more days in > or = 50% of women. Depending on the criteria used, 1 day after the onset of menstruation, 34-46% of women continued to report moderate to severe symptoms. LIMITATION Women in this sample were recruited for participation in a treatment study, and the results may not generalize to women with PMDD in the community. CONCLUSION The results of this analysis found significant within-patient variability in the time-to-onset and offset of PMDD symptoms, as well as their duration. The temporal pattern and high degree of within-patient variability across menstrual cycles of PMDD symptoms may have treatment implications.
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Affiliation(s)
- Teri Pearlstein
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
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Freeman EW. Effects of antidepressants on quality of life in women with premenstrual dysphoric disorder. PHARMACOECONOMICS 2005; 23:433-44. [PMID: 15896095 DOI: 10.2165/00019053-200523050-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review examines the effects of antidepressant medications on premenstrual dysphoric disorder (PMDD) and the diminished quality of life (QOL) that accompanies the disorder. PMDD is a chronic condition in women that emerges in the second half of the menstrual cycle and remits during the menstrual period. The affective and behavioural symptoms of PMDD adversely affect functioning and QOL to a disabling degree, particularly in the domains of family and personal relationships, work productivity and social activities. The serotonergic antidepressants, specifically the selective serotonin reuptake inhibitors (SSRIs), are effective for PMDD. Continuous and luteal-phase dosing regimens with SSRIs are similarly effective and well tolerated. Treatment of PMDD with a serotonergic antidepressant significantly improves functioning and QOL in all studies that have systematically examined QOL issues in this disorder. Although the data show that PMDD is effectively treated with serotonergic antidepressants and that functional impairment that accompanies the disorder is also improved with treatment, the social and economic burden of PMDD continues to be widely unrecognised. Greater awareness of the effectiveness of treatments and reliable measures of the direct and indirect healthcare costs of the disorder when it remains untreated are needed.
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Affiliation(s)
- Ellen W Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-5509, USA.
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Halbreich U. The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder--clinical procedures and research perspectives. Gynecol Endocrinol 2004; 19:320-34. [PMID: 15724807 DOI: 10.1080/0951590400018215] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Premenstrual syndromes (PMS) are quite prevalent among women of reproductive age. In up to 20% of women they are severe enough to warrant treatment, which is available and marketed as such. The impact of the cumulative burden of PMS is substantial and is in the same magnitude as affective disorders. Nevertheless, the definitions and diagnoses of PMS are still fragmented, not widely accepted and, if accepted, not always applied in day-to-day clinical practice. In the present paper, the current diagnostic entities are critically reviewed, problems with the current definitions are delineated and a unified definition is proposed. For clinical purposes, the recommended dinical practical diagnostic process and differential diagnosis are described. For clinical trials of medications for treatment of PMS/premenstrual dysphoric disorder, research diagnostic criteria, inclusion and exclusion criteria, as well as well-defined outcome measures, are of utmost importance; they are described here. The gaps of knowledge in the description and diagnosis of PMS are described, with suggestions for future directions for research.
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Affiliation(s)
- U Halbreich
- Biobehavioral Program, State University of New York at Buffalo, Buffalo, New York 14214-3016, USA
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Abstract
OBJECTIVE To estimate whether premenstrual syndrome (PMS) predicts common menopausal symptoms assessed longitudinally for 5 years among women in the transition to menopause. METHODS Data were obtained from a structured interview questionnaire, daily symptom ratings, and standard measures of depressive symptoms and sleep quality at 7 assessment periods in a population-based cohort of 436 women. Menstrual status was determined by menstrual bleeding dates. Hormones were measured in the early follicular phase, with a maximum of 14 measures per subject. Multivariate logistic regression models for repeated measures were used to estimate the effects of study variables. RESULTS Premenstrual syndrome significantly decreased with age (P <.001) and with changes in menstrual bleeding status (P =.003). Women with PMS at enrollment were more likely over the 5-year period to report menopausal hot flushes (odds ratio [OR] 2.09; confidence interval [CI] 1.42, 3.08; P <.001); depressed mood (OR 2.34; CI 1.60. 3.43; P <.001); poor sleep (OR 1.72; CI 1.16, 2.53; P =.007), and decreased libido (OR 1.54; CI 1.06, 2.24; P =.024) after adjusting for age, race, diagnosis of major depression, and estradiol. Subjects' fluctuations in estradiol were significantly associated with hot flushes, depressive symptoms, and poor sleep. CONCLUSION Premenstrual syndrome decreased in the transition to menopause. Women who reported PMS at baseline were at greater risk of menopausal hot flushes, depressed mood, poor sleep, and decreased libido. Further studies of the associations of symptoms and changes in ovarian function are needed to elucidate the underlying symptom physiology and aid in the development of effective treatments for women during the menopausal transition.
