Menstrual Distress Questionnaire (MEDI-Q): a new tool to assess menstruation-related distress.

RESEARCH QUESTION: Menstruation is a physiological event often associated with subjective distress. Is there a tool that assesses and objectively evaluates the global distress experienced by women during their period? DESIGN: An observational cross-sectional study conducted between June 2019 and May 2020 at Careggi University Hospital, Florence, Italy. A new questionnaire, The Menstrual Distress Questionnaire (MEDI-Q), was developed and administered to a group of healthy women (n = 418) of fertile age (18-50 years), without known uterine, psychiatric disorders, or both. The MEDI-Q investigated 25 items, covering the following areas: pain, discomfort, psychic or cognitive changes, gastrointestinal symptoms and changes in physiological functions. MEDI-Q Total Score and the three sub-scales, Menstrual Symptoms (MS), Menstrual Symptoms Distress (MSD) and Menstrual Specificity Index (MESI) were evaluated. The validation of MEDI-Q was achieved by testing test-retest reliability and internal consistency, convergent and concurrent validity. RESULTS: The MEDI-Q produced reliable results with good internal consistency, convergent and concurrent validity. MEDI-Q Total Score, MS and MSD all positively correlated with general psychopathology and premenstrual symptoms. A receiver operating characteristic analysis was used to determine the cut-off value of 20 (inclusive) and to identify the women with clinically relevant menstrual distress (area under the curve 0.90, 95% CI 0.86 to 0.93; P < 0.001). CONCLUSION: MEDI-Q is a new tool for evaluating menstruation-related distress, and provides a representative score of stress perception. MEDI-Q may be added to routine women's healthcare to help identify and adequately monitor menstruation-related disorders, and their effect on wellbeing, promptly.

Menstrual dysfunction and body weight dissatisfaction among Finnish young athletes and non-athletes.

To determine the prevalence of menstrual dysfunction (MD; ie, oligomenorrhea or amenorrhea) and attitudes toward body weight among athletes and non-athletes, we studied a cohort of athletes and non-athletes, in adolescence (14-16 years) and subsequently in young adulthood (18-20 years). We further studied the differences between athletes reporting MD and eumenorrheic athletes at both time periods and identified physical and behavioral characteristics that might predict MD in young adulthood. Data were collected using questionnaires, accelerometers, and a pre-participation screening. In adolescence, the athletes reported current primary amenorrhea more often than the non-athletes (4.7% vs 0%, P = .03). In young adulthood, athletes reported MD more frequently than non-athletes (38.7% vs 5.6%, P < .001). Athletes had less desire than non-athletes to lose weight at both time points, and in adolescence, athletes were more satisfied with their weight. However, about one fifth of the athletes and about 40% of the non-athletes experienced body weight dissatisfaction at both time points. In adolescence, athletes reporting MD had lower BMI than eumenorrheic athletes. In young adulthood, athletes with MD were more physically active than eumenorrheic athletes. The only longitudinal predictor of MD in young adulthood was MD in adolescence. Our findings indicate that MD is relatively frequent among young Finnish athletes. However, athletes appear to have a smaller tendency to experience body weight dissatisfaction than their non-athletic peers. MD seems to track from adolescence to adulthood, suggesting that there is a need to focus on possible causes at the earliest feasible phase of an athlete's career.

Symptoms experiences and attitudes towards menstruation among adolescent girls.

The study aimed to analyse the factors affecting menstrual symptoms and attitudes among adolescent girls and the relationship between them. The sample of the cross-sectional, descriptive and analytical research was composed of 604 adolescent girls studying at a university. Individual Information Form, Menstruation Symptom Questionnaire (MSQ) and Menstrual Attitude Questionnaire (MAQ) were used as data collection tool in the research. Average age of the students was 21.22 ± 1.71, and average menstrual cycle length was 29.3 ± 7.85 days. MSQ mean score was 69.84 ± 15.48 and MAQ mean score was 103.10 ± 9.84. These results are important for showing that students perceive menstruation as a natural phenomenon, despite significant menstrual symptoms.Impact statementWhat is already known on this subject? The intensity of menstrual symptoms is associated with negative menstrual attitudes. But, there have been few studies on the relationship between menstruation symptoms and attitudes and their impact on menstrual problems in Turkish adolescents.What the results of this study add? Adolescents' menstrual complaints are common, but their attitudes towards menstruation are positive. The lack of a significant relationship between menstrual symptoms and attitudes were more likely to be explained by the fact that young girls perceive menstruation as a natural phenomenon even though they have so many symptoms.What the implications are of these findings for clinical practice and/or further research? Further study should be extended to various cultures and destinations to understand the effect of culture on menstruation that rural areas may be surrounded by taboos and myths which might affect the negative attitude.

