Impact Of Menstruation Research Articles

Understanding gender-responsive needs of girls in the Children and Young People Secure Estate (CYPSE): menstrual cycle considerations

PurposeThe current study aimed to examine the population of girls in two secure children’s homes (SCHs) in the North East of England to consider the impact of menstruation on girls’ physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice.Design/methodology/approachA case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023.FindingsOf the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls’ menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls’ presentations.Originality/valueThe results indicate the impact of menstrual cycles on girls’ physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research.

Menstrual hygiene management and menstrual problems among adolescent girls in an urban area in north India: A cross-sectional study.

Most adolescent women face many restrictions, which become much more severe during menstruation. In India, millions of adolescent girls drop out of school every year due to menstruation-related problems and restrictions. Despite extensive research, a paucity of literature was observed on the level of knowledge, attitude, and practices of adolescent girls regarding menstruation. Hence, we proceeded to undertake the present study, to have a deeper understanding of the menstrual hygiene management of adolescents. To describe the menstrual hygiene management among adolescent school girls. (a) To examine the association, if any, between menstrual hygiene management and school absenteeism during menstruation in adolescent school girls. We conducted a school-based cross-sectional analytical study in an urban area in north India. The study population comprised adolescent school girls of all the high schools in the urban area. With a 95% confidence interval, and 5% margin of error, the sample size was calculated to be 369. However, an even larger sample size of 600 was actually studied. The probability proportional to size sampling approach was followed based on the number of adolescent girls in each school class/section. Participants were selected through a stratified proportionate sampling method. Ethical approval was obtained from the ethical committee of the district director of education of the urban area where the study was conducted before the commencement of the study. Confidentiality of the information collected was ensured. The data collected was quantitative in nature, using a pretested self-administered questionnaire consisting of both open-ended and close-ended questions. Data was checked for its completeness, coded, and entered into Microsoft Excel 2021 Spreadsheet. Subsequently, the data was imported into IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. for data analysis. Standard statistical methods were utilized for data analysis. The mean age (standard deviation [SD]) of the study participants was 13.68 (1.29). The mean age (SD) at menarche was 13.29 (0.96). Based on the overall menstrual hygiene management score, 377 (62.83%) of the study participants were engaged in good menstrual hygiene management, while 223 (37.17%) were engaged in poor menstrual hygiene management. The mean score (SD) was 7.80 (±0.43). Compared to those aged 17-19 years, those aged 10-13 years had a 0.36 (95% CI 0.17-0.75) decreased odds of good menstrual hygiene, while those aged 14-16 years had a 0.29 (95% CI 0.14-0.59) decreased odds of good menstrual hygiene. The adjusted odds ratios were 0.32 (95% CI 0.19-0.65) and 0.25 (95% CI 0.12-0.41) respectively. Out of 600 study participants, 229 (38.17%) reported school absenteeism at least once in the last 1 year because of menstruation. The mean (standard deviation) duration of school absenteeism was 2.4 (0.78) days per menstrual cycle. The commonest reason for menstruation-related school absenteeism was pain, wherein 105 (45.85%) study participants reported this reason. In our study, we observed that over two-thirds of the study participants were engaged in good menstrual hygiene practices, while ~40% of them reported menstrual-related school absenteeism. Our study also found evidence that the age of the school girls was associated with their menstrual hygiene management practices. We recommend further research on the impact of menstruation and its management on the academic performance of adolescent school girls. Efforts are also required to develop the capacity of teachers to teach menstrual hygiene education.

Patient-relevant health outcomes for von Willebrand disease, platelet function disorders, and rare bleeding disorders: a Delphi study

BackgroundTo assess patient value, it is essential to regularly measure health outcomes that matter to patients. It is currently unknown which health outcomes are important for patients with autosomal inherited bleeding disorders. ObjectivesThis study aimed to assess which health outcomes are important for patients with autosomal inherited bleeding disorders, consisting of von Willebrand disease, platelet function disorders, and rare bleeding disorders, as seen from the patients’, caregivers’, and healthcare professionals’ perspectives. MethodsTwo panels, one consisting of patients and caregivers, and one consisting of healthcare professionals participated in a Delphi process. A list of 146 health outcomes was identified from the literature. During 3 rounds, both panels rated the importance of health outcomes on a 5-point Likert scale. A health outcome was considered important by a panel if it received a median score of 5 with an IQR of ≤1. ResultsIn total, 13 patients, 10 caregivers, and 19 healthcare professionals participated in the Delphi study. Both panels reached consensus on the importance of health outcomes related to bleeding episodes, life-threatening complications, and the intensity and impact of menstruation. Patients and caregivers additionally reached consensus on the importance of health outcomes related to menstruation and the impact of the bleeding disorder on their daily lives. Healthcare professionals reached consensus on the importance of health outcomes related to treatment, joint health, and pain. ConclusionIn this study, health outcomes were identified that should be considered when implementing value-based health care in the care of patients with autosomal inherited bleeding disorders.

