Premenstrual Disorder Research Articles

Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes.

Premenstrual disorders encompass a spectrum that ranges from mild cyclical psychological and somatic symptoms to the rarer but much-more-severe premenstrual dysphoric disorder. This condition is serious and the etiology is unclear, but possible causes include genetic factors, hormonal fluctuations, and neurotransmitter dysfunctions. Differentiation from other affective disorders can be difficult but is key to providing appropriate management. This comprehensive review will discuss the most-recent classification of premenstrual disorders, etiology, diagnosis, and potential current management strategies.

Diagnosis, pathophysiology and management of premenstrual syndrome

Key content An overview of current information available on premenstrual syndrome (PMS), which is in accordance with the new RCOG Green‐top Guideline. Definition of PMS and explanation about the different types of premenstrual disorders. How to accurately diagnose PMS. Discussion about various treatment options available in accordance with the current literature. Learning objectives Develop an understanding of the pathophysiology behind PMS. How to diagnose PMS accurately and understand the different classifications of PMS. How to treat PMS, including the different treatment options available and discussion about side effects and benefits. Ethical issues Discussion about the long‐term risks of GnRH analogue use, and the impact of long‐term estrogen deficiency following a bilateral salpingoophorectomy. Misdiagnosed PMS in patients with underlying psychiatric and medical conditions.

Self-focused attention in response to laboratory stressors among women with premenstrual disorders.

The etiology of premenstrual disorders, including premenstrual syndrome (PMS) and premenstrual dysphoric disorders (PMDD), is not well understood. In the current study, the relationship between self-focused attention (SFA) and premenstrual disorders was examined to explore the hypothesis that women with premenstrual disorders tend to respond to symptoms in a maladaptive manner. Based on retrospective report, clinical interview, and 30-day prospective recording of premenstrual symptoms, women (N = 52) were categorized as meeting criteria for premenstrual disorders (PMD; n = 24) or not (controls; n = 28). Key findings indicated that women with premenstrual disorders reported greater use of SFA in response to negative affect elicited by laboratory tasks than controls, despite no significant differences in change in negative affect between the two groups. Women with premenstrual disorders also reported greater trait levels of SFA and maladaptive coping styles compared to controls. Women with premenstrual disorders may tend to respond to menstrual cycle changes using increased levels of SFA. The interaction between psychological and physiological menstrual cycle-related changes may lead to increased distress and impairment. Implications for psychological contributions to premenstrual distress and disorders are discussed.

Premenstrual mood disorders: pathogenesis, diagnostic criteria and treatment (a review)

Premenstrual mood disorders: pathogenesis, diagnostic criteria and treatment (a review)

Comparison of the effects of PMDD and pre-menstrual syndrome on mood disorders and quality of life: A cross-sectional study

In this study, we compared psychiatric symptoms, quality of life and disability in patients with pre-menstrual dysphoric disorder (PMDD) and pre-menstrual syndrome (PMS). Forty-nine women with PMDD were compared with 43 women with PMS. All participants were asked to complete a socio-demographic data collection form, a Brief Disability Questionnaire, a medical study short form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) forms. The patients with PMDD had higher HAD-A and HAD-D scores than the patients in PMS group (p < 0.01). No statistically significant differences were found on brief disability between two groups (p > 0.05), but both groups had medium level of brief disability. The PMDD group had a lower SF-36 scoring than the PMS group in every compared parameters (p < 0.01). PMS and PMDD may lead to brief disability, and PMDD may cause loss of quality of life and psychological problems. The evaluation of patients with PMS and PMDD pre-menstrual disorders should be more detailed.

Menstrual cycle influence on cognitive function and emotion processing-from a reproductive perspective.

