Menstrual disorders and occupational, stress, and racial factors among military personnel

Bloody stressed! A systematic review of the associations between adulthood psychological stress and menstrual cycle irregularity

Regular menstruation is a key indicator of general health and irregular menstrual parameters have been associated with elevated risk of adverse health outcomes. While psychological stress is believed to contribute to abnormal menstruation, little is known of the effects of discrete psychological stressors, including the COVID-19 pandemic, on menstrual function. A systematic database search was performed and studies investigating the relation between psychological stress and menstrual cycle irregularity in otherwise healthy adults were included. Two independent investigators completed abstract and full-text screening, data extraction, and risk of bias assessment. In the 41 included studies, a variety of stressors were assessed, namely COVID-19 pandemic stress, academic stress, and occupational stress. Our review found most studies report an association between psychological stress and menstrual dysfunction, with the most common disruptions being irregular menstruation and abnormal menstrual flow. Our findings also underlined notable discrepancies in the operational definitions used in the study of menstrual disorders. These observations emphasize the importance of psychological stress as a modifiable risk factor associated with irregular menstruation.

Social Determinants of Health and Dysmenorrhea: A Systematic Review

Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress).

The cross-cultural adaptation and psychometric properties of the menstrual symptom questionnaire (MSQ) among Chinese women of reproductive age

Objective

This study reports on a translation of the Menstrual Symptom Questionnaire (MSQ) into Chinese, a cross-cultural adaptation among Chinese women of reproductive age, and an assessment of its reliability and validity.

Methods

Previously published translation guidelines were followed to translate and cross-culturally adapt the English version of MSQ to produce a Chinese version. This Chinese version was then administered to 2800 Chinese women of reproductive age recruited by convenience sampling method. The reliability of the Chinese MSQ was tested for internal consistency and test-retest reliability. The concurrent and construct validity of the questionnaire was evaluated using correlation and factor analysis.

Results

The Chinese version of the MSQ showed no linguistic or semantic issues. The internal consistency of the Chinese MSQ Cronbach'α = 0.912, and the test-retest reliability r = 0.911. The exploratory factor analysis identified four factors. The confirmatory factor analysis demonstrated that the four factor structure of the Chinese version of the MSQ (Pain Experience, Emotional Changes, Pain Coping Strategies, and Other Physical Symptoms) is reasonable among Chinese women of reproductive age. There was a significant correlation found between these four factors and both the Pittsburgh Sleep Quality Index and the SF-8 Health Survey.

Conclusion

The Chinese version of the MSQ achieved semantic equivalence in translation and demonstrated good reliability and validity among Chinese women of reproductive age. Thus, it can serve as an effective tool to assess the experience of menstrual symptoms among Chinese women.

A Case-Control Study on Factors Associated With Secondary Amenorrhea Among the Medical Students of Universiti Malaysia Sabah

BACKGROUND AND AIM

This study aimed to evaluate the association between body mass index (BMI), anxiety, stress, depression, hormones, and secondary amenorrhea among female medical students at Universiti Malaysia Sabah (UMS).

METHODS

In this case-control study, UMS undergraduate female medical students aged 19-25 years who did not menstruate in the last three months (with a previous history of a regular menstrual cycle) or six months (with a history of irregular menstruation) were included as cases (40 students), and students with similar criteria but no menstrual irregularities were recruited in the study as controls (40 students). The study was conducted at Polyclinic UMS from January 1, 2021, until December 31, 2022. The chi-squared test and odd ratio examined the association of the above-mentioned factors with the secondary amenorrhea. A p-value less than 0.05 was considered significant, and an odds ratio if the confidence interval did not contain one was considered significant.

RESULT

Both the groups had a similar frequency of different BMI grades. The cases exhibited significantly higher levels of depression, anxiety, and stress than the controls. Again, the cases demonstrated higher estradiol (E2), testosterone, and thyroid-stimulating hormone (TSH) levels and lower levels of luteinizing hormone (LH) than those with regular menstruation. The research also revealed that a one-unit decrease in follicle-stimulating hormone (FSH) levels corresponds to a threefold increase in the risk of experiencing secondary amenorrhea, while the risk escalates to fourfold for LH. Moreover, E2, testosterone, and TSH levels exhibited protective effects on secondary amenorrhea.

CONCLUSION

Anxiety, serum LH, and FSH were significantly associated with secondary amenorrhea. Future studies should address the diurnal variation of the hormones and consider the participants' circumstances to get a proper effect of hormonal influence and stress.

Association between COVID-19 vaccines and the menstrual cycle in young Japanese women

INTRODUCTION

Although several studies have investigated the association between coronavirus disease 2019 (COVID-19) vaccines and the menstrual cycle, available data are limited. Therefore, this study investigated the effect of COVID-19 vaccines on the menstrual cycle and the effect of the menstrual cycle phase on the vaccine side effects during vaccine administration in Japan.

METHODS

A self-administered questionnaire was used to collect data on the date of vaccination; type of vaccine; type, grade, and duration of the side effects; regularity of menstruation; normal length of the menstrual cycle; and the day one date of menstruation around vaccination. The survey was conducted from October 2021 to March 2022.

RESULTS

The difference between the predicted and actual menstrual cycle length was 1.9 ± 3.0, 1.6 ± 2.8 (p = 0.557), and 2.5 ± 3.8 (p = 0.219) days before vaccination and after the first and second dose of the vaccine, respectively. In participants who received vaccinations twice within a single menstrual cycle, this difference was 1.3 ± 3.5 and 3.9 ± 3.3 (p = 0.045) days before and after vaccination, respectively. The grade and proportion of the side effects after the second dose of the vaccine was highest during the menstrual period and lowest during the ovulation period, with a significant effect on headache and chills.

