Autonomic arousal and pain sensitivity in women with premenstrual syndrome at different phases of the menstrual cycle

Eleven women with a clinical diagnosis of premenstrual syndrome (PMS) and ten non-PMS control women were compared on physiological measures in the intermenstrual and premenstrual phases of their menstrual cycle. Heart rate (HR) and skin conductance level (SCL) were monitored during baseline conditions and in response to a stressful laboratory procedure. Analyses for HR revealed a three-way interaction (groups X phase X tests) which approached significance indicating that the PMS group was generally lower during the intermenstrual testing but was higher in the premenstrual phase. No significant differences were observed on behavioral measures (pain threshold, pain tolerance) between the groups. Pain intensity ratings were found to be overall higher in the PMS group irrespective of menstrual cycle phase. The role of cognitive-perceptual processes is discussed in the context of the acquisition and maintenance of PMS symptomatology.     

Menstrually related symptom changes in women with treatment-responsive bipolar disorder

OBJECTIVE: In the present study, we aimed to evaluate menstrually related symptom changes in euthymic women with treatment-responsive bipolar disorder (BD) compared with healthy control subjects and investigate the presence of premenstrual dysphoric disorder (PMDD). METHODS: Thirty-four euthymic women with treatment-responsive BD on mood-stabilizers (lithium and/or valproate) for at least 6 months and 35 control subjects with no history of medical/mental disorder between ages of 18 and 35 years with regular menstrual cycles were prospectively followed up for at least two consecutive menstrual cycles using the Daily Record of Severity of Problems-Short Form (DRSP). Each subject was administered the retrospective self-report questionnaire, Premenstrual Assessment Form (PAF), in the first postmenstrual phase of the menstrual cycle. Venous blood samples were collected between 19 and 22 days of menstrual cycle to evaluate ovulation by measuring the serum progesterone levels. RESULTS: The differences in mean age, age of onset of menses, cycle length and bleeding length did not appear to be significantly meaningful between groups. In the retrospective assessment of premenstrual symptom changes, controls complained more than women with BD. More controls showed a 30% change in DRSP and in depressive and physical sub-groups than the women with BD. Controls demonstrated a significant increase compared with treatment-responsive BD patients in total, depressive, anxiety and attention sub-group scores of DRSP from the postmenstrual to the premenstrual phase, whereas the scores of vegetative symptoms of controls and women with BD did not differ significantly during one cycle or both. Significant menstrual cycle effect was observed in both groups. CONCLUSION: Within the limitations of the study, the results suggest that ongoing mood-stabilizing treatment may have a prophylactic effect against premenstrual symptom changes in women with treatment-responsive BD.     

The role of anxiety level, coping styles, and cycle phase in menstrual distress

Using three samples, researchers investigated the relation between various anxiety levels, coping strategy use, and menstrual cycle phase to menstrual distress. In Studies 1 and 2, women low in anxiety sensitivity used more acceptance coping strategies and women high in anxiety sensitivity reported using more maladaptive coping strategies. In Study 2, women with medium anxiety sensitivity reported similar coping strategies to women low in anxiety. Menstrual cycle phase did not differentially affect coping strategy use in women varying in anxiety sensitivity levels in Studies 1 and 2. In addition to depressed mood emerging as a significant predictor of premenstrual distress in these two studies for all participants, avoidance coping for women high in anxiety sensitivity and problem-focused coping for women low in anxiety sensitivity were also significant predictors of premenstrual distress. In Study 3, during the premenstrual phase, women with panic disorder, compared to controls, reported using more avoidance coping whereas controls reported used more active coping and seeking social support for emotional and instrumental reasons. Results are discussed within a continuity model from high anxiety sensitivity to anxiety disorder for maladaptive coping and menstrual distress.     

Patterns of mood changes throughout the reproductive cycle in healthy women without premenstrual dysphoric disorders

Objective

The cyclic nature of female reproductive function is a natural part of life accompanied by changes in several physical and psychological phenomena. The aim of our study was to investigate the fluctuation of psychological symptoms throughout the female reproductive cycle in healthy, non-PMDD (premenstrual dysphoric disorder) women.

