Management of Premenstrual Syndrome: Green-top Guideline No. 48

Turkish validity and reliability of the Premenstrual Change Coping Inventory

OBJECTIVE

This study was conducted to investigate the validity and reliability of the Turkish version of the Premenstrual Change Coping Inventory (PMS-Cope).

METHODS

A total of 170 women who met the inclusion criteria were included in the methodological study. Data were collected between the dates of November 5, 2018 and May 5, 2019 with personal information form, PMS-Cope Turkish version, and Premenstrual Syndrome Scale.

RESULTS

The PMS-Cope was obtained through the translation-back translation method and the content validity was obtained according to expert opinions. After the factor analysis, the Turkish version of the PMS-Cope consisted of three sub-dimensions as in the original scale. The factor loadings of the three-dimensional scale ranged from 0.46 to 0.84, and the explained variance (60.329%) was at the desired level. As a result of structural equation modeling; ×2/SD values of the scale were found to be 4.19, GFI 0.93, AGFI 0.91, CFI 0.95, RMSEA 0.079, and SRMR 0.082, and this scale was acceptable. The Cronbach alpha coefficient of the PMS-Cope was 0.86. It was determined that item-total score correlations were higher than 0.30 in all items of PMS-Cope and there was no need to remove items from the scale. When the mean scores of the lower 27% and upper 27% of the scale were compared, a statistically significant difference was found between the groups (p < 0.05). The PMS-Cope score was 41.04 ± 8.99.

CONCLUSION

It was determined that the Turkish version of the PMS-Cope was a valid and reliable measurement tool.

(S)-S-adenosylmethionine in the treatment of pre-menstrual disorders in adult women: A protocol for an open-label pilot study

Pre-menstrual disorders, including pre-menstrual syndrome and pre-menstrual dysphoric disorder, are highly prevalent disorders in women of reproductive age. Pre-menstrual disorders are associated with debilitating symptoms that onset in the days prior to menses. A complex interplay between hormonal fluctuations, cellular sensitivity, and psychosocial stressors likely underly the pathophysiology of pre-menstrual disorders. Current treatment options include selective serotonin reuptake inhibitors, hormonal therapies, and psychosocial support. There is growing evidence for oestrogen, progesterone, gonadotropin Releasing Hormone analogues and Complementary and Alternative Medicines in treating Pre-menstrual disorders. (S)-S-adenosylmethionine is a complementary and alternative medicine with postulated roles in the treatment of depression, with a rather rapid onset of action and minimal side effect profile. We propose a protocol for investigating the efficacy of (S)-S-adenosylmethionine in the treatment of pre-menstrual disorders. The proposed study is an open label pilot study, that will recruit thirty women between the ages of 18-45 who experience a pre-menstrual disorder. Daily and interval questionnaires will provide a quantification of symptoms across four menstrual cycles (16 weeks). During two consecutive menstrual cycles it is proposed that participants receive oral (S)-S-adenosylmethionine Complex 400 mg three times a day (total daily dose 1200 mg), during the pre-menstrual time-period (14 days prior to menses). Changes in pre-menstrual disorder symptoms between control and treatment cycles will assist in elucidating the clinical efficacy of (S)-S-adenosylmethionine. This study has the potential to support a larger double blinded, placebo controlled randomised control trial and aims to enrich the knowledge surrounding pre-menstrual disorders.

Changes in menstrual symptoms and work productivity after checklist-based education for premenstrual syndrome: an 8-month follow-up of a single-arm study in Japan

BACKGROUND

Premenstrual syndrome (PMS) is prevalent among women of reproductive age, but most do not seek medical advice. We hypothesized that building PMS awareness could promote medical help-seeking for PMS and thus reduce menstrual symptoms and improve work productivity.

METHODS

In January 2020, women aged between 25 and 44 years, having paid work, and not currently consulting with an obstetrics and gynecology doctor (n = 3090) responded to the Menstrual Distress Questionnaire (MDQ), the Premenstrual Symptoms screening tool, and the World Health Organisation Health and Work Performance Questionnaire. In addition, they received checklist-based online education for PMS. Of 3090 participants, 2487 (80.5%) participated in a follow-up survey in September 2020. We conducted multiple logistic regression analyses and text analyses to explore factors that encouraged and discouraged medical help-seeking. We also evaluated changes in menstrual symptoms and work productivity, using generalized estimating equations with interactions between the severity of PMS, help-seeking, and time.

RESULTS

During the follow-up period, 4.9% of the participants (121/2487) sought medical help. Those having high annual income (adjusted odds ratio [aOR] = 2.07, 95% confidence interval [CI]: 1.21-3.53) and moderate-to-severe PMS (aOR = 2.27, 95% CI: 1.49-3.46) were more likely to have sought medical help. Those who did not seek medical help despite their moderate-to-severe PMS reported normalization of their symptoms (36%), time constraints (33%), and other reasons for not seeking medical help. Participants with moderate-to-severe PMS who had sought medical help showed a significant improvement of - 8.44 points (95% CI: - 14.73 to - 2.15 points) in intermenstrual MDQ scores during the follow-up period. However, there were no significant improvements in premenstrual and menstrual MDQ scores or absolute presenteeism.

CONCLUSION

Medical help-seeking alleviated intermenstrual symptoms in women with moderate-to-severe PMS, but only a small proportion of them sought medical help after PMS education. Further research should be conducted to benefit the majority of women who are reluctant to seek medical help, including the provision of self-care information.

TRIAL REGISTRATION

UMIN Clinical Trials Registry number: UMIN000038917.

[Premenstrual syndrome and premenstrual dysphoric disorder-Overview on pathophysiology, diagnostics and treatment]

Premenstrual syndrome and premenstrual dysphoric disorder become episodically manifest during the second half of the female menstrual cycle and are characterized by psychological and physical symptoms causing relevant functional and social impairments. Mood swings, depression and dysphoria are associated depressive symptoms. Therefore, affective disorders should be considered as a differential diagnosis. Of women in reproductive age 3-8% suffer from premenstrual syndrome and 2% of women are affected by premenstrual dysphoric disorder. Genetic and sociobiographical risk factors are discussed. Furthermore, genetic polymorphisms of specific hormone receptors are considered to be genetic risk factors. From a pathophysiological perspective premenstrual syndrome and premenstrual dysphoric disorder are caused by a complex interaction between cyclic changes of ovarian steroids and central neurotransmitters. An imbalance of estrogen and progesterone in the luteal phase is believed to cause the symptoms. Therefore, the first treatment approach consists of regulation of the menstrual cycle or luteal support with progesterone or synthetic progestins even if their effectiveness has not yet been proven in randomized controlled studies and meta-analyses. The administration of combined oral contraceptives is also an option. Especially treatment with selective serotonin reuptake inhibitors (SSRI) represent an evidence-based approach. In severe cases the administration of gonadotropin releasing hormone (GnRH) agonists with add back treatment can also be considered. In the field of affective disorders premenstrual syndromes represent clinically relevant differential diagnoses and comorbidities, which confront the treating physician with particular clinical challenges. Therefore, this literature review gives the readership a clinical orientation for dealing with these disorders.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account. Reprinted from Int J Womens Health 2022; 14:1783-1801, with permission from Dove Medical Press Ltd. Copyright © 2022.

Do contrasting socio-ecological conditions bring difference in premenstrual syndrome and its concomitants? A sedente-migrant comparative study from Eastern India

OBJECTIVES

We asked in our research whether the premenstrual syndrome (PMS) and its concomitants, differ between "sedente" and "migrant" populations hailing from the same ethnic group, owing to their living in contrasting socio-ecological conditions.

