Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women.

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

The prevalence of self-reported premenstrual symptoms and evaluation of regular exercise with premenstrual symptoms among female employees in Taiwan.

Few studies have focused on premenstrual symptoms in employees. This study explored the prevalence of premenstrual symptoms in 7,193 female employees aged 18-55 years in a large electronics manufacturer in Taiwan from August 2014 to December 2014 and examined whether regular exercise was associated with premenstrual symptoms. Information was collected on demographics, lifestyle, menstrual history, menstrual pain, and premenstrual symptoms. Half of the participants reported irregular menstruation; 79.4% reported a moderate menstruation amount, and half reported little impact of menstrual pain at work. In order of prevalence, symptoms were "easy to fatigue" (24%), "backache" (21.2%), and "abdominal bloating" (17.4%). Participants who engaged in regular exercise reported fewer backaches (adjusted odds ratio [aOR] = 0.79, 95% confidence interval [CI] = 0.68-0.91), somatic discomfort (aOR = 0.78, 95% CI = 0.63-0.96), headache (OR = 0.82, 95% CI = 0.69-0.98), diarrhea (aOR = 0.76, 95% CI = 0.60-0.96), constipation (aaOR = 0.59, 95% CI = 0.44-0.78), less irritability (aOR = 0.78, 95% CI = 0.65-0.94), feeling morose and depressed (aOR = 0.75, 95% CI = 0.58-0.95), crying (aOR = 0.51, 95% CI = 0.27-0.87), and emotional lability (aOR = 0.73, 95% CI = 0.58-0.91). Regular exercise was associated with decreased menstrual pain (aOR = 0.85, 95% CI = 0.76-0.96). Our findings provide a better understanding of premenstrual symptoms in female workers, allowing for the development of premenstrual health programs to improve their health and quality of life.

Premenstrual dysphoric disorder in East Asia: a review of the literature.

OBJECTIVE: Fluctuations in ovarian steroids during specific phases of the reproductive cycle, such as pre-menstruation, have been hypothesized to contribute to women's increased vulnerability to depression. This current study's goal is to summarize the literature regarding Premenstrual Dysphoric Disorder (PMDD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea. METHOD: A Pubmed and Chinese Electronic Periodical Service (CEPS) literature review was conducted using the key words "Premenstrual Dysphoric Disorder" along with "Japan," rea," "Taiwan," "Hong Kong," and "Macau." Using these criteria, 17 articles were found. Three articles were excluded because they did not involve PMDD in the aforementioned countries. In addition to this search, an article found in a review of the research on reproductive mental health disorders in China was utilized. That review contained one article regarding PMDD with an English language abstract, which was utilized in this current article. RESULTS: The rates of PMDD in East Asia (1.3-2.8%) appear to be lower than that seen in the Western literature (3-8%). Many of the risk factors for PMDD were the same in the Eastern and Western literature, although some key differences were found. The few studies on treatment of PMDD in East Asia have shown positive results. CONCLUSIONS: The rates of PMDD appear to be lower in East Asia, though reasons for this result are discussed. Few studies have been conducted examining the efficacy of psychotropic medications commonly used to treat PMDD in this population.

Menstrual bleeding: perspective of Brazilian women.

BACKGROUND: Menstrual patterns, induced amenorrhea and the use of some contraceptive methods which induce non-bleeding are issues under debate among health professionals and women. The objective of the study was to describe perspectives and attitudes of Brazilian women regarding menstruation and its interference in daily activities. STUDY DESIGN: A semistructured questionnaire was applied to nonpregnant, nonlactating women between 18 and 45 years old, who were menstruating, consulting at public health services for other complaints than gynecological or reproductive health care, and staff members and teachers of public universities in one city of each geographic region of Brazil and the Federal District. RESULTS: Of the 885 women interviewed, 51.5% were aged 20-29 years, almost 60% reported normal frequency of bleeding, 22% and 43% reported interference of menstruation in their school activities and in the relationship with their partner, respectively. The value attributed to each interference (<5; ≥ 5; in a scale up to 10) was >5 for more than 60% of the women in all evaluated domains. The most common reason for disliking menstruation was inconvenient and/or discomfort, and for liking menstruation were feeling healthy and confirmation of not being pregnant. The variables associated to liking menstruation were attending <8 years of school and low economic class, having more than one child and no history of premenstrual tension. CONCLUSION: A great proportion of the interviewed women disliked having menstruation even when they did not present menstrual-related problems. However, some women still preferred monthly menstruation because they felt healthy and it was a free pregnancy test.

