Menstrual and premenstrual experiences of women in a developing country

Exploratory systematic review and meta-analysis on period poverty

BACKGROUND

Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.

AIM

To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.

METHODS

All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30^th of April 1980 and the 30^th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.

RESULTS

A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.

CONCLUSION

There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Menstrual Hygiene Management in Resource-Poor Countries

Importance

Adequate management of menstrual hygiene is taken for granted in affluent countries; however, inadequate menstrual hygiene is a major problem for girls and women in resource-poor countries, which adversely affects the health and development of adolescent girls.

Objective

The aim of this article is to review the current evidence concerning menstrual hygiene management in these settings.

Evidence Acquisition

A PubMed search using MeSH terms was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized.

Results

Most research to date has described menstrual hygiene knowledge, attitudes, and practices, mainly in sub-Saharan Africa and South Asia. Many school-based studies indicate poorer menstrual hygiene among girls in rural areas and those attending public schools. The few studies that have tried to improve or change menstrual hygiene practices provide moderate to strong evidence that targeted interventions do improve menstrual hygiene knowledge and awareness.

Conclusion and Relevance

Challenges to improving menstrual hygiene management include lack of support from teachers (who are frequently male); teasing by peers when accidental menstrual soiling of clothes occurs; poor familial support; lack of cultural acceptance of alternative menstrual products; limited economic resources to purchase supplies; inadequate water and sanitation facilities at school; menstrual cramps, pain, and discomfort; and lengthy travel to and from school, which increases the likelihood of leaks/stains. Areas for future research include the relationship between menarche and school dropout, the relationship between menstrual hygiene management and other health outcomes, and how to increase awareness of menstrual hygiene management among household decision makers including husbands/fathers and in-laws.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completion of this educational activity, the obstetrician/gynecologist should be able to define what is meant by “adequate menstrual hygiene management,” identify the challenges to adequate menstrual hygiene management that exist in resource-poor countries, and describe some of the intervention strategies that have been proposed to improve menstrual hygiene management for girls and women in those countries.

Examining Self-Care Behaviors and Their Associated Factors Among Adolescent Girls With Dysmenorrhea: An Application of Orem's Self-Care Deficit Nursing Theory

PURPOSE

To test a hypothesized model that examines the relationship between selected basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea using Orem's self-care deficit nursing theory as a framework.

DESIGN

This was a predictive correlational study conducted with a total of 531 secondary school girls.

METHODS

Self-care agency, self-care behaviors, and 11 variables that have been theoretically or empirically justified in previous studies as relevant to basic conditioning factors were selected and collected by means of structured questionnaires. Path analyses were performed to test the hypothesized linkages among variables.

FINDINGS

Path analysis revealed that age and received menstrual education had both direct and indirect effects through self-care agency on self-care behaviors. Mother's and father's educational level, pain intensity, and self-medication used when experiencing dysmenorrhea only affected the self-care behaviors directly.

CONCLUSIONS

This is the first study that provided information about the relationship between basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea. Knowledge of the factors influencing self-care behaviors in these adolescent girls will assist healthcare professionals in developing effective interventions to promote self-care and ameliorate the adverse impact of this condition.

CLINICAL RELEVANCE

Interventional strategies that aim at promoting self-care behaviors among adolescent girls with dysmenorrhea should strengthen girls' self-care agency and should target those with a younger age, higher pain intensity, mother with a higher educational level, father with a lower educational level, and those who do not take self-medication for dysmenorrhea.

Intergenerational Differences in Parenting Styles of Mother–Daughter Dyads Among Immigrants and Native-Born Israelis

The study examined and compared intergenerational differences in parenting styles, attitudes toward child-rearing, and corporal punishment (CP) in three groups of mother–daughter dyads in Israel: immigrants from Ethiopia and from the Former Soviet Union (FSU) and native-born Israelis. Results show that ethnicity, mothers’ parenting styles, and mothers’ attitudes toward CP significantly explain 21% to 26% of the variance in daughters’ parenting styles. However, the results also indicate the differential effect on parenting style of exposure to a culture other than the culture of origin. This is also reflected in the fact that the younger generation, especially among immigrants from Ethiopia, is more affected by the encounter with the host society than is the older generation.

