Premenstrual Mood Changes Research Articles

Premenstrual symptoms across the lifespan in an international sample: data from a mobile application

Premenstrual symptoms, including physical and mood symptoms, affect a large proportion of women worldwide. Data on premenstrual symptoms across nations and age groups is limited. In the present study, we leveraged a large international dataset to explore patterns in premenstrual symptom frequency with age. A survey was administered to users of the Flo mobile application (app), aged 18 to 55. The survey queried app users about a range of premenstrual symptoms. Respondents were asked whether they experienced each symptom every menstrual cycle, some cycles, or never. Age was also captured and categorized as 18–27, 28–37, 38–47, 48–55. Data was summarized and Pearson’s chi square test for count data assessed differences in symptom frequency by age group. A sample of 238,114 app users from 140 countries responded to the survey. The most common symptoms reported were food cravings (85.28%), mood swings or anxiety (64.18%), and fatigue (57.3%). Absentmindedness, low libido, sleep changes, gastrointestinal symptoms, weight gain, headaches, sweating or hot flashes, fatigue, hair changes, rashes, and swelling were significantly more frequent with increasing age (p’s < 0.001). Mood swings and anxiety did not vary by age group. Of the respondents, 28.61% reported that premenstrual symptoms interfered with their everyday life each menstrual cycle. In a large international sample, the majority of women reported premenstrual food cravings, mood changes, and fatigue every menstrual cycle. Mood symptoms did not vary by age group, suggesting that premenstrual mood changes are a persistent issue among women of reproductive age.

Managing the side effects of contraception

Side effects are the most common reason for the discontinuation of contraceptive methods. Dr Katie Boog summarises the available evidence on how to manage them Although often transient, side effects are the most common reason for individuals to discontinue contraception. The evidence to prove causality is limited, as is evidence-based guidance on how to manage these side effects. This article summarises the available evidence. For individuals who have new or worsening acne on progestogen-only contraception (POC), switching to combined hormonal contraception (CHC) is likely to improve their skin. Continuous or extended CHC use may be beneficial for individuals with premenstrual mood change, and for those who experience headaches in the hormone-free interval. Unpredictable bleeding patterns on POC are common. Injectable users can try reducing the interval between injections to 10 weeks. Implant, injectable or intrauterine system users can be offered a 3-month trial of a combined oral contraceptive pill (COC). CHC and POP users with unpredictable bleeding may benefit from switching to an alternative preparation.

Managing the side effects of contraception

Although often transient, side effects are the most common reason for individuals to discontinue contraception. The evidence to prove causality is limited, as is evidence-based guidance on how to manage these side effects. This article summarises the available evidence. For individuals who have new or worsening acne on progestogen-only contraception (POC), switching to combined hormonal contraception (CHC) is likely to improve their skin. Continuous or extended CHC use may be beneficial for individuals with premenstrual mood change, and for those who experience headaches in the hormone-free interval. Unpredictable bleeding patterns on POC are common. Injectable users can try reducing the interval between injections to 10 weeks. Implant, injectable or Intrauterine system users can be offered a 3-month trial of a combined oral contraceptive pill (COC). CHC and POP users with unpredictable bleeding may benefit from switching to an alternative preparation.

Loss of sexual interest and premenstrual mood change in women with postpartum versus non-postpartum depression: A nationwide community sample of Korean adults

BackgroundPostpartum depression (PPD) is a type of clinical depression that can affect women after childbirth. Few previous studies have explored the association of depressive and physical symptoms among women with PPD in a nationwide community study. MethodA total of 18,807 adults, randomly selected, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) (response rate 80.2%). PPD was defined as a major depressive episode that began within 4 weeks after delivery. ResultsOf 679 female subjects with major depressive disorder (MDD), 14.0% (n=95) experienced PPD. Subjects with PPD were significantly more likely to have higher income, education, and reside in an urban area, compared to those with non-PPD. No significant differences were found in number of children. Multiple logistic regression revealed that the loss of sexual interest was the only symptom among 23 depressive symptoms that was significantly associated with depressive episodes among individuals with PPD (AOR=1.91, 95% CI 1.01–3.60) when compared with non-PPD. Loss of sexual interest was also significantly associated with the subjects with lifetime PPD regardless of depressive episode (AOR=1.93, 95% CI 1.12–3.31). Conversely, loss of confidence and loss of pleasure were less frequent in subjects with PPD. Premenstrual mood change (χ2=5.57, p=0.0036) and comorbid alcohol use disorder (χ2=5.11, p=0.031) showed a valid association with PPD. ConclusionsLoss of sexual interest and premenstrual mood change were associated with women with PPD, whereas those with non-PPD were not, thereby suggesting the possible link between sexual hormones and PPD.

