A review of treatment and management modalities for premenstrual dysphoric disorder

Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019

STUDY QUESTION

What is the burden of premenstrual syndrome (PMS) at the global, regional, and national levels across 21 regions and 204 countries and territories?

SUMMARY ANSWER

Over the past few decades, the global prevalent cases of PMS have grown significantly from 652.5 million in 1990 to 956.0 million in 2019, representing a 46.5% increase.

WHAT IS KNOWN ALREADY

PMS, which affects almost half of reproductive women worldwide, has substantial social, occupational, academic, and psychological effects on women's lives. However, no comprehensive and detailed epidemiological estimates of PMS by age and socio-demographic index (SDI) at global, regional, and national levels have been reported.

STUDY DESIGN, SIZE, DURATION

An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of PMS by age and SDI across 21 regions and 204 countries and territories has been performed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The prevalence and YLD of PMS from 1990 to 2019 were retrieved directly from the Global Burden of Diseases (GBD) 2019 study. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels.

MAIN RESULTS AND THE ROLE OF CHANCE

Globally, the prevalent cases of PMS increased by 46.5% from 652.5 million in 1990 to 956.0 million in 2019; in contrast, however, the age-standardized prevalence rate was approximately stable at 24 431.15/100 000 persons in 1990 and 24 406.51/100 000 persons in 2019 (AAPC, 0[95% CI: -0.01 to 0.01]). Globally, the YLD was 8.0 million in 2019 and 5.4 million in 1990, with a sizable increase over the past 30 years. The age-standardized YLD rate was stable (AAPC 0.01, P = 0.182), at 203.45/100 000 persons in 1990 and 203.76/100 000 persons in 2019. The age-standardized burden estimates were the highest in the low-middle SDI regions and the lowest in the high SDI regions. Peaks in burden rate estimates were all observed in the 40-44 years age group. Regional age-standardized burden estimates were the highest in South Asia and the lowest in Western Sub-Saharan Africa. The national age-standardized burden estimates were the highest in Pakistan and the lowest in Niger.

LIMITATIONS, REASONS FOR CAUTION

The accuracy of the results depended on the quality and quantity of the GBD 2019 data. Fortunately, the GBD study endeavoured to retrieve data globally and applied multiple models to optimize the completeness, accuracy, and reliability of the data. In addition, the GBD study took the country as its basic unit and neglected the influence of race. Further study is warranted to compare differences in PMS burden associated with race. Finally, no data are available on the aetiology and risk information related to PMS, which might help us to better understand the trends and age distribution of PMS and help local governments formulate more detailed policies and comprehensive interventions.

WIDER IMPLICATIONS OF THE FINDINGS

Although the age-standardized prevalence/YLD rate has been stable over the past 30 years, the absolute number of prevalent cases and YLD grew significantly worldwide from 1990 to 2019. Public health-related policies should be implemented to reduce the prevalence and alleviate the symptoms of PMS. Lifestyle changes and cognitive-behavioral therapy are critical in helping to reduce the burden of PMS.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Key Research and Development Program of China (grant number 2022YFC2704100) and the National Natural Science Foundation of China (No. 82001498, No. 82371648). The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

[Premenstrual dysphoric disorder (PMDD): Drug and psychotherapeutique management, a literature review]

INTRODUCTION

Premenstrual Dysphoric Disorder (PMDD) was first recognised in July 2013 in the DSM-5 after a long journey to identify its existence. It was not until 1983 that the US National Institute of Mental Health determined research criteria for the study of PMS. In 1994, the term "premenstrual dysphoric disorder" (PMDD) replaced this term in the 4th edition of the Diagnostic System Manual (DSM). It was listed in the section "Mood Disorder Not Otherwise Specified" and remained under consideration until the DSM-5, in which it appeared in the depressive disorders section. The legitimisation of the psychiatric diagnosis as well as the determination of clear symptomatology criteria in 2013 opened up possibilities for management, development of clinical, pathophysiological, therapeutic and psychotherapeutic studies. This disabling disorder can affect personal, social, family and professional life. In 2019, the ICD-11 in turn introduced the diagnosis of premenstrual dysphoric disorder, which solidifies the recognition of the disorder.