A comparison of the prevalence of premenstrual dysphoric disorder and comorbidities among adolescents in the United States of America and Nigeria.

STUDY OBJECTIVE: Premenstrual dysphoric disorder (PMDD) often starts in adolescence, but there are limited data on its prevalence. The specific aims of this study were to (1) describe the prevalence of PMDD in adolescents presenting to clinics in the midwestern United States and 2 Nigerian cities, (2) identify cultural differences, and (3) screen for comorbidities. DESIGN: A cross-sectional survey was conducted among adolescents attending outpatient clinics in the 3 sites. Study participants provided demographic information and completed a modified version of the Premenstrual Symptoms Screening Tool. They also completed the modified Mini International Neuropsychiatric Interview screen for comorbid psychiatric conditions. RESULTS: Five-hundred thirty-seven patients participated in the study. The participants were between 13-21 years old (mean [SD] =16.9 [2.02] years). The overall prevalence of PMDD was 4.1% (Maiduguri, Nigeria 6.5%; Lagos, Nigeria 3.1%; and 2.9% in Akron, United States). The differences were not statistically significant (P = .167). The prevalence of moderate to severe premenstrual syndrome ranged from 12.4%-16.3% among the 3 sites, with an overall prevalence of 14.5%. There was a significantly higher prevalence of other mood disorders in Akron (19.3%) compared to the Nigerian sites (P < .001.). This difference across cultures was statistically significant. CONCLUSIONS: Premenstrual dysphoric disorder is prevalent across different cultures. It is a chronic condition that causes significant morbidity among adolescents. There is a need for simple diagnostic methods for early detection and evidence-based management guidelines.

Premenstrual syndrome and dysmenorrhea: urban-rural and multiethnic differences in perception, impacts, and treatment seeking.

BACKGROUND: Attitudes toward menarche and menstruation are largely influenced by sociological, cultural, and family environmental factors. Recognizing the influential effects that these factors might have on shaping adolescents' attitudes is crucial in designing a more effective means of transmitting health information. AIMS: This study aimed to gather an in-depth understanding of perceptions, impacts, and treatment seeking on menstruation-related issues from an ethnically mixed group of rural and urban girls. METHODOLOGY: In total, 27 focus group discussions (172 participants) were conducted between November 2008 and April 2009. Participants were adolescent girls aged 13-19 years, recruited from 7 public secondary schools in the Federal Territory of Kuala Lumpur and 4 public secondary schools from the rural districts of Kelantan, in Malaysia. RESULTS: Many participants revealed that they were not given or had not received detailed information about the mechanism or physiology of menstruation prior to its onset. Thus, many described the onset of menarche as shocking, an event for which they were unprepared, and which has had a tremendous impact on their emotions. More positive acceptance of menarche was reported in the urban than with the rural groups. Despite the high prevalence of premenstrual syndrome and dysmenorrhea, participants across urban-rural and ethnic groups perceived the problems as completely normal, hence they relied on self-care methods and did not want to seek professional treatment. More rural girls compared to urban girls were embarrassed to talk to their mothers or consult their physicians regarding menstruation-related problems. CONCLUSION: Menstruation-related education would have a positive impact in improving adolescent girls' knowledge and in nurturing a positive attitude toward menstruation-related matters at home, at school, and in the community.

Dysmenorrhea in a multiethnic population of adolescent Asian girls.

OBJECTIVE: To determine the prevalence of dysmenorrhea, its impact, and the treatment-seeking behavior of adolescent Asian girls. METHOD: A cross-sectional study with 1092 girls from 15 public secondary schools and 3 ethnic groups in the Federal Territory of Kuala Lumpur, Malaysia. RESULTS: Overall, 74.5% of the girls who had reached menarche had dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance. Ethnicity and form at school were significantly associated with the poor concentration, absenteeism, and restriction of social and recreational activities attributed to dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact, and management of dysmenorrhea. CONCLUSION: There is a need for culture-specific education regarding menstruation-related conditions in the school curriculum.

A culturally sensitive study of premenstrual and menstrual symptoms among Chinese women.

