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

Myocardial transcriptomic and proteomic landscapes across the menopausal continuum in a murine model of chemically induced accelerated ovarian failure

Risk of cardiovascular disease (CVD) in women increases with the menopausal transition. Using a chemical model (4-vinylcyclohexene diepoxide; VCD) of accelerated ovarian failure, we previously demonstrated that menopausal females are more susceptible to CVD compared with peri- or premenopausal females like humans. Yet, the cellular and molecular mechanisms underlying this shift in CVD susceptibility across the pre- to peri- to menopause continuum remain understudied. In this work using the VCD mouse model, we phenotyped cellular and molecular signatures from hearts at each hormonally distinct stage that included transcriptomic, proteomic, and cell biological analyses. The transcriptional profile of premenopausal hearts clustered separately from perimenopausal and menopausal hearts, which clustered more similarly. Proteomics also revealed hormonal clustering; perimenopausal hearts grouped more closely with premenopausal than menopausal hearts. Both proteomes and transcriptomes showed similar trends in genes associated with atherothrombosis, contractility, and impaired nuclear signaling between pre-, peri-, and menopausal murine hearts. Further analysis of posttranslational modifications (PTMs) showed hormone-dependent shifts in the phosphoproteome and acetylome. To further interrogate these findings, we triggered pathological remodeling using angiotensin II (Ang II). Phosphorylation of AMP-activated protein kinase (AMPK) signaling and histone deacetylase (HDAC) activity were found to be dependent on hormonal status and Ang II stimulation. Finally, knockdown of anti-inflammatory regulatory T cells (Treg) exacerbated Ang II-dependent fibrosis implicating HDAC-mediated epigenetic suppression of Treg activity. Taken together, we demonstrated unique cellular and molecular profiles underlying the cardiac phenotype of pre-, peri-, and menopausal mice supporting the necessity to study CVD in females across the hormonal transition.NEW & NOTEWORTHY Cycling and perimenopausal females are protected from cardiovascular disease (CVD) whereas menopausal females are more susceptible to CVD and other pathological sequalae. The cellular and molecular mechanisms underlying loss of CVD protection across the pre- to peri- to menopause transition remain understudied. Using the murine 4-vinylcyclohexene diepoxide (VCD) model of menopause we highlight cellular and molecular signatures from hearts at each hormonally distinct stage that included transcriptomic, proteomic, and cell biological analyses.

Translation and Validation of the Daily Record of Severity of Problems (DRSP) Scale in Indonesian Version

Objective: This research evaluated the translation and validation of the Daily Record of Severity of Problems (DRSP) scale in the Indonesian version. This study aimed at providing a measuring tool that can be used in nursing practice, especially in detecting and managing premenstrual syndrome (PMS) in Indonesian women. Methods: This study involved 315 girls in Indonesia. The DRSP used Cronbach's alpha and convenience sampling. In this study, the intraclass correlation coefficient (ICC) was utilized to assess test-retest reliability. This study used exploratory factor analysis (EFA) to evaluate factor structure and to investigate the structural model fit, and confirmatory factor analysis (CFA) was used in this study. Results: The study's overall Cronbach's alpha score was 0.90. The range of the test-retest reliability ICC score was 0.72-0.90. The results of CFA for this study showed the goodness-of-fit index. The comparative fit index (CFI) was 0.90, the related fit index (RFI) was 0.81, and normed fit index (NFI) was 0.84. The value of the Kaiser-Meyer-Olkin test was 0.873, and the Bartlett's test value of sphericity was statistically significant and indicated adequate of EFA. Conclusion: The result of this study showed that the DRSP scale has satisfactory reliability and validity for evaluating DRSP in Indonesia.

Podophyllum hexandrum Royle mitigates perimenopausal symptoms in an OVX rat model by activating the PI3K/AKT/mTOR pathway and enhancing estrogen receptor expression

ETHNOPHARMACOLOGICAL RELEVANCE

Podophyllum hexandrum Royle, recorded in the Pharmacopoeia of the People's Republic of China as Sinopodophyllum hexandrum (Royle) Ying (SH), is a nationally protected Tibetan medicinal plant in China, which has been traditionally used to regulate menstruation, enhance blood circulation, and treat blood stasis and dystocia. However, its potential role and mechanisms in managing perimenopausal syndrome (PMS) remain unclear.

AIM OF THE STUDY

This study evaluates the therapeutic potential of Sinopodophyllum hexandrum (Royle) Ying rhizomes (SHR) and fruits (SHF) in PMS and investigates their underlying molecular mechanisms.

MATERIALS AND METHODS

The anti-PMS effects of SHR and SHF were examined in an ovariectomized (OVX) rat model by assessing uterine histopathology and hormone levels. Serum lipid profiles, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), as well as malondialdehyde (MDA) levels and superoxide dismutase (SOD) levels, were analyzed using biochemical assays. Astral-DIA proteomics identified differentially expressed proteins (DEPs) and key signaling pathways affected by SHF. Protein expression was evaluated via western blotting, immunohistochemistry, and RT-qPCR. Estrogenic activity was further assessed in vitro through MCF-7 cell viability and estrogen receptor (ER) expression analysis.

