Macronutrient intake, eating habits, and exercise as moderators of menstrual distress in healthy women

Effects of a Healthy Diet on Reducing Symptoms of Premenstrual Syndrome and Improving Quality of Life among Omani Adolescents: A Randomized Controlled Open-Label Trial

Premenstrual syndrome (PMS) continues to impact the health outcomes and emotional well-being of reproductive-age women, globally. Several studies have provided conflicting evidence concerning the role of dietary approaches in improving PMS symptoms. Accordingly, this study aimed to evaluate the possible influence of a healthy diet and motivational strategies on PMS symptoms and health-related quality of life among Omani adolescents. This open-label, randomized, prospective controlled trial was conducted at two randomly selected secondary schools, in Al Seeb Willayah, in Muscat region. Adolescents with PMS symptoms, who were in grade 10 or 11, aged 16 years or above, had regular menstrual cycles, and were not known to have psychiatric disorder were included in this study. Participants in the intervention group received an individual face-to-face dietary consultation and motivational phone consultation. The health outcomes, including the PMS symptoms in both groups, and quality of life, were recorded using the Daily Record of Severity of Problems questionnaire (DRSP) and the 14-item Self-Reporting-Based Perceived Stress Scale tools, respectively. The primary outcome was the difference in the mean premenstrual symptom scores between the two groups. Secondary outcomes included the quality of life and stress levels of participants. The study period was from 1 February and ended 30 June 2021. SPSS was used to analyze the data, and intention-to-treat analysis was utilized. A total of 72 adolescents with PMS were randomized into intervention and control groups (n = 36 each). Both groups were similar at baseline (p-value > 0.05). No significant association was found between a healthy diet and PMS symptoms (p-value > 0.05). In addition, no significant association was found between a healthy diet and quality of life at follow-up (p-value = 0.216). The outcomes of this study refuted any possible relationships between a healthy diet and PMS symptoms. Accordingly, dietary consultations may not facilitate the clinical management of PMS symptoms in adolescent females.

Association between Dietary Habits and Severity of Symptoms in Premenstrual Syndrome

BACKGROUND

Premenstrual syndrome (PMS) is a set of physical, psychological, and emotional symptoms that occur during the luteal phase of the menstrual cycle. The etiopathogenesis of this condition is not fully understood, and several studies suggest a possible role of environmental factors, such as diet. The aim of this work was to investigate the relationship between dietary habits and the occurrence and severity of PMS.

METHODS AND RESULTS

Forty-seven women were enrolled in the study. Participants were asked to complete the Daily Record of Severity of Problems (DRSP) to diagnose PMS and to complete a three-day food record during the perimenstrual phase. Thirty women completed the study (16 with PMS and 14 controls). An analysis of the food diaries revealed no differences between the women with PMS and the control subjects in terms of total energy intake (1649 vs. 1570 kcal/day), diet composition, and the consumption of macro- or micronutrients, except for copper, whose consumption was higher in women with PMS than in the control subjects (1.27 ± 0.51 vs. 0.94 ± 0.49 mg/d, p < 0.05).

CONCLUSIONS

The data presented here are very preliminary, and only a significant difference in copper intake was found when comparing women with PMS and controls. Larger studies are needed to better define how diet may contribute to the exacerbation of the psychological and somatic symptoms associated with PMS and whether PMS itself may influence macro- or micronutrient intake by changing dietary habits.

How Lifestyle Changes during the COVID-19 Global Pandemic Affected the Pattern and Symptoms of the Menstrual Cycle

This research investigated the implications that the COVID-19 pandemic had on the menstrual cycle and any contributing factors to these changes. A questionnaire was completed by 559 eumenorrheic participants, capturing detail on menstrual cycle symptoms and characteristics prior to and during the COVID-19 pandemic lockdown period. Over half of all participants reported to have experienced lack of motivation (61.5%), focus (54.7%) and concentration (57.8%). 52.8% of participants reported an increase in cycle length. Specifically, there was an increase in the median cycle length reported of 5 days (minimum 2 days, maximum 32 days), with a median decrease of 3 days (minimum 2 days and maximum 17 days). A lack of focus was significantly associated with a change in menstrual cycle length (p = 0.038) reported to have increased by 61% of participants. Changes to eating patterns of white meat (increase p = 0.035, decrease p = 0.003) and processed meat (increase p = 0.002 and decrease p = 0.001) were significantly associated with a change in menstrual cycle length. It is important that females and practitioners become aware of implications of environmental stressors and the possible long-term effects on fertility. Future research should continue to investigate any long-lasting changes in symptoms, as well as providing education and support for females undergoing any life stressors that may implicate their menstrual cycle and/or symptoms.