Higher luteal progesterone is associated with low levels of premenstrual aggressive behavior and fatigue

Contradictory findings show both positive and negative effect of progesterone on the premenstrual mood changes in women. Here we present the study investigating this relationship on the large sample of premenstrual women. 122 healthy, reproductive age women collected daily morning saliva samples and recorded intensity scores for the mood symptoms: irritability, anger, sadness, tearfulness, insomnia, and fatigue. Saliva samples were assayed for progesterone concentrations and mood intensity scores were used to calculate behavioral indices. Women with low Aggression/Irritability and Fatigue had consistently higher progesterone levels during the luteal phase than women with high Aggression/Irritability and Fatigue. Additionally, Aggression/Irritability and Fatigue correlated negatively with maximal progesterone value during the luteal phase. Our results demonstrated a negative effect of low progesterone level on the premenstrual mood symptoms such as aggressive behavior and fatigue in healthy reproductive age women. This supports a previously proposed model of biphasic action of progesterone metabolites on mood.

Determination of Premenstrual Symptom Exacerbations

Back to table of contents Previous article Next article Communications and UpdatesFull AccessDetermination of Premenstrual Symptom ExacerbationsAnnie Harvey, Ph.D., and Susan G. Kornstein, M.D.Annie HarveyWichita, Kan.Search for more papers by this author, Ph.D., and Susan G. KornsteinSearch for more papers by this author, M.D.Published Online:1 Sep 2011https://doi.org/10.1176/appi.ajp.2011.11040605AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In the April 2011 issue of the Journal, Dias et al. (1) classify bipolar women as having premenstrual exacerbation of symptoms based on retrospective questioning. The poor reliability of self-reported premenstrual mood change has been known for decades (2), and prospective measurement has become the standard (3).Two unpublished analyses cast doubt on the validity of retrospective reports of premenstrual exacerbation in women with major depressive disorder. Kornstein et al. (4) analyzed data from a large multicenter treatment study of chronic depression in which women were asked, “Are you aware of regularly occurring worsening of your mood related to your menstrual cycle?” A subset of 97 women maintained a daily log of mood symptoms over one menstrual cycle prior to treatment. There was no association between the two types of reports: 27% of women with and 26% of women with no self-reported premenstrual exacerbation had prospectively confirmed premenstrual exacerbation on daily ratings. Harvey et al. (5) examined women in clinical trials of antidepressant efficacy. Premenstrual syndrome was reported by 18 of 27 women. When visit-to-visit changes in HAM-D scores were examined as a function of phase of the menstrual cycle at the time of rating, premenstrual exacerbation was apparent in 26% of the women. There was no association (r2=–0.002) between self-reported premenstrual syndrome and premenstrual exacerbation score.It is challenging to collect the daily mood data that are considered the gold standard in studies of premenstrual mood change, leaving self-report as the measure clinicians have tended to use (4). Although retrospectively reported premenstrual exacerbation has been associated with a more symptomatic and relapse-prone phenotype in bipolar women (1) and longer duration of depressive episodes in women with major depression (4), it is not a valid measure of symptom worsening near the onset of menses.Dias et al. (1) may be able to make an important contribution to the literature if the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study called for the recording of dates of menses throughout the study, as was done in the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D). Only access to dates of menses will permit the placement of observed acute exacerbation of symptoms during the treatment of women with antidepressants (5) into the context of the menstrual cycle.Wichita, Kan.Richmond, Va.Dr. Harvey has received an unrestricted educational grant from Pfizer. Dr. Kornstein has received research support from Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, NIMH, Novartis, Otsuka, Pfizer, Rexah, and Wyeth; is on the advisory board or has received honoraria from Bristol-Myers Squibb, Dey Pharma, Eli Lilly, PGxHealth, Pfizer, Rexahn, and Wyeth; and has received book royalties from Guilford Press.Accepted for publication in June 2011.

