Abstract
BackgroundThe premenstrual syndrome (PMS) causes clinically relevant psychological and physical symptoms in up to 20% of women of reproductive age. To date, no studies have investigated the relationship between PMS and residential surrounding greenspace, although a green living environment has been reported to have beneficial associations with overall and reproductive health. ObjectiveTo investigate whether lifelong exposure to residential surrounding greenspace is associated with PMS and whether such an association is mediated by BMI, air pollution or physical activity. MethodsThis study used data collected in 2013–2015 from 1069 Scandinavian women aged 18–49 years, participating in RHINESSA, a European multi-centre and population-based cohort. Satellite-derived Normalised Difference Vegetation Index was used as a proxy of greenspace. Presence of eight common PMS symptoms and their sum (PMS symptom count) were used as outcomes. The associations were assessed by adjusted multilevel logistic and negative binomial regressions. Subsequently we carried out mediation analyses for physical activity, BMI and air pollution exposure. ResultsHigher exposure to residential surrounding greenspace was associated with “Anxiety or tension” (Odds Ratio 0.82, 95% Confidence Interval (CI): 0.70 – 0.95), ”Depression or hopelessness” (0.84, 0.73 – 0.98), “Difficulty with sleeping” (0.82, 0.68 – 1.00) and “Breast tenderness and abdominal bloating” (0.84, 0.71 – 0.99) before or around the start of the menstrual period. There was also an association with a lower PMS symptom count (Risk Ratio: 0.94, 95% CI: 0.91 – 0.99). These associations were robust to sensitivity analyses and were not mediated by BMI, physical activity or air pollution. ConclusionsLiving in greener areas may be beneficial against PMS symptoms. Further studies are needed to confirm these novel findings and to explore the underlying biological mechanisms.
Highlights
During the preceding days of menstruation women often experience discomforting physical symptoms and psychological symptoms, which together constitute the premenstrual syndrome (PMS)
Living in greener areas may be beneficial against PMS symptoms
An increase of one interquartile range in residential surrounding greenspace was associated with “Anxiety or tension” (Odds Ratio: 0.82, 95% Confidence Interval (CI): 0.70 – 0.95), “Depression or hopeless ness” (0.84, 0.73 – 0.98), “Difficulty with sleeping” (0.82, 0.68 – 1.00) and “Breast tenderness and abdominal bloating” (0.84, 0.71 – 0.99) before or around the start of the menstrual period (Fig. 2) as well as the PMS symptom count (Risk Ratio: 0.94, 95% CI: 0.91 – 0.99), indicating a 6% decrease in the incidence rate ratio of the PMS symptom count for every IQR increase in Normalised Difference Vegetation Index (NDVI)
Summary
During the preceding days of menstruation women often experience discomforting physical symptoms (e.g. pain, bloating, sleep problems) and psychological symptoms (e.g. anger, depression, anxiety), which together constitute the premenstrual syndrome (PMS). PMS can sub stantially affect quality of life and impair cognitive function, attention span, and self-esteem (Ghodrati et al 2018; Slyepchenko et al 2017) As such, it is of great public health interest at an individual and population levels because of its high prevalence in menstruating women. Objective: To investigate whether lifelong exposure to residential surrounding greenspace is associated with PMS and whether such an association is mediated by BMI, air pollution or physical activity. We carried out mediation analyses for physical activity, BMI and air pollution exposure. There was an association with a lower PMS symptom count (Risk Ratio: 0.94, 95% CI: 0.91 – 0.99) These associations were robust to sensitivity analyses and were not mediated by BMI, physical activity or air pollution
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