Effects of Social Distancing During the COVID-19 Pandemic on Anxiety and Eating Behavior-A Longitudinal Study

As social animals, humans need to live in groups. This contact with conspecifics is essential for their evolution and survival. Among the recommendations to reduce transmission of the new coronavirus (SARS-CoV-2) responsible for COVID-19 are social distancing and home confinement. These measures may negatively affect the social life and, consequently, the emotional state and eating behavior of individuals. We assessed the impact of the COVID-19 pandemic on the anxiety, premenstrual symptoms, and eating behavior of young women. Data collection was conducted in person (prepandemic—from March to December 2019) and online (during the pandemic—August 2020). A total of 71 participants, average age of 21.26 years (SD = 0.41), took part in the study. Trait anxiety during the pandemic was significantly lower than in the prepandemic period. Investigation of the “anxiety/stress” symptom of the Premenstrual Symptoms Screening Tool (PSST) revealed that this symptom was more severe before the pandemic. There was a decline in the desire for sweet and fatty foods during the pandemic. However, craving for traditional foods rose significantly in the same period. Uncontrolled and emotional eating were significantly lower during the pandemic. The results suggest that the pandemic may have had a positive impact on anxiety and eating behavior of the participants, which may be due to differences between urban and rural populations and the latter living with their families. These findings are important for raising a discussion regarding the effects of the current environment on the regulation of cognitive and dietary adaptations.

The effect of diet and aerobic exercise on Premenstrual Syndrome: Randomized controlled trial

ABSTRACT Objective This study was conducted to determine the effectiveness of aerobic exercise and diet in female students with Premenstrual Syndrome Scale who were studying at the public university. Methods This randomized controlled trial was conducted in a public university in 2018. The population of the study was composed of all female first graders (N=426). The female students were followed-up for two cycles, premenstrual syndrome scale was administered to the students and premenstrual syndrome was found in 43.8% (n=187). However, 106 female students were included in the study divided in three groups (diet, aerobic exercise, control). The diet and aerobic exercise were administered during the three months. Results There was no significant difference in premenstrual syndrome scale mean scores between the post-intervention groups. However, the mean premenstrual syndrome score of the diet and aerobic exercise groups decreased significantly after the intervention. There was a significant difference in visual analogue scale score between the groups after intervention. Besides the students in exercise and diet groups experienced less dysmenorrhea intensity than the control group. Conclusion It was found that diet and aerobic exercise were effective in reducing the symptoms of premenstrual syndrome and dysmenorrhea intensity in female students with premenstrual syndrome.

Carbohydrate and fiber intake and the risk of premenstrual syndrome

BACKGROUND/OBJECTIVES

Women with premenstrual syndrome (PMS) are encouraged to reduce sugar and increase fiber intake to reduce symptoms. However, research supporting these recommendations is limited, and their role in PMS development is unclear. This study examines the relation between carbohydrate and fiber intake and the risk of PMS nested within the prospective Nurses' Health Study II cohort.

SUBJECTS/METHODS

Carbohydrate and fiber intake were assessed at baseline and three additional times during follow up by food frequency questionnaire. Incident cases of PMS were identified by self-reported PMS diagnosis during 14 years of follow up and validated by supplemental questionnaire (n = 1234). Women were classified as controls if they did not report PMS diagnosis during follow up and confirmed minimal or no premenstrual symptoms (n = 2426). We estimated relative risks (RR) and 95% confidence intervals (CI) using multivariable logistic regression.

