Effectiveness of computer-based stress inoculation training (SIT) counseling approach on anxiety, depression, and stress of students with premenstrual syndrome.

BACKGROUND: Premenstrual Syndrome (PMS) is a common public health issue affecting many women of reproductive age worldwide. This study has been designed to investigate of computer-based stress inoculation training (SIT) counseling approach on anxiety, depression, and stress of university students with PMS. METHODS: A randomized trial study with two parallel arms was done from 30 October 2022 to 21 June 2023 on 100 university students aged 18 to 38 at Babol University of Medical Sciences. The participants were randomly divided into two groups intervention and control. The data collection tools included questionnaires on demographic-fertility characteristics, the Premenstrual Symptoms Screening Tool (PSST), the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-14), the Sheehan Disability Scale (SDS) and Riff's Psychological Well-being Scale (RPWS). The data were assessed using chi-square, t-student, ANOVA repeated measure, and linear regression tests. A significance level of P < 0.05 was considered for the analysis. RESULTS: The results of the study showed that the SIT interventions decreased the PMS severity and most psychological factors so in the intervention group, SIT was able to significantly reduce anxiety, depression, perceived stress, and Sheehan's disability after intervention (P < 0.001). Based on multiple linear regression analysis, the most predictors of HADS were the PSS and SDS (ß = 0.285, p = 0.009 and ß = 0.236, p = 0.024, respectively). CONCLUSION: The computer-based SIT counseling approach could reduce the severity of symptoms and psychological factors in students. Therefore, SIT intervention is recommended to manage their PMS. TRIAL REGISTRATION: IRCT20230130057274N2.

The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis.

BACKGROUND: Premenstrual dysphoric disorder is characterised by symptoms confined to the premenstrual phase of the menstrual cycle. Confirmed diagnosis requires prospective monitoring of symptoms over two cycles, otherwise the diagnosis is provisional. We aimed to measure the point prevalence of premenstrual dysphoric disorder. METHODS: We searched for studies of prevalence using MEDLINE, EMBASE, PsycINFO and PubMed. For each study, the total sample size and number of cases were extracted. The prevalence across studies was calculated using random effects meta-analysis with a generalised linear mixed model. Potential sources of heterogeneity were explored by meta-regression and subgroup analyses. Pre-registration was with PROSPERO (CRD42021249249). RESULTS: 44 studies with 48 independent samples met inclusion criteria, consisting of 50,659 participants. The pooled prevalence was 3.2 % (95 % confidence intervals: 1.7 %-5.9 %) for confirmed and 7.7 % (95 % confidence intervals: 5.3 %-11.0 %) for provisional diagnosis. There was high heterogeneity across all studies (I2 = 99 %). Sources of heterogeneity identified by meta-regression were continent of sample (p < 0.0001), type of sample (community-based, university, high school) (p = 0.007), risk of bias (p = 0.009), and method of diagnosis (p = 0.017). Restricting the analysis to community-based samples using confirmed diagnosis resulted in a prevalence of 1.6 % (95 % confidence intervals: 1.0 %-2.5 %), with low heterogeneity (I2 = 26 %). LIMITATIONS: A small number of included studies used full DSM criteria in community settings. CONCLUSIONS: The point prevalence of premenstrual dysphoric disorder using confirmed diagnosis is lower compared with provisional diagnosis. Studies relying on provisional diagnosis are likely to produce artificially high prevalence rates.

Menstrual and psychosocial characteristics associated with high-risk of premenstrual dysphoric disorder among university students: a cross-sectional study.

