Age at Menarche and Menstrual Abnormalities in Adolescence: Does it Matter? The Evidence from a Large Survey among Italian Secondary Schoolgirls

OBJECTIVE

To explore the independent role of age at menarche on menstrual abnormalities among adolescents.

METHODS

The present study was a multicenter cross-sectional study on a large sample (n = 3782) of Italian girls aged 13-21 y attending secondary school who already had menarche. Girls were asked to fill in a questionnaire on menarcheal age and menstrual features during the latest three menses. The gynecological age was computed as the difference between age at the survey and the age at menarche. Main outcome measures were: prevalence of oligomenorrhea, polymenorrhea, menstrual cycle irregularity, abnormal bleeding length and dysmenorrhea. Irregularity in the recent past and since menarche was also studied. Multiple logistic models were used to identify any independent association between each abnormal feature and age at menarche or gynecological age. Adjusted ORs and 95%CI were performed.

RESULTS

After adjusting for covariates, menarcheal age was not independently associated with polymenorrhea (OR = 0.81; 95%CI 0.63-1.04), oligomenorrhea (OR = 1.16; 95%CI 0.94-1.43), menstrual cycle irregularity (OR = 0.99; 95%CI 0.86-1.14), abnormal bleeding length (OR = 0.96; 95%CI 0.87-1.06) and dysmenorrhea (OR = 1.03; 95%CI 0.85-1.24). The multivariate analysis suggests that the higher prevalence of oligomenorrhea and menstrual cycle irregularity among the girls who were older at menarche might be purely explained by their younger gynecological age.

CONCLUSIONS

No evidence of any independent influence of age at menarche on menstrual abnormalities among young girls was shown by the investigation. The findings suggest that, after menarche, adolescent girls' menstrual health should be checked to monitor the endocrine system maturation and to early intercept latent disorders becoming symptomatic.

Menarche and menstrual problems are associated with non-suicidal self-injury in adolescent girls

Menstrual problems and non-suicidal self-injury (NSSI) are common in adolescent girls. This study examined whether onset of menstruation and menstrual problems were related to NSSI in Chinese female adolescents. A total of 5696 adolescent girls participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort (SABHC) study in Shandong, China. A structured questionnaire was used to ask about participants' lifetime and last-year NSSI, age at menarche, menstrual cycle interval, menstrual flow length, menstrual irregularity, period pain, body weight and height, and demographics. Impulsivity was assessed by the Eysenck I7 impulsiveness scale. Internalizing and externalizing problems were measured by the Youth Self-Report of Child Behavior Checklist. The mean age of the sample was 15.0 years (SD = 1.4). The prevalence of lifetime and last year NSSI were 28.1% and 21.4% in Chinese adolescent girls. After adjusting for adolescent and family covariates (age, body mass index, impulsivity, internalizing and externalizing problems, paternal education, and family economic status), onset of menstruation was significantly associated with increased risk of lifetime NSSI (OR = 1.62, 95%CI = 1.20-2.20) and last year NSSI (OR = 1.92, 95%CI = 1.37-2.67). Among adolescent girls who had menarche, often irregular menstruation and period pain were significantly and independently associated with lifetime NSSI (OR = 1.36, 95%CI = 1.03-1.79; OR = 1.29, 95%CI = 1.05-1.58) and last year NSSI (OR = 1.46, 95%CI = 1.07-1.98; OR = 1.29, 95%CI = 1.03-1.61). Our findings suggest that onset of menarche, irregular periods, and period pain appear to be associated with increased risk of NSSI. These findings highlight the importance of menstruation hygiene education and treatment of menstrual problems to reduce the risk of NSSI among adolescent girls.

Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study

This study aimed to examine whether the characteristics of mental health and sleep duration, alone or in combination, are associated with menstrual cycle irregularity. This population-based, cross-sectional study analyzed the data from 4445 women aged 19-49 years, who participated in the Korea National Health and Nutrition Examination Survey 2010-2012. A structured questionnaire was used to assess mental health characteristics, sleep duration, and menstrual cycle irregularity. A multivariable logistic regression analysis was performed. High stress, depressive mood, and suicidal ideation were associated with increased risk of menstrual cycle irregularity after adjusting for confounding variables (odds ratio [95% confidence interval] = 1.33 [1.07-1.65], 1.56 [1.17-2.07], and 1.37 [1.01-1.87], respectively). Short sleep duration (≤ 5 h a day) was significantly associated with higher odds of severe menstrual cycle irregularity with menstrual interval of greater than 3 months (2.67 [1.35-5.27]). Participants with sleep duration of ≤ 5 h a day with psychological stress, depressive mood, or suicidal ideation had higher odds of menstrual cycle irregularity (1.96 [1.26-3.05], 2.86 [1.50-5.44], and 2.25 [1.18-4.29]). This study suggests positive associations of mental health problems and short sleep duration with menstrual cycle irregularity among Korean female adults. Therefore, strategies to deal with psychological stress, depressive mood, and sleep duration are needed for improving the reproductive health of women suffering from menstrual disturbances.

Polycystic ovary syndrome and its impact on Iranian women's quality of life: a population-based study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a major public health concern worldwide affecting up to one in five women at reproductive age. It is associated with biochemical and hormonal disturbances as well as adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in worsened quality of life. The aim of the present study is evaluating the quality of life and determining its degrading factors among Iranian women suffering from this syndrome.

METHODS

This cross-sectional study was conducted on 200 PCOS women in Hamadan, Iran. In order to measure quality of life we used the Persian version of Health-related Quality of Life Questionnaire for PCOS (PCOSQ). Descriptive statistics was used to explore the data. In addition linear regression analysis was performed to assess factors affecting health-related quality of life in this population.

RESULTS

The mean score for quality of life domains (from the greatest to the least serious concern) were: infertility (3.43 ± 1.63), emotions (3.55 ± 1.17), menstrual problems (3.77 ± 1.36), body hair (3.80 ± 2.05) and weight (4.32 ± 1.80), respectively. The higher score represents better function. However, multivariate analysis revealed that hirsutism had the strongest impact on the patients' quality of life (p < 0.001) followed by infertility (p = 0.038) and menstrual irregularity (p = 0.003).

CONCLUSION

The findings showed that impairment of quality of life was associated with PCOS related conditions such as hirsutism, infertility and menstrual problems.

Social impact of menstrual problems among adolescent school girls in rural Tamil Nadu

Background Adolescence is a period of physiological, psychological and social transition between childhood and adulthood and is characterized by the onset of menstruation in girls. A adolescent girls are naïve about menstruation and they take time to adapt to these changes both socially and psychologically. This study was carried out to assess the psychosocial impact of menstrual problems among schoolgoing adolescent girls. Methods This study is a cross-sectional study carried out in 350 schoolgoing adolescent girls in the year 2012 in the Thiruvallur district of Tamil Nadu. Girls who attained menarche 1 year prior to the data collection were included in the study. Data regarding background characteristics and psychosocial impact of menstrual problems were collected. Data was analyzed using SPSS ver. 15 software. The χ2-test was carried out to assess the statistical significance at the 95% level of significance. Results The mean age of the participants was 14.7 years. In this study, 87.7% of the girls had at least one menstrual problem. Among these, 78.5% could not attend school during menstruation, 51.1% were unable to perform household/sports activities (p < 0.001). It was observed that dysmenorrhea and menorrhagia were at increased risk of absenting the girls from school (p < 0.05). Conclusion The key to a sound adolescent health programme is a holistic approach which also focuses on the psychological and social domain of health. This could be achieved by involving all the stakeholders like parents, teachers, etc. to work as a team. It is also essential to develop adolescent friendly health services at the grass root level.

Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study

BACKGROUND

The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS.

METHODS

Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS.

RESULTS

Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal).

CONCLUSIONS

The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.

Associations between eating disorder diagnoses, behaviors, and menstrual dysfunction in a clinical sample

We explored associations between lifetime eating disorder (ED) diagnoses and behaviors and menstrual dysfunction using logistic regression models. Body mass index (BMI) fully explained differences in the odds of secondary amenorrhea (SA) across diagnoses. Women with dieting behaviors had borderline significantly higher odds of SA than those without after accounting for BMI. We suggest the presence of a strong association between BMI and SA and that dieting might represent a risk factor for SA regardless of BMI and ED diagnosis.

Of PCOS symptoms, hirsutism has the most significant impact on the quality of life of Iranian women

Introduction

Polycystic ovary syndrome is a common endocrine disorder affecting women both physically and psychologically and can lead to a poor quality of life compared to their normal counterparts. The aim of the present study was to assess the impact of various clinical features of polycystic ovary syndrome on the health-related quality of life of Iranian women diagnosed with this syndrome.

Materials and Methods

A total of 796 women diagnosed with polycystic ovary syndrome, aged 15–49 years, completed the questionnaires, interviews, and medical assessments required for this study. A reliable and validated Persian version of the health-related quality of life questionnaire for polycystic ovary syndrome patients was used. Linear regression models were used to assess the association between the symptoms of polycystic ovary syndrome and health-related quality of life.

Results

The mean age of participants was 28.02 years. 35.4% of the subjects were classified as overweight or obese. Hirsutism, was reported to have the strongest impact on the patients’ health-related quality of life, followed in descending order by body mass index, irregular menses and infertility. The relative level of hirsutism was directly proportional to decrease in health-related quality of life score (p<0.001).

Conclusions

The results of the study found that hirsutism had the strongest impact on the health-related quality of life measures in Iranian women diagnosed with polycystic ovary syndrome. Health care officials need to evaluate in depth the effect of each clinical feature of polycystic ovary syndrome separately and design management strategies, keeping in mind the psychological and physical manifestations.

Providing young women with credible health information about bleeding disorders

BACKGROUND

Approximately 1% of U.S. women may have an undiagnosed bleeding disorder, which can diminish quality of life and lead to life-threatening complications during menstruation, childbirth, and surgery.

PURPOSE

To understand young women's knowledge, attitudes, and perceptions about bleeding disorders and determine the preferred messaging strategy (e.g., gain- versus loss-framed messages) for presenting information.

METHODS

In September 2010, a web-assisted personal interview of women aged 18-25 years was conducted. Preliminary analyses were conducted in 2011 with final analyses in 2013. In total, 1,243 women participated. Knowledge of blood disorders was tabulated for these respondents. Menstrual experiences of women at risk for a bleeding disorder were compared with those not at risk using chi-square analyses. Perceived influence of gain- versus loss-framed messages also was compared.

RESULTS

Participants knew that a bleeding disorder is a condition in which bleeding takes a long time to stop (77%) or blood does not clot (66%). Of the women, 57% incorrectly thought that a bleeding disorder is characterized by thin blood; many were unsure if bleeding disorders involve blood types, not getting a period, or mother and fetus having a different blood type. Women at risk for a bleeding disorder were significantly more likely to report that menstruation interfered with daily activities (36% vs 9%); physical or sports activities (46% vs 21%); social activities (29% vs 7%); and school or work activities (20% vs 9%) than women not at risk. Gain-framed messages were significantly more likely to influence women's decisions to seek medical care than parallel loss-framed messages. Findings suggest that the most influential messages focus on knowing effective treatment is available (86% gain-framed vs 77% loss-framed); preventing pregnancy complications (79% gain- vs 71% loss-framed); and maintaining typical daily activities during menstrual periods.

CONCLUSIONS

Lack of information about bleeding disorders is a serious public health concern. Health communications focused on gain-framed statements might encourage symptomatic young women to seek diagnosis and treatment. These findings and corresponding recommendations align with Healthy People 2020 and with CDC's goal of working to promote the health, safety, and quality of life of women at every life stage.

Prevalence of menstrual disorders among adolescent girls in Osogbo, South Western Nigeria

BACKGROUND

Menstrual disorders are common sources of morbidity among adolescent girls and often cause anxiety for these girls and their families.

OBJECTIVE

This paper aims to determine the patterns of menstruation as well as the prevalence of menstrual disorders and their consequences among adolescent girls in Osogbo, South Western Nigeria.

SUBJECTS

Adolescent school girls aged 10-19 years comprised the sample.

METHODS

The study employed a descriptive cross-sectional design. A pre-tested, self administered, semi-structured questionnaire was used to elicit information from 402 adolescents selected from private secondary schools in the Osogbo Local Government Area (LGA) of Osun State, using a multistage sampling technique. Data were analyzed using SPSS version 15.

RESULTS

A total of 391 (97.8%) respondents had heard about menstruation before, with the three most important sources of information being their mothers (81.8%), teachers (7.4%), and peer groups (6.1%). The mean age at menarche was 12.5±1.0 years. Menstrual bleeding lasted between 2-7 days in 81.1% and cycle length lasted for 21-35 days in 81.6% of the respondents. The three most important menstrual disorders they experienced were dysmenorrhea (77.8%), menorrhagia (57.4%) and metrorrhagia (18.6%), among others. Menstrual disorders, especially dysmenorrhea, interfered with the daily activities of the respondents.

CONCLUSION

The prevalence of menstrual disorders among adolescents in the Osogbo LGA is high. Measures should be undertaken to educate the adolescents and their mothers about menstrual disorders and to mitigate their effects on the social and academic lives of these adolescents.

[Adolescent gynecology in the medical office]

In the age group of adolescents occur some gynecological problems which present different than in adult women. One is heavy menstrual bleeding, another menstrual problem is life burdening dysmenorrhea. Girls often do not speak about, they do not know what is really normal. Malignant breast masses are very rare, mostly fibroadenoma or cysts are found. With childhood obesity PCOS is a rising hormonal disturbance with impact on future fertility. Counseling adolescents in contraception is another challenge, focused on adherence, chronic disease and disabled teenagers. Together with the risks of unintended pregnancy adolescents have a high risk of sexually transmitted infections. Recommending preservative use and HPV and Hepatitis B vaccination is very important. Cervical cancer screening should start at age 21, girls with special risks (immunodeficiency, very early sexual activity) starting individually at earlier age.

Association of past and recent major depression and menstrual characteristics in midlife: Study of Women's Health Across the Nation

OBJECTIVE

The aim of this study was to examine the association of a history of major depression (MD) with menstrual problems in a multiethnic sample of midlife women.

