College women's attitudes and expectations concerning menstrual-related changes

Breaking the Silence: A Community-Based Cross-Sectional Study Exploring the Attitude Towards Premenstrual Syndrome Among Adults in Perambalur District of Tamil Nadu, India

Background Menstruation is a natural process crucial for female reproductive health. Premenstrual syndrome (PMS) is characterized by physical and emotional symptoms occurring before menstruation. Social and cultural factors significantly influence menstrual attitudes and PMS perception. Cultural norms and a lack of confidence during this phase may impede women's ability to lead innovation. This is where men can play a crucial role in driving change by actively engaging in menstrual health advocacy. By challenging restrictive practices and negative perceptions surrounding menstruation, men can contribute to better menstrual hygiene management. The objective of this study was to determine the independent predictors of attitude towards PMS among both male and female adult populations in Perambalur district, Tamil Nadu, India. Materials and methods A community-based cross-sectional study was conducted from August 2024 to October 2024. A pre-tested, structured questionnaire was utilized to assess the attitude towards PMS. The questions on attitude towards PMS were scored as per the recommendation of an expert committee. The data were entered into Microsoft Excel, numerically coded, and analyzed using IBM SPSS version 26. Descriptive statistics was used to characterize the study participants and was expressed in frequencies, percentages, and mean (±standard deviation (SD)). Independent samples t-test and one-way ANOVA were used to determine the significant difference between the mean attitude score and the independent variables. A multivariable linear regression model was used to determine the independent predictors of attitude score. A p-value <0.05 was considered statistically significant. Results The study included a total of 281 study participants. The mean (±SD) age of the study participants' age was 32.21 (±8.64) years. The mean (±SD) attitude score among the study participants was 7.12 (±2.17). The independent predictors, which had a positive impact on attitude score, were as follows: (1) age groups (18-25 years, 26-35 years, and 36-45 years), (2) male gender (B = 0.77; 95% CI 0.28-1.27), (3) school education (B = 0.74; 95% CI 0.21-1.28). The independent predictor, which had a negative impact on attitude scores, was a rural area of residence (B = -0.53; 95% CI -1.07 to -0.26). Conclusion The attitude towards PMS is multifaceted. Interventions should address the gaps through multi-pronged approaches, including education, community awareness, and policy changes, while also considering broader social and environmental factors impacting menstrual health.

The effect of gender-role orientation on attitudes towards menstruation in a sample of female university students

Objective

To examine the effect of gender role orientation on attitudes towards menstruation in a sample of Iranian female students of medical sciences.

Material and Methods

Three hundred female university students (94%; response rate: 282) were enrolled in the study via stratified random sampling. Data were collected using a demographic questionnaire, the Menstrual Attitude Questionnaire (MAQ), and the short version of the Bem Sex Role Inventory (BSRI). Data were analyzed using SPSS v.18. Analyses were performed using the Kruskal-Wallis test and the Mann-Whitney U test.

Results

The mean scores of the MAQ subscales ranged from 3.7±1.35 to 5.6±1.3, indicating that most of the respondents had natural to moderate attitudes toward menstruation. When participants were classified into one of four gender-role categories of BSRI, the results showed that the undifferentiated group with 33.7% was higher than other gender-role groups. The undifferentiated group was significantly less likely than the other groups to perceive “menstruation as a natural event”.

Conclusion

The study shows an association between gender-role orientation and attitudes toward menstruation in female university students. However, further research is still necessary in this issue.

Questionnaire Studies of Paramenstrual Symptoms

A number of formal questionnaires have been devised to study paramenstrual symptomatology. It has been suggested that women's responses to these questionnaires are vulnerable to forgetting and contaminated by culturally induced expectations. Nevertheless, concurrent reports of experienced symptoms may correlate highly with retrospective judgments, even when the relevance of the menstrual cycle is disguised. They also differentiate between women with and without a self-reported history of premenstrual symptoms, although concurrent reports across several menstrual cycles are impractical to collect and may be inconsistent between successive cycles. A number of methodological criticisms have been directed toward the most commonly used device, the Menstrual Distress Questionnaire. In principle, however, retrospective questions offer a reliable and accurate indication of women's experience during the normal menstrual cycle.

