Menstrual Cycle-related Symptoms Research Articles

Chronicling menstrual cycle patterns across the reproductive lifespan with real-world data

The intricate hormonal and physiological changes of the menstrual cycle can influence health on a daily basis. Although prior studies have helped improve our understanding of the menstrual cycle, they often lack diversity in the populations included, sample size, and the span of reproductive and life stages. This paper aims to describe the dynamic differences in menstrual cycle characteristics and associated symptoms by age in a large global cohort of period-tracking application users. This work aims to contribute to our knowledge and understanding of female physiology at varying stages of reproductive aging. This cohort study included self-reported menstrual cycle and symptom information in a sample of Flo application users aged 18–55. Cycle and period length and their variability, and frequency of menstrual cycle symptom logs are described by the age of the user. Based on data logged by over 19 million global users of the Flo app, the length of the menstrual cycle and period show clear age-associated patterns. With higher age, cycles tend to get shorter (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 1.85 days, Cohen’s D = 0.59) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.42 days, Cohen’s D = 0.09), until close to the chronological age (40–44) suggesting menopausal transition, when both cycles and periods become longer (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.86 days, t = 48.85, Cohen’s D = 0.26; Period length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.08, t = 15.6, Cohen’s D = 0.07) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 2.80 days, t = 111.43, d = 0.51; Period length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.23 days, t = 67.81, Cohen’s D = 0.31). The proportion of individuals with irregular cycles was highest in participants aged 51–55 (44.7%), and lowest in the 36–40 age group (28.3%). The spectrum of common menstrual cycle-related symptoms also varies with age. The frequency of logging of cramps and acne is lower in older participants, while logs of headache, backache, stress, and insomnia are higher in older users. Other symptoms show different patterns, such as breast tenderness and fatigue peaking between the ages of 20–40, or mood swings being most frequently logged in the youngest and oldest users. The menstrual cycle and related symptoms are not static throughout the lifespan. Understanding these age-related differences in cycle characteristics and symptoms is essential in understanding how best to care for and improve the daily experience for menstruators across the reproductive life span.

Breaking barriers: Exploring female-specific health challenges affecting performance in an elite multisport training environment

ObjectivesFemale-specific issues, such as breast injuries, pelvic floor dysfunctions, saddle sores, and menstrual symptoms, can significantly impact female athletes. This study examined the prevalence, perceived impact on performance, and role of the support staff in addressing and managing these issues in elite athletes based at a multisport training centre. DesignAnonymous online questionnaire. MethodsA total of 180 female athletes from various sport disciplines at the Dutch Olympic Training Centre were invited to participate in the study. An anonymous, 39-item questionnaire was developed and hosted on Qualtrics collecting data on respondents' characteristics, breast injuries, pelvic floor dysfunctions, saddle sores, menstrual symptoms, contraceptive use, and communication about these issues. ResultsA total of 105 valid responses were analysed. The findings revealed that athletes regularly experience breast injuries (15.2 %), urinary incontinence (29.5 %), other pelvic floor problems (21.0 %), saddle sores (65.7 %), and menstrual cycle-related symptoms, with negative performance effects. Communication with support staff remained limited, with only 23.8 % of athletes discussing any of these issues, often due to concerns about understanding, shame, or a lack of opportunity for easy communication. ConclusionsThe findings underscore the crucial role of creating a supportive environment, promoting early intervention, and utilising multisport centres to comprehensively address these concerns, emphasising the need for open communication, education, and support to enhance female athletes' performance and well-being.

Nutritional practices to manage menstrual cycle related symptoms: a systematic review.

