Aerobic exercise, mood states and menstrual cycle symptoms

Cannabis use across the menstrual cycle: The impact of negative affect and cannabis use motives

Women experience greater state negative affect (NA) and physical symptoms during the premenstrual and menstrual phases of the menstrual cycle. Although women use more cannabis during the premenstrual and menstrual phases, no known studies have tested whether this is due to the synergistic effects of heightened NA and using cannabis to cope with increased NA or physical symptoms. This study tested whether state NA interacts with cannabis motives to predict more frequent cannabis use during these phases. Normally cycling women who endorsed past-month cannabis use (N = 40) retrospectively reported NA, cannabis use, and motives for 65 days. Cannabis use was more frequent during the premenstrual (but not menstrual) phase, and cannabis use to manage physical pain/discomfort (physical motives) was greater in the menstrual (but not premenstrual) phase. There were significant interactions between phase, state NA (depression and anger, in separate models), and coping and physical motives. Among women with higher state depression, coping motives were associated with more frequent cannabis use in the ovulatory phase whereas among women with lower state depression, coping motives were associated with more frequent cannabis use in the premenstrual phase. Among women with lower (but not higher) state anger, coping motives were associated with greater cannabis use frequency in the premenstrual phase. Among women with higher state NA, physical motives were associated with more frequent cannabis use in the menstrual (but not premenstrual) phase. Findings support that state NA interacts with motives during high-risk phases and is differentially related to more frequent cannabis use, which has important clinical implications.

The behavioral and physiological correlates of affective mood switching in premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD), a more severe manifestation of premenstrual syndrome (PMS), is characterized by emotional, behavioral, and physical symptoms that begin in the mid-to-late luteal phase of the menstrual cycle, when estradiol and progesterone levels precipitously decline, and remit after the onset of menses. Remotely monitoring physiologic variables associated with PMDD depression symptoms, such as heart rate variability (HRV), sleep, and physical activity, holds promise for developing an affective state prediction model. Switching into and out of depressive states is associated with an increased risk of suicide, and therefore, monitoring periods of affective switching may help mitigate risk. Management of other chronic health conditions, including cardiovascular disease and diabetes, has benefited from remote digital monitoring paradigms that enable patients and physicians to monitor symptoms in real-time and make behavioral and medication adjustments. PMDD is a chronic condition that may benefit from real-time, remote monitoring. However, clinical practice has not advanced to monitoring affective states in real-time. Identifying remote monitoring paradigms that can detect within-person affective state change may help facilitate later research on timely and efficacious interventions for individuals with PMDD. This narrative review synthesizes the current literature on behavioral and physiological correlates of PMDD suitable for remote monitoring during the menstrual cycle. The reliable measurement of heart rate variability (HRV), sleep, and physical activity, with existing wearable technology, suggests the potential of a remote monitoring paradigm in PMDD and other depressive disorders.

Effectiveness of 8-Week Exercise Programs in Improving Menstrual Characteristics in Female Adolescents in Saudi Arabia

Background: This study aimed to evaluate the effectiveness of 8-week exercise programs (aerobic, stretching, and aerobic plus stretching) in improving menstrual characteristics in female adolescents in Saudi Arabia. Methods: In this quasi-experimental study, seventy-eight healthy female adolescents aged 12-18 from secondary and high schools in Riyadh participated. Participants were divided into three groups and subjected to different types of exercises (aerobic, stretching, and aerobic plus stretching) for 20-30 min, three times a week. Menstrual pain, stress, and attitudes were assessed using the Numerical Rating Scale, Adolescent Stress Questionnaire Short Version, and Adolescent Menstrual Attitude Questionnaire, respectively. Assessments were conducted before the intervention and after the third menstrual period post-intervention. Results: The aerobic exercise group experienced a significant reduction in the mean length of the menstrual cycle (p = 0.025). The aerobic plus stretching group had the most significant reduction in mean menstrual pain scores (p < 0.0001). Stress scores were significantly reduced in the stretching group (p < 0.0001). Conclusion: We conclude that combining aerobic and stretching exercises significantly reduces menstrual pain, while aerobic exercise decreases menstrual cycle length and pain.

Effects of exercise on sex steroid hormones (estrogen, progesterone, testosterone) in eumenorrheic females: A systematic to review and meta-analysis

BACKGROUND

The sex steroid hormones fluctuate during the menstrual cycle, which affects the strength and postural stability of females and leads to injuries and risk of falls. These hormones may be modulated by exercise to impact the overall health of females.

OBJECTIVE

To determine the effects of exercise on sex steroid hormones in eumenorrheic females.

METHODS

This review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines in Lahore, Pakistan. The full-length articles were searched using these databases/search engines (PubMed, Web of Science and Google Scholar, Sci-Hub). Randomized controlled trials along with single group experimental studies were also included. All types of exercises were compared with no exercise in the control group. The Cochrane Risk of Bias assessment tool assessed and screened the articles. The data were then analyzed. The primary outcomes were the levels of estrogen, progesterone and testosterone.

RESULTS

Eleven studies were included (5 randomized controlled trials and 6 quasi-experimental studies). The effects of exercise on free estradiol concentration and serum progesterone level were not significant [p = 0.37 (SMD = 0.33, 95% CI = 0.14 to 0.74, I2 = 0%) and p = 0.84 (S.D= -0.65, C.I= -6.92 to 5.62, I2 = 94%)] respectively, whereas, the effects on testosterone levels were significant [p value < 0.00001 (M.D = 0.89, 95% C.I= -2.16 to 3.95, I2 = 94%)].

CONCLUSION

A blinded randomized controlled trial should be conducted in which a structured approach should be followed by women along with warm-ups, cool down and rest intervals.

TRIAL REGISTRATION NUMBER

The systematic review was registered prospectively on PROSPERO with registration number CRD42023473767.

Neurobiological effects of exercise intervention for premenstrual syndrome

Background

Up to 75%-90% of women have varying degrees of premenstrual syndrome (PMS). Exercises are recognized to be beneficial to regulate the negative emotions associated with PMS; however, the effects of exercise on sadness inhibition have not yet been investigated from the neurobiological perspective.

Purpose

This study examined the effects of a single exercise intervention on the neural mechanisms mediating sadness response inhibition at the cortical level using multichannel event-related potential (ERP) recording in women with PMS.

Methods

Participants performed Go/No-go trials while viewing of sad or neutral images before and after exercise intervention, and changes in the No-go-evoked N200 (N2) ERP component were measured by electroencephalography (EEG) at multiple cortical sites. The associations of PMS Inventory scores with N2 amplitude and latency changes were then examined using Pearson's correlation analysis.

