The Influence of Depression on Biased Diagnosis of Premenstrual Syndrome and Premenstrual Dysphoric Disorder by the PSST Inventory

The diagnosis of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) poses a challenge for clinicians due to the overdiagnosis of retrospective methods and overlapping symptoms with depression. The present study utilized an Item Response Theory analysis to examine the predictive utility of the Premenstrual Symptom Screening Tool (PSST) in women with and without depression. Two hundred and fifteen women aged 20–35 completed the PSST, a daily symptom calendar, SCID-I, and CES-D for two consecutive menstrual cycles. PSST items: fatigue, depressed mood, feeling overwhelmed, anxiety/tension, and decreased interest in everyday activities were the best predictors of PMS. Unlike the daily symptom ratings, the PSST over-diagnosed PMS/PMDD in the depressed group but not in the group of women without PMS/PMDD. While diagnosing premenstrual disorders, clinicians should be aware that a retrospective diagnosis with PSST can be more sensitive to mood disorders and cycle phases than a prospective diagnosis with a daily symptoms calendar.

Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

PREVALENCE OF PREMENSTRUAL SYMPTOMS AMONG BULGARIAN WOMEN

INTRODUCTION: Premenstrual symptoms are common and can worsen women's quality of life. This study examines the prevalence of premenstrual symptoms such as weight gain; swelling of ankles, feet, and hands; frequent change of mood; fatigue; difficulty concentrating; depression; nervousness and irritability; and nausea. OBJECTIVES: The objectives of this study are: (1) to reveal the prevalence of premenstrual symptoms among Bulgarian women and (2) to establish how the presence of premenstrual symptoms affects the Emotional well-being of women. METHODS: The applied methodology includes an online-based anonymous study, which focuses on the prevalence of premenstrual symptoms among Bulgarian women and their emotional health. A characteristic of the studied contingent on age, BMI, and physical activity was made. RESULTS: The results of 126 women surveyed were analyzed. Of these, 96.8% have at least one premenstrual symptom. 30.2% have one or two symptoms, 43.7% have 3-4 symptoms and 23% have 5-8 symptoms. 14.8% of women with symptoms reported worsening of their symptoms because of increased stress associated with COVID-19. There is a statistically significant correlation between the number of symptoms and the emotional well-being of women. CONCLUSION: The prevalence of premenstrual symptoms is common among the studied Bulgarian women. A greater number of symptoms has a negative effect on women's emotional well-being. We consider it appropriate to introduce the application of physiotherapeutic methods as well as alternative therapies for the treatment and prevention of premenstrual syndrome.

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.

Knowledge and practices related to menstruation among Lucknow college students in North India: results from a cross-sectional survey

Background: Girls in many low and middle-income countries enter puberty with knowledge gaps and misconceptions about menstruation may lead to unsafe hygienic practices that increase health risk. Despite such importance, educated girls' knowledge and hygienic practice towards menstruation are not well addressed in India. Consequently, the present study attempted to assess menstrual hygiene knowledge and practice among college students in Lucknow city in north India. Method: An online college-based cross-sectional study design was employed in Lucknow, the capital of Uttar Pradesh in India. Data collection was carried out from September 11 to September 25, 2020, using a google form among undergraduate and Postgraduate students. All variables that were significant at bivariate level (at P-value < 0.05) were entered into multivariate analysis using a logistic regression model to control for confounding factors. In the final model, P-value of less than 0.05 was used as a base to identify factors having a statistically significant association with poor knowledge and hygiene practice at corresponding 95% confidence interval. Results: More than half of students' ages of menarche were between 12-15 years, and duration of menses flow was between 3-5 days. The most common premenstrual symptom was abdominal pain (67%) and back pain (50.5%). Majority of the students had first time discussed menstrual problems with their mothers (69.2%). Around 94% of students were currently using a sanitary pad as an absorbent. Regarding cleanliness, about (90.9%) girls clean their genitals after urinating during mensuration. Around 18.9% used medication during menstruation. Multivariate analyses reveal that students of Science and Technology (vs Commerce and Management Students) and monthly family income 50-100 thousand (vs < 25 thousands) were associated with good knowledge about menstruation. In contrast, students' fathers were graduates (vs school educated); the occupation was 'Other'(vs Farmer) ; living in a nuclear family(vs Joint family) and residing in urban areas(vs Rural) were less likely to have good menstruation knowledge. Besides, good hygiene practices are less likely to have with 'Other' Religion(vs Hindu), working mother(vs Housewife), monthly family income between 25 to 50 thousand(vs <25 thousands), and Nuclear family(vs Joint family) (p<0.05). Conclusions Most college students had poor knowledge but followed hygienic practices correctly. It demonstrates a need to design acceptable awareness creation and advocacy programs to improve college students' knowledge during menstruation. Of all the sociodemographic factors, monthly income and types of family influenced students' knowledge and practices related to menstruation.

Prevalence of Premenstrual Symptoms and Symptom Severity among Female Medical Students - An Institutional Study

BACKGROUND Premenstrual symptoms are generally seen 7 - 10 days before the menstruation period and are collectively called as premenstrual syndrome. Dysmenorrhea is the most common premenstrual symptom that affects the lifestyle and activity of young women. This study was aimed at estimating the prevalence of premenstrual symptoms and its severity in female medical student population of Government Medical college, Patiala, Punjab. METHODS 500 female medical students aged between 18 - 28 years were included in the study. Female students were asked to fill preformed questionnaire to elicit gynaecological information as well as the 4-point grading scale menstrual distress questionnaires. Symptoms were divided into two groups: physical symptoms and behavioural / psychological symptoms. RESULTS Only 30.24 % of the students reported one or more symptoms; of these, 22.76 % were having mild, 5.6 % moderate and 1.87 % severe degree of symptoms. From physical and behavioural / psychological symptoms, it was noticed that behavioural / psychological symptoms predominate. Among physical symptoms, breast tenderness is experienced most followed by bloating, and weight gain during premenstrual phase. Among psychological / behavioural symptoms, irritability predominates followed by restlessness & mood swings. CONCLUSIONS Diagnosis is best achieved through daily rating symptoms over at least one menstrual cycle; clinicians can ask patients to choose their worst symptoms and chart the severity daily, or can select a validated scale such as the Daily Record of Severity of Problems. Disappearance of symptoms after menstruation is the key to diagnosis. KEYWORDS Premenstrual Syndrome, Depressive Disorder, Prevalence, Dysmenorrhea

Pubertal development and risk of premenstrual disorders in young adulthood

STUDY QUESTION Is pubertal timing associated with risk of premenstrual disorders (PMDs) in young adulthood? SUMMARY ANSWER Late pubertal development is associated with decreased premenstrual symptom burden and risk of PMDs in young adulthood. WHAT IS KNOWN ALREADY PMDs, including premenstrual syndrome and premenstrual dysphoric disorder, may begin during the teenage years. Few risk factors in early life have been identified for PMD development. STUDY DESIGN, SIZE, DURATION A prospective cohort study of 6495 female participants during 1996–2013. PARTICIPANTS/MATERIALS, SETTING, METHODS We included participants from the Growing Up Today Study (GUTS). Pubertal development was indicated by the timing of menarche, breast and pubic hair growth. Self-reported age at menarche was longitudinally assessed at enrollment (in 1996/2004 for GUTS I/II) and onwards, and classified as early (age ≤ mean − SD, 11.64 years), normative and late menarche (age ≥ mean + SD, 13.95 years). Timing of pubic hair and breast growth were assessed multiple times during follow-up via Tanner scales, and classified into early, normative and late development according to mean ± SD. Using a validated questionnaire based on the Calendar of Premenstrual Experiences, we assessed premenstrual symptoms and identified probable cases of PMDs in 2013. We examined the associations of timing of pubertal development with premenstrual symptom score and disorders using multivariable linear and logistic regressions, respectively. MAIN RESULTS AND THE ROLE OF CHANCE In 2013 (mean age = 26), 1001 (15.4%) individuals met criteria for a PMD. An inverse association was found between age at menarche and premenstrual symptom z-score (β −0.05 per year, 95% CI −0.07 to −0.03) and risk of PMDs (odds ratio (OR) 0.93 per year, 95% CI 0.88 to 0.99). Compared to individuals with normative menarche, individuals with late menarche had a lower risk of PMDs (OR 0.73, 95% CI 0.59 to 0.91), while individuals with early menarche had comparable odds (OR 0.98, 95% CI 0.81 to 1.18). Moreover, early growth of pubic hair was associated with increased premenstrual symptoms (z-score β 0.09 per year, 95% CI 0.02 to 0.17) and PMD risk (OR 1.28, 95% CI 1.04 to 1.56), independent of age at menarche. No associations were noted for breast development. LIMITATIONS, REASONS FOR CAUTION One major limitation is some misclassification of menarche due to recall. We, however, showed robust association among participants who were premenarcheal at baseline. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that pubertal timing, particularly timing of menarche, is inversely associated with the risk of developing premenstrual symptoms in young adulthood, and that women with later menarche have significantly lower risk of PMDs. Information on PMDs should be provided to teenage girls and their parents. If these findings are confirmed in independent populations, prevention strategies and early detection programs may be considered for women with early pubertal development. STUDY FUNDING/COMPETING INTEREST(S) The work is supported by the National Institutes of Health and Swedish Research Council. TRIAL REGISTRATION NUMBER N/A

A study of impact of stress: examinations on menstrual cycle among medical students

Background: Premenstrual Syndrome (PMS), a common problem among adolescent girls, is associated with various physical, mental and behavioral symptoms that lead to social and occupational impairment. Stress has also been hypothesized to be an important etiologic factor. Examination stress may also be responsible for affecting the premenstrual symptoms. The objectives of this study was to study the impact of exam stress on the menstrual cycle and the relationship of perceived stress with the severity of premenstrual symptoms. Methods: This was a cross-sectional observational study conducted among female medical students of final MBBS, who were candidate of upcoming exams. They were assessed on semi structured socio-demographic and menstrual history proforma, ACOG guidelines, DSM-5 criteria, Perceived Stress Scale (PSS) and Premenstrual Symptom Screening Tool (PSST).Results: As per ACOG guidelines, 66% participants had PMS and 6% participants had PMDD according to DSM-5 criteria. On PSST total 88% participants had premenstrual symptoms and out of them 58% had mild/no PMS while 30% had moderate to severe PMS. 5% participants also fulfilled criteria for PMDD on PSST. Stress was found to be mild in 26% and moderate in 74% participants on PSS. PMS was found in 93.75% participants who had painful menstruation (dysmenorrhea) and this association was statistically significant. Data wise 73.1% participants having mild stress had PMS, while 93.2% participants having moderate stress, had PMS and this association was found to be statistically significant. Surprisingly not a single participant consulted to any health care provider for their menstruation related problems.Conclusions: Premenstrual Syndrome is common in adolescent girls and exam stress is an important etiological factor. PMS/PMDD was found significantly higher in participants who had dysmenorrhea and moderate stress. A positive and highly significant correlation was also found between the severity of stress and severity of premenstrual symptoms.

A potential relation between premenstrual symptoms and subjective perception of health and stress among college students: a cross-sectional study

Background A majority of women from all cultures and socioeconomic levels experience myriad symptoms known as premenstrual syndrome during the days prior to menstruation. The present study investigated commonly reported symptoms in the premenstrual phase among college students. The authors further scrutinized potential factors, including subjective perceptions of health, which may be related to the premenstrual-symptom constellation. Methods We conducted a cross-sectional survey, which included 200 participants (mean age: 19.8 ± 0.1 years old). The subjects completed a rating of their premenstrual experiences relative to 46 symptoms in eight categories of the self-reporting menstrual distress questionnaire (MDQ) to evaluate the prevalence and severity of premenstrual symptoms. The participants also answered a standardized health questionnaire regarding subjective perceptions of health, self-rating stress, lifestyle, and demographic variables. Results Regardless of severity, the 10 symptoms most often occurring among the participants included skin disorders, irritability, fatigue, mood swings, general aches and pains, lowered school or work performance, backache, painful breasts, weight gain, and swelling. Stepwise multiple regression analysis revealed subjective perception of health (β = 0.28; p < 0.001) and self-rating stress (β = 0.18; p = 0.008) as the factors most strongly related to the MDQ total scores. In addition, the 19 women who evaluated themselves as “unhealthy and stressed” had greater prevalence of severe or extremely severe physical (general aches and pains) and psychosocial symptoms (confusion, lowered school or work performance, decreased efficiency, loneliness, anxiety, restlessness, mood swings, and depression), compared to the healthy and non-stressed women. Conclusions The present study indicates the prevalence of premenstrual symptoms, regardless of severity and number, among college students and suggests that negative subjective perceptions of health and stress may be related to the intensity of premenstrual symptomatology.