Influences of premenstrual syndrome on daily psychological states and salivary cortisol level

The purpose of this study is to investigate the influences of premenstrual syndrome (PMS) on daily psychological states and salivary cortisol level. First, 42 women recorded their PMS symptoms and basal body temperatures every day for approximately two menstrual cycles. Based on these prospective records of PMS symptoms, participants were divided into two groups: Normal group (n=22) and PMS group (n=17). There were no significant differences between the two groups in age, height, weight, age at menarche, menstrual cycle length, menstrual period, depression score, and stressor score. Next, 14 women (7 Normal group, 7 PMS group) were selected and they were measured twice, once during the premenstrual phase and once during the postmenstrual phase of their cycles. Each day, they took saliva samples and recorded their psychological states six times (from waking to going to bed) per day at their homes. Results showed that the fear score in PMS group was high in the premenstrual phase, whereas salivary cortisol level in PMS group was low in the same phase compared to the Normal group. These results suggested the possibility of dysregulation of the stress system in women with PMS.     

Sleep quality and the sleep electroencephalogram in women with severe premenstrual syndrome

STUDY OBJECTIVES: Women with severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) commonly report sleep disturbances, but the few studies using conventional polysomnographic measures have produced conflicting results. We investigated sleep quality and sleep composition using conventional and quantitative electroencephalographic analyses in women with severe PMS, as compared with that of controls. DESIGN AND PARTICIPANTS: Women (aged 18-40 years) were screened to ensure that their PMS symptoms were severe and that they had ovulatory menstrual cycles. Nine women with PMS or PMDD and 12 asymptomatic control subjects then had laboratory-based polysomnographic recordings at 2 phases of the menstrual cycle: follicular phase and late luteal (premenstrual) phase. RESULTS: Women with severe PMS reported a significantly poorer subjective sleep quality during the late luteal phase (P = 0.02), but there was no evidence of disturbed sleep based on the polysomnogram specific to premenstrual symptom expression: both groups of women had increased wakefulness after sleep onset (P = 0.02) and increased sigma power (P < 0.01), especially in the 14-to 15-Hz band during non-rapid eye movement sleep, in the late luteal phase compared with the follicular phase. There were, however, some group differences in electroencephalographic measures regardless of menstrual phase, including decreased delta incidence (P = 0.02) and increased theta incidence and amplitude (P < 0.05) in women with PMS, suggesting the possibility of sleep electroencephalogram trait markers in women with PMS. CONCLUSION: Perceived poor quality sleep is a characteristic of severe PMS, but sleep composition based on polysomnographic measures and quantitative electroencephalographic analysis does not differ in association with premenstrual symptom expression in the late luteal phase.     

Daytime sleepiness, psychomotor performance, waking EEG spectra and evoked potentials in women with severe premenstrual syndrome

We assessed daytime sleepiness using objective and subjective measures in women with severe premenstrual syndrome (PMS) compared with women without significant premenstrual symptoms. Nine women with severe PMS and eight controls (aged 18−40 years) completed a laboratory-based daytime protocol including the maintenance of wakefulness test (MWT), psychomotor vigilance task (PVT), quantitative waking electroencephalogram (EEG), auditory and visual event-related potentials (ERPs), and sleepiness and mood scales during the mid-follicular and late-luteal (premenstrual) phases of the menstrual cycle. In association with increased perceived sleepiness, fatigue and other premenstrual symptoms in the late-luteal phase, women with PMS performed more poorly on the PVT, with increased lapses and slower reaction times ( P  <   0.05), compared with the follicular phase and controls. However, there were no significant group or menstrual phase differences in latency to sleep on the MWT. Waking spectral EEG power and ERP measures also did not differentiate PMS women when symptomatic. Both groups of women displayed increased spectral power in the delta/theta frequencies (2−6 Hz) and fast alpha frequency (11−12 Hz) in the late-luteal phase relative to the follicular phase. Trait-like differences were apparent in that women with PMS had increased beta1 (12−16 Hz) power and smaller P300 amplitude than controls in both menstrual cycle phases. Our findings indicate that women with severe PMS are subjectively sleepy and fatigued, and show psychomotor slowing when symptomatic compared with when they are symptom-free and compared with controls. However, the ability to maintain wakefulness under soporific conditions, spectral properties of waking EEG and cognitive processing do not vary in synchrony with premenstrual symptoms.     