Results

There were no significant differences in N2 latency and response error rate following exercise compared to baseline. However, women with higher PMS Inventory scores (greater symptom severity) demonstrated significantly lengthen N2 latency at the Fz electrode sites during correct sad face No-go trials after exercise (p < 0.05), which was not the case in the pre-exercise baseline. We detected no significant relationship between the PMS score and N2 amplitude, either pre- or post-exercise.

Conclusion

Women with higher PMS severity exhibited longer sad N2 latencies as well as slow down the speed of reaction to negative stimuli by exercise, suggesting that the prefrontal emotion regulation network is involved in PMS symptoms and is sensitive to the beneficial effects of exercise.

Effects of Yoga for Coping with Premenstrual Symptoms in Taiwan-A Cluster Randomized Study

Home-based yoga practice has not been approved as a method for alleviating premenstrual symptoms in Taiwan. This study was a cluster randomized trial. A total of 128 women self-reporting at least one premenstrual symptom were enrolled in the study, of which there were 65 participants in the experimental group and 63 participants in the control group. Women in the yoga group were provided with a yoga DVD program (30 min) to practice for three menstrual months, at least three times a week. All participants were given the Daily Record of Severity of Problems (DRSP) form to measure premenstrual symptoms. After the yoga exercise intervention, the yoga group had statistically significantly fewer and/or less severe premenstrual depressive symptoms, physical symptoms, and anger/irritability. Other disturbances and the impairment of daily routine, hobbies/social activities, and relationships also occurred significantly less often in the yoga group. The study found that yoga is useful to relieve premenstrual symptoms. Moreover, home-based yoga practice is more pertinent in the pandemic era. The strengths and drawbacks of the study are discussed and further study is recommended.

Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect

Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.

Do Recreationally-Trained Women of Different Ages Perceive Symptoms of the Menstrual Cycle and Adjust Their Training According to Phases?

We aimed to investigate the effects of the menstrual cycle (MC) in recreationally trained women athletes, including their perception of training, if age affected their perception of MC symptoms, and if they adjusted their training according to phases of the MC which they would perceive as the best/worst phase to train in. Three hundred- and ten-women amateur athletes with regular MC replied to an online quiz about their perception and the effects of MC on training and how they adjusted training according to their MC. Women were classified into three age groups: 18-25 years-old (n = 108), 26-35 years-old (n = 135), and 36-45 years-old (n = 67). Despite a higher ratio of younger perceived symptoms and the influence of MC phases in training, the group varied their training according to MC phases the least (37%) compared to 26-35 (50%) and 36-45-year-olds (40.2%). Most of athletes perceived the late follicular phase (LF) as the best phase to train in (18-25 = 79.6%; 26-35 = 80.7%; 36-45 = 91%) and the worst phases were early follicular (EF) (54.6%; 58% and 46.2%), and late luteal (LL) (38%; 48% and 47.7%). Regardless of age, most women perceived MC symptoms, and women in the 26-35 group adjusted their training more according to MC phases.

The effect of abdominal massage and stretching exercise on pain and dysmenorrhea symptoms in female university students: A single-blind randomized-controlled clinical trial

In this study the researchers aimed to determine the effect of abdominal massage and stretching exercises on the severity of pain, dysmenorrhea symptoms and menstrual blood lost in university students. In this single-blind randomized controlled clinical trial 63 university students were included. Participants were randomly assigned into massage group, exercise and control groups. Our findings showed that the 2^nd cycle scores related to abdominal-back pain and fatigue in the massage group and 2^nd cycle scores related to mood change in the exercise group were significantly lower than those of the massage and control groups. However, there was no difference between groups in terms of the Visual Analogue Scale scores and blood lost. Our evidence indicates that massage was effective on abdominal-back pain and weakness, and exercise was effective on mood change.

The impact of depressed mood and coping motives on cannabis use quantity across the menstrual cycle in those with and without pre-menstrual dysphoric disorder

BACKGROUND AND AIMS

Reported rates of cannabis use among Canadian females are increasing. Female cannabis users progress to cannabis use disorder more rapidly than males (telescoping) and have higher rates of emotional disorder comorbidity. Addictive behaviors may change, along with mood and motivations, across the menstrual cycle (MC), particularly for females with pre-menstrual dysphoric disorder (PMDD). This study aimed to determine whether increases in depressed mood and coping motives would predict increased cannabis use pre-menstrually/menstrually, particularly among females with PMDD. We also assessed positive mood and enhancement motive ratings to establish specificity of predicted depressed mood and coping motive results.

DESIGN

Observational study using data collected across 32 days using electronic daily diary methods.

SETTING

Nova Scotia, Canada.

PARTICIPANTS

Sixty-nine naturally cycling female cannabis users (Mean (M) age = 29.25, Standard Deviation  (SD) = 5.66) with and without retrospectively identified PMDD (via structured clinical interview) and prospectively identified PMDD (via elevated pre-menstrual depressed mood). Self-reported MC phase was validated using salivary progesterone concentrations.

MEASUREMENTS

Depressed/positive mood, coping-/enhancement-motivated cannabis use, and cannabis use quantity.

FINDINGS

Coping motives explained heightened cannabis use pre-menstrually/menstrually in those with retrospectively identified PMDD. Depressed mood explained increased cannabis use menstrually in those with retrospectively/prospectively identified PMDD. Moreover, prospectively identified PMDD significantly moderated the relationship between depressed mood and cannabis use quantity menstrually. In those with prospectively identified PMDD, positive mood and enhancement motives were associated with decreased cannabis use during the follicular/ovulatory phases. Females with versus without retrospectively identified PMDD also displayed greater overall cannabis use quantity (M [SD] = 3.44[2.84] standard joint equivalents versus 1.85[1.82], respectively; U = 277.50, P = 0.008).

CONCLUSIONS

Depressed mood may explain heightened cannabis use menstrually in females with pre-menstrual dysphoric disorder. Coping motives may explain heightened cannabis use pre-menstrually/menstrually in females with retrospectively identified with pre-menstrual dysphoric disorder.

A mixed-methods study to evaluate the effectiveness and cost-effectiveness of aerobic exercise for primary dysmenorrhea: A study protocol

BACKGROUND AND PURPOSE

Several studies have evaluated the effects of high-intensity aerobic training (HIAT) on pain severity and quality of life (QoL) among women with primary dysmenorrhea. However, to date, no studies have evaluated the effectiveness of HIAT on academic performance or absenteeism or examined the cost-effectiveness of HIAT relative to other treatments in women with primary dysmenorrhea. Furthermore, the mechanisms underlying aerobic exercise-induced analgesia in primary dysmenorrhea remain unclear. The objectives of this study are to: (1) evaluate the effects of HIAT on absenteeism and academic performance among university students, (2) identify the underlying mechanisms associated with aerobic exercise-induced analgesia in primary dysmenorrhea, and (3) determine the cost-effectiveness of HIAT compared with a wait-list control (WLC) group receiving usual care.