CONCLUSION

COVID-19 vaccines tended to prolong the menstrual cycle. The side effects of the COVID-19 vaccine tended to be at a maximum when vaccination occurred during the menstrual period and minimal during the ovulation period.

Gynecologic problems and healthcare behavior by shift patterns in Korean nursing staff

We aimed to evaluate the clinical impact of shift patterns at work on gynecologic problems and the healthcare behavior of Korean nursing staff. We conducted a web-based survey for over two weeks in September 2021, involving female nursing staff, including nurses, nurses' aides, and nursing assistants, working in five medical centers. The questionnaire included 40 questions on baseline characteristics, working information, and experiences with gynecologic problems and medical approaches. Overall, 885 nursing staffs participated in the survey, of the 1,904 who received the invitation with an online link of the survey. The response rate was 46.5%. Among the participants responding to all questions, 569 (64.4%) worked two or three shifts and 305 (34.5%) worked full-time. In women rotating two or three-shift patterns, irregular menstrual cycles (21.6% vs. 13.8%, p = 0.005), abnormal menstrual cycles (40.9% vs. 33.8%, p = 0.038), and dysmenorrhea (48.0% vs. 38.4%, p = 0.006) were more frequent than in those who worked full-time. The experience of visiting gynecologic clinics (47.5% vs. 44.1%, p = 0.332) and treating gynecologic conditions (33.4% vs. 29.3%, p = 0.211) did not differ according to the working patterns. However, diagnosis of gynecologic diseases was more frequent in women working full-time (36.4% vs. 29.7%, p = 0.043). The rates of screening (76.1% vs. 57.8%, p<0.001) and human papillomavirus vaccination (55.7% vs. 39.9%, p<0.001) for cervical cancer prevention were higher in women working full-time than in two-three shifts. This study showed that rotating shift work may be related to an increase in gynecologic problems and a decrease in cancer prevention activity among female nursing staff.

Menstrual disturbances in British Servicewomen: A cross-sectional observational study of prevalence and risk factors

Female athletes are at increased risk of menstrual disturbances. The prevalence of menstrual disturbances in British Servicewomen and the associated risk factors is unknown. All women under 45 years in the UK Armed Forces were invited to complete a survey about demographics, menstrual function, eating and exercise behaviors, and psychological well-being. 3,022 women participated; 18% had oligomenorrhoea or amenorrhoea in the last 12 months, 25% had a history of amenorrhoea, and 14% had delayed menarche. Women who sleep ≥ 8 h were at a lower risk of a history of amenorrhoea than women who sleep ≤ 5 h [odds ratio (95% confidence intervals) = 0.65 (0.48, 0.89), p = 0.006]. Women who completed > 10 days of field exercise in the last 12 months were at higher risk of a history of amenorrhoea than women completing no field exercise [1.45 (1.13, 1.85), p = 0.004]. Women at high risk of an eating disorder (FAST score >94) were at higher risk of oligomenorrhoea or amenorrhoea [1.97 (1.26, 3.04), p = 0.002] and history of amenorrhoea [2.14 (1.63, 2.79), p < 0.001]. Women with symptoms of anxiety or depression were at higher risk of a history of amenorrhoea [1.46 (1.20, 1.77) and 1.48 (1.22, 1.79), p < 0.001]. British Servicewomen had a similar prevalence of menstrual disturbances to some endurance athletes. Eating disorders, sleep behaviors, and management of mental health, provide targets for protecting health of the reproductive axis.

Uterine bleeding: how understanding endometrial physiology underpins menstrual health

Menstruation is a physiological process that is typically uncomplicated. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. Menstruation (that is, endometrial shedding) is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. An imbalance in any one of these processes can lead to the abnormal endometrial phenotype of AUB. Poor menstrual health has a negative impact on a person's physical, mental, social, emotional and financial well-being. On a global scale, iron deficiency and iron deficiency anaemia are closely linked with AUB, and are often under-reported and under-recognized. The International Federation of Gynecology and Obstetrics have produced standardized terminology and a classification system for the causes of AUB. This standardization will facilitate future research endeavours, diagnosis and clinical management. In a field where no new medications have been developed for over 20 years, emerging technologies are paving the way for a deeper understanding of the biology of the endometrium in health and disease, as well as opening up novel diagnostic and management avenues.

Triangle of COVID, anxiety and menstrual cycle

This study aimed to examine whether the menstrual cycles of women with regular cycles have been affected by the COVID 19 pandemic. This cross-sectional online survey study evaluated the menstrual cycle characteristics of women in the reproductive phase of their lives during the COVID-19 pandemic in May 2020. Changes before and after COVID-19 were evaluated with a paired sample t-test and chi-square test. A Pearson correlation test was used to show the relationships between variables. The study was completed with 263 participants in total. The average age of the participants was 26.3 ± 6.9 (18-45). Participants' duration of period (p = .003) and pads used per day (p = .002) decreased compared to their experience before the COVID-19 outbreak. The mean total MSQ score was 3.1 ± 0.8 (0-4), mean STAI-1 score was 45.1 ± 9 (20-78) and mean STAI-II score was 43.3 ± 5.9 (30-69). It was found that STAI-I and STAI-II scores showed a positive correlation with MSQ-Somatic subgroup scores(r = 0.153, p = .013; 0.190, p = .002) and MSQ-Total scores (0.144, p = .020; 0.175, p = .004). With the COVID-19 pandemic, increased anxiety scores increased women's menstrual symptoms while the length of periods and the number of pads used decreased.Impact statementWhat is already known on this subject? The COVID 19 pandemic, has caused enormous psychological distress potentially resulting in the development of posttraumatic stress disorder. The menstrual cycle is a process that can be affected by psychological stress.What do the results of this study add? This is the first study to examine the relationship between stress caused by the COVID-19 pandemic and the menstrual cycle. The increases in the degree of anxiety and stress as a result of the COVID-19 outbreak was found to be high enough to affect the characteristics of the menstrual cycle in the women surveyed.What are the implications of these findings for clinical practice and/or further research? In a prospective study intended to be carried out after the outbreak ends in the future, it will be possible to evaluate whether the menstrual cycle parameters return to their former order and consequently this hypothesis will be able to be more definitively confirmed.

