(S)-S-adenosylmethionine in the treatment of pre-menstrual disorders in adult women: A protocol for an open-label pilot study.

Pre-menstrual disorders, including pre-menstrual syndrome and pre-menstrual dysphoric disorder, are highly prevalent disorders in women of reproductive age. Pre-menstrual disorders are associated with debilitating symptoms that onset in the days prior to menses. A complex interplay between hormonal fluctuations, cellular sensitivity, and psychosocial stressors likely underly the pathophysiology of pre-menstrual disorders. Current treatment options include selective serotonin reuptake inhibitors, hormonal therapies, and psychosocial support. There is growing evidence for oestrogen, progesterone, gonadotropin Releasing Hormone analogues and Complementary and Alternative Medicines in treating Pre-menstrual disorders. (S)-S-adenosylmethionine is a complementary and alternative medicine with postulated roles in the treatment of depression, with a rather rapid onset of action and minimal side effect profile. We propose a protocol for investigating the efficacy of (S)-S-adenosylmethionine in the treatment of pre-menstrual disorders. The proposed study is an open label pilot study, that will recruit thirty women between the ages of 18-45 who experience a pre-menstrual disorder. Daily and interval questionnaires will provide a quantification of symptoms across four menstrual cycles (16 weeks). During two consecutive menstrual cycles it is proposed that participants receive oral (S)-S-adenosylmethionine Complex 400 mg three times a day (total daily dose 1200 mg), during the pre-menstrual time-period (14 days prior to menses). Changes in pre-menstrual disorder symptoms between control and treatment cycles will assist in elucidating the clinical efficacy of (S)-S-adenosylmethionine. This study has the potential to support a larger double blinded, placebo controlled randomised control trial and aims to enrich the knowledge surrounding pre-menstrual disorders.

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

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

Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis.

BACKGROUND: The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing. OBJECTIVE: The impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms. METHODS: A database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included "menstrual disturbances" and "medical students," "prevalence" OR "symptoms" of "Premenstrual syndrome" OR "Premenstrual dysphoric disorder" OR "Dysmenorrhea" in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS). RESULTS: Initially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms. CONCLUSIONS: The current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.

Development and initial validation of an electronic personal assessment questionnaire for menstrual, pelvic pain and gynaecological hormonal disorders (ePAQ-MPH).

OBJECTIVE: Menstrual disorders, pelvic-pain and gynaecological hormonal conditions in women can have a significant impact on quality-of-life. Reliable assessment and monitoring of these intimate conditions is challenging. Patient reported outcome measures (PROMs) can be invaluable in providing objective assessment, but no comprehensive PROM assessing all of these conditions and their impact on quality of life is currently available. The purpose of this study was to develop and undertake initial psychometric testing of a comprehensive interactive electronic patient reported outcome measure for these conditions. STUDY DESIGN: A prototype electronic PROM (ePAQ-MPH) was developed following systematic literature review, semi structured interviews with 25 patients and expert panel review. Exploratory factor analysis was undertaken in 291 women attending a menstrual-disorders clinic; establishing a domain structure and enabling item reduction. Two validated PROMS (Women's Health Questionnaire and Menstrual Distress Questionnaire) were completed to assess criterion validity in 213 patients. Test-retest reliability was carried out in 30 women completing ePAQ-MPH at least one week apart. Patients' views on 'Value' and 'Burden' were assessed in 278 women using a validated 10-item survey measuring questionnaire utility (QQ-10). Confirmatory factor analysis (CFA) of the revised version of ePAQ-MPH following item reduction was undertaken in a different sample of 254 women. RESULTS: Exploratory factor analysis identified 18 domains (Cronbach's α > 0.7) and 30 redundant items. Test-retest analysis found acceptable intra-class correlations of 0.6-0.9 (p < 0.05). Eight domains were compared with Menstrual Distress Questionnaire showing moderate or strong correlation in seven domains. Ten domains were compared with Women's Health Questionnaire, six of which showed moderate correlation. Mean QQ-10 Value and Burden scores were 76 and 25, respectively (SD=15.8 and 15.5). The mean completion time for ePAQ-MPH was 31 min. CFA of the revised version 2 instrument with 15 domains showed good model fit. CONCLUSIONS: Whilst wider psychometric testing of the revised version of ePAQ-MPH is required, including in different settings and in assessments of data quality and responsiveness, initial analysis provides some evidence for reliability, validity and acceptability of this multi-dimensional electronic PROM. ePAQ-MPH shows potential for both patient assessment and roles in service evaluation and research.

An observation study of the clinical evaluation of symptom relief and side effects associated with taking ulipristal acetate (esmya) including its effect on pre-menstrual syndrome.