METHODS

A sequential, embedded, mixed-methods study design, including a crossover, randomised controlled trial (RCT) and semi-structured focus groups, will be conducted alongside an economic evaluation. A total of 130 women aged 18-24 years will be randomised into either HIAT (n = 65) or wait-list control (n = 65) groups. Primary outcomes will include average pain intensity, absenteeism from university, and academic performance. Primary mediators will include salivary progesterone and prostaglandin F2α levels. Outcome and meditator variables will be assessed at baseline and post-treatment, at 12 and 28 weeks. An economic analysis will be conducted from the societal and healthcare perspective of Hong Kong. Semi-structured focus groups will be conducted at 32 weeks. Of the 130 participants included in the RCT, 70 will be included in the focus groups.

STATISTICAL ANALYSIS

All statistical analyses will be performed on an intention-to-treat basis, using SPSS (version 24). Preliminary analysis using an independent samples t-test and a two-sided, unpaired Student's t-test will be performed to exclude carryover effects and identify within-participant differences in outcome variables between the study periods, respectively. Treatment effects will be evaluated using analysis of variance via a mixed-effects model with fixed effects for intervention, period, and sequence. In all models, random effects will include the participants nested within the sequence as a sampling cluster. The mediation effects will be assessed using the Sobel test. The EQ-5D responses will be converted into utility scores to estimate the gain or loss of quality-adjusted life-years. Seemingly unrelated regression analyses will be used to estimate the total cost differences and effect differences. Qualitative data will be analysed using the process of thematic analysis.

Addictive behaviors across the menstrual cycle: a systematic review

Research examining relations between menstrual cycle phase and female addictive behaviors is accumulating. Theories suggest addictive behaviors may increase during specific phases of the menstrual cycle resulting from cyclical fluctuations in hormones and affect. In line with self-medication theory, we predicted that addictive behaviors would increase premenstrually and menstrually, phases marked by elevations in negative affect, relative to the follicular and luteal phases. We also hypothesized, coinciding with reward-sensitivity theory, that addictive behaviors may increase during ovulation, a phase characterized by increased positive affect, compared to the same phases. This systematic review summarizes extant literature examining the menstrual cycle phase-addictive behavior relationship and underlying motivations. Articles pertaining to menstrual cycle phase and addictive behaviors within the PsycINFO, CINAL, and PubMED databases were screened to determine eligibility following PRISMA guidelines (n = 1568). Thirty-four articles examining alcohol use, cannabis use, nicotine use, caffeine use, and gambling behavior across menstrual cycle phase met inclusion criteria. Consistent with self-medication theory, strong evidence indicated that nicotine use increased premenstrually and menstrually. Other factors increasing both nicotine and alcohol use premenstrually and menstrually include having a premenstrual dysphoric disorder diagnosis or having premenstrual syndrome. Motivations for using alcohol and nicotine may too vary by menstrual cycle phase. Results were less consistent or understudied for other addictive behaviors and thus conclusions cannot be drawn. Menstrual cycle phase appears to be a female-specific factor affecting some addictive behaviors, particularly nicotine use, and should be considered when conducting addictive behavior research or clinical interventions for reproductive-aged females with addictive disorders.

The Influence of Running and Dancing on the Occurrence and Progression of Premenstrual Disorders

Background: The aim of the study was to assess the influence of both physical activity, such as running and dancing, and the personal characteristics of the studied women on the occurrence and progression of premenstrual disorder (PMD). Methods: We surveyed 414 women aged 22-48 who were experiencing the menstrual cycle but not using hormonal contraception. There were two physically active groups, runners (N = 215) and Argentine tango dancers (N = 94), and there was one group not undertaking any physical activity-the control group (N = 104). The research was conducted using the researchers' own questionnaire. Results: The number of days of PMD symptoms in the tango vs. runner vs. control groups are as follows: pre-bleeding (mean: 4.14 vs. 4.86 vs. 4.85; p = 0.024), after the onset of bleeding (mean: 1.76 vs. 2.39 vs. 2.16; p = 0.001), and in total (mean: 5.94 vs. 7.25 vs. 7.01; p < 0.001). The regression analysis results without grouping results are as follows: the number of days of symptoms before bleeding and menarche (B: -0.16; 95% CIs: from -0.29 to -0.04; p = 0.011), the total duration of symptoms and menarche (B: -0.17; 95% CIs: from -0.32 to -0.01; p = 0.036), lower abdominal pain and age (B: -0.05; 95% CIs: 0.92-0.98; p = 0.002), diarrhoea (B: -0.08; 95% CIs: 0.88-0.97; p < 0.001), tearfulness, depressive states and age (B: -0.06; 95% CIs: 0.91-0.97; p < 0.001), skin problems and age (B: -0.05; 95% CIs: 0.92-0.98; p = 0.004), joint pain and age (B: -0.09; 95% CIs: 0.86-0.96; p = 0.001), pain in the lumbar spine (B: -0.06, 95% CIs: 0.91-0.98; p = 0.001), water retention and BMI (B: 0.09; 95% CIs: 0.92-0.98; p = 0.007), and water retention and menarche (B: -0.19; 95% CIs: 0.73-0.94; p = 0.003). Information: generally there is one regression model, we have several here, we have a bit the description. Conclusions: Physical activity such as dancing (tango) shortens the duration of PMD symptoms but does not completely eliminate them. Running does not have as beneficial an effect on symptom relief as dancing. Current age, age when menstruation began (menarche), and BMI were revealed to be important factors influencing the symptoms of premenstrual disorders.

