Psychometric Properties of a DSM-5-Based Screening Tool for Women's Perceptions of Premenstrual Symptoms.

A premenstrual screening tool is needed when time constraints and attrition limit the feasibility of daily ratings. The present study examines the utility of a novel, 33-item, retrospective, dimensional, DSM-5-based, screening measure developed to explore women's perceptions of premenstrual symptomatology. This is the first measure that examines perception of impairment for each DSM-5 symptom and assesses the frequency criterion. Participants (N = 331) reported symptoms ranging from none to a level consistent with a provisional DSM-5 diagnosis of Premenstrual Dysphoric Disorder (PMDD). Initial psychometric properties indicated a five-factor structure: (1) affective symptoms; (2) fatigue, sleep, and anhedonia; (3) symptom frequency; (4) impairment and severity of appetite change and physical symptoms; and (5) difficulty concentrating. The total symptom scale and the frequency, severity, and impairment subscales demonstrated high internal consistency. Strong correlations between this dimensional measure and other retrospective and prospective premenstrual symptom measures suggest strong convergent, concurrent, and predictive validity. Premenstrual symptom groups created using this screening measure (minimal, mild/moderate, severe) differed on other retrospective and prospective measures of premenstrual symptoms. There was evidence of divergent validity and lack of an acquiescence bias. We also report data describing women's perceptions of the frequency, level of impairment, and level of severity for each DSM-5 PMDD symptom over a 12-month period and discuss implications for future research on premenstrual phenomenology. Initial evidence for the reliability and construct validity of this symptom screening measure suggests potential value for assessing premenstrual symptomatology in research and practice.

Continuum of Symptoms in Polycystic Ovary Syndrome (PCOS): Links with Sexual Behavior and Unrestricted Sociosexuality.

Symptoms of polycystic ovary syndrome (PCOS) exist on a continuum, are associated with hyperandrogenism, and have fertility implications. The present study investigated the relationship between PCOS symptoms and sociosexuality in young women with a continuum of symptoms ranging from none to clinical levels. Given that unrestricted sociosexuality, or one's orientation toward uncommitted sexual activity, is associated with hyperandrogenism, we hypothesized that women experiencing more symptoms of PCOS, and a greater likelihood of androgen excess, would have a more unrestricted sociosexual orientation. Women completed questionnaires about PCOS symptoms, sociosexuality, and sexuality. Unrestricted sociosexuality, unrestricted desire, romantic interest in women, and masturbation frequency were all positively associated with PCOS symptoms (including male pattern hair growth). The sexuality scores were also higher in women who scored above (versus below) the cutoff on a self-report PCOS screening questionnaire. In addition, attraction to women was higher in participants reporting a past diagnosis of PCOS. The findings are in line with theories that androgens play a role in sociosexuality and sexual orientation. Future research should examine sociocultural explanations, and whether the continuum of PCOS symptoms (e.g., hirsutism) is a useful model for studying the effects of androgen exposure, hyperandrogenism, or androgen responsiveness on women's behavior.

Ontario's response to COVID-19 shows that mental health providers must be integrated into provincial public health insurance systems.

The fear, grief, social isolation, and financial and occupational losses from COVID-19 have created a mental health crisis. Ontario's response highlights the shortcomings of its physician-only public healthcare system that limits public access to appropriate and sustainable mental healthcare. Specifically, Ontario's attempt to rapidly expand mental healthcare access in response to COVID-19 includes new Ontario Health Insurance Program (OHIP) billing codes that enable physicians to provide telephonic trauma counselling and patient self-serve online tools while psychologist and other registered mental health provider services have been largely left out of the provincial response. Why? Non-physician mental health providers operate outside of the provincial healthcare infrastructure, including the provincial payer (i.e., OHIP) that facilitated the provincial physician response. A physician-centric mental healthcare system limits public access to quality, sustainable, evidence-based mental health services because most physicians do not have the capacity, training, or desire to provide mental health services. To improve public access to needed mental health services, provinces should integrate psychologists and other registered mental health providers directly into their public health insurance systems. Integrated providers can be strategically and sustainably mobilized to respond to COVID-19 and future mental health crises.

