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.

A comparison of the Tridimensional Personality Questionnaire in premenstrual dysphoric disorder and major depressive disorder

OBJECTIVE

Numerous symptoms of premenstrual dysphoric disorder (PMDD) overlap with those of major depressive disorder (MDD). This study investigates differences in novelty seeking, harm avoidance, and reward dependence between patients with PMDD, MDD without premenstrual symptoms or premenstrual exacerbation, and normal control subjects.

METHOD

The Chinese version of the Tridimensional Personality Questionnaire was administered to 51 PMDD, 39 MDD, and 52 normal control women during the luteal phase (between the menstrual cycle days 23 and 28).

RESULTS

Harm avoidance score was significantly higher in women with MDD and PMDD than in controls, whereas reward dependence score was lower in women with MDD than in controls. However, Tridimensional Personality Questionnaire (except for the subscale of impulsiveness) did not distinguish between PMDD and MDD during the luteal phase.

CONCLUSION

The similarities between PMDD and MDD during luteal phase suggest a similar psychopathology.

Diet and Lifestyle Factors Associated with Premenstrual Symptoms in a Racially Diverse Community Sample: Study of Women's Health Across the Nation (SWAN)

AIMS

We sought to determine if the frequency of reported physical or emotional premenstrual symptoms (PMSx) was associated with (1) dietary intake of phytoestrogens, fiber, fat, or calcium, (2) consumption of alcohol or caffeine, (3) active or passive smoke exposure or lack of physical exercise, and (4) race/ethnicity or socioeconomic status.

METHODS

A cross-sectional analysis was conducted of PMSx and demographic and lifestyle factors reported at baseline in the multiethnic sample of 3302 midlife women in the Study of Women's Health Across the Nation (SWAN). Stepwise multiple logistic regression analyses were performed for the overall sample and for each racial/ethnic group for each of five PMSx groupings.

RESULTS

Most dietary factors were not related to PMSx. Fat intake was negatively associated with craving and bloating (adjusted odds ratio [AOR] = 0.56, p = 0.024), and fiber intake was positively associated with breast pain (AOR = 1.39, p = 0.037). Alcohol intake was negatively associated with anxiety and mood changes (AOR = 0.63, p = 0.045) and headaches (AOR = 0.50, p = 0.009). Current smoking (AOR = 1.60, p = 0.028) and passive smoke exposure (AOR = 1.56, p = 0.050) were positively associated with cramps and back pain. Symptom reporting differed significantly by race/ethnicity. PMSx were also associated with comorbidities, early perimenopausal status, depressive symptoms, and symptom sensitivity.

CONCLUSION

We found little evidence to support a role for diet in PMSx reporting. However, alcohol intake was positively associated with premenstrual anxiety and mood changes, and active and passive smoke exposure was associated with a number of PMSx. Ethnic differences in symptom reporting and associations of comorbidities, early perimenopausal status, depressive symptoms, and symptom sensitivity with reported PMSx were also observed.

Intake of dietary soy isoflavones in relation to perimenstrual symptoms of Korean women living in the USA

This study was conducted to identify the potential relationship between the dietary intake level of soy isoflavones and perimenstrual symptomatology. The research design was a cross-sectional study. The sample was made up of 84 Korean women living in the USA, aged 28-40 years. The Moos Menstrual Distress Questionnaire (MDQ) and the Food Frequency Questionnaire were used as measurement tools. The soy isoflavone intake was significantly correlated with MDQ scores in the menstrual phase. In conclusion, the beneficial effect of dietary soy isoflavones on certain menstrual symptoms was established, suggesting that soy isoflavones could be one of the dietary factors related to the complexity of premenstrual syndrome (PMS). The positive effect of soy isoflavones on PMS warrants further study.

Perimenstrual Symptoms of Korean Women Living in the USA: Applicability of the WDHD(Women's daily health diary)on Prospective Report

PURPOSE

To compare perimenstrual (premenstrual, menstrual, postmenstrual) symptoms by concurrent reporting using the Women's Daily Health Diary (WDHD) and by retrospective reporting using the Moos Menstrual Distress Questionnaire (MMDQ).

METHODS

A prospective and retrospective study was conducted among 31 Korean women, aged 27 to 48 yrs, living in the USA.

RESULTS

On the prospective report using the WDHD, the most severe complaints were fatigue or tiredness (1.48 +/-.98), sensation of weight gain (.88+/-98), increased appetite (.79+/-.96) in premenstrual phase, fatigue or tiredness (1.34+/-.85), backaches (1.06+/-.79), and bloating or swelling of the abdomen (.93+/-.86) during the menstrual phase. On the retrospective report using the MMDQ, the most severe complaints during the premenstrual phase were fatigue (2.2 6+/-1.65), irritability (2.06+/-1.48), and backaches (1.97+/-1.68) and during the menstrual phase backaches (2.35+/-1.62), fatigue (2.29+/-1.75), and cramps (2.23+/-1.80). According to both measurements of PMS symptomology during the premenstrual and menstrual phases, the most frequently reported symptom was fatigue or tiredness. Highly rated symptoms on the MMDQ and on the WDHD were found to be similar.