RESULTS

SHR and SHF treatment significantly improved uterine morphology in OVX rats, restoring endometrial and epithelial thickness. High-dose SHF (SHF-H) increased serum estradiol (E2) by 100.02 %, anti-Müllerian hormone (AMH) by 34.68 %, and progesterone (PROG) by 39.96 % while decreasing luteinizing hormone (LH) by 31.53 %. High-dose SHR (SHR-H) treatment resulted in a 112.89 % increase in E2 levels and a 23.88 % decrease in LH levels. Additionally, SHR-H and SHF-H regulated the level of oxidative stress and serum lipid levels, showing a significant decline in MDA (48.32 %, 65.52 %), TG (34.71 %, 33.30 %), TC (22.34 %, 27.77 %), and LDL-C (57.09 %, 42.96 %). Proteomic analysis identified the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway and apoptotic regulation as key mechanisms underlying SHF's effects. SHF reversed the OVX-induced suppression of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR in the uterus. SHR and SHF also modulated apoptosis-related proteins, downregulating Bax and Cleaved caspase-3/9 while upregulating Bcl-2. Moreover, SHF significantly increased uterine ERα and ERβ expression at both mRNA and protein levels. In vitro, SHR and SHF extracts promoted MCF-7 cell viability and upregulated ERα, ERβ, and proliferating cell nuclear antigen (PCNA), indicating estrogenic activity.

CONCLUSIONS

SH alleviates PMS by inhibiting uterine apoptosis via PI3K/AKT/mTOR pathway activation and enhancing estrogen receptor expression. It also regulates hormone levels, lipid metabolism, and oxidative stress, potentially slowing PMS progression. These findings highlight SH as a promising therapeutic agent for PMS and provide novel insights into the molecular mechanisms of Tibetan medicine.

Impact of age on premenstrual syndrome prevalence and severity: A population-based survey in Brazil

OBJECTIVE

To evaluate the relationship between premenstrual disorders (PMD) and age, we analyzed the prevalence and severity of psycho-emotional and physical symptoms in a representative sample of Brazilian women.

METHODS

This observational and retrospective study analyzed data from Brazilian women aged 20-49 years from five regions of the country who reported premenstrual symptoms. Participants completed a premenstrual symptom screening questionnaire and self-reported the presence and severity of their symptoms. Among 23 104 women reporting does premenstrual symptoms, 38.91% (n = 8990) experienced PMD caused functional impairment. Finally, 5121 participants agreed to complete the adapted version of the screening questionnaire.

RESULTS

The age group distribution was 20-29 (46.7%), 30-39 (38.3%), and 40-49 years (15%). The most prevalent and severe physical symptom was acne/oily skin in participants aged 20-29 years and headache in women aged 30-49 years. Regarding psycho-emotional symptoms, the most prevalent was anxiety/tension in women aged 20-29 years and 40-49 years and irritability/anger in those aged 30-39 years. Irritability/anger was the most severe symptom in all groups.

CONCLUSION

PMD significantly impacts the quality of life of Brazilian women with varying intensity. Physical symptoms associated with PMD vary with age, while psycho-emotional symptoms, particularly irritability/anger and anxiety, were intense in Brazilian women of reproductive age. These findings inform early diagnosis and individualized treatment approaches for PMD, addressing the needs of women.

Cardiac Autonomic and Affective Reactivity to Laboratory Stressors across the Menstrual Cycle: A Systematic Review

Fluctuations in steroid sex hormones are associated with altered cardiac autonomic and affective functioning across the female lifespan. The neuroendocrine pathways which modulate sex hormone changes during the menstrual cycle have reciprocal interactions with the autonomic nervous system, an integral system for self-regulation and stress response. Cardiac autonomic activity is often imbalanced among individuals with mental and physical health conditions. However, it is unclear whether variations in female-typical sex hormones across the menstrual cycle significantly alter cardiac autonomic and affective stress reactivity, which may underlie menstrual-related mood and psychosomatic symptoms. The present systematic review aims to address this gap by characterizing patterns of cardiac autonomic activity at baseline, and cardiac autonomic and affective reactivity to laboratory stress tasks across the menstrual cycle in reproductive-aged women. The review was preregistered (https://doi.org/10.17605/OSF.IO/B2Y5Q) and conducted in line with PRISMA guidelines. Twenty studies and 28 records were identified and discussed. The study found modest support for increased cardiac sympathetic activation at baseline and in response to stress, and greater affective reactivity within the luteal phase of the menstrual cycle. These results expand upon prior research demonstrating cardiac autonomic imbalance and affective vulnerability within the luteal phase to show that these patterns also influence stress reactivity. Additionally, the review aims to identify notable methodological limitations and gaps within this body of literature and suggests areas of future research to clarify the role of cardiac autonomic and affective processes in steroid sex hormone-related symptomatology.

