What are the key differences between PMS and PMDD. How does PMDD affect women’s daily lives. What treatment options are available for managing PMDD symptoms. Why is it crucial to seek medical help for severe premenstrual symptoms.

The Spectrum of Premenstrual Disorders: From PMS to PMDD

Premenstrual syndrome (PMS) is a common condition affecting up to 75% of women at some point in their lives. While PMS symptoms can be uncomfortable, they are generally manageable. However, for a small percentage of women, these symptoms evolve into a more severe condition known as Premenstrual Dysphoric Disorder (PMDD). Understanding the distinction between these two conditions is crucial for proper diagnosis and treatment.

Common Symptoms of PMS and PMDD

• Moodiness
• Sleep disturbances
• Fatigue
• Breast tenderness
• Bloating
• Headaches or muscle aches
• Food cravings

While these symptoms are shared by both PMS and PMDD, the severity and impact on daily life differ significantly between the two conditions.

PMDD: When Premenstrual Symptoms Become Debilitating

PMDD is characterized by severe emotional and physical symptoms that can severely disrupt a woman’s life. Unlike PMS, which is often manageable with lifestyle changes, PMDD can make it challenging or even impossible to carry out everyday tasks.

Key Differences Between PMS and PMDD

1. Severity of symptoms
2. Impact on daily functioning
3. Intensity of emotional disturbances
4. Duration and persistence of symptoms

Women with PMDD may experience extreme mood swings, deep sadness, hopelessness, and anxiety that go beyond typical PMS symptoms. These emotional disturbances can significantly affect work performance, social relationships, and overall quality of life.

The Emotional Toll of PMDD: Beyond Physical Discomfort

PMDD can have a profound impact on a woman’s emotional well-being. The condition often manifests with symptoms that mirror clinical depression, causing intense feelings of sadness, hopelessness, and loss of interest in daily activities.

Emotional Symptoms of PMDD

• Extreme mood swings
• Intense feelings of sadness or hopelessness
• Anxiety and tension
• Irritability and anger
• Difficulty concentrating
• Feeling overwhelmed or out of control

These emotional symptoms can be particularly challenging to manage and may lead to relationship problems, work-related issues, and a decreased overall quality of life.

The Importance of Seeking Treatment for PMDD

Ignoring severe premenstrual symptoms can have serious consequences for a woman’s mental and physical health. Untreated PMDD may lead to persistent depression, anxiety disorders, and difficulties in personal and professional relationships.

Potential Consequences of Untreated PMDD

• Chronic depression
• Anxiety disorders
• Relationship problems
• Work performance issues
• Decreased quality of life
• Increased risk of other health problems

Recognizing the signs of PMDD and seeking timely medical intervention is crucial for managing symptoms and preventing long-term complications.

Understanding the Causes of PMDD: Hormonal Fluctuations and Sensitivity

While the exact cause of PMDD remains unclear, researchers believe that hormonal changes during the menstrual cycle play a significant role. However, studies have shown that these hormonal fluctuations are similar in women with and without PMDD, suggesting that some women may be more sensitive to these changes.

Factors Contributing to PMDD

• Hormonal sensitivity
• Genetic predisposition
• Neurotransmitter imbalances
• Environmental factors
• Stress and lifestyle factors

Understanding these contributing factors can help healthcare providers develop more targeted and effective treatment strategies for women with PMDD.

Comprehensive Approach to PMDD Treatment

Effective PMDD treatment requires a personalized approach that addresses both the physical and emotional symptoms of the condition. Healthcare providers often employ a combination of therapies to manage PMDD symptoms effectively.

PMDD Treatment Options

• Hormonal therapies
• Antidepressant medications
• Nutritional supplements
• Cognitive-behavioral therapy
• Lifestyle modifications
• Stress management techniques

A holistic treatment plan may include a combination of these approaches, tailored to the individual needs of each patient.

The Role of Holistic Healthcare in Managing PMDD

Holistic healthcare practices, such as those offered by Grassroots Healthcare in Tulsa, Oklahoma, take a comprehensive approach to treating PMDD. This approach considers the whole person, addressing not only the physical symptoms but also the emotional and lifestyle factors that may contribute to the condition.

Components of Holistic PMDD Care

• Thorough medical examination
• Hormone level testing
• Nutritional assessment
• Personalized treatment plans
• Ongoing support and monitoring

By addressing all aspects of a woman’s health, holistic care can provide more effective and sustainable relief from PMDD symptoms.

Empowering Women: Taking Control of PMDD Symptoms

While PMDD can be a challenging condition, it’s important for women to know that effective treatments are available. By understanding the condition and seeking appropriate medical care, women can take control of their symptoms and improve their quality of life.

Steps to Managing PMDD

1. Recognize the signs and symptoms
2. Track symptoms over several menstrual cycles
3. Consult with a healthcare provider
4. Explore treatment options
5. Implement lifestyle changes
6. Build a support network

With the right approach and support, women with PMDD can effectively manage their symptoms and lead fulfilling lives.

Advancing Research and Understanding of PMDD

As awareness of PMDD grows, researchers continue to explore the underlying mechanisms of the condition and develop new treatment approaches. Recent studies have focused on the role of stress reactivity and emotion regulation in premenstrual disorders.

Current Areas of PMDD Research

• Neuroimaging studies
• Genetic factors
• Hormonal therapies
• Psychosocial interventions
• Novel pharmaceutical treatments

Ongoing research in these areas promises to improve our understanding of PMDD and lead to more effective treatments in the future.

Breaking the Stigma: Promoting Open Dialogue About PMDD

Despite its significant impact on women’s lives, PMDD remains a relatively under-discussed condition. Promoting open dialogue about premenstrual disorders can help reduce stigma and encourage more women to seek the help they need.

Ways to Raise Awareness About PMDD

• Share personal experiences
• Educate friends and family
• Support PMDD advocacy groups
• Participate in research studies
• Encourage workplace accommodations

By speaking openly about PMDD, we can create a more supportive environment for women struggling with this condition.

The Future of PMDD Care: Personalized Medicine and Integrative Approaches

As our understanding of PMDD evolves, treatment approaches are becoming increasingly personalized and integrative. The future of PMDD care may involve tailored treatment plans based on individual genetic profiles, hormone levels, and lifestyle factors.

Emerging Trends in PMDD Treatment

• Precision medicine approaches
• Wearable technology for symptom tracking
• Telemedicine for PMDD management
• Mind-body interventions
• Nutritional and microbiome therapies

These innovative approaches hold promise for improving the lives of women with PMDD and other premenstrual disorders.

Supporting Women with PMDD: The Role of Family and Friends

The support of family and friends can be crucial for women managing PMDD. Understanding the condition and providing emotional support can make a significant difference in a woman’s ability to cope with her symptoms.

Ways to Support a Loved One with PMDD

• Educate yourself about the condition
• Listen without judgment
• Offer practical help during symptomatic periods
• Encourage professional treatment
• Be patient and understanding

By creating a supportive environment, friends and family can play a vital role in helping women manage PMDD effectively.

PMDD in the Workplace: Advocating for Accommodation and Understanding

For many women with PMDD, managing symptoms in the workplace can be challenging. Raising awareness about the condition and advocating for appropriate accommodations can help create a more supportive work environment.

Workplace Accommodations for PMDD

• Flexible work schedules
• Remote work options during symptomatic periods
• Access to quiet spaces for rest
• Extended break times
• Education for managers and colleagues

By implementing these accommodations, employers can support their employees with PMDD and promote a more inclusive workplace.

Navigating Relationships with PMDD: Communication and Understanding

PMDD can put a strain on personal relationships, particularly romantic partnerships. Open communication and mutual understanding are key to maintaining healthy relationships while managing PMDD symptoms.

Tips for Maintaining Healthy Relationships with PMDD

• Educate your partner about PMDD
• Develop a communication plan for symptomatic periods
• Practice self-care and encourage partner support
• Consider couples therapy or counseling
• Be patient with yourself and your partner

By working together, couples can navigate the challenges of PMDD and strengthen their relationship in the process.

PMDD and Mental Health: Addressing Comorbid Conditions

Women with PMDD may be at increased risk for other mental health conditions, such as anxiety disorders and depression. Addressing these comorbid conditions is an important aspect of comprehensive PMDD care.

Common Comorbid Conditions with PMDD

• Major depressive disorder
• Generalized anxiety disorder
• Panic disorder
• Bipolar disorder
• Eating disorders

Treating these conditions alongside PMDD can lead to better overall mental health outcomes and improved quality of life.

Lifestyle Modifications for Managing PMDD Symptoms

While medical treatments are often necessary for managing PMDD, lifestyle modifications can play a significant role in symptom management. Implementing healthy habits can help reduce the severity of PMDD symptoms and improve overall well-being.

Lifestyle Changes to Support PMDD Management

• Regular exercise
• Balanced nutrition
• Stress reduction techniques
• Adequate sleep
• Limiting caffeine and alcohol intake
• Mindfulness and meditation practices

Incorporating these lifestyle changes can complement medical treatments and enhance overall PMDD management.

The Global Perspective: PMDD Awareness and Treatment Worldwide

PMDD affects women around the world, but awareness, diagnosis, and treatment options can vary significantly between countries and cultures. Promoting global awareness and access to care is crucial for improving outcomes for women with PMDD worldwide.

Challenges in Global PMDD Care

• Cultural stigma surrounding menstrual health
• Limited access to specialized healthcare
• Lack of awareness among healthcare providers
• Socioeconomic barriers to treatment
• Variability in diagnostic criteria across countries

Addressing these challenges can help improve PMDD care and support for women globally.

Empowering the Next Generation: PMDD Education for Young Women

Education about PMDD and other premenstrual disorders is crucial for young women entering their reproductive years. Early awareness can lead to prompt diagnosis and treatment, potentially preventing years of unnecessary suffering.

Key Points for PMDD Education

• Understanding normal vs. abnormal menstrual symptoms
• Recognizing the signs of PMDD
• The importance of tracking symptoms
• When to seek medical help
• Available treatment options
• The role of self-care in managing premenstrual symptoms

By empowering young women with knowledge about PMDD, we can promote early intervention and better long-term outcomes.

Conclusion: Taking Action Against PMDD

PMDD is a serious condition that can significantly impact a woman’s quality of life. However, with proper diagnosis, treatment, and support, women with PMDD can effectively manage their symptoms and lead fulfilling lives. It’s crucial for women experiencing severe premenstrual symptoms to seek medical help and not dismiss their experiences as “just PMS.”

By raising awareness, promoting research, and advocating for comprehensive care, we can improve outcomes for women with PMDD and other premenstrual disorders. Remember, help is available, and no one should have to suffer in silence. If you suspect you may have PMDD, reach out to a healthcare provider to discuss your symptoms and explore treatment options. With the right support and care, it’s possible to take control of PMDD and reclaim your life.

Why You Shouldn’t Ignore Severe Emotional PMS Symptoms: Grassroots Healthcare: Primary Care Practice

Anxiety, moodiness, crying spells, food cravings, acne breakouts — they’re all symptoms of premenstrual syndrome, or PMS, a condition that affects as many as three-quarters of women at some point in their lifetimes. Although unpleasant, these symptoms can typically be weathered until they finally pass. 

For a small percentage of women, PMS mood-related symptoms are so severe they can interfere with daily living. These women suffer from a more serious form of PMS called premenstrual dysphoric disorder, or PMDD.

As a leading medical practice in Tulsa, Oklahoma, Grassroots Healthcare offers comprehensive women’s health services, including treatments for women suffering from both PMS and PMDD. If you think you might have PMDD, read on to learn more about the disorder and how to deal with it.

PMS vs. PMDD

PMS and PMDD share many of the same “symptoms:”

• Moodiness
• Problems sleeping
• Fatigue
• Tender breasts
• Bloating
• Headaches or muscle aches
• Food cravings

The primary difference between these two conditions is the severity of the symptoms women experience. Women suffering from PMDD may find the symptoms they experience are so severe, they make it hard — or even impossible — to carry out even simple, everyday tasks. They may find themselves awash in extreme feelings that are difficult to process and hard to handle, feelings that can interfere with work, school, and social relationships.

For instance, while feeling a little sad or down is common in PMS, a woman who suffers from PMDD may have deeper feelings of sadness and even hopelessness — akin to symptoms associated with clinical depression. Some women may lose interest in work or social activities, two other symptoms PMDD has in common with clinical depression.

PMDD can also cause feelings of anxiety or tension, leaving you feeling panicked or “on edge” all the time. Some women with PMDD are more likely to have feelings of irritability or outright anger. Even small disagreements can seem magnified and unjust, and you might even find yourself starting arguments more often.