The menstrual cycle has attracted research interest ever since the 1930s. For many researchers the menstrual cycle is an excellent model of ovarian steroid influence on emotion, behavior, and cognition. Over the past years methodological improvements in menstrual cycle studies have been noted, and this review summarizes the findings of methodologically sound menstrual cycle studies in healthy women. Whereas the predominant hypotheses of the cognitive field state that sexually dimorphic cognitive skills that favor men are improved during menstrual cycle phases with low estrogen and that cognitive skills that favor women are improved during cycle phases with increased estrogen and/or progesterone, this review has not found sufficient evidence to support any of these hypotheses. Mental rotation has gained specific interest in this aspect, but a meta-analysis yielded a standardized mean difference in error rate of 1.61 (95% CI −0.35 to 3.57), suggesting, at present, no favor of an early follicular phase improvement in mental rotation performance. Besides the sexually dimorphic cognitive skills, studies exploring menstrual cycle effects on tasks that probe prefrontal cortex function, for instance verbal or spatial working memory, have also been reviewed. While studies thus far are few, results at hand suggest improved performance at times of high estradiol levels. Menstrual cycle studies on emotional processing, on the other hand, tap into the emotional disorders of the luteal phase, and may be of relevance for women with premenstrual disorders. Although evidence at present is limited, it is suggested that emotion recognition, consolidation of emotional memories, and fear extinction is modulated by the menstrual cycle in women. With the use of functional magnetic resonance imaging, several studies report changes in brain reactivity across the menstrual cycle, most notably increased amygdala reactivity in the luteal phase. Thus, to the extent that behavioral changes have been demonstrated over the course of the menstrual cycle, the best evidence suggests that differences in sexually dimorphic tasks are small and difficult to replicate. However, emotion-related changes are more consistently found, and are better associated with progesterone than with estradiol such that high progesterone levels are associated with increased amygdala reactivity and increased emotional memory.

Gonadotropin-releasing hormone (GnRH) analogues for premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is a disorder affecting large numbers of women, characterized by a set of symptoms that occur during the second, or luteal, half of the menstrual cycle following ovulation. It occurs between the 14th and 28th day of an idealized 28 day cycle (see Figure 1, Figure 2, Figure 3). Symptoms disappear by the end of menstruation and do not recur before ovulation, giving a symptom-free interval of at least one week. PMS is cyclical and occurs in most menstrual cycles (O’Brien 2011), and at least 20% of adolescents experience moderate-to-severe premenstrual symptoms that are associated with functional impairment (Rapkin 2008). This condition most often begins in adolescence with the establishment of normal ovulatory menstrual cycles, however the underlying pathophysiology has yet to be determined. It is important to assess and confirm the diagnosis before the initiation of therapy, especially psychotropic therapies, due to the possibly harmful side effect profile for adolescents compared to adults. The diagnosis of a premenstrual disorder (PMD) requires a medical and psychological history and physical examination, but it is the daily prospective charting of symptoms for two menstrual cycles that will clearly determine if the symptoms are related to PMS or to another underlying medical or psychiatric diagnosis. The number and types of symptoms are less important than the timing (ISPMD 2011). PMS is marked by a variety of emotional, physical and behavioural symptoms. The symptoms typically include irritability, depression, mood swings, bloating, breast tenderness and sleep disturbances (Gianetto-Berruti 2002; O’Brien 2003; Johnson 2004; Panay 2005). A severe form of PMS known as premenstrual dysphoric disorder (PMDD) causes significant Gonadotropin-releasing hormone (GnRH) analogues for premenstrual syndrome (PMS) (Protocol) 1. distress and interferes with normal functioning. PMDD is comprised of a cluster of affective, behavioural and somatic symptoms recurring monthly during the luteal phase of the menstrual cycle. The disorder affects 3% to 8% of menstruating women and represents the more severe and disabling end of the spectrum of PMDs (DSM-V 2013).

Migraine and the menopausal transition.

The menopausal transition or "perimenopause" represents a time period of turbulent changes in ovarian hormones as middle-aged women progress into menopause. The purpose of this article is to review the literature to determine the effect of the menopausal transition on migraine headaches and to develop a rational treatment approach to these patients. The menopausal transition is divided into early and stages based upon patterns of menstruation and specific reproductive hormones. Studies would suggest that the prevalence of migraine and other climacteric symptoms tend to peak during the late menopausal transition particularly in those with a past history of premenstrual stress disorder. Treatment approaches vary by stage of the menopausal transition and include conventional daily preventatives, mini-prophylaxis and hormonal therapies.

