Epidemiology of premenstrual symptoms and disorders

Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia

Background

Premenstrual dysphoric disorder (PMDD) is the most prevalent but neglected psychiatric disorder, with somatic symptoms that are severe enough to markedly affect usual daily activities and have a negative impact on mental health and quality of life by affecting female patients' behavior and cognition. Studies regarding premenstrual dysphoric disorder and associated factors among high school students in low- and middle-income countries are limited. Therefore, the aim of this study was to assess the prevalence and associated factors of PMDD among high school students, and this is pivotal in further investigation.

Methods

A school-based cross-sectional study was conducted from March 25 to April 17, 2023 using a simple random-sampling technique to select a sample of 564 participants. Premenstrual dysphoric disorder was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Self-administered standardized questionnaires were used to collect data.

Result

A total of 548 study participants participated, with a 97.2% response rate. The prevalence of premenstrual dysphoric disorder among high school students was found to be 33.03% (95%CI: 29.20-37.09). In a multivariable analysis, irregular menstruation cycle (AOR = 4.242, 95%CI = 2.182-8.246), depression (AOR = 5.272, 95%CI = 2.779-10.002), having greater than 4 days of menstruation bleeding duration (AOR = 2.138, 95%CI = 1.105-4.138), and high perceived stress (AOR = 3.468, 95%CL = 1.217-9.880) were the factors significantly associated with premenstrual dysphoric disorder.

Conclusion

The overall prevalence of PMDD which was one-third among high school students was high. Moreover, long duration of menstruation bleeding, depressive symptoms, irregular menstruation cycle, and high perceived stress were significant factors in PMDD. Therefore, it needs early screening and intervention in primary healthcare settings, especially for those who have high perceived stress, having depression, having a long duration of menstruation bleeding, and having an irregular menstruation cycle, so as to have good academic achievement and psychological wellbeing.

Global burden and trends in female premenstrual syndrome study during 1990-2019

PURPOSE

Premenstrual syndrome (PMS) is prevalent worldwide and considered a crucial issue regarding women's health. In the present study, the Global Burden of Disease (GBD) Study 2019 dataset was utilized to assess the distributional trends in PMS burden and prevalence in regional, national, and sociodemographic index (SDI) categories.

METHODS

The analytical methods and approaches used in the 2019 GBD study were adopted to investigate the incidence rates and disability-adjusted life years (DALY) related to PMS in 204 countries or regions. Age-standardized incidence rates (ASIR), 95% uncertainty intervals (95% UI), and annual percentage changes (EAPC) were calculated from the data.

RESULTS

The global incidence and disability-adjusted life years of PMS exhibited a declining trend in the year 2019. Regions with medium-low SDI had the greatest burden of PMS, with the regions of South Asia (ASR = 7337.9 per 10,000) exhibiting the greatest Age-standardized incidence rates, while the high-income North American states presented the fastest upward trends in Age-standardized disability-adjusted life year rates. At the national level, 107 nations exhibited a decreasing trend in PMS incidence ASR, while 97 nations exhibited an increasing trend, with the United States presenting the greatest increase.

CONCLUSIONS

The present study highlighted that even though the global PMS incidence and disability-adjusted life years have decreased from the year 1990 to 2019, PMS remains a prevalent health concern for women worldwide. While addressing preventive measures and treatment, it is also important to consider the regional and national differences in PMS to develop further effective and targeted health policies.

Functional and structural neuroimaging in premenstrual dysphoric disorder: A systematic review

This systematic review aimed to summarize the most recent data on changes in brain structure and function in premenstrual dysphoric disorder (PMDD) as well as elucidate the possible correlations between these findings and symptom severity. Articles published in PubMed, EMBASE, ScienceDirect, PsycInfo, Web of Science, and Scopus from inception until April 2023 were systematically reviewed according to the PICO framework: population (women with PMDD), intervention (neuroimaging study), control (healthy subjects), and outcome (neuroimaging changes). In total, 1026 individuals were included from controlled (n = 22) and non-controlled (n = 2) trials. Among them, 608 had PMDD, and 418 were healthy controls. Different neuroimaging methods were addressed, such as task-based functional magnetic resonance imaging (MRI), resting-state functional MRI, proton magnetic resonance spectroscopy, diffusion tensor imaging, proton emission tomography, and structural MRI. Despite the absence of consensual results, several brain structures have been implicated in PMDD, including the prefrontal cortex, amygdala, hippocampus, insula, basal ganglia, and cerebellum. In addition, some brain changes are related to the intensity of symptoms and phases of the menstrual cycle, such as the correlation between depressive symptoms and increased serotonin transporter binding potential in the midbrain during the luteal phase.

The effects of taping in the management of primary dysmenorrhoea: A systematic review with meta-analysis

In this systematic review and meta-analysis, we explored the efficacy of taping as a non-pharmacological intervention for pain reduction in primary dysmenorrhoea (PD), a prevalent condition causing significant quality of life impairment. We conducted a comprehensive search across databases including PubMed, PEDro, and Web of Science to identify randomized controlled trials assessing taping's effectiveness in PD for pain relief. Our criteria focused on studies comparing taping to no intervention or alternatives, with pain outcomes primarily measured using the Visual Analogue Scale (VAS). The quality assessment utilized the PEDro scale, with scores ranging from 4 to 8, indicating a spectrum of moderate to high-quality evidence. The results indicate that both kinesiotaping (SMD = -1.22; 95 % CI: -2.15, -0.29; p = 0.01) and other tapes (SMD = -1.61, 95 % CI: -2.15, -0.65; p = 0.001) significantly reduces pain intensity in women with PD. However, the certainty of evidence was very low according to GRADE criteria. This underscores the necessity for further research to understand taping's analgesic mechanisms, its long-term effects, and its influence on related symptoms and overall quality of life. Our findings advocate for the inclusion of taping in PD management, offering a promising direction for enhancing care in affected women.

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

PURPOSE

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

TARGET POPULATION

Reproductive-aged adults and adolescents with premenstrual symptoms.

METHODS

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

RECOMMENDATIONS

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

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.

The menstrual cycle and the COVID-19 pandemic

BACKGROUND

The impact of COVID-19 virus on menstrual cycles in unvaccinated women is limited.

OBJECTIVE

To investigate the prevalence of changes to menstrual cycle characteristics, hormonal symptoms and lifestyle changes prior to and during the COVID-19 pandemic.

METHODS

A retrospective online cross-sectional survey completed by social media users between July 2020 to October 2020. Participants were living in the United Kingdom (UK), premenopausal status and, or over 18 years of age.

MAIN OUTCOME(S) AND MEASURES(S)

The primary outcome was to assess changes to menstrual cycle characteristics during the pandemic following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Secondary outcomes included assessment of hormonal and lifestyle changes.

RESULTS

15,611 social media users completed the survey. Of which, 75% of participants experienced a change in their menstrual cycle, with significantly greater proportions reporting irregular menstrual cycles (P<0·001), bleeding duration more than seven days (P<0·001), longer mean cycle length (P<0·001) and overall bleeding duration (P<0·001). Over half the participants reported worsening of premenstrual symptoms including low mood/depression, anxiety and irritability. When stratified according to COVID-19 infection, there was no significant difference in menstrual cycle changes.

