Lidando com um fenômeno natural e que ficará para sempre: a menstruação e suas influências na vida da mulher / Dealing with a natural phenomenon that will remain forever: menstruation and its influences in the life of women

A menstruação, biologicamente e de acordo com a visão médica, é definida como a eliminação de sangue e tecido superficial do endométrio após a prévia involução, em consequência à queda das concentrações séricas de estrogênios e progesterona ao final do ciclo ovariano. Porém, a Organização Mundial da Saúde (OMS) tem procurado desestimular este conceito mecanicista, buscando afirmar que o ato de menstruar também envolve variáveis psicológicas, sociais e culturais. Foram definidos os seguintes objetivos: Descrever as relações de influência da menstruação na vida de mulheres, segundo sua própria percepção e Analisar a relação de mulheres com a menstruação à luz do interacionismo simbólico. O estudo proposto é descritivo, qualitativo e visa a explorar diferentes aspectos das experiências de vida das participantes. Optou-se por abordagem qualitativa, baseada nos pressupostos da Grounded Theory, por oferecer elementos para a discussão e análise dos dados de modo comparativo constante dos resultados, e do interacionismo simbólico, que possibilita que a pesquisa qualitativa atinja o objetivo de pesquisar o sentido que os indivíduos propõem aos objetos, pessoas e símbolos com os quais interagem no meio social. Dos resultados evidenciados, foram geradas quatro categorias: "A chegada de algo inesperado e desconhecido que ficará para sempre...", "A influência dos outros na vivência/experiência da menstruação", "O conhecimento do corpo e a relação consigo mesma e com o mundo à sua volta" e "Reconhecendo e lidando com as influências na vida". Observou-se que as mulheres, ao lidarem com o fenômeno da menstruação, mesmo esta sendo algo natural, vivenciam-na diferentemente, sendo o seu meio social e sua cultura grandes influenciadores do processo, além de o próprio evento ser um marco em sua vida, pois, muitas vezes, ocorre de modo inesperado, podendo gerar ações positivas ou negativas. O suporte social é outra estratégia bastante importante como apoio tanto para as adolescentes que vivenciam esse momento de transição para a fase adulta como para as mulheres adultas que consideram importante receber apoio de seus familiares, amigos, entre outros. A participação do enfermeiro pode tornar-se uma importante mediação junto a essa mulher, para auxiliá-la na busca de significados mais contundentes por meio de um cuidado mais integral, qualificado, fazendo com que a mulher tenha uma visão reflexiva sobre o ato de estar menstruada e sobre as influências da menstruação em sua vida, bem como um olhar para além de assumir naturalmente este evento, conformar-se ou não aceitar a menstruação. Ao ajudá-la a ressignificar esse fenômeno, trazendo para ela uma visão diferenciada, mostrando a menstruação como algo natural, possibilitando que a mulher assuma a menstruação como símbolo do feminino e instrumento de empoderamento, a enfermagem desenvolve ação importante do cuidado, atribuindo a esse cuidado cunho libertador. Os resultados do presente estudo evidenciaram situações que merecem aprofundamento em estudos posteriores.