Up to 92 percent of Chinese women of reproductive age have pre-menstrual syndrome (PMS). The severe form of PMS (i.e. pre-menstrual dysphoric disorder [PMDD]) negatively affects women's everyday functioning and reproductive health. This study examined the relationships between menstrual, psychosocial characteristics and the risk of PMDD among young Chinese women. A cross-sectional online survey was conducted among Chinese university students in Hong Kong. Logistic regression was used to compute adjusted odds ratio (aOR) for the association of high-risk PMDD with menstrual and psychosocial characteristics. A total of 541 Chinese university students were recruited. Approximately 53 percent of female students were at high risk of developing PMDD. The high-risk PMDD group was significantly associated with a heavy volume of menstrual flow (aOR = 2.17, 95 percent CI 1.06-4.45), irregular menstrual cycle (1.72, 1.17-2.52), high dysmenorrhea (2.80, 1.95-4.04) and older ages of menarche (0.67, 0.45-0.98) in the menstrual characteristics. In the psychosocial characteristics, high-risk PMDD was significantly associated with symptoms of anxiety (2.19, 1.48-3.32) and depression (2.22, 1.48-3.32), high loneliness (1.94, 1.34-2.79) and low resilience (2.21, 1.52-3.23) levels. Additionally, resilience had a potential moderating effect on the associations between the high risk of PMDD and anxiety, depression and loneliness. The development and delivery of interventions that can enhance resilience and manage psychological distress would be beneficial for young Chinese women's reproductive health.

Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage.

To determine the relationships between luteal-phase steroidal hormonal profile and PMS for a large number of women attending a dedicated fertility clinic. This was a retrospective cross-sectional study on women attending a hospital-based clinic for fertility concerns and/or recurrent miscarriage. All participants were assessed with a women's health questionnaire which also included evaluation of premenstrual symptoms. Day of ovulation was identified based on the peak mucus symptom assessed by the woman after instruction in a fertility awareness-based method (FABM). This enabled reliable timing of luteal-phase serum hormone levels to be taken and analysed. Between 2011 and 2021, 894 of the 2666 women undertaking the women's health assessment had at least one evaluable serum luteal hormone test. Serum progesterone levels were up to 10 nmol/L lower for symptomatic women compared with asymptomatic women. This difference was statistically significant (p < 0.05) for the majority of PMS symptoms at ≥ 9 days after the peak mucus symptom. A similar trend was observed for oestradiol but differences were generally not statistically significant. ROC curves demonstrated that steroid levels during the luteal phase were not discriminating in identifying the presence of PMS symptoms. Blood levels for progesterone were lower throughout the luteal phase in women with PMS, with the greatest effect seen late in the luteal phase.

The impact of comorbid premenstrual syndrome or premenstrual dysphoric disorder on the clinical characteristics of bipolar disorder among Han Chinese women.

Bipolar disorder (BD) is commonly comorbid with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). However, little is known about their relationship. This study aimed to assess the impact of comorbid PMS or PMDD on the clinical characteristics of BD. A cross-sectional study was conducted on 262 women with BD. PMS and PMDD were screened with the Premenstrual Symptoms Screening Tool (PSST). Symptomatic features were assessed with Hamilton Depression Scale (HAMD), Young Mania Rating Scale (YMRS), and atypical features by the depressive episode section of SCID-I/P. The rates of PMS and PMDD among BD were 57.6% and 20.6% according to PSST. No significant difference in the rates of PMS and PMDD was found between BD I, BD II, and BD-NOS. Compared to BD patients without PMS or PMDD, patients with comorbid BD and PMS or PMDD were younger, more educated, had a higher risk of OCD, had an earlier age of onset, scored higher on HAMD-17 and its sub-scale of anxiety/somatization, cognitive deficit, psychomotor retardation, and were more likely to have increased appetite and leaden paralysis. In addition, patients with comorbid BD and PMDD were less likely to experience traumatic life events, more likely to have family history of mental disorders and have inflammatory or autoimmune disease, scored higher on HMAD-17, particularly in its sub-scale of anxiety/somatization, cognitive deficit, psychomotor retardation, and sleep disturbance. Compared with BD without PMS or PMDD, BD with PMS or PMDD might be a specific subtype of BD characterized with earlier onset age, heavier genetic load, increased symptom severity, and atypical features.

