Attitudes of general practitioners towards premenstrual symptoms and those who suffer from them

General practitioners'' views about premenstrual symptoms and about the women who suffer from them were sought by means of a postal questionnaire. An hormonal aetiology was favoured by the majority of the doctors and significantly more female than male doctors held this view. There was a diversity of opinion about the most appropriate management; the most favoured treatments were with progesterone analogues, pyridoxine and diuretics. Approximately half of the practitioners thought that women who suffer from premenstrual symptoms are no different from women in general. Those practitioners who felt that differences do exist claimed that sufferers from such symptoms are more likely than women in general to be more hypochondriacal, introverted and intelligent, as well as being more likely to be married, to have small families and to be from a higher social class. In general, the views of the doctors were not related to their years of experience, their practice base (that is, rural or urban) or their sex.     

The premenstrual syndrome. A psychological evaluation

The aim of the present study was to verify the presence of certain psychological factors in women complaining of the premenstrual syndrome which would differentiate these women from others. Of 42 women initially interviewed, 25 were finally selected for study, on the basis of clear premenstrual/menstrual symptoms. Twenty-three women who did not suffer premenstrual symptoms acted as controls. Women suffering from the premenstrual syndrome had significantly higher levels of 'trait' anxiety (STAI), 'neuroticism' (EPI-B), and more negative attitudes towards their bodies, genitals, sex and masturbation, as measured by a 'Role Acceptance Scale'. Both premenstrual syndrome sufferers and controls held negative attitudes toward menarche and menses.     

Comparison of depressed and nondepressed women with severe premenstrual tension syndrome

There is a need to better understand the relationship between premenstrual tension syndrome (PMS) and premenstrual depression. This research was designed to determine if severely depressed women experience a different kind of premenstrual dysfunction than nondepressed PMS patients. The nature and severity of premenstrual symptoms in both groups were evaluated and compared. The severely depressed women were found to have higher PMS scores, but did not differ from the nondepressed group in selection or ranking of symptoms. Depression appeared to influence the patient's perception and rating of symptoms, but the underlying premenstrual dysfunction was identical.     

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Japanese women

Summary To investigate the prevalence and impact of premenstrual symptoms in Japanese women, we developed the PSQ “The Premenstrual Symptoms Questionnaire” for the screening of premenstrual symptoms. The PSQ translates DSM-IV criteria into a rating scale with degrees of severity. One thousand one hundred and eighty-seven Japanese women between the ages of 20 and 49 yrs, who were seen at a clinic for uterine cancer screening, were assessed regarding their premenstrual symptoms using the PSQ. As many as 95% of these women were found to suffer from premenstrual symptoms. The rates of prevalence of moderate to severe PMS and PMDD in Japanese women were 5.3 and 1.2%, respectively, which are lower than those in Western women. Only 5.3% of women with moderate to severe PMS and PMDD were treated. The results of this study suggest that race and ethnicity influence the expression of premenstrual symptoms and that the current state of medical care for Japanese women with moderate to severe PMS and PMDD is not satisfactory.     

Relationship between personality and premenstrual symptoms: a study in five general practices.

A large representative sample of women of child bearing age in five urban practices were asked to complete two measures to record premenstrual changes in their health. The first method was a daily health record which sought to disguise the fact that the focus of the study was premenstrual changes while the second method was a conventional, retrospective checklist. In addition, the women completed a personality inventory which allowed them to be allocated to one of two personality subtypes according to level of neuroticism--neurotic or stable. The results suggest that women in the neurotic subgroup are, in general, more likely to report premenstrual changes than stable women and particularly so on the retrospective checklist rather than the daily record of health changes. It was also shown that women in the stable subgroup were less likely to be inconsistent reporters of symptoms on the two questionnaires than neurotic women. Better understanding of the variable nature of the premenstrual syndrome may demand that more attention is paid to the method of collection of data and to how this interacts with the woman's basic personality. In particular, for research purposes, the traditional method of a retrospective checklist introduces an unacceptable level of response bias in favour of the identification of women with high neuroticism scores, and underrepresents more stable women who suffer from premenstrual complaints. Previous treatment trials which have used this method may therefore be invalid and their conclusions should be reappraised.     

The role of menstrual cycle phase and anxiety sensitivity in catastrophic misinterpretation of physical symptoms during a CO2 challenge

The current study examined the interactive effects of anxiety sensitivity (AS; fear of anxiety and anxiety-related sensations) and menstrual cycle phase (premenstrual phase vs. follicular phase) on panic-relevant responding (i.e., cognitive and physical panic symptoms, subjective anxiety, and skin conductance level). Women completed a baseline session and underwent a 3-min 10?% CO₂-enriched air biological challenge paradigm during her premenstrual and follicular menstrual cycle phases. Participants were 55 women with no current or past history of panic disorder recruited from the general community (M _age?=?26.18, SD?=?8.9) who completed the biological challenge during both the premenstrual and follicular cycle phases. Results revealed that women higher on AS demonstrated increased cognitive panic symptoms in response to the challenge during the premenstrual phase as compared to the follicular phase, and as compared to women lower on AS assessed in either cycle phase. However, the interaction of AS and menstrual cycle phase did not significantly predict physical panic attack symptoms, subjective ratings of anxiety, or skin conductance level in response to the challenge. Results are discussed in the context of premenstrual exacerbations of cognitive, as opposed to physical, panic attack symptoms for high AS women, and the clinical implications of these findings.     

Higher luteal progesterone is associated with low levels of premenstrual aggressive behavior and fatigue

Contradictory findings show both positive and negative effect of progesterone on the premenstrual mood changes in women. Here we present the study investigating this relationship on the large sample of premenstrual women. 122 healthy, reproductive age women collected daily morning saliva samples and recorded intensity scores for the mood symptoms: irritability, anger, sadness, tearfulness, insomnia, and fatigue. Saliva samples were assayed for progesterone concentrations and mood intensity scores were used to calculate behavioral indices. Women with low Aggression/Irritability and Fatigue had consistently higher progesterone levels during the luteal phase than women with high Aggression/Irritability and Fatigue. Additionally, Aggression/Irritability and Fatigue correlated negatively with maximal progesterone value during the luteal phase. Our results demonstrated a negative effect of low progesterone level on the premenstrual mood symptoms such as aggressive behavior and fatigue in healthy reproductive age women. This supports a previously proposed model of biphasic action of progesterone metabolites on mood.     

Higher luteal progesterone is associated with low levels of premenstrual aggressive behavior and fatigue

Contradictory findings show both positive and negative effect of progesterone on the premenstrual mood changes in women. Here we present the study investigating this relationship on the large sample of premenstrual women. 122 healthy, reproductive age women collected daily morning saliva samples and recorded intensity scores for the mood symptoms: irritability, anger, sadness, tearfulness, insomnia, and fatigue. Saliva samples were assayed for progesterone concentrations and mood intensity scores were used to calculate behavioral indices. Women with low Aggression/Irritability and Fatigue had consistently higher progesterone levels during the luteal phase than women with high Aggression/Irritability and Fatigue. Additionally, Aggression/Irritability and Fatigue correlated negatively with maximal progesterone value during the luteal phase. Our results demonstrated a negative effect of low progesterone level on the premenstrual mood symptoms such as aggressive behavior and fatigue in healthy reproductive age women. This supports a previously proposed model of biphasic action of progesterone metabolites on mood.     

Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria

BACKGROUND/OBJECTIVE: To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. METHODS: Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. RESULTS: Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = < 0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). CONCLUSIONS: Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.     

Urbanicity,race, and psychological distress

Data from random samples of 645 rural White respondents, 398 rural Black respondents, and 700 urban residents of Nashville, Tennessee (375 White, 326 Black participants), are presented that address urbanicity and race differences in depressive symptoms, psychophysiologic symptoms, and general well-being. After demographic controls, significant urban-rural differences were found only on depressive symptoms, with greater distress in rural areas. Black participants had significantly higher depression scores than White respondents, though race differences were reversed on psychophysiologic symptoms and general well-being. Interaction effects were striking. Urban-rural differences were specific to Black participants—rural Black residents had higher depressive symptom scores than urban Black residents. These differences were reversed on psychophysiologic symptoms and well-being. Race differences were specific to the rural sample; rural Black respondents manifested more depressive symptoms than did rural White participants, though rural White residents had more psychophysiologic symptoms and lower well-being. These findings withstood further controls for migration/length of residence. Implications of these findings for stress models of urbanicity and race differences are considered.     

Atenolol treatment of late luteal phase dysphoric disorder

Activation of the renin-angiotensin-aldosterone system has been hypothesized as a potential pathophysiological factor in premenstrual tension syndrome (PMS). Atenolol is a predominate beta 1-blocker which can decrease plasma renin activity and inhibit the urinary excretion of aldosterone. Sixteen women meeting provisional diagnoses of late luteal phase dysphoric disorder were treated for symptoms of PMS with atenolol (50 mg once daily) in a randomized placebo-crossover double-blind design. The data indicated significant improvements on the irritability, vigor, elation, and friendliness scores in response to atenolol compared to placebo. Significant changes were not found for several other ratings scales, indicating that atenolol improved only selected symptoms in the group as a whole. However, the women who had premenstrual tension symptoms for more than 5 years (n = 8) were improved on most of the rating scales. Atenolol decreased premenstrual plasma aldosterone to a limited extent. There was also a trend in the data toward higher luteal progesterone levels during the month subjects took atenolol. Plasma renin activity and aldosterone correlated with estrogen and progesterone levels during the placebo month but not during the active month.     

The magnitude of premenstrual anxiety and depression.

The magnitude of premenstrual mood changes in 50 parous adult women between the ages of 30 and 45 was assessed using standardized measures of depression and anxiety. Premenstrual test scores were compared with those obtained during the intermenstrual phase of the cycle and with normative data. Premenstrual state anxiety and depression mean scores were significantly higher than those obtained midcycle, but were much lower than those of patients with psychiatric disorders. Trait anxiety scores were low and were not significantly correlated with premenstrual depression and anxiety scores.     