METHODS

Participants were 934 women enrolled in the Study of Women's Health Across the Nation, a multisite study of menopause and aging. The outcomes were menstrual bleeding problems and premenstrual symptoms in the year before study entry. The Structured Clinical Interview for the Diagnosis of DSM-IV Axis I Disorders was conducted to determine recent and past psychiatric diagnoses. Covariates included sociodemographic, behavioral, and gynecologic factors.

RESULTS

One third of the participants reported heavy bleeding, 20% reported other abnormal bleeding, and 18% reported premenstrual symptoms. One third had past and 11% had recent MD. Past MD was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89; 95% CI, 1.25-2.85), adjusting for recent MD, menopause status, and other covariates. Past MD was not associated with other abnormal bleeding or premenstrual symptoms in the final analysis that adjusted for recent MD.

CONCLUSIONS

Midlife women with a history of MD are more likely to report heavy bleeding.

Menopausal complaints in Slovak midlife women and the impact of CYP1B1 polymorphism on their incidence

A wide variety of symptoms have been attributed to menopause, negatively influencing women's physical and psychological health. In addition to lifestyle parameters and personal history, genetic factors are considered to be the main source of this variation. This study aims to investigate the incidence of menopausal symptoms among midlife women according to their menopausal status, and to evaluate the contribution to their manifestation from CYP1B1 Leu432Val polymorphism as a predisposing factor for menopausal symptoms. The studied cohort consisted of 299 women ranging from 39 to 59 years of age. Women were recruited from the western and middle parts of Slovakia, and all participants completed a menopause-specific questionnaire and provided blood or saliva samples for genotyping. Our results indicated that all women are at risk of typical menopausal symptoms, but there is a higher number of postmenopausal women affected than premenopausal ones. Regression analysis showed that the CYP1B1 Leu/Leu genotype can increase the experience of bloated stomach and facial hair increase in all the sampled women, while the Leu/Leu genotype may increase experience of palpitations and involuntary urination in the premenopausal women. The Leu/Leu genotype may increase the experience of nausea, bloated stomach, and vaginal dryness in peri- and postmenopausal women. We determined that women with the Leu/Leu, or Leu/Val genotypes were approximately five times more likely to suffer from vaginal dryness than the Val/Val women (OR = 4.948; 95% CI, 1.259-19.447). We therefore suggest that CYP1B1 Leu432Val polymorphism could be involved in individual susceptibility to menopausal symptoms in Slovak midlife women.

Developmental associations between adolescent change in depressive symptoms and menstrual-cycle-phase-specific negative affect during early adulthood

The causal factors associated with increases in depressive symptoms among adolescent girls remain an area of theoretical debate, and the limited research considering a hormonal influence has provided mixed results. The goal of the present study was to test a set of longitudinal associations, that, if found, would provide support for a hormonal contribution to these changes. Specifically, this study tested the hypotheses that changes in depressive symptoms among adolescent girls would be associated with phase-specific symptoms of the menstrual cycle during early adulthood; that these associations would differ across three phases of the menstrual cycle; and that the pattern of associations would differ for changes in depressive symptoms during early- and late-adolescence. The sample consisted of 47 women with longitudinal data from 12 to 21 years old (approximately 91% European Canadian, 4% Middle Eastern Canadian, 2% Haitian Canadian, and 2% Asian Canadian). Consistent with expectations, results showed that early-adolescent increases in depressive symptoms were negatively associated with menstrual-phase negative affect, and positively associated with mid-cycle negative affect, but not associated with premenstrual negative affect; whereas late-adolescent change in depressive symptoms was only associated with depressive symptoms at 20-21 years. Thus, early-adolescent changes in depressive symptoms are longitudinally associated with later mood change across the menstrual cycle, suggesting a common underlying cause, which is hypothesized to be hormonal. Moreover, results suggest that, with respect to variables that are involved in affective development, important differences exist between early- and late-adolescence. The discussion considers menstrual-cycle-related symptoms (e.g., dysmenorrhea) during adolescence, and the need to study their effects on development. It is suggested that focused intervention and prevention efforts may be indicated to interrupt negative developmental outcomes.

Psychological and neuroendocrinological effects of odor of saffron (Crocus sativus)

AIM

The purpose of this study was to clarify the effects of saffron odor on symptoms unique to women, such as premenstrual syndrome (PMS), dysmenorrhea (menstrual pain) and irregular menstruation.

MATERIALS AND METHODS

Thirty-five women with a normal sense of smell were exposed to saffron odor for 20 min. Saliva samples were then collected to measure levels of cortisol (C), testosterone (T) and 17-β estradiol (E) by enzyme immunoassay, and the State-Trait Anxiety Inventory (STAI) was administered as a psychological test.

RESULTS

Saffron odor significantly decreased C levels after short-term stimulation (20 min) in both follicular and luteal phases. E level after exposure to saffron odor was increased in both the follicular- and luteal-phase groups. STAI score decreased in the follicular and luteal phases in the saffron group.

CONCLUSIONS

The present findings support the existence of physiological and psychological effects of saffron odor in women. Our results indicate that saffron odor exert some effects in the treatment of PMS, dysmenorrhea and irregular menstruation. This is the first report to suggest that saffron odor may be effective in treating menstrual distress.

Menstrual psychosis: a bipolar disorder with a link to the hypothalamus

The literature on menstrual psychosis is briefly reviewed in this article. There are about 80 cases with substantial evidence, and about 200 other possible cases. The clinical features are generally those of manic depressive (bipolar) disorder. The diagnosis requires the accurate dating of the onsets of episodes and of menstrual bleeding. Obtaining a baseline of several carefully dated episodes is also important in finding the best way to arrest the periodic illness. Although conventional psychotropic drugs can shorten episodes, they do not prevent recurrences. For this, unconventional treatments appear to be more effective, especially thyroid hormone and clomiphene. Patients with menstrual psychosis usually have abnormal menstruation, such as anovulatory cycles, luteal defects, or periods of amenorrhea. This, and the occurrence of episodes before the menarche, suggests that the interaction between the bipolar diathesis and menstruation is in the hypothalamus.

Predictors of caregiver supportive behaviors towards reproductive health care for women with intellectual disabilities

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of "2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan" were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively.

Suicide attempts among women during low estradiol/low progesterone states

The relationship between the menstrual cycle and risk for suicidal behaviors is not clear. The aim of this study is to determine whether perimenstrual phases in fertile women are associated with acute risk for suicide attempt and explore whether risk is elevated during low estradiol/low progesterone states. Women (N=431) recruited within 24h of a suicide attempt were assessed for psychopathology, suicidal behavior and LH, FSH, estradiol and progesterone blood levels. Among fertile women (N=281/431), suicide attempts were more likely to occur during menses (26%, 72/281 observed vs. 15%, 43/281 expected attempts; p<0.001). Compared to women whose attempts occurred during other phases, women who attempted suicide during low estradiol/low progesterone states (menstrual phase, amenorrhea and menopause) reported severe suicide intent, a measure that may be predictive of eventual suicide death. Suicide attempts among women are more likely when estrogen and progesterone levels are low and attempts made under these conditions are associated with greater severity. Low gonadal hormone levels may constitute a key factor in the neurobiological basis of suicidal behavior among women, suggesting a novel, testable hypothesis regarding the underpinnings of suicidal acts.