Psychosocial and Cultural Factors Influencing Expectations of Menarche

This study explored how psychosocial and cultural factors influenced expectations of menarche among 476 Chinese premenarcheal teenage girls. Results showed that participants’ expectations of menarche were largely negative and heavily influenced by cultural beliefs about menstruation. Findings of hierarchical regression analyses revealed that positive emotional expectations of menarche were best predicted by perceptions of menstruation as a natural event, possession of positive self-concept, and rejection of indigenous negative menstrual attitudes. Negative emotional expectations of menarche were best predicted by perceptions of menstruation as a negative event, by inadequate preparation for menarche, by endorsement of indigenous negative menstrual attitudes, and by older age.

Suppression of Menstrual Distress Symptoms

The present study examined Type A and Type B women's reporting of chronic recurring symptoms of menstrual distress, which are culturally defined as interfering with daily activities. Based on previous laboratory experiments, it was expected that Type A women would be motivated to ignore symptoms during menstruation in order to carry on daily activities. Consequently, they would report less intense symptoms during menstruation relative to the intensity of the same symptoms reported when Type As would not be motivated to ignore symptoms. This hypothesis was supported and subsidiary analyses showed that both positive and negative sensations associated with menstruation were relatively underreported by Type As. Thus, it appears that Type As' suppression of acute symptoms during performance of specific tasks extends to suppression of menstrual distress.

Is a Little (Psychiatric) Knowledge a Dangerous Thing?: The Impact of Premenstrual Dysphoric Disorder on Perceptions of Premenstrual Women

One hundred thirty-four participants completed a revised Menstrual Distress Questionnaire (MDQ), which included criteria for premenstrual dysphoric disorder (PMDD). Two weeks later the participants again completed the revised MDQ after reading either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for the PMDD or a copy of the same criteria retitled “Episodic Dysphoric Disorder,” with all menstrual cycle references removed. Knowledge of the diagnosis did not affect women's perceptions of their own menstrual cycle-related symptoms, but it increased participants' perceptions of premenstrual changes as a problem for women in general. Chi-square analyses revealed that participants were more willing to attach a psychiatric diagnosis to women they know if they believed the diagnosis was related to the menstrual cycle.

Menstrual Joy

Fifty female college students participated in a study of women's health. In a counterbalanced design, half of the participants completed the Menstrual Joy Questionnaire (MJQ) and the Menstrual Attitude Questionnaire (MAQ) in the first testing session. A week later they completed the Menstrual Distress Questionnaire (MDQ) and the Menstrual Attitude Questionnaire. The other participants completed the MDQ and MAQ in the first session and the MJQ and MAQ in the second. A multivariate analysis of variance revealed that those who received the MJQ first reported more positive cyclic changes on the MDQ and more positive attitudes on the MAQ. A follow-up study of 40 college students examined their responses to the MJQ. Participants reported that they were surprised or incredulous; most had not previously considered positive aspects of the menstrual cycle. Thirty percent reported that the MJQ had caused them to look at menstruation in a different way.

Effects of Expectations and Bodily Sensations on Self-Reports of Premenstrual Symptoms

Two experiments examined expectations and bodily sensations in premenstrual symptom reports. Women took a fictitious test that indicated they were either “premenstrual” or “intermenstrual.” In Experiment 1, 48 women were studied during their premenstrual phase. In Experiment 2, 82 women were studied during either their premenstrual or intermenstrual phase. Individual differences in retrospective premenstrual distess were assessed prior to the experiments. Both experiments revealed that the higher the woman's retrospective reports of premenstrual distress, the more symptoms she reported in the lab during her premenstrual phase, regardless of what the test indicated. However, women who were told they were premenstrual reported greater symptoms than women who were told they were intermenstrual. In summary, although expectations affect women's symptom reports regardless of their actual phase and history of reported symptoms, premenstrual symptom reports cannot be dismissed as simply expectations, because some women do experience greater symptoms as they approach menstruation.

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.

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.

Attitudes toward menstruation in females with schizophrenia or schizoaffective disorders in Taiwan

OBJECTIVE

The aims of this cross-sectional, case-controlled, observational study were to examine attitudes toward menstruation in female patients with schizophrenia or schizoaffective disorder and in a control group, and to explore the associations between attitudes toward menstruation and psychopathology, menstrual regularity during antipsychotic treatment, and menstrual distress symptoms.