Because PMDD symptoms can be so severe, it’s essential to get treatment to help you deal with them successfully. Without treatment, women with PMDD may find themselves suffering from persistent feelings of hopelessness and depression, as well as developing work or relationship problems.

Treating PMDD

Changes in hormone levels that occur throughout the menstrual cycle are thought to play a role in both PMS and PMDD. However, some studies show these changes are similar even in women who don’t have either PMS or PMDD. Researchers think some women may be more predisposed to the effects of hormone fluctuations, which means they experience the effects much more acutely. To be effective, PMDD treatment needs to be tailored to each woman individually.

The team at Grassroots Healthcare takes a holistic approach to treating women with PMDD. Prior to any treatment, you’ll have a medical exam and you may have blood work or other lab tests to rule out other problems that could be causing the same symptoms. Lab tests can also be used to check your hormone levels and to identify nutritional deficiencies that could be contributing to your symptoms.

Depending on your needs, our team may prescribe supplements or hormone therapy. Behavioral counseling may be helpful, along with medications to help stabilize your brain chemistry. Because PMDD affects every woman differently, our team will work with you to create a treatment plan that’s just right for your needs.

Don’t suffer with PMDD

PMDD symptoms are chronic and severe — so severe, they can take a major toll on your quality of life. If you think you may have PMDD, don’t put off getting care. Call Grassroots Healthcare or use our online form and schedule your office visit today.

Stress reactivity and emotion in premenstrual syndrome

Neuropsychiatr Dis Treat. 2017; 13: 1597–1602.

Qing Liu

¹Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou

Yongshun Wang

²School of Physical Education and Sport, Huaqiao University, Xiamen, People’s Republic of China

Cornelis Hermanus van Heck

³DCC, Donders Institute for Neuroscience and Neurocognition, Arnhem, the Netherlands

Wei Qiao

⁴Department of Physical Education, Xiamen Institute of Technology, Xiamen, People’s Republic of China

¹Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou

²School of Physical Education and Sport, Huaqiao University, Xiamen, People’s Republic of China

³DCC, Donders Institute for Neuroscience and Neurocognition, Arnhem, the Netherlands

⁴Department of Physical Education, Xiamen Institute of Technology, Xiamen, People’s Republic of China

Correspondence: Wei Qiao, Department of Physical Education, Xiamen Institute of Technology, 1251 sunbannan Road, Jimei District, Xiamen, People’s Republic of China, Tel/fax +86 592 616 2116, Email moc. kooltuo@yspnomelCopyright © 2017 Liu et al. This work is published and licensed by Dove Medical Press LimitedThe full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.This article has been cited by other articles in PMC.

Abstract

Background

Hormone level fluctuation across the menstrual cycle causes women to experience negative emotions and also affects their mood regulation and stress sensitivity. However, the stress reactivity and emotional variations in women with premenstrual syndrome (PMS), who are especially sensitive to the variations in hormone cycles, have not been explained.

Methods

The present study used an electroencephalogram (EEG) stress evaluation test, a physiology stress evaluation test, and the positive affect and negative affect scale (PANAS) to evaluate the stress reactivity pattern and emotional state of women with PMS.

Results

The results showed that women with PMS had higher negative affect and lower positive affect compared with controls. Moreover, under stressful conditions, the women with PMS had a higher alpha activity and a lower respiration rate than the controls. The differences in stress reactivity and emotional states between women with PMS and controls were based on a covariant analysis with menstrual cycle (luteal and follicular phases) as the covariate.

Conclusion

The results demonstrated that, compared with controls, women suffering from PMS have a continuous abnormality in emotional state and stress reactivity, which was independent of the menstrual cycle.

Keywords: premenstrual syndrome, stress reactivity, emotion, EEG stress evaluation test, physiology stress evaluation test

Introduction

Most women of reproductive age may feel more physiological and/or emotional discomfort in the week before the menses. These symptoms can vary between individuals and have the potential to affect work, personal life, and place additional stress on a relationship. ^1,2 In all, 30%–40% of women of reproductive age suffer from the more severe premenstrual syndrome (PMS) and 3%–8% suffer from premenstrual dysphoric disorder (PMDD), which is the more serious variant of PMS.³ The symptoms of PMS cover emotion, physiology, and behavioral fields and can be related to the menstrual cycle. These symptoms typically occur in the premenstrual or luteal phase of the menstrual cycle and tend to vanish in or near the end of the cycle.⁴ The exact etiology of PMS is unknown, but it may be related to hormone variations.⁵ Some theories state that PMS is not caused by abnormal concentration of gonadal steroids but more likely by variations in levels of the sex hormones. The differences between women with and without PMS may also be explained by increased sensitivity to variations in levels of sex hormones.⁶ Moreover, some studies showed that the onset and course of PMS are related to stress. ⁷

The variations in hormone levels across the menstrual cycle cause an increase in negative emotions in women and can influence mood regulation and sensitivity to stress.^8,9 Specifically, women have stronger responses to stressors before the menstruation or in the luteal phase, which may increase the risk for negative emotions or moods, suggesting stress may strengthen PMS symptoms.¹⁰ Lustyk et al¹¹ made a distinction between a “high symptom” group and a “low symptom” group in women with PMS (N=114) on the severity of PMS symptoms. Their results showed that, compared with low symptom group, the high symptom group reported more stressful experiences. Previous studies have also found that stressful experiences of women with PMDD before the menses were mainly related to a higher stress sensitivity.^12,13

Although the abovementioned studies investigated the relationship of menstrual cycle, PMS, and stress, the results are inconclusive. A major issue was the lack of a comparison between the stress reactivity of women suffering from PMS and healthy controls, in confronting the same physiological and psychological stressors. In addition, the measurements of stress reactivity in the foregoing studies were based on the subjective reports by the participants themselves, which lack objective neural and physiological indexes.

Therefore, the present study adopted an electroencephalogram (EEG) stress evaluation test, a physiology stress evaluation test, and the positive affect and negative affect scale (PANAS) to investigate the stress reactivity pattern and emotional state of women with PMS and healthy controls. Based on the previous research,² we hypothesize that women with PMS may have more subjective concerns as well as abnormal neural activity and physiological reactivity under stressful conditions, when compared with healthy controls.

Methods

Ethics

All participants provided written informed consent before participating in the study. Experimental procedures were approved by the institutional review board of the State Key Laboratory of Cognitive Neurosciences and Learning of Beijing Normal University.

Participants

Before the experiment, a gynecological examination and B-mode ultrasonic echo were conducted on participants to eliminate other disorders and disease, as well as confirm the absence of past surgery. As such, it was confirmed that the participants were healthy. We also used PMS scales¹⁴ and self-compiled historic information (may contain retrospective recall biases) on the women’s menstrual cycles to screen and group the 86 participants. The participants were recruited via flyers in the university and the campus network. Exclusion criteria consisted of being currently pregnant or lactating, taking oral contraceptives, receiving medical treatment of any kind, taking medicine that could affect stress reactivity, having a personality disorder, clinical anxiety, depression, and abnormal psychological syndrome, or having irregular menstrual cycles.

Prospective self-reports about the start of the menses were combined with primary gynecological examination and B-ultrasonic wave results, to schedule the experiment. According to the individual physical character of the participants’ menstrual cycle and the hormone levels, all participants (both the PMS and control group) were tested twice; once in the luteal phase (1–3 days before the menstruation) and once in the follicular phase (1–3 days after the menstruation). The final sample was composed of 30 participants (22±2.19 years old), of whom 15 females were in the PMS group and 15 females were in the healthy control group. The demographic information of participants is shown in .

Table 1

Sociodemographic characteristics (mean ± SD) of both groups (PMS and control groups)

Materials

PMS scale

The PMS scale consisted of 12 items that are related to emotional and physical symptoms and gave the degree of severity of PMS. ¹⁴ The items were scored on a four-point scale, with 0 as “no symptoms” and 3 as “symptoms seriously affecting life, study and work, needing treatment”. Total scores >6 indicated the presence of PMS. The Chinese version of the PMS scale had good reliability and validity.¹⁵

PANAS

The PANAS includes 20 items that are divided equally into positive and negative affect dimensions. Participants indicate how much a statement applies to them using a 5-point Likert scale, where 1 represents “none” and 5 “very much”.¹⁶ Summing the items in the two categories generates the “positive affect score” and the “negative affect score”. As such, the scores of positive affect and negative affect range from 10 to 50. Both the validity and reliability of the PANAS are well established and considered to be effective tools for the evaluation of emotional state.¹⁷

Electroencephalogram and physiological stress evaluation tests

An Infiniti3000A (ProComp Infiniti; Thought Technology, Montreal, Canada) biofeedback system (including computer, Bioneuro Infiniti encoder, EEG electrodes, and physiological sensors) was used to conduct the electroencephalogram stress evaluation test and the physiology stress evaluation test.

The Infiniti3000A was used with a unipolar EEG electrode to conduct the EEG stress evaluation test, which uses three leads: one disk electrode, one ear clip reference electrode, and one ear clip ground electrode. The disk electrode was set at Cz, according to the international 10–20 electrode system. The “10” and “20” refer to the fact that the actual distances between adjacent electrodes are either 10% or 20% of the total front–back or right–left distance of the skull. The EEG stress evaluation tests included a baseline test, an attention test, and a cognition test. The EEG sensor recorded the analog EEG signal and converted it to a digital signal for analysis. The main EEG parameter used was the alpha wave amplitude (8–13 Hz, amplitude 20–100 μV), which is related to the relaxed mental state.

Physiological stress was recorded through the Infiniti3000A as well, using electromyography (EMG), skin conductance (SC), heart rate (HR), and respiration rate to estimate physiological reactivity. EMG was recorded using the MyoScan-Pro sensor, which is a head-worn unipolar-electrode (including positive, negative, and reference leads) mounted on the middle of the frontal region, on the occipito-frontal muscle. EMG amplitude below 5 μv was interpreted as a relaxed state, while an amplitude between 5 and 15 μv was interpreted as mild tenseness. EMG amplitude above 15 μv was interpreted as high tenseness. The SC sensor electrode was mounted on the tip of the ring finger of the dominant hand. The value of SC below 5 mho was taken to correspond with a relaxed state, while a value between 5 and 10 mho was taken to correspond with mild tenseness. A value between 10 and 20 mho was taken to correspond with tenseness, while a value above 20 mho was taken to correspond with anxiety and high tenseness. HR was recorded using a blood volume pulse sensor (BVP), which was mounted on the tip of the middle finger of the dominant hand. The BVP measures the blood flow through changes in infrared reflection and represents a reliable and stable measure of real-time HR. The HR is 75 bpm for normal adults in a state of relaxation. The respiration sensor (Resp) was placed on the participants’ abdomen.

The physiological stress evaluation test battery consisted of a baseline measurement, the color-word test, the first rest interval, the math test, the second rest interval, the stress event recall test, third, and final rest intervals. We computed the baseline test value and the values of the rest intervals for the evaluation of physiological stress reactivity. The baseline test value represents the baseline of stress reactivity, which belongs to the first stage of stress reactivity. The values of the first rest interval represent the effects of the color-word test on the physiology. The values of the second rest interval represent the effects of the math test. By combining, these values belong to the second stage of stress reactivity. The values of the third rest interval represent the effect of the stress event recall test on the physiology and were also used as the index of stress resilience, which is the third stage of stress reactivity.

Procedure

To provide a comfortable and stable testing environment, the testing room was kept clean, well ventilated, and dimly lit. Before the experiment, the participants filled in informed consent forms, as well as the PANAS. Before the connection of biofeedback equipment, the participants were presented with the operating principle of the biofeedback machine and the used methods. After the connection of the equipment, the participants were asked to sit in a comfortable manner and relax. The EEG stress evaluation test included three stages. The first stage was 2 minutes of baseline resting EEG. The second stage was a 3-minute attention test, and the third stage was a 3-minute cognition test. There were instructions between stages to guide the participants into the next stage. The EEG was recorded for each stage. The total time of the EEG stress evaluation test was 15 to 20 minutes. Next, the physiological stress evaluation test was carried out, which included seven stages. The first stage was the baseline stage, which lasted for 2 minutes. The second stage was the color-word test, which lasted for 3 minutes. The third stage was the first rest interval, which lasted for 2 minutes. The fourth stage was the math test, which lasted for 3 minutes. The fifth stage was the second resting interval, which lasted for 2 minutes. The sixth stage was the stress recall test which lasted for 3 minutes, and the last stage was the third resting interval, which lasted for 2 minutes. The total time of the physiology stress evaluation test was 20 to 30 minutes. The specific procedure is shown in .