A study of the relationship between mental health and menstrual abnormalities in female middle school students from postearthquake Wenchuan

The present field investigation sought to explore the relationship between mental health and abnormal menstruation in female middle school students from post-earthquake Wenchuan following the 2008 Sichuan earthquake (the earthquake's epicenter was in Wenchuan Couty, Sichuan Province). A total of 587 female middle students from post-earthquake Wenchuan were given the PCL-C, SCL-90, and a menstruation questionnaire. Outcomes were measured by diagnostic criteria. The general incidence of PTSD was 60.8%, and D symptoms were the most prevalent PTSD symptoms (49.6%). Of symptoms indicated by the Symptom Checklist, obsessive-compulsive traits were most prevalent (94.6%), followed by interpersonal sensitivity (91.9%). The incidence of abnormal menstruation was 76.6%. Incidence of abnormal menses among students who screened positive for PTSD was significantly higher than among students who did not (chi2 = 4.015, p = 0.045). The incidence of abnormal menses was higher among students who screened positive for somatization, obsessive-compulsive traits, phobic anxiety, and diet and sleep disorders than among those who did not (p < 0.05). In conclusion, there was a relationship between mental health and physical health in female middle school students in a post-earthquake area. A higher incidence of abnormal menstruation may occur in students with PTSD, somatization disorder, obsessive-compulsive disorder, phobic anxiety, and diet and sleep disorders. Therefore, psychological intervention is particularly necessary for female students who have survived a natural disaster like an earthquake.

Menstrual problems and health-seeking behaviour in Hong Kong Chinese girls

OBJECTIVE

To ascertain the prevalence of menstrual problems in adolescent girls and their health-seeking behaviour.

DESIGN

Questionnaire survey on menstruation, menstrual problems, medical consultation, and factors influencing girls seeking medical care.

SETTING

Secondary schools in the catchment area of a tertiary teaching hospital in Hong Kong.

PARTICIPANTS

A total of 5609 girls from 10 secondary schools.

MAIN OUTCOME MEASURES

Prevalence of menstrual problems and health-seeking behaviour of adolescent girls.

RESULTS

The mean age of the girls and their mean age at menarche were 15.1 (standard deviation, 2.0) years and 12.3 (1.1) years, respectively. The prevalence of menorrhagia, dysmenorrhoea, and menstrual symptoms were 17.9% (95% confidence interval, 16.9-19.1%), 68.7% (67.7-70.3%), and 37.7% (36.7-39.3%), respectively. The prevalence of menstrual symptoms (P<0.001) and dysmenorrhoea (P<0.001) increased with gynaecological age (calendar age minus age at menarche), whilst the proportion having short or long cycles decreased (P=0.002 and P=0.009). One in eight girls reported having been absent from school, whilst only 6.4% had sought medical care because of menses. Multivariate analysis indicated that seeking medical care for menorrhagia was dependent on the opinion of a family member (P=0.005), and for dysmenorrhoea on its severity (P=0.046) and anxiety about embarrassing questions (P=0.039).

CONCLUSIONS

The prevalence of menstrual problems in Hong Kong Chinese girls is high and causes significant disruption to their school and daily activities. However, only a minority seek medical advice.

[Menstrual cycle perception and psychological distress in a sample of Mexican women]

OBJECTIVE

To evaluate the association between psychological distress and menstrual bleeding perception, in order to design a psychological intervention for women in reproductive age.

MATERIAL AND METHODS

Ex post facto and retrospective study in a random sample of women living in Mexico City with ages between 15 to 35 years. The following instruments were administered after reading the informed consent form: demographic and social questionnaire, gyneco-obstetric clinical history, menstrual bleeding diagnostic scale, menstrual bleeding analogical scale and the Goldberg's General Health Questionnaire.

RESULTS

909 women were interviewed and 776 completed the study. A significant statistic association existed between the presence of menorrhagia and the symptoms of psychological distress.

CONCLUSIONS

Our results suggest a temporary interaction between physiological and psychological symptoms that produce an intense sense of distress in the women.

Individual differences in self-regulatory failure and menstrual dysfunction predict upper respiratory infection symptoms and antibody response to flu immunization

Prior research indicates that cognitive priming manipulations that activate personal goals acutely increase or decrease natural killer cell cytotoxicity depending on whether individuals see themselves as making or failing to make progress toward their goals. Those findings in a laboratory setting revealed a psychobiological pathway whereby experiences of failure can influence health, but did not assess the impact of chronic perceived success/failure in goal pursuit on actual health outcomes. Three new studies investigated whether individual differences in perceived failure to attain personal goals influenced the self-reported symptoms of upper respiratory infections (URIs) as well as antibody response to flu immunization. Based on pilot data in young women, it also was hypothesized that the occurrence of menstrual dysfunction might interact with goal pursuit failure to more specifically predict cold and flu symptoms and optimal responses to vaccination. Perceived failure to attain goals did predict the reporting of URI symptoms as well as antibody levels post-immunization, both alone and in combination with menstrual dysfunction.

The etiology of some menstrual disorders: a gynecological and psychiatric issue

Some menstrual disorders with distinct gynecological character such as amenorrhea or menometrorrhagia (MMR) may have psychogenic etiology. On the other hand, in menstrual psychosis (MP), a distinctly psychiatric disorder, the etiology is not necessarily psychogenic, but rather is hormonal-biological. We present 4 cases, one each of primary and secondary amenorrhea, MMR, and MP, respectively. In the first 3 cases (2 amenorrhea and 1 MMR), we found psychogenic factors: an insult to feminine development after rape (case 1) or marriage problems (cases 2 and 3). In the case of a recurrent MP, no relevant psychological etiology was found. Furthermore, some of the patient's relatives had menstrual or peripartum psychiatric disorders. Menstrual disorders' etiology can be psychogenic or hormonal. The correct etiology is the guide for the adequate therapeutic way: psychotherapy based in psychogenic disorders and neuroleptic or antiovulatory drugs in those of biological etiology.

Patterns of menstrual disturbance in eating disorders

OBJECTIVE

To describe menstrual disturbance in eating disorders (ED).

METHOD

We describe menstrual history in 1,705 women and compare eating, weight, and psychopathological traits across menstrual groups.

RESULTS

Menstrual dysfunction occurred across all eating disorder subtypes. Individuals with normal menstrual history and primary amenorrhea reported the highest and lowest lifetime body mass index (BMI), respectively. Normal menstruation and oligomenorrhea groups reported greater binge eating, vomiting, and appetite suppressant use. Amenorrhea was associated with lower caloric intake and higher exercise. Harm avoidance, novelty seeking, perfectionism, and obsessionality discriminated among menstrual status groups. No differences in comorbid Axis I and II disorders were observed.

CONCLUSION

Menstrual dysfunction is not limited to any eating disorder subtype. BMI, caloric intake, and exercise were strongly associated with menstrual function. Menstrual status is not associated with comorbidity. Menstrual irregularity is an associated feature of all ED rather than being restricted to AN only.