Women With Amenorrhea and Men With Menstruation: The Qualitative Experiences of People With Disorders of Sex Development in Nigeria.

BACKGROUND: Disorders of sex development (DSD) affect the quality of life of people who live with this condition. In developing countries, diagnoses of DSD are associated with a delay in presentation until the patients developed ambiguous physical traits and features. PURPOSE: This study explores the menstrual experiences of people with DSD and sex reassignment in Nigeria. METHODS: A qualitative approach with a phenomenological study design was employed in this study to explore and describe the experiences of people with DSD at the Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria. The data were collected using face-to-face interviews, transcribed verbatim, and analyzed using NVivo software. RESULTS: The findings show that the participants experienced menstrual problems: men with menstruation and women with amenorrhea. The female participants generally described amenorrhea as a disappointment and linked menstruation with womanhood. Amenorrhea evinced both emotional and psychological effects. However, some of the female participants considered amenorrhea in a positive light and were happy with their lives without menstruation. The menstrual experiences of male participants included menarche, lower abdominal pain, regular monthly bleeding, and ovulation. The male participants described menstruation as a disaster in their lives and a source of anxiety, suicidal ideation, and depression. Menstruation negatively affected their psychosocial well-being. CONCLUSIONS: The menstrual experience of individuals with DSD negatively affects their quality of life. The women with DSD in this study showed a generally poor knowledge of menarche, menstruation, and puberty, indicating that their parents had ignored the initial symptoms of DSD. DSD were only recognized at puberty because of the development of ambiguous physical traits and of the onset of menstruation in men and the confirmation of amenorrhea in women.

Indices of Resting Metabolic Rate Accurately Reflect Energy Deficiency in Exercising Women.

Energy deficiency in exercising women can lead to physiological consequences. No gold standard exists to accurately estimate energy deficiency, but measured-to-predicted resting metabolic rate (RMR) ratio has been used to categorize women as energy deficient. The purpose of the study was to (a) evaluate the accuracy of RMR prediction methods, (b) determine the relationships with physiological consequences of energy deficiency, and (c) evaluate ratio thresholds in a cross-sectional comparison of ovulatory, amenorrheic, or subclinical menstrual disturbances in exercising women (n = 217). Dual-energy X-ray absorptiometry (DXA) and indirect calorimetry provided data on anthropometrics and energy expenditure. Harris-Benedict, DXA, and Cunningham (1980 and 1991) equations were used to estimate RMR and RMR ratio. Group differences were assessed (analysis of variance and Kruskal-Wallis tests); logistic regression and Spearman correlations related ratios with consequences of energy deficiency (i.e., low total triiodothyronine; TT3). Sensitivity and specificity calculations evaluated ratio thresholds. Amenorrheic women had lower RMR (p < .05), DXA ratio (p < .01), Cunningham1980 (p < .05) and Cunningham1991 (p < .05) ratio, and TT3 (p < .01) compared with the ovulatory group. Each prediction equation overestimated measured RMR (p < .001), but predicted (p < .001) and positively correlated with TT3 (r = .329-.453). A 0.90 ratio threshold yielded highest sensitivity for Cunningham1980 (0.90) and Harris-Benedict (0.87) methods, but a higher ratio threshold was best for DXA (0.94) and Cunningham1991 (0.92) methods to yield a sensitivity of 0.80. In conclusion, each ratio predicted and correlated with TT3, supporting the use of RMR ratio as an alternative assessment of energetic status in exercising women. However, a 0.90 ratio cutoff is not universal across RMR estimation methods.