CONCLUSION

The COVID-19 pandemic resulted in considerable variation in menstrual cycle characteristics and hormonal symptoms. This appears to be related to societal and lifestyle changes resulting from the pandemic, rather than to the virus itself. We believe this may have an impact on the individual, as well as national economy, healthcare, and population levels, and therefore suggest this should be taken into consideration by governments, healthcare providers and employers when developing pandemic recovery plans.

Oral contraceptives containing drospirenone for premenstrual syndrome

BACKGROUND

Premenstrual syndrome (PMS) is a common problem. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. Combined oral contraceptives (COC), which provide both progestin and oestrogen, have been examined for their ability to relieve premenstrual symptoms. A combined oral contraceptive containing drospirenone and a low oestrogen dose has been approved for treating PMDD in women who choose combined oral contraceptives for contraception.

OBJECTIVES

To evaluate the effectiveness and safety of COCs containing drospirenone in women with PMS.

SEARCH METHODS

We searched the Cochrane Gynaecology and Fertility Group trial register, CENTRAL (now containing output from two trials registers and CINAHL), MEDLINE, Embase, PsycINFO, LILACS, Google Scholar, and Epistemonikos on 29 June 2022. We checked included studies' reference lists and contacted study authors and experts in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCT) that compared COCs containing drospirenone with placebo or with another COC for treatment of women with PMS.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recommended by Cochrane. The primary review outcomes were effects on premenstrual symptoms that were prospectively recorded, and withdrawal due to adverse events. Secondary outcomes included effects on mood, adverse events, and response rate to study medications.

MAIN RESULTS

We included five RCTs (858 women analysed, most diagnosed with PMDD). The evidence was very low to moderate quality; the main limitations were serious risk of bias due to poor reporting of study methods, and serious inconsistency and imprecision. COCs containing drospirenone and ethinylestradiol (EE) versus placebo COCs containing drospirenone and EE may improve overall premenstrual symptoms (standardised mean difference (SMD) -0.41, 95% confidence interval (CI) -0.59 to -0.24; 2 RCTs, N = 514; I2 = 64%; low-quality evidence); and functional impairment due to premenstrual symptoms in terms of productivity (mean difference (MD) -0.31, 95% CI -0.55 to -0.08; 2 RCTs, N = 432; I2 = 47%; low-quality evidence), social activities (MD -0.29, 95% CI -0.54 to -0.04; 2 RCTs, N = 432; I2 = 53%; low-quality evidence), and relationships (MD -0.30, 95% CI -0.54 to -0.06; 2 RCTs, N = 432; I2 = 45%; low-quality evidence). The effects from COCs containing drospirenone may be small to moderate. COCs containing drospirenone and EE may increase withdrawal from trials due to adverse effects (odds ratio (OR) 3.41, 95% CI 2.01 to 5.78; 4 RCT, N = 776; I2 = 0%; low-quality evidence). This suggests that if you assume the risk of withdrawal due to adverse effects from placebo is 3%, the risk from drospirenone plus EE will be between 6% and 16%. We are uncertain of the effect of drospirenone plus EE on premenstrual mood symptoms, when measured by validated tools that were not developed to assess premenstrual symptoms. COCs containing drospirenone may lead to more adverse effects in total (OR 2.31, 95% CI 1.71 to 3.11; 3 RCT, N = 739; I2 = 0%; low-quality evidence). This suggests that if you assume the risk of having adverse effects from placebo is 28%, the risk from drospirenone plus EE will be between 40% and 54%. It probably leads to more breast pain, and may lead to more nausea, intermenstrual bleeding, and menstrual disorder. Its effect on nervousness, headache, asthenia, and pain is uncertain. There was no report of any rare but serious adverse effects, such as venous thromboembolism in any of the included studies. COCs containing drospirenone may improve response rate (OR 1.65, 95% CI 1.13 to 2.40; 1 RCT, N = 449; I2 not applicable; low-quality evidence). This suggests that if you assume the response rate from placebo is 36%, the risk from drospirenone plus EE will be between 39% and 58%. We did not identify any studies that compared COCs containing drospirenone with other COCs.

AUTHORS' CONCLUSIONS

COCs containing drospirenone and EE may improve premenstrual symptoms that result in functional impairments in women with PMDD. The placebo also had a significant effect. COCs containing drospirenone and EE may lead to more adverse effects compared to placebo. We do not know whether it works after three cycles, helps women with less severe symptoms, or is better than other combined oral contraceptives that contain a different progestogen.

Relationship between covid-pandemic anxiety and sleep disorder with menstrual disorders among female medical workers

BACKGROUND

It has been more than 2 years since the 2019 novel coronavirus disease (COVID-19) pandemic destabilized the world, adversely affecting not only physical health, but also mental health. During this time, frontline medical workers were at a greater health risk, especially female medical workers. Changes or abnormalities in the menstrual cycle-an important indicator of women's health-may jeopardize female reproductive functioning. Considering that emotional health and sleep status may be related to the menstrual cycle, this study aimed to investigate the association between menstrual cycle changes, anxiety, sleep dysfunction, and other factors among female medical workers during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted by distributing online questionnaires to female medical workers in China from February to May 2022. The study included 160 women aged 18-45 years old. The questionnaires covered data related to the participants' sociodemographic characteristics, medical and reproductive history, and lifestyle. The Rating Scale for Clinical Manifestations of Menopathy (SCMM), Self-Rating Anxiety Scale (SAS), and Sleep Dysfunction Rating Scale (SDRS) were utilized. Data were analyzed using chi-square tests, t-tests, and linear regression analysis.

RESULTS

A total of 160 female medical staff were randomly selected in this research, of whom seven scored less than 3 points, 85 scored 3-11 points, and 68 scored more than 11 points on the total score of the SCMM. Compared to pre-pandemic scores, scores of dizziness and tinnitus were significantly higher during the COVID-19 pandemic. Scores corresponding to the following clinical symptoms were also higher during the pandemic: Menopathy, including hypaphrodisia, dim complexion, abnormal urination, languidness, dim menstruation, thin menstruation, dysmenorrhea, and empty or saggy lower abdomen (p < 0.05). However, pre-pandemic scores of vaginal bleeding quantity were significantly higher than those found during the COVID-19 pandemic (p < 0.05). Scores of vaginal bleeding quantity were significantly lower in cabin hospitals than other types of hospitals, and a similar finding was observed for vaginal bleeding duration (all p < 0.05). Moreover, the findings of the univariable and multivariable linear regression analysis revealed a link between consistent exercise, the underlying illness, the SDRS score, the SAS score, and the total score of SCMM (p < 0.05).

CONCLUSIONS

In this study, we found that menstruation in female medical workers was affected by the COVID-19 pandemic. Furthermore, regular exercise and good physical condition were protective factors, while anxiety and insomnia were risk factors for menstrual abnormalities.