Prevalence and factors associated with dysmenorrhea in women at child bearing age in the Dschang Health District, West-Cameroon

Introduction

dysmenorrhea is a painful phenomenon at the pelvis region preceding or following menstruation. Dysmenorrhea accounts among the most frequent problem of women at child bearing age and affects 45% to 95% of them. According to the WHO, 16.8 to 81% of women are affected by dysmenorrhea. The present study was carried out at the Dschang Health District in order to determine the prevalence of dysmenorrhea and associated factors among women at child bearing age.

Methods

a transversal community-based study was carried out from March to June 2018. Information regarding socio-demographic features, prevalence, factors associated with the dysmenorrhea and the effect of dysmenorrhea on daily activities were collected using structured questionnaire and data were analyzed using Epi Info version 7.1.3.3 Software.

Results

a total of 637 women aged 12 to 50 years were interviewed in the present study. The mean body mass index was 25.94 with an average weight of 66.41 kilogram. Fifty six point twenty percent (56.20%) of participants had dysmenorrhea. From all risks factors fund only the normal body mass index (OR = 3.08, P-value = 0.01) having a significant association with the occurrence of dysmenorrhea. Daily activities were affected in 73.25% of participants dysmenorrheic and those who had some episodes of dysmenorrhea.

Conclusion

the present study showed that more than a half of respondents were dysmenorrheic and several factors were associated with this pathology. This study also suggests that dysmenorrhea have a negative impact on the daily activities of women at child bearing age.

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

BACKGROUND

Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses.

OBJECTIVE AND RATIONALE

The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery.

SEARCH METHODS

We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies.

OUTCOMES

Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation.

WIDER IMPLICATIONS

Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.

Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military

Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and RED-S, but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.

Association between irregular menstrual cycles and occupational characteristics among female workers in Korea

OBJECTIVE

To examine the association between irregular menstrual cycles and occupational characteristics among Korean female workers.

STUDY DESIGN

We analyzed data on paid female workers from the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010-2012).

MAIN OUTCOME MEASURES

We evaluated the possible associations between irregular menstrual cycles and work variables (occupational classification, working hours, and shift work) using univariate and multivariate logistic regression analyses. Weighted prevalence was calculated according to each work variable to approximate the Korean population.

RESULTS

Irregular menstrual cycles were the most common in women in the 'pink collar' group (16.61%). The frequency of irregular menstrual cycles was 2-fold higher in women working >60 h per week (25.64%) than in those working 20-60 h per week (11.09%). Irregular menstrual cycles were more prevalent in shift workers (15.85%) than in non-shift workers (11.06%). A significantly high risk of irregular menstrual cycles was found for pink-collar occupations (adjusted odds ratio [OR] = 1.687, 95% confidence interval [CI] = 1.044-2.710, reference: white-collar occupation group) and in women with long working hours (adjusted OR = 2.139, 95% CI = 1.243-3.559, reference: 20-60 working hours group) and shift work (adjusted OR = 1.487, 95% CI = 1.028-2.118, reference: fixed working schedule group).

CONCLUSIONS

Our study showed associations between irregular menstrual cycles and occupational characteristics of female workers. Long working hours, shift work, and pink-collar occupations are positively associated with irregular menstrual cycles. Therefore, working hours and shift schedules for female workers should be structured considering these factors. Further research is needed to determine the optimal working time and shift schedules for female workers.

Mental health and primary dysmenorrhea: a systematic review

Several factors including demographic, reproductive, lifestyle, psychological and social factors can affect incidence and severity of primary dysmenorrhea. This study aimed to systematically review the psychological risk factors associated with primary dysmenorrhea. Embase, ISI web of knowledge, ProQuest, Science Direct, Scopus and PubMed central were searched using keywords related to risk factors and primary dysmenorrhea. Observational studies, published in English after 2000, focusing solely on psychological factors affecting primary dysmenorrhea were included. The search process retrieved 11,928 potential related articles. Thirty three articles met inclusion criteria and were assessed for final synthesis. The STROBE checklist was used to quality assessment of studies. Results of study showed that few studies had investigated relationship between dysmenorrhea and most psychological disorders. Most studies have investigated the relationship between dysmenorrhea and depression, anxiety, stress, alcohol abuse and somatic disorders. So, further studies are needed to investigate relation between most psychological disorders with primary dysmenorrhea. Significant relationship between some mental health components such as depression, anxiety and stress with primary dysmenorrhea shows the importance of psychological assessment before the choice of therapeutic methods. Also, the feasibility of designing and evaluating the effectiveness of the use of psychotherapy interventions for the treatment of primary dysmenorrhea as alternative therapies can be considered.

Menstrual characteristics, disorders and associated risk factors among female international students in Zhejiang Province, China: a cross-sectional survey

Background

Until now, no previous study has addressed the menstrual patterns among female international students in China. In this present study, our objectives are to ascertain the menstrual characteristics and address the menstrual problems together with their associated risk factors among international students in China.