[Premenstrual dysphoric disorder (PMDD): Drug and psychotherapeutique management, a literature review]. / Trouble dysphorique prémenstruel : prises en charge médicamenteuses et psychothérapeutiques, une revue de littérature.

INTRODUCTION: Premenstrual Dysphoric Disorder (PMDD) was first recognised in July 2013 in the DSM-5 after a long journey to identify its existence. It was not until 1983 that the US National Institute of Mental Health determined research criteria for the study of PMS. In 1994, the term "premenstrual dysphoric disorder" (PMDD) replaced this term in the 4th edition of the Diagnostic System Manual (DSM). It was listed in the section "Mood Disorder Not Otherwise Specified" and remained under consideration until the DSM-5, in which it appeared in the depressive disorders section. The legitimisation of the psychiatric diagnosis as well as the determination of clear symptomatology criteria in 2013 opened up possibilities for management, development of clinical, pathophysiological, therapeutic and psychotherapeutic studies. This disabling disorder can affect personal, social, family and professional life. In 2019, the ICD-11 in turn introduced the diagnosis of premenstrual dysphoric disorder, which solidifies the recognition of the disorder. OBJECTIVE: (I) to review the existing treatments, both medicinal and psychotherapeutic, and (II) to review their effectiveness. At the end of this work we will formulate recommendations for the management of these patients. METHODOLOGY: A bibliographic search was carried out from 7 June 2021 to 7 July2021 on the databases (bases de données) Psychinfo APA, Scopus, PubMed, as well as the bases de données of the Cochrane organisation and the recommendation documents of the Haute Autorité de la santé. After an initial selection based on keywords, the full text of all articles were read to arrive at the final selection of 32 articles. RESULTS: Antidepressants and Cognitive Behavioural Therapies (CBT) appear to be the most commonly recommended treatments for PMDD. Other research shows the effectiveness of oral contraceptives including drospirenone. Selective serotonin reuptake inhibitors (SSRIs) were identified as an effective treatment for PMDD. These data are consistent with the current etiological hypothesis of PMDD which has a negative impact of natural hormonal fluctuations on certain neurotransmitters. CBT showed positive results in reducing the functional impact of PMDD. DISCUSSION: Selective serotonin reuptake inhibitor (SSRI) antidepressants were reported to be first-line treatments for PMDD (sertraline 50-150 mg/d, fluoxetine 10-20 mg/d, escitalopram 10-20 mg/d, paroxetine 12.5-25 mg/d). Drospirenone (EE 3 mg and EE 20 mg/d 24 days of hormonal pills, 4 days inactive) appears to have been a first or second line treatment depending on the articles. Current results clearly point to the effectiveness of CBT in helping to reduce: functional impairment, depressed mood, feelings of hopelessness, anxiety, mood swings, sensitivity, irritability, insomnia, conflict with others, impact of premenstrual symptoms on daily life, intensity of symptoms experienced, and symptom handicap. CBTs could also become a first-line treatment if there were to be more evidence of their effectiveness. In the future, it would seem useful to offer a psychotherapeutic treatment that can be reproduced and to multiply research with a high level of scientific comparability in order to clarify the place of CBT in the management of PMDD. Research on the etiopathology of the disorder and the optimal drug regimen is still ongoing. There is a need to develop appropriate psychotherapeutic techniques to support and accompany these patients. CONCLUSION: In order to better evaluate treatments for PMDD, there is a need to homogenise studies on the subject at several levels: design, treatment doses, psychotherapeutic techniques, and evaluation measures. At present, some studies include both premenstrual syndrome (PMS) and PMDD patients. PMS and PMDD do not include the same symptoms, nor the same severity and potentially the same aetiology in the patients studied. In order to propose rigorous research that evaluates the effectiveness of treatments for PMDD and to properly support people with both these disorders, it seems essential to distinguish the two conditions. The role of the health practitioner is to be able to identify PMDD by differentiating it from other clinically related disorders. The patient must then be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications and her preferences. In 2021, the French National Authority for Health did not offer any guidelines or recommendations for the management of premenstrual dysphoric disorder. There is a need to develop research in France.