METHODS

Fifty-eight patients treated with anti-psychotic medications for at least the previous 6 months were placed in irregular (irregular menstrual cycle) (n = 31) and regular (regular menstrual cycle) (n = 27) groups. Sixty-two, age-matched, healthy female participants with regular menstrual cycles were enrolled as a control group. Psychopathology was assessed by psychiatrists using the Positive and Negative Syndrome Scale (PANSS). The Menstrual Attitude Questionnaire (MAQ) was used to assess attitudes toward menstruation, and symptom checklists based on the Moos Menstruation Distress Questionnaire (MMDQ) were used to assess menstrual distress symptoms.

RESULTS

Patients with psychotic disorders (both irregular and regular groups) had more negative attitudes toward menstruation than the control group. In the Schizophrenia group, there was no association between the severity of psychotic symptoms and their influence on attitudes toward menstruation. Moreover, regular menstrual cycles during antipsychotic treatment and fewer menstrual distress symptoms were the two main predictors for more positive attitudes toward menstruation in the patient group.

CONCLUSION

This is one of the first studies to explore the relationship between psychotic symptoms and attitudes toward menstruation. The findings provide more support for the assumption that attitudes toward menstruation are derived from a woman's perception of her bodily experience rather than a psychiatric disorder.

The biomedical standardization of premenstrual syndrome

This essay traces the history of premenstrual syndrome (PMS) in French, British, and American medical literature from 1950 to 2004. Aetiological theories, treatments and diagnostic criteria have varied over time and place, reflecting local conditions and changing notions of objectivity and evidence. During the 1970s researchers in each nation utilised different research strategies to overcome variation and contradictory results characteristic of PMS research. Since the 1980s, attempts have been made to standardise research internationally through prospective daily rating questionnaires that diagnose and measure PMS. Amidst controversy, a psychiatric reformulation of the syndrome was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the diagnostic criteria for this psychiatric category, now called premenstrual dysphoric disorder (PMDD), are widely accepted for research purposes, efforts to transfer them to medical practice have been less successful. PMDD remains a contested disease construct.

The premenstrual syndrome revisited

More women - and their families - are affected by the physical and psychological irregularities due to premenstrual symptoms than by any other condition. Up to 90% of women of childbearing age report perceiving one or more symptoms during the days before menstruation, symptoms which can alter their behaviour and wellbeing and which, therefore, can affect their family, social and work circle. However, and notwithstanding this general prevalence, the clinical entity that in a large number of cases results from these symptoms, commonly known as the premenstrual syndrome, still lacks defined and validated contents so that recommendations of treatments backed by adequate experimental and clinical evidence are only slowly appearing. In the present paper, we review recent experimental data as to a possible aetiology of the premenstrual problem. We propose a Premenstrual Profile, i.e. a new register of symptoms, to be used for the differential diagnosis of the three forms of the premenstrual alteration. Finally, we review the evidence-based recommendations from reliable sources as regards the treatment of "normal" and "abnormal" premenstrual symptoms.

Attitudes toward menstruation in premenstrual dysphoric disorder: a preliminary report in an urban Turkish population

The manner in which menstruation, femininity and the role of the mother are perceived, along with the social influences, are emphasized in the psychosocial dimension of premenstrual syndrome. This study attempts to investigate the perception of mothers and attitudes toward menstruation of a group of women diagnosed with premenstrual dysphoric disorder (PMDD) in a secular Muslim country. Thirty women with PMDD and 24 healthy women were studied using a semi-structured questionnaire. Menstrual attitude and the way the mother was perceived in the childhood-to-puberty period by women with PMDD, were significantly negative in comparison to the control group. In conclusion, menstrual attitudes and premenstrual experiences of women should be investigated cross-culturally and prospectively.

The impact of anxiety sensitivity, bodily expectations, and cultural beliefs on menstrual symptom reporting: a test of the menstrual reactivity hypothesis