METHODS

A total of 501 Oraon adolescents (sedente: 200, migrant: 301) were studied. Data on PMS was reported retrospectively using a list of 29 standard symptoms. Principal component analysis (PCA) was applied on PMS. PCA, which resulted in six principal components (PC1 to PC6) were loaded with "behavioral and cognitive," "negative mood," "pain and fluid retention," "vestibular and breast tenderness," and "fatigue," and/or "gastrointestinal" symptoms. Step-wise hierarchical regression was applied using migration status (step 1), socio-demographic (step 2), menstrual (step 3), and nutritional and lifestyle variables (step 4) as concomitants for each principal component.

RESULTS

Significantly, a greater number of migrants reported PMS but of milder intensity, unlike the sedentes. Significant sedente-migrant differences were found in the concomitants for PMS. Multivariate analyses showed differential socio-demographic (occupational, educational and wealth status, religion), nutritional (dietary carbohydrate protein and fat, tea intake, body mass index, percent body fat, waist hip ratio, fat mass index), menstrual (age at menarche, cycle length, dysmenorrhoea) and anemic status of the sedentes and the migrants were significantly associated with PMS.

CONCLUSIONS

Sedente and migrant participants, despite hailing from the same ethnic group, sharply differed in the prevalence of PMS and its concomitants owing to their living in contrasting socio-ecological conditions.

Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7

PURPOSE

To provide recommendations for the management of premenstrual syndrome and premenstrual dysphoric disorder, collectively referred to as premenstrual disorders, based on assessment of the evidence regarding the safety and efficacy of available treatment options. An overview of the epidemiology, pathophysiology, and diagnosis of premenstrual disorders also is included to provide readers with relevant background information and context for the clinical recommendations.

TARGET POPULATION

Reproductive-aged adults and adolescents with premenstrual symptoms.

METHODS

This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

RECOMMENDATIONS

This Clinical Practice Guideline includes recommendations on the following evidence-based treatment options for premenstrual disorders, with an acknowledgement that many patients may benefit from a multimodal approach that combines several interventions: pharmacologic agents (hormonal and nonhormonal), psychological counseling, complementary and alternative treatments, exercise and nutritional therapies, patient education and self-help strategies, and surgical management. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence. Based on review of extrapolated data from adult populations and expert consensus, it was determined that the recommendations also apply to adolescents, with a few exceptions that are noted in the Clinical Practice Guideline.

Women's Health Care Committee, Japan Society of Obstetrics and Gynecology: Annual report-2023

The Women's Health Care Committee was established in 2010 with the goal of improving women's health. In the current academic year, there are six subcommittees focusing on conducting the following surveys: (1) the current status of pregnancy-associated breast cancer in Japan; (2) surgery for disorders of sex development; (3) diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder; (4) obstetrics and gynecology-based treatment for patients with eating disorders in Japan; (5) multi-drug-resistant bacterial infections in the field of obstetrics and gynecology; and (6) changing the methodology of the treatment of dysmenorrhea and continuing medical education. The activities of each subcommittee are described below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2023;75(6):662-86).

Biomarkers of Postpartum Depression: A Narrative Review

Postpartum depression (PPD) is a disorder that impairs the formation of the relationship between mother and child, and reduces the quality of life for affected women to a functionally significant degree. Studying markers associated with PPD can help in early detection, prevention, or monitoring treatment. The purpose of this paper is to review biomarkers linked to PPD and to present selected theories on the pathogenesis of the disease based on data from biomarker studies. The complex etiology of the disorder reduces the specificity and sensitivity of markers, but they remain a valuable source of information to help clinicians. The biggest challenge of the future will be to translate high-tech methods for detecting markers associated with postpartum depression into more readily available and less costly ones. Population-based studies are needed to test the utility of potential PPD markers.

A case series of premenstrual disorders presenting to the UK's National Female Hormone Clinic

AIMS AND METHOD

We aimed to describe the clinical characteristics of female patients presenting with premenstrual disorders to a tertiary service in the UK. We conducted a retrospective case-note review of referrals to the National Female Hormone Clinic from April 2014 to August 2020. Based on clinical assessment, we determined whether the patient met criteria for premenstrual dysphoric disorder or premenstrual exacerbation of an underlying psychiatric disorder.

RESULTS

Of 146 patients seen in clinic for premenstrual disorders, an ICD-10 psychiatric diagnosis was made in 130 (89.0%); a minority 16 (11.0%) did not have a psychiatric diagnosis. Following assessment, 94 patients (64.4%) met criteria for premenstrual dysphoric disorder and 67 (45.6%) had exacerbation of a psychiatric disorder.

CLINICAL IMPLICATIONS

Patients presenting to this specialist service had complex psychiatric comorbidity; almost half presented with exacerbation of a psychiatric disorder.

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month. Both techniques were first taught for one session followed by home program to be performed by patients. The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Associations between Diet and Changes in Pain Levels among Young Women with Premenstrual Syndrome-A Preliminary Study during the COVID-19 Pandemic

The aim of this study was to investigate the association between PMS (premenstrual syndrome)-related pain among young women following a particular type of diet during the COVID-19 pandemic. This was compared to the period before the pandemic. Furthermore, we aimed to determine whether the increase in the intensification of pain was correlated to their age, body weight, height and BMI, and whether there are differences in PMS-related pain between women who differ in their diet. A total of 181 young female Caucasian patients who met the criteria for PMS were involved in the study. Patients were divided according to the kind of diet they had followed during the last 12 months before the first medical evaluation. The rise in pain score was evaluated according to the Visual Analog Scale before and during the pandemic. Women following a non-vegetarian ("basic") diet had a significantly higher body weight in comparison to those on a vegetarian diet. Furthermore, a significant difference was noted between the level of intensification of pain before and during the pandemic in women applying a basic diet, a vegetarian and an elimination diet. Before the pandemic, women from all groups felt weaker pain than during the pandemic. No significant difference in the intensification of pain during the pandemic was shown between women with various diets, nor was there a correlation between intensification of pain and the girl's age, BMI, their body weight and also height for any of the diets applied.

Effect of γ-tocopherol supplementation on premenstrual symptoms and natriuresis: a randomized, double-blind, placebo-controlled study

BACKGROUND

This randomized, double-blind, placebo-controlled study aimed to investigate the effects of γ-tocopherol (Toc) supplementation on premenstrual symptoms and natriuresis.

METHODS

We enrolled 51 Japanese women with premenstrual symptoms, particularly those who showed increased symptoms induced by water retention during the luteal phase compared with the follicular phase. Premenstrual symptoms were recorded in the first cycle's postmenstrual follicular phase; physical measurements and urine collection were conducted during the 48-h run-in period. The test supplement, which contained 180 mg of γ-Toc or placebo, was orally administered twice a day for 7 days during the luteal phase of the first and second cycles in a crossover manner. The same evaluation was conducted during the luteal phase, beginning in the morning of the sixth day of supplement administration.

RESULTS

Compared with placebo intake, γ-Toc intake significantly reduced "fatigue" and "irritability/anger" symptoms. Furthermore, compared with placebo intake, γ-Toc intake significantly reduced the thigh circumference. Regarding the "swelling of the legs" and "heavy legs" symptoms and the thigh circumference, the biphasic trend of increasing and decreasing values in the daytime and morning, respectively, during the follicular phase was not observed at the luteal phase with placebo intake. Contrastingly, γ-Toc intake resulted in significantly lower values in the morning than placebo intake. The mean difference in 24-h urinary sodium excretion between γ-Toc and placebo intake was 10.6 mEq (95% confidence interval (CI): -0.1, 21.4, p = 0.05, power 55%). Plasma γ-Toc and its metabolite γ-carboxyethyl hydroxychroman (CEHC) levels were significantly higher with γ-Toc intake than with placebo intake. There were no significant between-supplement differences in serum electrolyte levels or cumulative urinary potassium excretion.

CONCLUSION

γ-Toc intake could effectively alleviate certain premenstrual syndrome symptoms, particularly those related to water retention during the luteal phase. Furthermore, the underlying mechanism may involve the diuretic effect of γ-CEHC, which is a γ-Toc metabolite.