OBJECTIVE

(I) to review the existing treatments, both medicinal and psychotherapeutic, and (II) to review their effectiveness. At the end of this work we will formulate recommendations for the management of these patients.

METHODOLOGY

A bibliographic search was carried out from 7 June 2021 to 7 July2021 on the databases (bases de données) Psychinfo APA, Scopus, PubMed, as well as the bases de données of the Cochrane organisation and the recommendation documents of the Haute Autorité de la santé. After an initial selection based on keywords, the full text of all articles were read to arrive at the final selection of 32 articles.

RESULTS

Antidepressants and Cognitive Behavioural Therapies (CBT) appear to be the most commonly recommended treatments for PMDD. Other research shows the effectiveness of oral contraceptives including drospirenone. Selective serotonin reuptake inhibitors (SSRIs) were identified as an effective treatment for PMDD. These data are consistent with the current etiological hypothesis of PMDD which has a negative impact of natural hormonal fluctuations on certain neurotransmitters. CBT showed positive results in reducing the functional impact of PMDD.

DISCUSSION

Selective serotonin reuptake inhibitor (SSRI) antidepressants were reported to be first-line treatments for PMDD (sertraline 50-150 mg/d, fluoxetine 10-20 mg/d, escitalopram 10-20 mg/d, paroxetine 12.5-25 mg/d). Drospirenone (EE 3 mg and EE 20 mg/d 24 days of hormonal pills, 4 days inactive) appears to have been a first or second line treatment depending on the articles. Current results clearly point to the effectiveness of CBT in helping to reduce: functional impairment, depressed mood, feelings of hopelessness, anxiety, mood swings, sensitivity, irritability, insomnia, conflict with others, impact of premenstrual symptoms on daily life, intensity of symptoms experienced, and symptom handicap. CBTs could also become a first-line treatment if there were to be more evidence of their effectiveness. In the future, it would seem useful to offer a psychotherapeutic treatment that can be reproduced and to multiply research with a high level of scientific comparability in order to clarify the place of CBT in the management of PMDD. Research on the etiopathology of the disorder and the optimal drug regimen is still ongoing. There is a need to develop appropriate psychotherapeutic techniques to support and accompany these patients.

CONCLUSION

In order to better evaluate treatments for PMDD, there is a need to homogenise studies on the subject at several levels: design, treatment doses, psychotherapeutic techniques, and evaluation measures. At present, some studies include both premenstrual syndrome (PMS) and PMDD patients. PMS and PMDD do not include the same symptoms, nor the same severity and potentially the same aetiology in the patients studied. In order to propose rigorous research that evaluates the effectiveness of treatments for PMDD and to properly support people with both these disorders, it seems essential to distinguish the two conditions. The role of the health practitioner is to be able to identify PMDD by differentiating it from other clinically related disorders. The patient must then be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications and her preferences. In 2021, the French National Authority for Health did not offer any guidelines or recommendations for the management of premenstrual dysphoric disorder. There is a need to develop research in France.

Investigation of coping behaviors and premenstrual syndrome among university students

This study aims to examine premenstrual syndrome (PMS) in university students and their coping behaviors. 452 female students were included in this descriptive and correlational study. The data were collected using a descriptive information form, the Premenstrual Syndrome Scale (PMSS), and the Premenstrual Change Coping Inventory (PMS-Cope). PMS symptoms were found in 80.5% of students. Seeking positive affect-inducing activities to cope with PMS was found to be a significant predictor of reducing the severity of PMS (β =-0.265, p < .001). In coping with PMS, it is necessary to consider the perceptions of taking medication, seeking social support, or seeking positive affect-inducing activities as a coping method to determine the social and cultural beliefs of university students and control PMS. PMS is a significant health problem and raising awareness of the issue alone may not be enough. It should also be noted that the severity of PMS can vary markedly between ethnic groups, and women's strategies for coping with symptoms and their effectiveness may differ between cultures. It is pivotal to develop strategies for university students to cope with PMS and provide personalized care.

Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021

Background

Premenstrual syndrome (PMS) is used to describe physical, cognitive, affective, and behavioral symptoms that affect young and middle-aged women occurring cyclically during the luteal phase of the menstrual cycle. Despite the considerable prevalence and impact of PMS on individuals, their families and communities that interferes with the development of nations, many professionals are still unaware of it and little attention has been given in developing countries like Ethiopia, especially for university students. Therefore, this study was aimed for assessing the magnitude of premenstrual syndrome, associated factors and coping mechanisms among Wolkite university female regular students, 2021.

Methods

Institutional-based cross sectional study was conducted among Wolkite University regular female students from June 15/10/2021 to 30/10/2021 by using simple random and multistage with systematic random sampling technique to select the study participants (n = 591). Data were collected using a self-administered, pre-tested, semi-structured questionnaire. Premenstrual syndrome scales comprised of 40 questions with three sub-scales were used to determine Premenstrual syndrome. Data were cleaned, coded and entered into Epi-data version-3.1, and analyzed using SPSS software version 25. Descriptive statistics were computed for independent variables as well as for coping mechanisms and presented in narration, tables and graphs. Analytic analysis schemes including bi-variable and multivariable logistic regression were computed to identify factors associated with premenstrual syndrome and those variables with a P value of < 0.05 in multivariable analysis were declared as statistically significant.

Result

From the total of 631 study subjects, only 591 had completed the questionnaire, giving a response rate of 93.7%. From 591 study participants, 224 (37.9%) [95% CI: (34, 40.9)] of them had premenstrual syndrome. Abdominal cramp (78.8%), depression (73.3%) and fatigue (72.9%) were frequent premenstrual symptoms experienced by students. Having family history of PMS [AOR: 4.05; 95% CI: (2.49, 6.58)], no history of sexual intercourse [AOR: 2; 95% CI: (1.12, 3.47)], severe menstrual pain intensity [AOR: 3.09; 95% CI: (1.58, 6.05)], irregular menstrual cycle [AOR: 2.26; 95% CI: (1.41, 3.62)], early age of menarche (< 13 years) [AOR: 2.64; 95% CI: (1.34, 5.19)], long duration of menses (≥ 7 days) [AOR: 3.56; 95% CI: (1.53, 8.37)] and using many pads (> 8) during menstruation [AOR: 4.44; 95% CI: (2.16, 9.12)] were factors significantly associated with premenstrual syndrome. 93.4% of students apply at least one coping mechanism for premenstrual symptoms, of which; taking rest (67.6%) and sleeping (60.7%) were common strategies.

Conclusion

In this study, premenstrual syndrome was found to be a problem of many students. Abdominal cramp, depressed feeling and fatigue were the predominant premenstrual symptoms experienced by students. Taking rest and sleeping were mostly applied by students as a coping mechanism. Family history of PMS, no history of sexual intercourse, intense menstrual pain, use of many pads during menstruation, irregular menstrual cycle, early menarche, and long duration of menses were found to be predictors of premenstrual syndrome. PMS needs great attention as part of the health care service in Ethiopia by involving all stockholders, including policy makers and health care professionals, to reduce its impact on the academic performance of university students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01658-5.

Evaluation of a natural S-equol supplement in treating premenstrual symptoms and the effect of the gut microbiota: An open-label pilot study

AIM

Premenstrual syndrome causes disturbances in many women's daily activities. Isoflavones might cause changes in the estrogen cycle by their selective estrogen receptor modulator-like activities. Equol, which is a metabolite of a soy isoflavone, has greater biological activity than other soy isoflavones. In this preliminary study, we aimed to examine the effect of a natural S-equol supplement (SE5-OH) on premenstrual symptoms. The gut microbiota has recently been suggested to play an important role in brain function in psychiatric disease, such as depression. Therefore, we further aimed to evaluate the relationship of the effect of SE5-OH and the gut microbiota at preintervention.

METHODS

Twenty women who showed premenstrual symptoms and were nonequol producers were enrolled in an open-label, single-arm, clinical study in which they received oral SE5-OH for two period cycles. The Daily Record of Severity of Problems (DRSP) total score was evaluated during the intervention cycles. Before taking SE5-OH, fecal samples were obtained and subjected to terminal restriction fragment length polymorphism analysis.