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Affiliation(s)
- E W Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia 19104, USA.
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Halbreich U, Kahn LS. Treatment of premenstrual dysphoric disorder with luteal phase dosing of sertraline. Expert Opin Pharmacother 2004; 4:2065-78. [PMID: 14596660 DOI: 10.1517/14656566.4.11.2065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sertraline (Zoloft, Pfizer Inc.) is a selective serotonin re-uptake inhibitor (SSRI) which has been approved by the US FDA for the treatment of premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome (PMS) which affects at least 5 - 8% of women of reproductive age. It is characterised by cyclic appearance at the late luteal phase of the menstrual cycle, and disappearance following the beginning of menses, with no symptoms during at least 1 week of the cycle - usually during the mid-follicular phase. Due to the cyclic luteal occurrence of PMDD, luteal phase dosing of SSRIs has been suggested and proven effective for sertraline as well as several other SSRIs. The clinical response of sertraline is reported to be within several days following initiation of treatment. Despite repeated cyclic discontinuation, no significant discontinuation adverse effects have been reported. In addition to its proven clinical efficacy, luteal-phase dosing may offer the advantages of minimising adverse effects of SSRIs while reducing the personal and economic burden of taking a prescription medication continuously for long periods and thus increasing compliance.
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Affiliation(s)
- Uriel Halbreich
- Biobehavioural Program, School of Medicine & Biomedical Sciences, Hayes C, Suite 1, 3435 Main St, Building 5, Buffalo, NY 14214-3016, USA.
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Abstract
Though epidemiological data is difficult to collect, existing evidence indicates that there is a small but significant population of women in whom premenstrual symptoms, and particularly affective symptoms, severely impair functioning. Although PMDD is predominantly regarded as a biologically based illness, there is strong evidence that variables such as life stress, history of sexual abuse, and cultural socialization are important determinants of premenstrual symptoms. In diagnosing and treating PMDD patients, attention to biological and sociocultural variables is recommended.
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Affiliation(s)
- Lori E Ross
- Women's Health Concerns Clinic and Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Fontbonne Building, 6th Floor, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
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Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 2003; 28 Suppl 3:1-23. [PMID: 12892987 DOI: 10.1016/s0306-4530(03)00098-2] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Currently it is estimated that 3-8% of women of reproductive age meet strict criteria for premenstrual dysphoric disorder (PMDD). Assessment of published reports demonstrate that the prevalence of clinically relevant dysphoric premenstrual disorder is probably higher. 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress, though the number of symptoms may not meet the arbitrary count of 5 symptoms on the PMDD list. The impairment and lowered quality of life for PMDD is similar to that of dysthymic disorder and is not much lower than major depressive disorder. Nevertheless, PMS/PMDD is still under-recognized in large published epidemiological studies, as well as assessments of burden of disease. It is demonstrated here that the burden of PMS/PMDD as well as the disability adjusted life years (DALY) lost due to this repeated-cyclic disorder is in the same magnitude as major recognized disorders. Appropriate recognition of the disorder and its impact should lead to treatment of more women with PMS/PMDD. Efficacious treatments are available. They should reduce individual suffering and impact on family, society, and economy.
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Affiliation(s)
- Uriel Halbreich
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA.
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