Menstrual symptoms: the importance of social factors in women's experiences

BACKGROUND

Menstrual disorders are a common presentation in primary care. Heavy menstrual bleeding is the most common concern, and is often treated by medical and surgical means despite lack of pathology.

AIM

To explore women's experiences of menstrual disorders.

DESIGN OF STUDY

Two qualitative studies using semi-structured interviews.

SETTING

Inner-city London.

METHOD

An initial study recruited women with heavy menstrual bleeding via their GPs. A follow-up study recruited women with a variety of menstrual problems via general practice and the community. Interviews were taped and transcribed then analysed using the constant comparative method.

RESULTS

Management of menstruation was a prominent theme in interviews. Women acted to comply with a strong social message that menstruation should be concealed, although this behaviour was often 'taken for granted.' The need to conceal evidence or reminders of menstrual bleeding was particularly important. Onset of menstrual symptoms often challenged established strategies for menstrual management. Menstrual management then became a conscious problem and a source of continuing stress. The breakdown of management strategies, by real or threatened episodes of leaking or staining, influenced consultation behaviour and decisions about treatment.

CONCLUSION

The social pressure to maintain concealment of menstruation is a strong influence on women's health-related behaviour in response to menstrual concerns. Women's choices may be better understood if attention is paid to the social context in which they live.

Eating attitudes, body esteem, perfectionism and anxiety of judo athletes and nonathletes

The aim of the study was to examine the prevalence and relationships between disordered eating, menstrual irregularity, musculoskeletal injuries and psychological characteristics in 24 judo athletes (12 females and 12 males) and 31 controls (14 females and 17 males). All these parameters were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), the Multidimensional perfectionism scale, the Rosenberg Self-esteem, the Body esteem scale, and the Profile of Mood States. Body mass index (BMI) was also computed. Twenty-five percent of female athletes would be "at risk" of EDs (EAT-26 > 20) and 0 % in the other sample groups. Bone injuries sustained over the judo athlete career were reported by 25 % of females and 33.3 % of males, while 35.7 % of the female controls reported bone injuries. The total frequency of menstrual dysfunction among judo athletes was 58.3 %, while 7.1 % of female controls reported oligoamenorrhea. Regression analyses showed that BE-Weight Satisfaction and BMI contributed to 54.6 % and 17 % of the variance, respectively, in the prediction of log-transformed Global EAT scores among female judo athletes. These data indicate that while the prevalence of clinical eating disorders is low in judo athletes, many are "at risk" for an eating disorder, which places them at an increased risk for menstrual irregularity and bone injuries. This study also highlights the relevance of body esteem to eating disorder symptoms.

Knowledge, attitudes, and consequences of menstrual health in urban adolescent females

PURPOSE

There is a lack of current information concerning the knowledge and attitudes of urban adolescents regarding menstruation. The purpose of this research was to determine: (1) The prevalence of dysmenorrhea, premenstrual symptoms and other menstrual disorders among adolescents who receive their health care at an urban adolescent health center; (2) The attitudes and expectations adolescents have relating to their menstrual period; and (3) The relationship between teens' attitudes and expectations regarding menses and actual menstrual-related morbidities such as school absenteeism.

METHODS

A 35-item, survey was administered to postmenarcheal adolescents ages 12-21 years. Descriptive analysis of the prevalence of the menstrual disorders was completed. Chi-square testing was used to compare the prevalence of menstrual-related morbidities with the level of adolescents' expectations regarding menstruation.

RESULTS

91.5% of the respondents were African-American. Premenstrual syndrome (PMS) was the most prevalent reported menstrual disorder (84.3%) followed by dysmenorrhea (65%), abnormal cycle lengths (13.2%), and excessive uterine bleeding (8.6%). Only 2% of teens report receiving information about menstruation from their health care provider. Negative expectations regarding menstruation were associated with higher rates of school absenteeism and missed activities (P = 0.0790 and P = 0.0297 respectively).

CONCLUSIONS

PMS and dysmenorrhea are prevalent medical disorders among urban adolescents. Morbidities, including school absenteeism, are higher among those with negative period expectations. Since only 2% of teens received information regarding menstruation from their health care provider, it is imperative that health care providers increase their anticipatory guidance regarding normal menstruation. This may aid in the prompt diagnosis and treatment of menstrual disorders, and decrease their associated morbidities.

Menstrual disorders in adolescence

Altered frequency of the menstrual cycle accompanied by pain are manifestations of functional anomalies of the female reproductive system. These symptoms require prompt and accurate diagnosis and therapy to prevent a chronic condition that can seriously disturb the adolescent's psychic well being. The most common anomalies of the menstrual cycle and the causes of altered cycle frequency are outlined, as are useful criteria for diagnosing premenstrual syndrome dysmenorrhea and for distinguishing the causes and alterations in frequency and amount of menstrual discharge from other disturbances, including amenorrhea and abnormal uterine bleeding. The treatment of dysmenorrhea and quantitative alterations of the menstrual cycle is the focus of this article.

Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in quality of life. This study examines the extent of different PCOS symptoms on quality-of-life, psychosocial well-being and sexual satisfaction.

METHODS

Complete metabolic, hormonal, clinical and psychosocial data were obtained from a total of 120 women with PCOS. Patients were compared with 50 healthy women to establish reductions in quality-of-life and emotional well-being. In addition, the correlation between psychosocial variables and the major clinical PCOS features obesity (body mass index (BMI)), excessive body hair (hirsutism score), acne, hyperandrogenism (serum testosterone levels), disturbed insulin regulation (area under the insulin response curve and homeostasis model assessment of insulin resistance), menstrual cycle disturbances and infertility were analyzed.

RESULTS

PCOS patients showed significant reductions in quality-of-life, increased psychological disturbances, and decreased sexual satisfaction when compared with healthy controls. BMI and hirsutism scores, but not the presence of acne, were associated with physical aspects of quality-of-life and sexual satisfaction. No clear effect of androgens or insulin resistance on psychosocial variables was detected. Similarly, the type of menstrual cycle disturbances or infertility had no impact on psychological well-being.

CONCLUSION

In PCOS, changes in appearance, particularly obesity and hirsutism, reduce physical dimensions of quality-of-life and decrease sexual satisfaction. The role of biochemical, endocrine and metabolic parameters as well as menstrual irregularities and infertility appeared to be less important. Clinicians should pay attention to the psychosocial dimensions of PCOS on an individual basis, regardless of symptom severity or treatment response.

A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit

An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

The effect of gynecologic age, body mass index and psychosocial environment on menstrual regularity among teenaged females

BACKGROUND

The aim was to study the prevalence of menstrual irregularity at an early postmenarcheal age and various biopsychosocial factors associated with menstrual irregularity.

METHODS

The study was conducted in Tartu, Estonia. The 70-item questionnaire and the 21-item Beck Depression Inventory (BDI) were completed by 580 female students of grades 9-12 in four high schools. Their height and weight were measured and body mass index (BMI) calculated. The effects associated with regularity of the menstrual cycle were studied.

