Carbohydrate and fiber intake and the risk of premenstrual syndrome.

BACKGROUND/OBJECTIVES: Women with premenstrual syndrome (PMS) are encouraged to reduce sugar and increase fiber intake to reduce symptoms. However, research supporting these recommendations is limited, and their role in PMS development is unclear. This study examines the relation between carbohydrate and fiber intake and the risk of PMS nested within the prospective Nurses' Health Study II cohort. SUBJECTS/METHODS: Carbohydrate and fiber intake were assessed at baseline and three additional times during follow up by food frequency questionnaire. Incident cases of PMS were identified by self-reported PMS diagnosis during 14 years of follow up and validated by supplemental questionnaire (n = 1234). Women were classified as controls if they did not report PMS diagnosis during follow up and confirmed minimal or no premenstrual symptoms (n = 2426). We estimated relative risks (RR) and 95% confidence intervals (CI) using multivariable logistic regression. RESULTS: Total carbohydrate intake 2-4 years before reference year was not associated with PMS development (RR quintile 5 versus 1 = 0.99; 95% CI = 0.74-1.33). Intakes of specific carbohydrates or fibers were not associated with PMS development, except maltose. Adjusting for body mass index, smoking, and other factors, women with the highest maltose intake (median = 3.0 g/day) had a RR of 1.45 (95% CI = 1.11-1.88) compared to those with the lowest intake (median = 1.2 g/day). CONCLUSIONS: Overall, carbohydrate and fiber consumption was not associated with risk of PMS. As this is the first study to suggest that maltose may be associated with PMS development, further replication is needed.

Intake of dietary fat and fat subtypes and risk of premenstrual syndrome in the Nurses' Health Study II.

Approximately 8-20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses' Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2-4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; P trend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; P trend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.

Coping strategy in adolescents with premenstrual syndrome: application of the construal level theory and the precaution adoption process model.

This study aimed to apply the construal level theory (CLT) to increase the relaxation adoption as a coping behavior in adolescents with premenstrual syndrome (PMS). The theory offers a framework that assumes decision-making about adoption of any given behavior depends on perceived temporal distance from the desired or recommended behavior and thus individual might perceive any information or intervention, at two levels (low or high). In doing so, a trial was conducted on 1578 high school students suffering from PMS. The precaution adoption process model was applied to categorize students in six stages, based on their intention to adopt a behavior. The focus of this study was on students who were in stage 3 of the model (undecided to adopt a behavior that was relaxation). Overall, 411 students were identified and randomly assigned to the three study groups: group 1 (n = 98) who received a CLT-driven intervention containing detailed information about relaxation (low-level construal, LLC); group 2 (n = 150) who received a CTL-driven intervention containing general information about relaxation (high-level construal, HLC); and group 3 (n = 163) who received nothing (control group). The progression from stage 3 toward stage 6 (action) was considered as the desired outcome and it was hypothesized that LLC intervention would be more effective than HLC intervention. Compared to participants in the control group, participants in the high and low construal groups were significantly more likely to advance to the action stage (P < 0.001). In addition, students in the low construal group had made an apparent higher stage progression as compared to the high construal group, although this difference was not statistically significant (P = 0.33). The findings suggest that, for people who are undecided to adopt a new health action, LLC intervention might be more effective.

Dietary B vitamin intake and incident premenstrual syndrome.

BACKGROUND: Thiamine, riboflavin, niacin, vitamin B-6, folate, and vitamin B-12 are required to synthesize neurotransmitters that are potentially involved in the pathophysiology of premenstrual syndrome (PMS). OBJECTIVE: The objective was to evaluate whether B vitamin intake from food sources and supplements is associated with the initial development of PMS. DESIGN: We conducted a case-control study nested within the Nurses' Health Study II cohort. Participants were free of PMS at baseline (1991). After 10 y of follow up, 1057 women were confirmed as cases and 1968 were confirmed as controls. Dietary information was collected in 1991, 1995, and 1999 by using food-frequency questionnaires. RESULTS: Intakes of thiamine and riboflavin from food sources were each inversely associated with incident PMS. For example, women in the highest quintile of riboflavin intake 2-4 y before the diagnosis year had a 35% lower risk of developing PMS than did those in the lowest quintile (relative risk: 0.65; 95% CI: 0.45, 0.92; P for trend = 0.02). No significant associations between incident PMS and dietary intakes of niacin, vitamin B-6, folate, and vitamin B-12 were observed. Intake of B vitamins from supplements was not associated with a lower risk of PMS. CONCLUSIONS: We observed a significantly lower risk of PMS in women with high intakes of thiamine and riboflavin from food sources only. Further research is needed to evaluate the effects of B vitamins in the development of premenstrual syndrome.