Certain nutritional practices may reduce menstrual-related symptoms, but there is no current consensus on what foods/supplements are sufficiently evidenced to warrant promotion to reduce menstrual symptoms of naturally menstruating individuals. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two online databases were searched for published experimental studies that investigated the effects of foods/supplements on menstrual-related symptoms in eumenorrhoeic women. Extracted data and study characteristics were tabulated and grouped on the basis of food/supplement intervention and dosage compared with UK dietary reference values (DRV) and safe upper limits. In total, twenty-eight studies and twenty-one different foods/supplement interventions were included in the review. None of the studies reported a negative effect on symptoms, twenty-three reported a positive effect and five had no effect. Eighteen different ways of measuring menstrual-related symptoms were described across the studies. The results indicate a lack of consistency in studies to confidently provide information to eumenorrheic, naturally menstruating women regarding the use of foods/supplements to reduce menstrual symptoms. Determination of menstrual-related symptoms varied along with dose and duration of food or supplements provided. These data provide some evidence for the use of vitamin D, calcium, zinc and curcumin to reduce menstrual-related symptoms of non-hormonal contraceptive users, on an individual basis; however, further investigation is required prior to implementation with a focus on robust protocols to determine and measure changes in menstrual symptoms, with interventions adhering to DRV and safe upper limits.

Evaluation of menstrual symptoms after Coronavirus disease 2019 vaccination in women with endometriosis.

Vaccination can have an impact on menstruation, and this impact may be more notable in women with inflammatory gynecological pathologies such as endometriosis. We aimed to investigate the impact of mRNA-based SARS-CoV-2 vaccines on menstrual cycle-related symptoms in women with endometriosis and assess the effect of hormonal therapy on potential SARS-CoV-2 vaccination-induced menstrual changes. A total of 848 women who received at least two doses of mRNA-based COVID-19 vaccines were prospectively recruited: 407 with endometriosis (endometriosis group) and 441 healthy controls (non-endometriosis group). Data regarding demographics, clinical characteristics, hormonal treatment, and menstrual-associated symptoms in the first and second cycle after vaccination were collected through an online survey. A similar percentage of patients in both the endometriosis and the non-endometriosis group self-reported menstrual-associated changes the first (52.6% versus 48.8%, respectively) and second cycle after vaccination (29.0% versus 28.1%, respectively). Although the total symptoms recorded were not different between the two groups, several specific symptoms were statistically more frequent in the endometriosis group. These were pain disorders and fatigue in the first cycle after vaccination and pain disorders, menstrual headache and fatigue in the second cycle after vaccination. Bleeding frequency/regularity disorders were found to be more frequent in the non-endometriosis group in the first cycle after vaccination. Patients under hormonal treatment reported fewer changes in menstrual symptoms in the first and second cycle after vaccination compared with those not receiving this treatment. Similarly, patients in the endometriosis group receiving hormonal treatment reported fewer changes in menstrual-associated symptoms compared with those not following any hormonal treatment in the first and second menstrual cycle after the last vaccination. Women with endometriosis immunized with mRNA-based SARS-CoV-2 vaccines did not perceive greater worsening or new menstrual-associated symptoms after complete COVID-19 vaccination compared with healthy controls. Hormonal treatment may have a protective effect against worsened or new menstrual symptoms induced by COVID-19 vaccination.

Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports.

Female athletes train and compete under the potential influence of hormonal fluctuations during the menstrual cycle or during use of various hormonal contraceptives. Dysmenorrhea and premenstrual symptoms are common in the general population, as well as side effects of hormonal contraceptives. More detailed knowledge concerning prevalence and perceived impact of these symptoms on training and performance in different sports is required. The aim of the study was to 1) characterize perceptions of training and performance during the menstrual cycle phases and by hormonal contraceptive use in a large population of female athletes; 2) explore whether symptoms experienced are related to perceived performance; and 3) examine potential differences in these factors between athletes at different levels of performance. The study was based on self-reported data from 1,086 athletes from 57 sports at different performance levels via a web-based questionnaire. Thirty-seven percent (n = 407) of the athletes did not use hormonal contraceptives. In this group, menstrual cycle related symptoms were common across all athlete levels, particularly dysmenorrhea (74%, n = 300) and premenstrual symptoms (78%, n = 318), which also influenced perceived performance of aerobic fitness, muscle strength, mental sharpness, balance, and sleep quality. Sixty-three percent (n = 679) of the athletes used various hormonal contraceptives and 40% (n = 272) perceived a variety of side-effects. Physical performance was experienced equally independent of time-point of the pill-chart except for the period of inactive pills, which was associated with more negative impact. Nonetheless, only 18% (n = 191) of the athletes considered menstrual cycle or hormonal contraceptive issues when planning their training or competitions. These results indicate that greater focus is needed to identify and effectively treat different menstrual cycle and hormonal contraceptive related symptoms on an individual level.