Evidencia del mensaje de sufrimiento hereditario / Evidence for the hereditary suffering message

En este artículo pondremos un ejemplo de la vida real para demostrar con claridad todo lo escrito. Se trata del caso de una mujer de 35 años que llega a la consulta con un solo síntoma importante para ella. No le viene la menstruación desde hace años. Y si le viene, es solo esporádicamente. Refiere que la última vez que le ha venido regularmente fue cuando se separó de su novio; después se sintió libre y contenta, segura de sí misma. Años después, se ha vuelto a enamorar y han vuelto a desaparecer las menstruaciones. Cuando se configura la historia familiar nos encontramos (sin dar demasiados detalles) una historia con ciertas características que han constituido el lenguaje primordial, inconsciente y consciente, de la vida de la paciente. Resulta ser que, durante tres generaciones, mujeres dominantes y severas con los demás han tenido hijos naturales a escondidas, antes de casarse con sus maridos respectivos, que también han tenido otros hijos naturales fuera del matrimonio con anterioridad. Al final, acabaron casándose de manera oficial con sus respectivas mujeres (abuelas y madre de la paciente), ya que éstas habían quedado embarazadas. Ellos, hombres sin responsabilidad amorosa, vivieron ajenos a las obligaciones como padres; el condicionamiento social los forzó a mantener la casa y los hijos, pero sin que ello implicara la capacidad para proteger y educar a los hijos que, por tanto, siempre dependieron solo de ellas.

A percepção de mulheres sobre a menstruação: uma questão de solidariedade / Women's perception of menstruation: a question of solidarity / La percepción de mujeres sobre la menstruación: una cuestión de solidaridad

Objetivo: descrever a experiência de mulheres em relação à menstruação. Metodologia: estudo qualitativo baseado no método de análise de conteúdo temática. O cenário foi o campus de uma universidade pública no Rio de Janeiro. Participaram 23 mulheres entre 20 e 72 anos de idade. Os dados foram obtidos entre julho/2015 e julho/2016 através da entrevista semiestruturada. Resultados: foi identificada, como tema central/categoria, a questão da solidariedade entre mulheres quando o assunto é menstruação. Emergiram quatro sub-categorias: A conexão das mulheres com a menstruação; A experiência de menstruar afetando umas às outras; A influência e o suporte proveniente das mães e/ou de outras mulheres; e A transferência. Conclusão: a menstruação causa sentimentos ambíguos nas mulheres, resultando em predomínio de sentimentos negativos, como medo e sensação de vergonha. Ao mesmo tempo pode ser percebida como motivo de felicidade e tranquilidade. A solidariedade entre mulheres pode influenciar positivamente a percepção da mulher sobre a menstruação, sendo elemento de empoderamento.

Objective: to describe women's experience of menstruation. Methodology: this qualitative study was based on the thematic content analysis method. The setting was a public university campus in Rio de Janeiro. Twenty-three women from 20 to 72 years old participated. Data were obtained between July 2015 and July 2016 by semi-structured interview. Results: the central theme/category was identified as solidarity among women with regard to menstruation. Four subcategories emerged: women's connection with menstruation; one's experience of menstruating affects others; influence and support from mothers and/or other women; and transference. Conclusion: menstruation causes ambiguous feelings in women, with negative feelings, such as fear and a sense of shame, predominating. At the same time, it can be seen as a reason for happiness and tranquility. Solidarity among women is a factor of empowerment, and can influence women's perception of menstruation positively.

Objetivo: describir la experiencia de mujeres en relación con la menstruación. Metodología: estudio cualitativo basado en el método de análisis de contenido temático. El escenario fue el campus de una universidad pública en Río de Janeiro. Participaron 23 mujeres cuya edad estaba entre 20 y 72 años. Los datos se obtuvieron entre julio/2015 y julio/2016 a través de entrevista semiestructurada. Resultados: se identificó, como tema central/categoría, la solidaridad entre mujeres en relación con la menstruación. Surgieron cuatro subcategorías: la conexión de las mujeres con la menstruación; la experiencia de menstruar, afectando unas a las otras; la influencia y el apoyo de las madres y/o de otras mujeres; y la transferencia. Conclusión: la menstruación causa sentimientos ambiguos en las mujeres, resultando en predominio de sentimientos negativos, como el miedo y la sensación de vergüenza. Al mismo tiempo, podría percibirse como un motivo de felicidad y tranquilidad. La solidaridad entre mujeres puede influir positivamente en su percepción sobre la menstruación, siendo un elemento de empoderamiento

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease.