Premenstrual Mood Exacerbation Linked to Severe Bipolar Symptoms

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPremenstrual Mood Exacerbation Linked to Severe Bipolar SymptomsMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Mar 2011https://doi.org/10.1176/pn.46.6.psychnews_46_6_17_2AbstractPremenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. Women who have bipolar disorder and also experience premenstrual mood exacerbation appear to have a worse course of illness, a shorter time to relapse, and greater symptom severity than women with bipolar disorder who do not experience premenstrual mood exacerbation, according to a report that was published February 15 online in AJP in Advance."Mood exacerbation" was defined in the study as syndromal—corresponding to the DSM-IV mood states (depression, mania, hypomania, mixed)—or subsyndromal, not meeting criteria for any of these states but having three or four depression and/or mania symptoms. "Although time to relapse to a syndromal episode did not differ between women with premenstrual exacerbation and those without during follow-up, time to relapse in those with premenstrual exacerbation was half that of those without when relapse was defined more broadly as a syndromal or subsyndromal episode," wrote lead author Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital. "Women with premenstrual exacerbation also had more severe depressive and mood elevation symptoms during follow-up, reflecting greater symptom burden. Taken together, these findings suggest that premenstrual exacerbation may be a marker for a more recurrent and symptomatic course of illness among premenopausal women with bipolar disorder." In the study, 932 women aged 18 to 40 who were enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) responded to two questions about premenstrual mood changes: "Currently, do you typically experience depression symptoms around your menstrual period?" and "Currently, do you experience mood swings around your menstrual period?" Women who provided a positive response to one or both of these questions were categorized as having premenstrual exacerbation. After exclusion of women with previous unspecified gynecological surgeries and women for whom information was lacking about whether they had menstrual cycles, a total of 293 women—191 women with premenstrual exacerbation and 102 women without—were followed prospectively for one year. During follow-up, women with premenstrual exacerbation had more mood episodes overall than those without, including more depressive episodes, though the women did not have more episodes of mania or hypomania. Differences remained when episode frequency was categorized; women reporting premenstrual exacerbation were more likely to have one to three episodes a year (73.8 percent compared with 55.9 percent) and less likely to have no episodes (24.1 percent compared with 42.2 percent) during follow-up. Time to relapse was compared among 129 women (66 with premenstrual exacerbation and 63 without) who were in recovered status at baseline and had at least one additional assessment during the follow-up period. No significant difference was seen between groups in time to relapse to a syndromal episode; however, when the analysis included subsyndromal episodes as part of a broader definition of relapse, women with premenstrual exacerbation relapsed sooner on average than did those without, according to the report. Using this broader definition of relapse, the median time to relapse was 4.5 months in the group with premenstrual mood exacerbation, compared with 8.5 months in the group without it, a statistically significant difference. (No significant differences between groups were seen in the proportion of women changing medications before they relapsed.) Finally, statistical analysis of severity of symptoms as reported by women indicated that premenstrual exacerbation adversely affects the severity of both depression and mood elevation symptoms. Dias told Psychiatric News that the results suggest that clinicians treating women with bipolar disorder should follow the menstrual cycles of patients during appointments and ask them to make notes about the mood changes between appointments. "In the last five years, the scientific literature has been paying more attention to the subsyndromal mood states in depression and in bipolar disorder," he told Psychiatric News. "This kind of mood state, wherein the patient has mood symptoms but does not meet criteria for a mood episode, has been linked with poor functionality and more relapses of mood episodes. "In our study, we observed that women with premenstrual exacerbation spend more time in that kind of mood state and have more residual symptoms suggesting that they could be considered a group of patients who will have a more severe course of bipolar disorder." "Longitudinal Follow-Up of Bipolar Disorder in Women With Premenstrual Exacerbation: Findings From STEP-BD" is posted at <http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2010.09121816v1>. ISSUES NewArchived

Correlates of depressive symptomatology during the second trimester of pregnancy among Hong Kong Chinese

The study investigated the correlates of antenatal depressive symptoms among Hong Kong Chinese women during their second trimester of pregnancy. A total of 2178 women were recruited at five regional public hospitals in Hong Kong to participate in a study with a cross-sectional design. Associations were examined between depressive symptoms (using the Edinburgh Postnatal Depression Scale) and socioeconomic, obstetric, and Chinese family relations. Logistic regression analysis revealed that younger age, a personal or family psychiatric history, an unplanned pregnancy, a history of menstruation discomfort or premenstrual mood change, high marital conflict, and high mother-in-law conflict were found to be associated with more severe depressive symptoms. Antenatal depression is important because of its association with risk of adverse consequences for mothers and their families. There is a consensus that depression is most treatable when detected early. These findings therefore provide important information for the prevention of antenatal depressive symptoms among the Hong Kong population, amongst whom depression is rarely talked about. The implications and limitations of these findings and directions for future research are discussed.