A Novel Drug Modulator Diarylheptanoid (trans-1,7-Diphenyl-5-hydroxy-1-heptene) from Curcuma comosa Rhizomes for P-glycoprotein Function and Apoptosis Induction in K652/ADR Leukemic Cells.

Curcuma comosa has been used in traditional Thai medicine to treat menstrual cycle-related symptoms in women. This study aims to evaluate the diarylheptanoid drug modulator, trans-1,7-diphenyl-5-hydroxy-1-heptene (DHH), in drug-resistant K562/ADR human leukemic cells. This compound was studied due to its effects on cell cytotoxicity, multidrug resistance (MDR) phenotype, P-glycoprotein (P-gp) expression, and P-gp function. We show that DHH itself is cytotoxic towards K562/ADR cells. However, DHH did not impact P-gp expression. The impact of DHH on the MDR phenotype in the K562/ADR cells was determined by co-treatment of cells with doxorubicin (Dox) and DHH using an MTT assay. The results showed that the DHH changed the MDR phenotype in the K562/ADR cells by decreasing the IC50 of Dox from 51.6 to 18.2 µM. Treating the cells with a nontoxic dose of DHH increased their sensitivity to Dox in P-gp expressing drug-resistant cells. The kinetics of P-gp mediated efflux of pirarubicin (THP) was used to monitor the P-gp function. DHH was shown to suppress THP efflux and resulted in enhanced apoptosis in the K562/ADR cells. These results demonstrate that DHH is a novel drug modulator of P-gp function and induces drug accumulation in the Dox-resistant K562 leukemic cell line.

Relationship between fear of COVID-19 and premenstrual syndrome in Turkish university students

ABSTRACT Premenstrual syndrome (PMS) has been reported to be related to psychological distress. The COVID-19 pandemic has globally caused heightened levels of stress, anxiety, and fear. There is no sufficient evidence regarding the impact of the fear of COVID-19 on PMS and related symptoms. Therefore, this study examined the association of the fear of COVID-19 with PMS among Turkish university students. The sample of this cross-sectional study consisted of 829 Turkish university students. Data were collected online using the Questionnaire Form, the Premenstrual Syndrome Scale (PMSS), and the Fear of COVID-19 Scale (FCoV-19S). The prevalence of PMS was 73 percent. The most common symptoms were fatigue, irritability, appetite changes, and depression. Participants had a moderate fear of COVID-19 (mean FCoV-19S: 20.48 ± 5.96). Most participants stated that the pandemic did not affect the menstrual cycle length (72.5 percent) and bleeding (79.6 percent). Participants who noted that the pandemic impacted the length of their menstrual cycles and bleeding had a significantly higher mean FCoV-19S score than those who did not (p = .000). Moreover, FCoV-19S scores were positively correlated with PMS scores, PMS-related discomfort, and dysmenorrhea VAS scores (p < .001). This study revealed that the fear of COVID-19 affected PMS and menstrual cycle-related symptoms in Turkish university students.

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.

Hormonal Contraceptive Use in Football Codes in Australia.