RESULTS

Total carbohydrate intake 2-4 years before reference year was not associated with PMS development (RR quintile 5 versus 1 = 0.99; 95% CI = 0.74-1.33). Intakes of specific carbohydrates or fibers were not associated with PMS development, except maltose. Adjusting for body mass index, smoking, and other factors, women with the highest maltose intake (median = 3.0 g/day) had a RR of 1.45 (95% CI = 1.11-1.88) compared to those with the lowest intake (median = 1.2 g/day).

CONCLUSIONS

Overall, carbohydrate and fiber consumption was not associated with risk of PMS. As this is the first study to suggest that maltose may be associated with PMS development, further replication is needed.

An acute bout of cycling does not induce compensatory responses in pre-menopausal women not using hormonal contraceptives

There is a clear need to improve understanding of the effects of physical activity and exercise on appetite control. Therefore, the acute and short-term effects (three days) of a single bout of cycling on energy intake and energy expenditure were examined in women not using hormonal contraceptives. Sixteen active (n = 8) and inactive (n = 8) healthy pre-menopausal women completed a randomised crossover design study with two conditions (exercise and control). The exercise day involved cycling for 1 h (50% of maximum oxygen uptake) and resting for 2 h, whilst the control day comprised 3 h of rest. On each experimental day participants arrived at the laboratory fasted, consumed a standardised breakfast and an ad libitum pasta lunch. Food diaries and combined heart rate-accelerometer monitors were used to assess free-living food intake and energy expenditure, respectively, over the subsequent three days. There were no main effects or condition (exercise vs control) by group (active vs inactive) interaction for absolute energy intake (P > 0.05) at the ad libitum laboratory lunch meal, but there was a condition effect for relative energy intake (P = 0.004, η_p² = 0.46) that was lower in the exercise condition (1417 ± 926 kJ vs. 2120 ± 923 kJ). Furthermore, post-breakfast satiety was higher in the active than in the inactive group (P = 0.005, η_p² = 0.44). There were no main effects or interactions (P > 0.05) for mean daily energy intake, but both active and inactive groups consumed less energy from protein (14 ± 3% vs. 16 ± 4%, P = 0.016, η_p² = 0.37) and more from carbohydrate (53 ± 5% vs. 49 ± 7%, P = 0.031, η_p² = 0.31) following the exercise condition. This study suggests that an acute bout of cycling does not induce compensatory responses in active and inactive women not using hormonal contraceptives, while the stronger satiety response to the standardised breakfast meal in active individuals adds to the growing literature that physical activity helps improve the sensitivity of short-term appetite control.

Recreational Physical Activity and Premenstrual Syndrome in Young Adult Women: A Cross-Sectional Study

Introduction

It is estimated that up to 75% of premenopausal women experience at least one premenstrual symptom and 8–20% meet clinical criteria for premenstrual syndrome. Premenstrual syndrome substantially reduces quality of life for many women of reproductive age, with pharmaceutical treatments having limited efficacy and substantial side effects. Physical activity has been recommended as a method of reducing menstrual symptom severity. However, this recommendation is based on relatively little evidence, and the relationship between physical activity, premenstrual symptoms, and premenstrual syndrome remains unclear.

Methods

We evaluated the relationship between physical activity and premenstrual syndrome and premenstrual symptoms among 414 women aged 18–31. Usual premenstrual symptom experience was assessed with a modified version of the Calendar of Premenstrual Experiences. Total, physical, and affective premenstrual symptom scores were calculated for all participants. Eighty women met criteria for moderate-to-severe premenstrual syndrome, while 89 met control criteria. Physical activity, along with dietary and lifestyle factors, was assessed by self-report.

Results

Physical activity was not significantly associated with total, affective, or physical premenstrual symptom score. Compared to the women with the lowest activity, women in tertiles 2 and 3 of activity, classified as metabolic equivalent task hours, had prevalence odds ratios for premenstrual syndrome of 1.5 (95% CI: 0.6–3.7) and 0.9 (95% CI: 0.4–2.4), respectively (p-value for trend = 0.85).

Conclusions

We found no association between physical activity and either premenstrual symptom scores or the prevalence of premenstrual syndrome.