Prevalence and correlates of premenstrual syndrome and premenstrual dysphoric disorder among women aged 18-25 in Turkey.

OBJECTIVE: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are experienced in the luteal phase among women of reproductive age and are known to affect quality of life. This study sought to determine the prevalence and correlates of PMS and PMDD in women aged 18-25 in Turkey. METHOD: A cross-sectional study was conducted between December 2022 and May 2023, which recruited 1125 female college students. A personal information form, the International Physical Activity Questionnaire, and the Premenstrual Syndrome Scale (PMSS) were administered. Participants who met criteria for PMS during three consecutive menstrual cycles based on the ACOG and PMSS scores were diagnosed as having PMS. Participants who met the criteria for PMDD during three consecutive menstrual cycles based on the DSM-V were diagnosed as having PMDD. Logistic regression analysis was used to determine correlates of PMS and PMDD. FINDINGS: PMS was found in 49.2% and PMDD in 48.0% of the participants. Women having a blood group type B compared to those with blood group type A were more likely to have PMS (OR = 151.8, 95% CI = 54.5-422.6). In addition, women with PMS were less likely to be physically active based on the metabolic equivalent of task score (OR = 0.99, 95% CI= 0.98-0.99). Menstrual cycle duration was also longer among those with PMDD (OR = 1.47, 95% CI= 1.25-1.72), as was daily caffeine intake (OR = 1.01, 95% CI= 1.00-1.01). PMDD score was also found to be associated with major depressive disorder (OR = 1.06,95% = 1.05-1.07). CONCLUSIONS: PMS and PMDD among young women in Turkey were associated with blood groups, MET scores, and other clinical characteristics that may help clinicians to identify these conditions.

The multifactorial aetiology and management of premenstrual dysphoric disorder with leuprorelin acetate.

Up to 18% of women of reproductive age may experience symptoms during the luteal phase of the menstrual cycle known as premenstrual syndrome (PMS) or its more severe form, premenstrual dysphoric disorder (PMDD). A plethora of symptoms have been described, but both are commonly associated with other mood-related disorders such as major depression causing significant life impairment. Originally known as late luteal phase dysphoric disorder in the DSM-III-R (American Psychiatric Association 1987), the syndrome was renamed PMDD in the DSM-IV (American Psychiatric Association 1994). Between 3% and 8% of women meet the diagnostic criteria for PMDD. Currently, there is no consensus on its aetiology although it is thought to be multifactorial. Biological, genetic, psychological, environmental and social factors have all been suggested. However, an altered sensitivity to the normal hormonal fluctuations that influence functioning of the central nervous system is thought most likely. PMDD is identified in the DSM-5 by the presence of at least five symptoms accompanied by significant psychosocial or functional impairment. During evaluation, it is recommended that clinicians confirm symptoms by prospective patient mood charting for at least two menstrual cycles. Management options include psychotropic agents, ovulation suppression and dietary modification. Selective serotonin reuptake inhibitors (SSRIs) are considered primary therapy for psychological symptoms. Ovulation suppression is another option with the combined oral contraceptive pill (COCP) or GnRH (gonadotropin-releasing hormone) agonists. Rarely symptoms warrant a bilateral oophorectomy and a 6-month trial of GnRH agonists prior to surgery may be prudent to determine its potential efficacy. The authors present the case of a multiparous woman in her mid-30s experiencing severe symptoms during the luteal phase of her menstrual cycle. A trial of the contraceptive pill and SSRIs were unsuccessful. Treatment with leuprorelin acetate (Prostap) improved her symptoms. She therefore elected to undergo a bilateral oophorectomy with resolution of her symptoms. She started hormone replacement therapy (HRT). This case demonstrates the multifactorial aetiology of PMDD and the challenges in its management. Women with PMDD suffer functional impairments comparable with other depressive disorders and yet PMDD and its impact remain under-recognised. As the psychological nature and consequences of PMDD often seem indistinguishable from symptoms of other mental health difficulties, this condition presents distinct diagnostic challenges for healthcare professionals. It is crucial to establish the correct diagnosis using clearly defined criteria because if it is left untreated, it can cause considerable impairment to the woman's quality of life.