RESULTS

The response rate to treatment (≥50% reduction from baseline in the DRSP total score) was 10.5%. Post hoc analysis showed a significant improvement in the change in the DRSP total score (P = .008) and DRSP scores for four core premenstrual dysphoric disorder symptoms. Multiple regression analysis showed that the percentage improvement of the DRSP total score was positively related to Bifidobacterium and negatively related to Clostridium cluster IV.

CONCLUSION

SE5-OH supplementation may be an acceptable treatment for premenstrual symptoms. The intestinal microbiota may have an effect on SE5-OH.

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.

Psychometric Testing of the Japanese Version of the Daily Record of Severity of Problems Among Japanese Women

PURPOSE

The Daily Record of Severity of Problems (DRSP) is commonly used to assess premenstrual syndrome and premenstrual dysphoric disorder throughout the world. The aim of this study was to assess the validity and reliability of the Japanese version of the DRSP (DRSP-J).

MATERIALS AND METHODS

We analyzed 324 women with regular menstrual cycles who completed the DRSP-J and the Premenstrual Symptoms Questionnaire (PSQ). They had all applied to participate in an ongoing study for the treatment of their premenstrual symptoms. The DRSP-J was examined for evidence of reliability and validity. To examine reliability, we assessed Cronbach's α, a measure of internal consistency, and test-retest reliability. We assessed structural validity with principal component factor analysis (PCA) and confirmatory factor analysis (CFA). We used PSQ total score to examine concurrent validity.

RESULTS

Cronbach's α for DRSP total score was 0.97. DRSP total score and individual items showed high test-retest reliability. PCA showed a two-factor model describing mood and behavioral and physical symptoms. CFA showed that the two-factor model derived from the PCA was an acceptably good fit. DRSP total score correlated moderately with PSQ total score (r = 0.42).

CONCLUSION

The DRSP-J showed reliable and valid measures of premenstrual symptoms in Japanese women.

Study on urinary metabolomics of premenstrual dysphoric disorder patients with liver-qi depression syndrome treated with Xiaoyaosan: Study Protocol Clinical Trial (SPIRIT Compliant)

INTRODUCTION

Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome with mental symptoms as its main manifestation, which seriously affects women's health and daily life. Some basic research and clinical studies have shown that the Chinese herbal medicine of Xiaoyaosan can relieve the symptoms of mental disorders with few side effects. The aim of this study is to evaluate the clinical efficacy of Xiaoyaosan for treating PMDD with liver-qi depression syndrome. In addition, metabonomics and small molecular marker compounds closely related to the pathogenesis of PMDD are expected to be found, and mechanism of Xiaoyaosan is further explored from the metabolic level.

METHODS AND ANALYSIS

This study is a clinical pilot trial. Thirty PMDD patients with liver-qi depression syndrome and thirty healthy participants will be recruited. Study participants will be assigned in a 1:1 ratio to 2 groups: a normal control group and Xiaoyaosan treatment group. The treatment group will receive the Chinese patent medicine of Xiaoyaosan for 3 menstrual cycles. The primary outcome is the syndrome change in the Daily Record of Severity of Problems (DRSP). The secondary outcome is improvement in TCM syndrome, which will be measured with TCM symptom score scale. Urine metabolism profiles of participants by liquid chromatograph-mass spectrometer (LC-MS) method will be measured to explore the mechanism of PMDD pathogenesis and action of Xiaoyaosan on PMDD.

DISCUSSION

This trial will evaluate the effectiveness and the therapeutic mechanism from the metabolomics level of Xiaoyaosan in individuals with PMDD. If successful, the outcome of this trial will provide a viable treatment option for PMDD patients and objective evidence on the efficacy of Xiaoyaosan for PMDD.

ETHICS AND DISSEMINATION

The trial has been approved by the Institutional Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (file number: DZMEC-KY-2019-73). Written informed consent will be obtained from all participants. The results of the study will be published in peer-reviewed journals or communicated via yearly reports to funding bodies.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900026296.

Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges

Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.