The predictive role of psychosocial stress on symptom severity in premenstrual syndrome

Twenty-five women with well defined, severe premenstrual syndrome (PMS) were studied prospectively during three consecutive menstrual cycles to examine the association between concurrent psychosocial stress and symptom severity. Stress, mood, physical symptoms, and urinary ovarian steroid metabolites were measured daily. Stress accounted for only 6% and 10% of the unique variance in physical symptom and mood scores, respectively, across the menstrual cycle. In individual woman, there was no association between the severity of symptoms and the cumulative daily stress reported during each cycle. We conclude that in this carefully screened population of women without coexisting psychiatric disorder, PMS symptom severity could not be determined by the amount of psychosocial stress.     

β-Endorphin withdrawal: a possible cause of premenstrual tension syndrome

The authors propose that premenstrual tension syndrome (PMS) is the result of β-endorphin withdrawal. Sixteen women were included in this study which measured β-endorphin levels on the 7th and 24th day of each woman's menstrual cycle. A significant decline in β-endorphin levels was noted during the progression of the cycle. The severity of symptoms, however, was inversely proportional to the amount of decline in β-endorphin levels. It is hypothesized that the attenuation of endorphin decline may be a compensatory mechanism to moderate the severity of PMS symptoms.     

Psychosocial Profile of Women with Premenstrual Syndrome and Healthy Controls: A Comparative Study

Purpose

According to modern bio-psychosocial theories of premenstrual syndrome (PMS), the aim of this study is to investigate systematically associations between selected psychosocial factors and premenstrual symptoms in different menstrual cycle phases.

Method

Several psychosocial variables were assessed, in a sample of German women with PMS (N?=?90) and without premenstrual complaints (N?=?48) during the follicular and luteal phase of the menstrual cycle. Presence of PMS was indicated by analysis of contemporary daily ratings of premenstrual symptom severity and impairment for one menstrual cycle.

Results

Regarding perceived chronic stress (? ²?=?0.34), self-efficacy (? ²?=?0.12), and two dimensions of self-silencing (0.06?≤?? ²?≤?0.11) analyses revealed only a significant effect of group. Regarding body dissatisfaction and somatosensory amplification, a significant effect of group (0.07?≤?? ²?≤?0.16) and additionally a group by menstrual cycle phase interaction (? ²?=?0.06) was identified. Regarding relationship quality, a significant effect of menstrual cycle phase (? ²?=?0.08) and a group by menstrual cycle phase interaction (? ²?=?0.06) was demonstrated. In respect to sexual contentment, acceptance of premenstrual symptoms, and the remaining two dimensions of self-silencing statistical analyses revealed no effects at all. Linear multiple regression analysis revealed that 20 % of the variance in PMS symptom severity was explained by the psychosocial variables investigated. Body dissatisfaction (ß?=?0.26, p?=?0.018) and the divided self-dimension of self-silencing (ß?=?0.35, p?=?0.016) were significant correlates of PMS severity.

Conclusion

Results of this study are consistent with previous research and additionally show patterns of associations between specific psychosocial factors and PMS in dependence of menstrual cycle phase that have not been researched before. The role of the psychosocial variables we investigated in regard to the development and maintenance of PMS should be clarified in future research.

     

Premenstrual symptomatology: role of prior knowledge about premenstrual syndrome

OBJECTIVE: Most women have some premenstrual symptoms that may be influenced by diverse environmental factors. The aim of this study was to determine the influence of knowledge about premenstrual syndrome (PMS) in the reports of women and their symptoms. METHOD: We studied 86 healthy Mexican women whose highest level of education was sixth grade. Participants were assigned to one of two groups. The experimental group watched a videotape describing PMS and its negative consequences in daily life. The control group watched a videotape describing the menstrual cycle. The Menstrual Distress Questionnaire was administered to all women during the first week after menstruation, after which they were shown their designated videotape, and the questionnaire was administered again after the next menstruation. RESULTS: In the control group, there were no significant differences in premenstrual symptoms reported both before and after the women watched the videotape. However, women in the experimental group reported more severe premenstrual symptoms after watching the videotape. CONCLUSIONS: These results suggest that after observing the videotape, women's expectancies of negative symptoms in the premenstrual phase increased. Thus, the symptoms reported by these women were enhanced.     