OBJECTIVES: Women with sickle cell disease (SCD) are living longer as a result of advances in the care of their underlying disease. With the population growing of women living with SCD, reproductive health issues in this population have become an emphasized area of medical care. We sought to describe current patterns of contraception use, menstruation, and quality-of-life (QOL) measures in women with SCD. METHODS: Using a cross-sectional study design, we administered paper surveys at two academic medical centers to women aged 10 to 55 years with SCD to capture current contraceptive use, characteristics of menstrual cycles, and QOL metrics. RESULTS: Of the 103 women who participated, 12.7% (13/102) experienced a duration of menses >7 days (defined here as prolonged menstrual bleeding). Approximately half of women (51.5%, 53/103) used some form of contraception, with depot medroxyprogesterone acetate injections and condoms being the most common. During their last menstrual periods, women with both dysmenorrhea and prolonged menstrual bleeding (6.9%, 7/102) were more likely to experience more days of poor QOL, with more nights with sleep disturbance (P = 0.001) and more days with trouble taking care of themselves (P = 0.003), as well as being unable to do things they previously enjoyed (P = 0.001), compared with those with neither phenomenon (28.2%, 29/103). CONCLUSIONS: Dysmenorrhea and prolonged menstrual bleeding negatively affect the QOL of women with SCD. Menstrual histories and preventive measures for menstruation-related morbidity should be incorporated into routine evaluations of women with SCD.

Age at Menarche and Menstrual Abnormalities in Adolescence: Does it Matter? The Evidence from a Large Survey among Italian Secondary Schoolgirls.

OBJECTIVE: To explore the independent role of age at menarche on menstrual abnormalities among adolescents. METHODS: The present study was a multicenter cross-sectional study on a large sample (n = 3782) of Italian girls aged 13-21 y attending secondary school who already had menarche. Girls were asked to fill in a questionnaire on menarcheal age and menstrual features during the latest three menses. The gynecological age was computed as the difference between age at the survey and the age at menarche. Main outcome measures were: prevalence of oligomenorrhea, polymenorrhea, menstrual cycle irregularity, abnormal bleeding length and dysmenorrhea. Irregularity in the recent past and since menarche was also studied. Multiple logistic models were used to identify any independent association between each abnormal feature and age at menarche or gynecological age. Adjusted ORs and 95%CI were performed. RESULTS: After adjusting for covariates, menarcheal age was not independently associated with polymenorrhea (OR = 0.81; 95%CI 0.63-1.04), oligomenorrhea (OR = 1.16; 95%CI 0.94-1.43), menstrual cycle irregularity (OR = 0.99; 95%CI 0.86-1.14), abnormal bleeding length (OR = 0.96; 95%CI 0.87-1.06) and dysmenorrhea (OR = 1.03; 95%CI 0.85-1.24). The multivariate analysis suggests that the higher prevalence of oligomenorrhea and menstrual cycle irregularity among the girls who were older at menarche might be purely explained by their younger gynecological age. CONCLUSIONS: No evidence of any independent influence of age at menarche on menstrual abnormalities among young girls was shown by the investigation. The findings suggest that, after menarche, adolescent girls' menstrual health should be checked to monitor the endocrine system maturation and to early intercept latent disorders becoming symptomatic.