Effects of a Soccer Tournament on the Psychohormonal States of Collegiate Female Players

ABSTRACT

Broodryk, A, Pienaar, C, Edwards, D, and Sparks, M. Effects of a soccer tournament on the psychohormonal states of collegiate female players. J Strength Cond Res 35(7): 1873-1884, 2021-A gap exists in the literature concerning the connection between soccer players' hormonal and psychological responses when playing a tournament, or even a match, and its outcome (victory or defeat). This study evaluates the effects of a week-long tournament on the psychohormonal states of collegiate female soccer players. Eight players' cortisol (saliva sample), mood states (Incredibly Short Profile of Mood States [ISP]), and state-anxiety (state subscale of the State-Trait Anxiety Inventory) were assessed 1 hour before and 15 minutes after every game. Cortisol increased significantly after most matches, with intramatch differences observed (p < 0.05, d > 1.2). Match intensity influenced cortisol secretion, with greater secretion as intensity increased. The ISP demonstrated intramatch differences for the subscales' fatigue, depression, tension, and vigor (p < 0.05). Matches lost produced a higher total mood disturbance (TMD) index compared with matches won (p = 0.001, d = 1.4). Cortisol correlated with the TMD and various mood subscales before a winning outcome, with the ISP correlating at all times with the anxiety scores (p < 0.05). In conclusion, these results indicate that physiological and psychological variables combine to contribute to the stress response during a tournament. Focusing on high-intensity activities and minimizing fatigue are important, as both are associated with raised cortisol and negative mood states. Finally, implementing a mood questionnaire over a tournament can be beneficial, as sensitive information on players' hormonal and perceived anxiety states, which subsequently affect physical performance, can be obtained.

Exercise Performance Is Impaired during the Midluteal Phase of the Menstrual Cycle

PURPOSE

This study aimed to test the hypothesis that aerobic exercise performance is impaired in the midluteal (ML) compared with the midfollicular (MF) phase of the menstrual cycle.

METHODS

Twelve recreationally active eumenorrheic women (25 ± 6 yr) completed exercise sessions during the MF and the ML phases. Each session consisted of an 8-km cycling time trial that was preceded by 10 min of cycling performed at a constant power below and above gas exchange threshold. Heart rate, ventilation, and oxygen uptake were continuously measured. RPE and ratings of fatigue were assessed during the time trial using visual analog scales. Total mood disturbance was calculated from the POMS questionnaire administered before and 20 min postexercise.

RESULTS

Salivary progesterone concentration was 578 ± 515 pg·mL-1 higher in ML compared with MF phase (P < 0.01), whereas estradiol concentration did not differ between phases (167 ± 55 vs 206 ± 120 pg·mL-1, P = 0.31). Total mood disturbance before exercise was greater during the ML phase compared with the MF phase (P < 0.01), but this difference was abolished postexercise (P = 0.14). Mean power output was lower during the ML phase (115 ± 29 vs 125 ± 28 W, P < 0.01), which led to a slower time trial in the ML phase (18.3 ± 2.0 min) compared with the MF phase (17.8 ± 1.7 min, P = 0.03). Ratings of fatigue were greater during the ML phase from 2 to 8 km (P ≤ 0.01), whereas no differences in RPE were observed. Heart rate (P = 0.85), minute ventilation (P = 0.53), and oxygen uptake (P = 0.32) did not differ between phases during the time trial.

CONCLUSION

Aerobic exercise performance is worse in the ML phase compared with the MF phase in recreationally active women, which was accompanied by a more negative mood state preexercise and increased ratings of fatigue.

The effect of corrective and therapeutic exercises on bleeding volume and severe menstrual pain in non-athletic women

The aim of this study was to determine the relationship between lumbar lordosis and severe menstrual pain and bleeding for the improvement of the health status in women. This was a quasi-experimental study where the effects of a training program, (based on correctional and therapeutic exercises, on primary dysmenorrhoea and menstrual bleeding in women with hyper-lordosis) was determined. The severity of menstrual pain was evaluated by use of a questionnaire. There was a significant incidence of neurological pain, which was not reduced in the control group (who had no exercise). There was a significant relationship between the severity of menstrual pain and hyper-lordosis. In the intervention group, there was a significant decrease in the severity of menstrual pain following 12 weeks of exercise. Hyper-lordosis can be improved by performing corrective exercises and strengthening the abdominal muscles.Impact statementWhat is already known on this subject? Exercise is positively associated with changes in the menstrual cycle and has beneficial effects on menstruation.What do the results of this study add? This research determines the relationship between lumbar lordosis and severe menstrual pain and the association of severe menstrual bleeding, in order to take effective corrective actions to improve women's health.What are the implications of these findings for clinical practice and/or further research? Hyper-lordosis can be improved by corrective exercises and strengthening of the abdominal muscles.

Effect of whole body vibration versus resistive exercise on premenstrual symptoms in adolescents with premenstrual syndrome

Background

Premenstrual syndrome (PMS) is a cyclic disorder that affects social activities, interpersonal relationship, and educational productivity of adolescents. Therefore, this study aimed to compare the effect of whole body vibration (WBV) and resistive exercise on premenstrual symptoms in adolescents with PMS.

Methods

Sixty adolescents, aged 16–19 years and with body mass index > 19.9 kg/m2, participated in the study. They were randomly assigned to three groups equal in number. Control group received magnesium (Mg) (250 g) and vitamin B6 supplementation once daily. Resistive exercise group received the same supplementations and resistive exercise for three times/week, while the WBV group received the same supplementations and WBV training three times/week for 12 weeks. Premenstrual syndrome questionnaire (PMSQ) was used to evaluate premenstrual symptoms, including anxiety symptoms (PMS-A), depression symptoms (PMS-D), craving symptoms (PMS-C), hyperhydration symptoms (PMS-H), other symptoms, cramp, and low back pain.

Results

Pair-wise comparison test revealed a significant decrease (p = 0.000) in PMS-A, PMS-C, PMS-D, PMS-H, other symptoms, cramp, and low back pain of the resistive exercise group and WBV group after treatment. However, there was only a significant decrease in PMS-C (p = 0.03) of the control group after treatment. Post hoc test showed no significant difference (p > 0.05) between the resistive group and WBV group in all PMS symptoms after treatment.

Conclusions

Passive muscular training using WBV has a similar effect to resistive exercise on premenstrual symptoms that affect the quality of life in adolescents with PMS.

Trial registration

PACTR, PACTR201908589835132. Registered 26 June 2019—retrospectively registered.

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

OBJECTIVES

To explore athletes' past and current experiences and perceptions of the menstrual cycle in relation to its impact on sporting performance.

METHODS

15 international female rugby players participated in individual semi-structured interviews (age: 24.5±6.2 years). All interviews were recorded and transcribed verbatim, resulting in 37 376 words of text for descriptive and thematic analysis. Inter-rater reliability checks resulted in a concordance of agreement of 83%.

