Differential grey matter structure in women with premenstrual dysphoric disorder: evidence from brain morphometry and data-driven classification.

Premenstrual dysphoric disorder (PMDD) is a female-specific condition classified in the Diagnostic and Statical Manual-5th edition under depressive disorders. Alterations in grey matter volume, cortical thickness and folding metrics have been associated with a number of mood disorders, though little is known regarding brain morphological alterations in PMDD. Here, women with PMDD and healthy controls underwent magnetic resonance imaging (MRI) during the luteal phase of the menstrual cycle. Differences in grey matter structure between the groups were investigated by use of voxel- and surface-based morphometry. Machine learning and multivariate pattern analysis were performed to test whether MRI data could distinguish women with PMDD from healthy controls. Compared to controls, women with PMDD had smaller grey matter volume in ventral posterior cortices and the cerebellum (Cohen's d = 0.45-0.76). Region-of-interest analyses further indicated smaller volume in the right amygdala and putamen of women with PMDD (Cohen's d = 0.34-0.55). Likewise, thinner cortex was observed in women with PMDD compared to controls, particularly in the left hemisphere (Cohen's d = 0.20-0.74). Classification analyses showed that women with PMDD can be distinguished from controls based on grey matter morphology, with an accuracy up to 74%. In line with the hypothesis of an impaired top-down inhibitory circuit involving limbic structures in PMDD, the present findings point to PMDD-specific grey matter anatomy in regions of corticolimbic networks. Furthermore, the results include widespread cortical and cerebellar regions, suggesting the involvement of distinct networks in PMDD pathophysiology.

Key to Life: Physiological Role and Clinical Implications of Progesterone.

The most recent studies of progesterone research provide remarkable insights into the physiological role and clinical importance of this hormone. Although the name progesterone itself means "promoting gestation", this steroid hormone is far more than a gestational agent. Progesterone is recognized as a key physiological component of not only the menstrual cycle and pregnancy but also as an essential steroidogenic precursor of other gonadal and non-gonadal hormones such as aldosterone, cortisol, estradiol, and testosterone. Based on current findings, progesterone and novel progesterone-based drugs have many important functions, including contraception, treatment of dysfunctional uterine bleeding, immune response, and prevention of cancer. Considering the above, reproduction and life are not possible without progesterone; thus, a better understanding of this essential molecule could enable safe and effective use of this hormone in many clinical conditions.

[Secondary Data Analysis on the Factors Influencing Premenstrual Symptoms of Shift Work Nurses: Focused on the Sleep and Occupational Stress].

PURPOSE: This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress. METHODS: This study was conducted with a secondary data analysis that used data from the Shift Work Nurse's Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson's correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny's mediating analysis. RESULTS: The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses' PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS. CONCLUSION: These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses' PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

Menstrual Cycle Characteristics and Premenstrual Syndrome Prevalence Based on the Daily Record of Severity of Problems in Korean Young Adult Women.

PURPOSE: This descriptive study aimed to identify the menstrual cycle characteristics and premenstrual syndrome (PMS) prevalence in Korean young adult women using the retrospective and prospective Daily Record of Severity of Problems (DRSP). METHODS: In the first stage, participants included 151 nursing students studying in a university located in Seoul. Data were collected from April 20 to June 2, 2017, using the questionnaire on menstrual characteristics, pictorial blood assessment chart, and retrospective DRSP. In the second stage, participants included 17 students with PMS, based on the screening conducted in the first stage. Data were collected using the prospective DRSP from May 29 to 2 September 2, 2017. RESULTS: Of the study sample, 104 participants (68.9%) had regular periods. Those with regular periods had 11.97 periods annually with a menstrual cycle of 29.38 days and a period duration of 5.72 days. Fifty-five participants (37.4%) showed menorrhagia. Sixty-four participants (42.4%) were found to have PMS based on their retrospective DRSP. When the ratio of women (52.9%) with PMS shown in the prospective DRSP was used as a positive predictive value, the estimated PMS prevalence was 22.4%. CONCLUSION: This study provides clinically significant PMS prevalence among Korean young adult women, positive predictive value of the retrospective DRSP, and valid data to basically understand the menstrual cycle characteristics experienced by these women.

Primary dysmenorrhea with and without premenstrual syndrome: variation in quality of life over menstrual phases.

PURPOSE: The majority of studies on quality of life (QoL) of women with menstrual disturbances have not taken menstrual cycle phase into account. We aimed to determine the size of changes in QoL score during perimenstrual week compared to those during late follicular phase in women suffering from dysmenorrhea with or without premenstrual syndrome (PMS) and also to compare the two groups. METHODS: In this observational analytical study, participants were selected purposively from among single students aged 18-30 years, who were residing at university dormitories in Tabriz, Iran, and had moderate or severe dysmenorrhea. They reported quality of their life during the past week using the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) at two time points, days 3-4 and 11-12, of their menstrual cycle. RESULTS: Among 52 participants with PMS and 64 without PMS, about half reported severe dysmenorrhea. The mean total quality score was significantly lower during perimenstrual week than during late follicular phase in both group with PMS [48 vs 79, mean difference - 31 (95% confidence interval - 37 to - 26)] and group without PMS [56 vs 78, - 1 (- 27 to - 18)]. The score was significantly lower in the group with PMS than in those without PMS during perimenstrual week [- 8 (- 13 to - 2)] but not during late follicular phase [2.1 (- 2.9 to 7.0)]. CONCLUSIONS: Dysmenorrhea with or without PMS significantly reduces QoL of women during perimenstrual week. The QoL is slightly lower in group with PMS during perimenstrual week but not during late follicular phase.

Cortical and subcortical changes in patients with premenstrual syndrome.

BACKGROUND: Premenstrual syndrome (PMS) is characterized by a series of emotional, physical and behavioral symptoms. Although PMS is related to dysfunctions of the central nervous system, the neuropathological mechanism of PMS still has not been clearly established. The aim of this study is to evaluate potential differences in both cortical thickness and subcortical volumes in PMS patients compared to healthy controls (HCs). METHODS: Twenty PMS patients and twenty HCs underwent a structural magnetic resonance imaging scan and clinical assessment. Cortical thickness and subcortical volumes were computed using the FreeSurfer image analysis suite. Relationships between cortical thickness/subcortical volumes and the daily rating of severity of problems (DRSP) score were then measured in patients. RESULTS: Compared to HCs, PMS patients exhibited reduced cortical thickness in the medial prefrontal cortex (MPFC), orbitofrontal cortex (OFC) and insula, and increased subcortical volumes of the amygdala, thalamus and pallidum. Furthermore, negative correlations were detected between the DRSP and cortical thickness in the anterior cingulate cortex and precuneus. LIMITATIONS: The study is limited by a small sample size and narrow age range of participants. CONCLUSIONS: Our findings indicate that the abnormal morphological changes are mainly implicated in emotional regulation and visceral perception in PMS patients. We hope that our study may contribute to a better understanding of PMS.

Altered brain structure in women with premenstrual syndrome.

BACKGROUND: Functional brain abnormalities have been noted in premenstrual syndrome (PMS). However, the brain structural alterations related to PMS remain unclear. This study aimed to identify possible abnormalities in gray matter (GM) volumes and structural covariance patterns among PMS patients. METHODS: Structural magnetic resonance imaging data were obtained from 20 PMS patients and 20 healthy controls. Voxel-based morphometry (VBM) analysis was applied to examine GM volumes changes between the two groups. Receiver operating characteristic (ROC) curve was used to investigate the most reliable biomarker for distinguishing PMS patients from health controls based on the intergroup differences. Correlation analysis was then performed to assess relationships between the daily rating of severity of problems (DRSP) and abnormal brain regions. Finally, the regions identified from VBM analysis were served as seeds to characterize the whole-brain structural covariance patterns. RESULTS: Compared with healthy controls, PMS patients showed increased GM volumes in the precuneus/posterior cingulate cortex (precuneus/PCC) and thalamus, and decreased GM volumes in the insula. The precuneus/PCC exhibited the highest classification power by ROC analysis and positively correlated with the DRSP. Moreover, different patterns of structural covariance in the two groups were mainly located in the dorsolateral prefrontal cortex, anterior cingulate cortex, angular gyrus and hippocampus. LIMITATIONS: This study is limited by a small sample and narrow age range of participants. CONCLUSIONS: Our findings may provide preliminary evidence for brain morphology alterations in PMS patients and contribute to a better understanding of the pathophysiology of PMS.

Stability of resting state networks in the female brain during hormonal changes and their relation to premenstrual symptoms.

Resting-state fMRI is a promising imaging technique to evaluate functions in the human brain in health and disease. Different hormonal stages of the female menstrual cycle and hormonal contraceptives use affect results in task-based fMRI; it is however not yet clarified whether resting state networks are also altered. A population of 18 women with a natural cycle, and 19 women using hormonal contraceptives was examined in a longitudinal study-design. The natural cycle group was scanned at 3 time-points (follicular phase, ovulation, luteal phase), and the contraceptives group was scanned twice (inactive pill-phase, active pill-phase). Blood samples were acquired to evaluate hormonal concentrations, and premenstrual symptoms were assessed through daily record of severity of problems questionnaires. Results show no major alterations in the default mode network and the executive control network between different hormonal phases, across or within groups. A positive correlation of functional connectivity in the posterior part of the default mode network (DMN) was found with premenstrual-like symptoms in the hormonal contraceptives group. Using the current methodology, the studied resting state networks seem to show a decent stability throughout menstrual cycle phases. Also, no effect of hormonal contraceptive use is found. Interestingly, we show for the first time an association of DMN alterations with premenstrual-like symptoms, experienced during the inactive pill-phase by a sub-population of women.

Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women.

STUDY QUESTION: Are markers of chronic inflammation associated with menstrual symptom severity and premenstrual syndrome (PMS)? SUMMARY ANSWER: Serum levels of inflammatory markers, including interleukin (IL)-2, IL-4, IL-10, IL-12 and interferon (IFN)-γ were positively associated with menstrual symptom severity and/or PMS in young women. WHAT IS KNOWN ALREADY: Chronic inflammation has been implicated in the etiology of depression and other disorders that share common features with PMS, but whether inflammation contributes to menstrual symptom severity and PMS is unknown. STUDY DESIGN, SIZE, DURATION: Cross-sectional study of 277 women aged 18-30 years, conducted in 2006-2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants provided information on menstrual symptoms, lifestyle, diet, anthropometry and other factors by questionnaire and/or direct measurement, and a mid-luteal phase fasting blood sample was taken between 7 a.m. and 12 p.m. Total, physical and affective menstrual symptom scores were calculated for all participants, of whom 13% (n = 37) met criteria for moderate-to-severe PMS and 24% (n = 67) met PMS control criteria. Inflammatory factors assayed in serum included IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor-α, granulocyte macrophage colony stimulating factor, IFN-γ and C-reactive protein. MAIN RESULTS AND THE ROLE OF CHANCE: After adjustment for age, smoking status and BMI, total menstrual symptom score was positively associated with levels of IL-2 (percentage difference in women at the 75th percentile of total symptom score versus at the 25th percentile = 24.7%; P = 0.04), IL-4 (21.5%; P = 0.04), IL-10 (28.0%; P < 0.01) and IL-12 (42.0%; P = 0.02) in analyses including all participants. Affective menstrual symptom score was linearly related to levels of IL-2 (percentage difference at 75th percentile versus 25th percentile = 31.0%; P = 0.02), while physical/behavioral symptom score was linearly related to levels of IL-4 (19.1%; P = 0.03) and IL-12 (33.2%; P = 0.03). Additionally, mean levels of several factors were significantly higher in women meeting PMS criteria compared with women meeting control criteria, including IL-4 (92% higher in cases versus controls; P = 0.01); IL-10 (87%; P = 0.03); IL-12 (170%; P = 0.04) and IFN-γ (158%; P = 0.01). LIMITATIONS, REASONS FOR CAUTION: Our study has several limitations. While a single blood sample may not perfectly capture long-term levels of inflammation, ample data suggest that levels of cytokines are stable over time. Although we did not base our assessment of PMS on prospective symptom diaries, we used validated criteria to define PMS cases and controls, and excluded women with evidence of comorbid mood disorders. Furthermore, because of the cross-sectional design of the study, the temporal relation of inflammatory factors and menstrual symptoms is unclear. WIDER IMPLICATIONS OF THE FINDINGS: To our knowledge, this is among the first studies to suggest that inflammatory factors may be elevated in women experiencing menstrual symptoms and PMS. Additional studies are needed to determine whether inflammation plays an etiologic role in PMS. STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Departments of Public Health and Nutrition and by a Faculty Research Grant, University of Massachusetts Amherst. No conflicts declared. TRIAL REGISTRATION NUMBER: N/A.

Cyclic catamenial dermatoses.

Circulating sex hormones follow major fluctuations during the ovarian cycle. The so-called premenstrual syndrome represents a global condition grouping the diversity of catamenial disorders. At the skin level, the sebaceous gland activity is obviously modulated by these endocrine fluctuations. In addition, a series of pathological manifestations take place simultaneously in some women. Among them, the most frequent skin condition is represented by catamenial acne. Concurrently, the autoimmune progesterone dermatitis refers to a diversity of skin alterations resulting from an immune reaction to progesterone. It is present under variable clinical aspects. A series of other recurrent skin conditions are not specifically induced but are merely exacerbated at the end of the ovarian cycle.