Polycystic ovary syndrome and its impact on Iranian women's quality of life: a population-based study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a major public health concern worldwide affecting up to one in five women at reproductive age. It is associated with biochemical and hormonal disturbances as well as adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in worsened quality of life. The aim of the present study is evaluating the quality of life and determining its degrading factors among Iranian women suffering from this syndrome. METHODS: This cross-sectional study was conducted on 200 PCOS women in Hamadan, Iran. In order to measure quality of life we used the Persian version of Health-related Quality of Life Questionnaire for PCOS (PCOSQ). Descriptive statistics was used to explore the data. In addition linear regression analysis was performed to assess factors affecting health-related quality of life in this population. RESULTS: The mean score for quality of life domains (from the greatest to the least serious concern) were: infertility (3.43 ± 1.63), emotions (3.55 ± 1.17), menstrual problems (3.77 ± 1.36), body hair (3.80 ± 2.05) and weight (4.32 ± 1.80), respectively. The higher score represents better function. However, multivariate analysis revealed that hirsutism had the strongest impact on the patients' quality of life (p < 0.001) followed by infertility (p = 0.038) and menstrual irregularity (p = 0.003). CONCLUSION: The findings showed that impairment of quality of life was associated with PCOS related conditions such as hirsutism, infertility and menstrual problems.

Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study.

This study aimed to examine whether the characteristics of mental health and sleep duration, alone or in combination, are associated with menstrual cycle irregularity. This population-based, cross-sectional study analyzed the data from 4445 women aged 19-49 years, who participated in the Korea National Health and Nutrition Examination Survey 2010-2012. A structured questionnaire was used to assess mental health characteristics, sleep duration, and menstrual cycle irregularity. A multivariable logistic regression analysis was performed. High stress, depressive mood, and suicidal ideation were associated with increased risk of menstrual cycle irregularity after adjusting for confounding variables (odds ratio [95% confidence interval] = 1.33 [1.07-1.65], 1.56 [1.17-2.07], and 1.37 [1.01-1.87], respectively). Short sleep duration (≤ 5 h a day) was significantly associated with higher odds of severe menstrual cycle irregularity with menstrual interval of greater than 3 months (2.67 [1.35-5.27]). Participants with sleep duration of ≤ 5 h a day with psychological stress, depressive mood, or suicidal ideation had higher odds of menstrual cycle irregularity (1.96 [1.26-3.05], 2.86 [1.50-5.44], and 2.25 [1.18-4.29]). This study suggests positive associations of mental health problems and short sleep duration with menstrual cycle irregularity among Korean female adults. Therefore, strategies to deal with psychological stress, depressive mood, and sleep duration are needed for improving the reproductive health of women suffering from menstrual disturbances.

Menarche and menstrual problems are associated with non-suicidal self-injury in adolescent girls.

Menstrual problems and non-suicidal self-injury (NSSI) are common in adolescent girls. This study examined whether onset of menstruation and menstrual problems were related to NSSI in Chinese female adolescents. A total of 5696 adolescent girls participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort (SABHC) study in Shandong, China. A structured questionnaire was used to ask about participants' lifetime and last-year NSSI, age at menarche, menstrual cycle interval, menstrual flow length, menstrual irregularity, period pain, body weight and height, and demographics. Impulsivity was assessed by the Eysenck I7 impulsiveness scale. Internalizing and externalizing problems were measured by the Youth Self-Report of Child Behavior Checklist. The mean age of the sample was 15.0 years (SD = 1.4). The prevalence of lifetime and last year NSSI were 28.1% and 21.4% in Chinese adolescent girls. After adjusting for adolescent and family covariates (age, body mass index, impulsivity, internalizing and externalizing problems, paternal education, and family economic status), onset of menstruation was significantly associated with increased risk of lifetime NSSI (OR = 1.62, 95%CI = 1.20-2.20) and last year NSSI (OR = 1.92, 95%CI = 1.37-2.67). Among adolescent girls who had menarche, often irregular menstruation and period pain were significantly and independently associated with lifetime NSSI (OR = 1.36, 95%CI = 1.03-1.79; OR = 1.29, 95%CI = 1.05-1.58) and last year NSSI (OR = 1.46, 95%CI = 1.07-1.98; OR = 1.29, 95%CI = 1.03-1.61). Our findings suggest that onset of menarche, irregular periods, and period pain appear to be associated with increased risk of NSSI. These findings highlight the importance of menstruation hygiene education and treatment of menstrual problems to reduce the risk of NSSI among adolescent girls.

Social impact of menstrual problems among adolescent school girls in rural Tamil Nadu.