RESULTS

Irregularity of the menstrual cycle was reported by 40% of respondents at an early postmenarcheal age. The risks for irregular menstrual cycles (IRM) were BMI <17.5 kg/m(2)[odds ratio (OR) 2.06; 95% confidence interval (95% CI) 1.06-4.00], low economic status IRM [OR 1.77 (95% CI 1.41-2.20)], insufficient communication with parents [OR 1.46 (95% CI 1.02-2.09)], and never pleased to go to school [OR 1.27 (95% CI 1.03-1.56)]. Comparison of the answers to the BDI with the regularity of periods revealed a difference in the total score [OR 1.54 (95% CI 1.21-1.97)], with a mean score of 8.3 +/- 0.4 for the respondents with regular menstrual cycles (RM) vs. 10.6 +/- 0.5 for the respondents with IRM.

CONCLUSION

Menstrual irregularity at an early postmenarcheal age can be considered as an indicator of difficulties in psychosocial adaptability of teenaged females.

Menstruation across time: Menarche, menstrual attitudes, experiences, and behaviors

This study explored the relationship between early and current menstrual experiences. The primary hypothesis was that women who reported positive menarcheal experiences (including menstrual education and menarche) would tend to report positive current menstrual attitudes, experiences, and/or behaviors, and vice versa for women who reported negative menarcheal experiences. In this survey-based study, college-aged women (n = 327) were screened by completing a questionnaire concerning their menarcheal experiences. Women who had extremely negative ("negative group," n = 46) or extremely positive ("positive group," n = 38) early menstrual experiences returned to complete questionnaires concerning current menstrual attitudes, experiences, and behaviors. Early and current menstrual experiences were most strongly associated in the domain of menstrual attitudes. Women in the negative group reported more negative menstrual attitudes than did women in the positive group. There were additional associations between early menstrual experiences and measures of body image and health behaviors. Positive group participants reported more positive body image and better general health behaviors. Results suggest that early menstrual experiences may be related to menstrual experiences later in life. This study invites further investigation of the psychology of menstruation and suggests connecting menstruation with other women's health issues.

Association between psychological stress and menstrual cycle characteristics in perimenopausal women

In previous studies of the relationship between stress and menstrual cycles, stress has been found to be associated with longer cycles, to be associated with shorter cycles, and to have no association with cycle length. Some of the menstrual cycle changes that have been attributed to stress are similar to those experienced by women during perimenopause. In an effort to see whether an association between psychological stress and menstrual cycle characteristics can be detected in women approaching menopause, this study examines this relationship in perimenopausal women who are participants in the Tremin Research Program on Women's Health. The analyses used prospectively recorded bleeding data and retrospectively captured life-event data. A single-year cross-sectional analysis of data from 206 women shows no correlation between stress level, as measured by total number and severity of stressful life events, and cycle characteristics, including interval length, duration of bleed, and variability in both of these factors, nor are there significant differences in cycle characteristics between subgroups of women with different overall levels of stress. In analyzing stress levels and cycle characteristics across 2 years, however, women with marked increases in their level of stress (n = 30) are shown to have decreased length (-0.2 days/cycle) of menstrual cycle intervals and decreased duration of bleed (-0.1 day/cycle) compared with increases in these measures (+2.9 days/cycle for cycle interval; +0.3 days/cycle for duration of bleed) among women with no marked change in stress level (n = 103); t-tests indicate that these differences are significant (p < .05).

Bulimia nervosa in adolescents: a disorder in evolution?

BACKGROUND

There are few reports that describe the manifestation of bulimia nervosa (BN) among adolescents. Moreover, none make reference to the comparative clinical manifestation of adolescent BN and adolescent anorexia nervosa. Nor are any reports available of how distinct partial-syndrome BN cases are from those that meet full diagnostic criteria for BN.

OBJECTIVES

To describe 3 groups of adolescents, those with a full-syndrome eating disorder (BN and anorexia nervosa) or partial-syndrome BN, and to compare these groups along demographic, general psychopathology, and eating disorder variables.

DESIGN

The study population included 120 adolescents with eating disorders who were initially seen at The University of Chicago Eating Disorders Program, Chicago, Ill, for treatment. All participants completed an assessment prior to treatment.

MEASURES

Weight and height were obtained from all participants. Participants also completed a baseline demographic questionnaire (eg, menstrual status, ethnicity, family status), Beck Depression Inventory, Rosenberg Self-Esteem Scale, and the Eating Disorder Examination.

RESULTS

Partial-syndrome BN cases are clinically quite similar to their full-syndrome counterparts. Only objective binge eating episodes and purge frequency distinguished BN and partial-syndrome BN cases. Anorexia nervosa cases, on the other hand, were quite distinct from BN and partial-syndrome BN cases on almost all variables.

CONCLUSION

Early recognition and swift treatment of eating disorders in adolescents, regardless of whether a diagnostic threshold is met, are imperative because they will lead to early intervention thereby potentially improving eating disorder recovery rates.

Early life menstrual characteristics and pregnancy experiences among women with and without major depression: the Harvard study of moods and cycles

BACKGROUND

Other than premenstrual dysphoria, few studies have examined the extent to which basic characteristics of the menstrual cycle and the occurrence of other reproductive landmarks impact on the risk of major depression.

METHODS

From a population-based sample of 4161 premenopausal women 36-45 years of age, we identified 332 women who met DSM criteria for past or current major depression and a sample of 644 women with no such history. In person interviews included a detailed assessment of menstrual cycle characteristics from age at menarche through study enrollment as well as other reproductive landmarks.

RESULTS

Risk of depression increased significantly with decreasing age at menarche (P<0.001). The risk of depression was also higher in women with heavier menstrual flow and cycle irregularity during the first 5 years of menstruation. Women with a history of multiple abortions were 2-3-times more likely to develop major depression (95% CI 1.6-4.1). Increasing months of breastfeeding was associated with a decreased risk of depression after adjustment for education, marital status, and number of livebirths (P-value, test of trend=0.012). This association was largely confined to depression during the postpartum period.

LIMITATIONS

Menstrual and pregnancy history exposures were self-reported and retrospectively assessed. However, women with and without a HISTORY of depression were subject to similar recall requirements that likely resulted in an underestimate of most risk estimates.

CONCLUSIONS

Clinicians involved in routine obstetrical and gynecological care of women need to recognize that menstrual and pregnancy history events may serve as potential markers for subsequent psychiatric sequelae.

Sexuality during the perimenopause

The perimenopause is a time of physiologic, intrapsychic, and social/cultural changes for middle-aged women, who might require assistance to maintain and enhance their sexuality during this transition. Attending to the biologic, psychological, relational, social, and cultural domains, and encouraging perimenopausal women to address these developmental challenges of midlife facilitates the healthy adaptation to this biologic and social transition. Emphasizing the physiologic changes that affect sexual arousal, and educating about enhancing and attending to arousal, might assist middle-aged women to increasingly enjoy their sexuality.

Socioemotional correlates of self-reported menstrual cycle irregularity in premenopausal women

OBJECTIVE

Characteristics of menstrual functioning are associated with social rank and corresponding behavioral expression of dominance and subordination in female cynomolgus macaques. Extrapolating from this research, the present study examined socioemotional correlates of menstrual cycle irregularity in premenopausal women by focusing on the dimensions of dominance/submission and hostility/warmth.