Premenstrual syndrome and premenstrual dysphoric disorder among Jordanian women

The objectives of this study were to detect the prevalence, severity and factors associated with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) among Jordanian women, and to identify the most common self-treatment strategies used by women to alleviate the symptoms associated with PMS and/or PMDD. Data were collected from 254 women studying or working at one of the largest Jordanian governmental university using Shortened Premenstrual Assessment Form (SPAF), Perceived Stress Scale (PSS) and Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Text Revision (DSM-IV-TR) research criteria for diagnosis of PMDD. The findings indicated that the prevalence of PMS and PMDD were 80.2%, 10.2% respectively. Abdominal cramp, lower back pain and breast pain were reported to be the most severe symptoms associated with PMS and PMDD. Significant correlations were found between severity of premenstrual symptoms and perceived stress level, age, body mass index, marital status, perception of health in general and absent from work. The most frequently reported self-treatment strategies used by women to alleviate PMS and PMDD symptoms were: taking analgesics, increasing hot fluids intake, wearing heavy and warm clothes, and lying down on the abdomen. Understanding the prevalence, severity and self-treatment strategies for women experiencing PMS and PMDD symptoms help in improving women's quality of life and decrease their suffering from these symptoms.

The burden of health associated with benign gynecological disorders in low-resource settings

Benign gynecological conditions impact on women's lives in a myriad of ways. Many of these conditions exert their burden on women's health because they remain undiagnosed, unacknowledged, or unreported for many years. Some of these conditions cause debilitating primary symptoms, especially of heavy menstrual bleeding, the lethargy of iron deficiency, and of persistent pelvic pain, with substantial impact on quality of life and ability to function on a day-to-day basis. The distressing quality of life impact of pelvic floor prolapse or of local vulval lesions should not be overlooked. Many also have secondary health consequences with adverse effects on fertility and reproductive outcome.

Women's views and experiences of their vaginal bleeding patterns: an international perspective from Norplant users

OBJECTIVES

Contraceptive-induced vaginal bleeding changes may be an undesired side effect, or a welcome opportunity to alter menstrual patterns. In Europe and the US, such changes are increasingly accepted; this study explores the perceptions of women around the globe.

METHODS

Norplant users from five countries (Chile, China, the Dominican Republic, Indonesia and Tunisia; N = 486) were surveyed at entry into a contraceptive clinical trial regarding preferred frequency of menstruation, menses-associated symptoms, and activities during menses.

RESULTS

Most women preferred once-monthly menstruation (81%); women in Chile, younger women, women neither married nor cohabitating, Christian women, and women experienced with hormonal contraception were more likely to accept alternative bleeding patterns. Women in Tunisia and Chile reported more symptoms associated with menses, while women in Beijing reported very few; decreased energy (32%), headaches (26%), abdominal pain (23%) and depression (22%) were most common. Avoidance of activities during menses such as physical work, sports, praying and entering religious sites, was closely tied to study centre. Across all sites, women (90%) avoided sexual intercourse during menses.

CONCLUSIONS

Despite growing acceptance of altering bleeding patterns, women in this study preferred monthly vaginal bleeding. Understanding sociocultural contexts and individual preferences is important when addressing this issue with women from diverse backgrounds.

A systematic review and meta-ethnography of the qualitative literature: experiences of the menarche

AIM

This article is a report of a systematic review and meta-ethnography of women's experience of menarche.

BACKGROUND

Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood.

DESIGN

Systematic review and meta-ethnography.

METHODS

Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women's experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography.

RESULTS

Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women's experience of menarche. These included: menarche preparation, significant others' response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche.

CONCLUSIONS

Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood.

Menstrual-related attitudes and symptoms among multi-racial Asian adolescent females

BACKGROUND

Menstruation has important implications on the physical and emotional well-being of adolescents' reproductive health.