Background Adolescence is a period of physiological, psychological and social transition between childhood and adulthood and is characterized by the onset of menstruation in girls. A adolescent girls are naïve about menstruation and they take time to adapt to these changes both socially and psychologically. This study was carried out to assess the psychosocial impact of menstrual problems among schoolgoing adolescent girls. Methods This study is a cross-sectional study carried out in 350 schoolgoing adolescent girls in the year 2012 in the Thiruvallur district of Tamil Nadu. Girls who attained menarche 1 year prior to the data collection were included in the study. Data regarding background characteristics and psychosocial impact of menstrual problems were collected. Data was analyzed using SPSS ver. 15 software. The χ2-test was carried out to assess the statistical significance at the 95% level of significance. Results The mean age of the participants was 14.7 years. In this study, 87.7% of the girls had at least one menstrual problem. Among these, 78.5% could not attend school during menstruation, 51.1% were unable to perform household/sports activities (p < 0.001). It was observed that dysmenorrhea and menorrhagia were at increased risk of absenting the girls from school (p < 0.05). Conclusion The key to a sound adolescent health programme is a holistic approach which also focuses on the psychological and social domain of health. This could be achieved by involving all the stakeholders like parents, teachers, etc. to work as a team. It is also essential to develop adolescent friendly health services at the grass root level.

Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study.

BACKGROUND: The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS. METHODS: Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS. RESULTS: Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal). CONCLUSIONS: The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.

Menarche, menstrual problems and suicidal behavior in Chinese adolescents.

BACKGROUND: Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents. METHODS: An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality. RESULTS: The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10-1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00-1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05-1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06-1.66). LIMITATIONS: This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents. CONCLUSIONS: Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in adolescents.

The association between mental health problems and menstrual cycle irregularity among adolescent Korean girls.

BACKGROUND: Menstrual cycle irregularity is common among adolescents and can induce mental health problems such as stress, depression, and suicidal ideation. We examined the association between mental health problems and menstrual cycle irregularity among adolescent Korean girls. METHODS: This population-based cross-sectional study was on 808 female adolescents (12-18 years of age) participating in the 2010-2012 Korean National Health and Nutrition Examination Survey. Psychological stress, depressive mood, suicidal ideations, suicide attempts, and psychological counseling were assessed through questionnaires and surveys, and hierarchical multivariable logistic regression analysis was performed. RESULTS: The risk of menstrual cycle irregularity tended to increase, as the number of mental health problems increased (P for trend=0.016). High stress levels, depressive mood, and psychological counseling were associated with increased risks of menstrual cycle irregularity (odd ratio [95% confidence interval]=1.88 [1.1-3.21], 2.01 [1.01-4.03], and 2.92 [1.16-7.34], respectively) even after adjusting for age, body mass index, alcohol consumption, smoking status, physical activity, hemoglobin level, monthly household income, weight loss attempts, age at menarche, and sleep duration. Suicidal ideation was not significantly associated with menstrual cycle irregularity. LIMITATIONS: Menstrual irregularity was evaluated based solely on subjects' self-reports, which are subject to their subjective perceptions and appraisal. Cross-sectional design and retrospective data could not draw causal relationship. CONCLUSIONS: Positive associations were observed between mental health problems and menstrual cycle irregularity among adolescent Korean girls. More attention should be paid towards mental health, to improve menstrual cycle regularity and help prevent related chronic diseases later in life.

Path model of antenatal stress and depressive symptoms among Chinese primipara in late pregnancy.