The recent launch of the new National elite women's football competitions in Australia has seen a 20–50% increase in grassroots female participation. With the growing participation across grassroots to elite competitions, understanding the health of female athletes should be prioritized. In elite level athletes, hormonal contraceptive (HC) use is common (~50%), however, little is known about the prevalence and reasons for use and disuse of HC in elite female football athletes. As such, the impact of HC use is often not considered when monitoring the health of female footballers. This study involved a subset of data collected as part of a larger questionnaire investigating menstrual cycle function, hormonal contraception use, and the interaction with training load volume and perceived performance in elite female football code athletes. A total of 177 participants completed the questionnaire across three football codes within Australia (rugby league, rugby union/sevens, Australian football). One third (n = 58) of athletes were currently using HC, predominately in the form of an oral contraceptive pill (OC, n = 47). Reasons for use included: to avoid pregnancy (71%); to control/regulate cycle (38%); and to reduce menstrual pain (36%). However, most athletes using an OC (89%) could not identify the type of pill used (e.g., mono-, bi-, or triphasic). The main reason for disuse was due to the negative side effects (n = 23), such as mood swings, weight gain, and depression/anxiety. Comparing HC users and non-users, there were no statistical differences in the number of reported menstrual symptoms, use of medication to relieve menstrual pain, or frequency for needing to adapt training due to their menstrual cycle (p > 0.05). Since most athletes were unaware of the type of OC they used, female football athletes require further education about the different types of HC, and specifically OC, available to them. Similarities in the symptoms experienced, pain management, and training adaptation requirements between groups suggests that HC use may not have the intended outcome for certain athletes. As such, greater awareness of athlete's personal experiences with the menstrual cycle, how HC may influence their experience, and acknowledgment of non-pharmacological methods to help manage menstrual cycle related symptoms are warranted.

Effects of past environmental tobacco smoke exposure on the menstrual cycle and menstrual phase-related symptoms: A cross-sectional study.

This study examined the effects of current and past environmental tobacco smoke exposure on the menstrual cycle and menstrual phase-related symptoms in nonsmoking Japanese women of child-bearing age. Of 5000 women who agreed to participate, 3935 were analyzed (932 smokers, 2326 nonsmokers, and 677 past smokers). Nonsmokers were divided into three groups based on smoking status and environmental tobacco smoke exposure: nonsmokers without exposure (n = 352), nonsmokers with past exposure (n = 1196) and nonsmokers with current exposure (n = 778). Participants completed a questionnaire on background characteristics, environmental tobacco smoke exposure (location and relationship to smokers), abnormal menstrual cycle, days of menstrual cycle and menstrual cycle-related symptoms experienced in the past 3 months (assessed by the Menstrual Distress Questionnaire). Mean age was 29.7 ± 7.0 (20-44) years. Compared with nonsmokers without environmental tobacco smoke exposure, current smokers had the highest risk of an abnormal menstrual cycle (adjusted odds ratio [OR], 1.74 [1.194-2.545]), followed by nonsmokers with past exposure (adjusted OR, 1.70 [1.171-2.464]), past smokers (adjusted OR, 1.60 [1.081-2.366]) and nonsmokers with current environmental tobacco smoke exposure (adjusted OR, 1.49 [0.901-1.212]). Irrespective of environmental tobacco smoke exposure, current smokers reported significantly more severe premenstrual and menstrual symptoms than nonsmokers, and nonsmokers with past environmental tobacco smoke exposure had significantly more severe premenstrual and menstrual symptoms than nonsmokers without environmental tobacco smoke exposure. Past environmental tobacco smoke exposure, especially during childhood or adolescence, might harm women's reproductive health when they reach reproductive age.

Biomarker Validation of a New Case Definition of Menstrual Cycle-Associated Syndrome (MCAS) Opinion Paper

There are different case definitions of premenstrual syndrome, one proposed by the American College of Obstetricians and Gynecologists (ACOG) and another based on the Daily Record of Severity of Problems (DRSP) scores. Here we review our recent findings indicating that the gold-standard methods to assess PMS, including ACOG, provide a high degree of false-negative findings. We propose a new case definition of the Menstrual Cycle-Associated Syndrome (MCAS), which is characterized by increased DRSP scores during the menstrual cycle and symptom that increases the week prior to the menses. The MCAS case definition was externally validated by diverse biomarkers including plasma levels of progesterone and estradiol, chemokines (e.g. CCL2, CCL5 and CCL11), epidermal growth factor, hydroperoxides, paraoxonase 1 activity and complement C4. These biomarkers as well as IgA responses to Gram-negative bacteria are significantly associated with the DRSP and its subdomains including depression, anxiety, and physiosomatic symptoms(fatigue, pain). In conclusion, we propose, a) to use the MCAS diagnosis as an indicant of menstrual cycle-related symptoms; and b) to examine the associations of the time series in the DRSP and its subdomains and those in biomarkers including distributed lag models. Aberrations in the uterine-chemokine-brain-axis underpin the pathophysiology of MCAS whereby suboptimal pre-ovulatory follicular development coupled with a relative corpus luteum insufficiency may drive increased chemokine production, lowered antioxidant defenses, neuro-oxidative stress pathways, and increased bacterial translocation. As such, we have delineated new drug targets for the treatment of MCAS. This opinion paper reviews new possible treatments that should be trialed in MCAS.