CONCLUSION

The WDHD was found to be suitable for daily prospective PMS assessment, which will be necessary for the screening and management of women with severe PMS.

Constructions of Femininity and Experiences of Menstrual Distress

The purpose of this article is to explore the relationship between constructions of feminine gender identity and experiences of menstrual distress. Both quantitative and qualitative methods were used to assess the relationship between femininity and PMS. Statistically significant correlations were found between T-scores for femininity on the Bem Sex Role Inventory (Bem, 1978) and total distress scores on the Menstrual Distress Questionnaire (Moos, 1991). Analysis of the qualitative data suggests that women engage in intense premenstrual bodily surveillance, and the data support Ussher, Hunter, and Browne's (2000) findings that the 'PMS self' becomes lived as an identity position in contrast to a 'real' or 'non-PMS sell.' The authors conclude that our biopsychiatric discourse about PMS functions to legitimize traditional constructions of femininity and that future research should conceptualize menstrual distress as both lived experience and social construction.

Quality of life and menopausal transition for middle-aged women on Kinmen island

Although it seems reasonable to suggest that most women experience significant changes in quality of life (QOL) during the menopausal period, few researchers have quantified these changes. A total of 1497 women, aged 40-54 years and living on the island of Kinmen, were recruited for this survey. However, 137 were eliminated leaving 1360 for analysis. Women who used hormonal therapy or who had undergone surgically induced menopause were excluded. The subjects with incomplete data or who exhibited mental retardation or severe psychiatric disease were also eliminated. Univariate analysis demonstrated that, in general, QOL scores were poorer for perimenopausal and postmenopausal status. Comparing pre- and postmenopausal women, significant statistical differences were demonstrated for role limitations due to physical and emotional problems, even after adjusting for age, education level, body mass index, menarche, and chronic illness. A strong association was demonstrated between menopausal symptoms and premenstrual syndrome (PMS). Women with menopausal symptoms and PMS had significantly lower scores on all SF-36 dimensions. The results of this study suggest that poorer health status is experienced by peri- and postmenopausal women compared to premenopausal women.

Exploring the bio-psycho--social approach to premenstrual experiences

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.

Premenstrual symptoms in Mexican women with different educational levels

Most women present some premenstrual symptoms, which may be influenced by diverse sociocultural factors. The authors studied the premenstrual symptoms of 89 healthy Mexican women living in rural areas and whose education ranged from no schooling to middle school attendance, and 182 women living in urban areas whose education ranged from elementary school to professional studies. The Menstrual Distress Questionnaire (R. H. Moos, 1968) was completed by all the women during the premenstrual and postmenstrual phases of one menstrual cycle. The percentage of women who reported mild symptoms was 87% on somatic scales and 86% on psychological scales. Premenstrual symptoms were more severe among women engaged in professional studies. Urban women reported more severe psychological symptoms than rural women. When women who were engaged in professional studies were excluded from the data analyses, no differences between the groups were found. Thus, it appears that the women's level of education affected premenstrual symptoms more than their rural or urban backgrounds did.

Relationship between premenstrual tension syndrome and anxiety in Chinese adolescents

This study examined the relationship between anxiety and premenstrual tension syndrome. One hundred and fifty-three schoolgirls completed Spielberger's Trait Anxiety Inventory and Abraham's Menstrual Symptom Questionnaire. The high level of trait anxiety found in this sample was related to an increase in premenstrual tension symptoms.

Prospective assessment of menstrual and premenstrual experiences of Icelandic women

In the only Icelandic study on premenstrual symptoms, a retrospective one conducted in 1991, investigators found 30% of the sample to have severe premenstrual changes. In light of critique that retrospective data primarily reflect socioculturally held beliefs about menstruation, the present study was undertaken in order to assess prospectively Icelandic women's premenstrual and menstrual symptoms and experiences. A total of 211 menstrual cycles were recorded by 83 women using a daily health diary. A symptom pattern was defined for each woman. A small majority of the women (51.8%) displayed a low symptom pattern. Two women (2.4%) demonstrated a premenstrual syndrome pattern, and 5 women (6.0%) exhibited a premenstrual magnification pattern. The remaining women displayed mixed symptom patterns indicating wide variability in women's experiences. These findings differ from the Icelandic retrospective study and from a USA study using prospective data. Therefore, it is concluded that menstrual socialization influences symptoms expectation and reporting.

Menstrual and premenstrual experiences of women in a developing country

The menstrual and premenstrual experiences of black Zimbabwean women were examined. Twenty-five professional women and twenty-five domestic workers were interviewed using semistructured, open-ended interviews designed to explore their experiences. An analysis of consensual data indicated a number of predominant themes, including secrecy associated with menstruation, the negativity surrounding menarche, the breakdown of the traditional family network that passes on information about menstruation, and the acceptance of menstrual cycle experiences by the women. The main differences between the two groups concerned explanations of the functions and purpose of menstruation and the reporting of physical and affective symptoms. These differences are suggestive of the impact of educational level on experiences of menstruation.