The amenorrhea as a protective factor for healing of hysterotomy - a retrospective analysis one year postpartum.

The good healing of the hysterotomy after cesarean section is important for subsequent pregnancies. However, the factors which improve this healing have not been completely described, yet. In this study, we focused on factors which may affect healing of hysterotomy within one year after delivery, such as menstruation, breastfeeding, and the use of the contraception. Following delivery, total of 540 women were invited for three consecutive visits at six weeks, six months, and 12 months postpartum. The presence of menstruation, frequency of breastfeeding and contraception use were recorded. The scar was evaluated by vaginal ultrasound as already described. The impact of menstruation, breastfeeding, and contraception method on presence of niche was evaluated. The presence of menstruation increased odds to have niche by 45% (CI 1.046-2.018, p = 0.026). Secondarily, our results demonstrated a statistically significant protective effect of breastfeeding on the incidence of niche with OR 0.703 (CI 0.517-0.955, p = 0.024). Breastfeeding decreases odds to have niche by 30%. Also, the use of gestagen contraception lowered the odds by 40% and intrauterine device (IUD) or combine oral contraceptive (COC) by 46.5%. The other possibly intervening factors were statistically controlled. Amenorrhea, breast-feeding and progesterone-contraceptive decreases the risk of uterine niche within one year follow up.

The Impact of Menstrual Flow Intensity on Daily Activities for College Students in the United States

We investigated the prevalence of self-reported menstrual flow intensity among college students and the impact of differences in self-reported menstrual flow intensity on menstruation experiences and daily activities of college students. College students completed an online survey about menstrual flow intensity and symptoms, impact of menstruation on daily activities, and menstruation-related stress. Individuals with self-reported heavy menstrual flow were more likely to have missed class and work and canceled social activities compared to individuals with a light or moderate menstrual flow. Providing education about options to improve management of heavy menstrual flow is critical to mitigating negative menstruation experiences.

Menstrual status and perceived coaching strategy and training methodology in high-performance female swimmers from Slovenia - Preliminary study

Female swimmers participate in intensive swimming training during their menstrual periods, and they may appreciate additional understanding and flexibility regarding their training volume/intensity. Male coaches often view menstruation contemptuously as an unfortunate state that “is not a disease,” and high-performance female swimmers perceive coaching methods differently. Our study aimed to examine menstrual status and perceived coaching and training methodology. In a cross-sectional study, members of the Slovenian women’s national swim team (n = 14, age: 16.6 ± 3.1 years, body mass index: 20.1 ± 1.9 kg/m2) competing at international and national levels were included. The menstrual status (i.e., regularity, duration, perceived pain before and during menstruation, bleeding) and the opinion of these female swimmers regarding training during their menstrual periods were assessed via our in-depth questionnaire, and the athletes responded to additional questions pertaining to the motivation of swimming, coaching strategy and training methods via a questionnaire. All swimmers included in our study had experienced their first menstrual period, and the majority (85%) reported moderate or heavy menstrual bleeding. Most swimmers (93%) reported that their swimming training was “undisturbed” during their menstrual period; however, 64% of swimmers requested a reduction in training frequency or at least the usual training volume/intensity. In terms of the motivation for swimming, 74% of swimmers reported that they like swimming and like spending time with their friends. In terms of coaching and training methods, the swimmers reported polarized responses, probably because most of them are members of two major swimming clubs with different coaching styles. To conclude, when executed correctly, a similar kind of systematic screening method (i.e., anonymously and perhaps by experienced psychologists) may serve as a valuable tool to further modify training methods at a high-performance level. Moreover, unpleasant issues related to menstrual periods from the athlete’s perspective (i.e., pain, bleeding, malaise, discomfort, inability to achieve maximum effort) should not be ignored, left for swimmers to handle alone, or taken for granted. Male coaches need to seek to understand the impact of menstruation and work with athletes to maximize training.