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Japanese high school students

To determine the prevalence and the impact of premenstrual symptoms among Japanese adolescent girls, a total of 618 high school students were assessed. Of them, 64.6% were found to suffer from premenstrual symptoms, which is lower than that in adult women. On the other hand, the rates of prevalence of moderate to severe PMS and PMDD in girls were higher than those in adult women. Premenstrual symptoms could have significant consequences by interfering with the daily functioning of adolescent girls.     

Exercise participation, body mass index, and health-related quality of life in women of menopausal age

BACKGROUND: Menopausal symptoms can affect women's health and wellbeing. It is important to develop interventions to alleviate symptoms, especially given recent evidence resulting in many women no longer choosing to take hormone replacement therapy. Exercise may prove useful in alleviating symptoms, although evidence on its effectiveness has been conflicting. AIM: To examine the association between exercise participation, body mass index (BMI), and health-related quality of life in women of menopausal-age. DESIGN OF STUDY: Survey of women of menopausal age. SETTING: West Midlands, England. METHOD: Women aged 46-55 years (n = 2399) registered with six general practices in the West Midlands were sent a questionnaire containing items relating to demographics, lifestyle factors, weight, height, exercise participation, menopausal bleeding patterns, and health-related quality of life (including vasomotor symptoms). RESULTS: One thousand two hundred and six (50.3%) women replied. Women who were regularly active reported better health-related quality of life scores than women who were not regularly active (P<0.01 for all significant subscales). No difference in vasomotor symptoms was recorded for exercise status. Women who were obese reported significantly higher vasomotor symptom scores than women of normal weight (P<0.01). Women who were obese reported significantly higher somatic symptoms (P<0.001) and attractiveness concern scores (P<0.001) than women of normal weight or those who were overweight. CONCLUSION: The data suggest a positive association between somatic and psychological dimensions of health-related quality of life and participation in regular exercise. Women with BMI scores in the normal range reported lower vasomotor symptom scores and better health-related quality of life scores than heavier women. Further evidence from high-quality randomised controlled trials is required to assess whether exercise interventions are effective for management of menopausal symptoms.     

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.     

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.     

Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n=126) or not (n=129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA(1c) level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.     

Psychological and physiological changes in severe premenstrual syndrome.

This study investigated differences in nervous system activity and in psychological and behavioural variables between the "baseline" follicular and the premenstrual phases. Twenty women with severe premenstrual syndrome were compared with 20 non-sufferers (10 from each group in each cycle phase). The Patient groups had higher autonomic activity than controls in both phases. In the follicular phase, patients did not differ on other important variables, though most measures were somewhat higher. Premenstrually, patients were higher on several negative moods and lower on cortical arousal. The patients' premenstrual distress appears to arise mainly from chronically high autonomic activity and a decline in cortical arousal, presumably interacting with other neurophysiological fluctuations of the cycle, rather than from any psychological characteristics. The direction of any causal relationship between autonomic and central activity and premenstrual symptoms is unknown.     

Nocturnal sleep, daytime sleepiness, and napping among women with significant emotional/behavioral premenstrual symptoms

The objective of this study is to examine daytime sleepiness and alertness and nap characteristics among women with significant emotional/behavioral premenstrual symptoms, and to determine their relationship with nocturnal sleep. Participants spent one night during the follicular phase and two nights during the late-luteal phase, one of which occurred after a 40 min opportunity to nap, sleeping in the laboratory. Subjective measures of sleepiness and alertness were completed during the afternoon of each recording. Setting took place at the sleep laboratory at the University of Ottawa. A total number of participants were 10 women with significant and nine women with minimal emotional/behavioral premenstrual symptoms (mean age 26 years). The results were compared with the follicular phase, both groups of women had less slow wave sleep and more stage 2 sleep at night, as well as a higher daytime and nocturnal mean and maximum temperature during the late-luteal phase. Women with significant symptoms were sleepier and less alert during the late-luteal phase and had a higher overall mean nocturnal temperature compared with women with minimal symptoms. No significant differences were found between the two groups on nap characteristics and nocturnal sleep characteristics. Results show that women with more severe premenstrual symptoms are sleepier during the late-luteal phase than women with minimal symptoms. The increased daytime sleepiness seems to be unrelated to nocturnal sleep or nap characteristics.     

Blunting of neuroendocrine responses to infusion of L-tryptophan in women with perimenstrual mood change

The neuroendocrine response to L-tryptophan infusion was measured at two stages of the menstrual cycle, premenstrually and postmenstrually, in 13 women with and 13 women without premenstrual depression (the MC and NMC groups respectively). Previous studies have shown that in non-depressed women, this challenge test results in an increase in circulating prolactin and growth hormone. In depressed women both responses are blunted. In this study the growth hormone and cortisol responses were smaller in the MC group than the NMC group on both occasions. The prolactin response was blunted premenstrually compared with postmenstrually in both groups. These findings suggest that women who experience premenstrual depression may have neuroendocrine abnormalities throughout the cycle. The neurotransmitter abnormalities reflected in these altered endocrine responses appear to interact with neuroendocrine changes that normally occur premenstrually resulting in a vulnerability to depression at that phase of the cycle.