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Mackenzie ACL, Chung S, Hoppes E, Mickler AK, Cartwright AF. Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials. PLoS One 2024; 19:e0306491. [PMID: 39052601 PMCID: PMC11271926 DOI: 10.1371/journal.pone.0306491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.
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Affiliation(s)
- Amelia C. L. Mackenzie
- Global Health and Population, FHI 360, Washington, District of Columbia, United States of America
| | - Stephanie Chung
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Emily Hoppes
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
| | - Alexandria K Mickler
- Research, Technology and Utilization Division, United States Agency for International Development and the Public Health Institute, Office of Population and Reproductive Health, Bureau for Global Health, Washington, District of Columbia, United States of America
| | - Alice F. Cartwright
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Hennegan J, Brooks DJ, Schwab KJ, Melendez-Torres GJ. Measurement in the study of menstrual health and hygiene: A systematic review and audit. PLoS One 2020; 15:e0232935. [PMID: 32497117 PMCID: PMC7272008 DOI: 10.1371/journal.pone.0232935] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background The lack of established measurement tools in the study of menstrual health and hygiene has been a significant limitation of quantitative studies to date. However, there has been limited exploration of existing measurement to identify avenues for improvement. Methods We undertook two linked systematic reviews of (1) trials of menstrual health interventions and their nested studies in low- and middle-income countries, (2) studies developing or validating measures of menstrual experiences from any location. Systematic searching was undertaken in 12 databases, together with handsearching. We iteratively grouped and audited concepts measured across included studies and extracted and compared measures of each concept. Results A total of 23 trials, 9 nested studies and 22 measure development studies were included. Trials measured a range of outcomes including menstrual knowledge, attitudes, and practices, school absenteeism, and health. Most measure validation studies focused on assessing attitudes towards menstruation, while a group of five studies assessed the accuracy of women’s recall of their menstrual characteristics such as timing and cycle length. Measures of menstrual knowledge, attitudes, beliefs and restrictions were inconsistent and frequently overlapped. No two studies measured the same menstrual or hygiene practices, with 44 different practices assessed. This audit provides a summary of current measures and extant efforts to pilot or test their performance. Conclusions Inconsistencies in both the definition and operationalisation of concepts measured in menstrual health and hygiene research should be addressed. To improve measurement, authors should clearly define the constructs they aim to measure and outline how these were operationalised for measurement. Results of this audit indicate the need for the development and validation of new measures, and the evaluation of the performance of existing measures across contexts. In particular, the definition and measurement of menstrual practices, knowledge, attitudes, norms and restrictions should be addressed. Review protocol registration CRD42018089884.
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Affiliation(s)
- Julie Hennegan
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Deborah Jordan Brooks
- The John Sloan Dickey Center for International Understanding and Department of Government, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Kellogg J. Schwab
- The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - G. J. Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Fahs B. There Will Be Blood: Women’s Positive and Negative Experiences with Menstruation. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2019.1690309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Breanne Fahs
- Women and Gender Studies Program, Arizona State University, Glendale, Arizona, USA
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The Body Appreciation Scale-2: Item interpretation and sensitivity to priming. Body Image 2019; 28:16-24. [PMID: 30465919 DOI: 10.1016/j.bodyim.2018.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022]
Abstract
The Body Appreciation Scale-2 (BAS-2) is a widely-used measure of positive body image. Items are worded ambiguously to allow reference to any aspect of the body during measure completion. We examined (a) how BAS-2 items are interpreted and whether this interpretation is influenced by the content of measures administered prior to it, (b) whether measures administered prior to the BAS-2 alter its scores or (c) the correlation between BAS-2 scores and scores on a measure of body dissatisfaction, (d) how BAS-2 item interpretation relates to total scores, and (e) whether BAS-2 scores are associated with investment in appearance for aesthetic purposes. Canadian female undergraduates (N = 392) completed one of four priming questionnaires, followed by the BAS-2, and then indicated how they interpreted each BAS-2 item. Most items were interpreted in terms of appearance, with the primes having no impact on item interpretation, scores, or the magnitude of the correlation with body dissatisfaction. BAS-2 scores were highest among women interpreting a moderate number of items in terms of appearance and negatively correlated with investment for aesthetic purposes. Thus, the BAS-2 is not vulnerable to priming, but among young Western women, items are likely to be interpreted in terms of appearance.