BACKGROUND: Antenatal maternal mental health problems have numerous consequences for the well-being of both mother and child. This study aimed to test and construct a pertinent model of antenatal depressive symptoms within the conceptual framework of a stress process model. METHODS: This study utilized a cross-sectional study design. INCLUSION CRITERIA: participants were adult women (18 years or older) having a healthy pregnancy, in their third trimester (the mean weeks gestation was 34.71). DATA COLLECTION: depressive and anxiety symptoms were measured by Zung's Self-rating Depressive and Anxiety Scale, stress was measured by Pregnancy-related Pressure Scale, social support and coping strategies were measured by Social Support Rating Scale and Simplified Coping Style Questionnaire, respectively. ANALYSIS: path analysis was applied to examine the hypothesized causal paths between study variables. RESULTS: A total of 292 subjects were enrolled. The final testing model showed good fit, with normed χ (2) = 32.317, p = 0.061, CFI = 0.961, TLI = 0.917, IFI = 0.964, NFI = 0.900, RMSEA = 0.042. This path model supported the proposed model within the theoretical framework of the stress process model. Pregnancy-related stress, financial strain and active coping have both direct and indirect effects on depressive symptoms. Psychological preparedness for delivery, social support and anxiety levels have direct effects on antenatal depressive symptoms. Good preparedness for delivery could reduce depressive symptoms, while higher levels of anxiety could significantly increase depressive symptoms. Additionally, there were indirect effects of miscarriage history, irregular menstruation, partner relationship and passive coping with depressive symptoms. CONCLUSION: The empirical support from this study has enriched theories on the determinants of depressive symptoms among Chinese primipara, and could facilitate the formulation of appropriate interventions for reducing antenatal depressive symptoms, and enhancing the mental health of pregnant women.

A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: a focus upon prevalence, patterns and applications of use and users' motivations, information seeking and self-perceived efficacy.

INTRODUCTION: Complementary and alternative medicine (CAM) is used for treating cyclic perimenstrual pain and discomfort. This critical review examines women's reported CAM use, its perceived effectiveness and information relating to women's attitudes, behaviors, motivations and patterns of CAM use in its treatment. MATERIAL AND METHODS: An extensive search of the main medical databases EBSCO, CINAHL, Medline, AMED and SCOPUS, as well as additional hand searches, was conducted. Papers included were confined to those that had been peer-reviewed, written in English and that contained original research into CAM use for cyclic perimenstrual pain and discomfort among adult women. RESULTS: CAM, particularly herbal medicine, nutritional supplements and massage, is widely used for a range of cyclic perimenstrual pain and discomfort symptoms. A large number of CAM modalities are adopted, often simultaneously and with little professional oversight. Women's assessment of efficacy of different CAM modalities is positive, though the majority of users are self-prescribing apparently without professional guidance. Although the uptake of CAM for cyclic perimenstrual pain and discomfort is widespread, few empirical data are available regarding which women are using CAM, their motivations for doing so and, importantly, the sources through which women receive information about CAM. CONCLUSIONS: This review highlights the extensive use of (often self-prescribed) CAM in a number of countries to alleviate the widespread symptoms of cyclic perimenstrual pain and discomfort. An understanding of all health care use by women with perimenstrual pain and discomfort is vital to help ensure safe, effective and coordinated health care that can lead to optimal patient outcomes.

Women's preferences for menstrual bleeding frequency: results of the Inconvenience Due to Women's Monthly Bleeding (ISY) survey.

OBJECTIVES: Our aim was to assess the level of inconvenience associated with monthly bleeding, determine how many women would prefer a bleeding frequency of less than once a month, and what would motivate their choice. METHODS: A 15-min quantitative online survey was carried out among 2883 women aged between 18 and 45 years in six European countries (Austria, Belgium, France, Italy, Poland and Spain). RESULTS: Of those surveyed, 1319 women used a combined hormonal contraceptive (CHC group) and 1564 used a non-hormonal contraceptive or no contraceptive (non-HC group). The menstrual period was significantly longer (5 vs. 4.5 days), heavier (16% vs. 8% heavy menstrual flow) and associated with more symptoms (6.1 vs. 5.6) in non-HC users than in CHC users (p < 0.0001). More than half of the women in each group reported pelvic pain, bloating/swelling, mood swings and irritability, but the rate was significantly higher in the non-HC group. Given the choice, 57% of women in both groups said they would opt for longer intervals between periods. Sexuality, social life, work and sporting activities were key factors affecting their decision. CONCLUSIONS: The majority of women would prefer to have menstrual periods less than once a month, with a frequency ranging from once every 3 months to no periods at all. This can be explained by the desire to avoid the unpleasant aspects of menstruation and its negative impact on private and professional life.

Menstrual cycle characteristics in women with persistent schizophrenia.

OBJECTIVE: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. METHOD: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. RESULTS: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery-Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). CONCLUSION: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia.