Abstract
ABSTRACTBackground and objectivesThe underlying reasons why some women experience debilitating premenstrual symptoms and others do not are largely unknown. Here, we test the evolutionary ecological hypothesis that some negative premenstrual symptoms may be exacerbated by the presence of chronic sexually transmitted infections (STIs).Methodology34 511 women were recruited through a digital period-tracker app. Participants were asked: (i) Have you ever been diagnosed with a STI? (ii) If yes, when was it, and were you given treatment? Those data were combined with longitudinal cycle data on menstrual bleeding patterns, the experience of pain and emotions and hormonal contraceptive use.Results865 women had at least two complete menstrual cycle data and were eligible for analysis. Before diagnosis, the presence of an infection predicts a ca. 2-fold increase in the odds of reporting both headache, cramps and sadness during the late luteal phase and sensitive emotions during the wider luteal phase. After diagnosis, the odds of reporting negative symptoms pre-menstrually remain unchanged among STI negative individuals, but the odds of reporting sensitive emotions decrease among STI positive individuals receiving a treatment. No relationships between STIs, pain and emotions are observed among hormonal contraceptive users.Conclusions and implicationsThe results support the idea that a negative premenstrual experience might be aggravated by the presence of undiagnosed STIs, a leading cause of infertility worldwide. Caution is warranted in extrapolating the results as the data are self-reported, inflammatory levels are unknown and the tracker is biased towards recording negative premenstrual symptoms among Western individuals.
Highlights
Background and objectivesThe underlying reasons why some women experience debilitating premenstrual symptoms and others do not are largely unknown
The analysis aims at answering the following two questions: (Q1) Does the presence of an undiagnosed infection exacerbate the occurrence of pre-menstrual symptoms? (Q2) Do Premenstrual syndrome (PMS)-like symptoms improve after diagnosis and treatment? All analyses were performed using the R software version 3.3.3. [27] and aggregate data are available on Figshare data repository [28]
Why women experience negative premenstrual symptoms has recently been linked to inflammation [13, 14, 24], and it has been suggested that PMS is best conceptualized as an ‘inflammatory disease’ [24]
Summary
Background and objectivesThe underlying reasons why some women experience debilitating premenstrual symptoms and others do not are largely unknown. Those data were combined with longitudinal cycle data on menstrual bleeding patterns, the experience of pain and emotions and hormonal contraceptive use. Caution is warranted in extrapolating the results as the data are self-reported, inflammatory levels are unknown and the tracker is biased towards recording negative premenstrual symptoms among Western individuals. Premenstrual syndrome (PMS), a chronic condition experienced by women before their menses and characterized by >200 negative physical and psychological symptoms (PMSx) including anxiety, depression, pelvic pain and headaches [1, 2], is common yet poorly understood [3]. 80% of fertile women experience one or several symptoms and for 3–8% of naturally cycling women, the experience of the pre-menstrual period is so debilitating that it is categorized as a premenstrual dysphoric disorder (PMDD) that requires medical attention [7, 8]. While biomedical research views premenstrual changes as the mark of a hormonal and psychological disease rather than a natural event, an evolutionary perspective points to the fundamental dialogue between the immune and neuroendocrine systems for understanding the health of living organisms [6]
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