MENSTRUATION AND PERSONALITY

Patterns of premenstrual syndrome and depression symptoms in Chinese female university students: Results of a latent profile analysis

BACKGROUND

Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach.

METHODS

The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity.

RESULTS

The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude.

LIMITATIONS

Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results.

CONCLUSION

These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.

Mediating effect of interpersonal relations on negative emotions and dysmenorrhea in female adolescents

Background

Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relationships in dysmenorrhea and how they may interact with negative emotions.

Aims

To investigate the connection between negative affect and dysmenorrhea, and the role of interpersonal relationships plays in this relationship.

Methods

The Cox Menstrual Symptom Scale (CMSS), short-form of Depression Anxiety Stress Scale, Interpersonal Comprehensive Diagnostic Scale and UCLA (University of California at Los Angeles) Loneliness Scale were applied to 855 adolescent nursing students to collect information on severity and frequency of dysmenorrheal symptoms, negative emotions (including depression, anxiety and stress), interpersonal problems and subjective experience of loneliness among them, and the relationship among these variables was examined.

Results

(1) Both the severity and frequency of dysmenorrhea were positively correlated with negative emotions, loneliness experience and interpersonal problems, while negatively correlated with age at menarche. (2) The negative emotions, romantic relationship and menarche age, but not loneliness and interpersonal problems, significantly contributed to both the severity and frequency of dysmenorrhea. (3) Mediation analysis revealed that the effects of loneliness and interpersonal problems on dysmenorrhea were totally mediated by negative emotions.

Conclusions

This investigation indicates that the relationship between interpersonal relationships and dysmenorrhea is mediated by negative emotions.

Vestibular stimulation for management of premenstrual syndrome

OBJECTIVES

The present study was undertaken to observe the effectiveness of vestibular stimulation in the management of premenstrual syndrome (PMS).

MATERIALS AND METHODS

The present study was an experimental study; twenty female participants of age group 18-30 years were recruited in the present study. Conventional swing was used to administer vestibular stimulation. Variables were recorded before and after vestibular stimulation and compared.

RESULTS

Depression and stress scores are significantly decreased after 2 months of intervention. Anxiety scores decreased followed by vestibular stimulation. However, it is no statistically significant. Serum cortisol levels significantly decreased after 2 months of intervention. WHOQOL-BREF-transformed scores were not significantly changed followed by the intervention. However, psychological domain score (T2) and social relationships domain score (T3) were increased followed by intervention. Systolic blood pressure was significantly decreased after 2 months of intervention. No significant change was observed in diastolic pressure and pulse rate. Pain score was significantly decreased after 2 months of intervention. Mini mental status examination scores and spatial and verbal memory score were significantly improved followed by intervention.

CONCLUSION

The present study provides preliminary evidence for implementing vestibular stimulation for management of PMS as a nonpharmacological therapy. Hence, we recommend further well-controlled, detailed studies in this area with higher sample size.

Questionnaire Studies of Paramenstrual Symptoms

A number of formal questionnaires have been devised to study paramenstrual symptomatology. It has been suggested that women's responses to these questionnaires are vulnerable to forgetting and contaminated by culturally induced expectations. Nevertheless, concurrent reports of experienced symptoms may correlate highly with retrospective judgments, even when the relevance of the menstrual cycle is disguised. They also differentiate between women with and without a self-reported history of premenstrual symptoms, although concurrent reports across several menstrual cycles are impractical to collect and may be inconsistent between successive cycles. A number of methodological criticisms have been directed toward the most commonly used device, the Menstrual Distress Questionnaire. In principle, however, retrospective questions offer a reliable and accurate indication of women's experience during the normal menstrual cycle.

Mood Fluctuations: Women Versus Men and Menstrual Versus Other Cycles

Mood fluctuations in women and men were studied both prospectively and retrospectively to determine whether cyclic changes occur over phases of the menstrual cycle, lunar cycle, and/or days of the week. The participants (15 women using oral contraceptives, 12 normally cycling women, and 15 men), who did not know the purpose of the study, recorded the pleasantness, arousal, and stability of their moods daily for 70 days (concurrent data). Later they recalled (retrospective data) their average mood for each day of the week and phase of the menstrual cycle (women only). The only evidence of mood fluctuation over the menstrual cycle in the concurrent reports was that normally cycling women reported more pleasant moods in the follicular and menstrual phase than did men and women on oral contraceptives. Women's moods fluctuated less over the menstrual cycle than over days of the week. Recollections of menstrual mood changes differed from actual changes: Women recalled more pleasant moods in the follicular phase and more unpleasant moods in the premenstrual and menstrual phases than they had reported concurrently. Bias also was evident in recollections of weekday mood fluctuations: Weekend highs were exaggerated and Monday blues were reported even though they were not reported concurrently. There was no evidence of mood fluctuations over the lunar cycle and the groups did not differ in mood stability. The retrospective reporting bias for both the menstrual cycle and days of week suggests the influence of stereotypes about moods. Implications for research and practice are discussed.