RESULTS

Almost all athletes (93%) reported menstrual cycle-related symptoms. Thirty-three per cent perceived heavy menstrual bleeding and 67% considered these symptoms impaired their performances. Two-thirds of athletes self-medicated to alleviate symptoms. Thematic analysis generated 262 meaning units, 38 themes, 10 categories and 4 general dimensions. The four general dimensions were: (1) symptoms: physiological and psychological menstrual cycle-related symptoms such as dysmenorrhoea, flooding, reduced energy levels, worry, distraction, fluctuating emotions and reduced motivation; (2) impact: perceived impact of menstruation on different aspects of daily lives and performance including negative and neutral responses; (3) resolution: the methods/approaches in dealing with menstruation-related concerns including accepting, or adapting and managing symptoms with self-medication or expert treatment; (4) support: available support and comfortability in discussing menstrual cycle-related issues.

CONCLUSIONS

This study provides the first in-depth insight into athlete's experiences of the menstrual cycle and perceived impact on training and competition. It highlights individual responses to menstrual 'issues' and emphasises the need for clinicians and support staff to undertake menstrual cycle profiling, monitoring and continue to develop awareness, openness, knowledge and understanding of the menstrual cycle.

Menstrual cycle phase, alcohol consumption, alcohol cravings, and mood among women in outpatient treatment for alcohol use disorder

Research shows fluctuations in drinking across the menstrual cycle among women with alcohol use disorder (AUD), but little work has investigated moderators of these fluctuations. This study examined drinking and craving intensity across the menstrual cycle, and the moderating effect of baseline depression and emotional distress during the midlate luteal phase and/or menses, among women receiving AUD treatment. Fifty-nine regularly cycling women reported menstrual history and baseline depression. Over 3 months of treatment, they kept daily logs of drinks, alcohol cravings, and menstruation (yes/no). Emotional distress during the midlate luteal phase and/or menses of their most recent menstrual cycle was also assessed during treatment. Menstrual cycle phase was estimated for each within-treatment day. Mixed model analyses tested main and interactive effects of menstrual cycle phase, baseline depression, and emotional distress during the midlate luteal phase and/or menses on daily drinks and craving intensity. Women drank most during the midlate luteal phase and menses compared with other phases. Among women with lower baseline depression, those with lower distress during the midlate luteal phase and/or menses reported more intense cravings during the midlate luteal phase (ΔM = .77, p = .000) and menses (ΔM = .51, p = .012); those with higher distress reported more intense cravings during menses, compared with all other phases (p < .01). Among women with higher baseline depression, craving intensity remained consistently high. Results document more drinking during the midlate luteal phase and menses and suggest that cycle-related distress and depression moderate the alcohol-menstrual association among women in AUD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of exercise on premenstrual symptoms: A systematic review

INTRODUCTION AND PURPOSE

The aim of this systematic review is to examine the effect of exercise on premenstrual symptoms.

METHODS

In this systematic review, international databases (EBSCO Host, ScienceDirect PubMed, Google Scholar) were searched from the start of databases to 30 April 2018. Keywords used included "premenstrual syndrome" and "exercise". For the keywords, "Medical Subject Headings" were used. Articles were screened by the two authors independently, and in case of disagreements, items were discussed until consensus was reached. All studies evaluating the effect of exercise on premenstrual symptoms were extracted from included studies without limiting the type of exercise.

RESULTS

A total of 361 studies on the subject were examined, and 17 publications in accordance with the inclusion criteria were included in the study and evaluated. It can be said that exercise is effective in improving physical symptoms such as pain, constipation, breast sensitivity, and psychological symptoms such as anxiety and anger. However, although there is no clarity regarding other symptoms, exercise has a symptom-reducing effect.

CONCLUSION

Exercise is an effective intervention for alleviating premenstrual symptoms in women with premenstrual syndrome.

Does aerobic exercise induced-analgesia occur through hormone and inflammatory cytokine-mediated mechanisms in primary dysmenorrhea?

The popular accepted explanation for the pathogenesis of primary dysmenorrhea is elevated levels of uterine prostaglandins. Aetiological studies report that production of prostaglandins is controlled by the sex hormone progesterone, with prostaglandins and progesterone displaying an inverse relationship (i.e. increased progesterone levels reduce prostaglandin levels). Pro-inflammatory cytokines (interleukin-6 [IL-6] and tumor necrosis factor-alpha [TNF-α]) are also implicated in the pathogenesis of primary dysmenorrhea. High-intensity aerobic exercise is effective for decreasing pain quality and intensity in women with primary dysmenorrhea. However, why and how aerobic exercise is effective for treatment of primary dysmenorrhea remain unclear. Our preliminary non-randomized controlled pilot study to examine the effects of high-intensity aerobic exercise on progesterone, prostaglandin metabolite (13,14-dihydro-15-keto-prostaglandin F2 alpha (KDPGF_2α), TNF-α, and pain intensity found increases in progesterone and decreases in KDPGF_2α, TNF-α, and pain intensity following high-intensity aerobic exercise relative to no exercise. Given these promising preliminary findings, as well as what is known about the pathogenesis of primary dysmenorrhea, we propose the following scientific hypothesis: high-intensity aerobic exercise utilizes hormone (progesterone) and inflammatory cytokine-mediated mechanisms to reduce the pain associated with primary dysmenorrhea.

The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study

BACKGROUND

Premenstrual syndrome (PMS) is a common disorder among women of reproductive age. Nearly 40% of women report problems with their menstrual cycles. Exercise is one of the recommended treatments to reduce symptoms of premenstrual syndrome (PMS). The present study was conducted to determine the effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome (PMS).

METHODS

This study was a randomized clinical trial (IRCT2015021721116N1) that was performed on 65 students living in student dormitories of Mashhad University of Medical Sciences in 2016, Iran. Samples were randomly assigned to control and intervention groups. The intervention group engaged in 8 weeks of aerobic exercises, three times a week, and 20 min for each session. The tools were research unit selection questionnaire, midwifery and personal particulars, temporary determination of premenstrual syndrome, Beck Depression, recorded daily symptoms of premenstrual syndrome and Borg scale. We analyzed the data using SPSS software and Mann-Whitney U test and Friedman test.

RESULTS

At the beginning of the study, both control and intervention groups were homogeneous. The results of independent t-test showed that among the physical symptoms of the premenstrual syndrome in the intervention group compared to the control group, at the end of the study, headache (p = 0.001), nausea, constipation diarrhea (p = 0.01), swollen (p = 0/001) had a significant reduction. Also, the comparison of the difference between the mean of the signs at the beginning and the end of the study, bloating (p = 0.01), Vomiting (p = 0.002), hot flashes (p = 0.04), increase in appetite (p = 0.008) were significantly decreased.

CONCLUSION

Aerobic exercise as one of the ways to treat premenstrual syndrome can reduce the physical symptoms of the syndrome.