This was an observational study investigating the efficacy and side effects associated with ulipristal acetate (UPA), a progesterone receptor modulator, and the possible benefits to women who have co-existing pre-menstrual syndrome (PMS). 80 women returned a questionnaire on the bleeding, menstrual pain and side effects, and changes on PMS were recorded. 67 women (84%) showed improvement in their menses. 54 women (67%) became amenorrhoeic. Of those, 67% were within 10 days of commencing UPA. Menses returned in 33 amenorrhoeic women within 4 weeks of stopping UPA. 58 women (70%) reported an improvement in their pain score but 41 women had a return of their pain after stopping UPA. The majority of the women had no or infrequent side effects. 80% had demonstrable improvement in their PMS symptoms. UPA is effective in controlling symptoms due to uterine fibroids with infrequent side effects. Our data also showed new evidence of a concurrent dramatic improvement in PMS in these women. Impact statement The observational study explored the drug profile of ulipristal acetate (UPA), a selective progesterone receptor modulator, which has been licenced as pre-treatment for surgical therapies of fibroids since 2012. We aimed to investigate the efficiency and side effects of UPA. Since the introduction of UPA in clinical practice, there has yet to be a study looking at the drug profile outside a research setting. We have also decided to investigate the effect of UPA on pre-menstrual syndrome (PMS) in this group of women with symptomatic fibroids. As such this case report should be of interest to a broad readership including those interested in the medical management of symptomatic fibroids.

Comparison of the effects of PMDD and pre-menstrual syndrome on mood disorders and quality of life: a cross-sectional study.

In this study, we compared psychiatric symptoms, quality of life and disability in patients with pre-menstrual dysphoric disorder (PMDD) and pre-menstrual syndrome (PMS). Forty-nine women with PMDD were compared with 43 women with PMS. All participants were asked to complete a socio-demographic data collection form, a Brief Disability Questionnaire, a medical study short form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) forms. The patients with PMDD had higher HAD-A and HAD-D scores than the patients in PMS group (p < 0.01). No statistically significant differences were found on brief disability between two groups (p > 0.05), but both groups had medium level of brief disability. The PMDD group had a lower SF-36 scoring than the PMS group in every compared parameters (p < 0.01). PMS and PMDD may lead to brief disability, and PMDD may cause loss of quality of life and psychological problems. The evaluation of patients with PMS and PMDD pre-menstrual disorders should be more detailed.

Qualidade de vida de mulheres com tensão pré-menstrual a partir da escala WHOQOL-Bref / Quality of life of women with premenstrual tensionfrom the scale WHOQOL-Bref

O objetivo do estudo foi avaliar a qualidade de vida de mulheres com Tensão Pré-Menstrual (TPM).Trata-se de umestudo transversal e descritivo, realizado com 139 mulheres cadastradas em um Centro de Saúde da periferia de São Luís-MA. Os dados foram coletados no período de agosto de 2010 a maio de 2011 por meio da aplicação de questionário adaptado pelo pesquisador e a escala WHOQOL-Bref, com análise descritiva mediante utilização do programa WHOQOL-Bref/Microsoft Excel.A prevalência da Tensão Pré-Menstrual foi de 72,66%. Entre as mulheres participantes do estudo, observou-se predomínio dos sintomas irritabilidade, mastalgia, dor pélvica, cefaléia, ansiedade, diminuição do interesse em atividades habituais e baixa autoestima. Na autoavaliação da qualidade de vida foi encontrada média de satisfação de 51,63% em mulheres com TensãoPré-Menstrual. Com relação às facetas selecionadas dos domínios: físico, psicológico, relações sociais e meio ambiente, a média de respostas foi, respectivamente, Atividade de Vida Cotidiana (57,61%), Autoestima (46,01%), Relações Pessoais (44,57%) e Cuidado de Saúde (40,94%). Conclui-se que o tema requer maior atenção por parte dos profissionais de saúde em conjunto com a sociedade, visando à elaboração de estratégias para melhoria da qualidade de vida de mulheres com TPM

The objective of this study was to evaluate the quality of life of women with premenstrual Tension (PMT).This is atransversal and descriptive study, conducted with 139 women enrolled in a health center of the periphery of São Luís (MA). The data collected in the period from August 2010 to May 2011 through the application of a questionnaire adapted by researcher and WHOQOL-Bref scale, with descriptive analysis using the WHOQOL-Bref/program Microsoft Excel.The prevalence of premenstrual Tension was 72.66%. Among women participating in the study, it observed a predominance of symptoms irritability, breast tenderness, pelvic pain, headaches, anxiety, decreased interest in usual activities and low self-esteem. In the self-evaluation of the quality of life found to average satisfaction of 51.63% in women with premenstrual Tension. With respect to the selected facets of domains: physical, psychological, social and Environmental Affairs, the average responses was, respectively, activity of everyday life (57.61%), Esteem (46.01%), personal relationships (44.57%) and health care (40.94%). It concluded that the subject requires greater attention on the part of health professionals in conjunction with society, aiming at the elaboration of strategies for improving the quality of life of women with PMS.