How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players

ObjectivesTo explore athletes’ past and current experiences and perceptions of the menstrual cycle in relation to its impact on sporting performance.Methods15 international female rugby players participated in individual semi-structured interviews...

Activities of Serum Magnesium and Thyroid Hormones in Pre-, Peri-, and Post-menopausal Women.

Introduction: Females go through a complex hormonal variation once they reach menarche. The menstrual cycle repeats every month regularly and is dependent on the normal functioning of the hypothalamus, pituitary, and ovarian hormones. The overall wellness of the females during the menstrual cycle depends greatly on nutritional status. It is common that women develop menstrual cycle-related symptoms and are routinely prone to thyroid dysfunction. The present study is carried out to assess the activities of Mg and thyroid hormones in pre-, peri-, and post-menopausal women.Methods: A total of 165 women were recruited in the study after satisfying the inclusion criteria. An equal number of age-matched subjects were included as controls. All the subjects included in the study were selected from the patients attending various out-patient departments of the Prathima Institute of Medical Sciences, Karimnagar, Telangana, India. Blood samples from each subject were collected and analyzed by a semi-automated analyzer for the activities of Mg, and thyroid hormones tetra-iodothyronine (T4), tri-iodothyronine (T3), and thyroid-stimulating hormone (TSH).Results: There was a statistically significant relationship between the serum Mg activities and the thyroid hormones between the study subjects and the control group. The activities of the serum Mg (1.72±0.33) in relation to the TSH (5.09±7.54) in the cases were found statistically significant (p <0.001) when compared to the serum Mg (1.8±0.20) in relation to the TSH in the control group (2.41±2.05). The activities of Mg were noted to fall in women through the peri (1.70±0.43), and postmenopausal age (1.60±0.34). There was a significant increase in the activities of TSH in women of premenopause (4.27±5.76), perimenopause (5.65±8.53), and postmenopausal age (7.19±11.07). Conclusion: From the results of the present study, it can be concluded that the women reaching menopause could suffer from hypomagnesemia and inturn may develop thyroid and other hormonal disorders.

Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains.

BackgroundIt is unknown whether lowered steady state levels of sex hormones coupled with changes in those hormones during the menstrual cycle are associated with premenstrual syndrome (PMS).ObjectiveTo examine associations between levels of progesterone and oestradiol during the menstrual cycle and PMS considering different diagnostic criteria for PMS.MethodsForty-one women aged 18–45 years with a regular menstrual cycle completed the Daily Record of Severity of Problems (DRSP) for all 28 consecutive days of the menstrual cycle. Blood was sampled at days 7, 14, 21, and 28 to assay oestradiol and progesterone.ResultsWe developed a new diagnosis of peri-menstrual syndrome, which is characterized by increased DRSP severity in pre and post-menstrual periods and increased scores on the major DRSP dimensions, i.e., depression, physio-somatic symptoms, breast tenderness and appetite, and anxiety. This new diagnosis performed better than classical diagnoses of PMS, including that of the American College of Obstetricians and Gynecologists (ACOG). Lowered steady state levels of progesterone, when averaged over the menstrual cycle, together with declining progesterone levels during the luteal phase predict severity of peri-menstrual symptoms. Steady state levels of oestradiol and declining oestradiol levels during the cycle are also related to DRSP severity although most of these effects appeared to be mediated by progesterone.ConclusionA significant increase in menstrual-cycle related symptoms can best be conceptualized as “peri-menstrual syndrome” and may result from insufficient progesterone production (relative corpus luteum insufficiency), which, in part may result from lowered oestradiol production indicating suboptimal pre-ovulatory follicular development.