Elevated gray matter volume of the emotional cerebellum in women with premenstrual dysphoric disorder.

OBJECTIVE: Premenstrual dysphoric disorder (PMDD) is characterized by severe, negative mood symptoms during the luteal phase of each menstrual cycle. We recently reported that women with PMDD show a greater increase in relative glucose metabolism in the posterior cerebellum from the follicular to the luteal phase, as compared with healthy women, and that the phase-related increase is proportional to PMDD symptom severity. We extended this work with a study of brain structure in PMDD. METHODS: High-resolution magnetic resonance imaging (MRI) scans were obtained from 12 women with PMDD and 13 healthy control subjects (whole-brain volume-corrected p<.05). Voxel-based morphometry was used to assess group differences in cerebral grey-matter volume (GMV), using a statistical criterion of p<.05, correcting for multiple comparisons in the whole-brain volume. RESULTS: PMDD subjects had greater GMV than controls in the posterior cerebellum but not in any other brain area. Age was negatively correlated with GMV within this region in healthy women, but not in women with PMDD. The group difference in GMV was significant for women over age 30(p=.0002) but not younger participants (p>.1). CONCLUSIONS: PMDD appears to be associated with reduced age-related loss in posterior cerebellar GMV. Although the mechanism underlying this finding is unclear, cumulative effects of symptom-related cerebellar activity may be involved.

A influência da tensão pré-menstrual sobre os sintomas emocionais e o consumo alimentar / The influence of premenstrual syndrome (PMS) on emotional symptoms and food intake

The beginning of the cycle is marked by the first day of menstruation, dividing it into two distinct stages: the follicular phase and the luteal phase. The Premenstrual Syndrome (PMS) is a set of physical symptoms, emotional and behavioral disorders that starts the week before menstruation and marks the onset of menses, affecting women in the reproductive phase. Depending on the period of the menstrual cycle (MC), there may be no changes in food intake. There are few studies in the literature relating to dietary habits with PMS, pointing out interference and changes in diet. The purpose of this study was to determine whether PMS influences the emotional symptoms and food intake. A cross-sectional study was carried out with 54 randomly selected women aged 21 to 55 years old. The project was approved by the Ethics and Research Center of Sao Camilo University. Twenty-four-hour dietary recalls were used to evaluate food consumption, while the "Questionnaire on premenstrual symptoms" was utilized to assess the presence of PMS. Statistical analysis was performed and the paired t-test was of p<0.05 significance level. The emotional symptoms most frequently cited were impatience (65%), irritability (58%) and anxiety (51%). Regarding the physical symptoms, the following were predominant: headaches (56%), cramps (49%) and swollen painful breasts (44%). Some nutritional aspects were also observed: 49% of the women craved for sweet foods and 37% showed increased appetite. There was increased consumption of calories and lipids in the premenstrual period - but not significant. It was concluded that there is a predominance of physical and emotional symptoms, but no significant influence on the food habits of women.

El inicio del ciclo menstrual está marcado por el primer día de la menstruación, y se divide en dos fases distintas: fase folicular y fase lútea. La Tensión Pre-Menstrual (TPM) es un conjunto de síntomas físicos, emocionales y trastornos conductuales que se inician la semana anterior a la menstruación y se alivian al iniciar el flujo menstrual. Dependiendo de la época del ciclo menstrual pueden ocurrir alteraciones en la ingesta de alimentos. En la literatura existen pocos estudios que relacionan la ingesta de alimentos con la TPM. El objetivo de este estudio fue determinar la relación entre la TPM, los síntomas emocionales y los hábitos alimentarios. Se realizó un estudio transversal con 54 mujeres de 21 a 55 años, seleccionadas al azar. El proyecto fue aprobado por el comité de Ética e Investigación del Centro Universitario São Camilo. Para evaluar el consumo de alimentos se utilizó un "Recordatorio Alimenticio" de 24 horas y para evaluar la presencia de TPM se utilizó el "Questionario sobre los síntomas premenstruales". El análisis estadístico se basó en el test-t pareado, con nivel de significancia de p<0,05. Los síntomas emocionales más frecuentemente mencionados fueron impaciencia (65%), irritabilidad (58%) y ansiedad (51%). En cuanto a los síntomas físicos, prevaleció la cefalea (56%), dolores menstruales (49%), y mamas hinchadas y doloridas (44%). En lo concerniente al aspecto nutricional, se observó que 49% de las mujeres deseaban comer alimentos más dulces y 37% sentía deseos de comer más de lo habitual. Hubo un aumento, no significativo, en el consumo de calorías y lípidos en el período premenstrual. Se concluyó que hay predominio de síntomas físicos y emocionales, pero que éstos no causan influencia significativa en los hábitos alimentarios de las mujeres.