Antenatal Depression and Maternal-Fetal Attachment

Background: In recent years, attention has been turned to maternal mental health in relation to the mother-child relationship accompanying a widening in focus, i.e. taking into account not only the puerperium, but also the stage of pregnancy. This applies to studies that have revealed a connection between depression and maternal attachment in the postpartum period and late pregnancy. This study, however, was designed to evaluate the maternal-fetal relationship in the first and second trimesters, being the first one to address this issue in these early stages. Sampling and Methods: Zung’s Self-Rating Depression Scale (ZSDS), the original Antenatal Maternal Attachment Scale (AMAS), and a questionnaire addressing peripheral factors were given to 216 pregnant women (3–6 months of gestation) who visited the Nagoya University Hospital between September 1998 and June 2001. Results: Contrary to reports on the latter stages of pregnancy, no direct association was observed between depression in mothers and maternal-fetal attachment before fetal movement was perceived. Conclusion: However, education, form of employment, planning of pregnancy, and premenstrual mood changes were found to be associated with the ZSDS score (mean: 41.9), while form of employment, feelings regarding pregnancy, and sources of support were extracted as factors associated with the AMAS, which are of interest in terms of the subsequent association between depression and maternal-fetal attachment in the peri- and postnatal periods.

Efficacy of reboxetine in patients with severe major depression

Premenstrual mood changes have been described since the time of Hippocrates. RT Frank specifically identified physical, psychological, and behavioral changes corresponding to monthly changes in reproductive hormones in 1931 (Frank, 1931). Public awareness of changes in mood with phases of the menstrual cycle has increased markedly in recent years. Typically, premenstrual syndrome has been defined by symptoms, including irritability, tension, fatigue, dysphoria, distractibility, impaired motor coordination, changes in eating and sleeping, and libido, which occur in the late luteal phase and remit after the beginning of menstruation. Current nosology categorizes these symptoms under the diagnosis of premenstrual dysphoric disorder (PMDD).

Premenstrual mood changes and maternal mental health in pregnancy and the postpartum period.

To investigate the relationship between premenstrual mood changes and maternal mental health in the perinatal period, a prospective questionnaire survey of 1,329 women was carried out. Women with a premenstrual mood changes (irritability) before pregnancy showed significantly higher Zung's Self-rating Depression Scale (SDS) scores than those without it, throughout pregnancy and the postpartum period (6 time points: early, middle, and late pregnancy, 5 days, 1 month, and 6 months after childbirth). In addition, women with premenstrual irritability had greater anxiety about pregnancy and delivery, were more reluctant to accept mother roles, and felt their babies (fetuses or neonates) were more vulnerable. These findings suggest that premenstrual mood change is correlated with unstable mental health throughout the perinatal period.

Stress, serotonergic function, and mood in users of oral contraceptives

The relationship between stress and changes in insulin levels, plasma ratio of tryptophan to other large neutral amino acids (LNAAs), mood, and food intake was investigated in women taking monophasic oral contraceptives containing progestagens. Subjects experiencing high levels of stress displayed significant decreases of insulin and tryptophan to other LNAAs ratios, before and after the consumption of a standard meal during the pill-free period as compared with the period of pill use. The decline of the tryptophan to other LNAAs ratio was accompanied by worsening of mood. In a control group of subjects experiencing low levels of stress there was no relationship between insulin and tryptophan to other LNAAs ratio, nor between tryptophan to other LNAAs ratio and mood. These results suggest that the combination of stress and alterations in sex hormones may be responsible for mood changes during the pill-free period in women taking oral contraceptives.

Magnesium in obstetrics and gynecology

Pregnancy induces a significant decrease of magnesium levels in serum and myometrium of 15%. A 25% increase of magnesium excretion in urine may be the most important reason. Magnesium supplementation during pregnancy seems necessary because it improves maternal health and fetal outcome. Magnesium supplementation reduces the incidence of preterm labour and vaginal haemorrhage. Premature delivery is significantly reduced from 8.2 to 2.8%. Intravenous magnesium application in pharmacological doses is still the therapeutic basis in pre-eclampsia and eclampsia. In gynaecology magnesium relieves premenstrual mood changes and alleviates dysmenorrhoea.

Premenstrual changes and neuroticism: A twin study

The study assessed a possible genetic component to the retrospective reporting of premenstrual changes and investigated the association of neuroticism with the reporting of premenstrual changes. Twenty-four female MZ twin pairs, 24 female DZ twin pairs, and 24 pairs of unrelated age-matched females completed the Eysenck Personality Inventory and the Premenstrual Assessment Form. The order in which the questionnaires were completed was counterbalanced. As expected, MZ twins were more similar in their retrospective reporting of most premenstrual changes than DZ twins, especially premenstrual mood changes. Neuroticism was highly correlated with the reporting of premenstrual changes, especially those related to mood changes. Despite the correlation, the reporting of premenstrual changes appeared not to be merely a concomitant of the personality trait of neuroticism. A principal components analysis suggested the two main factors of mood and physical premenstrual changes.