Emotional Memory in Oral Contraceptive Users: Negative Stimuli Are More Forgettable.

Recent research suggests oral contraceptive use is associated with altered memory for emotional story information, blunted stress hormone responses to emotional stimuli, and altered structure or function of the amygdala and hippocampus. This study examined the extent to which oral contraceptives influence relative recall of (a) the spatial location of emotional versus neutral stimuli and (b) positive versus negative emotional stimuli. Participants (58 oral contraceptive users, 40 nonusers, and 37 men) completed an Emotional Spatial Memory test and were evaluated on short-term recall and long-term (one week) recall. There was no evidence for group differences in recall of the locations of emotional versus neutral stimuli. However, oral contraceptive users remembered relatively more positive than negative items compared with nonusers and men on the spatial memory test. This effect was driven by oral contraceptive users recalling fewer negative items than free cyclers. The results indicate that hormonal contraceptives may decrease immediate recall of negative emotional stimuli.

The hormonal sensitivity hypothesis: A review and new findings.

Previous women's health practitioners and researchers have postulated that some women are particularly sensitive to hormonal changes occurring during reproductive events. We hypothesize that some women are particularly sensitive to hormonal changes occurring across their reproductive lifespan. To evaluate this hypothesis, we reviewed findings from the existing literature and findings from our own lab. Taken together, the evidence we present shows a recurring pattern of hormonal sensitivity at predictable but different times across the lifespan of some women (i.e., menarche, the premenstrual phase, hormonal contraceptive use, pregnancy, the postpartum period, and menopause). These findings provide support for the hypothesis that there is a subgroup of women who are more susceptible to physical, psychological, and sexual symptoms related to hormonal shifts or abrupt hormonal fluctuations that occur throughout the reproductive lifespan. We propose that this pattern reflects a Hormonal Sensitivity Syndrome.

Preconception health behaviours: A scoping review.

Preconception health refers to the health of males and females at any point in time prior to a potential pregnancy. A goal of preconception health research is to use preventive behaviour and healthcare to optimize the health of future offspring that result from both planned and unplanned pregnancies. This paper briefly reviews evidence of the importance of various preconception health behaviours, and examines the extent to which specific preconception health behaviours have been included in recent studies of such knowledge, behaviours, and intentions. To describe this recent research in highly developed countries, a scoping review of the literature was completed of studies published within the past seven years. A total of 94 studies on preconception health were identified and reviewed: (a) 15 examined knowledge and attitudes, (b) 68 studied behaviours, (c) 18 examined interventions designed to improve knowledge or behaviour, and (d) no studies examined intentions to engage in preconception health behaviours. Over 40% of studies examining preconception health behaviour focussed exclusively on folic acid. Overall, folic acid, alcohol, and cigarettes have consistently been topics of focus, while exposure to harmful environmental substances, stress, and sleep have been largely neglected. Despite strong evidence for the importance of men's health during the preconception period, only 11% of all studies included male participants. Based on existing gaps in the research, recommendations are provided, such as including men in future research, assessing a wider variety of behaviours, consideration of behavioural intentions, and consideration of the relationships between preconception health knowledge, intentions, and behaviour.

Past reproductive events as predictors of physical symptom severity during the menopausal transition.

OBJECTIVE: This study aims to determine whether the severity of physical symptoms experienced during perimenopause can be predicted by physical symptoms experienced during past reproductive events (ie, symptoms experienced during pregnancy, the postpartum period, the premenstrual phase, and hormonal contraceptive use). METHODS: Two hundred ninety perimenopausal and postmenopausal women completed a series of questionnaires pertaining to their menopausal symptoms and the severity of both physical and emotional symptoms experienced during past reproductive events. RESULTS: The severity of some physical symptoms experienced during past reproductive events predicted the severity of menopausal physical symptoms. Some symptoms experienced during the premenstrual phase (ie, pain, lack of concentration, and water retention) and physical symptoms experienced during pregnancy were the best unique predictors of menopausal physical symptoms. CONCLUSIONS: The findings suggest that women with a history of more severe physical symptoms during periods of both low (ie, premenstrual phase) and high (ie, pregnancy) hormone exposure are at greatest risk for experiencing severe physical symptoms during the perimenopausal transition.