Wouldn't Anyone Rather Bathe in Forest Air?

Wouldn't Anyone Rather Bathe in Forest Air?

A longitudinal study on premenstrual disorders among female medical students of a tertiary-care hospital

A longitudinal study on premenstrual disorders among female medical students of a tertiary-care hospital

Evaluation of Semi Standardized Individualized Homeopathic Treatment of 77 Women with Premenstrual Disorders: Observational Study with 9 Months Follow-Up

Background: A large proportion (8-32%) of women in the fertile age suffers from premenstrual syndrome/symptoms (PMS/S). Individualized homeopathy could offer relief and this should be further investigated. Semi-standardized treatment with a limited number of homeopathic medicines and strictly defined prescription criteria could minimize prescription variability and increase reproducibility of the individualized treatment. 1.2. Objective: In an extension of a previous pilot study, the utility of a semi-standardized algorithm with 11 medicines for individualized homeopathic treatment of women with PMS/S was further evaluated in daily practice with 9 months follow-up. 1.3. Methods: Women completed symptom diaries during to 2 months to confirm PMS/S. Women diagnosed with PMS/S were included, consulted a homeopathic physician and completed a questionnaire with keynote symptoms for 11 homeopathic medicines. A computerized algorithm would process the answers and indicate the first homeopathic prescription. At follow-up visits change of prescription was possible. Main outcome measures were frequencies and proportions of (non-) algorithm-based prescriptions during the study and percentage of responders (≥50% drop in PMS scores). Secondary outcome measures were mean changes in PMS scores over time. 1.4. Results: 77 women were included, 52 completed the study. The usefulness of the semi-standardized treatment protocol was confirmed. In 30 (57.5%) of the 52 analyzed women, PMS scores had dropped by ≥50%. For the estimated mean changes in PMS scores, it made no difference if women had used one or more of the 11 algorithm-based or also other homeopathic medicines (p=0.765). A significant association was found between symptom severity at baseline and changes in mean PMS scores (p<0.001). 1.5. Conclusions: A semi-standardized individualized homeopathic treatment of women with PMS/S with 11 medicines proved useful in daily homeopathic practice, with improved reproducibility of individualized treatment. This treatment could be further tested in effectiveness research

Treatment of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is comprised of a cluster of affective, behavioral and somatic symptoms recurring monthly during the luteal phase of the menstrual cycle. The disorder affects 3-8% of menstruating women and represents the more severe and disabling end of the spectrum of premenstrual disorders, which includes premenstrual syndrome and premenstrual aggravation of underlying affective disorder. Rigorous and specific diagnostic criteria for PMDD were specified in the Diagnostic and Statistical Manual of Mental Disorders IV (1994) and reaffirmed in the Diagnostic and Statistical Manual of Mental Disorders V (2013) and, consequently, there has been a marked increase in well-designed, placebo-controlled studies evaluating treatment modalities. Although the exact pathogenesis of PMDD is still elusive, treatment of PMDD and severe premenstrual syndrome has centered on neuromodulation via serotonin reuptake inhibitor antidepressants, and ovulation suppression utilizing various contraceptive and hormonal preparations. Unlike the approach to the treatment of depression, serotonergic antidepressants need not be given daily, but can be effective when used cyclically, only in the luteal phase or even limited to the duration of the monthly symptoms. Less, well-substantiated alternative treatments, such as calcium supplementation, agnus castus (chasteberry), Hypericum perforatum (St John's wort) and cognitive/behavioral/relaxation therapies, may be useful adjuncts in the treatment of PMDD. This review provides an overview of current information on the treatment of PMDD.