Timeline of the experimental condition.

Abbreviation: EEG, electroencephalogram.

Data analysis

All the statistics were conducted using SPSS 16.0 software. Specifically, mixed-factor analyses of variance (ANOVAs) were performed on the EEG alpha activity, and physiology data of the physiological stress evaluation test. The within-subject variable was the TEST (“resting, attention, and cognition tests” for EEG alpha activity; “baseline, rest 1, rest 2, and rest tests for physiology data”), whereas the between-subject variable was GROUP (PMS vs control group). The PHASE (luteal and follicular phases) was the covariate.

Results

The positive affect and negative affect of PMS and control groups

Independent sample t-tests were conducted for the PANAS scores for women with PMS and healthy control separately. The results showed that there were significant differences in the positive affect (t₂₈=−1.782, P=0.086, d=−0.65) and negative affect (t₂₈=1.852, P=0.080, d=0.68) between these two groups. Compared with the healthy controls the women with PMS had a lower score for positive affect ().

The scores of positive affect and negative affect for PMS group (N=15) and control group (N=15).

Abbreviation: PMS, premenstrual syndrome.

The EEG stress evaluation test results of PMS and control groups

The results indicated that the main effect of GROUP (F_(1,27)=18.765, P<0.001, η²=0. 410) on alpha activity was significant. The main effect of TEST (F_(2,54)=1.138, P=0.328, η²=0.040) on alpha activity was not significant. However, the interaction of GROUP and TEST on alpha activity was significant, F_(2,54)=3.562, P=0.035, η²=0.117. Post hoc analysis of the significant interaction revealed that the alpha activity of PMS group under rest (F_(1,28)=25.85, P<0.001), attention test (F_(1,28)=14.10, P=0.001), and cognition test (F_(1,28)=10.06, P=0.04) was higher than the control group ().

The EEG alpha wave (Hz) under different tasks (resting, attention, and cognition tasks) of EEG stress evaluation test for PMS group (N=15) and control group (N=15). *P<0.05.

Abbreviations: EEG, electroencephalogram; PMS, premenstrual syndrome.

The physiological stress evaluation test results of PMS and control groups

The results showed that the main effects of GROUP on EMG, HR, and SC were not significant (F_EMG(1,27)=0. 098, p_EMG=0.756, η²_EMG=0.004; F_BVP(1,27)=1.991, p_BVP=0.170, η²_BVP=0.069; F_SC(1,27)=0.026, p_SC=0.872, η²SC=0.001). The main effects of TEST on EMG, HR, and SC were also not significant (F_EMG(3,81)=1.631, p_EMG=0.189, η²_EMG=0.057; F_BVP(3,81)=1.488, p_BVP=0.224, η²_BVP=0.052; F_SC(3,81)=1.918, p_SC=0.133, η²_SC=0.066). And the interaction of GROUP and TEST on EMG, HR, and SC was not significant either (F_EMG(3,81)=1.428, p_EMG=0.241, η²_EMG=0. 050; F_BVP(3,81)=0.564, p_BVP=0.640, η²_BVP=0.020; F_SC(3,81)=0.488, p_SC=0.692, η²_SC=0.018).

However, the main effect of GROUP on respiration rate was significant, F_(1,27)=4.132, P=0.052, η²=0.133. The main effect of TEST on respiration rate was significant, F_(3,81)=8.681, P<0.001, η²=0.243, and the interaction of GROUP and TEST was also significant, F_(3,81)=3.224, P=0.027, η²=0.107. Post hoc analysis found that the respiration rates of PMS group during rest interval 1 (F_(1,28)=4.06, P=0.054) and rest interval 2 (F_(1,28)=4.29, P=0.049) were significantly lower than the control group ().

The respiration rate (bpm) under different tasks (baseline, rest interval 1, rest interval 2, and rest interval 3 tasks) of physiology stress evaluation tests for PMS group (N=15) and control group (N=15). *P<0.05.

Abbreviation: PMS, premenstrual syndrome.

Discussion

The present study investigated the differences in neuro-physiological reactivity and emotional state to stressors in women with PMS compared with healthy controls. As expected, we found that compared with healthy controls, the women with PMS had higher negative affect and lower positive affect. In addition, under stressful conditions, compared with healthy controls, women with PMS had a more pronounced EEG alpha activity and lower respiration rates. The menstrual cycle (luteal and follicular phases) was used as the covariate in the analyses. In other words, compared with healthy females, women suffering from PMS had a continuous abnormality in emotional state and stress reactivity, which was independent of the menstrual cycle. Specifically, the women had a lower positive affect and a higher negative affect, together with stronger alpha wave activity, as well as an inhibition of the physiological response (lower respiration rate) when confronted with stressors.

Ossewaarde et al¹⁸ investigated the neural mechanism of stress sensitivity interactions with the menstrual cycle and found that the natural fluctuation of allopregnanolone may influence females’ stress sensitivity. Since women with PMS are more sensitive to allopregnanolone fluctuations, they would show increased stress sensitivity and reactivity when compared with healthy controls. This may explain the more pronounced EEG alpha activity, which we observed in women with PMS. The relationship between sensitivity to sex hormones and the stress reactivity of women with PMS is also supported at the neural level. The fact that function and even the anatomy of the amygdala are regulated by sex hormones has been extensively proven.^8,19,20 The amygdala is involved with detection of potential threats and responses to anger and fear stimuli and is activated in “fight or flight” behavior, as well as involved in the stress reactivity system. ²¹ As the amygdala has been implicated in the generation or maintenance of activity in the alpha spectrum, and in this study, we show increased alpha activity as well, it would follow that the amygdala is involved in the generation or maintenance of PMS.

We observed that, compared with healthy controls, women with PMS have lower respiration rates after the color-word and math tests. This showed that women with PMS were more physiologically affected by the stress tests. Women with PMS lack the flexibility to stimulate their physiological resources, which results in an increase in respiratory rate to stressors when compared with healthy controls. So, the lower respiration rate of women with PMS can reflect more “inhibition” of physiological stressors. We did not get the fast rise of HR in PMS groups, as in a study using the Trier Social Stress Test (TSST),²² because this needs more involvement of the participants and social interaction.²³ In contrast, our stress test involved mainly cognitive loads. Moreover, women with PMS have a distinctly different stress reactivity pattern compared with the control group, which means their stress coping mechanism is possibly incomparable.

The present study demonstrated that, compared with healthy controls, women with PMS experience more negative affect and less positive affect and also show a more pronounced alpha activity as well as lower respiration rates after being exposed to stressful conditions. These effects were independent of the menstrual cycle, which meant that continuous and permanent changes have occurred in women with PMS. However, the study may be underpowered to assess significant differences due to low sample size.

Acknowledgments

The work was funded by Huaqiao University’s Academic Project, which was supported by the Fundamental Research Funds for the Central Universities (15SKGC-QG15). The authors would like to express their gratitude for the support of these projects.

Footnotes

Disclosure

The authors report no conflicts of interest in this work.

References

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Menstrual Cycle Phase Modulates Emotional Conflict Processing in Women with and without Premenstrual Syndrome (PMS) – A Pilot Study

Abstract

Background

Premenstrual syndrome (PMS) is characterized by a cluster of psychological and somatic symptoms during the late luteal phase of the menstrual cycle that disappear after the onset of menses. Behavioral differences in emotional and cognitive processing have been reported in women with PMS, and it is of particular interest whether PMS affects the parallel execution of emotional and cognitive processing. Related to this is the question of how the performance of women with PMS relates to stress levels compared to women without PMS. Cortisol has been shown to affect emotional processing in general and it has also been shown that women with severe PMS have a particular cortisol profile.

Methods

We measured performance in an emotional conflict task and stress levels in women with PMS (n = 15) and women without PMS (n = 15) throughout their menstrual cycle.

Results

We found a significant increase (p = 0.001) in the mean reaction time for resolving emotional conflict from the follicular to the luteal cycle phase in all subjects. Only women with PMS demonstrated an increase in physiological and subjective stress measures during the luteal menstrual cycle phase.

Conclusions

Our findings suggest that the menstrual cycle modulates the integration of emotional and cognitive processing in all women. Preliminary data are supportive of the secondary hypothesis that stress levels are mediated by the menstrual cycle phase only in women with PMS. The presented evidence for menstrual cycle-specific differences in integrating emotional and cognitive information highlights the importance of controlling for menstrual cycle phase in studies that aim to elucidate the interplay of emotion and cognition.

Citation: Hoyer J, Burmann I, Kieseler M-L, Vollrath F, Hellrung L, Arelin K, et al. (2013) Menstrual Cycle Phase Modulates Emotional Conflict Processing in Women with and without Premenstrual Syndrome (PMS) – A Pilot Study. PLoS ONE 8(4):
e59780.

https://doi.org/10.1371/journal.pone.0059780

Editor: Ulrike Schmidt, Max Planck Institute of Psychiatry, Germany

Received: October 25, 2012; Accepted: February 18, 2013; Published: April 24, 2013

Copyright: © 2013 Hoyer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by project and salary support from the Alexander von Humboldt Foundation (AvH) and a Society in Science (SoS) Branco Weiss fellowship to Dr. Julia Sacher. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Up to 75 percent of women experience some degree of premenstrual syndrome (PMS) during their reproductive years [1], [2]. This condition includes somatic symptoms, such as fatigue, appetite-changes, and low energy, and affective symptoms, such as irritability, depressed mood, anxiety, and impulsive behavior [2], [3]. Typically, symptoms remit within a few days after the onset of menstruation. Approximately 10 percent of women with PMS experience a very severe form called premenstrual dysphoric disorder (PMDD), with similar prevalence in the United States [4], Canada [5], [6], Europe [7], India [8], Nigeria [9], and Japan [10]. As recently stated by Epperson and colleagues [11], PMDD shows comparable rates in Caucasians and African Americans in the United States [12], and symptoms appear to be relatively stable over time [7], [13]. PMDD is included in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Text Revision; the depressed mood that women with PMDD experience corresponds in severity to a major depressive episode (MDE) [14]. This emphasizes the interrelatedness of PMS/PMDD and depression, an association which is further supported by evidence revealing higher comorbidity and lifetime prevalence for major depressive disorder (MDD) in women experiencing PMS and PMDD [15], [16]. Transitions between PMS and PMDD are fluid and a common cause for both entities has been assumed [17].

However, the etiology of PMS and PMDD is largely unknown. Because PMS symptoms are closely related to the menstrual cycle and only affect women of reproductive age, sex hormones have been suggested to play a causative role. However, a large body of evidence indicates that women who are vulnerable to premenstrual mood changes do not have abnormal levels of sex hormones [18], [19]. Thus, it appears that women with PMS and PMDD show an abnormal response to normal sex hormone changes across the menstrual cycle [20]. As reviewed by Epperson et al. [11], genetic and psychosocial risk factors, such as a preexisting major mood disorder, history of sexual abuse, exposure to domestic violence, and a stressful work, home, or school environment have been implicated.

An interesting line of work has implicated the stress hormone cortisol due to the observation of an altered timing of cortisol profiles in women with PMDD compared to women without PMDD during the follicular menstrual cycle phases [21]. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been demonstrated in major depressive disorder and has been speculated to have an important role in the induction of sadness and impaired mood regulation [22], [23]. In a non-clinical population, cortisol levels have been shown to correlate with depressed mood and with poorer performance in an emotional processing task [24]. As endocrinological measures, such as salivary cortisol levels, thus seem useful to include in the research of premenstrual affective disorders, they would be more promising when combined with behavioral measures in order to better grasp the complexity of the potentially abnormal response to sex hormone changes that has been postulated to occur in women with PMS.

Investigators agree that premenstrual affective disorders, such as PMS, provide an unprecedented opportunity to study how changes in sex hormones impact the processing of emotional information and mood regulation on a behavioral level (for a detailed review see: [20]). Several lines of evidence support this concept: a subtle impairment in the identification of affective facial expressions has been observed for women with PMDD in the luteal versus the follicular cycle phase [25], as well as higher negative affect [26] and higher physiological reactivity [27]. Also, in the luteal phase, both women with PMDD and women without PMDD have demonstrated lower performance in a task that requires focused attention and high vigilance [26]. Women with clinical level premenstrual affect-disturbances showed enhanced bias to negative information, decreased bias to positive information, and diminished inhibitory control [28]. This was assessed in an emotional linguistic Go-No Go task designed to assess the interaction between emotion and motor inhibition using negative, neutral, and positive words as stimulus material. This task requires the subject to press a button when a word in normal font (go trial) appears and to withhold a response when a word in italicized font (no-go trial) appears.