Premenstrual disorders: Premenstrual syndrome and premenstrual dysphoric disorder

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Stress and rumination in Premenstrual Syndrome (PMS): Identifying stable and menstrual cycle-related differences in PMS symptom severity

Since the inclusion of Premenstrual Dysphoric Disorder (PMDD) as a mood disorder in the DSM-5, Premenstrual Syndrome (PMS) symptoms have received more attention from researchers and clinicians. In this large-scale study, we investigated core psychological concepts relevant to mood disorder vulnerability between people with 1) no to mild, 2) moderate to severe, and 3) PMDD levels of PMS symptoms. Several trait measures related to mood disorders including depressive symptoms, feelings of stress and anxiety, and ruminative thinking were measured (single measurement, N = 380) along with state (momentary) reports of stress and stress-related perseverative thinking (measured twice, once in the follicular and once in the premenstrual/luteal phase, N = 237). We consistently observed that participants with higher severity of PMS symptoms also scored higher on depression, anxiety, stress, and rumination (trait measures). We also found consistent increases in momentary stress and stress-related perseverative ruminative thinking with increased PMS symptoms at each of our two test moments (in the middle of the follicular and premenstrual/luteal phase respectively). Interestingly, we did not find significant differences between our two test moments for any group, despite PMS being characterized by specific systems in the premenstrual/luteal phase. However, this could be due to noise surrounding the testing moments due to the temporal resolution of the questionnaires and the menstrual cycle estimation method. Nevertheless, these results suggest that stress and rumination are important psychological mechanisms to consider in PMS. Future PMS research studying stress and rumination on a day-to-day basis in combination with hormonal measures is warranted.

Resident intruder paradigm-induced PMDD rat model of premenstrual irritability: behavioral phenotypes, drug intervention, and biomarkers

BACKGROUND

Premenstrual dysphoric disorder (PMDD) is high in women of childbearing age with obvious premenstrual irritability. However, reliable animal models are still lacking.

MATERIALS AND METHODS

PMDD rat model of premenstrual irritability was induced by the resident-intruder paradigm (RIP). Behavioral characteristics were determined by the aggressive behavior test, elevated plus maze, open-field test, and breast width measurement. The estrous cycle in rats was artificially manipulated by bilateral ovariectomy and exogenous hormone injection to verify the model phenotype's dependence on the estrous cycle. Fluoxetine and Baixiangdan capsules were administered by gavage to determine the symptom improvement effect of PMDD irritability. Biomarkers in serum and brain were detected using ELISA, and GABRA4 was detected in the brain by RT-PCR and Western blot.

RESULTS

Rat models demonstrated similar clinical characteristics as PMDD, such as premenstrual irritability and anxiety, and the above symptoms were estrous cycle-dependent. In addition, the levels of progesterone (P) and ALLO hormones decreased in the serum, hippocampus, amygdala, and frontal lobe in the NR phase. The contents of 5-HT in the brain were significantly increased, while NE and GABA contents were considerably reduced. Moreover, mRNA and protein expression of GABRA4 levels in model rats' amygdala, hippocampus, and frontal lobe were significantly increased, while drug intervention downregulated its expression in these tissues.

CONCLUSION

Premenstrual irritability rat model of PMDD demonstrates a behavioral phenotype consistent with the clinical symptoms of PMDD and micro index. The increased levels of 5-HT, NE, and expression of GABRA4, as well as the decrease of GABA, P, and ALLO levels, may be critical biomarkers of the abnormal changes that occur during the pathogenesis of PMDD.

Menstrual symptoms variation among Lebanese women before and after the COVID-19 pandemic

Objectives

Pandemic diseases and the confinement measures due to COVID-19 infection have introduced acute and persistent psychosocial stressors for different individuals with a greater influence on females manifested through changes in the menstrual cycle. The objective of this study was to assess Lebanese female of reproductive age about their menstrual cycle, their mental health, and their lifestyle, throughout the COVID-19 pandemic, Beirut blast, and the economic crises.

Methods

A cross-sectional online study conducted between October and December 2021, enrolled 398 Lebanese women using the snowball technique. The Menstrual Symptom Questionnaire (MSQ) was used to assess menstrual symptoms. A repeated measures ANOVA was used to assess factors associated with the variation in MSQ scores after vs before the pandemic.

Results

Our results showed that a significantly higher number of days of menses, number of pads per day and total MSQ score were significantly found after the pandemic compared to before it. More distress (Beta=0.68), more post-traumatic stress disorder due to COVID-19 (Beta=0.19), a higher number of waterpipes smoked per week (Beta=1.20) and being infected by COVID-19 compared to not (Beta=3.98) were significantly associated with an increase in the MSQ score after the pandemic compared to before it.

Conclusion

Our main findings indicate that females had irregular menstrual cycles, unpredictable bleeding pattern, and intense symptoms severity post COVID-19 pandemic. Furthermore, stress post COVID-19 and Beirut blast tended to be associated with increased menstrual symptoms. Thus, vulnerable women should be identified and offered appropriate care, information, and awareness regarding their menstrual period during a pandemic.

Licit Substance Use and Premenstrual Syndrome Symptom Severity in Female College Students

INTRODUCTION

Premenstrual syndrome (PMS) affects the majority of women and is characterized by physical, behavioral, and mood symptoms, which can have a profound impact on quality of life. PMS symptoms have also been linked to licit substance use. This study examined the relationships between daily/problem use (DPU) of caffeine (Caf⁺), alcohol (Alc⁺), and tobacco (Cig⁺) and PMS symptomology in a sample of college women.

METHODS

Participants (N = 196) completed an anonymous one-time health survey. Demographic, PMS symptomatology, and DPU of licit substance variables were examined. Independent t-tests compared PMS symptom scores in women with and without Caf⁺, Cig⁺, and Alc⁺ use. One-way analysis of variances examined the associations between PMS symptom severity and number of DPU-positive substances.

RESULTS

PMS subscale severity (pain [F(2,190) = 4.47, p = 0.013], affective [F(2,192) = 8.21, p < 0.001], and water retention [F(2,191) = 13.37, p < 0.001]) and total PMS symptom severity [F(2,189) = 10.22, p < 0.001] showed a dose response effect, with the number of licit substances with DPU significantly associated with PMS symptom severity.

CONCLUSIONS

This study findings provide important new information about the relationship between PMS symptoms and at-risk substance use. These are cross-sectional data, however, and affirm a need for longitudinal research to better understand the associations, with a focus on potential benefits of education and intervention.

Menstruation and menopause in autistic adults: Periods of importance?

Autism spectrum conditions were once seen as a predominantly male condition. This has caused a paucity of information on common events in the lives of women, such as menstruation and menopause. Some smaller studies indicate that autistic women might suffer from increased difficulties surrounding these events. This study aims to investigate whether autistic women experience more frequent premenstrual dysphoric disorder, and increased complaints surrounding menopause. In partly overlapping samples (premenstrual dysphoric disorder, n = 70, n_ASC = 28, n_comparisons = 42; menopause, n = 65, n_ASC = 30, n_comparisons = 35), we investigated premenstrual dysphoric disorder prevalence and menopausal complaints. In 70 individuals, we did not find an increased prevalence of premenstrual dysphoric disorder in autistic women (14.3%) compared with non-autistic women (9.5%). In 65 women aged 40 years and above, we found that autistic women did experience higher levels of menopausal complaints. In autistic women, higher menopausal complaints were associated with higher levels of depression and autistic traits. In non-autistic women, menopausal complaints were associated with increased inattention, hyperactivity/impulsivity (i.e. attention deficit hyperactivity disorder traits), and depression. With this work, we show the important role that major reproductive milestones can have in an autistic woman’s life.

Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

Functional brain network topology across the menstrual cycle is estradiol dependent and correlates with individual well-being

The menstrual cycle (MC) is a sex hormone‐related phenomenon that repeats itself cyclically during the woman's reproductive life. In this explorative study, we hypothesized that coordinated variations of multiple sex hormones may affect the large‐scale organization of the brain functional network and that, in turn, such changes might have psychological correlates, even in the absence of overt clinical signs of anxiety and/or depression. To test our hypothesis, we investigated longitudinally, across the MC, the relationship between the sex hormones and both brain network and psychological changes. We enrolled 24 naturally cycling women and, at the early‐follicular, peri‐ovulatory, and mid‐luteal phases of the MC, we performed: (a) sex hormone dosage, (b) magnetoencephalography recording to study the brain network topology, and (c) psychological questionnaires to quantify anxiety, depression, self‐esteem, and well‐being. We showed that during the peri‐ovulatory phase, in the alpha band, the leaf fraction and the tree hierarchy of the brain network were reduced, while the betweenness centrality (BC) of the right posterior cingulate gyrus (rPCG) was increased. Furthermore, the increase in BC was predicted by estradiol levels. Moreover, during the luteal phase, the variation of estradiol correlated positively with the variations of both the topological change and environmental mastery dimension of the well‐being test, which, in turn, was related to the increase in the BC of rPCG. Our results highlight the effects of sex hormones on the large‐scale brain network organization as well as on their possible relationship with the psychological state across the MC. Moreover, the fact that physiological changes in the brain topology occur throughout the MC has widespread implications for neuroimaging studies.

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

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

Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective cohort study

Background

It has been suggested that premenstrual syndrome (PMS) may derive from either elevated oxidative stress or reduced antioxidant vitamin levels in the body; however, these relationships have been minimally studied in a large cohort of healthy women. Our objective was to estimate the association between serum concentrations of antioxidant vitamins (A, C, and E) and markers of oxidative stress (F2-isoprostane) with symptoms and severity of PMS.

Methods

The BioCycle study was a prospective cohort study following 259 healthy premenopausal women aged 18–44 years for up to 2 menstrual cycles. Frequency/severity of 20 PMS symptoms were assessed via questionnaires 4 times/cycle, and antioxidant vitamins and oxidative stress biomarkers were measured up to 8 times/cycle to correspond with specific cycle phases. Generalized linear models were used to estimate associations between mean antioxidant concentrations and oxidative stress biomarkers with PMS symptoms and severity; linear mixed models were used to evaluate associations with symptom severity scores within groups (e.g. depression, cravings, pain).

Results

Higher concentrations of serum antioxidant vitamins were largely not associated with prevalence or severity of PMS symptoms. Though a few associations were observed, only associations between mean γ-tocopherol and decreased odds of swelling of the hands/feet survived adjustment for multiple comparisons (OR 0.33, 95% CI 0.16, 0.65, per ug/dL). However, F2-isoprostanes were associated with prevalence and severity of several symptoms specifically related to depression and cravings (depression score β = 0.07, 95% CI 0.02, 0.12, per 10 ug/dL; cravings score β = 0.16, 95% CI 0.10, 0.22, per 10 ug/dL), as well as with classification of PMS severity (OR 1.07, 95% CI 1.01, 1.14, per 10 pg/dL), with these associations surviving adjustment for false discovery rate.

Conclusions

F2-isoprostanes, but not antioxidant vitamins, were associated with select PMS symptoms, as well as symptom and severity categories. Specific symptom relationships merit further research.

Menstrual Cycle Characteristics and Premenstrual Syndrome Prevalence Based on the Daily Record of Severity of Problems in Korean Young Adult Women

PURPOSE

This descriptive study aimed to identify the menstrual cycle characteristics and premenstrual syndrome (PMS) prevalence in Korean young adult women using the retrospective and prospective Daily Record of Severity of Problems (DRSP).

METHODS

In the first stage, participants included 151 nursing students studying in a university located in Seoul. Data were collected from April 20 to June 2, 2017, using the questionnaire on menstrual characteristics, pictorial blood assessment chart, and retrospective DRSP. In the second stage, participants included 17 students with PMS, based on the screening conducted in the first stage. Data were collected using the prospective DRSP from May 29 to 2 September 2, 2017.

RESULTS

Of the study sample, 104 participants (68.9%) had regular periods. Those with regular periods had 11.97 periods annually with a menstrual cycle of 29.38 days and a period duration of 5.72 days. Fifty-five participants (37.4%) showed menorrhagia. Sixty-four participants (42.4%) were found to have PMS based on their retrospective DRSP. When the ratio of women (52.9%) with PMS shown in the prospective DRSP was used as a positive predictive value, the estimated PMS prevalence was 22.4%.

CONCLUSION

This study provides clinically significant PMS prevalence among Korean young adult women, positive predictive value of the retrospective DRSP, and valid data to basically understand the menstrual cycle characteristics experienced by these women.

Effect of zinc supplementation on quality of life and sleep quality in young women with premenstrual syndrome: a randomized, double-blind, placebo-controlled trial

INTRODUCTION

Premenstrual syndrome is a prevalent disorder affecting a large number of women in their reproductive ages. Nutritional importance of zinc has been known for a long time and studies have shown that zinc can positively affect psychological disorders.

PURPOSE

The aim of this study was to evaluate the effects of zinc supplementation on quality of life and sleep quality of young women diagnosed with premenstrual syndrome.

METHODS

This randomized, double-blind, placebo-controlled trial was carried out on 60 young university women that were allocated into two groups of intervention who took 30 mg/day of elemental zinc or placebo for three months. Pre- and post-intervention, participants completed the questionnaires of quality of life and Pittsburgh sleep quality.

RESULTS

After supplementation, quality of life score in the intervention group was increased (+ 9.185 ± 7.29, P < 0.001), however, in comparison with the control group, results were not significant; Physical aspects of quality of life score were significantly enhanced (+ 5.55 ± 3.71 vs. + 0.13 ± 2.87, P < 0.001). Sleep quality was marginally improved just in the zinc group (- 1.48 ± 4.12, P = 0.07).

CONCLUSION

Zinc supplementation for 12 weeks had beneficial effects on physical aspects of quality of life in young women with premenstrual syndrome.

Reciprocal effects between cognitive and affective states in women with Premenstrual Dysphoric Disorder: An Ecological Momentary Assessment study

Premenstrual Dysphoric Disorder (PMDD) is characterized by cyclical mood changes resulting in clinically significant distress and functional impairment. Studies on momentary cognitive and affective states and their interplay during daily life over the menstrual cycle in affected women are still lacking. Using Ecological Momentary Assessment with electronic diaries, 61 women with current PMDD and 61 healthy control women reported their current mood, rumination, and self-acceptance eight times a day over two consecutive days per cycle phase (menstrual, follicular, ovulatory, and late luteal phase). Results revealed that women with PMDD showed significant increases in negative affect and rumination and decreases in positive affect and self-acceptance toward the end of the cycle. Lagged analyses demonstrated stronger within-person reciprocal effects of cognitions and mood in PMDD women compared to controls with the effect of rumination on subsequent negative affect being limited to the late luteal phase. Identified stronger prospective associations between cognitive processes and mood deteriorations in women with PMDD suggest that affected women are more sensitive to detrimental effects of either dimension. Hence, therapeutic strategies aiming at reducing ruminative thoughts and improving self-acceptance such as mindfulness-based interventions could be promising for reducing the burden of PMDD.