Effects of the Menstrual Cycle on the Performance of Complex Perceptual-Psychomotor Tasks

Efforts in support of providing equal employment opportunities have created a serious interest in factors which may affect the potential aeronautical adaptability of women. The possible effects of the significant physical and hormonal changes associated with the menstrual cycle have been a focal point of considerable coacera. This study assesses an individual's ability to perform complex, perceptual-psychomotor tasks during different phases of the menstrual cycle. Seventeen women served as paid volunteer subjects. All were between 20 and 30 years of age with a mean age of 24 years. Each woman was tested during the premenstruum (3 or 4 days prior to menstrual flow), during the menstrual flow, and during the intermenstrual phase of the cycle. In addition, data were collected on the use of oral contraceptives and on the severity and prevalence of individual menstrual cycle symptomatology as measured by the Menstrual Distress Questionnaire. The perceptual-psychomotor data were used to evaluate the effects of menstrual cycle and oral contraceptives on performance under stress. The data were also used to test Dalton's hypothesis that the lethargy the premenstruum and menstruation is responsible for lowered judgment and slow reaction time which might result in accidents. The results of the study indicated that there were no performance decrements associated with the menstrual cycle or use of oral contraceptives and failed to support Dalton's hypothesis.

Social Stimulus Perception and Self-Evaluation: Effects of Menstrual Cycle Phase

Women in different phases of the menstrual cycle were compared to each other and to men in their responses to a social interaction stimulus: a videotape depicting a female nurse interacting with a hospitalized patient. Sex differences and cycle-phase differences were found for both affective and cognitive dimensions. Premenstrual women reported feeling more dominant, energetic, indifferent, negative, and somewhat more tense than women menstruating or women in the intermenstrual cycle phase. However, they did not differ from men in their affective ratings. Premenstrual women evaluated the nurse as less attractive than did men and they attributed greater responsibility for the nurse's behavior to the patient than men and intermenstrual women. Women in all groups evaluated the nurse as nicer and more pleasant, interesting, concerned and self-assured than did men. All women also felt more friendly toward the nurse and reported that they would be more comfortable asking her questions than the men did. The implications of these findings are discussed.

Menstrual Distress and Sex-Role Attributes

The relationship between severity of menstrual distress, measured by the Moos Menstrual Distress Questionnaire, and sex-role attributes, measured by the Bem Sex-Role Inventory, was examined for a group of 103 undergraduate women. Data were compared for women using and not using oral contraceptives and for women from different religious groups. Because trait anxiety, as measured by a 28-item short form adapted from the Taylor Manifest Anxiety Scale, was significantly correlated with menstrual distress, first-order correlations between distress and sex-role attributes partialled out anxiety scores. Although none of the sex-role attributes was significantly related to distress for the entire group or for the group of women using the pill, a significant positive relationship between masculinity and menstrual distress was noted for the group of women not using the pill. The pattern of results suggested that although sex role attributes and anxiety are related to reports of menstrual distress for Catholic women, only anxiety is associated with distress for Jewish women, and neither sex-role attributes nor anxiety is correlated with distress for Protestant women.

Estrogen receptor alpha (ESR-1) associations with psychological traits in women with PMDD and controls

Premenstrual Dysphoric Disorder (PMDD) is a mood disorder affecting about 5% of women and is associated with substantial morbidity. Albeit inconsistently, PMDD is described as being characterized by heritable personality traits. Although PMDD is a heritable disorder, it is unclear whether any of the heritable susceptibility to PMDD resides in heritable personality traits. In groups of carefully characterized women with PMDD (n=68) and controls (n=56), we attempted to determine whether diagnosis-related traits could be confirmed, as well as to determine whether such traits were associated with SNPs in estrogen receptor alpha (ESR-1) that we previously demonstrated were associated with PMDD. We observed 7/25 traits to be significantly different in patients and controls and further showed that 11/12 significant associations observed between these 7 traits and 16 ESR-1 SNPs involved the intron 4 SNPs previously shown to be the locus of the association with PMDD. While several interactions between genotype and diagnosis were observed, the effect of genotype in most instances was in the same direction in patients and controls. These data demonstrate affective state-independent personality traits that distinguish patients with PMDD from controls and further support the relevance of ESR-1 polymorphic variants in the regulation of non-reproductive behaviors.

[Longitudinal study comparing depressive female patients with and without premenstrual exacerbation]

INTRODUCTION

The aim of this study was to evaluate whether there are any differences in the clinical features of depression, personality and the G factor among women with and without premenstrual exacerbation (PE) of depression.

MATERIAL AND METHODS

Ninety-nine outpatients diagnosed with major depression (DSM-IV) were interviewed twice. At baseline, the patients were not taking medication. The 74 patients who achieved remission (Hamilton rating scale for depression ≤7) after 16 weeks were evaluated again through the 16-personality factor (16-PF) questionnaire (5(th) edition) and the D48 (or Dominos) test.

RESULTS

No differences in clinical characteristics or prognosis were found between the two groups of women, except for the greater presence of seasonal features among women with PE. Women with PE also scored higher for self-control on the 16-PF and scored lower on the D48 (Domino) test. The logistic analysis showed that higher self-control scores increased the risk for PE in 51.3% of the sample, while higher scores on the D48 test decreased the risk in 8.6%.