Additional preliminary evidence for changes in behavioral patterns across the menstrual cycle – including changes in selective attention, cognitive flexibility and processing speed – stems from a study that applied the Trail Taking Test and the Stroop task in women with PMS and a control group of women without PMS [29]. In the Trail Making Test, the assignment is to draw a consecutive line connecting alternating numbers and letters in sequence (1-A-2-B-3-C…). Performance in this task was better during the follicular phase of the menstrual cycle for all subjects, with an overall better performance of controls versus women with PMS. The Stroop task assesses performance to correctly name a color during interference created when the name of a color (e.g., “green”) is printed in a color not denoted by the name (e.g., the word “green” printed in blue ink instead of green ink). In both groups, more errors were made during the late luteal phase, but color naming was faster during this period, suggesting a degree of disinhibition and impulsivity in all women during the late luteal phase.

While these findings for emotional and cognitive processing represent important contributions to our understanding of different aspects of behavior that might be influenced by the menstrual cycle, it is the parallel execution of both emotional and cognitive processing that is required for optimal performance in a situation of emotional conflict. However, little is known about whether emotional conflict processing is affected by the menstrual cycle phase and how performance in women with PMS differs from that in women without PMS. Using an elegant modification of the traditional Stroop task [30], involving the identification of an emotional facial expression without being distracted by a word expressing an emotion written across that face instead of the indentification of a color, allows for the assessment of emotional incongruence. While this paradigm has been successfully applied to studying emotional conflict in depression [31], anxiety [31], and panic disorder [32], as well as menopausal transition [33], it has never been used in a population with premenstrual affective disorder.

In the present study, we investigated whether performance in an emotional conflict task and stress levels are altered by the menstrual cycle in a group of women affected by PMS (hereafter referred to as the PMS group) compared to a control group not affected by PMS (hereafter referred to as the control group). Based on the research outlined above, our main hypothesis is that performance of an emotional conflict task will be impaired in the PMS group reflected by an increase in reaction time during the emotional interference condition in women with PMS compared to controls. We further hypothesize that we will not detect any significant impact of menstrual cycle phase on the parallel execution of emotional and cognitive processing in the control group. Thus, in the control group we hypothesize reaction time during emotional interference not to reveal any significant differences between the late luteal and the late follicular cycle phase. As a secondary and more exploratory aim, we expect stress measures, both self-reported stress scores and levels of salivary cortisol, to increase in the PMS group in the late luteal cycle phase compared to the late follicular cycle phase, while we expect no such changes to be observed in stress measures in the control group.

Methods

1. Subject selection

We investigated 30 females (mean age  = 26±4 years; range  = 20–35 years). Subjects were healthy, medication-free, reported regular menstrual cycles, did not use hormonal contraception, were without any current or previous history of psychiatric illnesses (the Structured Clinical Interview for DSM-IV [34] was used to rule out any Axis I disorders), had no history of gynecological pathology, were ≥1 year post-partum or never pregnant, and not currently breast feeding. Subjects were recruited through advertisements and flyers in local universities, libraries, the local university clinic, and physicians’ offices. Participants were screened over the telephone and scheduled for an on-site visit at the Max Planck Institute of Cognitive and Brain Sciences, Department of Neurology in collaboration with the Day Clinic of Cognitive Neurology, University Clinic Leipzig, to determine study eligibility, using medical history and physical examination, which included a brief neurological examination. To monitor the accuracy of individual reporting, the information subjects provided was checked for any inconsistencies regarding length of menstruation, abnormal mid-cycle bleeding and length of cycle by an independent research administrator for at least 3 months prior to testing and were contacted to confirm the timing of menses-onset following testing. In total, 59 subjects were scheduled for an on-site visit, 49 subjects met eligibility criteria and 30 subjects completed the entire protocol. The reasons for discontinuation of the study for the 19 subjects (12 controls, 7 women with PMS) who initially met eligibility but did not complete the entire protocol were the following: inconsistencies/lack of compliance with menstrual cycle reports or scheduling of assessments (12), decision to start oral contraceptives (4), positive pregnancy test (2), and an accident resulting in leg-fracture (1). Before entry into the study, prospective participants were screened using the German version of the premenstrual symptoms screening tool (PSST) [5], [35], which is a valid and reliable instrument for PMS/PMDD screening, and assigned to either the PMS group (n = 15) or the control group (n = 15). Demographic details of the subjects can be found in Table 1; groups were matched for degree of education, profession and parity. All participants gave written consent to participate. Study and recruitment procedures were carried out in accordance with the Declaration of Helsinki and approved by the research ethics board of the University of Leipzig. All women were tested at the late follicular and the late luteal phase of the menstrual cycle; detailed information on day tested and menstrual cycle length is provided in Table 1. The order of the menstrual cycle phase during which the emotional Stroop task was administered was counter-balanced. At each time of testing, saliva samples for the determination of sex hormones (estradiol, progesterone, testosterone) and cortisol were collected. To guarantee a clean saliva sample, participants had to refrain from caffeine, eating, drinking, and brushing their teeth for two hours before the sample was taken. Cortisol and the sex hormones were determined with a competitive luminescence immunoassay (CLIA) by IBL (Hamburg, Germany). The determinable range in saliva was as follows: for cortisol 0.005–4 µg/dL, for progesterone 2.6–1000 pg/mL, for testosterone 1.8–500 pg/mL, and for 17β-estradiol 0.3–64 pg/mL. Intra-assay coefficients of variation (CV) were 9% for 17β-estradiol, 5% for progesterone, 2% for testosterone and 5% for cortisol. Inter-assay CVs were 15% for 17β-estradiol, 8% for progesterone, 7% for testosterone and 4% for cortisol. At each time of testing the Beck Depression Inventory (BDI) [36], the Hamilton Depression Scale (HAM-D) [37], and the Perceived Stress Scale (PSS) [38] were administered. Four subjects in the PMS group and two subjects in the control group did not return the PSS questionnaire at one point of testing and were excluded from the subjective stress score analysis.

2. The Emotional Stroop Task (EST)

We employed a German version of the emotional conflict paradigm, as described by Etkin et al. [30], which has been used previously in a German population [32]. In this paradigm, combinations of an emotional face in the background (happy or fearful expression, from the Ekman faces set [39]) and the word “GLÜCK” or “ANGST” (German for “HAPPINESS” and “FEAR”, respectively) printed across the face in bold, red capital letters are presented. Trials were displayed for 4000 msec with a jittering interstimulus interval (4.00±0.4 sec, range 3–5 sec; Presentations software, Neurobehavioral Systems, Albany, USA), thereby introducing a randomized variability in stimulus presentation that has been associated with increased vigilance to such a task. One run consisted of 190 trials in sections of 22 blocks and 20 breaks of 4 seconds. In between face presentations, a fixation cross (a cross hair displayed on the screen for orientation) was shown. Depending on the congruence between face expression and word, trials were classified as congruent (C) or incongruent (I). Order types were counterbalanced across the experiment. To avoid priming effects, direct repetitions of the same face and repetitions of the same face-word-distractor combination (e.g., happy face, word “fear”) were excluded, as has been done previously [31], [32]. Participants were instructed to identify the face expression and answer as quickly and precisely as possible by pressing the right (happy face) or left (fearful face) answer button with their index finger.

3. Data Analysis

Reaction times collected during the emotional Stroop experiment were analyzed. Error trials (wrong answers, omissions and double responses) and trials with outlier reaction times (> three interquartile lengths below the 1^st quartile or > three interquartile lengths above the 3^rd quartile) were excluded from any reaction time calculations. For the accuracy calculations, all types of errors were considered. Statistical analysis was performed using the IBM SPSS Statistics 19 program (SPSS Inc, Chicago, IL). Normal distribution was tested with a One-Sample-Kolmogorov-Smirnoff test. We computed independent t-tests for comparisons of menstrual cycle phases (follicular versus luteal) between groups, and paired-t tests for within-group comparisons. In a second step, we analyzed interactions, applying a general linear model (GLM) with repeated measures. The within-subject factor was the reaction time according to cycle phase: follicular or luteal. The between-subjects factor was the group differentiation in the PMS and control groups. The applied contrast was the Helmert contrast. Correlations between reaction times and cortisol levels were calculated with Spearman rank order correlation coefficients. For cortisol, logarithmic values (natural log) were computed before analyses to normalize the cortisol distribution [40].

Results

There were no significant differences in the average day of testing in the follicular cycle phase between the PMS group (day  = 13, SD  = 2) and the control group (day  = 12, SD  = 2), or in the late luteal cycle phase (PMS group: day  = 27, SD  = 3; control group: day  = 27, SD  = 2; details given in Table 1), or the average time of day when testing occurred (PMS group: Central European Time (CET) mean ± SD  = 12.50±114 min; control group: CET mean ± SD  = 12.06±102 min). Progesterone levels showed a significant rise from the follicular and luteal phase within subjects (PMS group, p = 0.03; control group, p = 0.02). We did not find any significant differences for any salivary sex hormone levels (estradiol, progesterone, and testosterone) between the PMS group and the control group; details are given in Table 2.

1. Psychopathological assessment

Mood ratings in the PMS group and the control group are shown in Figure 1. As expected, the PMS group showed a luteal phase increase in the BDI scale (t₁₄ = −2.51, p = 0.025) and low or absent symptoms in the follicular phase. The control group showed low or absent symptoms in both phases (t₁₄ = 0.25, p = 0.81). Differences in the BDI scale between the PMS and control groups were significant in the luteal phase (t₂₈ = −2.11, p = 0.04) but not in the follicular phase (t₂₈ = 0.18, p = 0.86). HAM-D scores were significantly increased in the PMS group in the luteal cycle phase compared to the follicular phase (t₁₄ = −4.6, p = 0.001) and symptoms in the follicular phase were low or absent. The control group showed low or absent symptoms in both phases (t₁₄ = 1.15, p = 0.27). Differences in the HAM-D scale between the PMS and control groups were significant in the luteal phase (t₂₈ = 2.21, p = 0.035) but not in the follicular phase (t₂₈ = −1.06, p = 0.3).

Figure 1. Affective symptoms in PMS subjects and control subjects across the menstrual cycle.

Top Panel: Beck Depression Inventory (BDI) scores in women with premenstrual syndrome (PMS) are significantly increased (*: p = 0.025) in the luteal cycle phase (dark grey) compared to the follicular phase (light grey) but not in women without PMS (CTL). Bars represent one standard deviation. Bottom Panel: Hamilton Depression Scale (HAM-D) scores are significantly increased in women with PMS (*: p = 0.001) in the luteal cycle phase (dark grey) compared to the follicular phase (light grey) but not in women without PMS (CTL). Bars represent one standard deviation.

https://doi.org/10.1371/journal.pone.0059780.g001

2. Emotional Conflict Task

The main outcome variables for task performance were reaction time and accuracy in determining the facial expression during congruent and incongruent conditions. Results of the task reaction time in the PMS group and the control group were as follows: the PMS group resolved the incongruent condition faster than the control group in the follicular cycle phase (t₂₈ = −2.34, p = 0.03) but not in the luteal cycle phase (t₂₈ = −1.35, p = 0.19). We found a tendency for a menstrual cycle effect, with slower reaction times in the luteal phase of the PMS group (t₁₄ = −1.99, p = 0.07) but not the control group (t₁₄ = −1.27, p = 0.23). When we tested the group by cycle interaction in a general linear model, we observed a trend for the group main effect: the PMS group resolved the incongruent condition faster than the control group (F_1,28 = 3.51, p = 0.08). Similarly, a shorter reaction time was evident in the congruent condition for the PMS group compared to the control group in the follicular phase (t₂₈ = −2.06, p = 0.05) but not in the luteal phase (t₂₈ = −1.18, p = 0.25). During congruent trials, we did not observe a menstrual cycle effect in the PMS group (t₁₄ = −0.79, p = 0.44) or the control group (t₁₄ = 0.01, p = 0.99). In the group by menstrual cycle interaction (GLM), there was a trend for the group main effect, indicating that the PMS group tended to resolve congruent trials faster than the control group (F_1,28 = 2.82, p = 0.10).

To assess the emotional face-word interference effect across the menstrual cycle, we then computed the mean differences in reaction time between the incongruent and the congruent conditions, as shown in Figure 2. Our data reveal a significant increase (t₂₉ = −3.9, p = 0.001) in the mean reaction time for resolving emotional conflict from the follicular to the luteal cycle phase in all subjects (Figure 2, top panel). On average, the PMS group tended to show a faster mean reaction time compared to the control group (follicular phase: PMS group mean  = 0.02±0.02 sec versus control group mean  = 0.03±0.02 sec; luteal phase: PMS group mean  = 0.04±0.03 sec versus control group mean  = 0.05±0.03 sec), however overlap exists (Figure 2, bottom panel) and this difference is not significant (follicular phase: t₂₈ = 1.4, p = 0.17; luteal phase: t₂₈ = 1.36, p = 0.19). As observed previously, accuracy rates were high for both conditions (above 89 percent in both groups for each menstrual cycle phase) and did not reveal any significant differences.