Age at menarche and digit ratio (2D:4D): relationships with body dissatisfaction, drive for thinness, and bulimia symptoms in women.

This study examined the hypothesis that lower prenatal androgen exposure and earlier puberty are associated with more dysfunctional eating attitudes and behaviors. Relationships between both age at menarche (AAM) and 2D:4D (a marker of prenatal androgen exposure), and EDI-2-Body Dissatisfaction, EDI-2-Drive for Thinness, and EDI-2-Bulimia scores, were examined in women using correlations and regressions. Earlier menarche was associated with higher drive for thinness after controlling for BMI and negative affect, but only in women who were not exclusively heterosexual. Higher 2D:4D was associated with higher Bulimia and Body Dissatisfaction scores, but only in exclusively heterosexual women, and relationships disappeared when covariates were controlled. Later AAM and higher 2D:4D were unique predictors of higher Bulimia scores for exclusive heterosexuals when BMI was controlled. These findings suggest future research should examine sexual orientation as a mediator or moderator of prenatal and postnatal organizational hormonal effects on women's disordered eating attitudes and behaviors.

Elevated eating disorder symptoms in women with a history of oral contraceptive side effects.

Previous research suggests a link between gonadal hormones and eating disorder symptomatology. This study examined the role of gonadal hormones and hormonal sensitivity in eating disorder (ED) symptoms by using oral contraceptive (OC) side effect history as an indicator of hormonal sensitivity. A questionnaire containing two scales of the Eating Disorder Inventory-2 and an OC side effect scale was completed by 174 healthy women who had used OCs. Histories of emotional and physical OC side effects were evaluated as predictors of body dissatisfaction and drive for thinness. Women with a history of negative OC side effects had higher levels of ED symptoms. After controlling for body mass index (BMI) and depression scores, OC side effect history remained a significant predictor of body dissatisfaction and drive for thinness. The experience of OC side effects may indicate a greater risk for increased eating disorder symptoms. The findings provide further support for a hormonal link to ED symptoms, as women who are more "sensitive" to exogenous gonadal hormones also experience more ED symptoms.

Age at menarche is associated with divergent alcohol use patterns in early adolescence and early adulthood.

A cross-sectional retrospective design was employed to examine the relationship between age at menarche (AAM) and alcohol use patterns from middle childhood (age 7) to early adulthood in 265 University-aged women. Earlier menarche was associated with: (a) earlier ages at first drink and first intoxication, (b) greater use between ages 9 and 14 (i.e., frequency, amount, vomiting), and (c) binge drinking between ages 11 and 14. In contrast, late menarche was associated with greater current use in the adult women (i.e., frequency, amount, hangovers). Early timing of first intoxication relative to menarche (FIRM) strongly predicted higher current drinking. These findings suggest: (a) a link between AAM and alcohol use as early as age 9, (b) opposite relationships between AAM and alcohol use during two distinct developmental periods separated by a period of use unassociated with AAM, and (c) that the impact of early FIRM on adult consumption deserves further study.

Putting a finger on potential predictors of oral contraceptive side effects: 2D:4D and middle-phalangeal hair.

Many women experience emotional or physical side effects when taking oral contraceptives (OCs). Despite the potential impact on women's health and well-being, there are no valid methods to screen women for their risk of OC side effects. The present paper presents the results of two studies where anthropometric indicators of androgen exposure, 2D:4D and middle-phalangeal hair, were examined for their potential as predictors of OC side effects. In study 1, 2D:4D was associated with women's reports of a history of: (a) negative mood side effects; (b) discontinuation due to negative mood side effects; (c) specific mood side effects (i.e., crying, sadness, and altered trust in one's partners) and (d) specific physical side effects (i.e., headaches, fatigue, and decreased sex drive). In study 2, 2D:4D and/or middle-phalangeal hair was/were associated with a reported history of: (a) discontinuation due to negative mood side effects; (b) specific mood-related side effects (i.e., negative mood, disrupted sleep, increased aggression, and altered trust in one's partner) and (c) specific physical side effects (i.e., headaches, decreased menstrual cramps, and increased sex drive/arousal). The general pattern was that adverse OC side effects were experienced by women with lower 2D:4D and fewer middle-phalangeal hairs. Almost all relationships remained significant when response bias was controlled. These results suggest a possible role for prenatal testosterone exposure and both androgen action and sensitivity in women's experience of OC side effects. Furthermore, these two digit measures may be useful predictors of hormonal contraceptive side effects in women.