CONCLUSIONS

There were no differences between the two groups in the clinical features or prognosis of depression, except for the higher rates of seasonal features in the PE group. In contrast, differences were found in personality traits and the D48 between the two groups.

Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates

AIMS

The rate of premenstrual dysphoric disorder (PMDD) amongst sub-Saharan Africans is unknown. This study aimed to estimate the rate of PMDD amongst Nigerian undergraduates and to evaluate psychosocial correlates and comorbid psychiatric conditions.

METHOD

Female university students (n=410) completed questionnaires detailing sociodemographic, menstruation, and gynaecological history. They also completed the Big Five Personality Inventory (BFI), and the presence of PMDD and any other DSM-IV axis 1 psychiatric diagnosis was assessed with the Mini International Neuropsychiatric Interview (MINI).

RESULTS

The prevalence of PMDD was 6.1% and the correlates included older age (p=0.001), painful menstruation (p=0.006), and high score on neuroticism scale (p=0.019). Compared with participants without PMDD, participants with PMDD have significantly higher rates for the following psychiatric diagnoses: dysthymia (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.68-8.69), major depressive disorder (OR, 17.00; 95% CI, 6.72-43.00), panic disorder (OR, 4.39; 95% CI, 1.35-14.30), and generalised anxiety disorder (OR, 1.21; 95% CI, 1.21-17.83).

CONCLUSION

The rate of PMDD in sub-Saharan African women was comparable to that in the western cultures. Planning and implementing an effective strategy to manage perimenstrual problems in this region should be an issue of priority.

The biomedical standardization of premenstrual syndrome

This essay traces the history of premenstrual syndrome (PMS) in French, British, and American medical literature from 1950 to 2004. Aetiological theories, treatments and diagnostic criteria have varied over time and place, reflecting local conditions and changing notions of objectivity and evidence. During the 1970s researchers in each nation utilised different research strategies to overcome variation and contradictory results characteristic of PMS research. Since the 1980s, attempts have been made to standardise research internationally through prospective daily rating questionnaires that diagnose and measure PMS. Amidst controversy, a psychiatric reformulation of the syndrome was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the diagnostic criteria for this psychiatric category, now called premenstrual dysphoric disorder (PMDD), are widely accepted for research purposes, efforts to transfer them to medical practice have been less successful. PMDD remains a contested disease construct.

The association between somatization and perceived ability: roles in dysmenorrhea among Israeli Arab adolescents

OBJECTIVE

The aim of this study was to investigate whether somatization and attitudes toward menstruation predict the incidence of pain intensity and dysmenorrhea among Israeli Arab adolescent females.

METHODS

Participants were 160 Israeli Arab adolescents, including 50 Muslims, 50 Christians, and 60 Druze. A 20-item questionnaire was used to assess attitudes regarding menstruation. The short version of the Brief Symptom Inventory was used to measure the level of somatization.

RESULTS

Factor analysis of the Attitudes Toward Menstruation Instrument revealed two significant composites: perceived ability and impurity during menstruation. High levels of somatization predicted pain intensity and low levels of perceived ability predicted the prevalence of dysmenorrhea. Although the Israeli Muslim adolescents revealed higher levels of somatization as compared with their Christian and Druze counterparts and the Druze revealed the lowest levels of perceived ability compared with the other subgroups, no significant role for ethnicity and impurity was found. No differences were found between groups in scores of menstrual pain and prevalence of dysmenorrhea. Higher levels of somatization and lower levels of perceived ability, as well as a greater portion of Muslim and Druze and higher levels of religiosity, were found among rural residents.

CONCLUSIONS

The role of cultural variables and personality traits in the complexity of dysmenorrhea as a socio-bio-psychological phenomenon is proposed in light of contemporary interactive models. It is suggested that within the Israeli Arab minorities the impact of cultural background on health affects more the perceptual and cognitive levels and are not generalized to overt behavior and morbidity such as dysmenorrhea.

Obesity as a risk factor for premenstrual syndrome

PURPOSE

To determine the association between obesity and Premenstrual Syndrome (PMS).

METHODS

A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18-44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index.

RESULTS

The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI > or = 30) had nearly a three-fold increased risk for PMS than non-obese women OR = 2.8 (95% CI = 1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers.

CONCLUSION

This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.

The etiology, biology, and evolving pathology of premenstrual syndromes

Menstrually related symptoms and disorders are multidimensional and affect diverse physiologic systems. Elucidation of the pathophysiologic mechanisms of these disorders should allow for a more precise diagnosis, and provide direction for targeted therapeutic interventions. Several biologic mechanisms that underlie menstrually related symptoms have been proposed. They focus mostly on gonadal hormones, their metabolites and interactions with neurotransmitters and neurohormonal systems, such as serotonin, GABA, cholecystokinin, and the renin-angiotensin-aldosterone system. Altered responses of these systems to gonadal hormone's fluctuations during the menstrual cycle, as well as an increased sensitivity to changes in gonadal hormones may contribute to menstrually related symptoms in vulnerable women. Disrupted homeostasis and deficient adaptation may be core underlying mechanisms. Future directions for clinically-relevant progress include identification of specific subgroups of menstrually-related syndromes, assessment of the genetic vulnerability and changes in vulnerability along the life cycle, the diversified mechanisms by which vulnerability is translated into pathophysiology and symptoms, the normalization process as well as syndromes-based and etiology-based clinical trials.