Figure 2. Resolution of Emotion Conflict differs according to menstrual cycle phase.

Top panel: Scatter plots show individual differences in reaction time (sec) between the incongruent and congruent condition of the emotional Stroop task in the follicular and the luteal cycle phase in all subjects (mean reaction time shown in black). These data indicate a significant increase (p = 0.001) in mean reaction time for resolving emotional conflict between the follicular and the luteal cycle phase in all subjects. Bottom panel: Boxplots-bars show mean differences in reaction time (sec) between the incongruent and congruent condition of the emotional Stroop task in the follicular and the luteal cycle phase split by subject group (dark grey  =  PMS group, light grey  =  control group). Whiskers represent minimum and maximum of data-range. On average, the PMS group tended to show a faster mean reaction time compared to the control group (follicular phase: PMS group mean ± SD  = 0.02±0.02 sec, Control group mean ± SD  = 0.03±0.02 sec; luteal phase: PMS group mean ± SD  = 0.04±0.03 sec, Control group mean ± SD  = 0.05±0.03 sec), however, overlap exists and this difference is not significant (follicular phase: p = 0.17; luteal phase: p = 0.19).

https://doi.org/10.1371/journal.pone.0059780.g002

3. Measures of acute physiological and subjective stress reactivity

We found an increase in salivary cortisol levels from the follicular to the luteal cycle phase in the PMS group (t₁₄ = −2.29, p = 0.04) (top panel, Figure 3). In the subjective stress reactivity measure, namely the Perceived Stress Scale, we detected a trend for a similar increase from the follicular to the luteal cycle phase in the PMS group (t₁₁ = −1.36, p = 0.20). The PMS group tended to report higher subjective acute stress levels compared to the control group, revealing a significant difference for the luteal cycle phase (t₂₃ = −2.78, p = 0.01) (bottom panel, Figure 3). There were no significant correlations between salivary cortisol levels and emotional Stroop task performance across the whole sample.

Figure 3. Heightened physiological and subjective stress levels in women with premenstrual syndrome (PMS) in the luteal menstrual phase.

Top Panel: Boxplots-bars show mean salivary cortisol values (ln) comparing the follicular and the luteal cycle phase in PMS subjects (dark grey) versus control subjects (light grey). Whiskers represent minimum and maximum of data-range. On average, salivary cortisol levels increased from the follicular to the luteal cycle phase in the PMS group (p = 0.04). Bottom panel: In the Perceived Stress Scale (PSS), the PMS group (dark grey) displayed a similar trend for an increase from the follicular to the luteal cycle phase (p = 0.20) as depicted by boxplot-bars. On average, the PMS group (dark grey) tended to report higher subjective acute stress reactivity compared to the control group (light grey), revealing a significant difference for the luteal cycle phase (p = 0.01). Whiskers represent minimum and maximum of data-range.

https://doi.org/10.1371/journal.pone.0059780.g003

Discussion

The primary goal of this study was to investigate a potential effect of menstrual cycle phases on parallel execution of cognitive and emotional processing in women affected by PMS compared to women not affected by PMS. We were particularly interested in whether women with PMS would demonstrate an increase in reaction time in the late luteal phase of the menstrual cycle, the time when they are symptomatic. Our data support the tendency of women with PMS to resolve an emotional conflict paradigm more slowly shortly before menses sets in, thus confirming our main hypothesis. As expected, subjects with PMS reported significantly increased scores in depression ratings during the luteal cycle phase while subjects without PMS showed low or absent symptoms in both phases (Figure 1). Heightened depression scores in the PMS group were consistent with PSST ratings, thereby confirming a symptom phase of irritability, anxiety, despair, and depression during the late luteal menstrual cycle phase. While it was also expected that, during the symptomatic luteal cycle phase, subjects with PMS would show a trend for a weaker performance when resolving the emotional interference paradigm than during the late follicular cycle phase when they are not symptomatic, it is interesting that we observed overall faster reaction times in subjects with PMS compared to subjects without PMS (Figure 2). Acknowledging that the effect was only moderate and limited by sample size and inter-subject variability, it is nevertheless an interesting observation, particularly when viewing subclinical premenstrual mood changes as an indicator for a system in distress that is still able to compensate in order to avoid any significant behavioral impairment when solving a task that requires parallel processing of emotional and cognitive stimuli.

We further hypothesized reaction time during emotional interference not to reveal any significant differences between the late luteal and the late follicular cycle phase in the control group. However, performance data for control subjects were not consistent with this hypothesis: we observed a significant increase in mean reaction time for resolving emotional conflict from the follicular to the luteal cycle phase in all subjects including the control group (Figure 2). These results suggest that the menstrual cycle is capable of modulating emotional interference in healthy premenopausal women regardless of whether premenstrual mood changes occur. The subtle fluctuations of sex hormones throughout the female menstrual cycle have previously been demonstrated to account for differences in the perception of emotionally salient stimuli, as reviewed by [41]. Our results are in line with these and other findings regarding the menstrual cycle phase: a trend for better performance in the recognition of facial expression has been observed during the follicular and ovulation phases compared to the luteal menstrual cycle phase [42]–[44]. While these differences in emotional recognition are important to note, it is the parallel execution of emotional and cognitive processing that is required for successful social interaction. PMS interferes in situations of social interaction [45]. Our data from an emotional interference task, which has been demonstrated to be a useful paradigm in the investigation of parallel execution of emotional and cognitive processing [30], [32], extend reports that emotion recognition is affected by menstrual cycle phase: our results reveal that women are more successful in the parallel processing of emotional and cognitive information in the follicular cycle phase compared to the luteal cycle phase (Figure 2).

As a secondary and exploratory line of observation, we obtained preliminary measures of subjective and objective stress to explore whether women with PMS would display any substantial intra-individual changes in stress patterns across the menstrual cycle. While menstrual cycle phase differences in the performance of emotional processing tasks have been linked to salivary cortisol variations over the menstrual cycle in women without PMS [46] and heightened levels of cortisol have been reported for women with PMS [47], [48], several other studies report an absence of typical cortisol patterns for women with PMS [49]–[51] or a decrease in cortisol levels compared to healthy controls [52], [53]. One reason for the difficulty in bridging all these seemingly inconsistent findings can be found in the methodology: the menstrual cycle phases that were compared and the method used to determine menstrual cycle phase differed across studies, as did the time of day for sample collection (cortisol secretion is lower in the evening), the sample medium (CSF, urine, plasma, saliva), the sample size (n = 2–42), the groups and characterization (severity of symptoms differed, some studies did not include a non-PMS control group, and the assessment tools used to identify premenstrual symptoms differed). While these are all aspects that need to be considered when reviewing the existing literature, Odber et al. [53] have proposed a compelling concept to consolidate the seemingly conflicting findings: that an increase in baseline cortisol levels in a subclinical sample could represent a physiological and healthy response to the stressful situation of PMS symptoms (albeit mild to moderate), a compensation mechanism protecting a healthy system from further imbalance. This would explain why the increases in cortisol that have been found in groups with a subclinical level of premenstrual mood changes could not be extended to PMDD: a clinical level disorder associated with a pronounced and more sustained imbalance of the HPA axis [21], [52]. Our exploratory observation of an increase in a single sample of salivary cortisol levels in the late luteal phase compared to the follicular phase in a pilot sample of women with PMS is consistent with this theory and in line with the marked increase in subjective stress that PMS subjects reported for this phase (Figure 3).

Several caveats are important to acknowledge in the interpretation of our results. First, the levels of significance obtained are in the modest range, which is likely explained by the limited sample sizes. While the menstrual cycle effect on reaction time during successful emotional conflict resolution is robust, the signals described for between-group effects during the emotional conflict paradigm, cortisol and subjective stress levels do not survive statistical correction for multiple comparisons and therefore warrant further investigation in a larger sample. Second, the determination of menstrual cycle phase was based on the individual diaries of subjects. To monitor the accuracy of individual reporting, subjects had to report menstrual cycle diaries for length of menstruation, abnormal mid-cycle bleeding and length of cycle for at least 3 months prior to testing, were checked for any inconsistencies by an independent research administrator and were contacted to confirm the timing of menses-onset following testing. Collected salivary samples for estradiol and progesterone levels were in the expected ranges for the designated menstrual cycle phases. Although additional validation of these self-reports stems was obtained from the observed rise of progesterone within the expected range, with a clear distinction between follicular and luteal phase (Table 2), it would have been preferable to also perform an ovary ultrasound to confirm ovulation and menstrual cycle phase or to assess lutropin peaks in urine for precise determination of ovulation. Finally, cortisol levels represent only one aspect of HPA axis function and inter-individual cortisol differences are considerable [54]. To obtain a valid assessment of baseline cortisol levels across the menstrual cycle, Nepomnaschy et al. suggest collecting 10–14 samples at multiple times in a longitudinal design [55]. We acknowledge this by limiting our interpretation to the within-group change of cortisol in the PMS group and conclude that this preliminary finding is of exploratory nature and needs further investigation in a larger sample following an assessment protocol as suggested by Nepomnaschy and colleagues [55].

In conclusion, our findings indicate a considerable modulating effect of the menstrual cycle on the parallel execution of emotional and cognitive processing in healthy women reporting regular menstrual cycles. The significantly faster resolution of an emotional conflict task during the follicular menstrual cycle phase compared to the late luteal menstrual cycle phase points towards a mediation of the integration of emotional and cognitive information by subtle fluctuation of sex hormones, possibly influenced by the HPA axis. The present findings emphasize the importance of considering menstrual cycle phase in the design of studies investigating the interplay of cognition and emotion. Furthermore, our data support the concept that subclinical PMS is a potential indicator of distress in a system that is still capable of compensating for the subjective stress associated with monthly mood changes. This study suggests that women with subclinical PMS represent a population of particular interest to studies that endeavour to reduce lifetime prevalence rates of depression in women.

Acknowledgments

We thank Helga Smallwood, Nadia Scott, and Dr. Philipp Gunz for comments.

Author Contributions

Conceived and designed the experiments: JS JH AV. Performed the experiments: JH IB MK FV JS ER KA. Analyzed the data: JH IB LH. Contributed reagents/materials/analysis tools: LH AV. Wrote the paper: JH ER JS.

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Premenstrual Syndrome (PMS) | ACOG

Antidepressants: Drugs that are used to treat depression.

Depression: Feeling of sadness for periods of at least 2 weeks.

Diuretics: Drugs or substances that increase the production of urine.

Irritable Bowel Syndrome (IBS): A digestive disorder that can cause gas, diarrhea, constipation, and belly pain.

Menstrual Cycles: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Menstruation: The monthly shedding of blood and tissue from the uterus that happens when a woman is not pregnant.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs that relieve pain by reducing inflammation. Many types are available over the counter, including ibuprofen and naproxen.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovulation: The time when an ovary releases an egg.

Perimenopause: The time period leading up to menopause.

Premenstrual Dysphoric Disorder (PMDD): A severe form of premenstrual syndrome (PMS) that interferes with a woman’s daily life. Symptoms may include sharp mood swings, irritability, hopelessness, anxiety, problems concentrating, changes in appetite, sleep problems, and bloating.

Premenstrual Syndrome (PMS): A term used to describe a group of physical and behavioral changes that some women experience before their menstrual periods every month.

Seizure Disorders: Any condition that causes seizures, which cause changes in movement, consciousness, mood, or emotions. Epilepsy is one kind of seizure disorder.

Selective Serotonin Reuptake Inhibitors (SSRIs): A type of medication used to treat depression.

5 Steps For Relieving Your PMS Symptoms

In the days before menstruation begins, many women navigate body aches, cramps, mood swings, even constipation and diarrhea. A subset of women have premenstrual symptoms so severe that they interfere with daily life.

“True premenstrual syndrome, or PMS, describes emotional and physical changes in the days leading up to a woman’s period that interfere with her ability to perform daily activities,” says Page Animadu, M.D., an obstetrician/gynecologist at Henry Ford Health System. “So while many women have premenstrual symptoms, only about 3 to 8% experience symptoms that are so severe that they can’t perform daily activities.”

Premenstrual Syndrome Explained

The menstrual cycle is typically described as a 28-day cycle with four phases. Each phase requires a woman’s body to produce different hormones, each of which comes with its own set of physical and emotional changes.

Here’s how the phases break down:

• Menstrual phase: Days 1–5
• Follicular phase: Days 6–13
• Ovulation: Days 14–16
• Luteal phase: Days 16–28

PMS is a syndrome caused by changing hormone levels during the luteal phase. After ovulation, women may feel tired, cranky and off-kilter. Those symptoms progress as you get closer to menstruation.

“Sometimes women are so fatigued they aren’t able to work or even concentrate,” Dr. Animadu says.

Symptoms include:

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating
• Cramping
• Headaches
• Mood swings
• Fatigue
• Difficulty concentrating

How To Manage PMS

Whether you’re trying to conceive or not, your body goes through the same cycle each month to prepare itself to support a pregnancy. Producing the best egg, releasing it and providing an environment suitable for a baby requires a surge of hormones like estrogen and progesterone followed by a sudden drop. That drop can cause a decrease in the body’s production of feel-good hormones, such as serotonin.

“Women need to be assured that nothing is wrong with them; they’re just experiencing a physiological response to the drop in hormones that cause joy and happiness,” Dr. Animadu says.

There are several things you can do to help compensate for changing hormone levels.

1. Eat a balanced diet. Cleaning up your diet can significantly reduce PMS symptoms. Eat a diet that’s high in fruits, vegetables (especially leafy greens), legumes and whole grains, as well as healthy fats like omega-3s and omega-6s. Limit processed foods and saturated fats. “Processed foods can make you feel bloated,” Dr. Animadu says. Not sure you’re getting the nutrients you need? Talk to a registered dietitian to help fill the gaps.
2. Exercise regularly. While it may seem counterintuitive, exercise can help keep PMS at bay. Not only is exercise a proven mood booster, it can also help you feel more energized. Plus, exercise helps reduce stress and stave off chronic disease.
3. Get sufficient sleep. It’s important to get more sleep in the days before your period begins. “If you usually need seven hours of sleep each night, try to get eight,” suggests Dr. Animadu. “When you’re tired, it’s more difficult to concentrate and you can become more easily agitated.”
4. Try supplements. A variety of different vitamins and minerals can help ease PMS symptoms. A few of the most popular include vitamin B6 (for energy), vitamin D (for mood lifting) and magnesium (for PMS-induced headaches). “Unfortunately, there’s not a one-size-fits-all nutrient mix to help alleviate PMS,” Dr. Animadu says. “But there are a plethora of nutrients that can make a difference.” Consult with a healthcare professional before introducing supplements. If you get too much of one nutrient, it can undermine your body’s ability to absorb others.
5. Relax. When you’re premenstrual, practicing relaxation techniques can help you feel better, both emotionally and physically. If you’re suffering from cramps, you can help tense muscles relax with a heating pad, warm bath or even certain essential oils. The key is to find what works for you and stick with it.

PMS Treatment Options

If you’re still suffering from severe PMS symptoms after adopting the above strategies, see your healthcare provider. While lifestyle changes are the first-line recommendation for PMS, there are plenty of prescription and over-the-counter treatments available to help.

“Combined oral contraception (birth control), including estrogen and progestin, can help alleviate PMS symptoms,” Dr. Animadu says. “If you don’t notice an improvement within three cycles, your doctor may recommend antidepressants — either continuous or only during the luteal phase.”

It’s important to note that some women have a more severe form of PMS called premenstrual dysphoric disorder, or PMDD. PMDD can cause severe changes in mood in the days before your period begins. Treatment for both PMS and PMDD is largely the same.

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To find a doctor or certified nurse midwife at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936). 

Dr. Page Animadu is an obstetrician and gynecologist who sees patients at Henry Ford Medical Center – Detroit Northwest.

Tags: Women’s Health, Page Animadu

6 tips for PMS relief

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There’s a lot of conflicting scientific data out there regarding premenstrual syndrome (PMS). The most important thing to know about PMS is that most people experience some premenstrual symptoms, but that doesn’t mean all people who menstruate have clinical PMS (1). 

Some experts even argue that the entire phenomenon of PMS is overhyped and exaggerated for commercial reasons. 

The best way to work around PMS is to figure out your unique patterns and what solutions work best for relieving your symptoms. 

There are many ways to manage PMS symptoms, and not all are medical, scientific, or evidence-based. From a hot bath to your favorite comfort food, you don’t always need evidence to know what makes you feel better. But if you’re wondering about evidence-based solutions to PMS symptoms, here are some tips:

1. Eat a well-balanced diet to curb PMS symptoms

Make sure you’re nourishing your body and eating a diet that provides it with the nutrients you need to thrive. Some research suggests that diets with adequate amounts of calcium and vitamin D may reduce the risk of PMS (2). Diets high in thiamine (vitamin B1) and riboflavin (vitamin B2) might also reduce the risk of experiencing PMS (3). Not sure if you’re getting the nutrients you need? Track your food for a few days to get an overall picture. 

2. Work out regularly to prevent PMS symptoms

Exercise is a crucial part of a balanced life, so get the juices flowing for your overall health. It’s important not to just exercise when you have symptoms, but keep an ongoing exercise routine. Regular exercise may help with premenstrual headache, breast swelling, nausea, constipation, diarrhea, bloating, and vomiting (4).

Track your period, PMS, cravings, and more in the Clue app.

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3. Reduce stress to fight PMS symptoms 

The combination of stress and premenstrual syndrome might create a cycle of exacerbation. If mild to moderate anxiety or irritation is part of your PMS pattern, try calming your nerves with yoga (5), breathing exercises (6), or mindfulness-based stress reduction (7). Some types of therapy like cognitive behavioral therapy may help with premenstrual symptoms, but more research is needed (8).

4. Magnesium supplements for PMS symptoms

Magnesium deficiency can cause a slew of symptoms, like anxiety, depression, irritability, and muscle weakness (9). Taking a magnesium supplement has been suggested to help relieve PMS-related symptoms, like headaches, bloating, and irritability (10). Pairing a magnesium supplement with B6 may be even more beneficial than taking magnesium alone (10). 

5. Don’t blame every bad mood on PMS

We are not robots. A natural part of being human is to go through varying emotions. Before associating mood swings with PMS, consider other important predictors of daily mood like overall health and well-being (11). Considering PMS is used to discredit women in business and government, it’s important to examine what it really is and how we talk about it. We’re only perpetuating harmful stereotypes by labeling PMS as a “witch syndrome.”

6. Could PMS really be a magnification of an existing health or mental health condition?

Brands that capitalize off of premenstrual syndrome spend a lot of money on sophisticated advertising that might lead people to believe certain symptoms can be attributed to PMS. It’s important to know that some existing conditions can be amplified in the premenstrual phase (12). Blaming any uncomfortable symptoms that occur during the premenstrual phase on PMS could mask an underlying health issue. Anxiety and depression often get misdiagnosed as PMS (12). Other health conditions could also be misdiagnosed as PMS. 

Tracking your PMS symptoms 

Keeping tabs on your symptoms can help you determine your typical premenstrual experience. Use Clue to record your data for at least three cycles and you may start to see patterns in your PMS symptoms, triggers, and relief measures. The PMS symptom relief strategies we mentioned are best for mild to moderate symptoms. If your symptoms are moderate to severe, it may be time to talk to your healthcare provider about exploring some potential causes for your symptoms and some more options for symptom relief.

This article was updated on June 3, 2020.

Overview and Current Treatment Approaches

US Pharm. 2021;46(9):21-25.

ABSTRACT: Premenstrual disorders are common among premenopausal women and can have a major impact on their daily lives. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can cause physical symptoms and psychological symptoms similar to those of depression, with PMDD being the most severe form of PMS. Treatment approaches range from lifestyle changes and self-care to behavioral therapies and prescription medications. Many patients express a preference for OTC supplements as a more natural approach to treating their symptoms. Selective serotonin reuptake inhibitors are the gold standard for pharmacologic treatment of PMS and PMDD. Pharmacist knowledge of these various therapies is invaluable for informing patients’ treatment selection, medication adherence, and therapeutic progress.

Premenstrual disorders are common among premenopausal women and can have a major impact on home, work, or school life and interpersonal relationships. Both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve physical and psychological symptoms that occur during the luteal phase of ovulation, resolve shortly after menstruation begins, and affect normal daily functioning.^1-4 The American College of Obstetrics and Gynecology defines PMS as a disorder in which a woman experiences at least one physical symptom and one emotional symptom that impact social, academic, or work performance, whereas PMDD is a severe form of PMS involving at least five emotional and physical symptoms that are significant enough to cause major functional impairment or disruptions to daily life.^3-7 For a diagnosis of PMDD, one of the key emotional symptoms must be mood swings, anger, irritability, depression, or anxiety.^4,7,8

Incidence and Prevalence

Approximately 80% of women report at least one physical or emotional symptom during the luteal phase of the menstrual cycle, and most of them do not experience a significant impact on daily functioning. It is estimated that 20% to 25% experience moderate-to-severe symptoms that affect some daily functioning (i.e., PMS), and 1.2% to 8% have received a clinical diagnosis of PMDD. PMDD patients report severe, disabling symptoms that affect their daily life.^2,3,7,9 PMS prevalence is not associated with age, level of education, or employment status.^3,4,7,10

Risk Factors

Several risk factors for the development of PMS have been identified. These risk factors include a family history of other affective disorders, including major depression and postpartum depression; physical, sexual, or emotional trauma; weight gain; Caucasian race; nicotine use; and having experienced a stressful event in the past year.^2-4,7

Etiology

The etiology of PMS and PMDD is unclear, but several theories have been proposed.^3-5,7 Cyclical fluctuations in levels of estrogen and progesterone may trigger the symptomology of PMS. In addition, decreased sensitivity to the circulating hormones may play a role. Serotonin levels drop during the mid-to-late luteal phase, and the lower density of serotonin transporters results in abnormal serotonergic transmission. Luteal-phase changes in the brain neurocircuitry that affect emotional and cognitive functioning may be involved as well. Lastly, a genetic predisposition has been noted.^3-5,7

Evaluation and Diagnosis

Patient evaluation should include a thorough history of present illness. Other factors in the patient’s medical history also must be considered with regard to the differential diagnosis. Ruling out premenstrual exacerbation of any underlying psychiatric disorders is paramount; therefore, the patient should be screened for mood disorders such as major depressive disorder, generalized anxiety disorder, dysthymic disorder, and seasonal affective disorder. In addition, the patient should be queried about various medical comorbidities that can mimic premenstrual symptoms or may worsen during the luteal phase of the menstrual cycle, including migraines, anemia, thyroid disease (hyperthyroidism or hypothyroidism), endometriosis, irritable bowel syndrome, chronic fatigue syndrome, rheumatologic disorders, and chronic pain.^1-3,6,7 A diagnosis of PMS can be made if the patient has physical symptoms that cause functional impairment even in the absence of emotional symptoms.⁴ Once a provisional or preliminary diagnosis of PMS has been made, the patient should prospectively chart her daily symptoms over two menstrual cycles. A definitive diagnosis is based on the patient’s history and completed daily symptom diary.^3-5,7

Symptoms

Common physical symptoms of PMS and PMDD include abdominal bloating, breast tenderness or swelling, headaches, nausea, abdominal cramps and pain, weight gain, swelling of the hands or feet, and joint or muscle pain. Common emotional symptoms of these disorders include angry outbursts, anxiety, confusion, depression, libidinal changes, mood swings, decreased concentration, irritability, appetite changes, confusion, restlessness, lack of interest in usual activities, feelings of hopelessness, and social withdrawal.^2,3 See TABLE 1 for a listing of common symptoms. The symptoms usually occur in the week prior to menstruation, start lessening when menstruation begins, and are minimal or nonexistent following menstruation. The peak symptoms normally occur from 2 days prior to, through the first day of, menstruation.^3-5,7

Management

Treatment plans for PMS and PMDD encompass nonpharmacologic and pharmacologic approaches used either together or separately. Self-treatment may include consistent exercise, vitamin and mineral supplementation, and relaxation therapy. Pharmacologic treatment is suggested when lifestyle changes and other nonpharmacologic therapies no longer provide adequate symptom relief or if the patient prefers to initiate therapy with a prescription medication instead of nonpharmacologic measures.¹¹ Pharmacologic options include serotonergic antidepressants, anxiolytics, and hormonal therapies.^6,11 Treatment should be based on symptom severity and duration, menstrual-cycle regularity, whether contraception is also desired, and whether the patient is willing to take medication.^4,12