Facial symmetry detection ability changes across the menstrual cycle.

The effects of menstrual cycle phase and hormones on women's visual ability to detect symmetry and visual preference for symmetry were examined. Participants completed tests of symmetry detection and preference for male facial symmetry at two of three menstrual cycle phases (menses, periovulatory, and luteal). Women were better at detecting facial symmetry during the menses than luteal phase of their cycle. A trend indicated the opposite pattern for dot symmetry detection. Similarly, change in salivary progesterone levels across the cycle was negatively related to change in facial symmetry detection scores. However, there was no clear evidence of a greater preference for facial symmetry at any cycle phase, despite an overall preference for facial symmetry across phases. These findings suggest a menses phase advantage and a low progesterone advantage in women's ability to detect facial symmetry. The results are discussed in the context of hormonal, evolutionary mate selection, and functional neurocognitive theories.

An inverse relationship between typical alcohol consumption and facial symmetry detection ability in young women.

The relationship between monthly alcohol consumption over the past 6 months and facial symmetry perception ability was examined in young sober women with typical college-age drinking patterns. Facial symmetry detection performance was inversely related to typical monthly alcohol consumption, r (41) = -0.57, p < 0.001. Other variables that were predictive of facial symmetry detection included alcohol-related hangover and blackout frequency over the past 6 months, number of alcoholic drinks over the past week, early adolescent alcohol consumption and frequency of drug use. The relationship between alcohol use and symmetry detection could not be explained by individual differences in personality, family alcoholism history or other drug use. These findings suggest the possibility of a neurotoxic effect of alcohol on facial symmetry perception ability in female undergraduate students. As similar results did not emerge for a test of dot symmetry detection, the findings appear specific to facial symmetry. No previous studies have examined the effect of alcohol history on symmetry detection. The findings add to a growing literature indicating negative visuospatial effects of early alcohol use, and suggest the importance of further research examining alcohol and drug effects on sober facial perception in non-alcoholic populations.

To what extent do oral contraceptives influence mood and affect?

BACKGROUND: Studies examining the effects of oral contraceptives (OCs) on mood, affect, and affect variability are reviewed. METHODS: MEDLINE and PsycLIT data bases were examined to identify studies that compared OC users with nonusers using daily ratings of mood, affect, or affect variability. RESULTS: Compared to non-users, OC users experience less variability in affect across the entire menstrual cycle, and less negative affect during menstruation (i.e. withdrawal bleeding). In women with OC-related negative mood and affect change, potential mediators of the relation between OCs and mood or affect were identified: a history of depression, psychiatric symptoms, dysmenorrhea, and premenstrual mood symptoms prior to OC use; a history of pregnancy-related mood symptoms; a family history of OC-related mood complaints; being in the postpartum period; and age. Furthermore, a lower ratio of progesterone to estrogen is associated with more negative mood change in women with a history of premenstrual emotional symptoms, higher progesterone to estrogen ratios are associated with increased negative mood effects in women without such a history, and monophasic OCs have a greater stabilizing effect on mood than triphasic OCs. LIMITATIONS: The 'survivor effect', psychological factors, and indirect pharmacological effects (e.g. weight gain) have not yet been systematically investigated. Furthermore, most studies have examined only negative mood or affect, as opposed to both positive and negative affect and affect variability; and few affect studies have assessed potential mediators of OC-related affect change. CONCLUSIONS: While the only consistent OC-related mood effects experienced by most women are beneficial, a subgroup of women do experience negative mood change. Future research must focus on expounding the individual difference and OC-related risk factors for negative mood change.