Relationship between a high Edinburgh Postnatal Depression Scale score and premenstrual syndrome: A prospective, observational study

OBJECTIVE

This study aimed to evaluate whether the Edinburgh Postnatal Depression Scale (EPDS) score predicts the occurrence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) after delivery.

MATERIALS AND METHODS

The women in this study were registered at 35-36 weeks of pregnancy at Mie University Hospital from 2013 to 2015. We prospectively divided the puerperants into those with an EPDS score ≥9 (the high-EPDS group) and those with an EPDS score <9 (the low-EPDS group) at 1 month postpartum. We compared the incidence rate of severe PMS and PMDD between both groups at 1 year after delivery.

RESULTS

Of 200 registered cases, 178 (89.0%) did not experience severe PMS or PMDD before pregnancy. Among them, 21 were in the high-EPDS group, and 89 in the low-EPDS group. Four of the 21 women (19.0%) in the high-EPDS group and five of the 89 (5.6%) in the low-EPDS group had severe PMS or PMDD at 1 year after delivery. The incidence rate of severe PMS or PMDD in the high-EPDS group was higher than that in the low-EPDS group (p = 0.07).

CONCLUSIONS

The novel finding of this study is that the EPDS may predict the occurrence of severe PMS/PMDD after delivery. The EPDS will contribute to the early detection of these diseases and to improving the quality of life of the patients by allowing treatment initiation at an early stage.

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

Background

A majority of women from all cultures and socioeconomic levels experience myriad symptoms known as premenstrual syndrome during the days prior to menstruation. The present study investigated commonly reported symptoms in the premenstrual phase among college students. The authors further scrutinized potential factors, including subjective perceptions of health, which may be related to the premenstrual-symptom constellation.

Methods

We conducted a cross-sectional survey, which included 200 participants (mean age: 19.8 ± 0.1 years old). The subjects completed a rating of their premenstrual experiences relative to 46 symptoms in eight categories of the self-reporting menstrual distress questionnaire (MDQ) to evaluate the prevalence and severity of premenstrual symptoms. The participants also answered a standardized health questionnaire regarding subjective perceptions of health, self-rating stress, lifestyle, and demographic variables.

Results

Regardless of severity, the 10 symptoms most often occurring among the participants included skin disorders, irritability, fatigue, mood swings, general aches and pains, lowered school or work performance, backache, painful breasts, weight gain, and swelling. Stepwise multiple regression analysis revealed subjective perception of health (β = 0.28; p <  0.001) and self-rating stress (β = 0.18; p = 0.008) as the factors most strongly related to the MDQ total scores. In addition, the 19 women who evaluated themselves as “unhealthy and stressed” had greater prevalence of severe or extremely severe physical (general aches and pains) and psychosocial symptoms (confusion, lowered school or work performance, decreased efficiency, loneliness, anxiety, restlessness, mood swings, and depression), compared to the healthy and non-stressed women.

Conclusions

The present study indicates the prevalence of premenstrual symptoms, regardless of severity and number, among college students and suggests that negative subjective perceptions of health and stress may be related to the intensity of premenstrual symptomatology.

The impact of menstrual symptoms on everyday life: a survey among 42,879 women

BACKGROUND

Menstrual symptoms such as dysmenorrhea, heavy menstrual bleeding, and perimenstrual mood disorders are known to be widespread among the general population. From studies in patients with endometriosis and premenstrual disorder, it has been shown that these symptoms can have a large impact on women's quality of life and account for substantial health care use. Furthermore, it is estimated that many women initially do not consult a doctor while facing menstrual symptoms. Consequently, the impact of menstrual symptoms on daily activities in the general population is unknown.

OBJECTIVE

To obtain a nationwide overview of menstrual symptoms and their impact on everyday activities.

STUDY DESIGN

Nationwide, cross-sectional, internet-based survey among 42,879 women aged 15-45 years, conducted from July to October 2017.

OUTCOME MEASURES

presence of menstrual symptoms, pain or intensity score, impact on daily activities.

RESULTS

Dysmenorrhea was the most common symptom, with a prevalence of 85%, followed by psychological complaints (77%), and tiredness (71%). During their menstrual period, 38% of all women reported not to be able to perform all their regular daily activities. From the women that had to skip tasks because of their symptoms, only 48.6% told their family that menstrual symptoms were the reason for the transfer of tasks.

CONCLUSION

Menstrual symptoms are widespread among the general population. One in 3 women quit daily activities owing to menstrual symptoms. Half of all women did not mention menstrual complaints being the reason for transferring tasks in a family setting. These results must be interpreted with caution owing to the potential for selection bias. However, considering the impact of menstrual symptoms on daily activities in a large group of women, it is time to open the societal dialogue and improve education for both patients and doctors.

Diet quality in adolescents with premenstrual syndrome: A cross-sectional study

AIM

Premenstrual syndrome (PMS) is a complex of symptoms that can seriously affect the quality of life in women. It has been suggested that the nutritional status of adult women may influence the presence and/or severity of PMS symptoms. However, little is known about this association in adolescents. The present study aimed to examine the relationship between diet quality and the presence/severity of PMS symptoms in adolescents.

METHODS

A case-control study of 272 female students, aged 13-18 years, was conducted in a high school. PMS was diagnosed and the symptoms were recorded using Premenstrual Syndrome Scale (PMSS)-2006 in 2 consecutive months. Dietary intake was assessed with 24-hour-dietary intake recall method and Healthy Eating Index-2010 (HEI-2010) score was calculated as an indicator of diet quality. Anthropometric measurements, including body weight, height, waist circumference and hip circumference were taken.

RESULTS

PMS was diagnosed in 56.9% of the study sample. The mean HEI-2010 score was significantly lower in the PMS group (47.5 ± 23.95) when compared to the control group (53.5 ± 20.98), P = 0.034. The PMS symptoms, anxiety (P = 0.009), depressive feelings (P = 0.016) and changes in sleeping pattern (P = 0.000) were associated with lower diet quality scores in the PMS group. No significant difference in anthropometric measurements was observed between the groups.

CONCLUSIONS

The present study suggested that adolescents with a high-quality diet might experience depressive feelings, anxiety or changes in sleeping less when compared to those with a low quality diet. Therefore, the causal relationship between diet quality and presence/severity of PMS should be investigated in further studies.

The effect of omega 3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trial

INTRODUCTION

Most reproductive aged women suffer from somatic and mental disorders prior to menstruation. This study investigated whether omega-3 supplement improved premenstrual symptoms and health-related quality of life among reproductive aged women.

METHODS

A multi-center, balanced (1:1), placebo-controlled, parallel-group randomized clinical trial was conducted in an urban academic institution. A sample consisting of 95 Iranian women aged 20-35 years who were suffering from premenstrual symptoms were randomly allocated into two groups. The treatment consisted of omega-3 supplement containing 1 g fish oil. Placebo was free of oil. The premenstrual symptoms' screening tool and 12-item short form health survey questionnaire were used for data collection.