According to the menstrual reactivity hypothesis, certain women report more severe as well as a greater number of menstrual symptoms due to accurate reports of physical symptoms and expectations (e.g., cultural beliefs, sex roles, bodily sensations). To test this hypothesis and to further examine the role that anxiety sensitivity plays in menstrual symptom reporting, women varying in levels of anxiety sensitivity completed measures of sex role socialization, menstrual attitudes, bodily preoccupations, affect, and fear of illness. To assess psychophysiological reactivity and the applicability of response styles theory to individuals varying in anxiety sensitivity, skin conductance was measured as participants engaged in a rumination or distraction task. In addition, participants completed a modified Stroop task consisting of anxiety, menstrual, and neutral words followed by a surprise recognition task. Retrospectively and prospectively, women high in anxiety sensitivity consistently reported more severe menstrual symptoms. High anxiety sensitivity women also reported preoccupation with bodily sensations and more negative attitudes toward illness, but did not differ from low anxiety sensitivity women on measures of menstrual attitudes or sex role socialization. While engaging in a rumination task, high anxiety sensitivity women exhibited more frequent skin conductance responses and greater skin conductance response magnitude than low anxiety sensitivity women. In addition, after the rumination task, high anxiety sensitivity women recognized more anxiety-related words from the Stroop task. Menstrual cycle phase had less of an impact than anxiety sensitivity level on the current results. Implications of these results for the menstrual reactivity hypothesis and rumination are discussed.

Psychophysiological, somatic, and affective changes across the menstrual cycle in women with panic disorder

This study explored menstrual symptoms, somatic focus, negative affect, and psychophysiological responding across the menstrual cycle in women with panic disorder and controls. Women with and without panic disorder completed a psychophysiological task and self-report measures of menstrual symptoms, somatic focus, and negative affect on 4 occasions across 2 menstrual cycles (twice during intermenstrual and premenstrual phases). Women in the panic disorder group exhibited greater skin conductance magnitude and more frequent skin conductance responses to anxiety-provoking stimuli during the premenstrual phase than did controls. Compared to controls, women with panic disorder endorsed more severe menstrual symptoms relating to bodily sensations, anxiety sensitivity, state and trait anxiety, fear of body sensations, and illness-related concerns. The applicability of anxiety sensitivity to understanding the relation of menstrual reactivity and panic disorder is discussed.

A comparison of cycle control and effect on well-being of monophasic gestodene-, triphasic gestodene- and monophasic desogestrel-containing oral contraceptives. Gestodene Study Group

This was an open-label multicenter study to compare the cycle control and effect on well-being of two oral contraceptives containing gestodene and one containing desogestrel. A total of 2419 healthy women < or = 41 years of age were randomized to receive oral contraceptives containing monophasic gestodene (Minulet; n = 806, mean age 24.5 years), triphasic gestodene (Tri-Minulet; n = 808, mean age 24.6 years) or monophasic desogestrel (Mercilon; n = 805, mean age 24.6 years). Subjects were to participate in the study for up to 13 treatment cycles. A modified Moos Menstrual Distress Questionnaire was used to evaluate menstrual symptoms and to assess overall well-being. A total of 698 women were withdrawn from the study, 154 due to adverse events. Cycle control with gestodene was superior to that with desogestrel at almost all time points, particularly for breakthrough bleeding and/or spotting, which occurred significantly less frequently with gestodene than with desogestrel at cycles 1-7 and 9-11 (p < 0.05). Generally, the proportion of subjects with breakthrough bleeding and/or spotting was almost twice as great with desogestrel as with gestodene. The duration of bleeding was not consistently different between the gestodene and desogestrel groups; however, the intensity of bleeding was greater with gestodene at all time points (p < 0.05). The latent period before withdrawal bleeding was significantly longer for monophasic gestodene at cycles 1-5 and 8-10 (p < 0.05). Treatment significantly improved overall well-being at cycles 6 and 9 with triphasic gestodene and at cycle 13 with desogestrel; however, no statistically significant differences among treatment groups in overall well-being scores or individual factors of well-being could be identified. All three treatments were well tolerated. The most common drug-related adverse events were headache (14.2%), breast pain (6.2%), nausea (4.1%), metrorrhagia (3.9%) and abdominal pain (3.5%). The incidence of adverse events in all treatment groups was similar, with the exception of metrorrhagia, which occurred in more patients in the desogestrel group than in the gestodene treatment groups (p < 0.05).

Pubertal development and school transition. Joint influences on depressive symptoms in middle and late adolescents

The impact of simultaneous changes in biological and social context on the mental health of adolescents was examined by testing the hypothesis that normative developmental transitions can be associated with increased dysphoria if they occur in close temporal proximity. Girls experiencing physical changes associated with middle or later stage pubertal development during the initial high school or college year were predicted to experience more dysphoria than those experiencing these changes during non-transitional times, with negative pubertal attitudes exacerbating the relation. Pubertal status and dysphoria of high school and college students were assessed. Among females experiencing pubertal changes, dysphoria was indeed highest for the 15 and 19 year olds, and lower for the 16, 17, and 18 year olds with females viewing menstrual onset as negative experienced depressive symptoms of moderate clinical severity. This pattern did not emerge for males, or females not experiencing pubertal changes. In contrast, the hypothesis was not supported when transition time was operationalized using grade level. Implications for psychopathology risk are discussed.