Method

63 psychiatrically healthy, non-PMDD women with normal regular menstrual cycles and not using hormonal contraceptive methods participated in the study. Participants completed the PRISM (Prospective Record of the Impact and Severity of Menstrual Symptoms) calendar every night for three cycles and in addition they completed several other psychometric measures (Symptom Distress Checklist-SCL-51, State Trait Anxiety Inventory-STAI, Zung Self-rating Depression Scale-ZSDS, Eating Attitude Test-EAT, Mind and Body Cathexis Scale) at three predefined days of the first cycle. Based on an at least 66% increase in physical symptoms from the late follicular to the late luteal phase on the PRISM, subjects were assigned to luteal phase physical symptoms (LPPS) and no luteal phase physical symptoms (nonLPPS) groups. The association of psychometric scores with timing within the cycle and with physical symptoms was analysed.

Results

Significant changes in psychometric scores over time were observed for STAI state anxiety, SCL anxiety, SCL somatization, SCL depression, SCL obsessive-compulsive, SCL interpersonal sensitivity, SCL total, and ZSDS. A significant time × LPPS grouping interaction emerged in case of the SCL somatization subscale and the ZSDS. LPPS grouping was associated with only the interpersonal sensitivity subscale of the SCL51.

Conclusion

Our results indicate that there is a significant increase in psychological symptoms related to neuroticism and depression from the late follicular to the late luteal phase in a healthy, non-PMDD female population. Although our results may not have direct clinical significance, since the statistically significant increases in psychometric scores are still small, it is an important finding that there is a consistent pattern observable in the fluctuation of psychological symptoms accompanying the female reproductive cycle.     

No correlation of depression and anxiety to plasma estrogen and progesterone levels in patients with premenstrual dysphoric disorder

A number of studies have demonstrated the correlation of depression and anxiety to estrogen and progesterone in premenstrual dysphoric disorder (PMDD), but the findings are still controversial. The purpose of this study was to determine the correlation of depression and anxiety to estrogen and progesterone concentrations in blood plasma in Taiwanese women with PMDD. A total of 43 women who met the 4th edition of the Diagnostic and Statistical Manual diagnostic criteria for PMDD were enrolled in this study. Blood samples were obtained for determination of estrogen and progesterone levels, and depression and anxiety ratings were summed for each subject during one menstrual cycle to obtain a premenstrual result (2-6 days before menses) and a postmenstrual result (menstrual cycle days 7-11). Anxiety was assessed using the 14-item Hamilton Anxiety Scale-A and was also assessed by the patients themselves using the Trait Anxiety Inventory. Depression was rated using the 21-item Hamilton Anxiety Scale-D. Calculations were made to determine the relationships between hormonal changes and mood changes. There were no statistically significant correlations between depression or anxiety ratings and estrogen or progesterone concentrations.     

Salivary cortisol in women with and without perimenstrual mood changes

An increase in the activity of the hypothalamic–pituitary–adrenal axis (HPA axis) is frequently associated with major depression. During the premenstrual phase of their reproductive cycle some women experience depressive mood changes that are proposed to be of similar intensity to that experienced during periods of major depression. This study examined the secretion of cortisol, the end-product in the HPA axis, at different stages of the menstrual cycle in women with and without premenstrual depression. Women who experienced only mild physical and emotional changes in the premenstrual phase of their cycle had a significantly higher cortisol secretion on a premenstrual day (measured hourly) compared to a postmenstrual day. Those who were significantly more depressed premenstrually showed the opposite pattern of cortisol secretion with significantly lower levels on the premenstrual day compared with the postmenstrual day. Across the menstrual cycle, women who were significantly more depressed premenstrually also had lower evening cortisol levels in their premenstrual phase. The results of this study indicate that, unlike major depression where the underlying neurological changes are manifest as overactivity of the HPA axis, premenstrual depressive changes are associated with reduced HPA axis activity. Premenstrual depression may, therefore, be similar neurologically to seasonal affective disorder, which is associated with underactivity of the HPA axis.     