Life Style Factors Associated with Premenstrual Syndrome among El-Minia University Students, Egypt

Aim. To determine the score and frequency of premenstrual syndrome (PMS) among female college students and to detect the possible risk factors of PMS. A trial of life style modification regarding prevention and control of PMS symptoms was carried out using counseling. Materials and Methods. A cross-sectional study was conducted on 253 El-Minia University unmarried female students. A self-administered questionnaire inquiring about symptoms of PMS in the previous three months and risk factors possibly related to it was used. PMS score was calculated. Multiple regression analysis was performed to determine which of several biopsychosocial and dietary factors influenced PMS. Life style modification counseling was done to prevent and control PMS. Results. The study revealed that 80.2% of the participants experienced various degrees of PMS symptoms which were significantly associated with a family history of PMS, physical inactivity, habitual excess consumption of coffee, BMI, frequent consumption of fast food, and smoking, but these factors explained only 52% of the variability in the logistic regression model. Conclusion. We recommend the introduction of a reproductive health component into school and college health education programs and encourage female adolescents and young adults to adopt a healthy behavior.

Menstrual cycle-related exacerbation of disease

Exacerbation of common medical and mental health disorders at specific phases of the menstrual cycle is a prevalent phenomenon. Although the precise cause is unclear, studies implicate complex interactions between the immune and neuroendocrine systems. The menstrual cycle also is a trigger for the onset of depressive disorders, including premenstrual dysphoric disorder, a disorder specific to the luteal phase of the menstrual cycle, and depression associated with the transition to menopause. This article discusses common mental health problems exacerbated by the menstrual cycle, with a particular focus on premenstrual dysphoric disorder and perimenopausal depression. Throughout the reproductive lifespan, routine screening and assessment for the presence of common psychiatric disorders are critical for accurate diagnosis and provision of effective treatment. Management options include referral or consultation with a primary care provider or psychiatrist; treatment options for premenstrual dysphoric disorder and perimenopausal depression include pharmacotherapy with antidepressant agents and/or psychotherapy. Hormones may be helpful.

Bulimia from a gynecological view: hormonal changes

Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.

Symptoms related to the menstrual cycle: diagnosis, prevalence, and treatment

Menstrual cycle-related symptoms are associated with the intrinsic hormonal fluctuations of the menstrual cycle. These symptoms can be physical, behavioral, or emotional and include problems such as dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). Because of the emotional and behavioral aspects of menstrual cycle-related symptoms, it is likely that clinical psychiatrists will encounter these symptoms in their daily practice and should therefore be familiar with their diagnosis, prevalence, etiology, and treatment. As many as 2.5 million women are affected by menstrual disorders each year, which can have a profound impact on their quality of life. Although a definitive etiology has yet to be established, fluctuations in estrogen and progesterone as well as genetic factors are thought to contribute to the occurrence of menstrual disorders. Current treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) (for dysmenorrhea), lifestyle changes, selective serotonin reuptake inhibitors (SSRIs), and ovulation suppression (e.g., with oral contraceptives). Treatment with oral contraceptives (OCs), particularly extended or continuous use, may significantly reduce the incidence of menstrual cycle-related symptoms.

Impact of the menstrual cycle on determinants of energy balance: a putative role in weight loss attempts

Women's weight and body composition is significantly influenced by the female sex-steroid hormones. Levels of these hormones fluctuate in a defined manner throughout the menstrual cycle and interact to modulate energy homeostasis. This paper reviews the scientific literature on the relationship between hormonal changes across the menstrual cycle and components of energy balance, with the aim of clarifying whether this influences weight loss in women. In the luteal phase of the menstrual cycle it appears that women's energy intake and energy expenditure are increased and they experience more frequent cravings for foods, particularly those high in carbohydrate and fat, than during the follicular phase. This suggests that the potential of the underlying physiology related to each phase of the menstrual cycle may be worth considering as an element in strategies to optimize weight loss. Studies are needed to assess the weight loss outcome of tailoring dietary recommendations and the degree of energy restriction to each menstrual phase throughout a weight management program, taking these preliminary findings into account.