Menstruation, biologically and according to the medical view, is defined as the elimination of blood and superficial tissue of the endometrium after previous involution, as a result of the drop in serum concentrations of estrogens and progesterone at the end of the ovarian cycle. However, the World Health Organization (WHO) has tried to discourage this mechanistic concept and sought to affirm that the act of menstruating also involves psychological, social and cultural variables. The following objectives were defined: Describe the relations of the influence of menstruation in the lives of women, according to their own perception and Analyze the relation of women with menstruation in the light of symbolic interactionism. The proposed study is descriptive, qualitative and aimed at exploring different aspects of the participants' life experiences. We chose a qualitative approach, based on the assumptions of the Grounded Theory, for it offers elements for the discussion and analysis of the data results in a constant comparative way, and of the Symbolic Interactionism, which enables the qualitative research to achieve the objective of researching the meaning that individuals propose to the objects, people and symbols with which they interact in the social environment. From the results, four categories were generated: "The arrival of something unexpected and unknown that will remain forever...", "The influence of others in living/experiencing menstruation", "The knowledge of the body and the relationship with herself and the world around her" and "Recognizing and dealing with the influences in life". It was observed that women, when dealing with the phenomenon of menstruation, although it is something natural, experience it differently, their social environment and culture being great influencers of this process, besides the event itself being a milestone in her life because it often occurs unexpectedly, and can generate positive or negative actions. Social support is another particularly important strategy as a support for both adolescents who experience this moment of transition to adulthood and for adult women who consider it important to receive support from their relatives, friends, among others. The participation of the nurse can become an important mediation with this woman to help her in the search for more significant meanings by means of a more integral, qualified care, causing the woman to have a reflexive vision about the act of being menstruated and about the influences of menstruation in her life, as well as having a look beyond just assuming this event naturally, conforming herself or not accepting the menstruation. By helping her to re-signify this phenomenon, bringing her a differentiated view, showing menstruation as something natural, enabling women to assume menstruation as a symbol of the feminine and an instrument of empowerment, nursing will be developing an important action of care with a liberating imprint. The results of the present study evidenced situations which deserve to be deepened in further studies.

Os efeitos do Toque Terapêutico na Síndrome Pré-Menstrual / The effects of Therapeutic Touch on Premenstrual Syndrome

O estudo teve por finalidade verificar a eficácia do Toque Terapêutico (TT ou Método Krieger-Kunz) sobre os sintomas da Síndrome Pré-Menstrual (SPM) que acometem muitas mulheres.Tratou-se de um estudo piloto e a amostra foi composta por vinte graduandas de enfermagem da Universidade de São Paulo que atenderam aos critérios de inclusão do projeto e se submeteram a uma sessão semanal de TT por três meses. Foi realizada uma análise das proporções com o teste t-pareado relacionada às variáveis, que corresponderam aos sintomas do Índice de Blatt e Kupperman, coletadas antes e depois das intervenções com a terapia complementar. O resultado encontrado foi p=0,000, o que indica uma diferença significativa antes e depois da intervenção, demonstrando a eficácia do TT na diminuição dos sintomas da SPM com mudanças significativas entre o momento zero e o momento final. Neste estudo a intervenção com o Toque Terapêutico trouxe alívio à Síndrome PRé-Menstrual.(AU)

This study aimed to verify the effectiveness of Therapeutic Touch (TT of Krieger-Kunz Method) on the symptoms of premenstrual syndrome (PMS) that affects many women. It was a pilot study and the sample was composed of twenty nursing students from USP who met the inclusion criteria of the project and underwent a weekly session of TT for three months. The researches conducted an analysis which the paired t-test related to the variables that corresponded to the symptoms of the Blatt and Kupperman Index, and they were collected before and after the interventions which the complementary therapy. The result found was p=0,000; this indicates a significant difference before and after the intervention, and it demonstrates the effectiveness of TT in reducing the symptoms of PMS with significant changes between the zero time and the final moment. The intervention with Therapeutic Touch provided relief on premenstrual syndrome in this study.(AU)

The effect of cognitive behavioural psycho-education on premenstrual syndrome and related symptoms.

Premenstrual syndrome (PMS) is a distressing group of symptoms related to menstrual cycle during reproductive age. Its substantial burden on daily function and quality of life, particularly on mental aspects, was to the impetus for this study with the aim of determining the effectiveness of a psycho-educational package on premenstrual syndrome and related symptoms. In a randomized clinical trial, 123 (17-19-year-old) adolescent girls with PMS were randomized to psycho-educational intervention (including 62 subjects) and control (including 61) groups. The participants completed a demographic questionnaire, premenstrual syndrome symptom daily record scale and the Symptom Checklist-90-Revised (SCL-90-R). A paired and two independent samples t-test and chi-squared test were used for analysing data using SPSS statistical package. At the end of the study there was statistically significant decrease in severity of total PMS in intervention compared with control group (P < 0.001). Also, a significant difference in somatization, anxiety and hostility was observed between two groups (P < 0.05). However, depression marginally decreased (P < 0.1) in intervention group, and interpersonal sensitivity was not statistically different between intervention and control groups. Intervention alleviated the severity of PMS and related somatization, anxiety and hostility, yet it could not change the severity of depression and interpersonal sensitivity.

