A potential relation between premenstrual symptoms and subjective perception of health and stress among college students: a cross-sectional study

Menstrual and psychosocial characteristics associated with high-risk of premenstrual dysphoric disorder among university students: a cross-sectional study

Up to 92 percent of Chinese women of reproductive age have pre-menstrual syndrome (PMS). The severe form of PMS (i.e. pre-menstrual dysphoric disorder [PMDD]) negatively affects women's everyday functioning and reproductive health. This study examined the relationships between menstrual, psychosocial characteristics and the risk of PMDD among young Chinese women. A cross-sectional online survey was conducted among Chinese university students in Hong Kong. Logistic regression was used to compute adjusted odds ratio (aOR) for the association of high-risk PMDD with menstrual and psychosocial characteristics. A total of 541 Chinese university students were recruited. Approximately 53 percent of female students were at high risk of developing PMDD. The high-risk PMDD group was significantly associated with a heavy volume of menstrual flow (aOR = 2.17, 95 percent CI 1.06-4.45), irregular menstrual cycle (1.72, 1.17-2.52), high dysmenorrhea (2.80, 1.95-4.04) and older ages of menarche (0.67, 0.45-0.98) in the menstrual characteristics. In the psychosocial characteristics, high-risk PMDD was significantly associated with symptoms of anxiety (2.19, 1.48-3.32) and depression (2.22, 1.48-3.32), high loneliness (1.94, 1.34-2.79) and low resilience (2.21, 1.52-3.23) levels. Additionally, resilience had a potential moderating effect on the associations between the high risk of PMDD and anxiety, depression and loneliness. The development and delivery of interventions that can enhance resilience and manage psychological distress would be beneficial for young Chinese women's reproductive health.

Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study

Introduction

Menstruation-related symptoms (MRSs) significantly impact women's health and contribute to economic burdens worldwide. Current interventions, primarily pharmacological ones, have limitations and side effects that underscore the need for alternative management strategies. This study explores the association between MRSs and lifestyle factors, specifically physical activity and sleep timing across menstrual cycle phases, to inform non-pharmacological intervention development.

Methods

Fourteen female students from Ritsumeikan University, Japan, with regular menstrual cycles (25-38 days), not on hormonal treatment or engaged in shift work, participated in this observational study. Using a Fitbit Inspire 2, total daily energy expenditure (TDEE) and sleep timing were monitored over a complete cycle. Menstrual cycle phases were defined based on ovulation day, predicted using home luteinizing hormone tests. Participants completed daily electronic questionnaires rating MRSs using a modified menstrual distress questionnaire. Data were analyzed using a generalized linear mixed model with a gamma distribution and logarithmic link function, examining the relationship of TDEE and the midpoint of sleep time (MS time) with MRS severity.

Results and discussion

The following observations were noted: first, MRS severity, except for behavioral change symptoms, significantly increased during the menstrual and luteal phases compared to the follicular phase. Second, delayed MS time was associated with reduced pain, concentration symptoms, water retention, and negative affect during the menstrual phase and reduced negative affect during the luteal phase. Finally, an increase in TDEE was associated with reduced concentration symptoms, autonomic reaction symptoms, and negative affect during the menstrual and luteal phases and reduced water retention only during the luteal phase. This study provides insights into the relationship between MRSs and TDEE/MS time, suggesting potential non-therapeutic approaches for symptom management, though further research is needed to substantiate these findings for practical applications.

Lactobacillus paragasseri OLL2809 Improves Premenstrual Psychological Symptoms in Healthy Women: A Randomized, Double-Blind, Placebo-Controlled Study

Lactobacillus paragasseri OLL2809 has been shown to ameliorate stress. This study employed a randomized, placebo-controlled, double-blind, parallel-group design to assess the efficacy of continuous ingestion of OLL2809 for managing menstrual symptoms in healthy women. Eighty healthy adult women aged 25-40 years who experienced premenstrual and menstrual symptoms were randomly assigned to either the OLL2809 or placebo group (n = 40 each) and ingested tablets containing OLL2809 or placebo for three menstrual cycles. The OLL2809 group exhibited a significantly greater change in premenstrual 'arousal' scores on the menstrual distress questionnaire compared to the placebo group after the three menstrual cycles. Specifically, changes in the 'activity' subfactor were significantly higher in the OLL2809 group than in the placebo group. Additionally, the OLL2809 group reported significantly lower premenstrual irritability on the visual analog scale than the placebo group. These results suggest that OLL2809 may contribute to enhancing the quality of life of women.