TRIAL REGISTRATION

UMIN000047989; registration date: 10/06/2022, retrospectively registered.

New insights on the impact of gut microbiota on premenstrual disorders. Will probiotics solve this mystery?

Premenstrual disorders (PMDs) refer to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), where both are characterized by physical and psychological changes occurring in the luteal phase of menstrual cycle. According to the available theories, there is no single accusation succeeded to explain the pathophysiology of PMDs. However, there is emerging evidence for the role of gut microbiota (GM) in PMDs, supported by the diverging impact of GM on our body systems. The direct secretory function of GM and their integration in hormonal, neurotransmitters and bioactive compounds secretion and activity reinforce this speculation. Moreover, the bidirectional relation between GM and steroid hormones and the impact of diet, drugs, and inflammation on both, GM and PMDs incidence and severity justify the need for more studies to determine the actual role of GM in PMDs and the possible potential of probiotics and prebiotics as therapeutic options.

Current status and problems in the diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder from the perspective of obstetricians and gynecologists in Japan

AIM

To investigate the current status and problems in the diagnosis and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) from the perspective of obstetricians and gynecologists (OB/GYNs) in Japan, the Japanese Society of Obstetrics and Gynecology (JSOG) conducted a national-wide survey.

METHODS

An email survey was sent to all JSOG members (16 732) and a web-based survey was conducted using a Google form between September and November 2021. The current status and problems in PMS/PMDD diagnosis and treatment were surveyed in this cross-sectional study.

RESULTS

In total, 1312 respondents (7.8% of all JSOG members) completed the questionnaire. In terms of diagnoses and treatment, OB/GYN was preferred over psychiatrist for PMS (91.4% vs. 45%); however, no differences were noted for PMDD (76.1% vs. 73.7%). A total of 1267 (96.6%) respondents engaged in routine PMS/PMDD treatment. Regarding the general diagnosis procedure, 84.4% respondents answered "only a vague medical interview," 8.4% kept a two-cycle symptom diary, and 10.3% used a screening questionnaire. The most commonly used medication was oral contraceptive pills (OCPs) (98.1%), followed by the Kampo, traditional Japanese herbal medicines, Kamishoyosan (73.6%). Concerning first-line drugs for treatment, OCPs were the most common (76.8%), followed by Kampo medicine (19.5%); selective serotonin reuptake inhibitors (SSRIs) were less frequently used (2.6%). Regarding first-line drugs among OCPs, 65.1% respondents reported drospirenone-ethinylestradriol use.

CONCLUSIONS

This study indicates that only a few OB/GYNs practicing PMS/PMDD in Japan use a prospective diary, which is an essential diagnostic criterion for PMS/PMDD. Regarding treatment, SSRIs were used less frequently.

Impact of Premenstrual Syndrome Symptoms on Sport Routines in Nonelite Athlete Participants of Summer Olympic Sports

PURPOSE

Most women during their lifetime experience a combination of premenstrual syndrome (PMS) symptoms (eg, menstrual cramps) before and often to the end of menstruation. However, the impact of these symptoms on sport routines (eg, performance, training absence) during phases around menstruation is still unclear. Therefore, we investigated the impact of PMS symptoms on sport routines among nonelite athletes over 3 phases related to menstruation.

METHODS

An online questionnaire was developed to recruit nonelite female athletes who participate in summer Olympic sports. Participants were allocated into 2 groups: those who experienced mild to moderate PMS symptoms (no-PMS) and those with severe PMS symptoms (p-PMS). Two hundred thirty-four responses from eumenorrheic women (p-PMS = 78%) were considered valid. An unpaired Student t test was conducted to compare demographic characteristics between groups and chi-square test to evaluate the impact of PMS status on sport routines between groups.

RESULTS

A significant (P < .05) proportion of women in the p-PMS group changed their training schedule because of menstrual (55%) and premenstrual (61%) symptoms compared with the no-PMS group. Overall, all participants indicated that training (P = .01) and competitive (P < .01) performance are impacted during menstruation, followed by a greater impact (P < .05) in the p-PMS group before menstruation.

CONCLUSION

The presence of PMS symptoms reduces training and competitive performance, primarily during and before menstruation, respectively. Severity of PMS symptoms was significantly associated with alterations in training schedule but not with competitive schedule.

Premenstrual disorders: Premenstrual syndrome and premenstrual dysphoric disorder

Recently, the term premenstrual disorders (PMDs), which includes premenstrual syndrome and premenstrual dysphoric disorder as a continuum, has been proposed. Although the precise etiology of PMDs remains unknown, the involvement of hormonal fluctuations is clear. The brain transmitters, serotonin and γ-amino butyric acid, also seem to be involved. Serotonin reuptake inhibitors and oral contraceptives are the current mainstay of treatment, but these are insufficient. Even the currently used prospective two-period symptom diary is not widely used in actual clinical practice, creating a major problem of discrepancy between research and clinical practice. In this review, I would like to outline the latest information and problems in the etiology, diagnosis, and treatment of PMDs, with an emphasis on promising new therapies.

The pharmacotherapeutic management of premenstrual dysphoric disorder

INTRODUCTION

Premenstrual dysphoric disorder (PMDD) is a prevalent psychiatric condition associated with substantial mental distress, impaired psychosocial functioning, high rates of co-morbid psychiatric conditions, and elevated risk of suicide.

AREAS COVERED

We provide an update on epidemiology, pathophysiology, clinical presentation, and diagnosis of PMDD, with a focus on the pharmacological management of this condition.

EXPERT OPINION

Given the high rates of false positives from retrospective assessments, prospective daily symptom monitoring for a minimal of two symptomatic menstrual cycles is critical to accurately confirm (or rule out) the diagnosis of PMDD. Serotonin-based antidepressants are well-established first-line treatments of PMDD. Second-line treatment includes the use of combined, monophasic oral contraceptives. In mild to moderate cases, independent meta-analyses have shown efficacy of Chasteberry extract (Vitex agnus cactus). Preliminary results with compounds blocking the synthesis of allopregnanolone are promising.

Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study

AIM

The study aimed to determine potential risk factors associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder.

METHODS

Three hundred two female student participants who were 18-45 years old completed a questionnaire including demographic characteristics, lifestyle factors, and a Vietnamese Premenstrual Syndrome Screening Tool. We then followed up participants during at least two menstrual cycles using the Daily Record of Severity of Problems. The Premenstrual Syndrome and Premenstrual Dysphoric Disorder diagnosis was established using The Carolina Premenstrual Assessment Scoring System, based on the American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

According to the Carolina Premenstrual Assessment Scoring System, 35 out of 302 students (11.6%; 95%CI: 8.2-15.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). We found that age at menarche (PR = 0.77, 95%CI: 0.63-0.96), having negative Rh blood type (PR = 4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR = 2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having Premenstrual Syndrome or Premenstrual Dysphoric Disorder after adjusting for other variables.

CONCLUSION

The prominent risk factors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account.

Characteristics of the Gut Microbiota in Japanese Patients with Premenstrual Syndrome

Purpose

The present study aimed to characterize the gut microbiota of individuals with premenstrual syndrome.

Patients and Methods

The gut microbiota of 24 Japanese women with PMS (PMS group) and 144 healthy Japanese women (control group) were compared. Analysis of the α- and β-diversities and the gut microbial composition at the genus level were performed using 16S rRNA gene sequence data obtained from stool samples.