The effect of menstruation on psychiatric hospitalization.

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission.

SRD5A1 genotype frequency differences in women with mild versus severe premenstrual symptoms.

The aims of this small pilot study were to explore the association between premenstrual symptom severity and two genes from the gamma-aminobutyric acid (GABA) pathway: steroid-5-alpha-reductase, alpha polypeptide 1 (SRD5A1) and gamma-aminobutyric acid receptor subunit alpha-4 (GABRA4). Saliva samples were obtained from a convenience sample of 19 Caucasian females ages 18-25 years, ten cases and nine controls. Deoxyribonucleic acid (DNA) was isolated, and genotyping performed on ten single nucleotide polymorphisms (SNPs). Ten percent of cases and 44% of controls had the cytosine/cytosine (C/C) genotype for the SRD5A1 SNP, rs501999 indicating that this genotype may protect women against severe premenstrual symptoms. Replication of this study using an adequately powered sample size is warranted.

Development and evaluation of a women's health support system at a Japanese company.

This research was designed to evaluate a work environment in which all female employees can work safely and comfortably by developing a health support system for women in the workplace. With consent from management, the occupational health nurse invited an OB/GYN physician, contracted from outside the company, to act as a specialist adviser. Because health-related concerns unique to women are sometimes difficult to differentiate from mental health issues, a health management system was developed to ensure that the psychological health of workers is promoted and maintained. After development of this system, case studies were reviewed and evaluated for menstrual disorders, perinatal health management, and menopausal disorders. Intraoffice cooperation and support were garnered from the Personnel Department, the Sexual Harassment Measures Committee, the industrial physician, and the Health and Safety Committee. In addition, through the review of the case studies, the roles for care on every level were clarified. The number of female employees who opted for early retirement due to menstrual disorders, miscarriage, or menopausal disorders was also reduced. It is believed that as a result of this study, a health management system for health-related concerns unique to women and based on mental health care measures in the workplace was developed and supportive measures were practiced. In the future, it will be important to continue to comprehensively view and create a work environment in which all female staff members can work safely and comfortably.

Common menstrual disorders in adolescence: nursing interventions.

Menstrual disorders such as amenorrhea, excessive uterine bleeding, dysmenorrhea, and premenstrual syndrome are common reasons for visits to healthcare providers by adolescent girls. Although menstrual irregularity can be normal during the first few years after menarche, other menstrual signs and symptoms may indicate a pathological condition that requires prompt attention and referral. This article discusses four common menstrual disorders seen in adolescent girls and focuses on specific nursing interventions aimed at eliciting an accurate menstrual history, providing confidentiality and communicating therapeutically, administering culturally sensitive care, and promoting independence and self-care.

Cyclic perimenstrual pain and discomfort: the scientific basis for practice.

OBJECTIVE: To review and organize the science related to cyclic perimenstrual pain and discomfort for the fifth research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses. DATA SOURCES: Computerized searches in CINAHL, MEDLINE, and the Cochrane Library, as well as hand searches of cited references. Keywords included cyclic pelvic pain, comfort, pain guidelines, and dysmenorrhea. DATA EXTRACTION: All relevant articles prior to 1999 were considered. Thirty-three research-based articles (1992-1999) were reviewed for relevance by the science team as part of the fifth research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses. DATA SYNTHESIS: The literature review and synthesis resulted in a cogent description of cyclic perimenstrual pain and discomfort and the development of three nursing diagnoses: perimenstrual cyclic pelvic pain, perimenstrual discomfort, and perimenstrual negative affect. Cyclic pelvic pain is a new concept, developed by the science team during the project. Perimenstrual cyclic pelvic pain is an acute, subjective experience defined by pelvic pain that presents in a repeating time frame associated with the menstrual cycle. It is usually clustered with other discomforts and appreciably affects a woman's quality of life. Because the science about interventions is complex and extensive, data synthesis led to organization of the interventions within seven categories. CONCLUSIONS: Translation of research into practice is essential. Cyclic perimenstrual pain and discomfort is an important clinical issue, yet the science had not previously been comprehensively reviewed with the mission to translate it for nursing practice. Translation of this complex literature was accomplished though an innovative clinical practice guideline and subsequently evaluated in nursing practice through the research-based practice project.