The impact of menstruation on participation in adventurous activities

ABSTRACT Menstruation is a ‘taboo’ subject in many cultures and its effect on women’s participation in sport and physical culture in western societies is under-researched. This study examines the effect of menstruation and premenstrual syndrome (PMS) on habitual participants in adventurous activities through the voices of women. It transcends the social/biological divide using a theoretical framework to ascertain the personal, socio-cultural and practical constraints and enablers to participation. In a survey to explore women’s lived experiences (n = 100), 89% of respondents noted that their participation is affected by menstruation/PMS. The dominant constraints to participation in adventurous activities were related to practical challenges of hygiene and waste disposal for managing menstruation. Rich qualitative data provide evidence for the negative and emotional responses of women to ‘missing out’ on adventurous activities with the majority of concerns about their performance in socio-cultural contexts related to personal anxieties. Some women commented on their belief in being a role model in professional work encouraging open discussion around menstruation and enabling more women and girls to take part in adventurous activities. Key practical recommendations for practice are suggested in respect of provision of toilet facilities where possible and biodegradable sanitary products. Raised awareness amongst leaders and educators, particularly men is important so that they might identify strategies to manage the constraints facing women and girls and enable more inclusivity and greater participation in adventurous activities.

‘A Crisis of Transition’: Menstruation and the Psychiatrisation of the Female Lifecycle in 19th-Century Edinburgh

Examining how the female body and lifecycle were constructed within 19th-century Scottish psychiatry, and the wider significance of such portrayals, this article situates the Period Products (Free Provision) (Scotland) Act within a much longer history that presents menstruation as a problem. We highlight the historical resonance of two prominent features of the Act and the debates leading to it: the enduring tension between views of menstruation as a normal versus a pathological process, and the perceived deleterious impact of menstruation upon female education and, by extension, women’s status. By 1900, Scottish psychiatry had achieved professional status. Asylums were recognised as the officially approved response to madness, and mass institutionalisation allowed the medical profession unparalleled opportunities to observe, classify and treat those deemed insane. Madness as a ‘female malady’, with doctors portraying the female sex as more vulnerable to insanity in publications and clinical documentation, largely due to their reproductive system, has become a popular theme in historical scholarship. This article examines how 19th-century psychiatry depicted the biological ‘crises’ of the female lifecycle and the extent to which menstruation was conceptualised as a pathological process. The widely cited and prolific medical writer, Thomas Clouston—physician-superintendent of the Royal Edinburgh Asylum (1873–1908), Scotland’s largest and most prestigious asylum—offers a particularly illuminating case study. An advocate of managing mental health holistically, Clouston advised society on healthy living through adherence to respectable Victorian standards. In his policing of social norms, he became a prominent spokesperson for limiting female education to protect women during the ‘dangerous’ transition from childhood to womanhood.

Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

BackgroundQualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students.MethodsData were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering.ResultsOverall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01–3.60), believing menstrual myths (aOR = 1.83; 0.95–3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04–3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33–4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89–3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28–6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21–4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23–0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66–8.77).ConclusionsMenstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.

A quality‐of‐life questionnaire for heavy menstrual bleeding in Thai women receiving oral antithrombotics: Assessment of the translated Menstrual Bleeding Questionnaire

BackgroundHeavy menstrual bleeding (HMB) is common among reproductive‐aged women receiving oral antithrombotics and frequently results in a negative impact on quality of life. MethodsWe translated the Menstrual Bleeding Questionnaire (MBQ) into Thai by forward translation, back‐translation, pretesting, and cognitive interviewing. The translated questionnaire was content validated by a gynecologist. A validation study was conducted for the translated MBQ and defined the optimal score for the diagnosis of HMB. We then performed a cross‐sectional study to determine the prevalence of HMB using the translated MBQ. Reproductive‐aged Thai women who visited outpatient clinics receiving oral antithrombotics were asked to assess menstrual characteristics after receiving antithrombotics. The impact of menstruation on quality of life was assessed by using the MBQ. ResultsThe translated MBQ had excellent reliability (intraclass correlation coefficient = 0.93) and discriminated between women with and without HMB (area under the receiver operating characteristic curve = 0.93). A score of 21.5 had 82.9% sensitivity and 83.1% specificity in the diagnosis of HMB. The mean (standard deviation) of the score was significantly higher in the HMB group than in the normal menstrual bleeding group (30.4 [9.4] vs 15.4 [5.6]; P < .001, respectively). Of the 49 women, the prevalence of HMB in patients receiving warfarin (n = 29), direct oral anticoagulants (n = 4), or antiplatelet agents (n = 16) was 27.6%, 25.0%, and 25.0%, respectively. ConclusionsMBQ is a simple and valid tool that can be applied to screen women experiencing HMB. One‐fourth of reproductive‐aged women who received oral antithrombotics experienced HMB that impacted their quality of life.