PURPOSE

This study aimed to investigate the perception towards menstruation and premenstrual syndrome (PMS), to provide insight into menstrual-related education information in order to help adolescent girls manage the physical and psychological changes associated with menstruation.

METHODS

This cross-sectional study included 1,092 adolescent females from 94 schools in the Federal Territory of Kuala Lumpur, Malaysia. A self-administered semi-structured questionnaire was used in the data collection.

RESULTS

The results showed the mean scores on the menstrual attitude questionnaire to be 2.80 (SD ±1.88) out of six. A total of 80.7% and 83.6% of the participants experienced one or more affective and somatic symptoms respectively in the premenstrual phase. Irritability, mood swing and tension were the three most frequently reported affective symptoms, while fatigue and menstrual cramps were highly prevalent somatic symptoms in both the premenstrual and menstrual phases. The effects on functional impairment and quality of life, in order of importance, include poor class concentration, restriction of social and recreational activities, difficulty to mingle with friends, and poor class performance. Despite the evident impact, only 10.3% of adolescent girls consulted doctors for PMS symptoms, while one-third did nothing about their condition. There were ethnic differences in the seeking of treatment for PMS.

CONCLUSION

The study calls for an education program related to PMS and menstrual-related disorders to provide information and support to adolescents. This will help them to cope better with menstrual-related problems, and encourage positive attitudes to menstruation.

Menarche among Brazilian women: memories of experiences

OBJECTIVE

to present women's experiences of menarche and related memories.

DESIGN

qualitative study using focus groups for data collection.

SETTING

the city of Campinas, São Paulo state, Brazil.

PARTICIPANTS

64 women aged 21-51 years, experiencing menstrual periods, with former or current sexual activity and no perceived infertility.

METHODS

eight focus groups were carried out using a semi-structured guideline. Discussions were recorded with participants' consent, and transcribed and revised. Thematic content analysis was carried out using gender relations as the theoretical framework.

FINDINGS

menarche was experienced as a passage from childhood to womanhood, associated with belonging to a new group and acquiring a new status in the family. The experiences of menarche were not always welcomed or expected, but were recalled as associated with body changes and awareness of sexual issues. The mother's behaviour and attitudes towards menarche were clearly seen as generators of strong and everlasting impressions, either in a positive or negative way. Memories related to the experience of menarche extended through their life, interfering with their relation with their own body, including their reproductive health.

KEY CONCLUSIONS

the way in which menarche is experienced may exert an impact on women's reproductive health, sexuality and lifestyle behaviours.

IMPLICATIONS FOR PRACTICE

the acknowledgement of menarche experiences can be useful to guide health-care providers towards more effective education of girls on sexual and reproductive health issues and better attention to women's needs.

A culturally sensitive study of premenstrual and menstrual symptoms among Chinese women

This is a two-part study of perimenstrual symptomatology in Chinese women. We developed and validated the Chinese Questionnaire of Perimenstrual Symptoms (CQ-PERI-MS), which was adapted from the Moos Menstrual Distress Questionnaire, and used this instrument to assess the prevalence and nature of perimenstrual symptoms among Chinese women in Hong Kong. The initial CQ-PERI-MS was first administered to a sample of 538 menstruating Chinese women in Hong Kong together with measures of anxiety, depression and neuroticism. Psychometric analyses rendered a 32-item CQ-PERI-MS which demonstrated good reliability, convergent and discriminant validity, and factorial validity. Four factors were yielded, namely, Dysphoria, Somatic distress, Cognitive problems and Arousal. The CQ-PERI-MS was then administered to a separate sample of 339 menstruating Chinese women in Hong Kong for further examination of validity as well as pattern of perimenstrual symptoms. It was found that perimenstrual symptoms were common, with 18.6% and 34.2% of the participants reporting 10 or more premenstrual and menstrual symptoms, respectively. Both premenstrual and menstrual distress were characterised by a combination of emotional and somatic symptoms. Contrary to previous preconceptions, perimenstrual symptoms are commonly experienced by Chinese women, with both overlapping and distinct features when compared with patterns in the West.