Methods

A cross-sectional survey was carried out with 500 previously piloted self-structured questionnaires which were administered to female international students enrolled in 15 universities in Zhejiang Province, China from May 2–August 31, 2016. Participants were required to provide answers to a semi-structured questionnaire which asked questions about their socio-demographics and their menstrual characteristics while in their home countries. Relevant changes in their menstrual pattern in terms of amount of flow and duration, regularity, length and suggestive symptoms for premenstrual syndrome in the months after coming to reside in China were also inquired. Respondents indicated changes in eating habits and selected stressors relevant to them from a given list. Their stress levels were assessed and further categorized with the help of the Perceived Stress Scale (PSS). Measurements for the main outcomes included the characteristics of menstrual patterns after arrival in China, stress levels, stressors and new lifestyle patterns.

Results

Four hundred and nine (81.8%) out of the 500 questionnaires met the criteria and constituted the population for this study. The respondents’ mean age was 21.405 years. Almost half of our respondents (49.1%) reported varying changes in their menstrual pattern after arrival to China. Although, menstrual regularity, normal menstrual length (21-35 days) and duration of flow (3–7 days) remained fairly normal among most of the respondents, disorders like premenstrual symptoms (PMS) (33.82%); abnormal amount (17.97%) and dysmenorrhea (16.38%) were prevalent. There was a significant association between high stress (PSS > 20) and menstrual change 0R = 1.636, 95% CI 1.051–2.547, p = 0.029) and dysmenorhea (p = 0.037). Common stressors included language barrier 81(25.88%), food 64(20.45%), and loneliness 56(17.89%).

Conclusion

Menstrual disorders are high among international students in China. We established premenstrual symptoms as the most common menstrual disorder. High levels of stress (PSS > 20) emanating from factors including the language barrier, diet and loneliness was significantly related to the disruptions in their menstruation.

Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences

Objectives:

To identify the prevalence of various menstrual problems in young females studying health sciences and to identify their association with academic stress.

Methods:

This was a cross-sectional study, conducted in the health colleges of Immam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia between February 2015 and February 2016. Seven hundred and thirty-eight female students aged 18-25 years anonymously completed menstrual problem identification and perceived stress scale questionnaire. The data was analyzed using the Statistical Package for Social Sciences version 16.0.

Results:

Ninety-one percent of the students were suffering from some kind of menstrual problem. The different menstrual problems reported, and their incidences included irregular menstruation (27%), abnormal vaginal bleeding (9.3%), amenorrhea (9.2%), menorrhagia (3.4%), dysmenorrhea (89.7%), and premenstrual symptoms (46.7%). High perceived stress (HPS) was identified in 39% of the students. A significant positive correlation was found between HPS and menstrual problems. Students with HPS had 4 times, 2 times, and 2.8 times increased odds ratio for experiencing amenorrhea, dysmenorrhea, and premenstrual syndrome (p<0.05).

Conclusion:

The most prevalent menstrual problems (dysmenorrhea and premenstrual symptoms) in the target population were strongly associated with stress. Therefore, it is recommended that health science students should be provided with early psychological and gynecological counselling to prevent future complications.

The effect of floods on anemia among reproductive age women in Afghanistan

This study uses biomarker information from the 2013 National Nutrition Survey Afghanistan and satellite precipitation driven modeling results from the Global Flood Monitoring System to analyze how floods affect the probability of anemia in Afghan women of reproductive age (15-49). In addition to establishing a causal relation between the two by exploiting the quasi-random variation of floods in different districts and periods, the analysis demonstrates that floods have a significant positive effect on the probability of anemia through two possible transmission mechanisms. The first is a significant effect on inflammation, probably related to water borne diseases carried by unsafe drinking water, and the second is a significant negative effect on retinol concentrations. Because the effect of floods on anemia remains significant even after we control for anemia's most common causes, we argue that the condition may also be affected by elevated levels of psychological stress.

A randomized controlled clinical trial evaluating quality of life when using a simple acupressure protocol in women with primary dysmenorrhea

OBJECTIVE

To evaluate a simple acupressure protocol in LIV3 and LI4 acupoints in women with primary dysmenorrhea.

METHODS

This paper reports a randomized, single blinded clinical trial. 90 young women with dysmenorrhea were recruited to three groups to receive 20min acupressure every day in either LIV3 or LI4, or placebo points. Acupressure was timed five days before menstruation for three successive menstrual cycles. On menstruation, each participant completed the Wong Baker faces pain scale, and the quality of life short form -12 (QOL SF-12).

RESULTS

Intensity and duration of pain between the three groups in the second and third cycles during the intervention (p<0.05) differed significantly. Significant differences were seen in all domains of QOL except for mental health (p=0.4), general health (p=0.7) and mental subscale component (p=0.12) in the second cycle, and mental health (p=0.9), and mental subscale component (p=0.14) in the third cycle.

CONCLUSION

Performing the simple acupressure protocol is an effective method to decrease the intensity and duration of dysmenorrhea, and improve the QOL. Registration ID in IRCT: IRCT2016052428038N1.

Comparison of the Effect of Stretching Exercises and Mefenamic Acid on the Reduction of Pain and Menstruation Characteristics in Primary Dysmenorrhea: A Randomized Clinical Trial

OBJECTIVES

Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea.

METHODS

In this randomized clinical trial, 122 female students with moderate to severe dysmenorrhea were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale.

RESULTS

The mean pain intensity was significantly higher in the exercise group only in the first cycle (p = 0.058). In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study (p = 0.056) and the first cycle (p = 0.007). There was no significant difference in the severity and duration of pain between the groups (p > 0.050).

CONCLUSIONS

Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time.

Influence of fixed orthodontic treatment on the menstrual cycle of adult females: A prospective longitudinal study

Objective: 

To investigate the influence of fixed orthodontic treatment on the menstrual cycle, including menstrual cycle length (MCL) and duration of menstrual bleeding (DMB), in adult female patients.