Adolescents' experiences of menarche and menstruation in disadvantaged schools in South Africa: a qualitative exploration

PurposeThis study explores how menstruation is perceived, experienced and navigated by school-going adolescent girls living in low-to-middle income settings in South Africa. Existing research from developing countries suggest that the onset of menstruation has implications for school attendance and academic performance. There is evidence that menstrual cycle–related symptoms (primarily physical) lead to difficulties in, or interference with, and disengagement from school, social relations, and physical activities (van Iersel et al., 2016; Steiner et al., 2011; Kiesner and Pastore, 2010; Taras, 2005). The onset of menstruation can be shame-inducing and has been associated with anxiety and confusion. Few studies have been conducted on menstruation in countries with a history of sectarian violence and characterised by substantial socio-economic disparities and high levels of gender-based violence. Understanding the experiences of girls in these contexts is important in generating contextually-grounded knowledge and appropriate interventions.Design/methodology/approachA qualitative, exploratory, descriptive and contextual research design was used to collect data from 48 adolescent girls aged 13–16 year-old. A total of six focus group discussions (FGDs) were conducted using a semi-structured questionnaire among a purposive sampling method. Data collected were transcribed verbatim and thematically analysed. Written parental consent was obtained for participants under 18 years old.FindingsThe findings illustrated complex psychological experiences in response to menarche and menstruation. Experiences of shame in relation to menstruation were aggravated by unsupportive responses from school teachers. Challenges such as scarcity of sanitary products were experienced as creating a barrier for girls' school attendance.Research limitations/implicationsExisting research from developing countries suggests that the onset of menstruation has implications for school attendance and academic performance. The research data includes the views of adolescent learners and their negative reactions and positive experiences towards menstruation within the school environment.Practical implicationsGiven the comparative paucity of research emerging from developing countries in sub-Saharan Africa, this paper addresses an important gap in the literature by providing contextually-nuanced information about the menstrual experiences of adolescent girls. The study can further provide information for efforts made by the Department of Education and Department of Health regarding the impact of menstruation on adolescent girls' school attendance.Social implicationsThis study provides important insights regarding the experiences of South African school girls in relation to menstruation. Although dominant feelings of shame, confusion and disgust may surround menstruation, the study also highlighted potential positive experiences associated with menstruation. Teachers and school administrators need to be oriented towards the needs of adolescent girls if issues regarding poor school attendance are to be addressed.Originality/valueTo reduce absenteeism in schools and ensure learners are provided with improved allocation of sanitary products in schools, there is a need for the advocacy regarding sexuality education and resources to promote the psychological health of adolescent girls.

The intersection of menstruation, school and family: Experiences of girls growing up in urban cities in the U.S.A

ABSTRACT Evidence on U.S.A. girls’ experiences with menstruation, especially in schools, remains limited. This includes learning from low-income, urban and Black, Indigenous and People of Colour (BIPOC) girls; with the latter often experiencing puberty and menarche earlier than their peers. Qualitative and participatory research methodologies were utilized with girls (15-19) and adults working with youth in three U.S.A. cities (New York City, Los Angeles, Chicago), exploring experiences of menstruation within school and family contexts. Findings revealed gaps in girls’ practical knowledge and support around menstruation, challenges with menstrual pain while in school, and the negative impact of menstruation on girls’ engagement in physical or sports-related activities. There is a need for improved guidance on the practicalities of period management and strategies to support girls with menstrual pain. Lastly, given the benefits of physical activity on girls’ health, new approaches are needed to improve their sport and physical activity experiences while menstruating.

‘I do what a woman should do’: a grounded theory study of women’s menstrual experiences at work in Mukono District, Uganda

Menstrual health has received increasing recognition as an essential issue for public health and gender equality. A growing body of research has elucidated adolescent girls’ menstrual needs and informed policy...

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease.