Sexuality and androgens in women with cyclical mood changes and pre-menstrual syndrome.

OBJECTIVE: To study the relation between androgen levels and sexual interest in women with different kinds of pre-menstrual syndrome (PMS). DESIGN: Causal comparative study. SETTING: Swedish university hospital outpatient clinic. POPULATION: Seventy women with cyclical mood changes. METHODS: Pre-menstrual syndrome patients were divided into those with and those without preovulatory symptoms. In 37 women, early follicular phase blood samples were analyzed for androstenedione, testosterone, sex hormone-binding globulin (SHBG), progesterone and estradiol, using radioimmunoassay. The participants were divided into subgroups depending on whether the levels of androgens and SHBG were above or below the median. In 33 of them it was possible to compare the cyclicity in sexual parameters between these subgroups. MAIN OUTCOME MEASURES: Daily ratings of sexual parameters and hormonal analyses. RESULTS: Plasma testosterone was significantly lower and SHBG significantly higher in women with luteal phase symptoms compared with those with additional follicular phase symptoms. ANOVA showed significant cyclicity for all sexual parameters consistently. For the "sexual feelings" and "pleasant sexual thoughts" parameters, cyclicity was the same whether or not the hormonal levels were "high" or "low." CONCLUSIONS: The "Pure-PMS" group and the "pre-menstrual-exacerbation" groups differed in their androgen and SHBG levels. Women suffering from PMS with higher neuroticism Eysenck Personality Inventory scores or "low" levels of androgens and SHBG would be more likely to have a decreased sexual interest pre-menstrually than would women with a high level.

Effects of aerobic exercise at different intensities in pre menstrual syndrome.

OBJECTIVES: The purpose of this study is to analyze the potential benefits of aerobic exercises at different intensities in the management of pre menstrual syndrome. METHODS: The study design is quasi-experimental; sixty-one female subjects were randomly allocated into three groups, Group A (mild intensity), Group B (moderate intensity) and Group C (severe intensity) and the intervention were given for 6 weeks. The study setting was general community settings. The outcome measures were menstrual symptom questionnaire, VO(2) max, forced vital capacity (FVC), maximum voluntary ventilation (MVV) and lipid profile (HDL, LDL, TGL). RESULTS: There is significant decrease in menstrual symptoms in both Groups B and C. However, Group C improved with increased rate of perceived exertion. LDL levels did not change significantly but HDL, TGL, VO(2) max, FVC, and MVV improved significantly in Groups B and C, but remains significantly unchanged in Group A. CONCLUSIONS: This study encourages the employment of regular, moderate intensity aerobic exercise as a potential intervention for pre menstrual syndrome.

Incidência da sindrome pré-menstrual na prática de esportes / Incidence of pre-menstrual syndrome in sports practice

Apesar do grande aumento do número de mulheres no esporte, é escassa a literatura sobre aspectos anatômicos, psicológicos e principalmente hormonais que afetam o desempenho das mulheres praticantes de exercício físico. Embora existam muitas pesquisas relatando como o exercício afeta a menstruação, são poucos os estudos de como o ciclo menstrual interfere no desempenho feminino. A maioria dos estudos cita a relação do desempenho e o ciclo menstrual, mas não leva em consideração as alterações do ciclo, as moléstias perimenstruais (MPM)(1). OBJETIVO: Observar a incidência e a frequência dos sintomas da síndrome pré-menstrual em atletas. CASUÍSTICA E MÉTODOS: Em 31 atletas de handebol em idade fértil foi aplicado um diário de sintomas pré-menstruais(2) por um período de três meses consecutivos. RESULTADOS: A prevalência de SPM em atletas foi de 71 por cento, sendo o sintoma mais relatado o de irritabilidade, em 86,4 por cento das atletas, seguidos de mudanças de humor (77,3 por cento) e cólicas (72,7 por cento); 59 por cento das atletas indicaram algum outro sintoma no período pré-menstrual. CONCLUSÕES: Observou-se alta prevalência de SPM em atletas.