Treatment continuation and satisfaction in women using combined oral contraception with nomegestrol acetate and oestradiol: a multicentre, prospective cohort study (BOLERO)

Objective: The aim of the study was to examine treatment continuation and satisfaction over 1 year among women receiving nomegestrol acetate (NOMAC)/oestradiol (E2) combined oral contraception (COC) in real-world clinical practice.Methods: The 17β-Estradiol and Nomegestrol Acetate (BOLERO) Study is an observational, non-interventional, prospective, multicentre cohort study of premenopausal women (aged 18–50 years) who received prescription NOMAC/E2 (2.5 mg/1.5 mg) for contraception during routine clinical practice. Assessments were carried out at enrolment and at 3, 6 and 12 months. Probability of treatment continuation through 12 months (primary outcome) was examined using Kaplan–Meier survival analysis. Secondary outcomes included treatment satisfaction, menstrual cycle-related symptoms, libido and adverse events (AEs).Results: Of 298 enrolled women, 292 were evaluable. The probability of NOMAC/E2 continuation through 12 months was 73.7% (95% confidence interval [CI] 68.0%, 78.5%). Satisfaction with NOMAC/E2 increased from 56.9% (37/65) of women at initial evaluation to 89.2% (58/65) of women at 12 months. Physician ratings at 12 months showed satisfactory to very satisfactory in 84.0% (168/200) of women. Libido was not affected. Menstrual cycle-related symptoms significantly declined from enrolment (6.04 ± 4.32) to 3 months (3.25 ± 3.05) and 12 months (2.62 ± 2.74; p < .0001). Treatment-related AEs were reported by 38.7% (113/292) of women.Conclusion: The real-world experience of women receiving NOMAC/E2 indicated very good treatment continuation, high satisfaction and significantly improved menstrual cycle-related symptoms.

Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey

BackgroundThe real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported.MethodsData were from the United States 2013 National Health and Wellness Survey. Eligible women (18–50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 “extremely dissatisfied” to 7 “extremely satisfied”), adherence (8-item Morisky Medication Adherence Scale©), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates).ResultsParticipants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values < 0.05). There were no other significant differences between groups.ConclusionsThis real-world observational study supports extended-cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.

The Menstrual Cycle-Response and Developmental Affective-Risk Model: A multilevel and integrative model of influence.

An integrative developmental model is presented in which menstrual cycle-related symptoms are hypothesized to result in a cascade of developmental challenges that contribute to increased affective symptoms among adolescent girls, and to long-term developmental sequelae. To provide the basis for this model a broad foundation is developed considering (a) psychological symptoms and disorders associated with reproductive events across the life span, and (b) the many and complicated effects that female reproductive steroids (estrogen & progesterone) have which trigger a variety of physical and psychological changes that are commonly associated with the menstrual cycle. The Menstrual Cycle-Response and Developmental Affective-Risk Model is driven by 3 central concepts: (a) individual differences in response to steroids are very large and thus require analysis of individual response, rather than group-level tendencies; (b) the menstrual cycle itself represents an important and complex set of biological, physical, psychological, behavioral, and social changes, and should not be studied exclusively as changing steroid levels; and (c) the effects of the menstrual cycle during adolescence and early adulthood may have long-term developmental consequences. This model integrates specific effects of the menstrual cycle with contextual and social developmental variables, and with past theoretical models. (PsycINFO Database Record

Characteristics of the menstrual cycle in 13-year-old Flemish girls and the impact of menstrual symptoms on social life.