RESULTS

No statistically significant differences in the baseline characteristics of the groups were reported. Most premenstrual symptoms and their interference with daily activities were significantly reduced over the follow-up period. The mean score of overeating in the omega-3 supplement group and insomnia in the placebo group showed no difference between the groups. The longer use of omega-3 supplement provides improvement of premenstrual symptoms and activities. The mean scores of physical and mental components of quality of life were significantly improved in the omega-3 supplement and placebo groups.

DISCUSSION

The treatment of premenstrual symptoms using omega-3 supplement reduced symptoms and ameliorated women's quality of life.

Development of Korean Menstrual Symptom Scale for University Students

PURPOSE

To develop Korean Menstrual Symptom Scale (KMSS) for university students and test its reliability and validity.

METHODS

The scale was developed by intensive literature review, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of final items. Thirty-nine items were constructed. Data for validity and reliability testing were collected with a questionnaire survey from 391 university students. Data were analyzed with descriptive statistics, factor analysis, and reliability coefficients (Cronbach's α) with the SPSS program.

RESULTS

There were 37 final items which were sorted into six factors: 'negative affection (8 items)', 'change of activity level (7 items)', 'physical symptom (9 items)', 'mood change (9 items)', 'change in concentration level (4 items)', and 'body water retention (5 items)'. The cumulative percent of variance was 63.3%. Regarding the reliability of the scale, its Cronbach's α was 0.96. Cronbach's α values for these factors ranged from 0.75 to 0.91.

CONCLUSION

The KMSS demonstrated acceptable validity and reliability. Repeated research is needed to measure menstrual symptom experienced by women of variable ages.

Association between Vitamin D Status and Premenstrual Symptoms

BACKGROUND

Premenstrual symptoms are experienced by up to 95% of women, and few treatments are available. Previous studies suggest that 25-hydroxyvitamin D (25(OH)D) may be associated with the severity of premenstrual symptoms, but the findings have been inconclusive.

OBJECTIVE

The objective of this study was to determine whether vitamin D status is associated with the severity of individual premenstrual symptoms.

DESIGN/PARTICIPANTS

Cross-sectional analysis of 998 women aged 20 to 29 years recruited at the University of Toronto campus from 2004 through 2010.

MAIN OUTCOME MEASURES

Participants provided data on their premenstrual symptoms in a premenstrual symptom questionnaire. Fasting overnight blood samples were collected, and plasma 25(OH)D was measured. Participants with plasma 25(OH)D concentrations <20 ng/mL were considered to have inadequate vitamin D status, and those with ≥20 ng/mL, adequate vitamin D status.

STATISTICAL ANALYSES PERFORMED

Multinomial logistic regressions were used to calculate the odds ratio (OR) and 95% confidence interval for the associations between vitamin D status and the severity of 15 premenstrual symptoms. Adjustments were made for age, body mass index, ethnicity/race, physical activity, hormonal contraceptive use, season of blood draw, use of analgesics, and calcium intake.

RESULTS

Compared with participants with adequate vitamin D status, those with inadequate vitamin D status had an increased risk (odds ratio [OR]; 95% CI) of experiencing the following mild symptoms: confusion (OR=1.72; 95% CI, 1.14 to 2.59) and desire to be alone (OR=1.47; 95% CI; 1.03 to 2.10), as well as the following moderate/severe symptoms: cramps (OR=1.50; 95% CI, 1.02 to 2.21), fatigue (OR=1.51; 95% CI, 1.04 to 2.21), anxiety (OR=1.63; 95% CI, 1.02 to 2.63), confusion (OR=2.23; 95% CI, 1.18 to 4.21), and sexual desire (OR=1.65; 95% CI, 1.09 to 2.51). Vitamin D status was not associated with other premenstrual symptoms (acne, bloating, mood swings, increased appetite, headache, clumsiness, insomnia, depression, or nausea).

CONCLUSION

Findings suggest that inadequate vitamin D status may be associated with increased severity of some, but not all, premenstrual symptoms.

Premenstrual disorders

Premenstrual disorders include premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual worsening of another medical condition. While the underlying causes of these conditions continue to be explored, an aberrant response to hormonal fluctuations that occurs with the natural menstrual cycle and serotonin deficits have both been implicated. A careful medical history and daily symptom monitoring across 2 menstrual cycles is important in establishing a diagnosis. Many treatments have been evaluated for the management of premenstrual disorders. The most efficacious treatments for premenstrual syndrome and premenstrual dysphoric disorder include serotonin reuptake inhibitors and contraceptives with shortened to no hormone-free interval. Women who do not respond to these and other interventions may benefit from gonadotropin-releasing hormone agonist treatment.

Premenstrual mood and empathy after a single light therapy session

To examine whether acute changes in cognitive empathy might mediate the impact of light therapy on mood, we assessed the effects of a single light-therapy session on mood and cognitive empathy in 48 premenstrual women, including 17 who met Premenstrual Symptoms Screening Tool criteria for moderate-to-severe premenstrual syndrome / premenstrual dysphoric disorder (PMS/PMDD). Using a participant-blind between-groups design, 23 women underwent 30min of morning light therapy (5,000lx; blue-enriched polychromatic light, 17,000K) while 25 women had a sham session (200lx, polychromatic light, 5,000K). We administered the Positive Affect and Negative Affect Schedule and the Affect Grid right before and after the intervention, and 60min later upon completion of a computerized empathic accuracy task. There were no significant effects of light condition on cognitive empathy as assessed using the computer task. Nonetheless, bright light reduced negative affect, specifically in women not using hormonal contraceptives. No effects of bright light on mood were observed in women who were using contraceptives. If a single light-therapy session does not alter cognitive empathy, then cognitive empathy may not mediate the impact of light therapy on mood in premenstrual women.

Mental and Reproductive Health Correlates of Academic Performance among Debre Berhan University Female Students, Ethiopia: The Case of Premenstrual Dysphoric Disorder

Background

Globally 3 to 8% of reproductive age women are suffering from premenstrual dysphoric disorder (PMDD). Several mental and reproductive health-related factors cause low academic achievement during university education. However, limited data exist in Ethiopia. The aim of the study was to investigate mental and reproductive health correlates of academic performance.

Methods

Institution based cross-sectional study was conducted with 667 Debre Berhan University female students from April to June 2015. Academic performance was the outcome variable. Mental and reproductive health characteristics were explanatory variables. Two-way analysis of variance (ANOVA) test of association was applied to examine group difference in academic performance.

Result

Among 529 students who participated, 49.3% reported mild premenstrual syndrome (PMS), 36.9% reported moderate/severe PMS, and 13.8% fulfilled PMDD diagnostic criteria. The ANOVA test of association revealed that there was no significant difference in academic performance between students with different level of PMS experience (F-statistic = 0.08, p value = 0.93). Nevertheless, there was a significant difference in academic performance between students with different length of menses (F-statistic = 5.15, p value = 0.006).

Conclusion

There was no significant association between PMS experience and academic performance, but on the other hand, the length of menses significantly associated with academic performance.

Relationships among Menstrual Attitude, Premenstrual Distress, and Premenstrual Coping in Korean College Women

PURPOSE

This paper presented a descriptive study which aimed to identify the relationship among menstrual attitude, premenstrual distress and premenstrual coping in Korean college women and to propose fundamental data for the development of guidelines for effective management of premenstrual distress.

METHODS

The data were collected from 111 college women and analyzed using descriptive statistics, t-tests, ANOVA and Pearson's correlation coefficients.