Materials and Methods: 

This was a prospective longitudinal study conducted in Chengdu, China. A total of 164 adult women with normal menstrual cycles were recruited in the study, with 79 patients undergoing orthodontic treatment and 85 serving as controls. Data of MCL, DMB, and accompanying symptoms were collected over six consecutive menstrual cycles in each participant. Student’s t test, Chi-square test, Moses extreme reaction test, and repeated measures analysis of variance were used for statistical analysis.

Results: 

The MCL of the first menstrual cycle (T1) was significantly elongated by 2.1 ± 0.5 days compared with baseline (P  =  .003, 95% CI [−3.7, −0.5]). Variability of MCL of the orthodontic group at T1 was also significantly greater (range, 15–46 days) than that of the control group (range, 24–36 days) (P &lt; .05). No significant difference in MCL was found in the subsequent five menstrual cycles (T2–T6) compared with baseline, and no significant differences in DMB or other accompanying symptoms were observed throughout the study.

Conclusion: 

Fixed orthodontic treatment may influence the MCL of adult females in the first month after bonding, but showed no effect on DMB or subsequent MCL through the follow-ups.

Dispositional resilience as a moderator of the relationship between chronic stress and irregular menstrual cycle

PURPOSE

Menstrual-cycle irregularity may have an important influence on the subsequent development of chronic diseases. Several risk factors for irregular menstrual cycles have been detected, including stress. Our aim was to extend research on the link between chronic stress and menstrual-cycle irregularity and to assess potential protective factors, such as dispositional resilience, which we hypothesize to be associated with the maintenance or promotion of a healthy menstrual cycle.

METHODS

For this cross-sectional study, data on 696 healthy women aged 20-40 years were obtained. The women completed measures of chronic stress, dispositional resilience and menstrual-cycle irregularity. Furthermore, potential confounds were assessed.

RESULTS

Of the participants, 383 (55%) reported no current use of hormonal contraceptives; 313 (45%) reported current use hormonal contraception and were included as a control group. The results suggest that in women not using hormonal contraception, chronic stress (OR = 1.05, 95%CI = 1.02-1.08, p = 0.001) and dispositional resilience (OR = 0.43, 95%CI = 0.31-0.59, p < 0.001) have a main effect on menstrual cycle regularity. In addition, women with greater dispositional resilience have reduced risk for irregular menstrual cycles in the face of low to moderate chronic stress; however, this association is changed at the highest level of chronic stress.

CONCLUSIONS

These findings suggest that dispositional resilience may be a protective psychological trait that modulates reproductive functioning.

Gynecologic pain related to occupational stress among female factory workers in Tianjin, China

BACKGROUND

Dysmenorrhea, dyspareunia, and non-cyclic pelvic pain are health concerns for factory workers in China and may be increased by occupational stress.

OBJECTIVES

To estimate the prevalence and demographic and occupational factors associated with three types of gynecologic pain among female factory workers in Tianjin.

METHODS

The study included 651 female workers from three factories in Tianjin, China. Logistic regression models were estimated to determine associations between occupational stress and gynecologic pain.

RESULTS

Occupational stress including high job strain, exhaustion, and stress related to working conditions was a risk factor for gynecologic pain. High job strain and poor job security were associated with an increased risk for dysmenorrhea. Compulsory overtime and exhaustion were associated with increased non-cyclic pelvic pain. Working overtime and exhaustion were associated with increased dyspareunia.

CONCLUSIONS

As China's population of female factory workers grows, research on the reproductive health of this population is essential.

Auricular acupressure to improve menstrual pain and menstrual distress and heart rate variability for primary dysmenorrhea in youth with stress

Background. Dysmenorrhea and accompanying symptoms can have a negative impact on academic achievement, physical activity and functioning, and quality of life. Unfortunately, stress increases the sensitivity and severity of pain, activating sympathetic responses while inhibiting parasympathetic responses. Objective. This study used objective, physiological measurements to evaluate the effects of auricular acupressure on menstrual pain and menstrual distress in young college students with primary dysmenorrhea across two menstrual cycles. The aim was to determine if significant differences could be detected between the intervention and follow-up phases after controlling life stress. Design. A one-group experimental research design was used, and repeated measurements and followups were done. Thirty-two women completed questionnaires and physiological parameters were measured. Results. Significant differences between the intervention and follow-up phases were found for high frequency (HF) and blood pressure on day 1 and no significant differences in menstrual pain and menstrual distress, heart rate variability, low frequency (LF), LF/HF ratio, or heart rate. Conclusion. Auricular acupressure effectively increases parasympathetic activity to maintain autonomic function homeostasis in young women with primary dysmenorrhea and may have a value in alleviating menstrual pain and menstrual distress in a high-stress life. Future studies should consider stress, stimulus dose of auricular acupressure, severity of menstrual pain, and a longitudinal research design.

The prevalence and risk factors of dysmenorrhea

Dysmenorrhea is a common menstrual complaint with a major impact on women's quality of life, work productivity, and health-care utilization. A comprehensive review was performed on longitudinal or case-control or cross-sectional studies with large community-based samples to accurately determine the prevalence and/or incidence and risk factors of dysmenorrhea. Fifteen primary studies, published between 2002 and 2011, met the inclusion criteria. The prevalence of dysmenorrhea varies between 16% and 91% in women of reproductive age, with severe pain in 2%-29% of the women studied. Women's age, parity, and use of oral contraceptives were inversely associated with dysmenorrhea, and high stress increased the risk of dysmenorrhea. The effect sizes were generally modest to moderate, with odds ratios varying between 1 and 4. Family history of dysmenorrhea strongly increased its risk, with odds ratios between 3.8 and 20.7. Inconclusive evidence was found for modifiable factors such as cigarette smoking, diet, obesity, depression, and abuse. Dysmenorrhea is a significant symptom for a large proportion of women of reproductive age; however, severe pain limiting daily activities is less common. This review confirms that dysmenorrhea improves with increased age, parity, and use of oral contraceptives and is positively associated with stress and family history of dysmenorrhea.