Relationship between the NEO personality inventory revised neuroticism scale and prospectively reported negative affect across the menstrual cycle

Previous research has suggested a possible link between neuroticism and premenstrual symptom changes. Results, however, are difficult to interpret given methodological problems such as retrospective reporting of premenstrual symptoms, and failure to control for the generalized influence of neuroticism on psychosomatic symptomatology. The present study aimed to address these issues. One hundred and nine women from the general population completed the modified Menstrual Distress Questionnaire daily for 70 days. Neuroticism was assessed using the NEO Personality Inventory Revised. Neuroticism accounted for a significant amount of variation in premenstrual negative affect both before and after controlling for baseline (follicular) symptom levels. The relationship between neuroticism and premenstrual negative affect could not be linked to any particular facet of neuroticism (e.g. anxiety, depression). Oral contraceptive (OC) users had significantly higher levels of neuroticism than the non-oral contraceptive (NOC) group. A significant interaction between OC use and menstrual cycle phase was also noted, with a trend toward OC users experiencing less premenstrual, but more menstrual, negative affect compared with the NOC group. The results are discussed in terms of the contribution of personality factors to the etiology of premenstrual change, and the utility of cognitive-behavioral treatment approaches.

Premenstrual symptoms are relieved by massage therapy

Twenty-four women meeting Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for premenstrual dysphoric disorder (PDD) were randomly assigned to a massage therapy or a relaxation therapy group. The massage group showed decreases in anxiety, depressed mood and pain immediately after the first and last massage sessions. The longer term (5 week) effects of massage therapy included a reduction in pain and water retention and overall menstrual distress. However, no long-term changes were observed in the massaged group's activity level or mood. Future studies might examine the effects of a longer massage therapy program on these symptoms. Overall, the findings from this study suggest that massage therapy may be an effective adjunct therapy for treating severe premenstrual symptoms.

The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France

Up to 80% of women experience mood and physical symptoms associated with the menstrual cycle. This study assessed the impact of premenstrual symptomatology on functioning and treatment-seeking behavior for a community-based sample of women in the United States, United Kingdom, and France. A sample of 1045 menstruating women (aged 18-49) completed a telephone questionnaire that measured, at a point in time, premenstrual symptoms, impact on functioning, and treatment-seeking behavior. Results were generally consistent across the three countries. Irritability/anger, fatigue, and physical swelling/bloating, or weight gain were among the most commonly reported symptoms (approximately 80%). Functional impairment tended to be highest at home, followed by social, school, and occupational situations. Among working women, over 50% reported at least somewhat affected occupational functioning. Of women who ever missed work because of symptoms, 1-7 days were missed in the past year. Almost three fourths of the women had never sought treatment, and symptom severity was an important factor in treatment-seeking behavior. Treatment with selective serotonin reuptake inhibitors (SSRIs), which have demonstrated efficacy in this population, occurred with surprisingly low frequency. The functional impairment of premenstrual symptomatology (home, social, and occupational) and treatment-seeking behavior is consistent across countries. Women who experience more impairment are more likely to have severe symptoms and are more likely to believe, relative to women with less severe symptoms, that no treatment is available. This suggests significant unmet medical need in this more severely affected population. Improved clinical identification of these women and increasing awareness of the efficacy of SSRIs in treating premenstrual symptomatology may be of benefit.

Isolation and characterization of an estrogen binding protein which may integrate the plethora of estrogenic actions in non-reproductive organs

A putative estrogen receptor (pER) from mouse liver has been characterized. The heterodimer protein (81-84 kDa) consists of two covalently bound subunits (61-67 and 17-27 kDa) with following characteristics: sedimentation constant--4.9 S; IP--4.8; dissociation constant (Kd) for estradiol-17beta binding--0.7 nmol; binding sites--0.746 pmol/mg protein; relative binding affinity--estradiol-17beta--100, estrone--80 and estriol--30; specificity--does not bind, other natural steroids, synthetic estrogens, antiestrogens and bioflavonoids. Importantly, immunosuppressants, neuroleptic and carcinogens influence 3H-estradiol-17beta binding to pER. Interestingly, pER is a serine phosphatase and this may have relevancy to estrogen action in Alzheimer's disease. The polyclonal anti-pER antibody does not react with estrogen receptors (ER). ER antibody does not react with pER. Remarkably, anti-pER antibody reacts with calcineurin, a brain phosphatase and anti-calcineurin antibody reacts with pER. Immunohistochemical analyses showed that pER is undetectable in reproductive organs (except ovary). It is localized on the plasma or the nuclear membranes in some, in cytoplasm and/or nucleus in other cells of non-reproductive organs (skeletal, neural, vascular, hair and retina), and in tumors (mammary, endometrial and prostate cancers, and prostatic hyperplasia). The information presented justifies the proposition that pER may mediate the estrogenic actions in non-reproductive organs.