RESULTS

The mean score of premenstrual coping was 3.25±0.60 out of 5 points. The 'Awareness and Acceptance of Premenstrual Change' score was highest and the 'Avoiding Harm' score was lowest. Menstrual attitude was significantly related to premenstrual distress (r=.37 p<.001) and the awareness and acceptance style of premenstrual coping (r=-.21. p=.021). And premenstrual distress was significantly related to the self-care coping style of premenstrual coping (r=.30, p=.001), the adjusting energy coping style of premenstrual coping (r=.45, p<.001) and the avoiding harm coping style of premenstrual coping (r=.48, p<.001).

CONCLUSION

Results of this study support that positive attitude about menstruation is necessary for the effective management of premenstrual distress. Also, premenstrual coping programs that consider the level of premenstrual distress will be needed for college women.

A specific profile of luteal phase progesterone is associated with the development of premenstrual symptoms

There is a consensus that the development of premenstrual dysphoric states is related to cyclical change in gonadal hormone secretion during the menstrual cycle. However, results from studies seeking to link symptom severity to luteal phase progesterone concentration have been equivocal. In the present study we evaluated not only the absolute concentrations of progesterone but also the kinetics of the change in progesterone concentration in relation to development of premenstrual symptoms during the last 10days of the luteal phase in a population of 46 healthy young adult Brazilian women aged 18-39 years, mean 26.5±6.7years. In participants who developed symptoms of premenstrual distress, daily saliva progesterone concentration remained stable during most of the mid-late luteal phase, before declining sharply during the last 3days prior to onset of menstruation. In contrast, progesterone concentration in asymptomatic women underwent a gradual decline over the last 8days prior to menstruation. Neither maximum nor minimum concentrations of progesterone in the two groups were related to the appearance or severity of premenstrual symptoms. We propose that individual differences in the kinetics of progesterone secretion and/or metabolism may confer differential susceptibility to the development of premenstrual syndrome.

Emotional regulation difficulties and premenstrual symptoms among Israeli students

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) reported to affect 3-8 % of women of reproductive age and resulting in marked emotional and occupational impairment. Despite its prevalence, the etiology of PMDD is largely unknown, and patients remain mostly undiagnosed and poorly treated. It has been suggested that PMDD is a manifestation of underlying depressive disorder which is associated with the inability to regulate emotions in an adaptive manner. Therefore, we hypothesized that women with PMDD would exhibit increased difficulty with emotional regulation. A total of 648 female Israeli college students were assessed by the Premenstrual Symptoms Screening Tool (PSST) and the Difficulties in Emotion Regulation Scale (DERS). Of these women, 166 (25.6 %) met the criteria for PMS. Sixty-four (9.9 %) suffered from PMDD. More emotion regulation deficits were observed in the PMDD and PMS groups compared to the control group. Furthermore, there were more emotional regulation deficits among the predominantly psychological and mixed symptom subtype compared to the predominantly physical symptom subtype group. This is the first study to report an association between emotional dysregulation and PMDD. These findings may lead to development of more individually tailored treatment protocols focused on improving emotional regulation techniques.

Cohort profile: Women's Healthy Ageing Project (WHAP) - a longitudinal prospective study of Australian women since 1990

Background

The cohort was commenced to examine women’s health from midlife (45–55 years) before the menopausal transition and into ageing.

Methods

Randomised selection and assessment of 2,001 women living in the Melbourne metropolitan area was conducted by the Roy Morgan Centre in 1990/91. Of the 779 women who met the entry criteria for the longitudinal follow-up (aged 45–55 years, menstruating, having a uterus and at least one ovary and not taking hormone therapy) 438 agreed to be seen annually across the menopausal transition from 1992 to 1999. Longitudinal prospective follow-up since 2000 has continued intermittently (2002/03, 2004/05, 2012/13, 2014/15). Data collection has included fasting biomarkers in each year since 1992, clinical assessment, lifestyle and quality of life data, physical measures and validated questionnaire data. Participants have consented to data linkage and, to date, mammogram and BioGrid data have been accessed. Biobank storage including serum, deoxyribonucleic acid (DNA) storage and PAXgene tubes are maintained.

Discussion

The WHAP has contributed to over 200 published research findings, several books, and book chapters in a variety of areas, including: health and wellbeing; mental and cognitive health; bone health; lifestyle, vascular risk and prevention; women’s health and hormonal transition; and cross-cultural research.

With all participants now aged over 70 years, the cohort is ideally placed to answer key questions of healthy ageing in women. With more than 25 years of longitudinal prospective follow-up this Australian dataset is unique in its duration, breadth and detail of measures including clinical review and specialized disease-specific testing and biomarkers. Ongoing follow-up into older ages for this long-running cohort will enable the association between mid to late-life factors and healthy ageing to be determined. This is particularly valuable for the examination of chronic diseases which have a 20–30 year prodrome and to provide knowledge on multiple morbidities. The dataset has a unique opportunity to improve our understanding of temporal relationships and the interactions between risk factors and comorbidities.

Electronic supplementary material

The online version of this article (doi:10.1186/s40695-016-0018-y) contains supplementary material, which is available to authorized users.

Toxoplasma gondii Infection and Premenstrual Dysphoric Disorder: A Cross-Sectional Study

Background

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome. The influence of Toxoplasma gondii (T. gondii) infection on clinical features in women with this disorder has not been studied. Therefore, we determined the association of T. gondii infection with symptoms and signs in women suffering from premenstrual dysphoric disorder.

Methods

We performed a cross-sectional study of 151 women suffering from premenstrual dysphoric disorder. Anti-Toxoplasma IgG and IgM antibodies were detected in sera of the participants using enzyme-linked immunoassays (EIAs). In addition, T. gondii DNA was detected in whole blood of IgG seropositive participants using polymerase chain reaction. We obtained the clinical data of women with the aid of a questionnaire. The association of T. gondii infection with clinical characteristics of women was assessed by bivariate and multivariate analyses.

Results

Anti-T. gondii IgG antibodies were found in 10 (6.6%) of the 151 women studied. Of the 10 IgG seropositive women, four (40.0%) were positive for anti-T. gondii IgM antibodies, and one (10.0%) for T. gondii DNA. Mean number (25.8 ± 7.58) of premenstrual clinical characteristics in seropositive women was similar to that (29.22 ± 9.13) found in seronegative women (P = 0.25). Logistic regression showed that seropositivity to T. gondii was negatively associated with difficulty concentrating (OR: 0.18; 95% CI: 0.03 - 0.91; P = 0.03), and positively associated with out of control feeling or overwhelmed (OR: 9.00; 95% CI: 1.32 - 62.00; P = 0.02).

Conclusions

Results of this first study on the association of T. gondii infection and clinical characteristics of premenstrual dysphoric disorder suggest that this infection might be linked to some symptoms of this disorder. We report for the first time the association of T. gondii infection and out of control feeling or overwhelmed. Results warrant for further research on the role of T. gondii in premenstrual dysphoric disorder.

Premenstrual symptom clusters and women's coping style in Korea: happy healthy 20s application study

INTRODUCTION

The purpose of this study was to identify premenstrual symptom clusters; and to explore the differences in and effectiveness of coping strategies among symptom cluster groups.