Attitudes toward menstruation, menstrual-related symptoms, and premenstrual syndrome among adolescent girls: a rural school-based survey

Folk culture surrounding menstrual-related matters has considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to examine these associations. With a higher score indicating a more positive attitude toward menstruation, the mean attitude score was 3.84 (SD ± 1.62) out of a maximum of six. No significant association was observed between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI 1.01-1.10) and menstrual phase (OR 1.04, 95% CI 1.01-1.07), were more likely to consult a physician for premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05-0.83). The findings imply the need for education to help adolescent girls manage menstrual symptoms and increase awareness of the benefit of treating them. Given that menstrual-related information was widely available from mothers, family, and social culture are potentially important in shaping good menstrual attitudes.

Military women's attitudes toward menstruation and menstrual suppression in relation to the deployed environment: development and testing of the MWATMS-9 (short form)

PURPOSE

To determine military women's attitudes toward menstruation and menstrual suppression with oral contraceptives in the deployed environment.

METHODS

A cross-sectional descriptive design with the administration of the Menstrual Attitude Questionnaire (MAQ) and the 55-item Military Women's Attitudes Towards Menstrual Suppression Scale (MWATMS) to a convenience sample (n = 278) of women in the U.S. Army with deployment experience.

FINDINGS

The MAQ's five subscales' mean scores ranged from 3.4 (+/-1.11) to 5.1 (+/-1.06), indicating neutral to moderate attitudes toward menstruation. Measurement development on the MWATMS produced a nine-item scale with three components: stress effects, benefits to self, and environmental barriers.

CONCLUSION

Menstrual attitudes were generally neutral in this sample; however, military women favor menstrual suppression during deployment owing to the effects of stress during deployment, benefits that suppression would provide, and the barriers to menstrual hygiene in the deployed environment. Women who perceived menstruation as bothersome and debilitating had positive attitudes toward menstrual suppression. These findings can contribute to appropriate predeployment women's health care and improve the readiness for deployment in female soldiers. Providers should educate women on the risks and benefits of menstrual suppression methods and provide guidance on impact that the deployed environment can have on their menstrual experiences.

Menstrual cycle and menstrual pain problems and related risk factors among Japanese female workers

Women's employment in Japan has increased substantially in recent decades, however little large scale research has been done on the impact of various types of working conditions on women's health. The aim of this study was to assess the menstrual cycle and menstrual pain problems of female workers and to investigate the factors that relate to them. The questionnaire was distributed to 8,150 women and 2,166 responded (26.6%). An anonymous self-administered questionnaire was used to get information about demographics, menstrual cycle status, the degree of menstrual pain, and employment and environmental factors. Irregular cycle menstruation was experienced in 17.1% of responded workers. We discovered the relationship between irregular menstrual cycles and stress, smell of cigarettes, age and smoking habits. Some degree of menstrual pain was experienced in 77.6% of responded workers. This study showed the relationship between menstrual pain and stress, high temperature and humidity, age, BMI, and number of births. In conclusion, we found that stress is thought to be an important factor related with menstrual cycle irregularities and menstrual pain among Japanese female workers.

Work and family stress is associated with menstrual disorders but not with fibrocystic changes: cross-sectional findings in Chinese working women

OBJECTIVES

To explore the separate and combined effects of work and family stress on menstrual disorders and fibrocystic changes in Chinese working women.

METHODS

Data were obtained from a cross-sectional study of 1,642 female railway workers. The Effort-Reward Imbalance Questionnaire and Family Stress Scale were used to measure work stress and family stress, respectively; the menstrual and breast conditions were evaluated by gynecologic interview and a medical examination. Multivariate log-binomial regression was performed to analyze the associations.

RESULTS

Menstrual disorders were found in 59.3% of female workers, and 54.8% had fibrocystic changes. The risk of menstrual disorders was significantly elevated with respect to work and family stress. The highest risk was found in the group with combined exposure to both work and family stress (RR with 95% CI 1.33 (1.18-1.49)). No significant association between stress and fibrocystic changes was observed.

CONCLUSIONS

Menstrual disorders were associated with stress from work and family life, but not fibrocystic changes, in working women. Tailored intervention measures reducing the burden of stressful psychosocial work and family environment are needed to improve women's reproductive well-being.

Menstrual cycle abnormalities among cosmetologists: the Reproductive Outcomes in Salon Employees (ROSE) study

This study was conducted to examine whether cosmetologists of reproductive age are at increased risk of menstrual cycle abnormalities compared to women of the same age working in other occupations. Participants in the study (450 cosmetologists and 511 noncosmetologists) were recruited through mass mailing of questionnaires. To be included in the study, respondents to the survey had to be between 21 and 55 years of age and not have had a hysterectomy/oophorectomy. The main outcome measures included irregular menstrual cycle length and pain during menstrual period. The results showed no statistically significant associations between being a cosmetologist and having menstrual cycle abnormalities. The observed estimates did not differ when including and excluding women who had ever used oral contraceptives. Thus, the findings of the study suggest that cosmetologists are not at increased risk of menstrual cycle abnormalities. Further studies using detailed salon exposure and work task data in relation to menstrual cycle outcomes should be conducted.