TRIAL REGISTRATION

Name of registry: Zahra Mohebbi Dehnavi. IRCT registration number: IRCT 2015021721116 N1. Registration date: 2015 - 08-28. Registration timing: retrospective.

Changes in coping and social motives for drinking and alcohol consumption across the menstrual cycle

BACKGROUND

Alcohol use has been reported to fluctuate over women's menstrual cycles (MCs), with increased intake occurring premenstrually/menstrually (phases characterized by heightened negative affect) and during the ovulatory phase (a phase characterized by positive affect). This suggests women may drink for particular emotion-focused reasons at specific points in their cycles. However, no research had yet examined MC variability in drinking motives, or links between cycle-related changes in drinking motives and alcohol consumption.

METHODS

Ninety-four normally cycling women (M_age  = 22.9 years old, SD_age  = 4.7) completed daily diary measures (via Smartphone surveys), with questions pertaining to state drinking motives and quantity of alcohol consumed for the course of a full MC.

RESULTS

Drinking motives differed by cycle phase. Women reported a slight increase in drinking to self-medicate for negative affect premenstrually, with drinking to cope peaking in the menstrual phase and declining mid-cycle. Women reported a slight increasing trend across the cycle in social motives for drinking, while enhancement motives remained relatively stable across the cycle. Cycle-related changes in drinking motives predicted increases in the quantity of alcohol consumed. Drinking to cope with negative affect predicted a greater number of drinks menstrually (days 1-5). While social motives predicted a greater number of drinks during the follicular and ovulatory phases (days 5-16), enhancement motives were unrelated to drinking quantity across cycle phase.

CONCLUSIONS

Clinicians should be attentive to cycle phase when treating reproductive-aged women with alcohol disorders (e.g., encouraging the use of healthier means of coping with negative affect during menses).

WITHDRAWN: Exercise for dysmenorrhoea

BACKGROUND

Dysmenorrhoea is characterised by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhoea. Physical exercise has been suggested as a non-medical approach to the management of these symptoms.

OBJECTIVES

To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea.

SEARCH METHODS

A search was conducted using the methodology of the Menstrual Disorders and Subfertility Group (August 2009). CENTRAL (The Cochrane Library), MEDLINE, EMBASE, AMED and PsycINFO electronic databases were searched. Handsearching of relevant bibliographies and reference lists was also conducted.

SELECTION CRITERIA

Randomised controlled trials comparing exercise with a control or no intervention in women with dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Trials were independently selected and data extracted by two review authors.

MAIN RESULTS

Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < 0.05).

AUTHORS' CONCLUSIONS

The results of this review are limited to a single randomised trial of limited quality and with a small sample size. The data should be interpreted with caution and further research is required to investigate the hypothesis that exercise reduces the symptoms associated with dysmenorrhoea.

Recreational Physical Activity and Premenstrual Syndrome in Young Adult Women: A Cross-Sectional Study

Introduction

It is estimated that up to 75% of premenopausal women experience at least one premenstrual symptom and 8–20% meet clinical criteria for premenstrual syndrome. Premenstrual syndrome substantially reduces quality of life for many women of reproductive age, with pharmaceutical treatments having limited efficacy and substantial side effects. Physical activity has been recommended as a method of reducing menstrual symptom severity. However, this recommendation is based on relatively little evidence, and the relationship between physical activity, premenstrual symptoms, and premenstrual syndrome remains unclear.

Methods

We evaluated the relationship between physical activity and premenstrual syndrome and premenstrual symptoms among 414 women aged 18–31. Usual premenstrual symptom experience was assessed with a modified version of the Calendar of Premenstrual Experiences. Total, physical, and affective premenstrual symptom scores were calculated for all participants. Eighty women met criteria for moderate-to-severe premenstrual syndrome, while 89 met control criteria. Physical activity, along with dietary and lifestyle factors, was assessed by self-report.

Results

Physical activity was not significantly associated with total, affective, or physical premenstrual symptom score. Compared to the women with the lowest activity, women in tertiles 2 and 3 of activity, classified as metabolic equivalent task hours, had prevalence odds ratios for premenstrual syndrome of 1.5 (95% CI: 0.6–3.7) and 0.9 (95% CI: 0.4–2.4), respectively (p-value for trend = 0.85).

Conclusions

We found no association between physical activity and either premenstrual symptom scores or the prevalence of premenstrual syndrome.

Effect of a physiotherapy program in women with primary dysmenorrhea

OBJECTIVE

To evaluate the efficacy of a physiotherapy program for relieving symptoms of primary dysmenorrhea among Mexican women.

STUDY DESIGN

This was a single-center, prospective, experimental, parallel group, randomized controlled trial. This cross-sectional study was performed at the Universidad Politécnica de Pachuca, Hidalgo, Mexico. Female patients with primary dysmenorrhea, age of 18-22 years; pain intensity from 4 to 10cm on a Visual Analogue Scale (VAS); and sedentary lifestyle were included. The patients were then randomized to receive a physiotherapy program for three months or to no intervention program. The physiotherapy program consisted of overall stretching, specific stretches, Kegel exercises, jogging, and relaxation exercises. Patient evaluations of symptomatology and pain intensity were recorded basally and throughout for three menstrual periods. The data were entered into a computerized database for descriptive and inferential statistical analyses.

RESULTS

A per-protocol population of eighty three women with a mean age of 20.2±1.8 years underwent the physiotherapy program, and seventy seven participants with a mean age of 20.4±1.2 years received no treatment. The participant assessments of pain on the VAS during the second and the third menstrual cycles demonstrated a significant reduction in the treatment group (p<0.05) compared with the control group.

CONCLUSIONS

The results showed that strengthening, stretching and muscle relaxation techniques, in addition to jogging, are effective for reducing dysmenorrheic symptoms when they are regularly performed.

Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women

The objective of this study was to investigate the effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women. A total of 30 participants aged 16-20 years and complaining of premenstrual syndrome (PMS) were randomly assigned into two groups: a control group received vitamin B6 and Ca supplements once daily and a study group received the same medical treatment and participated in treadmill training three times per week for 3 months. A premenstrual syndrome questionnaire (MSQ), complete blood picture and hormone assays were performed for the assessment of all participants at the start and after the end of the treatment course. The study group showed a significant decrease in all post-treatment subscale symptoms, scores and total score. Haemoglobin, haematocrit, red cell count and platelet count were significantly increased, while mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and white blood cell count showed no significant differences. There was also a significant decrease in prolactin, oestradiol and progesterone levels. In conclusion, aerobic exercise increases haemoglobin, haematocrit, red cell count and platelet count, and decreases levels of prolactin, oestradiol and progesterone, resulting in improvement of fatigue, impaired concentration, confusion and most premenstrual symptoms.