O início do Ciclo Menstrual é marcado pelo primeiro dia da menstruação, dividindo-o em dois estágios distintos: fase folicular e fase lútea. A Tensão Pré-Menstrual (TPM) é um conjunto de sintomas físicos, emocionais e comportamentais, que iniciam na semana anterior à menstruação e aliviam com o início do fluxo menstrual. Dependendo do período do ciclo menstrual, pode haver alterações no consumo alimentar. Na literatura, há poucos estudos que relacionam o consumo alimentar com a TPM. O objetivo do trabalho foi verificar a relação da TPM com os sintomas emocionas e o consumo alimentar. Foi realizado um estudo transversal com 54 mulheres de 21 a 55 anos, selecionadas aleatoriamente. O projeto foi aprovado pelo Comitê de Ética e Pesquisa do Centro Universitário São Camilo. Para avaliação do consumo alimentar foi utilizado o Recordatório Alimentar de 24 horas e para a avaliação da presença de TPM foi utilizado o "Questionário sobre Sintomas Pré-Menstruais". Para a análise estatística foi realizado o teste t pareado e o nível de significância adotado foi p<0,05. Os sintomas emocionais mais citados foram impaciência (65%), irritabilidade (58%) e ansiedade (51%). E nos sintomas físicos, a predominância foi de dor de cabeça (56%), cólicas (49%) e mamas inchadas e doloridas (44%). Quanto aos aspectos nutricionais, observou-se que 49% das mulheres apresentaram vontade de comer alimentos mais doces e 37%, vontade de comer mais que o habitual. Houve aumento do consumo de calorias e lipídios no período pré menstrual, porém não significativo. Concluiu se que há predominância dos sintomas físicos e emocionais, porém sem influência significativa no consumo alimentar das mulheres.

Gray matter abnormalities in patients with premenstrual dysphoric disorder: an optimized voxel-based morphometry.

BACKGROUND: Although brain neurochemistry is thought to play a role in the development of premenstrual dysphoric disorder (PMDD), neuroimaging studies of PMDD are sparse. We examined the extent to which gray matter (GM) abnormalities were present in women with PMDD compared to healthy controls. METHODS: 3.0T magnetic resonance imaging scans of 15 women with PMDD and 15 healthy controls were compared using optimized voxel-based morphometry (VBM) analysis. A regression analysis was used to assess the relationship between GM density and PMDD-symptom severity. RESULTS: Our results showed significantly increased GM density in the hippocampal cortex and significantly decreased GM density in the parahippocampal cortex among women with PMDD compared to healthy controls. However, these GM abnormalities were not significantly associated with the severity of PMDD. LIMITATION: Our inferences of the relationships between structural alterations and PMDD are drawn from a small sample, which may have increased the likelihood of type I error. CONCLUSIONS: GM abnormalities in limbic and paralimbic cortices were found to be associated with the pathophysiology of PMDD. Etiology of PMDD is likely related to emotional processing and self-regulation. Our findings provide a basis of neurobiological model for PMDD.

Ovarian morphology in premenstrual dysphoria.

Ovarian cyclicity is a prerequisite for premenstrual dysphoria (PMD), as illustrated by the fact that this condition is effectively eliminated by ovariectomy or by treatment with a GnRH agonist. Despite the possibility of differences in ovarian function between women with and without PMD, no study comparing ovarian morphology in these two groups has ever been published. Fifty-two women were recruited for this study; 26 had premenstrual dysphoria, fulfilling criteria slightly modified from those of the premenstrual dysphoric disorder, and 26 were asymptomatic age-matched controls. Ovarian morphology was assessed using transvaginal 7 MHz ultrasonography on day 5 after the start of menses, and venous blood was sampled for hormone analysis on days 3 and 8, the expected day of ovulation, and day -4 of the menstrual cycle. There were no significant differences between the groups with respect to the prevalence of polycystic ovaries (PCO), the total number of follicles, the total ovarian volume or serum levels of androgen hormones. In addition, serum free testosterone levels in late premenstrual phase showed an inverse association to premenstrual symptoms of irritability and a similar inverse association trend to symptoms of depressed mood. Unexpectedly, the prevalence of ovaries with fewer than five antral or growing follicles was significantly higher in women with PMD than in controls (p=0.016). While the results do not support a role for PCO or androgen hormones in eliciting late luteal phase irritability, the possible relationship between oligofollicular ovaries and PMD deserves further study.

Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences.

This study examined unique versus shared stress and pain-related phenotypes associated with premenstrual dysphoric disorder (PMDD) and prior major depressive disorder (MDD). Sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA)-axis measures were assessed at rest and during mental stress, as well as sensitivity to cold pressor and tourniquet ischemic pain tasks in four groups of women: (1) non-PMDD with no prior MDD (N=18); (2) non-PMDD with prior MDD (N=9); (3) PMDD with no prior MDD (N=17); (4) PMDD with prior MDD (N=10). PMDD women showed blunted SNS responses to stress compared to non-PMDD women, irrespective of prior MDD; while women with prior MDD showed exaggerated diastolic blood pressure responses to stress versus never depressed women, irrespective of PMDD. However, only in women with histories of MDD did PMDD women have lower cortisol concentrations than non-PMDD women, and only in non-PMDD women was MDD associated with reduced cold pressor pain sensitivity. These results suggest both unique phenotypic differences between women with PMDD and those with a history of MDD, but also indicate that histories of MDD may have special relevance for PMDD.

[The premenstrual syndrome: effectiveness of Vitex agnus castus]. / Das prämenstruelle Syndrom. Wirksamkeit von Vitex agnus castus.

Premenstrual syndrome (PMS) is a complex combination of a variety of symptoms including mood swings, anxiety, depression, tender breasts and food cravings. For some women the physical pain and emotional stress are severe enough to affect their daily routines and activities. The causes of the premenstrual syndrome have not yet been understood clearly, but have been attributed to hormonal and neuronal dysbalance, diet and lifestyle. Hyperprolactinemia seems to be an important factor which is considered to be part of the endocrine disorder. Different clinical investigations and double blind trials have shown that preparations containing Vitex agnus castus fruit extract are a useful tool to decrease pathophysiologicaly increased prolactin serum levels and though could be an effective treatment for women suffering from premenstrual syndrome.

Dynamic changes in serum estradiol and progesterone levels in patients of premenstrual syndrome with adverse flow of liver-qi.

OBJECTIVE: To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome (PMS) and reveal partial microcosmic mechanisms of adverse flow of liver-qi. METHODS: Estradiol (E2) and progesterone (P) levels in serum were determined at different phases of menstrual cycle by radioimmunoassay. RESULTS: In the group of PMS with adverse flow of liver-qi, the secretive peak value of E2 and P at the follicular phase significantly decreased, and the secretive peak value at the luteal phase did not come into being. CONCLUSIONS: Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi. One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2 and P.

[The symptomatology and prevalence of symptoms of premenstrual syndrome in Manisa, Turkey]. / Manisa ilinde premenstrüel sendrom belirti orüntüsü ve belirti yayginliginin arastirilmasi

OBJECTIVE: The aim of this study was to investigate the prevalence of premenstrual syndrome (PMS) symptoms, the frequency and severity of the symptoms, and their association with sociodemographic variables in fertile women between the ages of 15 and 49 years. METHOD: The study included 541 women living in the area of the 7th Primary Health Care Center of Manisa, Turkey. Face-to-face interviews were conducted and a sociodemographic data form, a DSM-IV diagnostic criteria form, and the premenstrual evaluation form (PEF) were administered. In the analysis of the data, K-means cluster analysis was performed and cluster analysis with 3 categories according to the severity was used. In the evaluation of the 18 subscales possible maximum variation quotient is obtained by dividing the maximum possible PEF score to the scores the subjects got. In the group comparison analyses, chi-square test for the categorical variables, and t-test for continuous variables were used. RESULTS: Among the study group, 6.1% had severe PMS symptoms and 72.2% of these women had some dysfunction as defined by DSM-IV. The most common symptoms were feeling irritable and restless (72%), anxiety (67.3%), feeling fullness, discomfort or pain in the abdomen (66.6%), lack of energy or easily fatigued (66.6%), and fatigue in the legs (65.5%). CONCLUSION: The prevalence of the risk of PMS was 6.1%. The most common and severe PMS symptoms were feeling irritable and restless.