The influence of ambient light and menstrual status on the moods of a nonclinical population of young women

OBJECTIVE

To study the influence of the daily variation in ambient light and menstrual status on mood fluctuation in a nonclinical population of young women.

METHODS

Women kept mood diaries (two per day) over a period of 32 days that straddled the spring equinox. One group believed the purpose of the study was to investigate women's moods are significantly elevated by light, and this elevation occurs irrespective of the subjects knowledge of the experimental purpose. No evidence for a depression of women's mood in the premenstruum was found, although women who claimed to suffer from premenstrual syndrome (PMS) showed more reversals of their mood during the 32 days records were kept.

CONCLUSIONS

The results highlight the fact that an individual's mood may be influenced by the levels of ambient light as well as the photoperiod.

Premenstrual dysphoric disorders: a diversified cluster of vulnerability traits to depression

Some biological factors which have been shown to be abnormal in subgroups of women with dysphoric premenstrual syndromes (PMS) have not been limited to the symptomatic late luteal phase of the menstrual cycle, but also existed during the non-symptomatic mid-follicular phase of the cycle. Personality, cognitive functions, alpha 2 and imidazoline binding, sensitivity to inducement of panic attacks, relative hypothyroidism, and some but not all serotonergic functions of women with dysphoric PMS differ from those with no PMS, and also differ during a non-symptomatic phase of the cycle. It is suggested that premenstrual symptoms are an expression of vulnerability traits that might surface in response to a trigger. Such traits are probably diverse, and the nature of the symptoms might depend upon the underlying trait. It is postulated-that some vulnerability traits to specific premenstrual syndromes might also be vulnerability traits to depression or anxiety in general.

Personality traits in LLPDD and normal controls during follicular and luteal menstrual-cycle phases

In 15 women with Late Luteal Phase Dysphoric Disorder (LLPDD) and in 15 normal control subjects, personality traits were assessed using the Millon Clinical Multiaxial Inventory (MCMI) during follicular and luteal menstrual-cycle phases. Compared with controls, LLPDD subjects had less compulsive but more passive/aggressive and borderline/cycloid traits, and more depression and hypomania. Menstrual-cycle phase did not significantly affect personality variables in either group. In particular, depression and hypomania in LLPDD subjects suggests a relationship with affective disorders.

Premenstrual exacerbation of symptoms in multiple sclerosis is attenuated by treatment with weak electromagnetic fields

It has been suspected that hormonal factors contribute to the etiology and pathogenesis of multiple sclerosis (MS). A direct relationship between MS and endocrine functions is suggested by changes in disease activity during the phases of the menstrual cycle. A subset of women with MS experience premenstrual worsening of symptoms which improve dramatically with the onset of menstruation. The biological mechanisms underlying these changes in disease activity are unexplained but may be related to cyclical fluctuations in gonadal sex steroid hormones, abrupt changes in the activity of the endogenous opioid peptides and fluctuations in plasma melatonin levels which affect neuronal excitability and immune functions. Extracerebral application of weak electromagnetic fields (EMFs) in the picotesla range intensity has been reported efficacious in the treatment of MS with patients experiencing sustained improvement in motor, sensory, autonomic, affective and cognitive functions. The present report concerns two women with chronic progressive stage MS who experienced, coincident with increasing functional disability, regular worsening of their symptoms beginning about a week before menstruation and abating with the onset of menstruation. These symptoms resolved two months after the initiation of treatment with EMFs. The report supports the association between the endocrine system and MS and indicates that brief, extracranial applications of these magnetic fields modifies the activity of neuroendocrine systems which precipitate worsening of MS symptoms premenstrually.

Personality factors in women with premenstrual syndrome

The recently developed Tridimensional Personality Questionnaire (TPQ) was used to examine personality correlates in women diagnosed with premenstrual syndrome (PMS). The hypotheses were that the TPQ scores, specifically harm avoidance (HA), would be higher in PMS subjects than in the general population but lower than in depressed populations because major mood disorder is an exclusion from the PMS diagnosis; harm avoidance would have the strongest association with PMS, but other TPQ factors might characterize nondysphoric subgroups in the PMS population. The sample included 157 women who sought medical treatment and met clearly defined criteria for PMS. Two comparison groups of age-matched women with major depression (MDD, N = 20) and premenstrual exacerbation of major depression (MDD + PMS, N = 24) were also evaluated. TPQ scores were significantly higher for PMS subjects on all three dimensions compared with external normative TPQ data. The TPQ dimensions of HA and novelty seeking (NS) were modestly correlated with the premenstrual symptom scores. The HA dimension correlated with premenstrual depression and physical aches; high NS scores correlated with premenstrual food cravings, headache, and mood swings. As hypothesized, the HA scores were significantly higher in the comparison groups diagnosed with major depression; the NS and reward dependence (RD) dimensions did not differ between the PMS and MDD groups. PMS was associated with only modest nonnormative personality correlates, as assessed by the TPQ. Elevations of the HA and NS dimensions were associated with a tendency for the PMS to present with specific symptom patterns: depressive symptoms for the HA factor and food cravings and mood swings for the NS factor. Further research employing other assessment methods is needed to confirm these findings.

Perimenstrual depression: its relationship to pain, bleeding, and previous history of depression

Daily ratings of depression, pain, and menstrual blood loss, as well as past history of treated depression, were analyzed in 210 women attending a Premenstrual Syndrome Clinic. Severity and duration of perimenstrual depression was strongly associated with the severity of premenstrual and menstrual pain, raising the possibility of a causal relationship. It is not yet clear whether the occurrence of depression alters a woman's perception of pain, pain aggravates a tendency to perimenstrual depression, or some common factor aggravates both. A relationship between depression and subjective ratings of blood loss was also observed but was less marked than the relationship with pain. Both relationships had been reported in an earlier study using retrospective ratings. A relationship between past history of treated depression and severity and timing of current perimenstrual depression, observed previously, was not found in this study. This discrepancy was not due to differences between retrospective and prospective methods of assessment, but may have partly resulted from differences in the reporting of premenstrual pain in the two studies. Further studies of this association should control for the confounding effect of pain.

Theory and methodology in premenstrual syndrome research

Premenstrual Syndrome (PMS) is a controversial and ill-defined phenomenon, the aetiology of which remains an enigma, despite considerable research effort. In this paper, four meta-theoretical approaches to PMS are described and evaluated. Approaches to PMS can be criticised on three inter-related grounds. They have failed to describe women's experiences in detail before explaining them; they have not placed experience within its socio-cultural context; and they have assumed a linear relationship between biology or culture and behaviour. Future research can address these issues in two ways. Biopsychosocial models of PMS may integrate a variety of approaches and improve our understanding of individual experiences but are unlikely to offer new insights into the phenomenon of PMS. These are more likely to emerge from anthropological and sociological studies which question the cultural and individual meaning of PMS.

Genetic and environmental factors in premenstrual symptom reporting and its relationship to depression and a general neuroticism trait

Previous work has indicated a genetic contribution to premenstrual symptom reporting, regularity and menarche but no genetic contribution to cycle length, and no consistent genetic contribution to premenstrual symptom reporting. This paper reports the results (n = 634) of multivariate genetic analysis in which premenstrual symptom reporting is included in a general personality factor along with extroversion (E), neuroticism (N) and depression (D). The results showed that N, E, D and PMS all fitted on a common personality factor. There was no evidence for a specific genetic contribution of depression or premenstrual symptom reporting over and above those shown in the common personality factor. There were, however, unique/specific environmental contributions for PMS. For E and N, in contrast, both unique genetic and environmental contributions were apparent.

PREMENSTRUAL SYMPTOMS AND THE FEMALE EMPLOYEE

A survey was taken of working women concerning any premenstrual symptoms they may have experienced and the self-reported effects) on their job productivity. The sample consisted of n = 197 completed survey instruments. The most commonly listed symptoms (listed by more than 50% of the respondents) were: irritability, bloating, mood changes, depression, weight gain, headaches, and anger. These symptoms were reported as affecting job performance by 57% of the women and 40% indicated feeling less productive during the onset of premenstrual symptoms. The symptoms of mood changes, irritability, anger, and depression were significantly correlated with lower job performance as reported by the women. When the sample was divided into three groups based on age, there were no significant differences in the reporting of premenstrual symptoms and the severity of the symptoms. However, the three groups did show significant differences in the way the symptoms were reported to have affected their job performance. The younger group of women had a significantly higher proportion of respondents reporting that their premenstrual symptoms were adversely affecting their lives and job performance/productivity. Finally, when the sample was divided between managerial and non-managerial women, no significant differences were found.

Influence of premenstrual syndrome on family, social life, and work performance

Premenstrual syndrome is characterized by mental and physical symptoms that vary with different phases of the menstrual cycle. Symptoms start shortly after ovulation, increase in severity, and reach a maximum during the last five premenstrual days. After the onset of menstrual bleeding, the symptoms rapidly disappear and are usually gone within three to four days. Diagnostic procedures using prospective daily symptom ratings have recently been developed, allowing a more precise diagnosis of the cyclical mood changes and leading to a clearer picture and definition of the condition. Results from community studies show that the severity of the cyclical mood changes varies within a population of women of fertile age, from those having no cyclical mood changes to those severely handicapped by the symptoms for 14 days of the month. The severity assessment of subjective symptoms is difficult since severity is difficult to compare among individuals. In this article the authors review the different approaches to estimating severity of premenstrual syndrome and compare the different approaches with approaches used for other conditions with subjective symptoms. Two possible approaches are discussed in detail. One measures symptoms by counting the number of days with and without symptoms. The other estimates how much the symptoms affect patients' family life, social life, and work performance. Differences between retrospective and prospective assessments are also discussed.

The Premenstrual Syndrome: Perceived Stress and Coping Efficacy

Twelve women suffering from premenstrual syndrome (PMS) were monitored over eight weeks to focus on the psychological processes involved in this menstrual disorder. PMS symptomatology, perceived stress, and coping efficacy were examined. Significant cyclical changes occurred in all three variables with the highest deviations appearing premenstrually. The relationship between coping strategies and the severity of symptoms was also studied. Qualitative analysis revealed themes pertinent to an understanding of PMS. It is suggested that alternative treatment options besides pharmacological intervention should be made available to PMS sufferers.