The role of low progesterone and tension as triggers of perimenstrual chocolate and sweets craving: some negative experimental evidence.

Approximately half of the 40-50% of North American women who crave chocolate or sweets do so principally in the perimenstrum, the part of the menstrual cycle surrounding the onset of menstruation. We test two hypotheses about the events that trigger these cravings: 1) the premenstrual drop in progesterone levels; or 2) dysphoria or tension in the perimenstruum. Chocolate craving, sweets craving, and other perimenstrual symptoms were rated daily for six menstrual cycles by a sample of women with severe premenstrual syndrome (PMS). Forty-four women satisfied criteria for cyclicity in chocolate craving, and 44 for sweet craving, determined during the first two cycles. Thirty-four subjects satisfied criteria for craving of both chocolate and sweets. After placebo treatments during the third cycle, subjects were randomly assigned, double blind, to administration of placebo, oral micronized progesterone, or alprazolam (a tranquillizer). Treatments were administered from the beginning of the third week to the second day postonset of menstruation during the fourth to sixth months of study. Neither progesterone nor alprazolam decreased chocolate or sweets craving.     

MMPI correlates of menstrual distress.

The MMPI and Moos' Menstrual Distress Questionnaire (MDQ) were administered to 60 undergraduate women. Partial correlations between MMPI clinical scales and menstrual and premenstrual MDQ symptom scales were computed with intermenstrual (baseline) symptom reports and response set (Gough's F-K index) statistically controlled MMPI variables tended to correlate with some symptom scales (premenstrual pain, negative affect; menstrual behavior change) but not with others (water retention, arousal). Where correlations did occur, common MMPI scales (Sc, Hs, Hy, Pt) were involved. Results suggest that psychological factors are more closely associated with some areas of menstrual symptomatoloty than with others.     

Suicidal behaviour and the menstrual cycle

BACKGROUND: To investigate the available data regarding possible associations between phases of the menstrual cycle and suicidal behaviour. METHOD: A systematic search of major relevant databases was performed using appropriate search terms. RESULTS: Forty-four relevant studies were identified in total, 13 pertaining to suicide, two pertaining to both attempted and completed suicide, 23 to suicide attempts, three to suicide attempts in those suffering from the premenstrual syndrome (PMS), three to suicidal ideation and two to repetitive self-harming behaviours. A variety of methodologies were used in these studies and there were notable differences in the conclusions reached. Studies with better methodology suggest that a positive relationship exists between aspects of the menstrual cycle and non-fatal suicidal behaviour. Such behaviour appears to be more common in those phases of the menstrual cycle when oestrogen levels are lowest (the late luteal and follicular phases), and in those suffering from PMS. CONCLUSIONS: There appears to be an association between the menstrual cycle and non-fatal suicidal behaviours. Interaction between oestrogen and the serotonergic system may provide a possible mechanism.     

Plasma leptin concentrations are increased in women with premenstrual syndrome

Leptin is a metabolic regulator of the hypothalamic- pituitary-gonadal axis, and plays an important role in human reproduction. Its neuro-endocrine effects are mediated by interactions with receptors in the hypothalamus, where emotional drive is also controlled. We postulated that circulating leptin concentrations are increased in premenstrual syndrome (PMS), and that this may be associated with the psychological symptoms of the disease. We obtained fasting venous samples from 32 women with PMS and 28 women with asymptomatic menstrual cycles, matched for age, body mass index and menstrual cycle length. Leptin concentrations were measured by radioimmunoassay. Leptin concentrations increased significantly during the luteal phases of the menstrual cycles of the control and PMS groups as compared with the follicular phase, having excluded the 11 women with PMS and six controls found to be anovulatory on the basis of mid-luteal plasma progesterone concentrations from the analysis. A greater increase was observed in women with PMS than the controls (P: = 0.00006 and 0.003 respectively). Although leptin concentrations in the follicular and luteal phases were higher in PMS than the controls, the difference was only statistically significant between the follicular phases (P: = 0.001). There was no clear relationship between leptin and oestradiol or progesterone in this study. These findings suggest that leptin may play a role in the pathophysiology of the disease, and requires further evaluation.     