Problematising menstrual tracking apps: presenting a novel critical scoping review methodology for mapping and interpreting research literature

OBJECTIVES

To showcase a novel, theoretically informed methodology for conducting scoping reviews by operationalising critical theory. And to advance the field of women's digital health by applying this critical scoping review methodology (CSR) to research on menstrual tracking apps (MTAs).

METHODS AND MEASURES

116 articles published in English, between November 2015 and November 2023, focusing on MTAs, and/or user's experiences of MTAs, were thematically analysed through the Foucauldian concept of problematisation and analytics from critical psychology. This method examined what was produced as a problem, and the underpinning discourses, subject positions, paradigms, desired outcomes, and absences within these problem categories.

RESULTS

Four problematisations were identified, (1) the problem of data privacy (subproblems: type of data, consent, abortion surveillance); (2) the problem with efficacy (subproblems: evaluating efficacy, accuracy, useability); (3) the problem of regulation (subproblems: self-surveillance, normative femininity, hormonal imperative, cycle regularity imperative, menstrual stigma); and (4) the problem of women (subproblems: health literacy, technology use, medically unknown, hard to design for).

CONCLUSION

MTA researchers would benefit from understanding their field through these problematisations. The CSR offers an important theoretically informed methodology for mapping and interpreting a research literature, which can identify, and expand, possibilities for research thought and practice.

Improving care experiences for premenstrual symptoms and disorders in the United Kingdom (UK): a mixed-methods approach

BACKGROUND

Poor care experiences are reported for premenstrual disorders, which may result in negative outcomes such as distress, reduced healthcare engagement, and delays to diagnosis. This research aimed to explore healthcare experiences for premenstrual symptoms in the United Kingdom and identify areas for potential improvements based on participant responses.

METHOD

An online survey was delivered, with participants recruited via social media. Experiences of care were explored using quantitative and qualitative questions. Quantitative data were explored using descriptive statistics, with group differences investigated using Mann-Whitney U tests and chi-square tests as appropriate. Qualitative data regarding care improvements was explored using inductive thematic analysis.

RESULTS

The sample included 339 participants who completed at least 97% of the survey, reported premenstrual symptoms in consecutive cycles, and had sought formal help for these symptoms. Mean age was 34.66 (SD = 5.88), with the majority identifying as women (n = 332, 97.94%) and white/Caucasian (n = 311, 91.74%). 75.22% (n = 255) felt that care was poor. 44.25% (n = 150) felt their symptoms were not taken seriously. 37.76% perceived a lack of healthcare professional knowledge (n = 128). The majority did not receive recommendations of non-formal sources of help (i.e., websites, support groups; 84.96%, n = 288) or lifestyle changes (74.63%, n = 253). Better care experiences were associated with healthcare professionals taking symptoms seriously (U = 1383.00, p < .001), higher perceived healthcare professional knowledge (U = 1370.50, p < .001), and receiving recommendations of non-formal sources of help (X2 = 48.251, df = 1, p < .001, Φc = .382) or lifestyle changes (X2 = 7.849, df = 1, p = .005, Φc = .152). Thematic analysis revealed 8 aspects of care improvement: Empathetic care provision; Healthcare professional education, understanding, and research; Comprehensive symptom assessment and investigations; Diagnosis; Professional support and treatment provision; Signposting or referral to additional resources or sources of help; Wider healthcare system improvements; and Patient role/voice and preferences.

CONCLUSIONS

Poor care experiences for premenstrual symptoms in the UK are characterised by dismissive attitudes and perceived lack of knowledge. Improved training provision for healthcare professionals is required to address this and other aspects of care identified by qualitative analysis. However, research is needed to identify appropriate methods to deliver training. Utilisation of standardised screening tools and patient-centred communication will likely ensure comprehensive assessments and reduce self-advocacy burdens.

Clustering of > 145,000 symptom logs reveals distinct pre, peri, and menopausal phenotypes

The transition to menopause is associated with disappearance of menstrual cycle symptoms and emergence of vasomotor symptoms. Although menopausal women report a variety of additional symptoms, it remains unclear which emerge prior to menopause, which occur in predictable clusters, how clusters change across the menopausal transition, or if distinct phenotypes are present within each life stage. We present an analysis of symptoms in premenopausal to menopausal women using the MenoLife app, which includes 4789 individuals (23% premenopausal, 29% perimenopausal, 48% menopausal) and 147,501 symptom logs (19% premenopausal, 39% perimenopausal, 42% menopausal). Clusters generated from logs of 45 different symptoms were assessed for similarities across methods: hierarchical clustering analysis (HCA), K-Means clustering of principal components of symptom reports, and binomial network analysis. Participants were further evaluated based on menstrual cycle regularity or natural versus medically induced menopause. Menstrual cycle-associated symptoms (e.g., cramps, breast swelling), digestive, mood, and integumentary symptoms were characteristic of premenopause. Vasomotor symptoms, pain, mood, and cognitive symptoms were characteristic of menopause. Perimenopausal women exhibited both menstrual cycle-associated and vasomotor symptoms. Subpopulations across life stages presented with additional correlated mood and cognitive, integumentary, digestive, nervous, or sexual complaints. Symptoms also differed among women depending on the reported regularity of their menstrual cycles or the way in which they entered menopause. Notably, we identified a set of symptoms that were very common across life stages: fatigue, headache, anxiety, and brain fog. Finally, we identified a lack of predictive power of hot flashes for any symptom except night sweats. Together, premenopausal women exhibit menstrual cycle-associated symptoms and menopausal women reported vasomotor symptoms, while perimenopausal women report both. All report high rates of fatigue, headache, anxiety, and brain fog. Limiting focus of menopausal treatment to vasomotor symptoms, or to premenstrual syndrome in premenopausal women, neglects a large proportion of overall symptom burden. Future interventions targeting mood and cognition, digestion, and the integumentary system are needed across stages of female reproductive life.