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Kaiser G, Schormann A, Kues JN, Weise C. Knowledge about Positive Premenstrual Changes and Somatosensory Amplification Increase the Report of Positive Premenstrual Changes: An Experimental Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:237-239. [PMID: 29788011 DOI: 10.1159/000489499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/19/2018] [Indexed: 11/19/2022]
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Kues JN, Janda C, Krzikalla C, Andersson G, Weise C. The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes. Women Health 2016; 58:16-37. [PMID: 27892822 DOI: 10.1080/03630242.2016.1263274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although women predominantly report negative premenstrual changes, a substantial portion of women also reports positive changes. Little is known about factors related to report of positive and negative premenstrual changes. The aim of this experimental study at the Philipps-University of Marburg from January and February 2015 was to investigate the effect of manipulated information about premenstrual changes on the retrospective report of premenstrual changes. A total of 241 healthy women were randomly assigned either to an experimental group (EG) reading: (1) text focusing on negative and positive premenstrual changes (EG1 (+/-)); (2) text focusing on negative changes (EG2 (-)); or (3) control group (CG) text. At least one positive premenstrual change was reported by the majority of the participating women. The results of the MANOVA and discriminant analysis showed that, after having read the text, EG2 (-) reported more negative and fewer positive premenstrual changes in a retrospective screening compared to EG1 (+/-) and CG. No significant difference was observed between EG1 (+/-) and CG. The results show the negative influence of information focusing on negative premenstrual changes on the retrospective report of both negative and positive premenstrual changes.
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Affiliation(s)
- Johanna N Kues
- a Division of Clinical Psychology and Psychotherapy, Department of Psychology , Philipps-University of Marburg , Marburg , Germany
| | - Carolyn Janda
- a Division of Clinical Psychology and Psychotherapy, Department of Psychology , Philipps-University of Marburg , Marburg , Germany
| | - Clara Krzikalla
- a Division of Clinical Psychology and Psychotherapy, Department of Psychology , Philipps-University of Marburg , Marburg , Germany
| | - Gerhard Andersson
- b Linnaeus Centre, Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.,c Psychiatry Section, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Cornelia Weise
- a Division of Clinical Psychology and Psychotherapy, Department of Psychology , Philipps-University of Marburg , Marburg , Germany.,b Linnaeus Centre, Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
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Wister JA, Stubbs ML, Shipman C. Mentioning Menstruation: A Stereotype Threat that Diminishes Cognition? SEX ROLES 2012. [DOI: 10.1007/s11199-012-0156-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dunnavant NC, Roberts TA. Restriction and Renewal, Pollution and Power, Constraint and Community: The Paradoxes of Religious Women’s Experiences of Menstruation. SEX ROLES 2012. [DOI: 10.1007/s11199-012-0132-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lustyk MKB, Gerrish WG, Douglas H, Bowen S, Marlatt GA. Relationships Among Premenstrual Symptom Reports, Menstrual Attitudes, and Mindfulness. Mindfulness (N Y) 2011; 2:37-48. [PMID: 27162560 DOI: 10.1007/s12671-011-0041-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The physical and affective symptoms of a broad range of conditions are improved following mindfulness-based practices. One set of symptoms that has yet to be explored through the lens of mindfulness, however, is that associated with the premenstruum. Also, given the relationships among negative attitudes towards menstruation and amplified symptom reporting, it is reasonable to expect that mindfulness qualities cultivated through practices aimed at dispelling negative anticipatory and judgmental thinking will moderate these relationships. Thus, in this study we examined interrelationships among premenstrual symptom severity reports (PMSR), menstrual attitudes, and mindfulness qualities in a sample of 127 women (age range 18-26 years). Results revealed several statistically significant positive relationships between menstrual attitudes and PMSR. Also, higher scores on measures of mindfulness were significantly associated with lower PMSR. Moderating effects revealed that mindfulness significantly buffered the relationships between menstrual attitudes and PMSR, specifically between: anticipation of menses onset and PMSR as well as anticipation of menses onset and premenstrual water retention. These results may offer the first empirical evidence of relationships among menstrual attitudes, PMSR, and mindfulness qualities. Results from this study align with the body of research showing that mindfulness is predictive of improved symptomatology and well-being across varied conditions. We conclude with discussion supporting the development of a mindfulness-based intervention aimed at reducing symptom severity in premenstrual symptom sufferers.
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Affiliation(s)
- M Kathleen B Lustyk
- School of Psychology, Family, and Community, Seattle Pacific University, 3307 Third Ave. West, Suite 107, Seattle, WA 98119, USA
| | - Winslow G Gerrish
- School of Psychology, Family, and Community, Seattle Pacific University, 3307 Third Ave. West, Suite 107, Seattle, WA 98119, USA
| | - Haley Douglas
- School of Psychology, Family, and Community, Seattle Pacific University, 3307 Third Ave. West, Suite 107, Seattle, WA 98119, USA
| | - Sarah Bowen
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - G Alan Marlatt
- Department of Psychology, University of Washington, Seattle, WA, USA
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HOPWOOD MAX, BRENER LOREN, FRANKLAND ANDREW, TRELOAR CARLA. Assessing community support for harm reduction services: Comparing two measures. Drug Alcohol Rev 2010; 29:385-91. [DOI: 10.1111/j.1465-3362.2009.00151.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rose JG, Chrisler JC, Couture S. Young Women's Attitudes Toward Continuous Use of Oral Contraceptives: The Effect of Priming Positive Attitudes Toward Menstruation on Women's Willingness to Suppress Menstruation. Health Care Women Int 2008; 29:688-701. [DOI: 10.1080/07399330802188925] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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