Changes in nutrient intake during the menstrual cycle of overweight women with premenstrual syndrome

This study presents the nutrient data collected from women who were being screened for premenstrual syndrome (PMS) for entry into an intervention study. Screening was by the Steiner self-rated questionnaire. One hundred and forty-four overweight women completed the screening process and eighty-eight met the criteria for PMS. All women kept 4 d diet diaries pre- and postmenstrually over two menstrual cycles. The mean energy and macronutrient intakes were compared between the pre- and postmenstrual phases. Energy and macronutrient intake was also calculated according to food categories. Goldberg's cut-off limit for the ratio of energy intake to estimated basal metabolic rate was used to exclude data that was incompatible with predicted energy requirements. The diet diaries were also used to determine the mean number of meals or snacks eaten pre- and postmenstrually. Nutrient analysis of the diet diaries of the women with PMS showed a significant increase (P<0.001) in total energy and all macronutrients premenstrually when compared to nutrient intake postmenstrually. Women who did not meet the criteria for PMS showed a significant increase in energy and fat intake (P<0.05) but not in the other macronutrients. When adjusted for energy, data collected from women with PMS showed a premenstrual significant increase in fat, carbohydrate (P<0.05) and simple sugars (P<0.001). There was a significant decrease (P<0.001) in protein premenstrually. Women not meeting the PMS criteria showed no significant difference between pre- and postmenstrual intakes when adjusted for energy. Analysis according to food categories in women with PMS showed a significantly greater intake premenstrually of energy and all macronutrients for cereals, cakes and desserts and high-sugar foods (P<0.001). In women with PMS there was a significantly greater number of ‘episodes of eating’ premenstrually (P<0.001). This study provides further evidence, to support the very limited number of earlier studies, that there is a group of women with PMS who increase their nutrient intake during the premenstrual phase. This could potentially be a contributing factor for some women experiencing difficulties adhering to suggested dietary modification and should be considered when counselling premenopausal women.

Obesity as a risk factor for premenstrual syndrome

PURPOSE

To determine the association between obesity and Premenstrual Syndrome (PMS).

METHODS

A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18-44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index.

RESULTS

The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI > or = 30) had nearly a three-fold increased risk for PMS than non-obese women OR = 2.8 (95% CI = 1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers.

CONCLUSION

This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.

Related Factors and Consequences of Menstrual Distress in Adolescent Girls with Dysmenorrhea

This study investigated symptoms, related factors, and consequences of menstrual distress in adolescent girls with dysmenorrhea. A total of 198 participants were recruited by convenience sampling from a technical college in Tainan County, Taiwan. Four instruments were used to collect data: a Demographic Data Questionnaire, a Menstrual Distress Questionnaire, the Short Form McGill Pain Questionnaire, and an Adolescent Menstrual Attitude Questionnaire. The top five symptoms of menstrual distress were cramps, fatigue, backache, swollen abdomen, and tender breasts. Results of stepwise multiple regression indicated that the best subsets for predicting adolescent menstrual distress, including age, mother's occupation, menstrual pain, and menstrual attitude, accounted for 59% of total variance. From the correlation analysis, the more severe the menstrual distress, the higher the impact on daily activities as well as the more frequent the absence from class and analgesic usage. The results of this study may provide a useful reference for school nurses designing menstrual health programs for adolescents.

Prevalence and predictors of premenstrual syndrome among college-aged women in Saudi Arabia

BACKGROUND

Research on risk factors for premenstrual syndrome (PMS) is lacking for the Gulf countries of the Middle East, a region with unique cultural features that might influence expectations and self-perception of the disease. We examined the association of PMS frequency with possible risk factors for the disease.

METHODS

Using a self-report questionnaire, we surveyed all eligible young women (n=464) enrolled in the medical, nursing and medical technology/respiratory therapy educational programs at a university in Dammam. Women were asked about the frequency of symptoms during the previous six months. A stepwise multiple regression analysis was performed to determine which of several biopsychosocial and dietary factors influenced the premenstrual symptom score.

RESULTS

At least one premenstrual symptom was experienced by 448 women (96.6%), and 176 (37.5%) had a high symptom severity score. Premenstrual symptom frequency was significantly associated with a maternal history of premenstrual syndrome, self-perception of mental stress, physical activity, consumption of sweet-tasting foods, and coffee, but these factors only explained 14% of the variability in the multiple regression model.