Premenstrual dysphoric disorder in Arab women: Validation and cultural adaptation of the Arabic version of the premenstrual screening tool

Premenstrual dysphoric disorder (PMDD) is not well-studied in Arab populations. The goal of this study was to validate the Arabic version of the Premenstrual Symptoms Screening Tool (PSST) using the DSM diagnosis of PMDD as the gold standard. The PSST was translated and culturally adapted using back translation and the approval of the original author. We recruited 194 adult women (between October 2013 and March 2014) from two primary care centers in Doha, Qatar. A psychiatrist determined the diagnosis using the semi-structured Mini International Neuropsychiatric Interview, and another rater blinded to the diagnosis finalized the Arabic PSST and administered other clinical questionnaires. The data showed that premenstrual symptoms and PMDD were observed in about 37 percent and 15 percent, respectively, of the women enrolled. The mean age of the women with PMDD according to the PSST was about 30 years, and the majority had children. The Arabic PSST showed high specificity of 95.6 percent but low sensitivity of 26.7 percent. A factor analysis of the different items in Arabic PSST showed that the Arabic PSST could detect the cases with definite PMDD and thus can be a useful tool in primary care settings as this treatable disorder is underdiagnosed in the Arab populations.

Effectiveness of natural S-equol supplement for premenstrual symptoms: protocol of a randomised, double-blind, placebo-controlled trial

INTRODUCTION

Premenstrual syndrome (PMS) comprises a range of mood, behavioural and physical symptoms, and impairs many women's quality of life. Isoflavones are expected to stabilise the natural fluctuation of the oestrogen cycle through their selective oestrogen receptor modulator-like activities that alleviate PMS symptoms. Equol, a metabolite of a soy isoflavone converted from daidzein by specific gut bacteria, has a greater bioavailability compared with other soy isoflavones. We aim to examine the effect of natural S-equol supplements on premenstrual symptoms.

METHODS AND ANALYSIS

This study will enrol 124 women (aged 20-45 years) who have PMS symptoms and are non-equol producers in a double-blind, parallel, randomised, placebo-controlled trial, in which they will receive natural S-equol supplement (equol 10 mg a day) or placebo, orally, twice daily, for three menstrual cycles. The primary outcome measure (Daily Record of Severity of Problems total score) will be assessed during intervention cycles. To compare the primary outcomes between the S-equol group and the placebo group, the mean differences in the Daily Record of Severity of Problems total score between the two groups will be determined. The p values will be determined using Student's t-test, where the significance level is 5% (two-sided).

ETHICS AND DISSEMINATION

The institutional review board at Kindai University approved the study. The findings of this trial will be submitted to an international peer-reviewed journal. Abstracts will be submitted to national and international conferences.

TRIAL REGISTRATION NUMBER

UMIN000031815.

Premenstrual symptoms interference and equol production status in Japanese collegiate athletes: A cross-sectional study

Aim

Consumption of soy isoflavones reduces the risk of estrogen‐related diseases, such as menopausal symptoms, osteoporosis, and cardiovascular disease. Equol is metabolized from the isoflavone daidzein by intestinal bacteria and has higher bioavailability than other isoflavones. Equol producers are believed to benefit from soybean consumption to a greater extent than non‐producers. Recently, we showed that equol non‐producers were at significant risk of premenstrual syndrome (PMS). Previously, we reported that PMS is a common menstrual problem in female athletes, and almost half of the studied athletes felt a negative effect of premenstrual symptoms on their athletic performance. This study was conducted to evaluate the relation between PMS and equol production status in Japanese collegiate athletes.

Methods

This was a cross‐sectional, observational study that included 88 Japanese female collegiate athletes. Equol production status was determined using urine samples collected after a soy challenge test. The subjects also completed a questionnaire about their premenstrual symptoms and their competitive career.

Results

The prevalence of equol producers was 29.5% in Japanese collegiate athletes. The athletic performance of 54.5% of athletes was found to suffer in competition or in practice due to premenstrual symptoms. In multivariate analysis, equol non‐producers (odds ratio, 3.34; 95% confidence interval, 1.03–12.20) and restriction of bodyweight (odds ratio, 4.94; 95% confidence interval, 1.47–20.00) were shown to be significant risk factors for poor athletic performance.