Progestagens and progesterone receptor modulation: Effects on the brain, mood, stress, and cognition in females

Progesterone is a highly lipophilic gonadal hormone that can influence behavior and mental health through its receptors in the brain. Fluctuations in progesterone levels across critical periods of a females life are associated with increased susceptibility to mental conditions. This review highlights the effects of progestagens, including progesterone and synthetic progestins, on the brain, mood, stress, and cognition in females. The primary focus is on experimental pharmacological research that teases out the distinct effects of progestagens from those of estrogens. Additionally, the key literature on puberty, the menstrual cycle, pregnancy, perimenopause, hormonal contraceptives, and menopausal hormone therapy is reviewed, although conclusions are limited by the nested effects of progestagens and estrogens. Single study-findings suggest an influence of progesterone on amygdala reactivity related to processing of emotional stimuli and memory. In patients with premenstrual dysphoric disorder, progesterone receptor modulation improves premenstrual mood symptoms and potentially enhances fronto-cingulate control over emotion processing. The interaction between progestagens and the systems involved in the regulation of stress seems to influence subjective experiences of mood and stress. Sparse studies investigating the effects of progestin-only contraceptives suggest effects of progestagens on the brain, mood, and stress. Progesterone and progestins used for contraception can influence neural processes as myelination and neuroprotection, exerting protective effects against stroke. Concerning menopausal hormonal therapy, the effects of progestins are largely unknown. Levels of progesterone as well as type, administration route, timing, dose regimen, metabolism, and intracellular activity of progestins in hormonal contraceptives and menopausal hormonal therapy are factors whose effects remain to be elucidated. Altogether, current knowledge highlights the potential role of progestagens in females health but also calls for well-designed pharmaco-behavioral studies disentangling the effects of progestagens from those of estrogens.

Validation of the premenstrual symptoms questionnaire among Mongolian nursing school students

BACKGROUND

Premenstrual disorders (PMDs) significantly affect the daily lives of women. This study evaluated the reliability and validity of the Mongolian-translated Premenstrual Symptoms Questionnaire (PSQ) among female nursing students at the Mongolian National University of Medical Sciences.

METHODS

This cross-sectional study was conducted from February 2023 to January 2024. The PSQ was translated into Mongolian, and its reliability and validity were assessed. A total of 431 participants completed the translated PSQ along with the Premenstrual Dysphoric Disorder (PMDD) Scale, Somatic Symptom Scale (SSS-8), Patient Health Questionnaire (PHQ-9), and Beck Anxiety Inventory (BAI). Reliability was evaluated via Cronbach's alpha for internal consistency. Validity was assessed via factor analysis and correlations with external measures.

RESULTS

The internal consistency of the Mongolian PSQ was 0. 945. Factor analysis supported the tool's construct validity, which revealed a one-factor structure consistent with that of the original Japanese PSQ. The PSQ had strong positive correlations with the PMDD Scale (r = 0.760), SSS-8 (r = 0.640), PHQ-9 (r = 0.580), and BAI (r = 0.620), which indicated good convergent validity.

CONCLUSION

The Mongolian-translated PSQ is a reliable and valid tool for assessing premenstrual symptoms in female nursing students. These findings suggest that the PSQ is a useful tool for screening PMDs in this population.

Mood symptoms and gut function across the menstrual cycle in individuals with premenstrual syndrome

Gastrointestinal (GI) symptoms such as bloating, constipation, and nausea are common in the days before menstruation, experienced by as many as 73 % of menstruating individuals. Mood may influence the link between menstrual cycle and GI symptoms, with prior studies indicating that even among healthy controls, GI symptoms worsen premenstrually and are associated with worsening mood. Associations between GI symptoms and mood are poorly understood among those with premenstrual syndrome (PMS), a cluster of mood and/or physical symptoms that occur in the week before menses affecting roughly 20 % of menstruators. Our primary aim was to examine associations between GI symptoms and mood symptoms across the menstrual cycle, in those who do and do not report PMS using a menstrual tracking app. We hypothesized that GI symptoms would be reported more frequently in the luteal phase than follicular phase, and that frequency of GI symptoms would be positively associated with mood symptoms in those with PMS. We analyzed data from 33,628 menstrual cycles across 32,241 participants, including n = 27,897 controls (29,137 menstrual cycles) and n = 4344 PMS participants (4491 menstrual cycles). GI symptoms were reported significantly more frequently in the luteal phase than the follicular phase in both control and PMS groups (p < 0.001). Mood symptoms were significantly positively associated with GI symptoms in both groups, in both follicular and luteal phases (p < 0.001). Results suggest that premenstrual GI symptoms are a common issue, and additional work is needed to explore associations between mood and GI symptoms in the context of the menstrual cycle.

Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019

STUDY QUESTION

What is the burden of premenstrual syndrome (PMS) at the global, regional, and national levels across 21 regions and 204 countries and territories?

SUMMARY ANSWER

Over the past few decades, the global prevalent cases of PMS have grown significantly from 652.5 million in 1990 to 956.0 million in 2019, representing a 46.5% increase.

WHAT IS KNOWN ALREADY

PMS, which affects almost half of reproductive women worldwide, has substantial social, occupational, academic, and psychological effects on women's lives. However, no comprehensive and detailed epidemiological estimates of PMS by age and socio-demographic index (SDI) at global, regional, and national levels have been reported.

STUDY DESIGN, SIZE, DURATION

An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of PMS by age and SDI across 21 regions and 204 countries and territories has been performed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The prevalence and YLD of PMS from 1990 to 2019 were retrieved directly from the Global Burden of Diseases (GBD) 2019 study. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels.

MAIN RESULTS AND THE ROLE OF CHANCE

Globally, the prevalent cases of PMS increased by 46.5% from 652.5 million in 1990 to 956.0 million in 2019; in contrast, however, the age-standardized prevalence rate was approximately stable at 24 431.15/100 000 persons in 1990 and 24 406.51/100 000 persons in 2019 (AAPC, 0[95% CI: -0.01 to 0.01]). Globally, the YLD was 8.0 million in 2019 and 5.4 million in 1990, with a sizable increase over the past 30 years. The age-standardized YLD rate was stable (AAPC 0.01, P = 0.182), at 203.45/100 000 persons in 1990 and 203.76/100 000 persons in 2019. The age-standardized burden estimates were the highest in the low-middle SDI regions and the lowest in the high SDI regions. Peaks in burden rate estimates were all observed in the 40-44 years age group. Regional age-standardized burden estimates were the highest in South Asia and the lowest in Western Sub-Saharan Africa. The national age-standardized burden estimates were the highest in Pakistan and the lowest in Niger.

LIMITATIONS, REASONS FOR CAUTION

The accuracy of the results depended on the quality and quantity of the GBD 2019 data. Fortunately, the GBD study endeavoured to retrieve data globally and applied multiple models to optimize the completeness, accuracy, and reliability of the data. In addition, the GBD study took the country as its basic unit and neglected the influence of race. Further study is warranted to compare differences in PMS burden associated with race. Finally, no data are available on the aetiology and risk information related to PMS, which might help us to better understand the trends and age distribution of PMS and help local governments formulate more detailed policies and comprehensive interventions.

WIDER IMPLICATIONS OF THE FINDINGS

Although the age-standardized prevalence/YLD rate has been stable over the past 30 years, the absolute number of prevalent cases and YLD grew significantly worldwide from 1990 to 2019. Public health-related policies should be implemented to reduce the prevalence and alleviate the symptoms of PMS. Lifestyle changes and cognitive-behavioral therapy are critical in helping to reduce the burden of PMS.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Key Research and Development Program of China (grant number 2022YFC2704100) and the National Natural Science Foundation of China (No. 82001498, No. 82371648). The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Global burden and trends in female premenstrual syndrome study during 1990-2019

PURPOSE

Premenstrual syndrome (PMS) is prevalent worldwide and considered a crucial issue regarding women's health. In the present study, the Global Burden of Disease (GBD) Study 2019 dataset was utilized to assess the distributional trends in PMS burden and prevalence in regional, national, and sociodemographic index (SDI) categories.

METHODS

The analytical methods and approaches used in the 2019 GBD study were adopted to investigate the incidence rates and disability-adjusted life years (DALY) related to PMS in 204 countries or regions. Age-standardized incidence rates (ASIR), 95% uncertainty intervals (95% UI), and annual percentage changes (EAPC) were calculated from the data.

RESULTS

The global incidence and disability-adjusted life years of PMS exhibited a declining trend in the year 2019. Regions with medium-low SDI had the greatest burden of PMS, with the regions of South Asia (ASR = 7337.9 per 10,000) exhibiting the greatest Age-standardized incidence rates, while the high-income North American states presented the fastest upward trends in Age-standardized disability-adjusted life year rates. At the national level, 107 nations exhibited a decreasing trend in PMS incidence ASR, while 97 nations exhibited an increasing trend, with the United States presenting the greatest increase.