Perimenstrual symptoms among Chinese women in an urban area of China

We explored perimenstrual symptoms among 16 Chinese women in an urban area of southeastern China using a retrospective questionnaire, the Menstrual Distress Questionnaire (MDQ), and a prospective daily symptom diary, the Daily Health Diary (DHD), modified for cultural relevance. Mean scores on the DHD were significantly (p < .03) higher during the perimenstrual phase for the symptoms fatigue, increased sensitivity to cold, increased sleeping, abdominal pain/discomfort, painful or tender breasts, and decreased sexual desire. The women who reported higher DHD physical symptom scores prospectively were more likely to recall more severe physical symptoms retrospectively on the MDQ. However, there were remarkable discrepancies between the DHD and MDQ regarding psychoemotional symptoms. By retrospective MDQ, the percentages of women who experienced severe mood swings and irritability ranged from 13% to 25% during the premenstrual and menstrual phases; on the DHDs, however, these emotional symptoms were not statistically associated with the menstrual cycle. The failure of prospective charting to confirm the retrospective reports of cyclic psychoemotional symptoms agrees with findings of studies of U.S. samples. We conclude that perimenstrual distress in Chinese women may be affected by the data collection methods.

Premenstrual syndrome in employed Chinese women in Hong Kong

Premenstrual syndrome (PMS) has been studied in many countries, but few studies have been reported internationally on the experience of Chinese women. Because culture and employment are important factors in the perception of health status, in this study we sought to determine the existence and features of PMS in Chinese clerical women in Hong Kong. We used a cross-sectional, retrospective approach to collect data with a translation of an established questionnaire (the Menstrual Distress Questionnaire). Fatigue was found to be the most prevalent symptom, and the Pain, Water Retention, Behavioral Change, and Negative Affect scales had more than 64% frequency. The main difference between these findings and those of other studies is that negative affect featured most prominently in Western samples, whereas pain featured most highly in this sample of Chinese women.

Menstrual cycle symptom reporting in three British ethnic groups

Three different British ethnic groups were targeted to assess the influence of learned or culturally prescribed symptom reporting behaviour across different phases of the menstrual cycle. Forty-eight Afro-Caribbean, 73 Caucasian and 32 Oriental subjects completed a Positive/Negative Affectivity scale, a Retrospective assessment of premenstrual symptoms and daily symptom reports for 35 days. The results showed a significantly elevated level of symptomatology premenstrually and menstrually in the Caucasian group compared to both others. Analysis of subscales suggested elevated symptom reporting occurred for the psychological mood, body symptoms and pain, but not for the mental performance and social behaviour subscales. Intermenstrual reports of symptoms and Negative Affectivity did not differ between groups. A response bias or underlying trait is therefore unlikely to account for the selective reporting observed. It is suggested that the question of learning variables playing an important role in the reporting of symptoms at different phases of the menstrual cycle may be reopened.

The social construction of premenstrual syndrome

In 1931 a physician coined the term Premenstrual Tension, thereby commencing an extensive biomedical inquiry into the relationship between women's menstrual cycle and the occurrence of physical, emotional and behavioral changes. However, despite 58 years of scientific research, fundamental questions remain unanswered. For example, there is still no consensus on the definition of PMS. This, in turn, has led to disagreement among researchers about which medical specialty is best suited for diagnosing and treating PMS. Is PMS a disease whose pathology is best understood by physicians in reproductive medicine or in psychiatry? This paper argues that the inconclusiveness surrounding PMS is symptomatic of the persistence of cultural beliefs in the production (and reproduction) of medical knowledge. The roots of these cultural beliefs and their 'naturalness' in the context of Western ideas about reason, rationality and women are explored in the first section. The second section discusses the ubiquity of these same cultural beliefs in contemporary scientific research of PMS and in the controversy surrounding the proposed psychiatric diagnostic category of Late Luteal Phase Dysphoric Disorder (LLPDD). Finally, a new, anthropologically and sociologically informed approach to understanding the phenomenon of PMS is suggested.

Prevalence and correlates of perimenstrual symptoms: a study of Israeli teenage girls

The prevalence of common premenstrual symptoms and menstrual period pain were studied in a cohort of 545 Israeli adolescent girls aged 16 to 21 years, and their correlation with biological, behavioral, and sociocultural traits were analyzed. A high proportion of the girls (80%) commonly experienced at least one premenstrual symptom. About 70% experienced menstrual pain in the past and 25% reported pain which severely interfered with daily activities during the last three cycles. Premenstrual symptoms and menstrual pain were positively associated. Oral contraceptive use appeared to reduce the prevalence of menstrual pain, and among smokers who had menstrual pain, heavier smokers experienced more pain. Girls of Asian or African ethnic origin reported consistently higher perimenstrual distress than those of Israeli or Western origin, suggesting that social expectations may affect the perception and reporting of these symptoms.