Prevalence and Associated Factors of Premenstrual Syndrome in Chinese Adolescent Girls

Epidemiological data on premenstrual syndrome (PMS) in Chinese adolescents are limited. This study reported the prevalence and associated factors of PMS in a large sample of Chinese adolescents. A total of 5099 adolescent girls who had menarche participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort study in Shandong, China. A self-administered questionnaire was used to ask about PMS, age at menarche, menstrual cycle interval, menstrual flow length, menstrual regularity, period pain, body weight and height, trait anger, stressful life events, and demographics. The mean age of the sample was 15.19 years (SD = 1.32). The overall prevalence of PMS was 24.6%. The prevalence rates of PMS-anxiety, PMS-water retention, PMS-craving, and PMS-depression were 18.9%, 4.0%, 7.9%, and 11.5%, respectively. The most common symptoms were premenstrual irritability (54%) and fatigue (52.5%). Stepwise logistic regression showed that high levels of life stress (OR 2.26), high levels of trait anger (OR 4.65), alcohol consumption (OR 1.28), menstrual cycle interval ≤ 24 days (OR 1.45), and mild (OR 1.50), moderate (OR 2.57) or severe period pain (OR 4.84) were all significantly associated with increased likelihood of PMS. In conclusion, approximately 1 in 4 Chinese adolescent girls suffered from PMS. Multiple psychosocial and menstrual factors were associated with PMS. Further research is needed to understand developmental changes of PMS and its long-term impacts on psychosocial wellbeing in Chinese adolescent girls.

Menstrual Abnormalities in Female International Students in Japan: Changes during Pre-Arrival, Difficult, and Current Periods

The number of Japan's international students has rapidly increased in the last decade. This study examines the relationship between menstrual abnormalities in cycle and symptoms, stress level, and lifestyle of female international students in Japan across three time periods, namely pre-arrival, difficult, and current time periods. A cross-sectional design was employed, and data were collected through a self-administered questionnaire, including the menstrual distress questionnaire (MDQ), between December 2022 and February 2023. The questionnaire was distributed to 56 female international students from two universities in Japan, and a total of 29 valid responses were collected. We found varying menstrual cycle abnormalities and severity of menstrual symptoms across three time periods, with the difficult period after arrival in Japan displaying the highest symptom severity. Higher stress levels were significantly associated with more severe menstrual symptoms. Lifestyle habits such as alcohol consumption were also linked to menstrual symptoms. The current study emphasizes the importance of providing menstrual education, support, and resources to address international students' unique challenges in managing their menstrual health while studying abroad. By promoting awareness, education, and access to healthcare services, universities may contribute to international students' well-being and academic success.

The experiences of menstrual symptom changes among international students studying in China during the acculturation period: A phenomenology study

Objectives

Menstruation is a normal physiological phenomenon among female which could be influenced by the process of acculturation. Few studies have explored the experience of menstrual symptom changes among international female students studying in China. Therefore, this paper aims to summarize international female students' experiences of menstrual symptom changes when they were studying in China and interpret these changes through considering the influence of acculturation on their social and academic lives.

Methods

We used a descriptive phenomenology approach. Structured in-depth face-to-face interviews were conducted between May and November 2019 among ten international female students studying in one Province located in south central China. Participants were those who reported having experienced menstrual symptom changes during the acculturation period, which was defined as the first six months of living in China. All interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo 11.0 with the guidance of Colaizzi's seven-step method.

Results

The international female students' experiences of menstrual symptom changes were summarized and grouped into five main categories and 13 subcategories. The main categories include: 1) demonstration of menstrual symptom changes, 2) challenges of maintaining menstrual function in the new setting, 3) coping styles to take care of menstrual health, 4) consequences of the menstrual symptom changes, and 5) culture-based attitude toward menstruation.

Conclusions

International female students reported experiences of menstrual symptom changes, including somatic and psychological symptoms during the acculturation period. Culture barriers, academic stress, and sleep patterns are common factors influencing their menstrual symptom changes. More culturally-tailored interventions should be explored to improve the menstrual health of international female students in China.

Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

Validation and usability study of the framework for a user needs-centered mHealth app selection

BACKGROUND

Most mHealth app users rely on an app's rankings, star ratings, or reviews, which may not reflect users' individual healthcare needs. To help healthcare providers, researchers, and users select an optimal mHealth app, the Method of App Selection based on User Needs (MASUN) 1.0¹ was developed and tested in prior research. Initial testing found the need for improvement.

OBJECTIVE

This multiple-phase study aimed to simplify and improve MASUN 1.0, resulting in MASUN 2.0, and verify the feasibility and usability of MASUN 2.0.

METHODS

This study was conducted in three phases: (1) modification of MASUN 1.0 to improve its importance, applicability, relevance, and clarity, in consultation with 21 experts in medical or nursing informatics; (2) validation of the draft MASUN 2.0, with 13 experts; and (3) feasibility testing of MASUN 2.0 and usability evaluation of the best app found through MASUN 2.0. Menstrual apps were used to test the framework.