This study aimed to investigate the characteristics of symptoms related to the menstrual cycle and their impact on social activities in young teenage girls. Between March and June 2009, all girls born in 1996 who were residents of eight regions in Flanders (Belgium) received a semi-structured questionnaire, including questions about the age of menarche, characteristics of the menstrual cycle, and its impact on social activities. Participants were 792 13-year-old girls (15.7 % of the target population). Out of 363 (47.2 % of participants) postmenarcheal girls, 41.6 % (95 % confidence interval (CI) 36.4-47.0 %) reported painful menstruations. The proportion of girls with painful menstrual periods decreased approximately 16 % with each year the age at menarche increased (relative risk (RR) = 0.84; 0.73-0.98; p < 0.05) and was positively correlated with the amount of blood loss (RR = 0.33; 0.16-0.67; p < 0.05 when little and 1.85; 1.49-2.31; p < 0.001 when abundant, compared to average). One in four (25.4 %) postmenarcheal girls indicated a negative impact of menstruation on social activities, but this proportion was significantly higher in girls who experienced menstruation as painful (41.3 %) compared to those who did not (14.2 %). Early menstrual complaints are common in young adolescent girls and the likelihood of pain increased significantly with lower menarcheal age. What is Known? • Menstrual cycle-related symptoms may negatively interfere with school absence and social activities. • Early menarche and severe dysmenorrhea are correlated with endometriosis. What is New? • In this large population-based study on the characteristics of the menstrual cycle in young teenage girls at or shortly after menarche, painful menstruation was highly prevalent (41.7 %), but related school absenteeism was low (3.2 %). The likelihood of pain increased significantly with lower menarcheal age. • The findings support the need for a systematic evaluation of the characteristics of the menstrual cycle shortly after menarche.

Ambivalent sexism, attitudes towards menstruation and menstrual cycle-related symptoms.

The objective of the present study was to investigate the relationship between ambivalent sexism and beliefs and attitudes towards menstruation, and, in turn, to study the influence of these variables on menstrual cycle-related symptoms. One hundred and six Mexican women completed the Ambivalent Sexism Inventory, the Beliefs about and Attitudes toward Menstruation Questionnaire and the Menstrual Distress Questionnaire. The higher scores on benevolent sexism were associated with the most positive attitudes towards menstruation and also with the belief that a menstruating woman should or should not do some activities and that menstruation keeps women from their daily activities. The higher scores on hostile sexism were associated with rejection of menstruation as well as with feelings of embarrassment about it. Beliefs about and attitudes towards menstruation predicted menstrual cycle-related symptoms related to negative affect, impaired concentration and behavioural changes, but did not predict somatic symptoms. These results will be useful to health professionals and advocates who want to change the negative expectations and stereotypes of premenstrual and menstrual women and reduce the sexism and negative attitudes towards women that are evident in Mexican culture.

Chromium Supplementation for Menstrual Cycle-Related Mood Symptoms

ABSTRACTBackground: Premenstrual dysphoric disorder (PMDD) afflicts ∼7% of reproductive-age women resulting in impaired relationships, diminished overall quality of life, and disability-adjusted life years lost on par with other major psychiatric disorders. Response to pharmacological treatment is inadequate in ∼50% of women with PMDD. Objective: The goal of the present study is to evaluate the effects of a novel approach—short-term chromium supplementation—on menstrual cycle-related mood and physical symptoms. Methods: Five women were studied under single-blind conditions in a private clinical setting (2 of them were referred specifically for treatment-resistant menstrual-related symptoms); 6 women completed a double-blind crossover study of chromium plus placebo versus chromium plus sertraline in a university clinical research setting. Treatments were administered from mid-cycle to onset of menses in 1-month intervals. Symptom ratings were obtained by self-report, using daily symptom checklists, and by clinical assessment, using the Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impressions (CGI) scale. Results: Overall, chromium treatment was associated with reduced mood symptoms and improved overall health satisfaction in most participants. In some cases, chromium alone was associated with marked clinical improvement; in others, chromium plus an antidepressant resulted in greater improvement than either chromium alone or an antidepressant alone. Conclusion: These preliminary observations suggest that chromium may be a useful monotherapy or adjunctive therapy for women suffering from significant menstrual cycle-related symptoms. Larger, controlled studies are needed to evaluate the efficacy of chromium treatment in this patient population.