The premenstrual syndrome--a reappraisal of the concept and the evidence

The Premenstrual Syndrome (PMS) remains a controversial issue. As a clinical concept it is surrounded by confusion. Attempts to establish a consensus definition have resulted in the majority of women seeking help for such problems excluded from the diagnosis. Furthermore, there is no consensus about how such problems should be treated, with a variety of methods being advocated usually on very uncertain scientific grounds. The issue also has its political implications; there are those who see PMS as a way of reducing the status of women, by linking the normal ovarian cycle to a phenomenon which, on the face of it, impairs women's ability to cope. Yet there are a substantial number of women who experience significant negative changes which vary with the menstrual cycle, and produce long-term effects on their well being and family relationship which can be serious. There is also a real possibility that recurrent perimenstrual mood changes of this kind may increase the likelihood of chronic depressive illness in susceptible individuals. In most respects the features of depression which occurs perimenstrually are essentially similar to those of major depressive disorder, except for the short duration and recurrent pattern. PMS, therefore, remains an issue not only of clinical importance, but of considerable potential relevance to our understanding of major depressive disorder, which is substantially more common in women of reproductive age than in their male counterparts. In this review the concept of PMS, and some prominent operational definitions of it, are critically evaluated; it is now questionable whether the concept, as currently applied, still carries any heuristic or clinical value. Some current theoretical and aetiological issues are considered: e.g. the role of the corpus luteum, the effects of hormonal regimes which block ovulation, such as oral contraceptives, and the possibility that cyclical mood change represents an entrained rhythm in the brain. The conclusions reached at this stage in the review lead to a 'paradigm shift' with the proposal of a three-factor model to account for the complexities of menstrual cycle-related problems.(ABSTRACT TRUNCATED AT 400 WORDS)

The Zurich Study. XIX. Patterns of menstrual disturbances in the community: results of the Zurich Cohort Study

This paper reports on the prevalence of emotional and somatic symptoms of the pre- and peri-menstrual phases of the female reproductive cycle among women who participated in a 10-year prospective epidemiologic cohort study of young adults in Zurich, Switzerland. The association between menstrual syndrome and sociodemographic features, personal habits, and psychopathology is investigated. The findings confirm those of previous studies, which have shown that symptoms of menstrual syndrome are quite common in non-clinical samples in the community, and increase with age. Women with menstrual problems could be distinguished from other women in a number of domains, including demographic characteristics such as nulliparity, higher educational level, distressing life events, lack of oral contraceptive use, psychiatric disorders, and personality traits. The combined evidence for a strong association between menstrual syndrome and anxiety, both in the subjects and their relatives, suggests that menstrual problems may represent a manifestation of underlying anxiety disorders rather than strictly affective disorders as traditionally believed.

Severity of premenstrual symptoms in relation to medical/psychiatric problems and life experiences

The Premenstrual Experience Assessment, a comprehensive questionnaire, was completed by 878 women who were currently having menstrual cycles. Their severity of premenstrual symptoms was studied in relation to demographic variables, gynecological problems, use of medications, psychiatric experience, life stressors, and duration of severity. 14 significant relationships were found. The findings are discussed both in terms of research and clinical practice.

Genetic and environmental factors in the aetiology of menstrual, premenstrual and neurotic symptoms: a population-based twin study

Symptoms during the premenstrual and menstrual phases of the female reproductive cycle were assessed in 827 pairs of female same-sex twins from a population-based registry. By conventional factor analysis, premenstrual and menstrual symptoms were relatively independent of one another and of baseline 'neurotic' symptoms (i.e. anxiety, depression and somatization). Familial resemblance for menstrual and premenstrual symptoms was due solely to genetic factors with heritability estimates of 39.2% and 35.1%, respectively. Multivariate genetic analysis revealed distinct genetic and environmental factors for menstrual, premenstrual and neurotic symptoms. The genes and individual-specific experiences that predispose to premenstrual symptoms appear to be largely distinct from those which predispose either to menstrual or to neurotic symptoms. The generalizability of these results may be limited because only a modest number of premenstrual and menstrual symptoms were assessed, all by retrospective self-report.

Premenstrual syndrome--psychiatric or gynaecological disorder?

The premenstrual syndrome (PMS) is a combination of mental and physical symptoms arising in the luteal phase of the menstrual cycle. The symptoms disappear after the onset of menstruation. During the rest of the follicular phase the patient is free from symptoms. The cyclical nature of the symptom variations is characteristic of the syndrome. The lack of a commonly accepted definition and a way to diagnose PMS has led to contradictory results in the search for its aetiology and treatment. The diagnosis of PMS should be based on prospective daily ratings of symptoms and defined criteria of subgroups. In our studies three subgroups can be identified. The "Pure PMS" group with significant cyclical symptoms being worse during the luteal phase and no symptoms during the follicular phase. A "Premenstrual aggravation" group with symptoms always present but with an aggravation premenstrually. A "Non-PMS" group of women who do not suffer from menstrual cycle related symptoms. These three groups show significant differences in the number of patients with an earlier psychiatric history and are different in the extent of neurosis on a personality test. The Pure PMS group had less neurosis and a lower frequency of patients with an earlier psychiatric history. In anovulatory cycles, whether induced or spontaneous, the cyclical nature of symptoms disappeared. This shows the important role that the corpus luteum has in precipitating symptoms in PMS. GnRH-agonists can be used to induce anovulation and this will stop the cyclical changes. Postmenopausal women receiving oestradiol/progestagen sequential treatment develop PMS-like symptoms when progestagen is added to the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of hormone therapy, coping skills training, and relaxation for the relief of premenstrual syndrome