MATERIALS AND METHODS

Participants were 153 premenopausal women (70 African-Americans, 83 European-Americans) who reported no current use of hormonal contraceptives. All women completed measures of socioemotional traits and reported whether the onset of their menstrual cycles was generally predictable within 4 days over the course of the past year.

RESULTS

Menstrual cycle irregularity was significantly and positively associated with the socioemotional trait of submission. This association held after adjusting for age and a number of potentially confounding health behaviors.

CONCLUSIONS

Results are consistent with the notion that menstrual functioning is sensitive to socioemotional processes, particularly those pertaining to social hierarchies. Given recent findings linking menstrual cycle irregularity to cardiovascular disease, the results of the present study highlight new biobehavioral pathways to be explored with regard to women's cardiovascular disease risk.

Symptoms related to the reproductive tract and mental health among women in rural southern India

BACKGROUND

Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India.

METHODS

The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ).

RESULTS

Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors.

CONCLUSION

The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

Menstrual irregularity in female military cadets: comparison of data utilizing short-term and long-term recall

STUDY OBJECTIVES

(1) To assess menstrual function in freshman cadets at a structured, rigorous military college utilizing a weekly e-mail questionnaire, (2) to compare these results to longer-term recall results from written questionnaires completed at the start and end of the same year, and (3) to determine if a relationship exists between personality attributes and menstrual regularity in this setting.

DESIGN, SETTING, PARTICIPANTS

A questionnaire developed by the investigators about menstrual function was distributed weekly via e-mail and completed satisfactorily by 116 female freshman at the United States Military Academy (USMA), class of 1995. These data were compared to questionnaires completed by this same cohort at the start and end of the year, as well as to personality questionnaires distributed to some of these cadets as part of a larger study. Pearson's chi-square and analysis of variance were performed to determine statistical significance.

RESULTS

Weekly e-mail data revealed that only 1.7% of cadets had regular menstrual periods throughout the whole year. The remaining 98.3% were irregular: 10.3% mildly, 35.3% moderately, 30.2% severely, and 22.4% extremely irregular. Only 0.8% of subjects did not menstruate at all during the year. In comparison, on long-term recall data, 90% reported some change in menstrual function, with 48% specifically reporting menstrual irregularity. Those with the greatest irregularity prior to USMA and those who expected greater irregularity at USMA reported the greatest irregularity during the year. Irregularity was associated with coping and with commitment to health on personality questionnaires.

CONCLUSIONS

On data collected via weekly e-mail, almost all freshman females at USMA experienced menstrual irregularity. This data, utilizing short-term recall, yielded different, more dramatic results than the data utilizing long-term recall. A link between menstrual irregularity and both coping and commitment suggests that menstrual irregularity may be adaptive in this environment.

Cognitive dietary restraint is associated with eating behaviors, lifestyle practices, personality characteristics and menstrual irregularity in college women

This study characterized associations of restraint with selected physical, lifestyle, personality and menstrual cycle characteristics in female university students. The survey instrument, distributed to 1350 women, included standardized questionnaires (Three-Factor Eating Questionnaire, Perceived Stress Scale and Rosenberg's Self-esteem Scale), and assessed weight and dieting history, exercise, lifestyle characteristics, menstrual cycle characteristics and whether participants were following vegetarian diets. Among the 596 respondents included in the analysis (44%), women with high (n=145), medium (n=262) or low (n=189) restraint had similar ages, heights and weights. Despite this, compared to women with low scores, those with high scores exercised more (4.6+/-5.3 vs. 3.2+/-3.5 h/wk), were more likely to be vegetarian (14.5 vs. 3.7%), have a history of eating disorders (13.7 vs. 1.2%), be currently trying to lose weight (80.3 vs. 15.3%), report irregular menstrual cycles (34.7 vs. 17.0%), and have scores reflecting lower self-esteem and higher perceived stress. Menstrual irregularity was an independent predictor of restraint score, and restraint score was the only variable to differentiate women with regular and irregular menstrual cycles. We conclude that women with high restraint may use a combination of behavioral strategies for weight control, and differ from women with low restraint scores in personality characteristics and weight history. Some of these behaviors or characteristics may influence menstrual function.

Dietary recommendations and athletic menstrual dysfunction

Exercise-induced or athletic menstrual dysfunction (amenorrhoea, oligomenorrhoea, anovulation, luteal phase deficiency, delayed menarche) is more common in active women and can significantly affect health and sport performance. Although athletic amenorrhoea represents the most extreme form of menstrual dysfunction, other forms can also result in suppressed estrogen levels and affect bone health and fertility. A number of factors, such as energy balance, exercise intensity and training practices, bodyweight and composition, disordered eating behaviours, and physical and emotional stress levels, may contribute to the development of athletic menstrual dysfunction. There also appears to be a high degree of individual variation with respect to the susceptibility of the reproductive axis to exercise and diet-related stresses. The dietary issues of the female athlete with athletic menstrual dysfunction are similar to those of her eumenorrhoeic counterpart. The most common nutrition issues in active women are poor energy intake and/or poor food selection, which can lead to poor intakes of protein, carbohydrate and essential fatty acids. The most common micronutrients to be low are the bone-building nutrients, especially calcium, the B vitamins, iron and zinc. If energy drain is the primary contributing factor to athletic menstrual dysfunction, improved energy balance will improve overall nutritional status and may reverse the menstrual dysfunction, thus returning the athlete to normal reproductive function. Because bone health can be compromised in female athletes with menstrual dysfunction, intakes of bone-building nutrients are especially important. Iron and zinc are typically low in the diets of female athletes if meat products are avoided. Adequate intake of the B vitamins is also important to ensure adequate energy production and the building and repair of muscle tissue. This review briefly discusses the various factors that may affect athletic menstrual dysfunction and two of the proposed mechanisms: the energy-drain and exercise-intensity hypotheses. Because energy drain can be a primary contributor to athletic menstrual dysfunction, recommendations for energy and the macro- and micronutrients are reviewed. Methods for helping the female athlete to reverse athletic menstrual dysfunction are discussed. The health consequences of trying to restrict energy intake too dramatically while training are also reviewed, as is the importance of screening athletes for disordered eating. Vitamins and minerals of greatest concern for the female athlete are addressed and recommendations for intake are given.

Menstrual irregularity and menstrual symptoms

The authors examined whether women with irregular cycles showed more symptoms of menstrual distress than women with regular cycles. One hundred fourteen college women prospectively recorded the dates of 6 to 8 menstrual cycles and replied to a menstrual-symptoms questionnaire. The researchers cross-classified regularity and irregularity, by the women's self-definitions (questionnaire data) and by objective criteria (based on the respondents' prospective recordings of their menstrual data). The results showed that women with irregular cycles experienced twice as many menstrual symptoms as women with regular cycles. The use of a more valid criterion for menstrual irregularity revealed that women with irregular cycles suffered more menstrual distress than did women with regular cycles.

Listening to patients with unexplained menstrual symptoms: what do they tell the gynaecologist?