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

Some biological factors which have been shown to be abnormal in subgroups of women with dysphoric premenstrual syndromes (PMS) have not been limited to the symptomatic late luteal phase of the menstrual cycle, but also existed during the non-symptomatic mid-follicular phase of the cycle. Personality, cognitive functions, α₂ and imidazoline binding, sensitivity to inducement of panic attacks, relative hypothyroidism, and some but not all serotonergic functions of women with dysphoric PMS differ from those with no PMS, and also differ during a non-symptomatic phase of the cycle. It is suggested that premenstrual symptoms are an expression of vulnerability traits that might surface in response to a trigger. Such traits are probably diverse, and the nature of the symptoms might depend upon the underlying trait. It is postulated that some vulnerability traits to specific premenstrual syndromes might also be vulnerability traits to depression or anxiety in general.     

Premenstrual depression predicts future major depressive disorder

To assess the power of premenstrual changes as a risk factor for future major depressive disorder (MDD), we conducted a follow-up study of 36 women who had volunteered for menstrual cycle studies. Scores on the depressive subscale of the Premenstrual Assessment Form (PAF) at initial evaluation were found to be significantly correlated (r = 0.35) with the occurrence of MDD during the follow-up period. Moreover, multiple regression analysis indicated that the PAF scores had predictive value above and beyond 2 known risk factors for MDD, family history of depression and prior personal history of depression. The Premenstrual Change Index, a score derived from prospective daily self-ratings of severity of dysphoric symptoms, was also correlated with interval MDD, but did not enhance the predictive power of the PAF score. We conclude that the assessment of premenstrual depression has validity in identifying women at risk for future MDD, even when a retrospective instrument, PAF, is utilized for such assessment.     

产后抑郁症与社会心理因素

目的：经前不适、社会支持和心理应激对产后抑郁症发生的影响。方法：对88例产妇评定Edinburgh产后抑郁量表（EPDS）、社会支持评定量表（SSRS）、艾森克人格问卷（EPQ）。结果：产后抑郁症发生率为17％；产后抑郁症的既往经前不适率比正常对照组的明显为高；EPDS总分与SSRS的客观支持呈显著负相关性；产后抑郁症的住房拥挤率比正常对照组明显为低。结论：有经前不适史的产妇易感产后抑郁症；产后抑郁症病人感到客观支持减少是抑郁的结果；产妇在小家庭受到的照顾不如大家庭周到。     

Panic disorder and the menstrual cycle: panic disorder patients, healthy control subjects, and patients with premenstrual syndrome

The authors prospectively evaluated 20 normally menstruating women with panic disorder across a minimum of two drug-free menstrual cycles. There were no significant effects of menstrual cycle phase on anxiety ratings in the panic disorder patients or in 20 healthy control subjects; this contrasted with a robust increase in premenstrual anxiety in 20 subjects with premenstrual syndrome. These findings suggest that the symptoms of panic disorder are not commonly exacerbated by the premenstrual phase of the menstrual cycle and highlight the need for prospective evaluation in the attempt to document an association between psychiatric symptoms and the menstrual cycle.     

Heart rate variability in premenstrual dysphoric disorder

Measuring heart rate variability (HRV) is a way to assess the autonomic regulation of the heart. Decreased HRV, indicating reduced parasympathetic tone, has previously been found in depression and anxiety disorders. The objective of this study was to assess HRV in women with premenstrual dysphoric disorder (PMDD). To this end, time domain variables and frequency domain variables were assessed in 28 women with PMDD and in 11 symptom-free controls during both the symptomatic luteal phase and the non-symptomatic follicular phase of the menstrual cycle. Two variables reflecting vagal activity in the time domain, the root mean square of differences of successive normal RR intervals (rMSSD) and standard deviation of normal RR intervals (SDNN) were lower in PMDD patients, but this difference was statistically significant in the follicular phase only. The most important vagal measure in the frequency domain, supine high frequency (HF), also appeared lower in PMDD subjects during the follicular phase. It is suggested that PMDD may be associated with reduced vagal tone compared to controls and that this difference is most apparent in the non-symptomatic follicular phase of the menstrual cycle.     