CONCLUSIONS

The present study highlighted that even though the global PMS incidence and disability-adjusted life years have decreased from the year 1990 to 2019, PMS remains a prevalent health concern for women worldwide. While addressing preventive measures and treatment, it is also important to consider the regional and national differences in PMS to develop further effective and targeted health policies.

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 ¯  = 1.85 days, Cohen's D = 0.59) and more variable (Cycle length SD: D ¯  = 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 ¯  = 0.86 days, t = 48.85, Cohen's D = 0.26; Period length: D ¯  = 0.08, t = 15.6, Cohen's D = 0.07) and more variable (Cycle length SD: D ¯  = 2.80 days, t = 111.43, d = 0.51; Period length SD: D ¯  = 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.

Use of Vitex agnus-castus in patients with menstrual cycle disorders: a single-center retrospective longitudinal cohort study

PURPOSE

To evaluate clinical characteristics, quality of life (QoL) and effectiveness in patients with menstrual cycle disorders (MCDs) including abnormal uterine bleeding, dysmenorrhea and mastodynia/mastalgia related to premenstrual syndrome taking the Vitex agnus-castus (VAC) products Cyclodynon® or Mastodynon® in a real-world setting.

METHODS

A single-center retrospective longitudinal cohort study (3 ± 1 months), using data obtained from healthcare data archive and telephone interviews. The main study variables were changes in bleeding, menstrual pain, breast tenderness and patients' QoL.

RESULTS

Data from 1700 women with a mean age of 30.2 years (± 6.3) were analyzed. The most common MCDs were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%). Improvement in bleeding intensity, frequency and menstrual pain was experienced by 83.4%, 79.2%, and 85.2% of the patients, respectively. When analyzed by disease category, these parameters improved in almost all dysmenorrhea patients, while they improved to a lesser extent in mastodynia/mastalgia patients. QoL improved in all aspects, but was reported by a higher proportion of dysmenorrhea patients compared to mastodynia/mastalgia patients. Treatment was overall well tolerated with a favorable safety profile.

CONCLUSION

These real-world data demonstrate the effectiveness of the VAC-containing products Cyclodynon® and Mastodynon® in the three-month treatment of MCDs, with a pronounced improvement in key disease symptoms and QoL. Intriguingly, while QoL was generally greatly improved, the response to VAC therapy varied depending on the type of underlying MCD.

A cross-sectional study of the relationship between premenstrual syndrome and missed nursing care among female nursing staff

Purpose

Premenstrual syndrome (PMS) is a cyclical psychosomatic disorder prevalent among women of reproductive age. However, research on the potential impact of PMS on routine nursing schedules and activities is limited. This study aims to identify the prevalence of PMS among female nursing staff and to examine the relationship between PMS and missed nursing care (MNC).

Method

Between November 1, 2022, and April 30, 2023, this study was conducted among female nursing staff working in nine inpatient departments at Sun Yat-sen University Cancer Center. This study used a cross-sectional design. The participants were recruited through convenience sampling. Data were collected using the standardized Menstrual Distress Questionnaire, the Oncology Missed Nursing Care self-rating scale, and a sociodemographic questionnaire. One-way analysis of variance, Fisher's least significant difference test for post-hoc comparisons, and Spearman's correlation coefficient were utilized for data analysis. A trend test was also performed to explore patterns in the severity of PMS and MNC over time.

Results

We collected a total of 224 questionnaires, with 154 (68.7%) female nursing staff reporting PMS. The most common symptoms were low back pain (91.1%), abdominal discomfort (90.6%), cold hands and feet (87.1%), and lethargy (87.1%). Moreover, 91.5% of the 224 female nursing staff reported at least one MNC activity. The nursing activities most frequently missed or left incomplete were liquid intake and output monitoring as ordered (43.3%), medication administration within 30 min before or after the scheduled time (43.3%), and electrocardiogram monitoring as ordered (42.9%). "Abdominal discomfort" from the Menstrual Distress Questionnaire was significantly correlated with the majority of MNC activities (p < 0.001).

Conclusions

This study provides evidence for a strong association between PMS and MNC among female nursing staff, suggesting that administrators should take the premenstrual conditions of female nursing staff into consideration. It is necessary to provide appropriate understanding and support to mitigate the impact on patient care and safety.

Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study

BACKGROUND

Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures.

OBJECTIVE

The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle.

METHODS

This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle.

RESULTS

The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458).

CONCLUSIONS

We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.