Approximately 10% of women are severely affected by premenstrual syndrome (PMS) during their reproductive years. Several biological theories of causation have been proposed and each has provoked treatment attempts through medication to little sustained effect. As many of the reported complaints are psychological, a new treatment approach was considered using cognitive-behavioral therapy. A preliminary study which combined cognitive-behavioral therapy with drug treatment produced considerable symptom reduction. The present study examined the efficacy of cognitive-behavioral therapy alone in direct comparison with hormone treatment. Relaxation instructions were provided to a control group. Initial rapid responses to drug treatment and relaxation diminishes after 2 months, together with marked attrition in the control group. Significant positive benefits from cognitive-behavioral therapy were achieved after the first treatment month that continued throughout and were maintained at follow-up 3 months later. Implications for future management are discussed.

The relationship between perimenstrual depressive mood and depressive illness

In a study of 144 women, mainly self-designated PMS sufferers, the premenstrual depression experienced was, apart from its shorter duration, quantitatively and qualitatively similar to major depressive disorder for a substantial proportion of subjects. The associations with previous history of depression were complex: the severity of premenstrual depression was related to previous history of postnatal depression, whereas its duration (i.e., whether it persisted through longer) was related to a history of treatment with antidepressants. Two independent dimensions are proposed. (i) A menstrual cycle-related factor which in vulnerable women can results in severe and disabling premenstrual dysphoria, and which may be aetiologically related to a subgroup of postnatal depression. (ii) In a minority of women a more general propensity for depressive illness evidence as a tendency for any premenstrual depression to be prolonged.

The influence of the menstrual cycle and pregnancy on atopic dermatitis

The prevalence of a premenstrual deterioration in the symptoms of atopic dermatitis, as determined by a postal questionnaire completed by 150 women, was 33%. There was a significant association between a premenstrual worsening of atopic dermatitis and the presence of the symptoms of the premenstrual syndrome (P less than 0.002). Pregnancy had an adverse effect on atopic dermatitis in the majority of cases (52%), usually starting in the first 20 weeks of gestation, although an appreciable proportion of women (24%) had improved during their pregnancy.

Low dose danazol in the treatment of the premenstrual syndrome

This double-blind, randomized, crossover study compared the efficacy and safety of danazol (100 mg twice daily) with matching placebo in the treatment of severe premenstrual syndrome. Nineteen patients were randomly allocated to receive danazol for 3 months followed by placebo, and 18 to receive treatment in the reverse order. Assessments of overall condition showed improvement to be statistically significantly more likely with danazol than with placebo (P less than 0.001) after 3 months' treatment. Furthermore, daily visual analogue scale assessments demonstrated statistically significantly better premenstrual scores with danazol in comparison to placebo for breast discomfort, irritability, depression, anxiety, mood swings, crying, depressed libido and abdominal swelling. It is concluded that danazol provides effective and generally well tolerated treatment for severe premenstrual syndrome.

Premenstrual tension: a placebo-controlled efficacy study with spironolactone and medroxyprogesterone acetate

Forty-three healthy women with a characteristic history of premenstrual tension participated in a placebo controlled, crossover study. The effects of spironolactone (Aldactone) and medroxyprogesterone acetate (Gestapuran) on ten symptoms of premenstrual tension were evaluated. Placebo tablets as well as spironolactone and medroxyprogesterone acetate significantly improved a mood index score (which is a generally accepted method to measure premenstrual symptoms). Spironolactone and medroxyprogesterone acetate were however both significantly (P less than 0.05) better than placebo in relieving the symptoms.

The experience of dysmenorrhea and its relationship to personality variables

The aims of this study were: to relate women's subjective experience of primary dysmenorrhea to psychogenic needs assessed longitudinally at the age of 15 and at the age of 25 in a nonclinical sample; to compare the psychogenic needs of women with severe primary dysmenorrhea with those of other women who never have experienced dysmenorrhea; and to examine whether women with severe dysmenorrhea were less conventionally feminine than women who never have experienced dysmenorrhea. At 25 years, 42% of the women experienced dysmenorrhea and 15% experienced pain that limited their daily activity. Differences in psychogenic needs according to the Cesarec Marke Personality Schedule and in psychological masculinity and femininity according to the Attitude Interest Schedule were found in women with severe primary dysmenorrhea compared with women who never experienced dysmenorrhea. The results indicate that women with severe dysmenorrhea have less self-esteem at 15 years, but compensate for this at 25 years by being more achievement-oriented and aggressive than women who never experienced dysmenorrhea. Further, women with severe dysmenorrhea are more conventionally feminine than women who never have experienced dysmenorrhea.