Review on treatment of premenstrual syndrome: from conventional to alternative approach

Abstract Premenstrual syndrome (PMS) is the most common problem associated with women's health. Most women take alternative therapies for the treatment of PMS along with conventional therapies. A literature search was conducted which investigated various conventional and alternative therapies for the treatment of PMS. Web- and manual-based literature surveys were conducted to assess the information available on conventional and alternative treatment of PMS. Pubmed, Scopus, and Google scholar databases were screened, using the terms 'PMS and its management', 'pharmacotherapy of PMS', 'Alternative therapies for the treatment of PMS'. Publications with abstract/full articles and books were reviewed. Based on the available literature, there have been randomized clinical trials (RCTs) and high levels of evidence studies. The review addressed that drosperinone with ethinylestradiol has shown great improvement in symptoms of PMS in various RCTs. Among the alternative therapies use of micronutrients and herbs were found effective in treatment for symptoms of PMS.

Effects of aerobic exercise at different intensities in pre menstrual syndrome

OBJECTIVES

The purpose of this study is to analyze the potential benefits of aerobic exercises at different intensities in the management of pre menstrual syndrome.

METHODS

The study design is quasi-experimental; sixty-one female subjects were randomly allocated into three groups, Group A (mild intensity), Group B (moderate intensity) and Group C (severe intensity) and the intervention were given for 6 weeks. The study setting was general community settings. The outcome measures were menstrual symptom questionnaire, VO(2) max, forced vital capacity (FVC), maximum voluntary ventilation (MVV) and lipid profile (HDL, LDL, TGL).

RESULTS

There is significant decrease in menstrual symptoms in both Groups B and C. However, Group C improved with increased rate of perceived exertion. LDL levels did not change significantly but HDL, TGL, VO(2) max, FVC, and MVV improved significantly in Groups B and C, but remains significantly unchanged in Group A.

CONCLUSIONS

This study encourages the employment of regular, moderate intensity aerobic exercise as a potential intervention for pre menstrual syndrome.

Menstrual cycle effects on perceived exertion and pain during exercise among sedentary women

BACKGROUND

Increasing cardiovascular fitness through exercise participation among sedentary people is important for decreasing all-cause mortality. From an intervention perspective, identifying modifiable factors that maximize the successful initiation of exercise is of utmost importance. For women, cyclic hormonal variations can influence aspects of health and health behaviors, from smoking cessation efficacy to physiological responses to exercise. The purpose of this study was to examine the influence of menstrual cycle phase and hormonal contraceptive (HC) use on subjective response to an initial bout of moderate intensity exercise among previously sedentary women (n = 117).

METHODS

Women completed a treadmill exercise challenge session at 65% of their previously determined maximum oxygen consumption (Vo(2) max) during the early follicular, late follicular, or luteal phase. Participants reported ratings of perceived exertion and pain using Borg's Rating of Perceived Exertion (RPE) and CR10 scales at 10, 20, and 30 minutes during the exercise session.

RESULTS

There was a significant menstrual phase x birth control interaction on change in RPE [F(2, 111) = 3.75, p < 0.05] and change in perceived pain [F(2, 110) = 3.31, p < 0.05]. Women in the early follicular phase who were not using HCs had significantly greater increases in RPE and increases in pain compared with women in the late follicular and luteal phases.

CONCLUSIONS

Our results indicate that the use of HC and cycle phase influence sedentary women's subjective response to exercise. These results have important implications for the timing of exercise interventions aimed at increasing exercise among sedentary women.

Exercise for dysmenorrhoea

BACKGROUND

Dysmenorrhoea is characterised by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhoea. Physical exercise has been suggested as a non-medical approach to the management of these symptoms.

OBJECTIVES

To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea.

SEARCH STRATEGY

A search was conducted using the methodology of the Menstrual Disorders and Subfertility Group (August 2009). CENTRAL (The Cochrane Library), MEDLINE, EMBASE, AMED and PsycINFO electronic databases were searched. Handsearching of relevant bibliographies and reference lists was also conducted.

SELECTION CRITERIA

Randomised controlled trials comparing exercise with a control or no intervention in women with dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Trials were independently selected and data extracted by two review authors.

MAIN RESULTS

Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < 0.05).

AUTHORS' CONCLUSIONS

The results of this review are limited to a single randomised trial of limited quality and with a small sample size. The data should be interpreted with caution and further research is required to investigate the hypothesis that exercise reduces the symptoms associated with dysmenorrhoea.

Exercise and primary dysmenorrhoea : a comprehensive and critical review of the literature

Primary dysmenorrhoea (PD) is chronic, cyclic, pelvic, spasmodic pain associated with menstruation in the absence of identifiable pathology and is typically known as menstrual cramps or period pain. PD is the most common gynaecological disorder in menstruating women. Despite treatments being available for PD, relatively few women consult a clinician about their symptoms, preferring not to use treatment, or to self-treat using non-pharmacological or over-the-counter interventions. The notion that exercise is effective in preventing and treating symptoms has prevailed for many years and led to the promotion of anecdotal belief that exercise is beneficial. Behavioural interventions such as exercise may not only reduce dysmenorrhoea, but also eliminate or reduce the need for medication to control menstrual cramps and other associated symptoms. With emphasis on data from experimental studies, this report seeks to review the available evidence regarding the role of exercise in the management of PD and menstruation-related symptomatology. Using key search terms, online bibliographical databases were searched from the beginning of each database to 1 April 2007. Despite the widespread belief that exercise can reduce PD, empirical support is limited. Evidence from observational studies was mixed. Several observational studies reported that physical activity/exercise was associated with reduced prevalence of dysmenorrhoea, although numerous other studies found no significant association between outcomes. Evidence from controlled trials suggests that exercise can reduce PD and associated symptoms, but these have been small and of low methodological quality. There are, however, several plausible mechanisms by which exercise might be effective in the management of PD. A large randomized controlled trial is required before women and clinicians are advised that exercise is likely to be effective in reducing PD and related menstrual symptoms.

Management Strategies for Premenstrual Syndrome/Premenstrual Dysphoric Disorder

Objective:

To evaluate the current nonpharmacologic and pharmacologic treatment options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Data Sources:

Literature was obtained through searches of MEDLINE Ovid (1950–March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well as a bibliographic review of articles identified by the searches. Key terms included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and treatment.