Results

A significant difference in age was observed between the PMS and control groups; however, no significant difference was observed in BMI. The α-diversity measured using the Simpson index was significantly higher in the PMS group than the control group. Visualization of the β-diversity using non-metric multidimensional scaling and permutational multivariate analysis of variance (PERMANOVA) showed that the distance of the gut microbiota between the PMS and control groups is significantly different. Furthermore, a significant difference in the composition of the gut microbiota was observed between the PMS and control groups. At the genus level, the abundances of Collinsella, Bifidobacterium, and Blautia were significantly higher in the PMS group than in the control group. In particular, the abundance of Collinsella in the PMS group was approximately 4.5 times higher than that in the control group. To rule out the confounding effect of age in the abundances of Bifidobacterium, Blautia, and Collinsella, the gut microbiota of the PMS and control groups were compared by age group. Results showed that Collinsella had the highest effect size in participants of 30–40 years of age (mean age: 36.39 ± 4.68 years).

Conclusion

These results suggest that the PMS group possesses a characteristic gut microbiota. In particular, Collinsella was strongly associated with PMS. Since Collinsella has been reported to be associated with diet, dietary interventions such as prebiotics targeting Collinsella may be effective in preventing, improving, and alleviating PMS.

The association between premenstrual syndrome before pregnancy and antenatal depression: A cross-sectional study with prerecorded information

Aim

Some studies have examined the relationship between premenstrual syndrome (PMS) and antenatal depression. However, retrospective designs were used to obtain the PMS experiences. Different from such earlier research, this study aims to investigate the association between PMS before pregnancy and antenatal depression with a prospective design.

Method

This is a secondary analysis of a randomized controlled trial (RCT) conducted among pregnant women. Premenstrual symptoms before pregnancy of the participants were obtained prospectively via a period tracking app. At the baseline of the RCT, 5073 women participated. Of those, 3004 had one or more symptom records related to menstruation 1 year before pregnancy. The outcome, antenatal depression, was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at the RCT baseline, and the cut-off value was set at 11. For covariates, age, education, planned pregnancy, and the number of children were also measured at the same time. Multiple logistic regression analyses were employed to estimate the odds ratio (OR) of having antenatal depression, adjusting for the covariates.

Results

A total of 366 individuals who had three or more cycles of menstrual-related symptom records were included in the analyses, and of those 52 were applicable to PMS before pregnancy. There was no significant association between PMS and antenatal depression (adjusted OR = 1.28, P = 0.61).

Conclusion

The present study was the first study to utilize a prospective design to obtain premenstrual symptoms. Future research should consider using a validated and objective measure of PMS diagnosis and a larger sample.

Development and Psychometric Testing of a New Short-Form of the Premenstrual Symptoms Questionnaire (PSQ-S)

Purpose

The Premenstrual Symptoms Questionnaire (PSQ) is a patient-reported outcome measurement tool for premenstrual symptoms. Although the PSQ is a very useful tool with 14 items to screen for a wide variety of premenstrual symptoms, not everyone will respond to all the questions. Fewer questions would be less burdensome on the respondents. We aimed to develop and analyze the psychometric properties of a short-form of the PSQ (PSQ-S).

Patients and Methods

The study participants were from an earlier study with a sample of 1388 female students. We reanalyzed data collected from 922 students with regular menstrual cycles who completed the PSQ, premenstrual dysphoric disorder (PMDD) scale, Somatic Symptom Scale-8 (SSS-8), and numerical rating scale (NRS) for menstrual pain. First, we selected nine items for the PSQ-S based on the results of the corrected item-total correlation analysis. The PSQ-S was then analyzed for reliability and validity using the classical test theory. Moreover, item response theory was applied to test the psychometric properties of the PSQ-S.

Results

Cronbach's α for the PSQ-S score was 0.93. Principal component factor analysis revealed a one-factor model. Confirmatory factor analysis showed that the one-factor model was a good fit. The PSQ-S total score was strongly correlated with the PSQ total score, PMDD scale score, and SSS-8 score (r=0.978, 0.854, and 0.648, respectively) and moderately correlated with the NRS (r=0.437). Item response theory analyses showed that the constructs and items of the PSQ-S had satisfactory discrimination, difficulty parameters, item information curves, and test information curves. Receiver operating characteristic curve analysis revealed a cut-off score of ≥22 for suspected premenstrual disorders based on the total PSQ-S score.

Conclusion

The PSQ-S, consisting of nine items from the PSQ, had sufficient reliability and validity and could be a convenient assessment tool for premenstrual symptoms in routine clinical practice.

Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study

Purpose

Premenstrual symptoms can negatively impact the quality of life of women through a range of mood, behavioral, and physical symptoms. The association between the microbiota and brain function has been extensively studied. Here, we examined the characteristics of the microbiota in women with premenstrual disorders (PMDs) and the association between premenstrual symptoms and the microbiota.

Materials and methods

In this single center cross-sectional pilot study, we recruited 27 women reporting premenstrual symptoms and 29 women with no serious premenstrual symptoms. Among them, we further selected 21 women experiencing premenstrual symptoms resulting in interference to their social life (PMDs group) and 22 women with no serious premenstrual symptoms and thereby no interference to their social life (control group). The severity of symptoms was evaluated by a premenstrual symptoms questionnaire (PSQ). Inflammatory markers were analyzed in blood samples, including C reactive protein, soluble CD14, and lipopolysaccharide binding protein. Sequencing of 16S ribosomal ribonucleic acid genes was performed on stool samples.

Results

Inflammatory markers in blood samples did not differ significantly between the PMDs and control groups. A difference in beta, but not alpha diversity, was detected for the gut microbiotas of the PMDs and control groups. The relative abundance of the Bacteroidetes phylum was lower in the PMDs group. At the genus level, the prevalence was decreased for Butyricicoccus, Extibacter, Megasphaera, and Parabacteroides and increased for Anaerotaenia in the PMDs group, but after false discovery rate correction, these differences were no longer significant. Linear discriminant effect size analysis revealed a decrease in Extibacter, Butyricicoccus, Megasphaera, and Parabacteroides and an increase in Anaerotaenia in the PMDs group. The PSQ total score correlated with Anaerotaenia, Extibacter, and Parabacteroides. Multiple regression analysis showed that Parabacteroides and Megasphaera negatively predicted the PSQ total score.

Conclusion

The properties of the gut microbiota are associated with premenstrual symptoms.

Successful control of menstrual cycle-related exacerbation of inflammatory arthritis with GnRH agonist with add-back therapy in a patient with rheumatoid arthritis

Patients with rheumatoid arthritis may demonstrate fluctuations in arthritis symptoms associated with the menstrual cycle. This is the first case report of successful control of menstrual cycle-related exacerbation of rheumatoid arthritis with a gonadotropin-releasing hormone agonist and add-back therapy. A 49-year-old premenopausal woman experienced recurrent severe arthritis flares despite aggressive immunotherapy. Her arthritis symptoms started 10 days before her menstruation and spontaneously resolved after the initiation of menstruation. We chose a gonadotropin-releasing hormone agonist with percutaneous estradiol gel to prevent a hypoestrogenic state and a levonorgestrel-releasing intrauterine system to facilitate uterine protection by estrogen. Thereafter, her symptoms significantly improved without experiencing major flares. In addition, she did not demonstrate any menopausal symptoms. This case highlights that rheumatoid arthritis disease activity may be associated with the menstrual cycle, and hormonal therapy may be beneficial as an adjunct therapy for controlling premenstrual exacerbation of rheumatoid arthritis.

Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials

OBJECTIVE

Combined oral contraceptives are often considered a treatment option for women with premenstrual syndrome or premenstrual dysphoric disorder also seeking contraception, but evidence for this treatment is scarce. We aimed to determine (1) the level of evidence for the efficacy of combined oral contraceptives in managing premenstrual depressive symptoms and overall premenstrual symptomatology and (2) the comparative efficacy of combined oral contraceptives (the International Prospective Register of Systematic Reviews registration number CRD42020205510).

DATA SOURCES

We searched Cochrane Central Register of Controlled Trials, PubMed, Web of Science, PsycINFO, EMCare, and Embase from inception to June 3, 2021.