Symptoms related to the menstrual cycle: diagnosis, prevalence, and treatment.

Menstrual cycle-related symptoms are associated with the intrinsic hormonal fluctuations of the menstrual cycle. These symptoms can be physical, behavioral, or emotional and include problems such as dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). Because of the emotional and behavioral aspects of menstrual cycle-related symptoms, it is likely that clinical psychiatrists will encounter these symptoms in their daily practice and should therefore be familiar with their diagnosis, prevalence, etiology, and treatment. As many as 2.5 million women are affected by menstrual disorders each year, which can have a profound impact on their quality of life. Although a definitive etiology has yet to be established, fluctuations in estrogen and progesterone as well as genetic factors are thought to contribute to the occurrence of menstrual disorders. Current treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) (for dysmenorrhea), lifestyle changes, selective serotonin reuptake inhibitors (SSRIs), and ovulation suppression (e.g., with oral contraceptives). Treatment with oral contraceptives (OCs), particularly extended or continuous use, may significantly reduce the incidence of menstrual cycle-related symptoms.

[Study of an antioxidant dietary supplement "Karinat" in patients with benign breast disease]. / Izuchenie antioksidantnoi biologicheski aktivnoi dobavki k pishche "Karinat" u bol'nykh s fibroadenomatozom molochnykh zhelez.

A randomized double blind placebo-controlled trial of efficiency of a dietary supplement "Karinat" in patients with benign breast disease was carried out. Karinat contains beta-carotene 2.5 mg, alpha-tocopherol 5 mg, ascorbic acid 30 mg and garlic powder 150 mg per one tablet. Out of 66 patients, 33 patients were given karinat, 33 were given placebo. The patients reccived a tablet of karinal or placebo twice a day during 6 months. Examinations of the patients included clinical estimation of symptoms of mastopathy and dysalgomenorrhea, breast sonography and mammography. It was found that karinat reduced the severity of mastalgia, premenstrual syndrome, dysmenorrhea and algomenorrhea and caused regression of palpable symptoms of the breast fibromatosis. On the whole karinat had positive action in 75.8% that was significantly greater by 45.5% as compared with placebo. Karinat may be useful for the treatment of patients with benign breast disease.

The significance of "nonsignificance" in randomized controlled studies: a discussion inspired by a double-blinded study on St. John's wort (Hypericum perforatum L.) for premenstrual symptoms.

OBJECTIVES: This study aimed to investigate the efficacy of St. John's wort extract (SJW) as a treatment for premenstrual symptoms. DESIGN: The study was a randomized, double-blinded, placebo-controlled trial, with two parallel treatment groups. After a no-treatment baseline cycle, volunteers were randomized to either SJW or placebo for a further two menstrual cycles. SETTINGS/LOCATION: A postal trial conducted from The University of Reading, Berkshire, England. SUBJECTS: One hundred and sixty-nine (169) normally menstruating women who experienced recurrent premenstrual symptoms were recruited onto the study. One hundred and twenty-five (125) completed the protocol and were included in the analysis. INTERVENTIONS: Six hundred milligrams (600) mg of SJW (standardized to contain 1800 microg of hypericin) or placebo (containing lactose and cellulose). OUTCOME MEASURE: A menstrual diary was used to assess changes in premenstrual symptoms. The anxiety-related subgroup of symptoms of this instrument was used as the primary outcome measure. RESULTS: After averaging the effects of treatment over both treatment cycles it was found that there was a trend for SJW to be superior to placebo. However, this finding was not statistically significant. CONCLUSION: The possibility that this nonsignificant finding resulted from insufficient statistical power in the study, rather than a lack of efficacy of SJW, is discussed. Following this discussion the recommendation is made that, in future, similar studies should be powered to detect a minimum clinically relevant difference between treatments.

Osteoporosis. Part III--Not just for bone loss: potential benefits of calcium and vitamin D for overall general health.

The potential benefits of dietary or supplemental calcium and vitamin D for osteoporosis prevention have been well reviewed. However, less well known is the potential of these two compounds to reduce the risk of recurrence of a number of overall general health conditions. For example, calcium may play a role in increasing levels of high-density lipoprotein, preventing colon polyp formation, reducing blood pressure in some hypertensive individuals, reducing kidney stone recurrence, promoting weight loss, and reducing the symptoms of premenstrual syndrome. Vitamin D may play a role in cancer prevention, provide synergism or enhancement to some chemotherapy protocols, prevent Type I diabetes, and along with calcium reduce the risk of tooth loss.

Premenstrual syndrome.