Psychological assessment of women seeking treatment for premenstrual syndrome

One hundred (100) women who sought evaluation for premenstrual syndrome were administered a battery of standardized psychological tests, including a Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI) and Short Marital Adjustment Scale (MAS), during the follicular phase of the menstrual cycle. A BDI was repeated in the luteal phase of the menstrual cycle. MMPI profiles were classified by code type using Lachar system as follows: ‘Normal’—36%; ‘Neurotic’—31%; ‘Characterological’—11%, ‘Psychotic’—5%, ‘Unclassified’—17%. A common feature of MMPI profiles was a low Scale 5 (Mf). BDI scores had several patterns; however, a significant group (25%) appeared to have clinically significant continuous depression regardless of superimposed premenstrual changes. About half of the women (42%) reported marital distress (MAS scores < 100) at the time of evaluation.     

The role of anxiety sensitivity in the experience of menstrual-related symptoms reported via daily diary

The current study examined the interactive effects of Anxiety Sensitivity (AS) and menstrual cycle phase in the experience of menstrual-related symptoms. Participants were 55 community women who completed prospective tracking of menstrual-related symptoms across at least one full menstrual cycle using the Daily Record of Severity of Problems (DRSP) and completed the Menstrual Distress Questionnaire (MDQ) once in their premenstrual and follicular cycle phases. Results revealed that women with higher levels of AS reported greater menstrual-related symptoms, regardless of cycle phase, as compared to women with lower levels of AS. These findings suggest that AS may be an important psychological factor involved in the experience of psychological and somatic symptoms across the menstrual cycle. Results are consistent with previous literature documenting the role of AS in menstrual-related symptoms as well as in other physical health conditions.     

Late luteal phase dysphoric disorder in young women

The authors determined the prevalence of late luteal phase dysphoric disorder in 217 university women aged 17-29 years. Unaware of the focus on premenstrual syndrome (PMS), the participants rated DSM-III-R symptoms of late luteal phase dysphoric disorder over 90 days. Using a 30% or greater premenstrual change as an index of luteal variation, the authors found that 10 women (4.6%) met the symptom criteria during two menstrual cycles. Compared to 25 young women seeking treatment for PMS who met the same diagnostic criteria, the 10 women from the university sample reported significantly less fatigue and impaired concentration and somewhat less severe depression and overall symptoms.     

Menstrual cycle phase-related changes in appetite in patients with premenstrual syndrome and in control subjects

Menstrual cycle phase-dependent changes in appetite in women with premenstrual syndrome has not thus far been systematically demonstrated. In this study of 21 patients with premenstrual syndrome and 13 control subjects, there were significant increases in appetite in both groups, with a greater effect of menstrual cycle phase on appetite in the patients. Further, the premenstrual increase in appetite was highly correlated with self-ratings of mood (particularly depression) in the patients only. The authors discuss these findings with respect to endocrine influences on appetite regulation and potential implications for investigation of atypical depression.     

Oral contraception and induced depressive states

Cultural, psychological, and biochemical explanations for depression in users of oral contraceptives are discussed. The suppression of taboos against sexuality cannot be expected to bring about instant psychological adjustment, as shown by the large numbers of women who are afraid to take the pill or who develop psychosomatic disorders and depression. Incidence of depression as reported in the literature ranges from 5% to 45%. Some authors attribute psychogenic causes for depression associated with the pill, such as temporary castration, instant sexual liberation, or womens' undeniable maternal instinct. Others present evidence for biochemical causes of depression. General explanations for pill-related depression include imbalance of hypothalamic amines and consequently of releasing factor, prolactin-inhibiting factor, decreased brain serotonin due to inhibition of tryptophan hydroxylase by progestagens, or diminished brain biogenic amines because of lowered pyridoxal levels. From clinical work with neuroleptic drugs it is known that drugs, stress, or anxiety can disturb the biochemical balance and result in amenorrhea. High progestin levels may be responsible for premenstrual anxiety and headaches.     