Conclusion

This study showed a relation between athletic performance and equol production status in Japanese collegiate athletes.

Hormonal contraceptive use and prevalence of premenstrual symptoms in a multiethnic Canadian population

Background

Hormonal contraceptive use may be associated with a reduction in some premenstrual symptoms, however, the evidence remains equivocal. The objectives of the present study were to investigate the associations between ethnicity and hormonal contraceptive use with premenstrual symptoms.

Methods

One thousand one hundred two women participating in the Toronto Nutrigenomics and Health Study provided data on their premenstrual symptoms and hormonal contraceptive use. Severity of symptoms was classified as none, mild, moderate, or severe. Prevalence of premenstrual symptoms was determined in the total population and among major ethnic groups. Logistic regressions were used to determine the association between ethnicity and prevalence of premenstrual symptoms. Logistic regressions were used to determine the associations between hormonal contraceptive use, and premenstrual symptoms, adjusting for ethnicity and other covariates.

Results

Prevalence of individual symptoms varied, and the most commonly reported were cramps (75%), bloating (75%), mood swings (73%), increased appetite (64%), and acne (62%). Prevalence of cramps differed between ethnic groups with East Asians reporting a lower prevalence than Caucasians and South Asians (p < 0.05). Use of hormonal contraceptives was associated with a lower RR (95% CI) of experiencing moderate/severe: cramps (0.82, 0.72-0.93), clumsiness (0.22, 0.07-0.73), confusion (0.22, 0.09-0.54) and desire to be alone (0.45, 0.28-0.73). Hormonal contraceptive use was not associated with the risk of premenstrual symptoms at mild severity. Hormonal contraceptive use was not associated with symptoms of anxiety, bloating, mood swings, increased appetite, acne, fatigue, sexual desire, depression, nausea, headache and insomnia.

Conclusion

This study demonstrates that East Asians may be at a lower risk of experiencing premenstrual cramps and that hormonal contraceptive use is associated with a lower risk of experiencing many, but not all, premenstrual symptoms at moderate/severe severity.

Roles of the µ-opioid receptor and its related signaling pathways in the pathogenesis of premenstrual syndrome liver-qi stagnation

The present study aimed to investigate the roles of the µ-opioid receptor (MOR) and its related signaling pathways in the pathogenesis of premenstrual syndrome (PMS) liver-qi stagnation, along with the therapeutic effects of the Shu-Yu capsule in treating the condition. A PMS liver-qi stagnation rat model was established using a chronic restraint stress method. The protein expression level of MOR within rat hippocampal tissue was detected via western blot analysis and cyclic adenosine monophosphate (cAMP) levels within the supernatant of a rat hippocampal cell culture were determined by ELISA. The western blot analysis indicated that the hippocampal expression level of MOR was significantly elevated in the PMS liver-qi stagnation model group. However, subsequent treatment with a Shu-Yu capsule was found to significantly decrease the level of MOR expression. In addition, in vitro experiments were performed, whereby primary hippocampal neurons were treated with model rat serum. It was observed that the level of MOR expression was significantly elevated, while brain-derived neurotrophic factor (BDNF) and cAMP levels in the culture supernatant were significantly decreased. These effects were reversed by treatment with serum from the Shu-Yu capsule-treated rats. Furthermore, when treated with the MOR activator DAMGO, the following were significantly decreased in the primary neurons: Phosphorylation levels of cAMP response element binding protein and extracellular signal-regulated protein kinases (ERK); BDNF expression; and cAMP content in the culture supernatant. These effects were reversed in primary neurons treated with DAMGO and Shu-Yu-containing rat serum. Collectively, the data suggest that increased MOR expression and activation of the cAMP/ERK signaling pathway in the hippocampus may be involved in the pathogenesis of PMS liver-qi stagnation. Furthermore, the efficacy of the Shu-Yu capsule in treating the condition may be via its regulation of MOR receptor signaling.