Nonpharmacologic Treatment

Self-treatment of PMS and PMDD ranges from lifestyle modifications and cognitive-behavioral therapy (CBT) to OTC supplements. Although the evidence for alternative therapies and self-treatment options for PMS and PMDD is weak, the use of alternative therapies as concomitant treatment is widely accepted.^7,8,12 The use of CBT has been shown to enhance the ability of PMS and PMDD patients to modify irrational thoughts and develop better coping strategies.^8,12 Dietary changes, such as consuming complex carbohydrates rather than simple carbohydrates, reducing salt intake, and eliminating caffeine, have theoretical effects on reducing symptoms such as bloating and mood swings; however, evidence is lacking and more research is needed.^7,12 Whereas the Royal College of Obstetricians and Gynaecologists suggests that exercise, CBT, and vitamin B₆ be considered first-line treatment for PMS, other experts have concluded that the body of evidence is too limited to recommend these options for first-line use.^12,13

Although many patients express a preference for OTC supplements as a more natural approach to treating PMS and PMDD symptoms, the evidence for these products is limited and inconclusive. Calcium 600 mg twice daily carries the strongest evidence for OTC treatment of mood symptoms associated with PMS and PMDD.^8,12 Other supplements that may provide some benefit for symptoms include vitamin B₆, omega-3 fatty acids, evening primrose oil, ginkgo biloba, and chasteberry; however, the consensus is that more evidence is needed for all of these treatment alternatives.^7,8,12

Additional complementary therapies that may be considered for PMS and PMDD treatment include light therapy, acupuncture or acupressure, massage, yoga, and chiropractic care; however, all of these treatment options require further evidence to determine their effectiveness for treating symptoms of PMS and PMDD.^7,14

Pharmacologic Treatment

Similar to their use for major depression, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZDs) are used to treat PMS and PMDD. Other pharmacologic classes include oral contraceptives (OCs) and gonadotropin-releasing hormone (GnRH) agonists.^5,6,11 SSRIs, which may be dosed either intermittently or continuously, are considered the primary treatment option for PMDD and severe PMS.^6,8,15 Intermittent dosing is an effective strategy because SSRIs have a short onset of action of just hours or days in PMDD treatment; this is unlike the response seen in the treatment of major depression, in which full onset of action can take several weeks.^8,16 In intermittent dosing for PMDD, the medication is taken in the luteal phase (i.e., from ovulation until the beginning of menses) only.¹² Intermittent dosing appears to be more efficacious for symptoms of irritability and mood swings and less beneficial for depressed mood and somatic symptoms. Therefore, continuous dosing may be a better option when depressed mood and somatic symptoms are present.⁸

Currently, the FDA has approved three SSRIs for treatment of PMDD: fluoxetine, sertraline, and paroxetine (TABLE 2).¹⁶ The off-label SSRI agents citalopram and escitalopram are also effective, and the SNRI venlafaxine is an alternative primary option (TABLE 2).^5,6,12 In general, side effects from SSRIs and SNRIs are common upon initiation of therapy; these include nausea, insomnia, headache, fatigue, diarrhea, dizziness, and decreased libido.^3,12 With the exception of decreased libido, which may be a long-term effect and can adversely impact medication adherence, most side effects subside in a matter of days regardless of dosing strategy. The burden of side effects can be further reduced with use of luteal-phase dosing.^6,12

Another first-line option for PMS and PMDD is drospirenone-containing OCs (TABLE 2). For PMDD, the combination OC drospirenone 3 mg and ethinyl estradiol 20 mcg is taken for 24 days of a 28-day cycle.⁴ This regimen, which is FDA approved for PMDD treatment in women who also desire contraception, has been shown to lessen emotional and physical premenstrual symptoms.⁷ However, drospirenone-containing OCs carry an increased risk of venous thromboembolism, a serious adverse effect that should be part of the risk-versus-benefit counseling session with the patient.^5,6

Patients with PMS or PMDD who experience anxiety, tension, or irritability may benefit from taking the BZD alprazolam during the luteal phase. The use of an intermittent-dosing strategy may reduce the risk of medication misuse. In general, BZDs are less effective than SSRIs in treating symptoms, and they can cause significant central nervous system side effects (e.g., drowsiness, weakness, fatigue, ataxia, and dizziness). Accordingly, alprazolam is considered a second-line treatment option.^6,12

For treatment-resistant PMDD, GnRH agonists are a last-resort pharmacologic option.¹¹ GnRH agonists, such as depot leuprolide, have been shown to alleviate physical symptoms as well as some emotional symptoms associated with PMDD.⁵ However, women with premenstrual depression did not report an improvement in their depression after receiving this treatment.⁶ Additionally, GnRH agonists may cause hypoestrogen adverse effects including hot flashes, night sweats, and decreased bone density.^5,12 For these reasons, combined with the substantial cost of these agents, the use of GnRH agonists is limited.¹¹ Lastly—and only when all other therapeutic options have been exhausted—surgical treatment (hysterectomy with bilateral oophorectomy) may be considered.^4,6

The Pharmacist’s Role

The role of the pharmacist in treating PMS and PMDD lies largely in patient education and the dissemination of appropriate information. Because alternative and self-treatment options are often the most accessible therapies for patients with PMS or PMDD, pharmacists frequently interact with patients who are contemplating their use. Pharmacists’ drug expertise is also essential in counseling patients on the proper use of the multitude of prescription medications used to treat symptoms of PMS and PMDD. Further, attention to medication adherence is of utmost importance in ensuring effective pharmacologic therapy results and to reduce the risk of serotonin withdrawal syndrome. Finally, pharmacist knowledge is critical for counseling patients on potential drug interactions and adverse effects of PMS and PMDD treatment options. Patients often assume that supplements are completely safe because of their OTC classification, and that assumption can lead to incorrect dosing and dangerous adverse drug effects or interactions.

Conclusion

PMS and PMDD are common in ovulatory women, and the resultant recurrent symptomology begins during the luteal phase of the menstrual cycle and resolves upon menstruation. These symptoms can cause minor to major impairment that interferes with work, social activities, school, and interpersonal relationships. Pharmacologic treatment options such as SSRIs, SNRIs, BZDs, OCs, and GnRH agonists are available to these patients, as are a number of OTC and alternative therapies. Pharmacists can contribute to positive patient outcomes by guiding medication decisions, providing counseling on both pharmacologic and nonpharmacologic treatments, and supporting the patient through various alternative therapies.

REFERENCES

1. Umland EM, Klootwyk J. Menstruation-related disorders. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education; 2017:1263-1278.
2. DynaMed [online database]. Premenstrual syndrome. www.dynamed.com/condition/premenstrual-syndrome. Accessed June 7, 2021.
3. Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016;94(3):236-240.
4. Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018;218(1):68-74.
5. Maharaj S, Trevino K. A comprehensive review of treatment options for premenstrual syndrome and premenstrual dysphoric disorder. J Psychiatr Pract. 2015;21(5):334-350.
6. Appleton SM. Premenstrual syndrome: evidence-based evaluation and treatment. Clin Obstet Gynecol. 2018;61(1):52-61.
7. Lanza di Scalea T, Pearlstein T. Premenstrual dysphoric disorder. Med Clin North Am. 2019;103(4):613-628.
8. Hantsoo L, Epperson CN. Premenstrual dysphoric disorder: epidemiology and treatment. Curr Psychiatry Rep. 2015;17(11):87.
9. Wittchen HU, Becker E, Lieb R, Krause P. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med. 2002;32(1):119-132.
10. Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. J Womens Health (Larchmt). 2009;18(1):31-39.
11. Imai A, Ichigo S, Matsunami K, Takagi H. Premenstrual syndrome: management and pathophysiology. Clin Exp Obstet Gynecol. 2015;42(2):123-128.
12. Nevatte T, O’Brien PM, Bäckström T, et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291.
13. Green LJ, O’Brien PM, Panay N, Craig M, on behalf of the Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome. BJOG. 2017;124(3):e73-e105.
14. Armour M, Ee CC, Hao J, et al. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database Syst Rev. 2018;(8):CD005290.
15. Marjoribanks J, Brown J, O’Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;(6):CD001396.
16. Lexi-Drugs [online database]. Riverwoods, IL: Lexicomp, Inc. https://.online.lexi.com. Accessed June 30, 2021.

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In almost 90% of women of reproductive age, before menstruation, mood changes and the state of health changes far from the better. Everyone is well aware of the existence of premenstrual syndrome, and the phrase: “I have PMS …” has entered the vocabulary of most modern women.

For some women, the existence of PMS is a good chance for a few days a month to write off their whims on the physiological characteristics of the body, while for another part of women, PMS symptoms can have a significant impact on the quality of life and performance.

By definition, PMS is a certain set of symptoms that appear in the second phase of the cycle a few days before menstruation and disappear with the onset of menstruation. More than 200 symptoms of this syndrome have been described.

PMS symptoms are divided into physical (related to well-being) and emotional-behavioral.

The following physical symptoms are most common:

• Bloating
• Feeling of weight gain
• Fluid retention in the body, swelling
• Increased appetite
• Tension and soreness in the mammary glands
• The appearance of acne and oily skin
• Tide
• Headache
• Dizziness, poor coordination of movements
• Change in libido
• Intestinal upset
• Thirst

Emotional symptoms include:

• Irritability
• Mood variability
• Outbursts of Anger
• Impulsivity
• Tension
• Anxiety
• Depression
• Drowsiness / insomnia
• Tearfulness
• Conflict / isolation
• Poor concentration

There are many other symptoms as well.

The severity of PMS varies from mild to very severe, interfering with a woman’s work and adequately communicating with people.

In addition to premenstrual syndrome, premenstrual dysphoric disorders are also distinguished. This disease is rare; it affects 4 to 8% of women. Everything is very similar to PMS, but the symptoms of emotional disturbances are very pronounced.

Here are some descriptions of conditions that occur in premenstrual dysphoric disorders:

• Severe depression, feelings of hopelessness, hopelessness, hopelessness and complete despair, self-deprecating thoughts
• Pronounced restlessness, anxiety, tension, a state of extreme “inflatedness” and irritation
• Sudden attacks of intense sadness and desire to cry
• Constant anger and irritability, pronounced conflict

The presence of such disorders significantly affects the quality of life of a woman.

It is important to note that some women may somewhat aggravate the manifestations of this syndrome, programming themselves that these disorders must necessarily occur to her before menstruation. That is, a woman simply adjusts herself to the fact that all these emotional disorders will soon begin to happen to her, and when the time comes, even minimal manifestations of mood instability are amplified many times over.

Why does PMS occur?

No one still knows why this condition occurs, despite the fact that this syndrome has been actively studied for over 60 years.Many hypotheses have been proposed, but they are all defective, since individual disorders that are detected in some women do not occur in others, and vice versa. The effect of hormones, various substances in the brain, the effect of endocrine disorders, prolactin and prostaglandins was studied, but the identified abnormalities in some women did not occur in others, despite the fact that their symptoms were similar.

The only thing that is clear is that PMS does not occur in adolescence before menstruation, after menopause and during pregnancy.The rest of the time, 90% of women, to one degree or another, experience these unpleasant phenomena.

It seems to me that PMS is a general reaction of the body to the fact that pregnancy has not occurred. Indeed, from a biological point of view, every month the body of women tune in to the beginning of pregnancy and is completely not privy to the woman’s plans. In the second phase of the cycle, all organs and systems undergo changes in their work, since if pregnancy begins, they will need to quickly engage in a different rhythm of work.When information arrives that there will be no pregnancy, the body begins a reverse readjustment, which is manifested by a whole gamut of a wide variety of reactions, both emotional and physical.

How to overcome PMS?

There is no universal recipe. To correct this condition, many symptomatic remedies have been proposed, that is, hotel recipes for how to cope with the most unpleasant manifestations of the syndrome.

Physical symptoms are easiest to manage.For this, monophasic hormonal contraceptives are prescribed, which turn off the cyclicity of the reproductive system, as if creating a false state of pregnancy. More than half of women with PMS on the background of hormonal contraception disappear or significantly alleviate the manifestations of this syndrome. However, in 25% of women, there may even be an exacerbation of the condition, or there may be no effect.

In the presence of strongly expressed individual symptoms, they are treated, for example, with severe fluid retention, diuretics are prescribed, for headaches, pain relievers are prescribed, etc.d.

Emotional symptoms are more difficult to deal with. To correct these disorders, almost the entire range of drugs was proposed, from simple valerian, ending with antidepressants. For some, it helped, for others, the side effects of the treatment became more severe than the symptoms of the disease themselves.

A lot of attention in the treatment of PMS is paid to diet. It is proposed to temporarily exclude coffee, alcohol from the diet and reduce salt intake. These foods are thought to exacerbate the symptoms of the syndrome.