The influence of menstrual cycle phase upon symptom recording using data from health diaries

Data on 151 women aged 20–44 years old who completed health diaries were analysed for the effect of menstrual cycle phase upon symptom recording, taking into account the influence of age, marital status, parity, social class, anxiety level and oral contraceptive practice. Results indicated that (i) Pill-takers reported symptoms more frequently than non pill-takers. (ii) Headache was the most frequently reported symptom in all menstrual phases for both pill-takers and non pill-takers. This was followed by changes in energy, backache, colds and sore throats. (iii) Symptom rates were ranked marginally higher for the menstrual phase than for the other two phases in both pill-takers and non pill-takers. (iv) For pill-takers the difference in symptom rates between the menstruum and the intermenstruum was greatest in the married group and smallest in the widowed, divorced or separated group (p?0.10). In this same group the difference between menstrual and intermenstrual symptom rates varied significantly with the number of children (p< 0.05). For non pill-takers the difference in symptom rates between the menstrual and intermenstrual phases increased with number of children.     

Premenstrual symptoms and perimenopausal depression

OBJECTIVE: The role of ovarian steroids in both premenstrual dysphoria and perimenopausal depression has led to the suggestion that these conditions represent expressions of the same underlying disorder. Premenstrual mood symptoms were evaluated in women with perimenopause-related depression. METHOD: Self-reports and daily symptom ratings during one menstrual cycle were examined in 70 depressed perimenopausal women attending a menopause clinic and 35 nondepressed perimenopausal women. RESULTS: Twenty-six percent of the depressed and 9% of the nondepressed women reported premenstrual symptoms. Thirty-one percent of the depressed and 20% of the nondepressed women met criteria for significant menses-related symptom cyclicity (at least a 30% increase in the average ratings of at least two of four measured negative mood symptoms in the premenstrual versus the postmenstrual week); 5 of these depressed women and none of the comparison subjects described premenstrual symptoms on self-reports. Finally, 21% of the depressed and 3% of the nondepressed women met criteria for premenstrual dysphoria (symptom cyclicity and at least moderate severity, with symptoms exceeding a minimum luteal symptom severity threshold of 2.5). CONCLUSIONS: A higher-than-expected rate of menses-related symptom cyclicity and premenstrual dysphoria was observed in perimenopausal depressed women. However, neither menses-related symptom cyclicity nor premenstrual dysphoria was an invariant accompaniment of perimenopausal depression. Additionally, the rate of premenstrual dysphoria was not predicted by initial self-reports.     

Correlates of confirmed premenstrual dysphoria

This study found that women with prospective reports of premenstrual dysphoria could be significantly differentiated from others on self-report measures of anxiety, depression and negative self-statements. Women who reported premenstrual dysphoria retrospectively but not prospectively did not significantly differ from controls on any of these measures using the State-Trait Anxiety Inventory, the Beck Depression Inventory and the Automatic Thoughts Questionnaire. Issues for further investigation are highlighted.     

Evidence for a menstrual-linked artifact in determining rates of depression

This is the first empirical report suggesting a menstrual-linked artifact in determining rates of depression. We investigated the effects of perceived menstrual cycle phase, and premenstrual and postmenstrual timing in the cycle, on scores for a self-report measure of depression that is widely used in epidemiological studies, the Center for Epidemiologic Studies Depression Scale (CES-D). The first study used a cross-sectional design and the second used a follow-up design with repeated measures across the menstrual cycle. Both studies assessed a community-based sample of regularly menstruating women. In the second study, testing was also done at 2-week intervals in men for comparison purposes. Both studies supported the hypothesis of a significant menstrual cycle-related effect on CES-D scores. The menstrual-linked effect is greater than the test-retest variability observed in men, such that women more often tend to meet the cut-off criteria for depression on the CES-D premenstrually, as compared with postmenstrually. Thus it is possible that cyclic variations in ratings on the CES-D may elevate epidemiological estimates of depression, as defined by RDC criteria, for menstruating women. Further longitudinal assessment in randomly selected samples will be needed in order to clarify whether a menstrual-linked effect is substantial and specific enough to require correction, or documentation of cycle phase, in epidemiological studies of depression.