PMS in the workplace. An occupational health nurse's guide to premenstrual syndrome.

1. Premenstrual syndrome (PMS) is defined as the cyclic recurrence of physical, psychological, or behavioral symptoms that appear after ovulation and resolve with the onset of menstruation. These symptoms can be severe enough to disrupt personal relationships, social activities, or job performance. 2. The exact cause of PMS is unknown. The best tool to diagnose PMS is a daily symptoms rating calendar. To have the diagnosis of PMS, the symptoms must be severe enough to disrupt normal daily activities. 3. The occupational health nurse can provide information about first line treatment modalities for PMS symptoms including dietary modifications, nutritional supplements, aerobic exercise, and stress management skills. 4. More research is needed about PMS in the workplace and the effect of treatments on outcomes such as job attendance and work performance.

Positively reframing perceptions of the menstrual cycle among women with premenstrual syndrome.

OBJECTIVE: To positively reframe perceptions of menstrual cycle experiences to diminish reports of negative perimenstrual symptoms among women with premenstrual syndrome (PMS). DESIGN/SAMPLE: A longitudinal quasi-experimental research design; data were collected on 28 women. SETTING: Treatment sessions were conducted in a university classroom in the northeastern United States. INTERVENTION: The intervention consisted of a health promotion program that provided social support and a psychoeducational intervention with a positive reframing psychotherapeutic maneuver. MAIN OUTCOME MEASURES: To describe (a) perceptions of biologic, psychologic, and social outcomes related to perimenstrual changes and (b) compare biologic, psychologic, and social outcomes of women participating in a health promotion intervention with women not participating. RESULTS: Negative perimenstrual symptom reports decreased for women in the experimental group. In addition, the participants' personal resources increased significantly. CONCLUSIONS: Participation in a peer support group that provides women with information on positive concomitants of the menstrual cycle can benefit women with PMS.

Differences in cortisol, a stress hormone, in women with turmoil-type premenstrual symptoms.

BACKGROUND: A significant number of American women of childbearing age are troubled by premenstrual symptoms, but the underlying cause is not understood, resulting in inadequate therapy. OBJECTIVES: To use basal levels of cortisol to differentiate women with low symptom (LS) patterns of turmoil-type premenstrual symptoms from women with premenstrual symptom (PMS) patterns and from women with premenstrual magnification (PMM) patterns of turmoil-type premenstrual symptoms. METHOD: Symptom and cortisol patterns of women were monitored for three consecutive menstrual cycles. Three distinct groups of women were identified based on symptom patterns and types. RESULTS: Significant differences in symptom severity among groups were observed during the follicular (F = 203; df= 2, 24; p < .0001) and luteal phases (F= 51.3; df= 2, 24; p< .0001) of the cycle. There were no statistically significant differences in cortisol among groups for the follicular phase, but there were during the luteal phase (F= 4.0; df= 2, 24; p= .03). CONCLUSIONS: Altered regulation of the stress axis may be involved in mediating turmoil-type PMS.

Evaluating therapeutic change in symptom severity at the level of the individual woman experiencing severe PMS.

Treatment effectiveness of an intervention designed for women experiencing severe Premenstrual Syndrome (PMS) was assessed at the level of the individual woman since patterns of individual response are of most relevance to practitioners. Symptom severity was evaluated daily in five women across seven menstrual cycles using a time-series methodology. Three symptom severity patterns emerged from the baseline data analysis: a "classic" PMS pattern, a premenstrual magnification pattern and a social week pattern. Patterns of therapeutic response emerged from the time-series analysis of post-treatment data compared with baseline symptom severity patterns: a "normalized" response pattern where symptom severity declined to a mild, cyclic process and an "unstable" response pattern that remained reactive. Treatment effects for menstrual cycle phenomena may be evaluated using the "normalizing" or "unstable" patterns as clinical indicators.