CONCLUSIONS

We recommend that women vulnerable to mental stress take advantage of relaxation techniques and psychotropic therapies. Moreover, women with PMS might eliminate sweet-tasting food and caffeine-containing beverages, particularly coffee, from their diet.

Treatment of premenstrual dysphoria with selective serotonin re-uptake inhibitors: focus on safety

Many women experience physical or mood symptoms associated with the menstrual cycle. For approximately 3 - 8% of women, the symptoms are severe enough to significantly affect social, domestic and occupational functioning. This cluster of primarily emotional and behavioural symptoms is now labelled premenstrual dysphoric disorder (PMDD). Women who meet criteria for PMDD do not usually respond to conservative interventions; selective serotonin re-uptake inhibitors (SSRIs) taken either daily or intermittently are considered to be an effective first-line therapy for this population. In this paper, the authors report on the efficacy and tolerability of SSRIs that are currently recognised as the treatment of choice for PMDD.

Current management of premenstrual syndrome and premenstrual dysphoric disorder

About 5% of women of reproductive age experience affective or physical premenstrual symptoms that markedly influence work, social activities, or relationships. Prospective charting of symptoms for at least two menstrual cycles is required to facilitate an accurate diagnosis of premenstrual syndrome or premenstrual dysphoric disorder. The optimal treatment plan begins with lifestyle modifications, followed by pharmacotherapy. Evidence from numerous controlled trials has clearly demonstrated that low-dose serotonin reuptake inhibitors, using intermittent or continuous administration, have excellent efficacy with minimal side effects. Modification of the menstrual cycle should be considered only after all other treatment options have failed.

Cyclical mastalgia: prevalence and associated health and behavioral factors

Perimenstrual breast pain (cyclical mastalgia) is a common problem that can be sufficiently severe to interfere with usual activities, and has been associated with elevated mammography usage in young women. This study was undertaken to replicate clinic-based research on cyclical mastalgia, and to examine the association between this disorder and health-related behaviors and perceived stress. Using random digit dialing throughout Virginia, 874 women aged 18-44 were interviewed. Sixty-eight per cent of women experienced cyclical breast symptoms; 22% experienced moderate to extreme discomfort (classified as cyclical mastalgia). Hormonal contraceptive usage was associated with significantly less mastalgia and premenstrual syndrome (PMS). Smoking, caffeine consumption and perceived stress were associated with mastalgia (odds ratios = 1.52, 1.53 and 1.7, respectively). Young women (under 35 years) with mastalgia were more likely to have had a mammogram (20.2%) than those without mastalgia (9.9%). Most women with this disorder (77.5%) did not have PMS. The prevalence of cyclical mastalgia and its association with mammography replicate clinic-based findings. Associations with smoking and stress had not previously been reported. Prospective research is needed to determine the biopsychosocial factors contributing to this disorder.

Menstrual cycle, contraception, and performance

Although understanding of the unique physiology of the female athlete has increased, there are still many questions to be answered. Endogenous and exogenous female sex steroids have been shown to influence various cardiovascular, respiratory, and metabolic parameters, but these changes probably have minimal impact on the ability of most recreational athletes to participate in and enjoy their sport. Statistically significant data may or may not have clinical or performance relevance. By the same token, a statistically nonsignificant change may mean the difference between first and second place to an elite athlete. For an athlete concerned about maximizing performance, individual variability in menstrual cycle changes to various performance parameters must be considered. It is difficult to predict how accurately controlled laboratory findings from a study population apply to an individual competitor on the playing field. Athletes taking OCs for contraception or for menstrual cycle control may be able to minimize any potential side effects and performance influences by taking the lower dose triphasic pills and the newer progestins. For women with menstrual dysfunction, OCs may provide a predictable hormonal milieu for training and competition. Further scientific study is needed using large-scale, prospective, randomized clinical trials on trained athletes and accurate hormonal measurements to determine the phase of the menstrual cycle to determine short- and long-term effects of cycle phase and OCs in exercising women. As more questions continue to be answered, physicians and sport scientists will be better able to guide women not only to maximize their performance but to ensure lifelong good health.