Placebo-controlled cross-over study of effects of tibolone on premenstrual symptoms and peripheral beta-endorphin concentrations in premenstrual syndrome

Central nervous system hormones have been linked to premenstrual syndrome (PMS) and beta-endorphin (beta-EP) is thought to be involved in the pathophysiology. We have tested the efficacy of the synthetic steroid Org OD 14 (tibolone) in the treatment of PMS. This prospective, randomized, placebo-controlled, double-blind cross-over study included 18 ovulatory women with PMS as ascertained by a visual linear analogue scale (VLAS). The women in each group received either 2.5 mg per day Org OD 14 (n = 9) or a multi-vitamin pill as placebo (n = 9) for 3 months. Treatments were then crossed over to a placebo for a further 3 months. VLAS ratings were evaluated at the end of each menstrual cycle throughout the study. Peripheral beta-EP concentrations were determined by radioimmunoassay on days 7 and 25 of each menstrual cycle. Changes in VLAS score and beta-EP concentrations from baseline were calculated and analysed by Student's paired t-test. Improvements in VLAS scores and beta-EP concentrations were evident during the second and third months of tibolone treatment. At the end of the third month, there was a significant improvement in VLAS scores of all symptom categories compared with pretreatment and placebo during treatment with tibolone (P < 0.05). Similar results were obtained in the first placebo group when switched to tibolone. Beta-EP concentrations were not significantly different between the study groups at the initial cycle (15.9 +/- 3.6 versus 17.2 +/- 2.3 pg/ml). The increase in beta-EP concentration was significantly greater on day 25 of the menstrual cycle in women treated with tibolone compared with baseline and placebo group (22.5 +/- 4.4 versus 15.9 +/- 3.6 and 17.2 +/- 2.3 pg/ml respectively, P < 0.05). Our data confirm the clinical efficacy of tibolone in PMS-related symptoms, as well as its effects on serum beta- EP concentrations in patients with PMS.      

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

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

Resting heart rate (HR) in women with and without premenstrual symptoms (PMS)

A sample of 64 undergraduate female students participated in the present experiment. During 3 consecutive months women answered a chart of daily report of symptoms, and finally, two groups were formed: women with premenstrual symptoms (PMS group) and women without premenstrual symptoms (NPMS group). Heart rates (HR) at rest were recorded throughout premenstrual, menstrual, postmenstrual, and ovulatory phases. In the premenstrual phase, PMS group showed significantly higher resting HR levels than NPMS group. With regard to resting HR levels across the four phases studied, significant differences within PMS group were observed. Our results are discussed from a psychophysiological point of view.     

Personality disorders in women with severe premenstrual syndrome

Premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder, affect up to 18% of women. Both are commonly associated with other mood-related disorders such as major depression, and cause significant life impairment, but their relationship with personality disorders is less clear. After completing the Structured Clinical Interview for DSM-IV-TR disorders, 33 women with severe PMS and 26 asymptomatic women, counterbalanced for menstrual cycle phase, were administered the Structured Interview for DSM-IV Personality Disorders, a diagnostic interview with low transparency, strong inter-rater reliability, and good diagnostic clarity. Women with severe PMS had a higher prevalence of personality disorders (p = 0.003) than asymptomatic women (27% versus 0%), and were more likely to have odd–eccentric, dramatic–erratic, and anxious–fearful personality disorder traits (p < 0.05). Obsessive–compulsive personality disorder (OCPD) was the most common character pathology in the PMS group (n = 6, 18%). OCPD, although not necessarily associated with greater severity of premenstrual symptoms, was related to poorer life functioning in women with PMS. The comorbidity of a personality disorder and severe PMS places an additive burden on general life functioning and may have implications for psychiatric treatment or medication given to those with severe premenstrual symptoms.     