Women with more severe premenstrual syndrome have an enhanced anticipatory reward processing: a magnetoencephalography study

Laboratory studies reveal that young women with premenstrual syndrome (PMS) often exhibit decreased reward processing during the late luteal phase. However, studies based on the self-reports find opposite results (e.g., higher craving for high-sweet-fat food). These differences may lie in the difference between the stimulus used and measuring the different aspects of the reward. The present study was designed to expand previous work by using a classic monetary reward paradigm, simultaneously examining the motivational (i.e., reward anticipation, "wanting") and emotional (i.e., reward outcome, "liking") components of reward processing in women with high premenstrual symptoms (High PMS). College female students in their early twenties with High PMS (n = 20) and low premenstrual symptoms (Low PMS, n = 20) completed a monetary incentive delay task during their late luteal phase when the premenstrual symptoms typically peak. Brain activities in the reward anticipation phase and outcome phase were recorded using the magnetoencephalographic (MEG) imaging technique. No group differences were found in various behavioral measurements. For the MEG results, in the anticipation phase, when High PMS participants were presented with cues that predicted the upcoming monetary gains, they showed higher event-related magnetic fields (ERFs) than when they were presented with neutral non-reward cues. This pattern was reversed in Low PMS participants, as they showed lower reward cue-elicited ERFs than non-reward cue-elicited ones (cluster mass = 2560, cluster size = 891, p = .03, corrected for multiple comparisons), mainly in the right medial orbitofrontal and lateral orbitofrontal cortex (cluster mass = 375, cluster size = 140, p = .03, corrected for multiple comparisons). More importantly, women with High PMS had an overall significantly higher level of ERFs than women with Low PMS (cluster mass = 8039, cluster size = 2937, p = .0009, corrected for multiple comparisons) in the bilateral precentral gyrus, right postcentral gyrus, and left superior temporal gyrus (right: cluster mass = 410, cluster size = 128, p = .03; left: cluster mass = 352, cluster size = 98, p = .05; corrected for multiple comparisons). In the outcome phase, women with High PMS showed significantly lower theta power than the Low PMS ones for the expected non-reward feedback in the bilateral temporal-parietal regions (cluster mass = 47620, cluster size = 18308, p = .01, corrected for multiple comparisons). These findings reveal that the severity of PMS might alter reward anticipation. Specifically, women with High PMS displayed increased brain activities to reward-predicting cues and increased action preparation after the cues appear.

Sex steroids and the female brain across the lifespan: insights into risk of depression and Alzheimer's disease

Despite widespread sex differences in prevalence and presentation of numerous illnesses affecting the human brain, there has been little focus on the effect of endocrine ageing. Most preclinical studies have focused on males only, and clinical studies often analyse data by covarying for sex, ignoring relevant differences between the sexes. This sex- (and gender)-neutral approach is biased and contributes to the absence of targeted treatments and services for all sexes (and genders). Female health has been historically understudied, with grave consequences for their wellbeing and health equity. In this Review, we spotlight female brain health across the lifespan by informing on the role of sex steroids, particularly oestradiol, on the female brain and on risk for diseases more prevalent in females, such as depression and Alzheimer's disease.

Prevalence and Associated Factors of Premenstrual Syndrome in Chinese Adolescent Girls

Epidemiological data on premenstrual syndrome (PMS) in Chinese adolescents are limited. This study reported the prevalence and associated factors of PMS in a large sample of Chinese adolescents. A total of 5099 adolescent girls who had menarche participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort study in Shandong, China. A self-administered questionnaire was used to ask about PMS, age at menarche, menstrual cycle interval, menstrual flow length, menstrual regularity, period pain, body weight and height, trait anger, stressful life events, and demographics. The mean age of the sample was 15.19 years (SD = 1.32). The overall prevalence of PMS was 24.6%. The prevalence rates of PMS-anxiety, PMS-water retention, PMS-craving, and PMS-depression were 18.9%, 4.0%, 7.9%, and 11.5%, respectively. The most common symptoms were premenstrual irritability (54%) and fatigue (52.5%). Stepwise logistic regression showed that high levels of life stress (OR 2.26), high levels of trait anger (OR 4.65), alcohol consumption (OR 1.28), menstrual cycle interval ≤ 24 days (OR 1.45), and mild (OR 1.50), moderate (OR 2.57) or severe period pain (OR 4.84) were all significantly associated with increased likelihood of PMS. In conclusion, approximately 1 in 4 Chinese adolescent girls suffered from PMS. Multiple psychosocial and menstrual factors were associated with PMS. Further research is needed to understand developmental changes of PMS and its long-term impacts on psychosocial wellbeing in Chinese adolescent girls.

Development and validation of risk prediction model for premenstrual syndrome in nurses: results from the nurses-based the TARGET cohort study

Objective

Premenstrual syndrome (PMS) stands as a significant concern within the realm gynecological disorders, profoundly impacting women of childbearing age in China. However, the elusive nature of its risk factors necessitates investigation. This study, therefore, is dedicated to unraveling the intricacies of PMS by focusing on nurses, a cohort with unique occupational stressors, to develop and validate a predictive model for assessing the risk of PMS.

Methods

This investigation employed a multi-center cross-sectional analysis drawing upon data from the TARGET Nurses' health cohort. Utilizing online survey versions of the Premenstrual Syndrome Scale (PMSS), a comprehensive dataset encompassing physiological, social, psychological, occupational, and behavioral variables was collected from 18,645 participants. A stepwise multivariate logistic regression analysis was conducted to identify independent risk factors for PMS. Furthermore, a refined variable selection process was executed, combining the Least Absolute Shrinkage and Selection Operator (LASSO) method with 10-fold cross-validation. The visualization of the risk prediction model was achieved through a nomogram, and its performance was evaluated using the C index, receiver operating characteristic (ROC) curves, and the calibration curves.