STUDY ELIGIBILITY CRITERIA

All randomized clinical trials that evaluated the efficacy of combined oral contraceptives in women with premenstrual syndrome or premenstrual dysphoric disorder were considered eligible for inclusion in this meta-analysis.

STUDY APPRAISAL AND SYNTHESIS METHODS

A random effect Bayesian pairwise and network meta-analysis was conducted with change in premenstrual depressive symptoms and overall premenstrual symptomatology between baseline and 3 cycles as outcome. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

Of 3664 records, 9 eligible trials were included that studied 1205 women with premenstrual syndrome or premenstrual dysphoric disorder (mean age per study range, 24.6-36.5 years). The pairwise meta-analysis revealed that combined oral contraceptives were more efficacious than placebo in treating overall premenstrual symptomatology (standardized mean difference, 0.41; 95% credible interval, 0.17-0.67), but not premenstrual depressive symptoms specifically (standardized mean difference, 0.22; 95% credible interval, -0.06 to 0.47). However, none of the combined oral contraceptives were more effective than each other in reducing premenstrual depressive symptoms and overall premenstrual symptomatology.

CONCLUSION

Combined oral contraceptives may improve overall premenstrual symptomatology in women with premenstrual syndrome or premenstrual dysphoric disorder, but not premenstrual depressive symptoms. There is no evidence for one combined oral contraceptive being more efficacious than any other.

Pilot Data on the Feasibility And Clinical Outcomes of a Nomegestrol Acetate Oral Contraceptive Pill in Women With Premenstrual Dysphoric Disorder

Background

Up to 80% of reproductive-aged women experience premenstrual symptoms. Premenstrual Dysphoric Disorder (PMDD) is a severe form, affecting 2-5% of women. Combined oral contraceptive pills (COCPs) are used in the treatment of PMDD. Clinical practice suggests that a newer COCP containing nomegestrol acetate (2.5mg) and 17-beta estradiol (1.5mg), may be a suitable treatment for mood symptoms in PMDD.

Materials and Methods

This was a clinical follow-up feasibility study of women who had attended the Monash Alfred Psychiatry research centre, Women's Mental Health Clinic, with a diagnosis of PMDD. 67% of the sample also had concurrent cPTSD, 29% co-morbid anxiety, and 20% depression. They were recommended treatment with nomegestrol acetate/17-beta estradiol. Eligible women were contacted by telephone to answer a questionnaire to assess women's subjective response to nomegestrol acetate/17-beta estradiol, acceptability and the Depression, Anxiety and Stress Scale-21 (DASS-21) after being recommended nomegestrol acetate/17-beta estradiol. The paired-sample t-test was used to determine if there were any statistically significant differences in the DASS-21 scores over the study observation period (before and after taking nomegestrol acetate/17-beta estradiol).

Results

35 (74.5%) women reported a subjective positive mood response to nomegestrol acetate/17-beta estradiol, 31 (63.3%) adhered to the medication, and only 10 (20.4%) women reported side effects as the main reason for discontinuing nomegestrol acetate/17-beta estradiol. There were statistically significant reductions (p<0.05) in the overall DASS-21 scores from before women commenced nomegestrol acetate/17-beta estradiol and after commencement of treatment.

Conclusions

This preliminary study supports the acceptability and effectiveness of nomegestrol acetate/17-beta estradiol as a treatment for mood symptoms in PMDD. Further research, particularly a randomized controlled trial, is required to elucidate the effect of nomegestrol acetate/17-beta estradiol treatment on mood in PMDD.

Dydrogesterone indications beyond menopausal hormone therapy: an evidence review and woman's journey

Dydrogesterone is an orally active synthetic progestogen, with a molecular structure similar to that of natural progesterone. As dydrogesterone does not inhibit ovulation at standard doses, is devoid of estrogenic or androgenic properties, and does not induce metabolic side effects, it is suitable for use throughout a woman's lifetime, from adolescence to older age, for conditions associated with altered levels of endogenous progesterone. Aside from its well established role as a component of menopausal hormone therapy, dydrogesterone is indicated in younger women for treatment of dysmenorrhea, irregular menstrual cycles, premenstrual syndrome, and threatened or recurrent miscarriage; and is effective as luteal phase support during assisted reproduction techniques. In this narrative review, evidence is examined for use of dydrogesterone across a range of disorders affecting menses and pregnancy. A case study woven into the review illustrates the clinical uses of dydrogesterone during a young woman's journey to become a mother.

Evaluation of the effectiveness of a training program for coping with PMS symptoms based on IMB model in university students

Premenstrual syndrome (PMS) is a common health problem that adversely affects young women's quality of life. This paper evaluated the effectiveness of a "Training Program for Coping with PMS Symptoms based on Information-Motivation-Behavioral Skills (IMB) model" in university nursing students. This controlled intervention study was conducted between September 2017 and February 2018. No sampling was performed. The goal was to include all students who met the inclusion criteria. The sample consisted of 95 first-year nursing students from two universities divided into two groups: intervention (n = 40) and control (n = 45) (power of 84.5%, p = .05, effect size = 0.45). The intervention group received the training, followed by individual motivational counseling first and second months after the training. The control group did not participate in the training program. The intervention group had more PMS symptoms coping behaviors (recognizing premenstrual change, performing regular exercises, relaxation techniques, pursuing a healthy diet, communicating with family and friends) than their counterparts in the control group after the training program (p < .05). The intervention group had higher Premenstrual Coping Measure scores (recognizing premenstrual changes, performing self-care, avoiding harm, communicating) after training program (p < .05). Although habits are hard to break, especially at young ages, the training helped university students adopt PMS coping behaviors.

Altered fractional amplitude of low-frequency fluctuation in women with premenstrual syndrome via acupuncture at Sanyinjiao (SP6)

BACKGROUND

Premenstrual syndrome (PMS) is a prevalent gynecological disease and is significantly associated with abnormal neural activity. Acupuncture is an effective treatment on PMS in clinical practice. However, few studies have been performed to investigate whether acupuncture might modulate the abnormal neural activity in patients with PMS. Thereby, the aim of the study was to assess alterations of the brain activity induced by acupuncture stimulation in PMS patients.

METHODS

Twenty PMS patients were enrolled in this study. All patients received a 6-min resting-state functional magnetic resonance imaging (rs-fMRI) scan before and after electro-acupuncturing stimulation (EAS) at Sanyinjiao (SP6) acupoint in the late luteal phase of menstrual. Fractional amplitude of low-frequency fluctuation (fALFF) method was applied to examine the EAS-related brain changes in PMS patients.

RESULTS

Compared with pre-EAS at SP6, increased fALFF value in several brain regions induced by SP6, including brainstem, right thalamus, bilateral insula, right paracentral lobule, bilateral cerebellum, meanwhile, decreased fALFF in the left cuneus, right precuneus, left inferior temporal cortex.

CONCLUSIONS

Our findings provide imaging evidence to support that SP6-related acupuncture stimulation may modulate the neural activity in patients with PMS. This study may partly interpret the neural mechanisms of acupuncture at SP6 which is used to treat PMS patients in clinical.

TRIAL REGISTRATION

The study was registered on http://www.chictr.org.cn . The Clinical Trial Registration Number is ChiCTR-OPC-15005918, registry in 29/01/2015.

Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review

Previous research has identified how menstruation is an important factor in both attempted and completed suicides for women. The purpose of this review was to outline (a) the risk profile for suicidality in women who were identified to experience Premenstrual Dysphoric Disorder (PMDD), a condition characterized by severe physical and psychological changes that occur during the luteal menstrual phase, and (b) the implications of these findings for clinical practice. A systematic literature review was conducted using five databases to identify any peer-reviewed articles published between 1989 and 2019. Ten papers eligible for inclusion were identified: three pertaining to suicide cognitions, five to suicide attempts and two to both cognitions and attempts. Findings showed that suicidal thoughts, ideation, plans and attempts were strongly associated with experiences of PMDD and that these findings were independent of psychiatric co-morbidities. However, women with PMDD did not present with more severe risk profiles for suicide attempts (in terms of frequency, impulsivity and lethality) or make more frequent attempts during the luteal menstrual phase compared with suicide attempters without PMDD. Women with PMDD should be considered a high risk group for suicidality; thus, identifying and treating symptoms are vital in reducing suicide attempts. Implications for clinical practice are outlined in the discussion.

Premenstrual Symptoms and Work: Exploring Female Staff Experiences and Recommendations for Workplaces

Most women experience some premenstrual symptoms during their reproductive years. Yet, this is an under-researched health issue, particularly in the context of work. This study aimed to: (i) understand the prevalence and severity of premenstrual symptoms experienced by working females, and their association with key work outcomes; (ii) explore factors that may be influencing these symptoms and their severity; and (iii) examine how organizations might help staff with premenstrual symptoms that may be impacting their working lives. An online, anonymous survey collected quantitative and qualitative data from 125 working women in the UK. Over 90% of the sample reported some premenstrual symptoms; 40% experienced premenstrual symptoms moderately or severely. Higher symptom severity was significantly (p < 0.05) associated with poor presenteeism, intention to reduce working hours, and higher work absence (time off work, being late, leaving early). Moderate/severe symptoms were significantly associated with several individual-related variables: lower perceived general health, higher alcohol consumption, poorer sleep quality, anxiety, depression, hormonal contraception, and using fewer coping approaches towards premenstrual symptoms (avoiding harm, adjusting energy levels); and work-related variables: poorer work–life balance, lower levels of psychological resilience, higher perceived work demands, less control over work. Disclosure of premenstrual symptoms and sickness absence because of premenstrual symptoms was very low, typically because of perceptions of appropriateness as a reason for work absence, gender of line managers (male), and it being a personal or embarrassing topic. Staff with moderate to severe premenstrual symptoms were statistically more likely to disclose reason for absence than those with milder symptoms. Recommendations and suggestions for employers and line managers include the need to train staff to improve knowledge about women’s experience of premenstrual symptoms, to be able to communicate effectively with women and to provide tailored support and resources for those who need it. Implications for future research, policy and practice are discussed.

The reliability and validity of the Japanese version of the Daily Record of Severity of Problems (J-DRSP) and Development of a Short-Form version (J-DRSP (SF)) to assess symptoms of premenstrual syndrome among Japanese women

PURPOSE

To assess the validity and reliability of the Japanese version of the Daily Record of Severity of Problems (J-DRSP, 24 items) for evaluating symptoms of premenstrual syndrome (PMS), and to develop a short form version of the J-DRSP.

METHODS

Using the "DRSP-JAPAN" smartphone app, we collected daily J-DRSP records from cycle day - 6 (CD - 6) to CD 10, with CD 1 representing the menstruation onset date. Factorial validity (exploratory factor analysis: EFA, confirmatory factor analysis: CFA) and criterion validity were examined, and test-retest reliability (intraclass correlation: ICC) evaluated. The short-form version of the J-DRSP was developed using classical test theory.

RESULTS

In total, 304 women participated and 243 recorded symptoms on at least 4 days spanning the week of the luteal phase (CD - 6 to CD 0) and 4 days spanning the week of the follicular phase (CD 4 to CD 10), with CD 0 set as the day before menstruation started. The EFA revealed a two-factor structure. Kaiser-Meyer-Olkin was 0.992, and Bartlett's test of sphericity chi-square was 3653.89 (P < 0.001). However, the model fitness of CFA was found to be suboptimal (comparative fit index (CFI): 0.83, root mean square error of approximation (RMSEA): 0.12). Total scores for J-DRSP and the sum scores for each subscale were higher on CD 0 than on CD 10 (p < 0.001), suggesting validity for some criteria. ICC values for the total J-DRSP score from CD 0 to CD - 1, and between CD 9 to CD 10, were 0.60 (95% CI: 0.48-0.72) and 0.76 (95% CI: 0.69-0.82), respectively. Having eliminated some original items after considering factor loading for each item, we developed an 8-item Short-Form J-DRSP (J-DRSP (SF)) comprising 2 factors (S-Psychological and S-Physical, 4 items for each). CFA showed a better model fit (CFI: 0.99, RMSEA: 0.048), and ICC values in the luteal and follicular phases were 0.61 (95%CI: 0.51-0.68) and 0.70 (95%CI: 0.62-0.77), respectively.

CONCLUSION

The J-DRSP has moderate to good reliability and a certain level of validity. The 8-item J-DRSP (SF) has a two-factor structure and can be used effectively among Japanese women to assess their PMS symptoms.

Does premenstrual syndrome before pregnancy increase the risk of postpartum depression? Findings from the Australian Longitudinal Study on Women's Health

BACKGROUND

Previous literature suggests a positive association between history of premenstrual syndrome (PMS) and development of postpartum depression (PPD); however, limited evidence has come from prospective population-based studies and whether history of depression affects this association is unknown.

METHODS

This study included 5479 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health and estimated the association between pre-pregnancy PMS and PPD. Participants were followed from 22-27 years in 2000 to 37-42 years in 2015. PMS was collected from a 4-category Likert-scale reporting on frequency of PMS in the last 12 months (never, rarely, sometimes, or often) at the survey preceding an index birth. PPD was ascertained from reports of doctor diagnoses for each birth. Relative risks (RRs) and 95% confidence intervals (CIs) were used to estimate the association of interest. The role of history of depression was assessed by testing its interaction with pre-pregnancy PMS.

RESULTS

During 15 years' follow-up, 15.4% of participating women reported PPD; and 55.1% reported PMS (rarely: 17.2%, sometimes: 25.7%, and often: 12.2%). Compared to women who had no PMS before pregnancy, those who rarely had PMS had similar risk of PPD (1.03, 0.82-1.30); whereas those who sometimes or often had PMS had significantly higher risk of PPD (1.31, 1.09-1.57 and 1.51, 1.22-1.87, respectively). History of depression did not affect the association.

LIMITATIONS

PMS was self-reported. PMS severity was not collected.

CONCLUSIONS

This large population-based study provides evidence of a dose-response relationship between PMS prior to pregnancy and PPD, independent of history of depression. Evidence to date suggests PMS has the potential to help identify women at increased risk of PPD before pregnancy.

Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review

Bipolar disorder (BD) differs in its clinical presentation in females compared to males. A number of clinical characteristics have been associated with BD in females: more rapid cycling and mixed features; higher number of depressive episodes; and a higher prevalence of BD type II. There is a strong link between BD and risk for postpartum mood episodes, and a substantial percentage of females with BD experience premenstrual mood worsening of varying degrees of severity. Females with premenstrual dysphoric disorder (PMDD)-the most severe form of premenstrual disturbances-comorbid with BD appear to have a more complex course of illness, including increased psychiatric comorbidities, earlier onset of BD, and greater number of mood episodes. Importantly, there may be a link between puberty and the onset of BD in females with comorbid PMDD and BD, marked by a shortened gap between the onset of BD and menarche. In terms of neurobiology, comorbid BD and PMDD may have unique structural and functional neural correlates. Treatment of BD comorbid with PMDD poses challenges, as the first line treatment of PMDD in the general population is selective serotonin reuptake inhibitors, which produce risk of treatment-emergent manic symptoms. Here, we review current literature concerning the clinical presentation, illness burden, and unique neurobiology of BD comorbid with PMDD. We additionally discuss obstacles faced in symptom tracking, and management of these comorbid disorders.

Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app

OBJECTIVES

The menstrual cycle can affect sports participation and exercise performance. There are very few data on specific menstrual cycle symptoms (symptoms during various phases of the cycle, not only during menstruation) experienced by exercising women. We aimed to characterise the most common symptoms, as well as the number and frequency of symptoms, and evaluate whether menstrual cycle symptoms are associated with sporting outcomes.

METHODS

6812 adult women of reproductive age (mean age: 38.3 (8.7) years) who were not using combined hormonal contraception were recruited via the Strava exercise app user database and completed a 39-part survey. Respondents were from seven geographical areas, and the questions were translated and localised to each region (Brazil, n=892; France, n=1355; Germany, n=839; Spain, n=834; UK and Ireland, n=1350; and USA, n=1542). The survey captured exercise behaviours, current menstrual status, presence and frequency of menstrual cycle symptoms, medication use for symptoms, perceived effects of the menstrual cycle on exercise and work behaviours, and history of hormonal contraception use. We propose a novel Menstrual Symptom index (MSi) based on the presence and frequency of 18 commonly reported symptoms (range 0-54, where 54 would correspond to all 18 symptoms each occurring very frequently).

RESULTS

The most prevalent menstrual cycle symptoms were mood changes/anxiety (90.6%), tiredness/fatigue (86.2%), stomach cramps (84.2%) and breast pain/tenderness (83.1%). After controlling for body mass index, training volume and age, the MSi was associated with a greater likelihood of missing or changing training (OR=1.09 (CI 1.08 to 1.10); p≤0.05), missing a sporting event/competition (OR=1.07 (CI 1.06 to 1.08); p≤0.05), absenteeism from work/academia (OR=1.08 (CI 1.07 to 1.09); p≤0.05) and use of pain medication (OR=1.09 (CI 1.08 to 1.09); p≤0.05).

CONCLUSION

Menstrual cycle symptoms are very common in exercising women, and women report that these symptoms compromise their exercise participation and work capacity. The MSi needs to be formally validated (psychometrics); at present, it provides an easy way to quantify the frequency of menstrual cycle symptoms.

Women's experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation

BACKGROUND

Premenstrual dysphoric disorder (PMDD) is a complex and disabling condition that affects women of reproductive age, characterised by severe physical and psychological symptoms that occur cyclically and remit following the onset of menses. As the psychological nature and consequences of PMDD often seem indistinguishable from symptoms of other mental health difficulties, this condition presents distinct diagnostic challenges for healthcare professionals. Therefore, this study aimed to explore women's experiences of both having PMDD and of receiving this diagnosis.

METHODS

Participant recruitment took place in the United Kingdom during 2018. Seventeen women who had been diagnosed with PMDD by a medical specialist and met the clinical criteria for PMDD on the premenstrual symptoms screening tool were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using reflexive thematic analysis.

RESULTS

Twelve subthemes were identified and organised around four main themes: (1) A broken woman, (2) Misdiagnosis and the lost decades, (3) A life transformed and (4) Negotiating the aftermath.

CONCLUSIONS

The findings of this study highlight the critical importance of the accurate and timely detection of PMDD, with the aim of preventing women from experiencing severe and prolonged psychological distress. In order to achieve this, there needs to be a greater understanding and awareness of PMDD within both the medical and lay communities, alongside training for healthcare practitioners in PMDD assessment.

Effect of exercise on symptoms of premenstrual syndrome in low and middle-income countries: a protocol for systematic review and meta-analysis

INTRODUCTION

Premenstrual syndrome (PMS) has the potential to affect the quality of life adversely. Published guidelines recommend the use of exercise as part of the first-line management interventions for PMS. However, the published evidence related to the effectiveness of physical activity and PMS is inconclusive. This review will assess the effectiveness of exercise-based interventions in reducing PMS in women screened or diagnosed with PMS in low and middle-income countries, where the prevalence of PMS is high.

METHODS AND ANALYSIS

Electronic databases will be researched, including Embase, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov and Google Scholar. All the studies published until March 2020 will be included. A standardised data extraction form will be used adapted from the Cochrane Handbook of Systematic Reviews of Interventions. Included articles will be assessed using the risk of bias tools based on study design. Data will be analysed using Review Manager V.5.3. The inverse-variance random-effects method will be used to report the standardised mean difference. A meta-analysis will be used only if studies are sufficiently homogenous. A narrative synthesis will be undertaken when studies are heterogeneous. Methodological heterogeneity between studies will be evaluated by considering the study types. Statistical heterogeneity will be tested using the I² test. Subgroup analyses may be performed only for the primary outcome in case of sufficient studies. Sensitivity analysis will be conducted to assess the impact of intervention excluding studies without randomisation and studies with a high risk of bias. Funnel plots will be used to assess the potential reporting bias and small-study effects only when there are more than 10 studies included in the meta-analysis.

ETHICS AND DISSEMINATION

This study does not require ethical approval, as the review is entirely based on published studies. The results will be published and/or will be presented at a pertinent conference.

PROSPERO REGISTRATION NUMBER

CRD42020163377.

Psychometric Testing of the Premenstrual Symptoms Questionnaire and the Association Between Perceived Injustice and Premenstrual Symptoms: A Cross-Sectional Study Among Japanese High School Students

Purpose

Premenstrual symptoms comprise a wide range of mood, behavioral, and physical symptoms occurring during the luteal phase. Perceived injustice is a belief linked to unfairness (ie, unnecessary suffering caused by illness). This study aimed to assess the validity and reliability of the Premenstrual Symptoms Questionnaire (PSQ), a patient-reported outcome measurement tool, and to examine the association between perceived injustice/perception of menstruation and premenstrual symptoms, as measured by the PSQ.

Materials and Methods

Of 1388 female students, we analyzed 879 students with regular menstrual cycles who completed the PSQ, the premenstrual dysphoric disorder (PMDD) scale, the Somatic Symptom Scale-8 (SSS-8), and the Injustice Experience Questionnaire-chronic (IEQ-chr). First, the PSQ was examined for evidence of reliability and validity. Next, we used multiple regression and multivariate logistic regression to investigate the association between perceived injustice and premenstrual symptoms, using PSQ score as both a continuous variable and a dichotomous variable (premenstrual disorders or not). Moreover, the association between PSQ score and perceived menstruation was tested using student's t-test and analysis of variance.

Results

In terms of reliability, Cronbach's α for PSQ score was 0.93. To assess structural validity, we used confirmatory factor analysis, which showed that the one-factor model and the two-factor model were a good fit. The PSQ showed good agreement with the PMDD scale. In terms of concurrent validity, PSQ total score correlated strongly with PMDD scale score, SSS-8 score, and IEQ-chr score (r = 0.88, 0.69, 0.57, respectively). IEQ-chr score predicted PSQ score (standardized regression coefficient = 0.53; P < 0.0001) and higher prevalence of premenstrual disorders (odds ratio: 1.15; 95% confidence interval: 1.12-1.19). Negative perception of menstruation was associated with premenstrual symptoms.

Conclusion

The PSQ showed sound psychometric properties among the adolescents in our sample. Perceived injustice and negative perception of menstruation were associated with premenstrual symptoms.

Short report: cognitive behavioral therapy - a primary mode for premenstrual syndrome management: systematic literature review

Most women in reproductive age experience at least one premenstrual syndrome (PMS) symptom every month over many years, and about 5% experience significant impairment, requiring professional intervention. Offering effective and sustainable treatment, is essential. While research acknowledges the effectiveness of nonpharmacological methods, cognitive behavioral therapy (CBT) and lifestyle modifications, as a treatment alternative, selective serotonin reuptake inhibitors or hormonal ovulation suppression continue to be recommended as a first-line treatment. We hypothesize that nonpharmacological methods will be sufficient for effective and sustainable PMS management. A systematic literature review was conducted for peer-reviewed original studies with the search terms: CBT, psychoeducation, PMS and premenstrual dysphoric disorder. All 32 identified studies found a significant reduction in PMS to complete remission with nonpharmacological interventions. No side effects were reported, and positive effect was sustained over time. Psychoeducational self-help packages, delivered with the affordance of modern technology, appeared to be enough for most women to manage successfully their PMS distress. Most severe PMS forms required one-to-one CBT. Nonpharmacological methods can be recommended as the primary mode for PMS management. More high-quality research is required, for developing personalized self-help packages, as well as the full use of modern technology for delivering the service.