A clinician's guide to the premenstrual syndrome

Many women have menstrual symptoms, but relatively few have severe PMS. PMS is a well-defined premenstrual cluster of predominantly affective symptoms that disrupt a woman's daily functioning. PMS is diagnosed with prospective charting of symptoms and should be differentiated from nondisruptive menstrual symptoms, major affective disorders, and other common medical and gynecologic conditions. Most women with PMS can be helped. The serotonin reuptake inhibitors are becoming the first line of therapy for PMS because they are effective, easily tolerated, and free of major side effects. There is also evidence supporting the role of other antidepressants, anxiolytics, and GnRH agonists in the treatment of PMS. Although increasing control of one's life, promoting a healthy diet, the avoidance of salt and caffeine, vitamin supplementation, and exercise have not been proved as effective treatment for PMS, they should be promoted for their obvious general health benefits. No one treatment fits the heterogeneous PMS population. A trial of medication should be continued for two or three menstrual cycles with appropriate dose adjustments. If relief is not sufficient, other agents or other treatments should be initiated.

The menstrual cycle, science and femininity: assumptions underlying menstrual cycle research

This paper examines the relationship between popular knowledge of menstruation and scientific research. It suggests that despite evidence to indicate that pre-menstrual cognitive, behavioural and emotional 'impairment' is relatively rare, the population notion that PMS routinely affects many women adversely is difficult to displace. It concludes that mainstream menstrual cycle research is subject to the influence of misogynist mythology upheld as staunchly by women influenced by patriarchy as by men. Reasons are suggested which lie in the differential power of claims to knowledge.

Menstrual attitudes among black and white premenarcheal girls

PROBLEM

To determine if a difference exists between black and white fifth-grade girls' attitudes about menarche and menstruation.

METHODS

The Menstrual Attitude Questionnaire-Adolescent Form (Brooks-Gunn & Ruble, 1980) was used to collect data from 55 premenarcheal females, ages 10-12 years.

FINDINGS

The findings indicated no difference between black and white girls in Affirmation or Worry. Like older samples, the girls were moderate in affirmation. Unlike older samples, they evidenced less worry.

CONCLUSION

Analysis of the instrument used in this study raises questions in general regarding its use as originally developed. In addition, specific questions were raised about its use with different cultural groups.

Social pathways to premenstrual symptoms

The purpose of this study was to explore feminine and menstrual socialization, expectations about experiencing symptoms, and the stressful nature of women's lives among women with three perimenstrual symptom patterns. Social learning and stress theory provided a theoretical framework for understanding why some menstruating women experience premenstrual syndrome or premenstrual magnification symptom patterns. Data about socialization, stressful life context, expectations about symptoms, depressed mood, and other health-related and demographic indicators were obtained from an interview. Subsequent daily recordings in a health diary for two or more menstrual cycles provided data with which to classify women's symptoms across the menstrual cycle as a low severity symptom (LS, n = 73), premenstrual syndrome (PMS, n = 36), or premenstrual magnification (PMM, n = 62) pattern. Stepwise discriminant function analysis demonstrated that stressful life context, menstrual socialization, and expectations about symptoms related to menstruation differentiated women with an LS from those with a PMS or PMM symptom pattern. In addition, depressed mood differentiated the three groups.

Menstrual cycle symptom reporting in three British ethnic groups

Three different British ethnic groups were targeted to assess the influence of learned or culturally prescribed symptom reporting behaviour across different phases of the menstrual cycle. Forty-eight Afro-Caribbean, 73 Caucasian and 32 Oriental subjects completed a Positive/Negative Affectivity scale, a Retrospective assessment of premenstrual symptoms and daily symptom reports for 35 days. The results showed a significantly elevated level of symptomatology premenstrually and menstrually in the Caucasian group compared to both others. Analysis of subscales suggested elevated symptom reporting occurred for the psychological mood, body symptoms and pain, but not for the mental performance and social behaviour subscales. Intermenstrual reports of symptoms and Negative Affectivity did not differ between groups. A response bias or underlying trait is therefore unlikely to account for the selective reporting observed. It is suggested that the question of learning variables playing an important role in the reporting of symptoms at different phases of the menstrual cycle may be reopened.