OBJECTIVES

To describe how women present unexplained menstrual symptoms to gynaecologists; to find out whether presentation reflects how intense their symptoms feel or how much benefit they expect from gynaecological treatment; and to test the prediction that surgical treatment decisions are more likely to follow specific types of presentation.

DESIGN

A cross sectional cohort study.

SETTING

Gynaecological outpatient clinics in a teaching hospital.

SAMPLE

Fifty-nine patients, referred for menstrual problems, in whom investigations had excluded physical disease.

METHODS

Patients indicated symptom intensity and expectations of treatment before consultation on self-completed questionnaires. Audiotape recordings of consultations with the gynaecologist were transcribed and patients' use of specific communication strategies was coded according to a previously reported scheme.

MAIN OUTCOME MEASURES

Treatment decision was noted.

RESULTS

In a third to a half of patients, presentation extended beyond symptom report to include catastrophisation about consequences of symptoms, reference to other individuals to substantiate the patient's problems, criticism of previous or possible future interventions or request for hysterectomy. Those with greatest expectations of gynaecological treatment were more likely to catastrophise and request hysterectomy. Those with most intense subjective symptoms were more likely to catastrophise, refer to other individuals and request hysterectomy, and these strategies were more likely to be followed by surgical treatment decisions.

CONCLUSIONS

Surgical treatment for unexplained menstrual problems is not driven by gynaecologists. Reduction in unnecessary hysterectomies will require training in communication skills that reflects the challenging nature of many patients' presentation in the gynaecology clinic.

Menstrual functioning and psychopathology in a county-wide population of high school girls

OBJECTIVE

To examine the association between menstrual functioning and depressive disorder symptoms (DDS), obsessive-compulsive disorder symptoms (OCDS), and eating disorder symptoms (EDS) in high school girls.

METHOD

Survey data from a county-wide high school population (completion rate 91%) were used. Associations between menstrual indices and scores above clinical cutoff on the Beck Depression Inventory, Leyton Obsessive-Compulsive Inventory-Child Version, and Eating Attitudes Test were examined by using logistic regression ( = 2,547 girls).

RESULTS

Controlling for chronological age and other risk factors, late menarche was associated with DDS (odds ratio [OR] = 2.26, 95% confidence interval [CI] = 1.16-4.18). Gynecological year 1 (GY1) was associated with DDS (OR = 3.13, CI = 1.23-7.33), EDS (OR = 3.11, CI = 1.00-8.09), and OCDS, both number (OR = 5.75, CI = 1.79-15.74) and interference (OR = 12.55, CI = 3.20-41.4). Secondary amenorrhea was associated with DDS (OR = 1.94, CI = 11.30-2.84) and EDS (OR = 2.32, CI = 1.51-3.49); polymenorrhea with EDS (OR = 1.92, CI = 1.27-2.86); and irregular cycles with EDS (OR = 1.70, CI = 1.11-2.54) and DDS (OR = 1.76, CI = 11.21-2.53).

CONCLUSIONS

In high school girls, late menarche, GY1, and menstrual cycle abnormalities are associated differentially with DDS, OCDS, and EDS.

Inadequate luteal function is the initial clinical cyclic defect in a 12-day stress model that includes a psychogenic component in the Rhesus monkey

As part of our goal to develop nonhuman primate models to prospectively study how different types of stress may affect the menstrual cycle, we have investigated whether a short-term stress challenge that includes a significant psychogenic component can induce cyclic dysfunction. The study was performed in rhesus monkeys. The stress challenge had several components that included the psychological response to both a tethering system and to a simultaneous move to an unfamiliar environment and the response to the short surgical procedures required to install and disconnect the tethering system. The stress challenge lasted for 12 d and was initiated in the follicular (n = 5) or luteal (n = 6) phase of the menstrual cycle. At the end of the stress period, the tethering system was removed, and the animal was returned to its regular housing. To monitor cyclicity, FSH, LH, E2, and progesterone were measured daily throughout the two preceding control cycles, the experimental cycle, and the two poststress cycles, whereas the adrenal endocrine axis response was monitored by measuring cortisol. Animals remained ovulatory after the short-term stress; however, integrated progesterone secretion in the luteal phase (from the day of LH surge +1 to the day of menstruation -1) of the stress cycle was significantly decreased by 51.6% when the stress was initiated in the follicular phase and by 30.9% when it started in the luteal phase. Lower integrated LH levels (luteal d 5-13) accompanied the decreased progesterone. Cyclic parameters were still abnormal in the first poststress cycle, such as a prolonged follicular phase after a stress in the preceding follicular phase or inadequate luteal function after a stress in the preceding luteal phase. Within 4 h of the stress, there was a rapid 3-fold increase in cortisol levels over controls. Levels decreased progressively thereafter but remained significantly higher than controls during the entire short-term stress period. They were still significantly higher in the first 2 wk after stress. Overall, the data suggest that secretory inadequacy of the corpus luteum represents a first clinical stage in the damage that stress can inflict on the normal menstrual cycle. Of interest is the observation that this limited 12-d stress, which includes a significant psychogenic component, continues to produce detrimental effects on the menstrual cycle past the period during which it is exerted. Significant decreases in integrated luteal LH values in the poststress cycle suggest that these effects may be related to continuing disturbances in the neuroendocrine component of the reproductive axis.

The polycystic ovary syndrome--a medical condition but also an important psychosocial problem

PCOS, the leading cause of anovulatory infertility that affects up to one fifth of the female population, is a complex chronic disease of genetic as well as environmental determination, but still unclear etiology. Besides of infertility, PCOS leads to menstrual dysfunctions, hirsutism and obesity--symptoms that are known to cause profound psychosocial distress. The present paper review the problematic of etiology and symptom expression of PCOS, which is not only a disease needing medical treatment but also a psychosocial problem for the affected women. PCOS may not only coinduced by psychosocial factors, the main symptoms of PCOS such as infertility, menstrual dysfunctions, hirsutism and obesity cause by themselves increased psychosocial stress.

Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management

OBJECTIVES

To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome.

DESIGN

Questionnaire survey, with partial review of case notes after 8 months.

SETTING

Three hospital gynaecology clinics in Glasgow and Edinburgh.

PARTICIPANTS

952 women completed the questionnaire, and the first 665 were reviewed.

OUTCOME MEASURES

Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment.

RESULTS

Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance.

CONCLUSIONS

Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration.

Self-preoccupation and general stress level as sensitizing factors in premenstrual and menstrual distress

This study considered whether general stress level and self-preoccupation sensitize women to symptoms of menstrual and premenstrual distress and whether this effect is more pronounced for premenstrual symptoms. Equal-size categories of normal college women reporting greater distress during the premenstrual period (PD), during the menstrual period (MD), or about equally in both periods were constituted. The PD women demonstrated significantly greater self-preoccupation than either the MD or equivalent groups; they also reported higher general stress than either comparison group, although statistical reliability was not attained. However, when both sensitizing factors were introduced into the same analysis, high self-preoccupation and a high level of general stress were found only in the PD group. The present evidence suggests that stress and personality not only sensitize premenstrual symptoms in PMS women but are prominent features in normal women who report more serious symptoms during the premenstrual period.