The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students

The aim of this study was to examine the relationship between menses-associated health problems of women, such as premenstrual symptoms, menstrual pain and irregular menstrual cycles, and psychosocial stress. A cross-sectional study was conducted among Japanese college students, measuring psychosocial stress levels by means of IMPS (The Inventory to Measure Psychosocial Stress). A total of 264 female students (mean age 19.4 years), who were invited to participate in the study in October 2007, completed the questionnaire, which dealt with anthropometric data, lifestyle, menstrual history, and menstrual health status. Forty-three students were excluded due to missing data, and the remaining 221 were analyzed. The proportions of students who reported premenstrual symptoms, menstrual pain, and the experience of irregular menstrual cycles were 79%, 79%, and 63%, respectively. Students who reported premenstrual symptoms, menstrual pain, and the experience of irregular menstrual cycles had higher stress scores than those who did not. Multiple logistic regression analyses were used to identify independent factors associated with having premenstrual symptoms, menstrual pain, and the experience of irregular menstrual cycles. Stress score, heavy menstrual flow, and menstrual pain were significant predictors for premenstrual symptoms, while age at menarche and having premenstrual symptoms were significant predictors for menstrual pain. Both stress score and body mass index were found to be significant predictors for having experienced irregular menstrual cycles. The results suggest that psychosocial stress is independently associated with premenstrual symptoms and the experience of irregular menstrual cycles among college students, implying that changes in the functional potentiality of women as a result of stress are related with changes in their menstrual function.

Menstrual disorders and their influence on low back pain among Japanese nurses

An increasing body of evidence now suggests that menstrual disorders may influence the development of Low Back Pain (LBP) among women of reproductive age. To investigate this issue in Japan, we conducted a large cross-sectional survey of female nurses from a university teaching hospital during 2008. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI: 1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, our study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.

Menstrual disorders and their adverse symptoms at work: an emerging occupational health issue in the nursing profession

Menstrual disorders and their adverse symptoms represent an important health issue for many women of child-bearing age. Aside from a deleterious effect on the individual's private life, menstrual disorders are being increasingly recognized as having significant implications at work. This is particularly relevant in occupations such as nursing, where the majority of staff is female. Various investigations have identified the prevalence, distribution, and risk factors associated with menstrual disorders, both in the general community and within the nursing profession. Overall, it is clear that menstrual disorders and their adverse symptoms represent an important occupational health challenge for modern nursing. Future interventions specifically aimed at reducing the work-related burden of these issues should be urgently considered. A more dedicated commitment from higher management regarding the overall health of nurses at work is also required.

Work-related stress factors and menstrual pain: a nation-wide representative survey

While imposing research has been conducted with respect to the biological determinants of painful menstruation, little is known about the psychosocial factors, including work-related stress that might influence menstrual pain. We conducted a study in which we aimed to determine besides the prevalence of dysmenorrhoea whether menstrual pain was associated with job control, co-worker social support, job security and dissatisfaction with the job. Data of 2772 working women aged 18-55 years, participants in the Hungarostudy 2002 nation-wide representative survey was analyzed. Binary logistic regression was used to determine the association between work stress factors and menstrual pain. Altogether 15.5% of women reported to experience menstrual pain that limits their daily activity. Low job control, low co-worker social support and low job security were found to be associated with a higher risk for menstrual pain even after controlling for the effect of age, educational attainment, parity status, smoking, body-mass index and treatment for gynecological problems. Job dissatisfaction was also related to dysmenorrhoea, albeit not significantly. The relationship between work-related psychosocial factors and painful menstruation deserves further investigation in order to determine the possible pathways of this association.

The impact of self-perceived job stress on menstrual patterns among Taiwanese nurses

The purpose of this study was to assess the impact of self-reported job stress on menstrual patterns among nurses. We conducted a cross-sectional survey of nursing staff from five psychiatric institutions and four general hospitals in Taiwan. A total of 746 participants were eligible for the final analysis, among whom, 72.3% were ascertained as having a self-perceived high level of job stress. Self-perceived high job stress was significantly associated with irregular menstrual cycles [Adjusted odds ratio (AOR): 4.8, 95% confidence interval (CI): 3.3-7.2] and longer menstrual bleeding periods (more than 7 d) [AOR: 2.5, 95% CI: 1.7-3.7], but was not significantly related to long or short menstrual cycles. Overall, this study suggests that nurses' self-perceived job stress may be associated with certain aspects of menstrual dysfunction. Further investigations with prospective follow-up studies and urine hormonal measurements are now recommended to provide additional insight into the pathophysiological mechanisms of our findings.

Dysmenorrhea among Japanese women

OBJECTIVE

To investigate the epidemiology of dysmenorrhea in Japanese women of menstrual age.

METHODS

A prospective cohort study was conducted using a health diary in a sample representative of Japanese women. Information on health care use was also collected.

RESULTS

Among 823 enrolled participants (age range, 18-51 years), dysmenorrhea (mean duration 1.75 days; range 1-5 days) was reported in 15.8% (95% CI, 13.3-18.3) during the 1-month study period. Common associated symptoms included headache (10.77%), back pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a physician, while 51.5% of the women used self-medication, and 7.7% used complementary/alternative medicine.

CONCLUSION

Dysmenorrhea is common in Japanese women. In our study, about half used self-medication, while some preferred complementary/alternative medicine. Dysmenorrhea is significantly associated with younger age and employment status.

Mind over matter: psychological factors and the menstrual cycle

PURPOSE OF REVIEW

Increasingly, gynaecologists are becoming aware of the impact of psychosocial factors on women's health generally, and on the menstrual cycle in particular. This review highlights developments in this field in the last triennium.