Botanicals and Their Bioactive Phytochemicals for Women's Health

Botanical dietary supplements are increasingly popular for women's health, particularly for older women. The specific botanicals women take vary as a function of age. Younger women will use botanicals for urinary tract infections, especially Vaccinium macrocarpon (cranberry), where there is evidence for efficacy. Botanical dietary supplements for premenstrual syndrome (PMS) are less commonly used, and rigorous clinical trials have not been done. Some examples include Vitex agnus-castus (chasteberry), Angelica sinensis (dong quai), Viburnum opulus/prunifolium (cramp bark and black haw), and Zingiber officinale (ginger). Pregnant women have also used ginger for relief from nausea. Natural galactagogues for lactating women include Trigonella foenum-graecum (fenugreek) and Silybum marianum (milk thistle); however, rigorous safety and efficacy studies are lacking. Older women suffering menopausal symptoms are increasingly likely to use botanicals, especially since the Women's Health Initiative showed an increased risk for breast cancer associated with traditional hormone therapy. Serotonergic mechanisms similar to antidepressants have been proposed for Actaea/Cimicifuga racemosa (black cohosh) and Valeriana officinalis (valerian). Plant extracts with estrogenic activities for menopausal symptom relief include Glycine max (soy), Trifolium pratense (red clover), Pueraria lobata (kudzu), Humulus lupulus (hops), Glycyrrhiza species (licorice), Rheum rhaponticum (rhubarb), Vitex agnus-castus (chasteberry), Linum usitatissimum (flaxseed), Epimedium species (herba Epimedii, horny goat weed), and Medicago sativa (alfalfa). Some of the estrogenic botanicals have also been shown to have protective effects against osteoporosis. Several of these botanicals could have additional breast cancer preventive effects linked to hormonal, chemical, inflammatory, and/or epigenetic pathways. Finally, although botanicals are perceived as natural safe remedies, it is important for women and their healthcare providers to realize that they have not been rigorously tested for potential toxic effects and/or drug/botanical interactions. Understanding the mechanism of action of these supplements used for women's health will ultimately lead to standardized botanical products with higher efficacy, safety, and chemopreventive properties.

Characteristics of Perceived Stress and Salivary Levels of Secretory Immunoglobulin A and Cortisol in Japanese Women With Premenstrual Syndrome

Background:

Several studies have demonstrated the associations between Premenstrual Syndrome and perceived stress, and no studies quantifying stress based on biochemical parameters have been conducted.

Objectives:

The objective of this study was to examine the changes in biochemical parameters of stress and measured perceived stress during the menstrual cycle of women with premenstrual syndrome.

Patients and Methods:

A longitudinal observational study was conducted in 2010 in the Kansai region of Japan. Thirteen women with premenstrual syndrome and 11 controls, all with regular menstrual cycles, participated in this study. Salivary secretory immunoglobulin A (S-IgA) and cortisol levels were measured as biochemical parameters, and scores on the Stress Check List KM (SCL-KM) (Cronbach’s α in this study ranged from 0.76 to 0.84) were used to indicate perceived stress through two complete menstrual cycles. Before stress measurements were taken, premenstrual, menstrual and postmenstrual phases were confirmed based on records of basal body temperature across two menstrual cycles. Data analysis was performed using the Student’s t-test, analysis of variance with repeated measures, and Pearson’s correlation coefficient, as appropriate.

Results:

Both the postmenstrual S-IgA concentration and secretion rate were significantly lower in the group with premenstrual syndrome than in controls (P < 0.05). Premenstrual S-IgA concentrations were significantly higher than postmenstrual levels in the group with premenstrual syndrome (P < 0.05). No significant differences in cortisol levels were seen in either group during any phase. Premenstrual and postmenstrual phase SCL-KM scores were significantly higher in the group with premenstrual syndrome than in controls (P < 0.05). No significant changes in the SCL-KM scores were observed among menstrual cycle phases in either group. Postmenstrual S-IgA levels were negatively correlated with the SCL-KM score (P < 0.05).

Conclusions:

The stress due to psychosomatic changes in the menstrual cycle is associated with premenstrual syndrome. Measures of S-IgA, rather than cortisol or subjective responses to stress, may be most closely associated with PMS.