Preferences regarding treatments for period problems: relationship to menstrual and demographic factors

Beliefs about periods and hysterectomy and preferences regarding treatment for period problems were assessed in 362 women--patients referred for menorrhagia, premenstrual syndrome, or dysmenorrhea (n = 99, 102 and 56 respectively), and a control sample (n = 105). Overall, women were predominantly in favor of a treatment which normalized periods (89%) and which coincidentally provided reversible contraceptive effect (74%), while they marginally preferred a one-off operation to tablets. Preferences with regard to contraceptive effect of treatment, effect on periods and hypothetical treatment option were most strongly related to reproductive status (p < 0.00002), in that nulliparous or unsterilized women were least likely to rate as acceptable a treatment that affected their periods or fertility. The women's feelings about their periods and their evaluation of the utilitarian consequences of hysterectomy were most strongly related to their report of menstrual problem(s), with the potential benefits of an end to periods being most often affirmed by women reporting 'severe' menorrhagia, dysmenorrhea or multiple period problems. In contrast, women's evaluation of the reproductive consequences of hysterectomy were most strongly related to reproductive status, with nulliparous women and unsterilized parous women finding them least acceptable. Feelings about periods did not predict intentions with respect to periods, or treatment preferences, and in this regard the usefulness of menstrual attitudes is questioned.

The Premenstrual Syndrome: Perceived Stress and Coping Efficacy

Twelve women suffering from premenstrual syndrome (PMS) were monitored over eight weeks to focus on the psychological processes involved in this menstrual disorder. PMS symptomatology, perceived stress, and coping efficacy were examined. Significant cyclical changes occurred in all three variables with the highest deviations appearing premenstrually. The relationship between coping strategies and the severity of symptoms was also studied. Qualitative analysis revealed themes pertinent to an understanding of PMS. It is suggested that alternative treatment options besides pharmacological intervention should be made available to PMS sufferers.

Mood effects of alcohol and expectancies across the menstrual cycle

To examine menstrual cycle phase variations in alcohol absorption and mood before and after drinking alcohol, 96 volunteers female heavy drinkers, unaware they were in a menstrual cycle study, were randomly assigned to 12 equal-sized groups with controls for the effects of alcohol, expectancy, and menstrual cycle phase. Alcohol subjects received sufficient alcohol to raise their blood alcohol level to .07 mg %. Mood, assessed with the Profile of Mood States, did not differ across menstrual cycle phases at baseline, failing to support the notion of menstrual phase-related moods. The only mood changes were a Beverage by Trials interaction on the Vigor and Confusion scales and a main effect for trials on the Tension-Anxiety and Vigor scales. Peak intoxication level did not differ across phases. The present findings of an absence of menstrual cycle phase-related differences in mood or alcohol absorption support social learning theory and suggest that phasic variations in mood are socially learned. They also suggest the need for systematic study of methodologic factors in this research area.

The attitudes towards menstruation among Icelandic nursing students--their relationship with menstrual preparation and menstrual characteristics

The purpose of this study was to describe the attitudes towards menstruation of Icelandic female nursing students and see if a relationship exists between the attitudes with recollection of menarche and characteristics of present menstruation. Findings show that the students (N = 178) view menstruation as natural, not very predictable or debilitating, even though they do not deny that menstruation can effect behaviour in some way. Findings also indicate that the heavier the menstrual flow, the less likely the student is to deny all affects of menstruation as well as finding menstruation more debilitating and more predictable; the longer the menstrual period the more predictable is the coming of the next menstrual period and the less likely is the student to deny all effects of menstruation. It is suggested that inconveniences brought about by menstruation influence the formation of menstrual attitudes.

Cultural variations in attitudes toward menstruation

Attitudes towards menstruation play an important role in the perception of menstrual distress. The influence of cultural and social factors was studied in a group of 48 Indian women using the Menstrual Attitudes Questionnaire (modified version). Women over 25 years of age were significantly more likely to consider menstruation as being "natural". No other significant relationships were found between menstrual attitudes and demographic variables. The menstrual attitudes of Indian and American college women (from a previous study) were also compared.