Menstrual-cycle lengthening and reduction in premenstrual distress through guided imagery.

This study investigated the effects of a program of relaxation and specific guided imagery on menstrual-cycle length and premenstrual distress. Thirty healthy college women with regular menstrual cycles were studied for 6 months. The subjects completed the Menstrual Distress Questionnaire (MDQ) at the beginning and end of the study and recorded their menstrual cycles for 3 months on an investigator-developed calendar recording sheet. Subjects were then given an audiotape with a progressive muscle relaxation exercise followed by guided imagery with a suggestive message focusing on lengthening the menstrual cycle and delaying the onset of menstrual bleeding. The 15 subjects who completed the entire study had significant increases in cycle lengths during the 3 months of imagery. The total premenstrual distress scores also declined significantly, as did the subscales measuring behavior and negative affect. This study provides preliminary evidence that menstrual-cycle rhythmicity and premenstrual distress are amenable to the mind-body intervention of guided imagery and suggests that further investigation of this phenomena with larger sample size and careful controls for confounding variables be conducted.

Family coping and premenstrual symptomatology.

OBJECTIVE: To examine how families cope when the woman experiences premenstrual symptomatology. DESIGN: A descriptive panel design and purposive, nonprobability sampling through interviews and questionnaires. SETTING: Participants' homes. PARTICIPANTS: One hundred four couples who met the study criteria were recruited from medical practices and community seminars and through media announcements. MEASURES: Study outcome measures were formulated after data collection. RESULTS: High-symptom families used spiritual coping strategies more frequently than low-symptom families (R = .427, p = 0.003 in women, p < 0.001 in men). Husbands were more likely than wives to report that their families coped by believing that the problem would go away if they waited long enough (t = -3.06, p = 0.003). Husbands of women with high symptomatology reported that their families used this passive approach to a significant degree (t = -3.43, p = 0.001). CONCLUSIONS: Religious or spiritual support may be especially important to families in which the woman suffers from premenstrual symptomatology. These families may also keep problems within the family and be socially detached. Nurses may help by encouraging the use of social supports, religious or spiritual support, and other family resources.

Retrospective assessment of premenstrual changes in Icelandic women.

The purpose of this study was to increase our knowledge of the condition of Icelandic women aged 29 to 40 years during the premenstrual phase of the menstrual cycle. Premenstrual symptoms were measured by a retrospective instrument adapted from Halbreich and colleagues' Premenstrual Assessment Form. Our findings showed that Icelandic women experience premenstrual changes as do their peers in other countries. The most common symptoms were bloating, mood swings, irritability, abdominal discomfort-pain, and intolerance-impatience. Women who were symptomatic in the week before menses tended to manifest more symptoms at other times as well. In general, women responded to their symptoms by taking some time to relax, take pain medication, or seek support. Women experiencing more severe symptoms were more likely to seek support from a partner, relative, or friend. More than 40% of the sample reported that they perceived the symptoms as having negative effects on their relationships with their partners and children, and those experiencing more severe symptoms were more likely to report these perceptions.

Premenstrual syndrome: family impact and nursing implications.

Premenstrual syndrome is a growing concern for health-care providers. The physical, psychologic, and behavioral manifestations of the syndrome may impair interpersonal relationships and family functioning. Premenstrual syndrome should be regarded not only from the woman's perspective but with respect to the entire family. Nursing intervention should be geared toward assisting the entire family system.

Management of perimenopausal symptoms.

The perimenopausal period brings about many changes. The significance of many of the signs and symptoms associated with menses also may change. Premenstrual syndrome (PMS) and uterine bleeding need close follow-up during the perimenopausal period. Urinary incontinence appears to worsen because of hormonal changes occurring during the climacteric. All three of these conditions present a special challenge to the health care practitioner.