Results

Among the diverse variables explored, this study identified several noteworthy predictors of PMS in nurses, including tea or coffee consumption, sleep quality, menstrual cycle regularity, intermenstrual bleeding episodes, dysmenorrhea severity, experiences of workplace bullying, trait coping style, anxiety, depression and perceived stress levels. The prediction model exhibited robust discriminatory power, with an area under the curve of 0.765 for the training set and 0.769 for the test set. Furthermore, the calibration curve underscored the model's high degree of alignment with observed outcomes.

Conclusion

The developed model showcases exceptional accuracy in identifying nurses at risk of PMS. This early alert system holds potential to significantly enhance nurses' well-being and underscore the importance of professional support.

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month. Both techniques were first taught for one session followed by home program to be performed by patients. The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA

Premenstrual dysphoric disorder (PMDD) is a severe mood disorder, with affective symptoms that rise and fall in concert with the hormonal fluctuations of the menstrual cycle. PMDD's pathophysiology is poorly understood. This review describes recent research on potential biological contributors to PMDD, with a focus on neuroactive steroids, genetics, neuroimaging and cellular studies. Studies suggest that a key contributor is abnormal central nervous system (CNS) response to fluctuations in neuroactive steroid hormones. Imaging studies are limited but support alterations in serotonergic and GABA transmission. Genetic studies suggest heritability, yet specific genetic contributors have not been characterized. Finally, recent cutting-edge cellular studies indicate an underlying vulnerability to the effect of sex hormones at a cellular level. Overall the findings across studies do not yet fit together into a complete description of the underlying biology of PMDD. It is possible that PMDD consists of biological subtypes, and future research may benefit from a subtyping approach.

New Pharmacological Approaches to the Management of Premenstrual Dysphoric Disorder

Premenstrual symptoms are experienced by many female individuals during their fertile age. Premenstrual dysphoric disorder (PMDD), a sex-specific mood disorder, affects about 5% of female individuals during the luteal phase of the menstrual cycle. Treatment with selective serotonin reuptake inhibitors represents a valid solution to manage PMDD for many, but not all, patients. Owing to maladaptive neural reactivity to gonadal hormone fluctuations, that is, the putative mechanism postulated to underlie PMDD, drugs suppressing or stabilizing such variations have been tested. Recently, a clinically significant reduction in the severity of the mental symptoms of PMDD was observed upon treatment with a selective progesterone receptor modulator (SPRM), as demonstrated when comparing ulipristal acetate with placebo in a randomised controlled trial. Stable and low progesterone levels, with maintained low-medium oestradiol levels, define the endocrine profile of this treatment. Importantly, the efficacy of SPRM treatment was accompanied by negligible side effects. These promising results represent a headway to understanding the mechanisms behind PMDD symptomatology and opening up new solutions in the management of PMDD. They also call for studies on the long-term efficacy, safety, and viability of SPRMs in female individuals during their fertile age to further support the development of targeted management of female's mental ill-health in relation to the menstrual cycle. The present overview thus seeks to inform about current and new pharmacological approaches to the management of premenstrual dysphoric disorder.

Menstrual cycle symptomatology during the COVID-19 pandemic: The role of interoceptive sensibility and psychological health

The literature on the COVID-19 pandemic has shown the importance of investigating its impact on mental health during this sensitive period, also in relation to the female menstrual cycle. To this end, interceptive sensibility has emerged as a fundamental construct for studying the mind-body interaction among psychosomatic and pain symptoms, particularly through the distinction between two attentional styles (namely, a "mindful" and a "non-mindful" sensibility). The aim of the following study is to verify the role of mental health and interoceptive sensibility on menstrual symptoms in women of childbearing age, during the pandemic, as well as to identify the specific contribution of the existing dimensions of interoceptive sensibility in the prediction of symptoms' severity. Data were collected through an online survey, for which 5294 women responded on demographic information, menstrual history, symptoms' disturbance, and completed the Italian versions of the GHQ-12 and the MAIA. The analyses showed that symptoms were strongly correlated to either the GHQ-12 and the MAIA subscales Noticing, Emotional Awareness, Trusting and Not-Worrying. This result was further verified via a hierarchical regression, which revealed that the same interoceptive dimensions and mental health strongly predicted the intensity of menstrual symptoms (R² = 0.177, ΔR² = 0.143) compared to other considered dimensions (R² = 0.180, ΔR² = 0.002). Results are partially in line with the premises but suggest that mental health has a strong impact on the experience of the menstrual cycle and that only a few interoceptive dimensions may be relevant in explaining the severity of menstrual symptoms. It is here suggested that noticing internal bodily signals and being aware of emotional states might become dysfunctional if not reconciled with a good ability to self-regulate internal states, but may rather contribute to the perpetuation of the 'vicious cycle' of heightened affective and attentional reactions to interoceptive sensations.