Sociocultural aspects of menstrual attitudes and premenstrual experiences in India

Menstrual attitudes were studied in a group of 48 Indian women using the Menstrual Attitude Questionnaire, modified and adapted for Indian background. Attitudinal factors of menstruation being a natural, bothersome and debilitating event were studied, as also denial of the event and healthy/unhealthy attitudes. High rating was seen in menstruation being perceived as a natural event and least as a debilitating one. Older women considered menstruation as a natural event. Relating premenstrual experiences to attitudes, it was observed that distressful symptoms correlated significantly with debilitating and unhealthy attitudes. Similarly, premenstrual well-being correlated highly with naturalness attitudes, thereby suggesting that the personal experiences are likely to influence the menstrual attitudes.

Premenstrual syndrome in hysterectomized women: mood and physical symptom cyclicity

In 36 hysterectomized women presenting with PMS, a daily record of eight mood states and five physical symptoms was kept during 109 ovarian cycles. Premenstrual tension (PMT) was estimated at a point 92% through the ovarian cycle after fitting a five-term Fourier series to the data. Although significant mood and physical-symptom swings were common (present in 71% and 69% of cycles respectively), the incidence of symptoms late in the luteal phase (PMT) was low (36%). In nine women no PMT was detected, in twenty-two women PMT was sporadic, and in five there was evidence of the consistent appearance of both mood and physical symptom-related PMT. Symptoms clustered significantly around a point 85% through the ovarian cycle for moods, and 83% for physical symptoms; this differs significantly from the 92% observed in menstruant women with PMS and is consistent with the removal of a factor associated with menstrual onset, which may contribute to the symptoms perceived by women as PMT.

Performance and state changes during the menstrual cycle, conceptualised within a broad band testing framework

Using a broad band testing framework, indices of performance and state were examined in 10 women during one menstrual cycle, over six separate testing sessions. Indices of state were heart rate, the Cruickshank self-report questionnaire and time to basal skin potential. Results showed that self reported arousal was increased premenstrually. There was dissociation between indices of state, supporting the contention that simple models of arousal are inadequate. Performance tests of cognitive processing, tracking skill, reaction time and vigilance, dual task, speed and accuracy, and short term memory capacity showed only one significant result: semantic processing on a word matching task improved premenstrually. There was no significant relationship between state and performance: with high individual differences found between subjects. It was concluded that menstruation was not acting as a stressor for these subjects, and that there was no evidence for a decrement in performance in the menstrual or premenstrual phases of the cycle. Results are discussed in terms of coping with perceived increase in demand premenstrually, resulting in utilisation of compensatory effort and it is suggested that future work should examine womens ability to cope with perceived increase in demand and attribution of arousal during the menstrual cycle. The implications of the findings in terms of the critique of PMS as a valid construct are discussed, and it is concluded that future work should be carried out within an integrated multi-variate framework.

Premenstrual syndrome

The Premenstrual Syndrome (PMS) was described as a unique entity meriting therapeutic attention in 1931. Although researchers in the area have failed to develop a widely accepted definition of PMS, substantial progress has been made in describing the variety of psychobiological profiles encompassed by this syndrome, particularly with respect to its typical symptoms, cyclical nature, symptoms recurrence and severity. Therapies ranging from diet and exercise to vitamin, hormone and drug treatment have been proposed. While none is more efficacious than placebo, several have been popularized. Our failure to develop adequate treatment may reflect our lack of understanding of either the psychosocial or biological factors involved in PMS. This, in turn, may reflect inadequate theoretical development in this research area. We provide a critical assessment of research on PMS, suggest a framework for theoretical development and advocate research strategies that might provide insights into the etiology of the premenstrual syndrome.

Premenarcheal predictors of the experience of menarche: a prospective study

The goals of this study were (1) to assess, with a prospective design, the impact of premenarcheal menstrual attitudes and personality attributes for menarcheal experience and (2) to assess the relative strength of these variables, in relation to menarcheal timing and preparation for menarche, for predicting menarcheal experience. The subjects were 92 girls, who changed from pre- to postmenarcheal between two test occasions, 6 months apart. When premenarcheal menstrual attitudes and personality attributes were examined independently, results revealed that affirmation, a menstrual attitude, and depression significantly predicted emotional response to menarche. When these two variables were examined, together with preparation and timing variables, the two significant predictors of menarcheal experience were preparation and affirmation. The results provide direction for, and optimism about, the potential efficacy of menstrual education in promoting more positive menarcheal experience.

