Menstrual symptoms: a social cognition analysis

Premenstrual dysphoric disorder: evaluation, pathophysiology and treatment

A small percentage of women describe a prominent dysphoric disturbance that is present during the premenstrual week, remits soon after the onset of menses and produces significant impairment in domestic, social or occupational functioning. Premenstrual dysphoric disorder must be distinguished from minor premenstrual emotional changes, from dysmenorrhea and from premenstrual exacerbations of psychiatric illness. Diagnostic evaluation should include the prospective assessment of symptoms over at least two complete menstrual cycles. Although the pathophysiology of premenstrual dysphoric disorder is linked to cycling of the intact hypothalamo-pituitary-gonadal axis, many studies have contained serious methodological weaknesses and no single etiological theory has received widespread support. No single pharmacological treatment has been shown to be clearly more effective than placebo in controlled studies and premenstrual dysphoric disorder appears to respond favorably to most interventions in uncontrolled studies. Interruption of pituitary-ovarian cycling will alleviate premenstrual symptoms, but treatments of this type cannot be recommended for general use until potential hazards are clarified.

Trend analysis of the symptoms of 150 women with a history of the premenstrual syndrome

The daily symptom records of 150 untreated women with a convincing history of the premenstrual syndrome were investigated qualitatively and quantitatively by means of time series analysis in the form of Trigg's technique for trends. Symptoms were monitored with use of a modified menstrual distress questionnaire. Analysis showed that, depending on the symptom cluster, 60.7% to 85.3% of the women showed symptom trends consistent with the syndrome, 14.0% to 35.3% had trends not typical of the syndrome, and in 0% to 5.3% of records significant trends were absent. Since over 80% of the women were found to have premenstrual syndrome trends for three or more of the six symptom clusters studied, including 32% who showed this trend pattern for all symptoms, a retrospective history of premenstrual syndrome is likely to be confirmed on prospective assessment for at least some symptoms. Quantitatively women who fulfilled the diagnostic criteria for premenstrual syndrome differed from those who did not by exhibiting significantly greater exacerbation of symptoms premenstrually and lesser morbidity postmenstrually. While water retention, negative affect, and pain were the three symptom clusters associated with the most severe ratings, the majority of women suffered from a mixture of physical, psychological, and behavioral complaints, and it was not possible to subdivide the study group by the type of symptoms.

Premenstrual tension, expectancy, and mother-child relations

The role of expectancy in enhancing or mitigating premenstrual symptoms was examined in 51 mothers of preschoolers. Expectancy was manipulated by providing information either in support of a biological cause for genuine universal mood changes or in support of a psychological cause arising out of negative societal myths. A third group was given no information. Mood, cognitive function, and mother-child interaction were assessed both at mid-cycle and premenstrually, and the results suggested that expectancy enhances symptoms. The Psychological group lowered their symptom expectations and reported less negative mood premenstrually as well as fewer symptoms at the end of the test month. The other groups reported no change in symptoms and greater premenstrual negative mood than the Psychological group. All groups demonstrated greater task persistence and more positive mother-child interaction during the premenstrual phase.

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 Effect of Cycle Phase on the Adolescent Swimmers

In brief: Performance times of six postmen-archeal adolescents who competed on junior and senior national levels were recorded during a 12-week period. The fastest times for the 100-yd freestyle and 100-yd best event occurred during the menstrual phase and the slowest times during the premenstruum. Symptoms were rated biweekly with the Moos Menstrual Distress Questionnaire. Subjects reported feeling better during menstruation than premenstruation, and none reported dysmenorrhea. Based on basal body temperature, five of ten cycles were clearly biphasic, two were monophasic, and three were possibly biphasic with very short luteal phases. These results, albeit from a small sample, suggest that menstrual cycle phase may affect athletic performance as measured by practice times.

Premenstrual syndromes: past and future research strategies

Premenstrual Syndrome remains a poorly understood controversial disorder largely because of the errors in design found in research into this subject. The first task is to clearly define the entity to be studied. It is necessary to look at the nature, intensity and time of occurrence of symptoms in relation to menstruation. One must further differentiate the appearance of symptoms premenstrually from the premenstrual exacerbation of symptoms present throughout the menstrual cycle. Research has clearly shown the superiority of prospective versus retrospective data in establishing a linkage between symptoms and menstruation. Premenstrual Syndrome research offers a unique opportunity to study classical psychiatric disorders. A relationship appears to exist between this syndrome and major affective disorders. Studies of the appearance or exacerbation of mood disturbances in relation to the menstrual cycle may inform us about the development, course and vicissitudes of psychiatric illness.

The premenstrual syndrome: selection of women for treatment trials

Statements made at interview by 31 women presenting with the premenstrual syndrome (PMS) were compared with the moods and physical symptoms reported daily during the next 6 menstrual cycles. Diagnosis was confirmed in 21 women (premenstrual tension (PMT) present in greater than or equal to 5/6 cycles), not substantiated in two (PMT in less than or equal to 1/6 cycles) and in doubt in eight. Placebo treatment was associated with a significant over-all reduction in both the incidence and the severity of mood-related PMT, but had no clear effect on premenstrual physical symptoms; women with PMT in 5 cycles were usually placebo-resistant. Criteria are proposed for the selection of women for treatment trials based on their response to placebo.

Methodological issues in studies of premenstrual changes

The main methodological issues that should be considered in studies of premenstrual changes are discussed. They include: the selection of well-defined groups of subjects who reflect the diversity of subtypes of premenstrual changes (PMC); the confirmation of retrospective reports through daily monitoring of changes by ratings, or by objective procedures when possible; the need to consider the diversity of premenstrual biological changes instead of comparing average levels, since there is a likelihood that different pathophysiological changes are connected with diverse behavioral and mood changes; application of a multivariate, time-related approach to explore the pathophysiology of PMC; the need to exclude placebo responders prior to the active drug phase in treatment trials and the need for such trials to be double-blind, placebo-controlled and, if possible, of a cross-over design. Attention to such issues should lead to increased consistency of findings across studies and eventually to a better understanding of the pathophysiology of PMC and to a rational, effective treatment.

Premenstrual tension syndrome: diagnostic criteria and selection of research subjects

The investigation of premenstrual tension syndrome (PMTS) has been hampered by several methodological problems, particularly an inadequate definition of study subjects. Diagnostic criteria for PMTS that use both interview and self-report information were tested in 24 symptomatic female volunteers. Each woman subsequently completed daily reports of emotional and somatic symptoms for 1 1/2 menstrual cycles. Symptom profiles from subjects meeting the diagnostic criteria for PMTS were compared with profiles from subjects who failed to meet the criteria. This study demonstrated that the diagnostic instruments used could identify a group of women with a severe and time-limited premenstrual psychological disturbance and distinguish them from women with milder and more temporally diffuse changes. The need for such instruments and their importance for further research into this disorder are discussed.

The effects of EMG biofeedback and relaxation training on primary dysmenorrhea

Fifteen dysmenorrhea sufferers received relaxation training with EMG biofeeddback, relaxation training with no feedback, or no treatment. Participants who received biofeedback training did not differ from participants who received relaxation training in their ability to maintain a reduced level of EMG activity prior to the onset of menstruation. On the first day of menstruation, those receiving biofeeback training were able to maintain reduced EMG activity, whereas those receiving relaxation training showed an elevated level of EMG activity. Subjective reports indicated that the symptoms of dysmenorrhea improved for the biofeedback group during training but did not improve for the relaxation or control groups. Suggestions for further research are noted.