The association of behavior and lifestyle factors with menstrual symptoms

The present study examines the association of obesity, cigarette smoking, alcohol consumption, and exercise with the prevalence of menstrual cycle disorders among 2912 women aboard U.S. Navy ships. Self-administered surveys obtained information on weight, height, cigarette smoking, alcohol consumption, and exercise. Participants also indicated whether they experienced cramps or pain during their period requiring medication or time off work, bleeding between periods, excessive frequency of periods, heavy periods, periods lasting for longer than a week, scanty menstrual flow, and irregular periods during the past 90 days. Women ranged in age from 18 to 49 years, with an average of 26 years. After adjustment for age, race, and pay grade, current cigarette smoking was associated with increased risk of all menstrual symptoms and cycle disorders. As compared with nonsmokers, current smokers were at increased risk of cramps or pain requiring medication or time off work (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.03, 1.25), bleeding between periods (OR = 1.22, CI = 1.09, 1.38), excessive frequency of periods (OR = 1.33, CI = 1.17, 1.51), heavy periods (OR = 1.17, CI = 1.06, 1.29), periods lasting longer than a week (OR = 1.31, CI = 1.16, 1.48), scanty flow (OR = 1.13, CI = 1.01, 1.29), and irregular periods (OR = 1.14, CI = 1.05, 1.24). Obesity, exercise, and alcohol consumption did not show consistent associations with menstrual symptoms or cycle disorders. Logistic regression models that included age, race, pay grade, and all behavioral and lifestyle variables indicated only cigarette smoking was associated with an increased risk of bleeding between periods (OR = 1.33, CI = 1.05, 1.68), excessive frequency of periods (OR = 1.38, CI = 1.21, 1.58), periods lasting longer than a week (OR = 1.45, CI = 1.13, 1.84), and irregular periods (OR = 1.25, CI = 1.05, 1.47). Although the lifestyle factors are all potentially modifiable, results suggest that only interventions targeted at smoking cessation might be useful in reducing the prevalence of menstrual symptoms, cycle disorders, and time lost from work.

Premenstrual syndrome

The advances in the careful screening and diagnosis of women with PMS has led to the ability to conduct epidemiologic, etiologic, and treatment studies in well-defined samples of women. Prospective symptom charting, scoring methods, and careful clinical psychiatric and medical evaluation are necessary to rule out concurrent psychiatric and medical disorders. Studies of women with PMDD have suggested several promising pharmacologic treatment options. Whether these treatment options are also successful for women with milder premenstrual symptoms, with premenstrual exacerbation of underlying conditions, or with premenstrual symptoms superimposed on underlying psychiatric and medical conditions remains to be studied. Treatment of premenstrual symptoms by pharmacologic or nonpharmacologic methods may be unsuccessful if the underlying psychiatric or medical condition is not addressed first.

Effects of exercise participation on menstrual pain and symptoms

Using prospective daily reporting, this study examined the relationship between exercise participation and menstrual pain, physical symptoms, and negative mood. Twenty-one sedentary women and 20 women who participated in regular exercise completed a modified version of the Prospective Record of the Impact and Severity of Menstrual Symptoms (PRISM) calendar for two complete menstrual cycles. Analyses revealed that pain was greater in all women during menses compared to the follicular and luteal phases. Moreover, exercise status was found to interact with menstrual cycle phase in predicting pain. Specifically, exercise participants reported less pain than sedentary women during menses, though there were no differences between the two groups during the follicular and luteal phases. Exercise status was also associated with greater reports of anxiety during menses. Otherwise, exercise status was not observed to influence reports of symptoms or negative mood throughout the menstrual cycle. These results suggest that participation in even moderate amounts of exercise affects the experience of menstrual pain in women.

Women, food, and mood

Associations between food intake and mood greatly interest both lay and scientific audiences, although scientific support for many observed associations is sparse. Of particular interest are issues surrounding food intake, food cravings, and mood in women throughout the menstrual cycle. Further research is necessary to support or disprove current hypotheses about the relationship between food intake and mood. Meanwhile, health professionals should be prepared to inform the public about the complexity of factors that influence the relationship between food intake and mood.