METHODS

Using the happy healthy 20s smartphone application, 349 women with premenstrual symptoms participated in the study. Premenstrual symptoms and health outcomes such as perceived health, depressive feelings, quality of life, suicidal ideation/attempts and coping strategies were explored. Factor analysis and silhouette analysis were used to identify premenstrual symptom clusters. Analysis of variance was used to explore the differences among symptom clusters in health outcomes and coping strategies.

RESULTS

Three premenstrual symptom clusters were identified: general discomfort, negative affect and turmoil. Three symptom cluster groups experienced different health outcomes in perceived health, depressive feelings, quality of life and suicidal ideation. However, few differences were noted in participants' engagement in coping strategies, frequencies and perceived effectiveness among women with different symptom clusters.

DISCUSSION

Findings of this study support previous reports that women do not receive tailored care for their premenstrual symptoms. Learning about the symptom structure, women's ways of coping, and perceived effectiveness is important in identifying the issues in current premenstrual symptoms management and providing tailored care.

Personality Traits of Suicidality Are Associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder in a Suicidal Women Sample

Objective

Both Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) might increase the risk of suicidal behavior. The aim of this study was to assess the relationship between personality dimensions specifically involved in suicidal vulnerability and PMS/PMDD.

Method

We collected data from 232 women consecutively hospitalized after a suicide attempt. We examined the relationship between impulsivity, aggressiveness/hostility, hopelessness, trait anger, affect intensity, emotional lability, and PMS/PMDD. Notably, we created an algorithm from the shortened Premenstrual Assessment form in order to assess PMDD status.

Results

The proportions of PMS and PMDD among female suicide attempters were 50% and 23% respectively. Women with PMS or PMDD were more likely to endorse most of these personality traits to than those without even after controlling for potential confounders. We found an impulsive-aggressive pattern of personality in women with PMS or PMDD, independently from the time of the menstrual cycle. Interestingly, trait anger remained associated with both PMS and PMDD independently of every other personality traits. The higher the anger level, the higher the risk was to suffer from both PMS and PMDD.

Conclusions

This study demonstrates a strong, independent association between PMS/PMDD and trait anger among a representative sample of female suicide attempters. It is of major interest for clinicians in view of addressing a substantial public health problem among women of reproductive age.

The role of allelic variation in estrogen receptor genes and major depression in the Nurses Health Study

PURPOSE

The role of exogenous and endogenous sex hormones in the etiology of depression remains elusive, in part because sex hormone variation is often correlated with behaviors, life stage changes, and other factors that may influence depression. Estrogen receptor alpha (ESR1) and beta (ESR2) are known to regulate gene expression and estrogen response in areas of the brain associated with major depression and are unlikely to be correlated with exogenous factors that may influence depression.

METHODS

We examined whether functional polymorphisms in these genes are associated with lifetime major depression and chronic major depression among a sample of women from the Nurses' Health Study II (N = 2527). DSM-IV depressive disorder symptoms were assessed by structured interview in 2007. Genotyping was performed on DNA extracted from blood using Taq-man.

RESULTS

Women with the AA alleles of ESR2 RS4986938 had the higher prevalence of lifetime major depression than women with other allele frequencies (36.7 % for those with AA versus 28.5 % with GA and 29.1 % with GG, p = 0.02) and chronic major depression (14.7 % for those with AA versus 9.3 % with GA and 9.1 % with GG, p = 0.01). History of post-menopausal hormone (PMH) use modified the association of ESR1 polymorphism RS2234693 with any lifetime depression; specifically, those with the TT allele had the highest risk of lifetime depression among PMH users, and the lowest risk of depression among non-PMH users (p value for interaction = 0.02). Further, carriers of the AA alleles in ESR1 polymorphism RS9340799 had increased prevalence of lifetime major depression only among lifetime PMH users (p = 0.007).

CONCLUSIONS

Our findings support the hypothesis that estrogen receptor polymorphisms influence risk for major depression; the role of estrogen receptors and other sex steroid-related genetic factors may provide unique insights into etiology.

Premenstrual Dysphoric Disorder: Epidemiology and Treatment

Recently designated as a disorder in the DSM-5, premenstrual dysphoric disorder (PMDD) presents an array of avenues for further research. PMDD's profile, characterized by cognitive-affective symptoms during the premenstruum, is unique from that of other affective disorders in its symptoms and cyclicity. Neurosteroids may be a key contributor to PMDD's clinical presentation and etiology, and represent a potential avenue for drug development. This review will present recent literature on potential contributors to PMDD's pathophysiology, including neurosteroids and stress, and explore potential treatment targets.

Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal study

BACKGROUND

Premenstrual syndrome (PMS) is common among women of reproductive age. Limited studies have investigated the long-term association between illicit drug use and PMS.

METHODS

The 1973-1978 cohort from the Australian Longitudinal Study on Women's Health, a prospective cohort study, was followed up for 13-year from 2000 to 2012. Data were collected through self-reported questionnaires on all variables, including PMS, illicit drug use and a range of sociodemographic, lifestyle, reproductive and psychological factors.

RESULTS

When the women were 22-27 years of age, over 40% use illicit drug in the last 12 months, 9% first used drug before age 15 years and approximately 35% reported PMS. Over the study period, the prevalence of drug use in the last 12 months declined whereas that of PMS remained fairly stable except an increase when they were 34-39 years old. Generalised estimating equations analysis showed that, compared to never drug users, significantly higher odds of reporting PMS were detected for illicit drug use in the last 12 months: multiple drugs (odds ratio (OR) 1.31, 95% confidence interval (CI) 1.21, 1.43), exclusive marijuana (OR 1.23, 95% CI 1.08, 1.40). A higher odds of PMS was identified for age at first drug use before 15 years (OR 1.20, 95% CI 1.03, 1.40).

CONCLUSIONS

Illicit drug use in the last 12 months, especially early age at first use and multiple drug use, is associated with increased risk of PMS. However current study is unable to prove causality.

Treatment of premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is comprised of a cluster of affective, behavioral and somatic symptoms recurring monthly during the luteal phase of the menstrual cycle. The disorder affects 3-8% of menstruating women and represents the more severe and disabling end of the spectrum of premenstrual disorders, which includes premenstrual syndrome and premenstrual aggravation of underlying affective disorder. Rigorous and specific diagnostic criteria for PMDD were specified in the Diagnostic and Statistical Manual of Mental Disorders IV (1994) and reaffirmed in the Diagnostic and Statistical Manual of Mental Disorders V (2013) and, consequently, there has been a marked increase in well-designed, placebo-controlled studies evaluating treatment modalities. Although the exact pathogenesis of PMDD is still elusive, treatment of PMDD and severe premenstrual syndrome has centered on neuromodulation via serotonin reuptake inhibitor antidepressants, and ovulation suppression utilizing various contraceptive and hormonal preparations. Unlike the approach to the treatment of depression, serotonergic antidepressants need not be given daily, but can be effective when used cyclically, only in the luteal phase or even limited to the duration of the monthly symptoms. Less, well-substantiated alternative treatments, such as calcium supplementation, agnus castus (chasteberry), Hypericum perforatum (St John's wort) and cognitive/behavioral/relaxation therapies, may be useful adjuncts in the treatment of PMDD. This review provides an overview of current information on the treatment of PMDD.