Pattern and correlates of premenstrual symptomatology amongst Nigerian University students

This study aimed to evaluate the pattern and correlates of premenstrual symptomatology amongst Nigerian female undergraduates. Female University students (n = 409) completed questionnaires detailing sociodemographic, menstruation/gynecological history and personality traits. They were then rated with a checklist for premenstrual symptoms. The most frequent premenstrual symptoms were 'breast tenderness' (35.5%), 'sleeplessness' (15.6%), 'decreased interest in usual activities' (15.4%), 'lethargy/easy fatigability/lack of energy' (13.2%) and 'change in appetite' (13.2%). The prevalence of premenstrual symptomatology was 50.1% and the correlates of increasing premenstrual symptomatology included increasing age, increasing severity of menstrual pain, personality traits of neuroticism and agreeableness and increasing body mass index. Although the rate of premenstrual symptomatology in sub-Saharan African women was comparable with that in the western cultures, there may be cross-cultural differences in the pattern of presentation. Dysmenorrhoea and personality traits should be taken into consideration when planning and implementing effective strategy to manage perimenstrual problems in this region.

Blood, men and tears: keeping IUDs in place in Bangladesh

The Intra-Uterine Device (IUD) is an effective method of contraception, but in Bangladesh is associated with high levels of discontinuation within the first year. This study involved data collection from a retrospective cohort of women who had an IUD inserted 12 months earlier. In the cohort, 330 women were interviewed to identify factors associated with discontinuation. Later, 20 women, of the 103 who reported discontinuing because of excessive menstrual bleeding, were interviewed again and in depth about these issues. Of 330 women who had an IUD inserted, 47.3% had discontinued use one year post-insertion. In univariate and multivariate analyses, IUD discontinuation was strongly associated with side-effects (heavier periods; abdominal pain) and spousal factors (not discussing IUD with husband pre-insertion), but not with service delivery factors. In-depth interviews with women who reported excessive blood loss as the main reason for discontinuation found a doubling of both menstrual days and blood loss after IUD insertion. In Bangladesh, women cannot pray, have sexual intercourse, perform household tasks or participate in community activities during menstruation. Thus, women with menstrual side-effects faced serious physical, social and psychological challenges that made continuation difficult. Among those who discontinued, spouses were generally unsupportive and sometimes abusive, particularly when not involved in the decision to use the IUD.

Prevalence and severity of menstrual symptoms among institutionalised women with an intellectual disability

BACKGROUND

Perimenstrual syndrome (PMS) among women with an intellectual disability (ID) has not been investigated in Taiwan. This study explores the prevalence/severity of PMS experienced by women with ID who are institutionalised.

METHOD

Ninety two female residents aged 15 to 54 at six public institutions completed a structured interview between June and November 2006, together with the Moos Menstrual Distress Questionnaire (MMDQ).

RESULTS

Strong significant differences were detected between the participants' physical, emotional, behavioural, and psychological changes during the perimenstrual and remainder phases in all domains other than Arousal. Cramps, hot flushes, affection, orderliness, excitement, and bursts of energy/activity were most prevalent during the perimenstruum (>50%). The participants' unique characteristics and cultural context were associated with the various domains of the PMS.

CONCLUSIONS

Special attention should be paid in future to ascertain whether these experiences and perceptions of PMS are common among all women with ID.

Stereotypes of women in different stages of their reproductive life: data from Mexico and the United States

College students from Mexico and the United States (n = 349) were surveyed to explore stereotypes regarding women in different menstrual cycle phases and other stages of reproductive life. Participants from both countries defined a premenstrual or menstrual woman as irritable and moody and a menopausal woman as old and irritable. A woman with a hysterectomy was defined as sad, and only Americans used other words that did not have any negative connotation. Participants used some positive adjectives to describe other stages. For example, a pregnant woman was defined as happy, but only by Mexicans. Finally, a woman with a young baby was defined in both countries as happy; however, Americans implied that having a baby is complicated. The findings are discussed in light of sociocultural differences and similarities.

Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates

AIMS

The rate of premenstrual dysphoric disorder (PMDD) amongst sub-Saharan Africans is unknown. This study aimed to estimate the rate of PMDD amongst Nigerian undergraduates and to evaluate psychosocial correlates and comorbid psychiatric conditions.

METHOD

Female university students (n=410) completed questionnaires detailing sociodemographic, menstruation, and gynaecological history. They also completed the Big Five Personality Inventory (BFI), and the presence of PMDD and any other DSM-IV axis 1 psychiatric diagnosis was assessed with the Mini International Neuropsychiatric Interview (MINI).

RESULTS

The prevalence of PMDD was 6.1% and the correlates included older age (p=0.001), painful menstruation (p=0.006), and high score on neuroticism scale (p=0.019). Compared with participants without PMDD, participants with PMDD have significantly higher rates for the following psychiatric diagnoses: dysthymia (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.68-8.69), major depressive disorder (OR, 17.00; 95% CI, 6.72-43.00), panic disorder (OR, 4.39; 95% CI, 1.35-14.30), and generalised anxiety disorder (OR, 1.21; 95% CI, 1.21-17.83).

CONCLUSION

The rate of PMDD in sub-Saharan African women was comparable to that in the western cultures. Planning and implementing an effective strategy to manage perimenstrual problems in this region should be an issue of priority.

Related Factors and Consequences of Menstrual Distress in Adolescent Girls with Dysmenorrhea

This study investigated symptoms, related factors, and consequences of menstrual distress in adolescent girls with dysmenorrhea. A total of 198 participants were recruited by convenience sampling from a technical college in Tainan County, Taiwan. Four instruments were used to collect data: a Demographic Data Questionnaire, a Menstrual Distress Questionnaire, the Short Form McGill Pain Questionnaire, and an Adolescent Menstrual Attitude Questionnaire. The top five symptoms of menstrual distress were cramps, fatigue, backache, swollen abdomen, and tender breasts. Results of stepwise multiple regression indicated that the best subsets for predicting adolescent menstrual distress, including age, mother's occupation, menstrual pain, and menstrual attitude, accounted for 59% of total variance. From the correlation analysis, the more severe the menstrual distress, the higher the impact on daily activities as well as the more frequent the absence from class and analgesic usage. The results of this study may provide a useful reference for school nurses designing menstrual health programs for adolescents.

Women's menarche stories from a multicultural sample

This paper reports on the findings of a focus group study that examines how women have experienced menarche at the personal level and in relation to the larger cultural, religious, and societal environment. Fifty-three women from 34 different countries were recruited in 13 focus groups. On the one hand, at the personal level, menarche stories shared in this study revealed salient themes concerning feelings experienced at the time of menarche, the importance of mother's reactions to their daughter's first menstruation, difficulties around understanding the meanings attached to menarche by others, managing menstrual products, as well as making sense of formal education related to menstruation, and the age of menarche. On the other hand, the discussions concerning how women experienced menarche in relation to the larger cultural, religious, and societal environment revealed secrecy to be a defining feature of many stories. Cultural expectations of learning, and following the rules and regulations surrounding menstruation led to different reactions in women at the time of their menarche. Very few women mentioned a ritual or celebration at the time of their menarche. Findings are discussed in terms of similarities and differences in menarche stories of women from different cultural backgrounds. Limitations of the study are mentioned and suggestions for future research are provided.

Menstrual-related changes expected by premenarcheal girls living in rural and urban areas of Mexico

Most women experience changes surrounding the start of menstruation. These changes are influenced by sociocultural context. Consequently, certain changes are more pronounced in some cultures than in others. Girls enter menarche with a clear set of paramenstrual expectations that may alter their menstrual cycle-related experiences when they become postmenarcheal. This study explored expectations concerning the paramenstrual changes of 1,173 premenarcheal girls living in rural and urban areas of Mexico. In accordance with the findings of studies conducted in other countries, Mexican premenarcheal girls associate menstruation with a set of mostly negative expectations. A comparison of the results from urban and rural girls revealed that urban girls expected negative paramenstrual changes more, while rural ones expected positive changes more. These differences suggest that the cultures in which girls are brought up have an impact on their expectations. Urban girls are more exposed to media which present a picture of menses as a debilitating event, while rural girls link menses with health because it is associated with the ability to have children.