RECENT FINDINGS

Stress impairs the ovarian cycle through activation of the hypothalamus pituitary adrenal axis. The effect of psychological stress on the menstrual cycle is mediated by metabolic factors. Stress-induced impairment of ovarian function may not necessarily manifest as menstrual irregularity, and the effects of stress may persist beyond the cycle in which the stress episode occurred. Response to stress may be determined not so much by the nature of the stress as by the intrinsic neuronal attributes of the individual.

SUMMARY

Interventions to address underlying stress should be part of the management regime for women with menstrual cycle abnormalities.

Polychlorinated biphenyls and menstrual cycle characteristics

BACKGROUND

Experimental studies in nonhuman primates provide evidence that low-level exposure to persistent organochlorine pollutants such as polychlorinated biphenyls (PCBs) may affect aspects of their menstrual cycle, including cycle length, regularity, and bleeding duration. Few studies have examined these associations in humans.

METHODS

We used data from 2314 pregnant women who participated in the Collaborative Perinatal Project, a cohort study that enrolled pregnant women in the 1960s in 12 centers in the United States. Information about usual (prepregnancy) menstrual cycle length, regularity, bleeding duration, and dysmenorrhea was collected at enrollment, and 11 PCBs and p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) were measured in stored blood samples collected during the third trimester of pregnancy. We used multivariate linear and logistic regression to examine the association between organochlorine levels and menstrual cycles, adjusting for demographic factors, cholesterol, and triglycerides.

RESULTS

Total PCBs were positively associated with increasing menstrual cycle length (adjusted difference across 5 categories of PCB exposure = 0.7 days, trend-test P value = 0.02). Irregular cycles were slightly more frequent among those in the 2 highest categories of PCB exposure (odds ratio for highest category = 1.5; 95% confidence interval = 0.70-3.3), and there also was some evidence of an association with DDE. The strengths of these associations increased with various exclusions made to decrease potential misclassification of the outcome and the exposures. There was little evidence for associations between DDE or PCBs and bleeding duration, heavy bleeding, or dysmenorrhea.

CONCLUSIONS

This study supports experimental studies in monkeys showing an effect of low-dose PCB exposure on menstrual function.

The Associations between Menstrual Function and Life Style/Working Conditions among Nurses in Taiwan

This study was aimed at understanding the relationship among menstrual pattern, dysmenorrhea, life style and working conditions in nurses. The nurses were randomly selected from a medical center in Northern Taiwan. Each subject completed daily records including life and working conditions during the study period. The study showed that there were statistically significant differences in work years, daily working hours and type of work shift among nurses that worked at different units in the hospital. In the perceived regular cycle group, nurses that worked the night shift only exhibited the shortest menstrual cycles, less than 25 d. There was a significant difference (p<0.05) among the nurses' menstrual cycles. Many life factors (such as passive tobacco smoke exposure, perceived life satisfaction and perceived life stress) and working factors (such as work years, perceived work satisfaction and perceived work stress) were not significantly related to menstrual cycle regularity. In addition, 30% of the nurses complained of dysmenorrhea. Some factors including age, marital status and perceived life satisfaction were significantly related to dysmenorrhea. However, other life factors (such as passive tobacco smoke exposure, smoking, coffee, alcohol, cold drink habits, exercise and perceived life stress) and working factors (such as working places, type of work shift, daily work hours, perceived work satisfaction and perceived work stress) showed no correlation with dysmenorrhea. This study indicates that women should pay attention to their menstrual function and dysmenorrhea phenomenon.

The Relation of Occupational Organic Solvent Exposure to Symptom Reporting in a Sample of White and Chinese Midlife Women

OBJECTIVE

This study examined the relation of occupational solvent exposure to menopausal and other symptoms in midlife women.

METHODS

We conducted a cross-sectional study of 480 Chinese and 494 white women, aged 40-55 years, in Northern California. Levels of exposure to organic solvents (none, low, medium, or high) were assigned to each current job using a job-exposure matrix.

RESULTS

A lower proportion of women with low occupational organic solvent exposure reported hot flashes or night sweats than working women with no solvent exposure (adjusted prevalence odds ratio [APOR] = 0.48, 95% confidence interval [CI] = 0.19-1.21). A greater proportion of women with high solvent exposure reported forgetfulness than women with no exposure (APOR = 2.51, 95% CI = 1.12-5.63).

CONCLUSIONS

Some symptom reporting in midlife women was related to their occupational organic solvent exposure.

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.

Stress and dysmenorrhoea: a population based prospective study

BACKGROUND

Dysmenorrhoea is the most common gynaecological disorder in women of reproductive age. Despite the association between stress and pregnancy outcomes, few studies have examined the possible link between stress and dysmenorrhoea.

AIMS AND METHODS

Using a population based cohort of Chinese women, the independent effect of women's perceived stress in the preceding menstrual cycle on the incidence of dysmenorrhoea in the subsequent cycle was investigated prospectively. The analysis included 1160 prospectively observed menstrual cycles from 388 healthy, nulliparous, newly married women who intended to conceive. The perception of stress and the occurrence of dysmenorrhoea in each menstrual cycle were determined from daily diaries recorded by the women.

RESULTS

After adjustment for important covariates, the risk of dysmenorrhoea was more than twice as great among women with high stress compared to those with low stress in the preceding cycle (OR = 2.4; 95% CI 1.4 to 4.3). The risk of dysmenorrhoea was greatest among women with both high stress and a history of dysmenorrhoea compared to women with low stress and no history of dysmenorrhoea (OR = 10.4, 95% CI 4.9 to 22.3). Stress in the follicular phase of the preceding cycles had a stronger association with dysmenorrhoea than stress in the luteal phase of the preceding cycles.

CONCLUSION

This study shows a significant association between stress and the incidence of dysmenorrhoea, which is even stronger among women with a history of dysmenorrhoea.