Premenstrual emotional changes a prospective study of symptomatology in normal women

Fifty-one subjects completed a modified version of the Moos Menstrual Distress Questionnaire daily for 8 weeks. The true purpose of the study was not revealed. These prospective data showed no pattern of increase in symptoms of negative affect during the premenstrual or menstrual phases, although the majority of women retrospectively reported having experienced premenstrual tension during the study. Explanations for this discrepancy in terms of an information processing bias and the popularising of internal hormonal explanations are offered. A number of demographic and menstrually related variables are investigated and found to show no relationship to the experience of PMT in this sample. No evidence is found to suggest that older women are more likely to experience PMT.

Alcohol use and premenstrual symptoms in social drinkers

The relationship between premenstrual dysphoria and alcohol acquistion and use patterns was studied in 14 women over 35 days on a clinical research ward. A 7-day drug-free baseline was followed by 21 days of alcohol availability and a post-alcohol drug-free period of 7 days. Women could earn alcohol or 50 cents for 30 min of performance on a simple operant task. The Premenstrual Assessment Form (PAF) was administered during baseline and at the premenstruum. Menstrual cycle phase was associated with changes in alcohol use by 8 of the 14 women. Five women drank more during the premenstruum and scored higher on 12 of 18 PAF factors than women whose drinking remained the same (N = 6) or decreased (N = 3). Women who increased drinking had significantly higher PAF scores on impaired social functioning, hostility/anger and hysteroid features (P less than 0.05, 0.01). Women who drank less during the premenstruum reported more pain and physical discomfort, whereas women who drank about the same amount were relatively asymptomatic. PAF profiles reported at the premenstruum and baseline PAF profiles based on recall of the preceding three menstrual cycles were concordant in 13 of the 14 women (P less than 0.001-0.0001). These data suggest that women's perceptions of premenstrual symptomatology are stable through time.

The measurement of perimenstrual distress

This study was undertaken to explore whether the implicit requirement of phase comparison in menstrual research influences the data obtained. One hundred fifty Israeli women responded to the Menstrual Distress Questionnaire in an altered procedure. They rated their experience of behaviors and feelings during the nonmenstrual phase. Later, on a separate form, they rated their experience of the same behaviors and feelings during the menstrual and premenstrual phases. With this altered procedure, nonmenstrual distress scores were consistently higher than the perimenstrual scores. This pattern of results is the reverse of what most studies using the questionnaire have shown and does not seem to justify treating the perimenstrual period as especially problematic.

Effects of ovarian hormones on eating behaviors, body weight, and glucoregulation in rhesus monkeys

The influences of ovarian hormones on food intake, taste preferences, and glucoregulation were examined in intact and ovariectomized rhesus monkeys. Intake of intact monkeys was lowest in the preovulatory stage of the cycle, when estrogen levels are elevated, and exogenous estradiol transiently suppressed food intake of ovariectomized monkeys in a dose-related manner, confirming previous observations. Progesterone treatment did not affect food intake when given alone, but it did attenuate the effect of estradiol when both hormones were given concurrently. Preferences for sweet solutions were not detectably influenced by chronic treatment with estradiol or progesterone, and compensatory responses to ingestion of sugar were unaltered by hormone treatment. Glucose tolerance tests did not reveal significant influences of ovarian hormones on glycemia, but insulin levels were elevated during periods of progesterone treatment. These results do not support the suggestion that fluctuations in caloric intake during the menstrual cycle are secondary to changes in taste preference or glucoregulation. However, possible changes in sweet preference and glucoregulation shortly after initiation of estrogen treatment, i.e., during the time of suppressed food intake, remain to be examined.

Assessing premenstrual syndrome using the premenstrual experience assessment

A comprehensive assessment device was developed and validated on 878 women. The inventory seems useful both in research and clinical practice. The instrument solicits information on medical, gynecological and psychological conditions, life-event stressors, sociocultural influences and premenstrual symptomatology. Responses generated a number of significant findings. One of seven women experienced severe premenstrual discomfort, one out of two women described themselves as having mild premenstrual discomfort, and severity of symptoms is a matter of degree rather than type, and women on oral contraceptives differed from nonusers with regard to reporting less interference premenstrually with sexual behavior and feelings and less difficulty with eating behavior and water retention.