Despite the increasing number of women who practice physical exercise, there are still few reports concerned with anatomy, psychology and mainly hormones that could affect their performance. Although there is a multitude of articles about the effects of physical exercise in menstruation, only a few of them report how this function interferes in women's performance. The association physical exercise - menstruation has been studied but without considering the changes during the cycle, the perimenstrual symptoms. Therefore, the aim of this article was to investigate the incidence and periodicity of pre-menstrual symptoms in athletes. A daily questionnaire was applied with the aim to follow the pre-menstrual symptoms during a period of 3 consecutive months. The population of the study was composed by 31 female athletes in fertile age. RESULTS: The prevalence of PMS in athletes was of 71 percent and the mainly reported symptoms were irritability (86.5 percent), mood swings (77.3 percent) and cramps (72.7 percent). Other symptoms were reported by 59 percent of the athletes during the pre-menstrual period. CONCLUSION: Our data show a high prevalence of PMS among athletes.

Ciclo menstrual e consumo de alimentos / Menstrual cycle and food consumption / Ciclo menstrual y el consumo de alimentos

Objetivou-se neste trabalho, avaliar o consumo alimentar de mulheres durante as fases folicular e lútea do ciclo menstrual e estabelecer as possíveis relações entre a ingestão alimentar e os sintomas da Síndrome Pré-Menstrual. Foram investigadas 30 alunas dos cursos de Pós-Graduação da Universidade Federal de Santa Catarina, por meio de registro alimentar de três dias, sendo um de final de semana, durante as fases folicular e lútea. Na lútea, aplicou-se um questionário de sintomas pré-menstruais. Os dados foram avaliados no programa SPSS 14 for Windows. O consumo energético, de carboidratos e lipídios, foi significativamente maior na fase lútea (p<0,0001). Os sintomas da Síndrome Pré-Menstrual ocorreram em 96,7% da amostra investigada, sendo que 63,4% apresentaram manifestação severa e 3,3% leve. Os sintomas emocionais foram os mais citados pela amostra (93,3%). O apetite foi maior na fase pré-menstrual em 53,3% das participantes e 43,3% relataram ter vontade de comer alimentos doces neste período. Não foram encontradas correlações entre o consumo alimentar (energético e de macronutrientes) e a manifestação de sintomas. A partir destes resultados, acredita-se que exista interferência do ciclo ovariano sobre o comportamento alimentar. Assim, sugere-se a realização de pesquisas com maior amostragem, a fim de verificar a estreita relação entre o consumo alimentar e a manifestação de sintomas da Síndrome Pré-Menstrual.

The objective of this study was to evaluate the dietary intake of women during the follicular and luteal phases of the menstrual cycle and establish the possible relationship between food intake and symptoms of Premenstrual Syndrome. We investigated 30 female students of graduate courses at the Federal University of Santa Catarina, through three days of food records, one weekend during the follicular and luteal phases. In the luteal, applied a questionnaire to premenstrual symptoms. The data were analyzed using SPSS 14 for Windows. The energy consumption of carbohydrates and lipids, was significantly higher in the luteal phase (p <0.0001). The symptoms of premenstrual syndrome occurred in 96.7% of the investigated sample, and 63.4% had severe outbreak and 3.3% mild. The emotional symptoms were the most cited by the sample (93.3%). The appetite was higher in the premenstrual phase in 53.3% and 43.3% of participants reported having cravings for sweet foods in this period. No correlation was found between dietary intake (energy and nutrients) and the manifestation of symptoms. From these results, we believe that there is interference of the ovarian cycle on feeding behavior. Thus, it is suggested to conduct research using larger samples to verify the close relationship between food consumption and manifestation of symptoms of premenstrual syndrome.

El objetivo de este estudio fue evaluar la ingesta alimentaria de las mujeres durante las fases folicular y lútea del ciclo menstrual y establecer la posible relación entre la ingesta de alimentos y los síntomas del Síndrome Premenstrual. Se investigaron 30 alumnas de los cursos de postgrado en la Universidad Federal de Santa Catarina, a través de tres días a partir de los registros de alimentos, un fin de semana durante las fases folicular y luteínica. En la fase lútea, aplicó un cuestionario a los síntomas premenstruales. Los datos fueron analizados utilizando el programa SPSS 14 para Windows. El consumo de energía de los carbohidratos y lípidos, fue significativamente mayor en la fase lútea (p <0,0001). Los síntomas del síndrome premenstrual se produjo en el 96,7% de la muestra investigada, y 63.4% tenían brote severo y el 3,3% leve. Los síntomas emocionales son los más citados por los encuestados (93,3%). El apetito es mayor en la fase premenstrual en el 53,3% y 43,3% de los participantes reportó haber antojos por alimentos dulces en este período. No se encontró correlación entre el consumo de la dieta (energía y nutrientes) y la manifestación de los síntomas. A partir de estos resultados, creemos que hay interferencia del ciclo ovárico en la conducta alimentaria. Por lo tanto, se sugiere llevar a cabo la investigación con muestras más grandes para comprobar la estrecha relación entre el consumo de alimentos y la manifestación de los síntomas del síndrome premenstrual.