The Association between the Severity of Dysmenorrhea and Psychological Distress of Women Working in Central Tokyo-A Preliminary Study.

This study aims to clarify the association between the severity of dysmenorrhea and psychological distress among working women in central Tokyo and examine the effect modification of job stressors. The participants in this cross-sectional study were 312 women who had undergone health check-ups in the "Marunouchi Hokenshitsu" project. The severity of dysmenorrhea was defined as the degree of daily life disturbance with menstrual pain, and the outcome variable was the K6 scores. To assess the association of psychological distress with the severity of dysmenorrhea, multiple regression analyses were performed. The results revealed that 18.3% of the 289 working women were in the moderate/severe group of dysmenorrhea. In multiple regression analysis, moderate/severe dysmenorrhea was significantly associated with higher levels of psychological distress, but the significance disappeared after adjusting for gynecology such as premenstrual syndrome (PMS) and workplace-related factors. The degree of job control was significantly associated with lower levels of psychological distress and may modify psychological distress caused by dysmenorrhea. Moderate/severe dysmenorrhea may be associated with higher levels of psychological distress in working women, and psychological symptoms of PMS) and the degree of job control were possible effect factors, and there may be effect modification by the degree of job control.

The Effect of Premenstrual Dysphoric Disorder Diagnosis and Severity on Depression Sensitivity.

ABSTRACT: Premenstrual dysphoric disorder (PMDD) is thought to be associated with depressive disorder. In our study, the depression susceptibility of female patients with PMDD was assessed using the depression sensitivity scale, which is different from previous studies. The study was conducted on 32 PMDD patients aged 18-40 years who applied to the psychiatry outpatient clinic and 30 healthy controls. The mean age of women diagnosed with PMDD was similar ( p = 0.467). The probability of having a family history of PMDD was significantly higher in the PMDD group than in the control group (χ 2 = 11.182, p = 0.001). Previous psychotropic drug use (χ 2 = 8.862, p = 0.003) and family history of mental illness (χ 2 = 5.995, p = 0.014) were significantly higher in PMDD patients compared with the control group. The sociodemographic questionnaire, the Leiden Index of Depression Sensitivity (LEIDS), and the Premenstrual Assessment Form were administered to the participants. No significant difference was found between the patient and healthy groups regarding LEIDS scores ( r = 0.75, p > 0.05). In patients with PMDD, the clinical severity of PMDD was found to increase susceptibility to depression ( r = 0.460, p < 0.01). It was revealed that PMDD severity was associated with susceptibility to depression rather than PMDD diagnosis.

Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder in Female Medical Students of Nepal.

Background Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder can have negative impact on medical students and remains mostly underdiagnosed. Different treatment modalities like medications (doctor-prescribed or self-medicated), and alternative therapies are used by students to cope with pre-menstrual symptoms. Objective To estimate the prevalence and severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among medical students in Nepal along with its impact in their quality of life, their health seeking behavior and treatment modalities used to cope with these disorders. Method A cross-sectional study was conducted among female medical students studying MBBS in various medical colleges in Nepal using a self-administered questionnaire from September 2020 to March 2021. Result The prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among female medical students in Nepal was 64% and 36.3% respectively as per this study. Among the areas impacted by premenstrual symptoms, concentration in class was the most affected (68.1%), followed by distress (64.6%). Only 7.3% of the responding participants sought medical consultation for their symptoms. Among those who suffered from at least one symptom for any length of time, 34.8% of participants reported of using at least one medication (either prescribed or selfmedication). Similarly, alternative remedies were used by 44.4% of the participants. Conclusion Premenstrual syndrome and premenstrual dysphoric disorder were found to be common in female medical students of Nepal. However, very few students sought medical consultation despite a significant impact in their academic and other activities. Self-medication and traditional therapies were common modalities used for treatment of premenstrual symptoms.

Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study.

Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.

Characterization of pathogenic factors for premenstrual dysphoric disorder using machine learning algorithms in rats.

We established a methodology using machine learning algorithms for determining the pathogenic factors for premenstrual dysphoric disorder (PMDD). PMDD is a disease characterized by emotional and physical symptoms that occurs before menstruation in women of childbearing age. Owing to the diverse manifestations and various pathogenic factors associated with this disease, the diagnosis of PMDD is time-consuming and challenging. In the present study, we aimed to establish a methodology for diagnosing PMDD. Using an unsupervised machine-learning algorithm, we divided pseudopregnant rats into three clusters (C1 to C3), depending on the level of anxiety- and depression-like behaviors. From the results of RNA-seq and subsequent qPCR of the hippocampus in each cluster, we identified 17 key genes for building a PMDD diagnostic model using our original two-step feature selection with supervised machine learning. By inputting the expression levels of these 17 genes into the machine learning classifier, the PMDD symptoms of another group of rats were successfully classified as C1-C3 with an accuracy of 96%, corresponding to the classification by behavior. The present methodology would be applicable for the clinical diagnosis of PMDD using blood samples instead of samples from the hippocampus in the future.

Frequency of Premenstrual Dysphoric Disorder (PMDD) and Comparison of Quality of Life between Female Medical Students with and without Premenstrual Dysphoric Disorder.

OBJECTIVE: To determine the frequency of Premenstrual Dysphoric Disorder (PMDD) in female medical students, and to compare the quality of life between those with and without PMDD. STUDY DESIGN: Descriptive Study. Place and Duration of the Study: Fatima Jinnah Medical University, Lahore, from November 2019 to April 2020. METHODOLOGY: The study included 635 female medical students from the third year to the final year of MBBS. Quality of life was measured by using the World Health Organization Quality of Life Brief (WHOQOL-BREF) Scale and PMDD was diagnosed as per DSM-V Diagnostic criteria. Data were entered and analysed by IBM SPSS version 23.0. Scores of 4 domains of the WHOQOL-BREF scale were compared between the female medical students with and without PMDD. A p-value of ≤0.05 was considered statistically significant. RESULTS: Significant proportion i.e., 12.1% (77) out of 635 female medical students had PMDD. There was a significant difference in the physical and psychological domains scores of the WHOQOL-BREF scale between healthy students and students with PMDD (p-value <0.001). CONCLUSION: The physical and Psychological aspects of quality of life are significantly lower in female medical students with PMDD. KEY WORDS: WHOQOL-BREF, Premenstrual dysphoric disorder, Female medical students.

The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review.

BACKGROUND: Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes. OBJECTIVE: To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms. METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist. RESULTS: Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8-85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality. DISCUSSION: MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms. TRIAL REGISTRATION: This review has been registered in the PROSPERO database (CRD42021268757).

What's Stopping Us? Using GnRH Analogs With Stable Hormone Addback in Treatment-Resistant Premenstrual Dysphoric Disorder: Practical Guidelines and Risk-Benefit Analysis for Long-term Therapy.