Perceptions of Health and Somatic Sensations in Women Reporting Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Focus on bodily sensations may be involved in the etiology of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This study investigated the relationship between two types of somatic self-focus (i.e., health anxiety and anxiety sensitivity) and health-related quality of life (QOL) in women with provision diagnoses of PMS and PMDD. On the basis of responses to a screening measure, 731 college women were divided into three groups: PMDD, Moderate/Severe PMS, and Mild/No PMS. Measures included health-related QOL, health anxiety, anxiety sensitivity, and trait anxiety. Women with provisional diagnoses of PMDD and moderate/severe PMS reported higher levels of health anxiety and anxiety sensitivity. These relationships were not accounted for by trait anxiety. Furthermore, women in the PMDD and Moderate/Severe PMS groups reported lower health-related QOL. There is a significant health-related QOL burden for college women with PMDD and PMS. Health anxiety and anxiety sensitivity may contribute to the etiology of premenstrual disorders.

Premenstrual dysphoric disorder and prefrontal reactivity during anticipation of emotional stimuli

Premenstrual disorder (PMDD) affects around 5% of women in childbearing ages. An increased sensitivity in emotion processing areas of the brain to variations in ovarian steroid levels has been suggested as part of the pathophysiology in PMDD, but prior neuroimaging studies of emotion processing are yet inconclusive. Previous behavioral studies of women with PMDD have, however, reported enhanced luteal phase startle responsivity during emotional anticipation. Here we used functional magnetic resonance imaging (fMRI) to investigate central neural circuitry activity during anticipation of, and exposure to, emotional stimuli across the menstrual cycle in women with and without PMDD. As compared to healthy controls, women with PMDD displayed significantly enhanced reactivity in the prefrontal cortex during anticipation of, but not exposure to, negative emotional stimuli during the luteal phase. In PMDD patients, BOLD reactivity during anticipation or viewing of negative emotional stimuli was not dependent on absolute levels of estradiol or progesterone. However, progesterone levels were positively correlated with emotion-induced reactivity in the dorsolateral prefrontal cortex to positive emotional stimuli. These findings suggest that cortical emotional circuitry reactivity during anticipation is altered in PMDD during the luteal phase, which might be part of the pathophysiology behind the emotional symptoms or lack of emotional control reported by women with PMDD.

Premenstrual Disorders: Prevalence and Associated Factors in a Sample of Iranian Adolescents

BackgroundPremenstrual disorders usually refer to Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). This study was designed to find out the frequency of premenstrual disorders and evaluate the associated factors in a sample of Iranian adolescents.ObjectivesThis study was conducted to investigate the frequency of premenstrual disorders (PMS and PMDD) based on Premenstrual Assessment Scale (PAS) and also to determine the association of some demographic and menstrual characteristics with these disorders in adolescent girls.Patients and MethodsThis was a cross sectional study. A sample of adolescent school girls aged between 14 and 19 years were included in the study. Diagnostic assessments were based on Premenstrual Assessment Scale (PAS). The data were analyzed in a descriptive fashion and were compared among subgroups of the study sample. In addition, demographic and menstrual factors associations with premenstrual disorders were assessed.ResultsIn all 1379 female students were included in the study. About 99.5 % of the students reported at least one premenstrual symptom. Of these, 66.3% was mild, 31.4% moderate and 2.3% severe. A total of 814 girls (59%) met the diagnostic criteria for premenstrual dysphoric disorder (PMDD). Most frequently reported symptoms were back pain, lethargy, fatigue and anxiety. Early menarche, lower education was associated with higher scores on PAS.ConclusionPremenstrual disorders are common in adolescent girls. Preventive and treatment strategies are highly recommended.

Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16–20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20min) and late (24h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20min. A papule after 24h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20min, 24h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.