RESULTS

From Phases 1 and 2, MASUN 2.0, the framework for mHealth App selection, was derived with improved simplicity, usability, and applicability through a reduced number of tasks and time required. In Phase 3, after screening and scoring 2377 menstrual apps, five candidate apps were selected and evaluated by five clinical experts, five app experts, and five potential users. Finally, 194 users evaluated the usability of the app selected as the best. The best app helped users understand their health-related syndromes and patterns. Additionally, user-provided scores for impact, usefulness, and ease of use for the app were higher than for others.

CONCLUSIONS

This study successfully modified MASUN 1.0 into MASUN 2.0 and verified MASUN 2.0 through content validity, feasibility, and usability testing. The selected apps through MASUN 2.0 helped health consumers more easily address health discomfort. Future research should extend this work to an automated system and different medical conditions with multiple stakeholders for digital health equity.

Mood Swing during Menstruation: Confounding Factors and Drug Use

Background

Premenstrual syndrome (PMS) is a physiologic process in women where mood swing is one of the symptoms influencing the psycho-emotional, physical, and behavioral reactions exhibited by women during menstruation. This study elucidates the effect of mood swing, confounding factors and healthcare-seeking behaviors of women in an educational environment.

Methods

Exactly 328 women who were within reproductive ages 16 and 35 years participated in this study. A survey method was adopted; validated and standardized questionnaires were administered to confidentially assess the effect of mood swing via PMS. All data were analyzed with SPSS 25.0; descriptive method was adopted and results were expressed in percentages.

Results

Mood swing was discovered as a symptom overlapping with psycho-emotional, physical, and behavioral symptoms during menstruation. The overall PMS prevalence was 67.4% while PMDD prevalence was 25.6%. Psycho-emotional symptoms: anger, irritability, depression. Physical symptoms: coldness, paleness, food craving, breast tenderness, digestive changes. Behavioral symptoms: social withdrawal, nocturnal social activity, absenteeism, poor work or academic performance, increased libido. Confounding factors include stress, gynecological conditions such as endometriosis, uterine fibroid, ovarian cyst, pelvic adhesion, and polycystic ovarian syndrome. Also, 22.9% had a family history of bipolar disorder (BD) while 30.2% had previous diagnosis. Severe pain was a major factor for seeking treatment; Paracetamol, and Piroxicam were frequently used drugs.

Conclusions

Severe PMS triggers mood swing and can badly affect academic or work activities; victims either endure the pain due to socio-cultural and financial factors or take unsuitable medications where abuse is inevitable.

Premenstrual Syndrome and Its Association with Perceived Stress: The Experience of Medical Students in Jordan

Objective

To assess the prevalence of premenstrual and menstrual symptoms and to investigate premenstrual severity’s association with perceived stress of premenstrual syndrome among medical students.

Methods

This is a cross-sectional study. Data were collected between March and April 2021, a self-administered online questionnaire (Supplementary Material) was distributed to a sample of female medical students in Jordan (n=594).

Results

The mean age was 21.6 ±2.2 years, and the mean body mass index (BMI) was 22.8 ±4.1 kg/m2. Most students were in their 5th and 6th university year, where 75.4% reported having dysmenorrhea, 45.8% used pharmacological agents for pain relief, while 54.2% used non-pharmacological means, and 58.1% occasionally skipped lectures. Most participants reported a constellation of physical and psychological symptoms. The mean for the premenstrual severity scale score was 29.3, and the mean for the perceived stress scale scores was 21.6. There was a statistically significant correlation between the premenstrual severity scale score and the perceived stress scale, between the premenstrual severity scale and absenteeism, between premenstrual severity scale and year of study, and between dysmenorrhea and the perceived stress scale, but not between the severity of symptoms and method of pain relief.

Conclusion

Premenstrual and menstrual symptoms have a negative impact on students that affects their academic participation. More support should be given from universities to address the menstruation-related struggles of female students.

Females with Diabetes Mellitus Increased the Incidence of Premenstrual Syndrome

Background: Premenstrual syndrome (PMS) is a multifactorial disorder caused by hormone and autonomic imbalance. In our study, hyperglycemia-induced insulin secretion increased progesterone secretion and progressive autonomic imbalance. The young patients with diabetes mellitus (DM) revealed hypo-parasympathetic function and hypersympathetic function compared with nondiabetic controls. Young female patients with DM with higher blood sugar and autonomic malfunction may be associated with PMS. However, there is a lack of evidence about DM in females related to PMS. We evaluated female patients with DM who subsequently followed PMS in a retrospective cohort study. Methods: We retrieved data from the National Health Insurance Research Database in Taiwan. Female patients with DM between 20 and 50 years old were assessed by the International Classification of Disease, 9 Revision, Clinical Modification (ICD-9-CM) disease code of 250. Patients who were DM-free females were fourfold matched to the control group by age and disease index date. The ICD-9-CM disease code of 625.4 identified the incidence of PMS followed by the index date as events. The possible risk factors associated with PMS were detected with a Cox proportional regression. Results: DM was a significant risk factor for PMS incidence with an adjusted hazard ratio of 1.683 (95% confidence interval: 1.104−2.124, p < 0.001) in females after adjusting for age, other comorbidities, season, urbanization status of patients and the hospital status of visiting. Conclusions: This study noted an association between DM and PMS in female patients. Healthcare providers and female patients with DM must be aware of possible complications of PMS, aggressive glycemic control, decreased hyperglycemia and autonomic dysfunction to prevent this bothersome disorder.

COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related anxiety, depression, and stress on the other among medical students in Jordan. Medical students were invited through teaching platforms and social media to complete an online survey. SPSS software was used to analyze data. A total of 385 medical students participated in this research. Hence, 49.9% of the study population reported severe dysmenorrhea during COVID-19 compared to 36.9% before COVID-19 (p = 0.000). Dysmenorrhea was significantly associated with disruptions of sport and daily activities during COVID-19 (p = 0.015 and p = 0.002, respectively). The prevalence of PMS components, e.g., mastalgia, fatigue, headache, palpitation, and emotional and sleep disturbances, was raised during COVID-19 compared with before (p < 0.05). Symptoms of genitourinary tract infections, such as lower abdominal pain, vaginal discharge, genitalia rash/ulcers and itching, and urgency, were significantly increased after COVID-19 (p < 0.05). Positive Pearson correlations between COVID-19-associated mental health disorders and dysmenorrhea severity, PMS, and genital tract health abnormalities were observed (p < 0.05). The multiple linear regression model revealed that dysmenorrhea severity, PMS symptoms like palpitation, and genitourinary symptoms like lower abdominal pain and urgency were associated with worsening of depression, while dysuria was associated with a protective effect against depression. Moreover, it was observed that dysmenorrhea severity, PMS symptoms, such as headache and palpitation, and urinary urgency were associated with aggravation of anxiety. However, food craving and dysuria were protective against anxiety. Finally, dysmenorrhea severity, PMS symptoms of headache and palpitation, lower abdominal pain, and urgency were related to worsening of stress, whereas the premenstrual symptom of breast pain was a protective factor against stress. This work showed that COVID-19 pandemic-related psychological distress and menstrual, premenstrual, and genitourinary symptoms are closely related. Further future work is required to evaluate the long lasting-effects of the pandemic on mental health and the physiology of reproduction.

Differences in Menstruation-Related Symptoms of University Students Depending on Their Living Status in Japan

Mothers and family members of young female students play important roles for guiding their self-care strategies for menstruation-related symptoms; which often affect their daily life and academic life. The aim of this study is to clarify the differences in menstruation-related symptoms before and during menstruation in university students living alone and university students living with their family in Japan. We conducted a cross-sectional online survey to assess menstruation-related symptoms before and during menstruation using the menstrual distress questionnaire (MDQ). Among 135 students; the proportion of students living alone was 60.7% and the proportion of students living with their family was 39.3%. Before menstruation; the MDQ total score and the scores for negative affect and behavior change were significantly higher in students living alone than in students living with their family. During menstruation; scores for negative affect and impaired concentration were also significantly higher in students living alone. In addition; before menstruation; scores for an increase in appetite and craving for sweets were significantly higher in students living alone. Thus; living alone affected the psychological aspects of menstruation-related symptoms in young women. The results suggest that university students who live alone should be aware of the importance of talking about their menstruation problems with family members and seeking their advice

Increased Incidence of Premenstrual Syndrome in Females with Palmar Hyperhidrosis

Background: Premenstrual syndrome (PMS) is a common disorder affecting the quality of life of women of reproductive age. In a previous study, sex hormone imbalances and alterations in autonomic function were present in PMS, with parasympathetic dysfunction and sympathetic overactivity during the late luteal phase. Palmar hyperhidrosis (PH) presents with oversweating, heat and emotional stimulation, sympathetic hyperactivity and parasympathetic hypofunction. We hypothesized that the incidence of PMS is increased in females with PH. Methods: Data were retrieved from the Taiwanese National Health Insurance Database. The patients with PH were identified by the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) disease code 780.8. Female patients matched by age and index day were used as the control group. The incidence of PMS was considered an outcome by the ICD-9-CM disease code 625.4. The factors related to PMS were analyzed by Cox regression. Results: The adjusted hazard ratio for the incidence of PMS was 1.276 (95% confidence interval: 1.05–1.488) in females with PH. Conclusions: This study found a positive correlation between PMS and female PH patients. Patients and physicians must understand the relationship of PMS with autonomic function alterations and other risk factors to prevent this problematic disorder.