Objective: Despite the documented success of gonadotropin-releasing hormone analogs (GnRHa) for the treatment of treatment-resistant premenstrual dysphoric disorder (PMDD), many patients struggle to find providers who have sufficient knowledge of PMDD and its evidence-based treatments and/or who are comfortable treating PMDD after first-line treatment options have failed. Here, we discuss the barriers to initiating GnRHa for treatment-resistant premenstrual dysphoric disorder (PMDD) and offer practical solutions to address these barriers for providers who encounter patients with treatment-resistant PMDD but may not have the necessary expertise or comfort with providing evidence-based treatments (ie, gynecologists, general psychiatrists). We have included supplementary materials including patient and provider handouts, screening tools, and treatment algorithms with the hope that this review may serve as a primer on PMDD and the use of GnRHa with hormonal addback as a treatment, as well as a guideline for clinicians delivering this treatment to patients in need.Options: In addition to offering practical treatment guidelines for first and second lines of treatment for PMDD, this review offers an in-depth discussion of GnRHa for treatment-resistant PMDD.Outcomes: The burden of illness in PMDD is estimated to be similar to that of other mood disorders, and those suffering from PMDD are at a high risk for suicide.Evidence: We present a selective review of relevant clinical trials evidence supporting the use of GnRHa with addback hormones in treatment-resistant PMDD (the most recent evidence cited was published in 2021), highlighting the rationale for addback hormones and presenting the different possible hormonal addback approaches.Values: The PMDD community has and continues to suffer from debilitating symptoms despite the known interventions. This article provides guidance for implementing GnRHa into practice among a broader scope of clinicians including general psychiatrists.Benefits, Harms, and Costs: The primary benefit of implementing this guideline is that a broad range of clinicians beyond reproductive psychiatrists who encounter patients with PMDD will have a template for assessing and treating PMDD and implementing GnRHa treatment when first-line treatments fail. Harms are expected to be minimal; however, some patients may have side effects or adverse reactions to the treatment or may not respond as they had hoped. Costs of GnRHa can be high depending on insurance coverage. We provide information within the guideline to help navigate this barrier.Recommendations: (1) Prospective symptom rating in evaluating for PMDD is necessary for diagnosis and evaluating treatment response. (2) SSRIs and oral contraceptives should be trialed as the first- and second-line treatments for PMDD. (3) When first- and second-line treatments have failed to yield symptom relief, the use of GnRHa with hormone addback should be considered. Risks and benefits of GnRHa should be weighed among clinicians and patients, and potential barriers to access should be discussed.Validation: This article adds to the available systematic reviews on the effectiveness of GnRHa in the treatment of PMDD and Royal College of Obstetrics and Gynecology's guidelines on the treatment of PMDD.

Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation.

BACKGROUND: Premenstrual Dysphoric Disorder (PMDD) is a premenstrual condition that affects 3-8% of the US population, yet knowledge on treatment and consistent diagnostic testing is lacking. While research concerning the epidemiology and pharmaceutical treatments for this condition has increased, there is a lack of qualitative studies on the experiences of patients who live with this condition. The aim of this study was to explore the diagnostic and treatment experiences of PMDD patients in the U.S. healthcare system and identify barriers to diagnosis and treatment. METHODS: This study uses a feminist framework with qualitative phenomenological methods. We recruited participants who identified as having PMDD, regardless of official diagnosis, through online forums within the U.S. PMDD community. The study conducted 32 in depth interviews with participants on their experiences with PMDD diagnosis and treatment. Thematic analysis methods revealed key barriers within the diagnostic and care process including patient, provider, and societal barriers. RESULTS: This study presents a PMDD Care Continuum that represents the timeline of participant experiences beginning from symptom onset towards official diagnosis, treatments, and ongoing management of the condition. Participant experiences demonstrated that much of the diagnostic and treatment processes were burdened on the patient, and that successful navigation within the healthcare system was dependent on high levels of self-advocacy. CONCLUSIONS: This was the first study to describe the qualitative experiences of patients who identified as having PMDD in the U.S. Further research is needed to refine and operationalize diagnostic criteria and treatment guidelines for PMDD.

The prevalence of moderate-severe premenstrual syndrome and premenstrual dysphoric disorder and the related factors in high school students: A cross-sectional study.