Women with sickle cell disease (SCD) are living longer as a result of advances in the care of their underlying disease. With the population growing of women living with SCD, reproductive health issues in this population have become an emphasized area of medical care. We sought to describe current patterns of contraception use, menstruation, and quality-of-life (QOL) measures in women with SCD. Using a cross-sectional study design, we administered paper surveys at two academic medical centers to women aged 10 to 55 years with SCD to capture current contraceptive use, characteristics of menstrual cycles, and QOL metrics. Of the 103 women who participated, 12.7% (13/102) experienced a duration of menses >7 days (defined here as prolonged menstrual bleeding). Approximately half of women (51.5%, 53/103) used some form of contraception, with depot medroxyprogesterone acetate injections and condoms being the most common. During their last menstrual periods, women with both dysmenorrhea and prolonged menstrual bleeding (6.9%, 7/102) were more likely to experience more days of poor QOL, with more nights with sleep disturbance (P = 0.001) and more days with trouble taking care of themselves (P = 0.003), as well as being unable to do things they previously enjoyed (P = 0.001), compared with those with neither phenomenon (28.2%, 29/103). Dysmenorrhea and prolonged menstrual bleeding negatively affect the QOL of women with SCD. Menstrual histories and preventive measures for menstruation-related morbidity should be incorporated into routine evaluations of women with SCD.

Impact of menstruation on school performance in Sarwaran and Shahid Khajabawa high school in Erbil city

Background: Menstruation is episodic uterine bleeding in response to cyclic hormonal changes and lead to the following discomforts for the girls: a bloody discharge of the vagina, pains, abdominal bloating, headache, fatigue, breast tenderness, nausea, vomiting, loose stools, mood swings, irritability, and sweating which affect on school performance. Objectives: finding out the effect of menstruation and associated discomforts on school performance including attendance, assignment and activities among female students. Methods: A descriptive study was conducted in the two high school of Erbil city on 185 female students (90 of Sarwaran and 95 of Shahid khajabawa high school) during 2nd of Jan to 30th of May, 2012. Data were collected by an interview, using a questionnaire designed by the researchers. Chi-square test was used to study the significance of association between school performance and menstrual characteristics and associated physical discomforts. Results: the affected percentage of students by menstruation on their school performance were as following: school homework (69.2%), school attendance (23.2%), exam (62.7%) and participation in class activity and presentation (57.1%). There were significant association between age at menarche, amount of blood flow, taking medication during menstruation and menstrual discomforts (abdominal pain, back pain, nausea and vomiting, anxiety) with school performance. Conclusion: Menstruation characteristics and associated physical and psychological discomforts affect on school performance.

Die Menstruation und ihre Bedeutung für die Frauengesundheit

The impact of menstruation on women's health manifests itself on different levels. The sociocultural dimension shows the influence of societal and cultural norm, which regulate the way of dealing with menstruating women. These rules are at first glance in most cultures characterized by rather expulsion, rejection and submission of women. At a closer look many traditions however reflect the fascination and the power which is associated with the "blood of women", which means that throughout history menstruation is conceived in an ambivalent manner. This ambivalence is still present in the subjective experience of modern women, who experience the biological process of menstruation but finally attribute emotional and cognitive meaning to it. This means that women finally decide when menstruation becomes a "disease" for them. Many empirical studies show that although a majority of women declare menstruation as something negative and disturbing, only a much smaller percentage would want to get rid of it, because menstruation seems to be associated with feelings of connectedness with nature and with other women. The biomedical view on menstruation is historically new and quite different: uterine bleeding can either be a sign of disease (uterus, ovaries) or it can lead to anemia, pain, anxiety, frustration in women consulting. Menstrual disorders are in fact one of the most frequent reasons for consultation. Modern medicine has developed a large range of interventions which modify or abolish menstruation. From a medical standpoint menstruation is not necessary and may be obsolete. The transition from "healthy menstruation" to "menstruation related diminution of quality of life", to "Menstrual Disease" is continuous and has to be elaborated in the physician patient interaction, the patient being expert for her values, aims and health objectives and the physician being the expert for knowledge and information. The patient has to use this to come to a personal and individual solution of her menstruation problem.

Metabolic control, food intake and mood during the menstrual cycle in patients with insulin-dependent diabetes

The impact of menstruation on metabolic control was studied among 20 insulin-dependent diabetics (IDDM) and 20 healthy controls during two menstrual cycles. No systematic fluctuation in glycated protein, blood glucose levels, food intake, intake of mono- and disaccharides, body weight, or mood could be seen during different weeks in the menstrual cycle. A tendency towards menstruation-related variations in the number of insulin reactions and amount of extra injected insulin was observed in the patient group. Levels of glycated protein were significantly ( P<0.05) higher during the premenstruational than during the postmenstruational week, although the difference was small in absolute terms. A poorer mood during the premenstruation weeks (indicating premenstruation syndrome) was associated with a high number of hypoglycemic events ( P<0.01) and frequent changes in insulin doses ( P<0.01). Thus, taken as a group diabetic women do not experience great changes in food intake or metabolic control during the menstrual cycle. This does not exclude the possibility that a small proportion of women have major menstruation related difficulties in controlling their diabetes.