This is a two-part study of perimenstrual symptomatology in Chinese women. We developed and validated the Chinese Questionnaire of Perimenstrual Symptoms (CQ-PERI-MS), which was adapted from the Moos Menstrual Distress Questionnaire, and used this instrument to assess the prevalence and nature of perimenstrual symptoms among Chinese women in Hong Kong. The initial CQ-PERI-MS was first administered to a sample of 538 menstruating Chinese women in Hong Kong together with measures of anxiety, depression and neuroticism. Psychometric analyses rendered a 32-item CQ-PERI-MS which demonstrated good reliability, convergent and discriminant validity, and factorial validity. Four factors were yielded, namely, Dysphoria, Somatic distress, Cognitive problems and Arousal. The CQ-PERI-MS was then administered to a separate sample of 339 menstruating Chinese women in Hong Kong for further examination of validity as well as pattern of perimenstrual symptoms. It was found that perimenstrual symptoms were common, with 18.6% and 34.2% of the participants reporting 10 or more premenstrual and menstrual symptoms, respectively. Both premenstrual and menstrual distress were characterised by a combination of emotional and somatic symptoms. Contrary to previous preconceptions, perimenstrual symptoms are commonly experienced by Chinese women, with both overlapping and distinct features when compared with patterns in the West.

Pattern and correlates of premenstrual symptomatology amongst Nigerian University students.

This study aimed to evaluate the pattern and correlates of premenstrual symptomatology amongst Nigerian female undergraduates. Female University students (n = 409) completed questionnaires detailing sociodemographic, menstruation/gynecological history and personality traits. They were then rated with a checklist for premenstrual symptoms. The most frequent premenstrual symptoms were 'breast tenderness' (35.5%), 'sleeplessness' (15.6%), 'decreased interest in usual activities' (15.4%), 'lethargy/easy fatigability/lack of energy' (13.2%) and 'change in appetite' (13.2%). The prevalence of premenstrual symptomatology was 50.1% and the correlates of increasing premenstrual symptomatology included increasing age, increasing severity of menstrual pain, personality traits of neuroticism and agreeableness and increasing body mass index. Although the rate of premenstrual symptomatology in sub-Saharan African women was comparable with that in the western cultures, there may be cross-cultural differences in the pattern of presentation. Dysmenorrhoea and personality traits should be taken into consideration when planning and implementing effective strategy to manage perimenstrual problems in this region.

Skipping breakfast adversely affects menstrual disorders in young college students.

In the present study we conducted a questionnaire survey to examine the relationship between dietary habits and menstrual disorders in young women. Subjects were recruited from 315 college students and were classified as: Group I, eating breakfast; Group II, skipping breakfast; Group III, not eating fast foods; Group IV, eating fast foods; Group V, not eating processed foods; and Group VI, eating processed foods. The intensity of dysmenorrhea was scored using three grades. All participants were further divided into groups based on having regular or irregular menstruation, having premenstrual symptoms or not, and self-perception of good or poor general health. General health was poor in Groups II and VI, and dysmenorrhea scores were high in Groups II, IV and VI. The incidence of irregular menses was also high in Group II. However, there was no apparent relation between premenstrual symptoms and dietary habits. These findings suggest that skipping breakfast adversely affects menstrual disorders in young college students.

Luteal phase administration of paroxetine for the treatment of premenstrual dysphoric disorder: a randomized, double-blind, placebo-controlled trial in Canadian women.

OBJECTIVE: To evaluate the efficacy and safety of intermittent, luteal phase-only administration of paroxetine (10 mg and 20 mg) in the treatment of premenstrual dysphoric disorder (PMDD). METHOD: In this multicenter trial, female outpatients (aged 18-45 years) from 4 Canadian health centers meeting DSM-IV criteria for PMDD were asked to perform daily ratings of their premenstrual symptoms for 2 consecutive menstrual cycles. Those displaying the symptoms of irritability and/or depressed mood in the luteal phases but not in the follicular phases of their menstrual cycles were randomly assigned to intermittent, luteal phase-only treatment with paroxetine 10 mg or 20 mg or placebo for 4 additional cycles. The primary efficacy endpoint was the percent change from baseline at study endpoint on the visual analog scale irritability score. Treatment differences were tested using analysis of covariance ad hoc. Estimated treatment mean differences and their associated 95% confidence intervals were also calculated. Data were collected from May 1999 to November 2002. RESULTS: Ninety-nine patients were included in the intention-to-treat population. When compared with placebo, patients treated with paroxetine 20 mg attained a significant reduction in irritability (difference in median percent change: -23.9, 95% CI = -51.3 to -6.2, p = .014; difference in mean absolute change: -18.6, 95% CI = -32.5 to -4.6, p = .007). A statistically significant difference was not observed when the patients treated with the lower dose of paroxetine (10 mg) were compared with placebo. Treatment was well tolerated with no unexpected side effects. CONCLUSIONS: Intermittent administration of paroxetine 20 mg significantly reduced irritability symptoms in patients with PMDD. These results are consistent with previous studies suggesting that PMDD may be treated effectively by luteal phase-only administration of a selective serotonin reuptake inhibitor. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00620581.

Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates.

AIMS: The rate of premenstrual dysphoric disorder (PMDD) amongst sub-Saharan Africans is unknown. This study aimed to estimate the rate of PMDD amongst Nigerian undergraduates and to evaluate psychosocial correlates and comorbid psychiatric conditions. METHOD: Female university students (n=410) completed questionnaires detailing sociodemographic, menstruation, and gynaecological history. They also completed the Big Five Personality Inventory (BFI), and the presence of PMDD and any other DSM-IV axis 1 psychiatric diagnosis was assessed with the Mini International Neuropsychiatric Interview (MINI). RESULTS: The prevalence of PMDD was 6.1% and the correlates included older age (p=0.001), painful menstruation (p=0.006), and high score on neuroticism scale (p=0.019). Compared with participants without PMDD, participants with PMDD have significantly higher rates for the following psychiatric diagnoses: dysthymia (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.68-8.69), major depressive disorder (OR, 17.00; 95% CI, 6.72-43.00), panic disorder (OR, 4.39; 95% CI, 1.35-14.30), and generalised anxiety disorder (OR, 1.21; 95% CI, 1.21-17.83). CONCLUSION: The rate of PMDD in sub-Saharan African women was comparable to that in the western cultures. Planning and implementing an effective strategy to manage perimenstrual problems in this region should be an issue of priority.

Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women's Health Across the Nation (SWAN).

AIMS: We sought to determine if the frequency of reported physical or emotional premenstrual symptoms (PMSx) was associated with (1) dietary intake of phytoestrogens, fiber, fat, or calcium, (2) consumption of alcohol or caffeine, (3) active or passive smoke exposure or lack of physical exercise, and (4) race/ethnicity or socioeconomic status. METHODS: A cross-sectional analysis was conducted of PMSx and demographic and lifestyle factors reported at baseline in the multiethnic sample of 3302 midlife women in the Study of Women's Health Across the Nation (SWAN). Stepwise multiple logistic regression analyses were performed for the overall sample and for each racial/ethnic group for each of five PMSx groupings. RESULTS: Most dietary factors were not related to PMSx. Fat intake was negatively associated with craving and bloating (adjusted odds ratio [AOR] = 0.56, p = 0.024), and fiber intake was positively associated with breast pain (AOR = 1.39, p = 0.037). Alcohol intake was negatively associated with anxiety and mood changes (AOR = 0.63, p = 0.045) and headaches (AOR = 0.50, p = 0.009). Current smoking (AOR = 1.60, p = 0.028) and passive smoke exposure (AOR = 1.56, p = 0.050) were positively associated with cramps and back pain. Symptom reporting differed significantly by race/ethnicity. PMSx were also associated with comorbidities, early perimenopausal status, depressive symptoms, and symptom sensitivity. CONCLUSION: We found little evidence to support a role for diet in PMSx reporting. However, alcohol intake was positively associated with premenstrual anxiety and mood changes, and active and passive smoke exposure was associated with a number of PMSx. Ethnic differences in symptom reporting and associations of comorbidities, early perimenopausal status, depressive symptoms, and symptom sensitivity with reported PMSx were also observed.

A comparison of the Tridimensional Personality Questionnaire in premenstrual dysphoric disorder and major depressive disorder.

OBJECTIVE: Numerous symptoms of premenstrual dysphoric disorder (PMDD) overlap with those of major depressive disorder (MDD). This study investigates differences in novelty seeking, harm avoidance, and reward dependence between patients with PMDD, MDD without premenstrual symptoms or premenstrual exacerbation, and normal control subjects. METHOD: The Chinese version of the Tridimensional Personality Questionnaire was administered to 51 PMDD, 39 MDD, and 52 normal control women during the luteal phase (between the menstrual cycle days 23 and 28). RESULTS: Harm avoidance score was significantly higher in women with MDD and PMDD than in controls, whereas reward dependence score was lower in women with MDD than in controls. However, Tridimensional Personality Questionnaire (except for the subscale of impulsiveness) did not distinguish between PMDD and MDD during the luteal phase. CONCLUSION: The similarities between PMDD and MDD during luteal phase suggest a similar psychopathology.