Premenstrual syndrome (PMS) affects the quality of life of millions of women. The complexity and variety of clinical presentation together with the cyclic recurrence of affective and somatic symptoms increase the difficulty in understanding and treating the disease. The precise pathophysiology of PMS is still unknown, but it is increasingly believed that, in women with PMS, the sensitive equilibrium between sex-steroids and central neurotransmitters is altered. Several studies have been carried out to understand the origin of the syndrome and to discover new ways of treatment. This review summarizes the most accepted PMS theories and treatments currently available based on the results of the best-designed trials.

A tensão pré-mestrual e o tempo para mudanças / Premenstrual tension and time for change

Neste livro, a autora traz a sua experiência de médico e pesquisador para ajudar a mulher - e também seu companheiro - a reconhecer e a lidar de modo criativo com a TPM. Ilustrado com histórias do cotidiano e com uma agenda para a mulher identificar se é vítima ou não da doença, A Tensão Pré-Menstrual e Tempo para Mudanças é uma contribuição importante para análise da tão falada TPM.

The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms.

Many types of dietary supplements have been advocated for the reduction of certain symptoms of premenstrual syndrome (PMS). However, only one supplement-calcium-has been demonstrated to be of significant benefit in a large, rigorous, double-blind, placebo-controlled trial. Limited evidence suggests that magnesium, vitamin E and carbohydrate supplements might also be useful, but additional research is needed to confirm these findings. Trials of vitamin B6 supplementation have had conflicting results, and high doses of this vitamin taken for prolonged periods of time can cause neurological symptoms. Trials of evening primrose oil have also had conflicting results; the two most rigorous studies showed no evidence of benefit. A variety of herbal products are suggested to reduce symptoms of PMS. The efficacy of these products is uncertain because of a lack of consistent data from scientific studies. Health professionals should be aware of the possible use of these supplements and ask those with PMS about their use of such products and counsel them based upon the totality of evidence.

Non-nutritional uses of vitamin B6.

Vitamin B6 is a water-soluble vitamin, and is readily metabolized and excreted, so it has generally been assumed to have negligible toxicity, although at very high levels of intake it can cause peripheral nerve damage. Nutritional deficiency disease is extremely rare, although a significant proportion of the population shows biochemical evidence of inadequate status, despite apparently adequate levels of intake. The vitamin has been used to treat a wide variety of conditions, which may or may not be related to inadequate intake. In some conditions use of vitamin B6 supplements has been purely empirical; in other conditions there is a reasonable physiological or metabolic mechanism to explain why supplements of the vitamin many times greater than average requirements may have therapeutic uses. However, even in such conditions there is little evidence of efficacy from properly conducted controlled trials.

Menstrual-cycle lengthening and reduction in premenstrual distress through guided imagery.

This study investigated the effects of a program of relaxation and specific guided imagery on menstrual-cycle length and premenstrual distress. Thirty healthy college women with regular menstrual cycles were studied for 6 months. The subjects completed the Menstrual Distress Questionnaire (MDQ) at the beginning and end of the study and recorded their menstrual cycles for 3 months on an investigator-developed calendar recording sheet. Subjects were then given an audiotape with a progressive muscle relaxation exercise followed by guided imagery with a suggestive message focusing on lengthening the menstrual cycle and delaying the onset of menstrual bleeding. The 15 subjects who completed the entire study had significant increases in cycle lengths during the 3 months of imagery. The total premenstrual distress scores also declined significantly, as did the subscales measuring behavior and negative affect. This study provides preliminary evidence that menstrual-cycle rhythmicity and premenstrual distress are amenable to the mind-body intervention of guided imagery and suggests that further investigation of this phenomena with larger sample size and careful controls for confounding variables be conducted.

Muscle tension and its relation to symptoms in the premenstruum.

Muscle tension as a function of sympathetic arousal may play a causal or contributory role in symptomatology in the premenstruum. The purpose of this study was to determine whether women exhibit an increase in muscle tension in the premenstrual phase over that in the follicular phase of the menstrual cycle, and whether the incidence and severity of premenstrual symptoms were associated with premenstrual muscle tension. A sample of 22 women with variable levels of predicted premenstrual symptomatology was chosen. A report of symptoms was obtained in the premenstrual and follicular phases of the menstrual cycle. Frontalis and trapezius muscle tension levels also were obtained during these cycle phases, during relaxation, and during focus on an emotional image. A difference was found in the subjects' premenstrual and follicular phase frontalis electromyogram (EMG) levels both in the initial relaxation period and while focusing on an emotional image. A significant positive correlation was found between the premenstrual physiologic symptoms women predicted they would have and the premenstrual frontalis EMG levels measured during relaxation. The results suggest that training in muscle tension reduction may benefit premenstrual symptoms.