The effects of psychoeducation based on the cognitive-behavioral approach on premenstrual syndrome symptoms: A randomized controlled trial

PURPOSE

The present study investigated the effects of psychoeducation based on a cognitive-behavioral approach on premenstrual syndrome (PMS) symptoms in young adult women.

DESIGN AND METHODS

The study was performed as a randomized controlled trial. The sample size was identified as 90 (45 intervention group/45 control group) students. The psychoeducation intervention consisted of five sessions performed over a 4-week period.

FINDINGS

There was a significant difference between the pretest and posttest total mean scores of the intervention group that received psychoeducation (P < .05). There was also a significant difference in depressive thoughts, irritability, and fatigue mean scores between the two groups (P < .05).

PRACTICAL IMPLICATIONS

The use of this approach and its inclusion in nursing care interventions is recommended to reduce PMS symptoms in young adult women.

Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials

Background

Exercise is recommended as a treatment for premenstrual syndrome (PMS) in clinical guidelines, but this is currently based on poor-quality trial evidence.

Aim

To systematically review the evidence for the effectiveness of exercise as a treatment for PMS.

Design & setting

This systematic review searched eight major databases, including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), and two trial registries from inception until April 2019.

Method

Randomised controlled trials (RCTs) comparing exercise interventions of a minimum of 8-weeks duration with non-exercise comparator groups in women with PMS were included. Mean change scores for any continuous PMS outcome measure were extracted from eligible trials and standardised mean differences (SMDs) were calculated where possible. Random-effects meta-analysis of the effect of exercise on global PMS symptoms was the primary outcome. Secondary analyses examined the effects of exercise on predetermined clusters of psychological, physical, and behavioural symptoms.

Results

A total of 436 non-duplicate returns were screened, with 15 RCTs eligible for inclusion (n = 717). Seven trials contributed data to the primary outcome meta-analysis (n = 265); participants randomised to an exercise intervention reported reduced global PMS symptom scores (SMD = -1.08; 95% confidence interval [CI] = -1.88 to -0.29) versus comparator, but with substantial heterogeneity (I² = 87%). Secondary results for psychological (SMD = -1.67; 95% CI = -2.38 to -0.96), physical (SMD = -1.62; 95% CI = -2.41 to -0.83) and behavioural (SMD = -1.94; 95% CI = -2.45 to -1.44) symptom groupings displayed similar findings. Most trials (87%) were considered at high risk of bias.

Conclusion

Based on current evidence, exercise may be an effective treatment for PMS, but some uncertainty remains.

Cognition, The Menstrual Cycle, and Premenstrual Disorders: A Review

Sex hormones, such as estrogens, progesterone, and testosterone, have a significant influence on brain, behavior, and cognitive functioning. The menstrual cycle has been a convenient model to examine how subtle fluctuations of these hormones can relate to emotional and cognitive functioning. The aim of the current paper is to provide a narrative review of studies investigating cognitive functioning in association with the menstrual cycle in biological females, with a focus on studies that have investigated cognitive functioning across the menstrual cycle in females with premenstrual mood disorders, such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). In line with previous reviews, the current review concluded that there is a lack of consistent findings regarding cognitive functioning across the menstrual cycle. Most studies focused on changes in levels of blood estrogen, and neglected to explore the role of other hormones, such as progesterone, on cognitive functioning. Cognitive research involving premenstrual disorders is in its infancy, and it remains unclear whether any cognitive disturbances that are identified may be attributed to negative experience of mood and psychological symptoms or be a more direct effect of hormonal dysregulation or sensitivity. Suggestions for future research are provided.

Open-label placebo treatment of women with premenstrual syndrome: study protocol of a randomised controlled trial

INTRODUCTION

Recent evidence suggests that for certain clinical conditions, placebos can improve clinical outcomes even without deception. These so-called open-label placebos (OLPs) bear the advantage of a significant lower risk of adverse events and comply with ethical principles. Although premenstrual syndrome (PMS) seems to be considerably susceptible to placebo effects, no study has examined open-OLP responses on PMS.

METHODS AND ANALYSIS

To test the efficacy of OLPs in women suffering from PMS, a clinical randomised controlled trial including two OLP study groups (with and without treatment rationale) was designed to investigate on the effect on PMS. PMS symptoms are monitored on a daily basis via a symptom diary, adverse events are monitored intermittently. The study started in spring 2018 and patients will be included until a maximum of 150 participants are randomised. Besides the primary outcome PMS symptom intensity and interference, an array of further variables is assessed. Multilevel modelling will be used for data analyses.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee Northwest and Central Switzerland. Results of the main analysis and of secondary analyses will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBERS: (1) ClinicalTrials.gov (NCT03547661); (2) Swiss national registration (SNCTP000002809).

History of premenstrual syndrome and development of postpartum depression: A systematic review and meta-analysis

BACKGROUND

Premenstrual syndrome (PMS) is thought to be a risk factor for postpartum depression (PPD), but results from studies examining the association have been mixed.

OBJECTIVES

To estimate the association between pre-pregnancy history of PMS and development of PPD and evaluate the risk of bias of included evidence.

SEARCH STRATEGY

PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang Data, and reference lists of relevant papers were searched.

SELECTION CRITERIA

Observational studies that collected pre-pregnancy history of PMS and measured PPD status between one week and one year after delivery were included.

DATA COLLECTION AND ANALYSIS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence interval (CI). Small study effect was analysed by funnel plot. Risk of bias was assessed using the Risk of Bias Instrument for Non-Randomized Studies of Exposures (ROBINS-E).

MAIN RESULTS

Our meta-analysis included 19 studies. Overall, women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68). However, the quality of evidence was low: five studies had moderate risk, eleven studies had serious risk, and three studies had critical risk of bias.

CONCLUSIONS

Current evidence supports a significant association between history of PMS and development of PPD. Well-designed prospective studies are needed to further investigate this relationship.

Development of a Japanese Version of the Daily Record of Severity of Problems for Diagnosing Premenstrual Syndrome

Background: Premenstrual syndrome (PMS) causes physical and mental symptoms in women during the luteal phase of the menstruation cycle. To confirm the relationship between symptoms and the menstruation cycle, daily symptom records are essential for diagnosing PMS. The daily record of severity of problems (DRSP) is currently the most validated tool for tracking symptoms to confirm and scale the severity of PMS, but there has been no validated Japanese version of this instrument. We developed a Japanese version of the DRSP and assessed its psychometric properties.

Methods: A Japanese version of the DRSP was developed following the translation guidelines of the latest Patient-Reported Outcomes Consortium. We conducted a computational psychometric study among 119 women, all of whom completed the Japanese version of the DRSP, the Center for Epidemiologic Studies Depression Scale (CES-D), the Premenstrual Dysphoric Disorder (PMDD) scale, and a Numerical Rating Scale (NRS) for general health status. Each was filled out twice, 2 weeks apart, so that one set was completed in the luteal phase.

Results: The Japanese version of the DRSP was developed with translation and cultural adaptation. The internal consistency coefficient for the total score was 0.93. The DRSP in the luteal phase correlated highly with the CES-D, PMDD scale, and NRS for general health status.

Conclusions: Our Japanese version of the DRSP, developed as a PMS/PMDD diagnostic tool, was shown to provide substantial validity and reliability to rate premenstrual symptoms for Japanese women.