Intake of dietary soy isoflavones in relation to perimenstrual symptoms of Korean women living in the USA.

This study was conducted to identify the potential relationship between the dietary intake level of soy isoflavones and perimenstrual symptomatology. The research design was a cross-sectional study. The sample was made up of 84 Korean women living in the USA, aged 28-40 years. The Moos Menstrual Distress Questionnaire (MDQ) and the Food Frequency Questionnaire were used as measurement tools. The soy isoflavone intake was significantly correlated with MDQ scores in the menstrual phase. In conclusion, the beneficial effect of dietary soy isoflavones on certain menstrual symptoms was established, suggesting that soy isoflavones could be one of the dietary factors related to the complexity of premenstrual syndrome (PMS). The positive effect of soy isoflavones on PMS warrants further study.

Perimenstrual symptoms of Korean women living in the USA: applicability of the WDHD(Women's Daily Health Diary) on prospective report.

PURPOSE: To compare perimenstrual (premenstrual, menstrual, postmenstrual) symptoms by concurrent reporting using the Women's Daily Health Diary (WDHD) and by retrospective reporting using the Moos Menstrual Distress Questionnaire (MMDQ). METHODS: A prospective and retrospective study was conducted among 31 Korean women, aged 27 to 48 yrs, living in the USA. RESULTS: On the prospective report using the WDHD, the most severe complaints were fatigue or tiredness (1.48 +/-.98), sensation of weight gain (.88+/-98), increased appetite (.79+/-.96) in premenstrual phase, fatigue or tiredness (1.34+/-.85), backaches (1.06+/-.79), and bloating or swelling of the abdomen (.93+/-.86) during the menstrual phase. On the retrospective report using the MMDQ, the most severe complaints during the premenstrual phase were fatigue (2.2 6+/-1.65), irritability (2.06+/-1.48), and backaches (1.97+/-1.68) and during the menstrual phase backaches (2.35+/-1.62), fatigue (2.29+/-1.75), and cramps (2.23+/-1.80). According to both measurements of PMS symptomology during the premenstrual and menstrual phases, the most frequently reported symptom was fatigue or tiredness. Highly rated symptoms on the MMDQ and on the WDHD were found to be similar. CONCLUSION: The WDHD was found to be suitable for daily prospective PMS assessment, which will be necessary for the screening and management of women with severe PMS.

Constructions of femininity and experiences of menstrual distress.

The purpose of this article is to explore the relationship between constructions of feminine gender identity and experiences of menstrual distress. Both quantitative and qualitative methods were used to assess the relationship between femininity and PMS. Statistically significant correlations were found between T-scores for femininity on the Bem Sex Role Inventory (Bem, 1978) and total distress scores on the Menstrual Distress Questionnaire (Moos, 1991). Analysis of the qualitative data suggests that women engage in intense premenstrual bodily surveillance, and the data support Ussher, Hunter, and Browne's (2000) findings that the 'PMS self' becomes lived as an identity position in contrast to a 'real' or 'non-PMS sell.' The authors conclude that our biopsychiatric discourse about PMS functions to legitimize traditional constructions of femininity and that future research should conceptualize menstrual distress as both lived experience and social construction.

Quality of life and menopausal transition for middle-aged women on Kinmen island.

Although it seems reasonable to suggest that most women experience significant changes in quality of life (QOL) during the menopausal period, few researchers have quantified these changes. A total of 1497 women, aged 40-54 years and living on the island of Kinmen, were recruited for this survey. However, 137 were eliminated leaving 1360 for analysis. Women who used hormonal therapy or who had undergone surgically induced menopause were excluded. The subjects with incomplete data or who exhibited mental retardation or severe psychiatric disease were also eliminated. Univariate analysis demonstrated that, in general, QOL scores were poorer for perimenopausal and postmenopausal status. Comparing pre- and postmenopausal women, significant statistical differences were demonstrated for role limitations due to physical and emotional problems, even after adjusting for age, education level, body mass index, menarche, and chronic illness. A strong association was demonstrated between menopausal symptoms and premenstrual syndrome (PMS). Women with menopausal symptoms and PMS had significantly lower scores on all SF-36 dimensions. The results of this study suggest that poorer health status is experienced by peri- and postmenopausal women compared to premenopausal women.

Exploring the bio-psycho--social approach to premenstrual experiences.

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.