Anxiety sensitivity, the menstrual cycle, and panic disorder: a putative neuroendocrine and psychological interaction

The 2:1 female-to-male sex difference in the prevalence of panic disorder (PD) suggests that there is a sex-specific vulnerability involved in the etiology and/or maintenance of this disorder. The purpose of this paper is to present a new conceptual model, which emphasizes the interaction between a cognitive vulnerability for PD, anxiety sensitivity, and the effects of progesterone and its metabolite, allopregnanolone, on behavioral and physiological responses to stress during the premenstrual phase. This interaction is proposed to be a potential sex-specific pathway that may initiate and/or maintain panic and anxiety symptoms in women. This review paper presents preliminary evidence from both the human and animal literatures to support this new model. Specific topics reviewed include: psychopathology related to the menstrual cycle, anxiety sensitivity and its relationship to the menstrual cycle, PMS, and PMDD, anxiety-modulating effects of progesterone and its neuroactive metabolite, allopregnanolone, and how results from the neuroendocrine literature relate to psychopathology or symptoms associated with the menstrual cycle.     

Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part I. Effects of demand characteristics and expectations.

Daily symptom ratings were evaluated in 31 women who met DSM III-R criteria for a diagnosis of Late Luteal Phase Dysphoric Disorder (LLPDD), and 34 women who reported no premenstrual symptomatology. Women in both groups were randomly assigned to be aware or unaware of the menstrual cycle focus of the study. Results revealed a consistent pattern of cyclic effects, with higher ratings in the mid-luteal, premenstrual and menstrual phases for many symptoms. Ratings of women reporting severe symptoms were not affected by knowing the purpose of the study and were higher than ratings in the asymptomatic group for many symptoms relevant to the LLPDD diagnosis. Awareness of the study focus did increase cyclicity in the ratings of asymptomatic women aware of the study focus compared with those who were unaware, but these differences were small and most were not significant. The implications of these findings for research and clinical diagnosis of PMS/LLPDD are discussed.     

Menstrual and circadian variations in time perception in healthy women and women with premenstrual syndrome.

A time production test was performed in seven normal females and seven females with premenstrual syndrome (PMS). We used a time production test for six time intervals (6, 12, 24, 36, 48, 60 s). Time production tests were performed at 08:00, 14:00 and 20:00 h in the follicular, early luteal and late luteal phases (LLP), respectively. The results are as follows. (1) Normal females showed diurnal variations in time production only in the follicular phase (FP). In this phase, they overproduced time at 08:00 h suggesting that the interval clock in normal females was slowest in the morning. (2) Normal females showed menstrual variations in time production only at 20:00 h. They overproduced time in the LLP suggesting that the interval clock in normal females was slowest in the LLP. (3) Neither diurnal nor menstrual variation was found in PMS subjects at any menstrual stage or at any time of the day. These results suggest that the interval timing system in normal females is under the control of ovarian steroid hormones and the circadian clock, but the control of ovarian steroid hormone or the circadian clock does not operate in PMS subjects.     

Menstrual cycle and appetite control: implications for weight regulation

Hormonal fluctuations associated with the menstrual cycle influence appetite control and eating behaviour. Energy intake varies during the reproductive cycle in humans and animals, with a periovulatory nadir and a luteal phase peak. Patterns of macronutrient selection show less consistency but a number of studies report carbohydrate cravings in the premenstrual phase, particularly in women with premenstrual syndrome. The cyclical nature of food cravings are frequently, but not invariably, associated with depression. Fluctuations in appetite, cravings and energy intake during the menstrual cycle may occur in parallel with cyclical rhythms in serotonin, which can be accompanied by affective symptoms. The premenstrual phase can be considered as a time when women are especially vulnerable to overconsumption, food craving and depression; this is often associated with low serotonin activity.      

Stressful Life Events and Perimenstrual Symptoms

Abstract

The purpose of this study was to determine whether the effects of stressful life events on perimenstrual symptoms were due to operational confounding of the instruments used to measure the independent and dependent variables. Women aged 18 to 35 (n = 179) completed the Schedule of Recent Events (SRE) and the Moos Menstrual Distress Questionnaire during a home interview. When variance in PMS scores attributable to age, parity, education, and contraceptive method was controlled using hierarchical multiple regression, total SRE scores were correlated with premenstrual and menstrual negative affect, menstrual water retention, and menstrual performance impairment. When health-related components of the SRE score were controlled in a similar manner, however, the residual SRE scores explain a diminished amount of the variance in premenstrual and menstrual negative affect and menstrual performance impairment. Future investigations are needed to clarify whether the effects of health-related life events on perimenstrual symptoms are simply a matter of operational confounding of measures of the independent and dependent variables, or whether women who recently have experienced personal illness or injury are at greater risk of developing perimenstrual symptoms.