Study Selection/Data Extraction:

All pertinent clinical trials, retrospective studies, and case reports in human subjects published in the English language were identified and evaluated for the safety and efficacy of pharmacologic and nonpharmacologic treatments of PMS/PMDD. Data from these studies and information from review articles were included in this review.

Data Synthesis:

Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMDD and are recommended as first-line agents when pharmacotherapy is warranted. Currently fluoxetine, controlled-release paroxetine, and sertraline are the only Food and Drug Administration-approved agents (or this indication. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective; however, adverse effects limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory drugs can be used as supportive care to relieve symptoms. Despite lack of specific evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS/PMDD and may be all that is needed to treat mild-to-moderate symptoms. Herbal and vitamin supplementation and complementary and alternative medicine have been evaluated for use in PMS/PMDD and have produced unclear or conflicting results. More controlled clinical trials are needed to determine their safety and efficacy and potential for drug interactions.

Conclusions:

Healthcare providers need to be aware of the symptoms of PMS and PMDD and the treatment options available. Treatment selection should be based on Individual patient symptoms, concomitant medical history, and need for contraception.

Aerobic fitness in women with chronic discogenic nonradicular low back pain

OBJECTIVE

The purpose of this study was to determine if aerobic fitness varies between women with and without chronic discogenic non-radicular low back pain.

DESIGN

Prospective cross-sectional descriptive study.

RESULTS

: Analysis of variance revealed that maximal oxygen consumption was lower (P = 0.05) in women with low back pain compared with the control group. In addition, there was a significant reduction (P = 0.05) in reported exercise training duration and frequency but no change in exercise intensity (P = 0.1) in the study group after the onset of low back pain. The low back pain group had minimal disability (19%) based on the Oswestry Disability Questionnaire.

CONCLUSIONS

Women with chronic discogenic non-radicular low back pain have lower maximal oxygen consumption than age-matched controls. However, this study group continued to exercise safely at the same exercise training intensity as before their low back pain and had minimal disability and above-average aerobic fitness.

Intake of dietary soy isoflavones in relation to perimenstrual symptoms of Korean women living in the USA

This study was conducted to identify the potential relationship between the dietary intake level of soy isoflavones and perimenstrual symptomatology. The research design was a cross-sectional study. The sample was made up of 84 Korean women living in the USA, aged 28-40 years. The Moos Menstrual Distress Questionnaire (MDQ) and the Food Frequency Questionnaire were used as measurement tools. The soy isoflavone intake was significantly correlated with MDQ scores in the menstrual phase. In conclusion, the beneficial effect of dietary soy isoflavones on certain menstrual symptoms was established, suggesting that soy isoflavones could be one of the dietary factors related to the complexity of premenstrual syndrome (PMS). The positive effect of soy isoflavones on PMS warrants further study.

Stress, quality of life and physical activity in women with varying degrees of premenstrual symptomatology

Premenstrual symptomatology, stress, quality of life (QOL) and exercise frequency, volume, and intensity were assessed in 114 females (18-33 years). Based on premenstrual symptoms (PMS), women were divided into high and low PMS groups and compared on stress, QOL and exercise variables. Results revealed women with high PMS had significantly more stress and poorer QOL than women with low PMS (p <.05 for both comparisons). Groups did not significantly differ on any of the exercise variables. Further analyses were performed to determine if exercise variables impacted PMS symptoms, stress and QOL reports in the high PMS group. While exercise volume and intensity did not impact any of the variables assessed, women with high PMS who reported exercising "sometimes" had more stress than women who reported exercising "often" or "never". This nonlinear relationship suggests that women with the worst symptoms may respond by exercising, while women who exercise often or never do not associate exercise with their symptoms.

An integrative medicine approach to premenstrual syndrome

Complementary and alternative medicine (CAM) approaches are widely used by women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This article provides a comprehensive review of the medical literature on clinical applications of CAM for these conditions. The information was collected via a Medline review dating back to 1966 and subsequent selected review of bibliographies from these articles for non-Medline referenced but relevant clinical studies. For many of the therapies discussed, there is a lack of conclusive evidence either confirming or refuting efficacy. For other therapies, including certain herbal and nutritional approaches, the use of exercise, and the use of mind-body approaches, there is substantial evidence of efficacy. This review will be relevant to the practicing clinician seeking to become aware of and to understand the relevance of the complementary/alternative therapies being used by his/her patients for PMS and PMDD.

A preliminary study of hormone replacement therapy and psychological mood states in perimenopausal women

Hormone replacement therapy (HRT) for perimenopausal women has been suggested to minimize the physical symptoms of menopause and improve mood and psychological functioning; however, the therapy remains controversial. In this study the effects of such therapy (comprising tablets, patches, and implants) on mood states was investigated within a sample of 70 perimenopausal women who were attending a family planning clinic within the Brisbane metropolitan area. On a battery of standardized questionnaires, including the General Health Questionnaire, the Profile of Mood States, the Eysenck Personality Questionnaire, and the Menstrual Distress Questionnaire, those 35 women who were using hormone replacement therapy prescribed by the clinic physician reported significantly lower scores on anxiety, insomnia, and somatic symptoms than did a comparable group of 35 untreated perimenopausal women. These findings provide some tentative support for the beneficial effects of the therapy on physical symptoms and psychological mood states related to the onset of menopause. Given increased life expectancy, there is a growing need for research into issues of aging.

The female athlete

Over the past 30 years, the number of women participating in organized sports has grown dramatically. Several forms of menstrual irregularities have been described in the female athlete: primary and secondary amenorrhoea, oligomenorrhoea, short luteal phases and anovulation. The incidence of menstrual irregularities is much higher in activities where a thin body is required for better performance. The hormonal pattern seen in these athletes is a hypothalamic amenorrhoea profile. There appears to be a decrease in gonadotrophin-releasing hormone (GnRH) pulses from the hypothalamus, which in turn decreases the pulsatile secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and shuts down stimulation of ovary. Recently, another type of amenorrhoea has been described in swimmers which is characterized by mild hyperandrogenism. Athletes with low weight are at risk of developing the female athletic triad, which includes amenorrhoea, osteoporosis and disordered eating. Athletes with this triad are susceptible to stress fractures. Other issues include the pregnant athlete. Intensive exercise during pregnancy can cause bradycardia. Safe limits of aerobic exercise in pregnancy depend on previous exercise habits. Infertility, which may develop with exercise, is probably reversible with reduction of exercise or weight gain. High impact sports activities may produce urinary incontinence. Oestrogen replacement therapy is often prescribed in amenorrhoeic athletes, but bone loss may not be completely reversible.