OBJECTIVE: Premenstrual syndrome (PMS) is a clinical condition with physical and psychological symptoms affecting female students' quality of life, social activity, and school performance. Since most studies have focused on adult women, this study aimed to evaluate the prevalence of moderate-severe PMS, premenstrual dysphoric disorder (PMDD), and their related factors in high school students. METHODS: The participants of this cross-sectional study, conducted in 2019, were 900 high school students in Sari, north of Iran. They were selected by census method from six high schools. Data were collected using Premenstrual Syndrome Screening Tool and General Health Questionnaire. RESULTS: The prevalence of moderate-severe PMS and PMDD were 33.9% and 12.3%, respectively. According to the logistic regression model, dysmenorrhea was significantly associated with a higher prevalence of moderate-severe PMS [adjusted odds ratio (AOR) 2.356, confidence interval (CI): 1.706-3.254, p < 0.0001] and PMDD (AOR: 1.924, CI: 1.186-3.120, p = 0.0008). Moreover, optimal general health was associated with a lower prevalence of moderate-severe PMS (AOR: 0.326, CI: 0.221-0.480, p < 0.0001) and PMDD (AOR: 0.309, CI: 0.161-0.593, p < 0.0001). The findings revealed that a family history of PMS and adding excess salt to the food were associated with a higher prevalence of PMDD (p < 0.05). CONCLUSION: Although many high school students do not meet the criteria for PMDD, many experience PMS, which could be diminished with proper diet and improved general health.

Premenstrual Syndrome among Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Introduction: Premenstrual syndrome is the premenstrual disorder with wide range of prevalence world-wide leading to higher rates of work absences, higher medical expenses, and lower health-related quality of life. The aim of this study was to find out the prevalence of premenstrual syndrome among medical students of a medical college. Methods: A descriptive cross sectional study was conducted in a medical college among medical students using self-reported questionnaires based on American College of Obstetricians and Gynaecologists criteria for premenstrual syndrome, and 12-Item Short Form Health Survey for quality of life, from 1 January 2022 to 31 March 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 207807955). Convenience sampling was used among students who met the inclusion criteria. Point estimate and 95% Confidence Interval were calculated. Results: Among 113 patients, premenstrual syndrome according was seen in 83 (73.45%) (82.93-83.06, 95% Confidence Interval) out of which, 56 (67.46%) showed mild premenstrual syndrome, and 27 (32.53%) had moderate premenstrual syndrome. The most commonly reported affective symptoms of premenstrual syndrome was irritability 82 (98.79%), while the somatic symptoms was abdominal bloating 63 (75.90%). Conclusions: The prevalence of premenstrual syndrome among medical students was similar to in the other studies done in similar settings. Keywords: premenstrual syndrome; prevalence; quality of life.

The longitudinal predictive effect of self-reported frequency of premenstrual syndrome on depression: Findings from the Australian Longitudinal Study on Women's Health.

Background: Previous studies have revealed a high comorbidity between premenstrual syndrome (PMS) and depression; however, whether PMS can longitudinally predict depression has not been examined in large sample studies. Methods: This study surveyed 8,133 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Participants completed seven repeated measurements at 3-year intervals starting in 2000 (aged 22-27 years). Binary logistic and multivariate ordered logistic regression models were used to examine the predictive role of self-reported frequency of PMS symptoms in 2000 on self-reported diagnosis of depression and frequency of depressive symptoms, respectively, for each follow-up survey. Results: Self-reported frequency of PMS symptoms in the year 2000 predicted self-reported diagnosis of depression in most follow-up surveys. Specifically, compared to women who reported "never" had PMS symptoms in 2000, those who reported "often" had them were more likely to report a diagnosis of depression in 2006 (OR = 1.72), 2012 (OR = 1.88), 2015 (OR = 1.49), and 2018 (OR = 1.90); and those who reported "sometimes" had PMS symptoms in 2000 were more likely to report a diagnosis of depression in 2012 (OR =1.37) and 2018 (OR = 1.59). Furthermore, self-reported frequency of PMS symptoms in 2000 predicted self-reported frequency of depressive symptoms in each follow-up survey. Compared to women who reported "never" had PMS symptoms in 2000, those who reported "sometimes", or "often", had PMS symptoms reported depressive symptoms more frequently. Conclusion: Self-reported frequency of PMS can predict the self-reported frequency of depressive symptoms and the subsequent diagnosis of depression.