Premenstrual Dysphoric Disorder: Recognition and Treatment

Premenstrual dysphoric disorder (PMDD) represents the more severe and disabling end of the spectrum of premenstrual syndrome and occurs in an estimated 2% to 9% of menstruating women. The most frequent PMDD symptoms among women seeking treatment consist of anger/irritability, anxiety/tension, feeling tired or lethargic, mood swings, feeling sad or depressed, and increased interpersonal conflicts. Women who develop PMDD appear to have serotonergic dysregulation that may be triggered by cyclic changes in gonadal steroids. The marked increase in the number of well-designed placebo-controlled studies in the past decade has established several selective serotonin reuptake- inhibiting antidepressants as effective first-line treatments for this disorder. Both continuous dosing and intermittent luteal dosing strategies lead to rapid improvement in symptoms and functioning. The present article provides a brief review of current information on the epidemiology, clinical presentation, neurobiology, and treatment of PMDD.

Symbols of menarche identified by African American females

This study was conducted to identify and describe symbolic themes of menarche. The qualitative case study design was used with a purposive sample of 30 participants (15 mothers and their 15 daughters) in answering 2 questions: (a) How do 9- and 10-year-old African American girls view the meaning of their menarcheal flow?, and (b) How do African American mothers view the meaning of menarche? Data were collected through interviews 2 to 5 days after completion of menarche. A cross-case comparison analysis of the interviews revealed 4 themes: (a) vaginal bleeding, (b) sexual maturation, (c) premenarcheal sexual activity, and (d) sexual payback to fathers. With the exception of the latter all themes were supported in earlier studies of Euro-American girls. These findings indicate the need for further research addressing self-concept at menarche, impact of menarche on family relationships, and views of fathers about sexual payback as a symbol of menarche.

The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women

AIM OF THE STUDY

This study explored characteristics of the menstrual cycle including duration, prevalence and severity of symptoms and examined the relationship of these characteristics with attitudes toward menstruation.

BACKGROUND

Conceptualization of menstrual phenomena and attitudes toward menstruation may vary among cultures. While data about menstrual health among American women are widely available, there are little data concerning menstrual health in Taiwanese women.

DESIGN/METHODS

A total of 30 healthy women with a mean age of 24.4 years participated in the study and made daily records of symptoms over a 90-day period with the Woods Daily Health Diary (WDHD). They then retrospectively completed the Moos Menstrual Distress Questionnaire (MMDQ) and the Menstrual Attitudes Questionnaire (MAQ).

RESULTS

The mean age of menarche of these women was 13 years, their mean cycle duration was 5.8 days and the cycle length was 31.1 days. The mean scores of five subscales for MAQ ranged from 2.19 to 3.28. Forty-six percent of the surveyed Taiwanese women agreed that the onset of menstruation can be predicted and anticipated, and 78% of these women agreed that menstruation was a natural event.

CONCLUSIONS

Menstrual attitudes in Taiwanese women are multidimensional, and that significant cross-cultural differences are present. Attitudes toward menstruation in Taiwanese women are related to their physical, cognitive, behavioural and psychological changes in the premenstrual and menstrual phases.

Exploring the bio-psycho--social approach to premenstrual experiences

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.

Premenstrual syndromes: closing the 20th century chapters

The need to re-evaluate premenstrual syndromes became apparent in 1997-1998 and early 1999. The success stories of some symptomatic treatment modalities and more sophisticated studies of pathobiology chart the pathways for future progress: the shift from a descriptive diagnosis to diagnoses based on etiology, the recognition of diversified vulnerabilities and their expression in particular situations, and specific treatment modalities.