Premenstrual Disorders and Rumination

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve emotional, behavioral, and physical symptoms; however, there is little understanding of psychological factors that contribute to these disorders. It was hypothesized that rumination, a form of depressive self-focused attention, is related to premenstrual distress. Study 1 involved women (N = 735) meeting criteria for No/Mild PMS, Moderate/Severe PMS, and PMDD using retrospective self-report. Study 2 involved women (N = 85) meeting diagnostic criteria for PMS or PMDD (i.e., PMD group) and healthy controls (i.e., No PMD group) following 60-day symptom monitoring. Participants in both studies completed questionnaires of rumination, anxiety sensitivity, and coping styles. Rumination was strongly related to premenstrual disorders using both retrospective and prospective reports, as well as both categorical and continuous approaches to classification of premenstrual distress. Rumination, a transdiagnostic factor in psychopathology, may contribute to the onset and maintenance of premenstrual distress.

ISPMD consensus on the management of premenstrual disorders

The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists, psychologists and pharmacologists each formally presented the evidence within their area of expertise; this was followed by an in-depth discussion leading to consensus recommendations. This article provides a comprehensive review of the outcomes from the meeting. The group discussed and agreed that careful diagnosis based on the recommendations and classification derived from the first ISPMD consensus conference is essential and should underlie the appropriate management strategy. Options for the management of premenstrual disorders fall under two broad categories, (a) those influencing central nervous activity, particularly the modulation of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin-releasing hormone agonists, danazol and estradiol all most likely function by ovulation suppression. The role of oophorectomy was also considered in this respect. Alternative therapies are also addressed, with, e.g. cognitive behavioural therapy, calcium supplements and Vitex agnus castus warranting further exploration.

Premenstrual Dysphoric Disorder and Severe Premenstrual Syndrome in Adolescents

Numerous epidemiologic studies have demonstrated that premenstrual disorders (PMDs) begin during the teenage years. At least 20% of adolescents experience moderate-to-severe premenstrual symptoms associated with functional impairment. Premenstrual syndrome (PMS) consists of physical and/or psychological premenstrual symptoms that interfere with functioning. Symptoms are triggered by ovulation and resolve within the first few days of menses. The prevalence of premenstrual dysphoric disorder (PMDD), a severe form of PMS accompanied by affective symptoms, is likely equal to or higher than in adults. The diagnosis of a PMD requires a medical and psychological history and physical examination but it is the daily prospective charting of bothersome symptoms for two menstrual cycles that will clearly determine if the symptoms are related to a PMD or to another underlying medical or psychiatric diagnosis. The number and type of symptoms are less important than the timing. Randomized controlled trials of pharmacologic treatments in teens with moderate-to-severe PMS and PMDD have yet to be performed. However, clinical experience suggests that treatments that are effective for adults can be used in adolescents. PMS can be ameliorated by education about the nature of the disorder, improving calcium intake, performing exercise and reducing stress, but to treat severe PMS or PMDD pharmacologic therapy is usually required. Eliminating ovulation with certain hormonal contraceptive formulations or gonadotropin-releasing hormone agonists will be discussed. Serotonergic agonists are a first-line therapy for adults, and some serotonin reuptake inhibitors such as fluoxetine and escitalopram can be administered safely to teens.

Circulating insulin and leptin in women with and without premenstrual disphoric disorder in the menstrual cycle

Premenstrual dysphoric disorder (PMDD) is a syndrome related with mood and appetite changes during the late luteal phase. Leptin and insulin are the hormones related to appetite, and leptin may have a role in reproductive functions and mood. Our aim was to determine whether there are differences in serum leptin and insulin levels between women with and without PMDD during the follicular and luteal phases. In this study, 20 women with PMDD and 18 women without PMDD were included. Fasting blood glucose, insulin, leptin, progesterone levels and HOMA-IR were measured in the follicular and luteal phases separately. Repeated-measures analysis of variance revealed significant interactions for serum leptin, insulin and HOMA-IR levels between the diagnosis of PMDD and menstrual phases (F = 5.4, p = 0.025; F = 5.4, p = 0.026; and F = 4.7, p = 0.036, respectively). A significant correlation was found between progesterone and insulin levels in subjects without PMDD in the luteal phase (r = 0.58, p = 0.01). Whether the alterations in serum leptin and insulin are related with the changes of appetite and mood in PMDD or secondary to other factors should be clarified.