Premenstrual mood changes and gating of the auditory evoked potential

To assess the effect of the menstrual cycle on a measure of brain physiology known to be affected in psychiatric illness, auditory-evoked electroencephalographic potentials were recorded from 12 women on the day prior to menstruation and nine days after the initiation of their cycle. Eight were normal college students, and four were patients in a premenstrual syndrome clinic. The women showed significant changes in self-ratings of mood between the two recordings. The P50 wave of the auditory-evoked response was evaluated in a conditioning-testing paradigm, in which stimuli were presented in pairs, allowing assessment of putative excitatory and inhibitory processes involved in the gating of central nervous system sensory responsiveness to auditory stimuli. The auditory-evoked potentials were unchanged between the two recording periods. There was also no difference between the women and age-matched male controls. The data suggest that these central nervous system functions are not responsive to hormonal fluxes in menstruation. Since inhibitory gating of the P50 wave is lost in the manic phase of manic-depressive illness, the data also suggest that premenstrual mood changes in normal women do not share electrophysiological properties of mania.

Premenstrual mood changes in affective disorders.

Premenstrual mood changes in affective disorders.

The effects of oral contraceptives on mood and sexuality: A comparison of triphasic and combined preparations

Women starting on oral contraceptives were first assessed for premenstrual symptoms and then randomly assigned to either a combined pill (Microgynon, n = 18) or a triphasic pill (Logynon, n = 19). Each subject made daily ratings of mood, physical symptoms and sexual feelings for the first two pill cycles. Each pill cycle was divided into 5 phases (7, 5, 6, 5 and 5 days duration). Mean daily ratings for the 5 phases of the 2nd pill cycle were subjected to analysis of variance for repeated measures, with ‘emotional’ and ‘physical’ premenstrual scores from the pre-pill assessment and age as additional stratification factors. of women with high premenstrual mood change before starting the pill, those who took the triphasic pill showed significantly more lowering of mood (P < 0.05) and loss of sexual feelings (P < 0.05) than those taking the combined pill. These changes which were not necessarily of severe degree occurred early in the pill cycle. As numbers in this study were small, the findings require replic...

Premenstrual mood changes: Characteristic patterns in women with and without premenstrual syndrome

Methodologic errors have compromised previous attempts to establish the relationship between mood and menstruation in women with the premenstrual syndromes. These syndromes cannot be diagnosed by history and require confirmation with longitudinal, prospective ratings. In this paper we present the characteristic pattern of mood changes in women with and without menstrually-related mood syndrome. The theoretical and diagnostic implications of the pattern differences are discussed.

The psychobiology of premenstrual dysphoria: review of theories and treatments

(1) Premenstrual mood changes such as depression, elation, anxiety, hostility and irritability are a common cause of disability in women. (2) The nature of the disorder, the clinical dimensions, the incidence, the psychological and psychosocial theories are reviewed. (3) A long list of treatments recommended over the years is also reviewed and discussed, illustrating the ambiguity and uncertainty in this area. (4) The relationship to other periodic functional conditions, especially manic-depressive illness is discussed with particular emphasis on predictive studies. (5) The psychoneuroendocrine mechanisms possibly involved in these premenstrual conditions are reexamined. A specific role for prolactin in the etiology of these premenstrual dysphoric states is suggested.

The effect of premenstrual anxiety and depression on cognitive function.

The Depression Adjective Check List, State-Trait Anxiety Inventory, and a battery of factor analytically derived cognitive tests sensitive to anxiety or depression were administered to 50 women between the ages of 30 and 45 during the 4 days prior to the onset of menstruation and again 2 weeks later. Testing sessions were scheduled on the basis of a previously completed Menstrual Distress Questionnaire. There were significant increases in anxiety and depression during the premenstruum. However, no statistically significant differences were found in cognitive test performance, and correlation data failed to support any consistent relationship between premenstrual mood and cognitive function. Moreover, no significant correlations were found between premenstrual complaints on the Menstrual Distress Questionnaire and either cognitive test performance or mood scores obtained during the premenstrual testing sessions. It was concluded that the magnitude of the premenstrual mood change was not great enough to affect intellectual function. Alternative explanations of the absence of decrements in performance are discussed.