The intake of certain vitamins and microelements is encouraged, for example vitamin B6, vitamin E, calcium and magnesium.

There are some herbal remedies and homeopathic remedies that in some women are able to relieve the manifestations of PMS.

Yoga and aerobic exercise can be very effective.

Psychotherapy with elements of hypnosis also copes with emotional symptoms. The doctor can teach a woman the techniques of self-regulation of the emotional state and remove the subconscious expectation of this difficult period.

90,000 How the menstrual cycle affects a woman’s mental abilities

• Zaria Gorvett
• BBC Future

August 8, 2018

Immediately after menstruation, women’s spatial imagination improves, and verbal skills peak in the middle of the cycle. Hormones do affect a woman’s brain, but this effect may very well be positive.

Photo by Getty Images

This article is from The Health Gap series on women and men in health and medicine.

First there was “hysteria”. From the priests of Ancient Egypt to the bearded philosophers of classical Greece, doctors attributed a wide variety of symptoms to this condition, from anxiety to erotic fantasies. Only one thing was clear: hysteria is an exclusively female disease.

Plato believed that hysteria is caused by the uterus, which is sad because she does not bear a child. His contemporaries argued that hysteria occurs when the uterus of a non-pregnant woman wanders around the body, getting stuck in different parts of it.

This latest concept persisted until the 19th century, when the disorder began to be treated by bringing women to orgasm with the first mechanical vibrators.

However, even today the idea that hormones in a woman’s body affect her intellectual abilities and mood is firmly entrenched in the mass consciousness. Irritability is immediately explained by PMS, and sexual desire – by ovulation.

There is, of course, a good deal of truth in this. Some women do experience a lot of anxiety and irritability before and during their period, and libido does increase during ovulation.

But it is obvious that these symptoms are not always explained by hormonal changes. And most importantly, it is important to remember that the tradition of attributing any health problems to hysteria led to very dangerous consequences.

Photo author, Getty Images

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Some women do experience anxiety and irritability before their period, but on other days of the cycle hormones have a positive effect on the female body

However, much less is known about the fact that hormonal changes during menstruation cycles improve various types of mental activity.

It turns out that immediately after menstruation in women, some cognitive skills, in particular spatial orientation, significantly improve. In the third week of the cycle, women reach a peak in communication with others, they are especially good at detecting when others are experiencing fear.

And in other periods of the cycle, the woman’s brain even increases in size.

Let’s find out what happens in the female body.

The reason for such changes, of course, is not the uterus, but the ovaries, which produce estrogen and progesterone in different quantities during the month.The main task of these hormones is to thicken the inner lining of the uterus and release the egg. But they also seriously affect a woman’s mood and behavior.

Scientists have been studying the menstrual cycle since the 1930s. This is a surprisingly popular research topic, and thanks to it we now know a lot about the effects of the cycle on the female body – from when women should quit smoking, to the dreams they see on different days of the cycle.

Photo author, Getty Images

Signs to the photo,

Hormone fluctuations – monthly in women and seasonal in men – affect the differences between the male and female brain

The close attention to this topic is obviously explained by the desire to understand what is the difference between a man and a woman, and above all – how their brains are different.

Scientists have long assumed that hormones are the root cause.

“Women’s brains are influenced by the menstrual cycle, and men’s brains are influenced by seasonal fluctuations in testosterone levels,” notes Markus Hausmann, a neurologist at the University of Durham.

Women, for example, have better social skills. They have a more developed ability to empathize and understand that the worldview of other people may differ from theirs.

They also have the best communication skills. This partly explains why boys are four times more likely to be diagnosed with mild autism than girls, while girls are able to mask the symptoms of the disorder.

“Female children start to speak earlier, women are generally more fluent in the language and learn spelling faster,” says Pauline Mackie, a psychologist at the University of Illinois at Chicago.

Photo author, Getty Images

Signs to the photo,

Women have better verbal skills than men. Perhaps this is inherent in evolution, since women must transmit information to their children

This is obviously a consequence of evolution, because mothers are able to clearly formulate their thoughts, better transmit vital knowledge to their children, for example, about the dangers of poisonous plants.

But do hormones affect these skills? And to what extent?

Hormonal balance

Back in 2002, researchers found that at the peak of the female hormone estrogen, women performed much worse on spatial thinking tasks (usually good for men), but performed well on linguistic tasks (in which women usually have an advantage ).

When estrogen levels decreased, spatial imagination skills were restored.

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Signs to the photo,

A high level of estrogen in a woman’s blood impairs her ability to solve problems in spatial thinking

However, female hormones improve some other cognitive abilities, for example, “subconscious memorization”, which, according to scientists, is very important for the development of communication skills.

“Subconscious memorization” manifests itself when we suddenly use in our speech words that are not inherent in us or not entirely clear, which we have recently heard or read.

Estrogen actively affects two adjacent areas of the brain. The first is the hippocampus, which is involved in the storage of memories and is very important for social skills. The ability to remember your experiences helps you better understand other people’s motives.

Interestingly, this area of ​​the brain increases every month when the hormone estrogen enters the woman’s bloodstream.

The second area, the amygdala, is involved in the processing of emotions, primarily fear, and helps make decisions in critical situations.

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Signs to the photo,

Female hormones improve linguistic skills

It is also very important in communication, as understanding what the other person is afraid of and thinking about whether or not we should be afraid of this also contribute to vision situations from the point of view of the interlocutor.

This ability also allows us to make moral judgments and even lie.

Studies show that the ability to recognize another person’s fear coincides with the peak of estrogen in a woman’s body.This is confirmed by the fact that women in general have better social skills than men.

Psychologist Polina Maki is sure that the influence of the menstrual cycle on our brain is completely random.

Photo author, Getty Images

Signs to photo,

It is thanks to estrogen that women are able to empathize more and see the situation from the point of view of another person.

For many years, researchers believed that changes in a woman’s body during the menstrual cycle are a consequence of evolution.

Researchers at one time came to the conclusion that during the period of the greatest probability of fertilization, women prefer men with masculine, symmetrical features. The discovery, of course, received widespread publicity.

However, subsequently, none of the large-scale studies was able to confirm this hypothesis.

Girl power

Whatever the reasons for this monthly transformation, the female brain obviously has several other benefits.

So, unlike men, when solving any problem, for example a mathematical problem, women use both hemispheres of the brain.

The distribution of activity between the right and left hemispheres is relatively constant. “This is primarily manifested in the activity of the hands, – explains Markus Hausmann. – For example, if I am right-handed, language processes in my brain occur mainly in the left hemisphere.”

This specialization is not accidental, because many animals, from fish to amphibians, have a similar brain structure.

Author of the photo, Getty Images

Signs to the photo,

Women use both hemispheres of the brain more often, which contributes to the flexibility of thinking

Why a woman’s brain is smaller is a big mystery. But perhaps the reason is its greater flexibility.

Back in 2002, Hausmann found that the tendency to use both hemispheres peaks when estrogen and progesterone levels are highest during a cycle.

“When a person’s brain works differently during a month, this obviously leads to different strategies for solving a certain problem,” the scientist notes.

“If a person relies more on the left hemisphere, he thinks more logically, and if on the right, he has a more complex approach to solving the problem.”

Therefore, the next time someone jokes that your hormones are playing out, you can safely answer – exactly so, but this has huge advantages.

To read the original of this article in English, visit the BBC Future website.

Female syndrome (PMS)

Olga Alekseevnoa Stambulova, Deputy Chief Physician for Obstetrics and Gynecology, Leading Obstetrician at the Scandinavia Clinic, talks about the common but still a mystery premenstrual syndrome.

Sometimes it is so difficult to pull yourself together and not yell at someone, not slam the door, not cry from the slightest offense … And even the realization that these emotions are due to quite definite physiological reasons does not help. We talked with Olga Alekseevna Stambulova, the deputy chief physician for obstetrics and gynecology, and the leading obstetrician of the Scandinavia clinic, about the common but still a mystery premenstrual syndrome.

– Olga Alekseevna, what is premenstrual syndrome (PMS) from a medical point of view?

– Premenstrual syndrome is a wide range of vegetative-vascular, neuropsychiatric and metabolic-endocrine disorders that appear in the second half of the menstrual cycle. Symptoms of premenstrual syndrome are individual for each woman, but the most common of them are swelling and changes in the emotional background.Moreover, the mood changes for each woman in different ways: some become aggressive, others – whiny, others – irritable. Some of the fair sex during this period fall into depression. Also, typical complaints include swelling of the face, legs, engorgement and soreness of the mammary glands, headaches, and even an increase in body temperature. There is a clear relationship between the complex of the above symptoms with the cycle: the manifestations of PMS become noticeable a few days before menstruation, and disappear with its onset.Women of any age can suffer from premenstrual syndrome, but most often it is noticeable at the age of 30-40.

Usually, women do not attach much importance to the symptoms of PMS, considering such processes to be normal. But I would advise you to listen carefully to the signals given by the body, since some manifestations of painful sensations on the eve of menstruation may indicate certain disturbances in the work of the female body. So, especially intense pain in the lower abdomen on the eve of menstruation can be the result of endometriosis, inflammatory processes, hormonal imbalance.To exclude these diseases, you need to consult a gynecologist.

– What causes PMS?

– There are many theories on this score, but none, unfortunately, fully explains the occurrence of premenstrual syndrome. It is believed that PMS is based on hormonal changes occurring in the second, luteal phase of the menstrual cycle, when there is an excess of the ratio of prolactin and estrogen relative to progesterone.There is also an opinion that PMS can be caused by a deficiency of vitamins and minerals, as well as endorphins – substances responsible for our good mood and well-being. At the same time, there is a psychophysiological side of the issue: premenstrual syndrome is more typical for women who have emotional or physical overload – stressful work or a tense family environment. A certain effect on the occurrence of the syndrome can be exerted by such provoking factors as the consequences of unsuccessful pregnancies, abortions, and infectious diseases.

In any case, PMS is a consequence of a number of reasons, individual in each case, which is why the diagnosis of the syndrome is specific for each woman.

– Olga Alekseevna, tell us about the diagnosis and therapy of PMS.

– First of all, you should carefully listen to the patient, then conduct a thorough gynecological examination and ultrasound examination of the pelvic organs. In the most difficult cases, MRI diagnostics are used.After this, a hormonal examination should be carried out. It is also advisable for patients with complaints of PMS symptoms to recommend consultations of doctors of other specialties – a psychologist, endocrinologist, neurologist, mammologist, therapist.

Most often, when premenstrual syndrome is detected, hormonal treatment is prescribed. But each case is special, and it is possible to say what treatment is needed only after a full examination. However, there is one general recommendation: women with premenstrual syndrome should normalize their lifestyle – half of the success of treatment depends on this, especially if a woman works a lot.It is necessary to sleep at least eight hours, systematically, but within reasonable limits, to play sports, not to abuse fatty and carbohydrate foods, coffee and strong tea, to reduce the number of cigarettes smoked to the possible minimum, and it is better to quit smoking altogether.

– Tell me, what can mean pain in the lower abdomen already during menstruation? Are these painful sensations similar to PMS pain, do they have the same nature?

– The cause of such pain can be endometriosis (especially if pain occurs on the eve and on the first day of menstruation), inflammatory diseases of the pelvic organs.In any case, such pain is a good reason to consult a specialist, especially if it appears with the arrival of each menstruation. In no case should you self-medicate while taking pain medications. It is believed that pain that occurs before and during menstruation disappears after pregnancy and childbirth. This is possible because pregnancy and lactation is a physiological process in which the hormonal background of a woman is often leveled. However, pregnancy is not a panacea, and often the pain comes back again.To understand the nature of pain and help cope with it, a woman needs a comprehensive examination under the supervision of a gynecologist.

90,000 Before the storm. Why some scientists consider premenstrual syndrome to be fictitious and how to tell if it has developed into a full-fledged periodic mental disorder

ICP Key Facts

There are many wild associations and myths associated with PMS, or premenstrual syndrome, in the public mind.There are thousands of memes and jokes about PMS turning women into hysterical berserkers. At the same time, even the basic facts about PMS are known to few. Here they are:

1. PMS and menstruation are not the same

A rare girl, being in a bad mood, at least once in her life did not hear from a man a comment in the spirit of “what is so evil? What’s your period? ” Surprisingly, even the ubiquity of the Internet with Google and Wikipedia has not helped some men learn that there is a difference between PMS and menstruation.PMS is a premenstrual syndrome that does not appear during menstruation, but, as you might guess from the prefix “pre”, before them – usually a few days or a week.

2. Not all PMS are affected

Contrary to popular belief, PMS is not observed in all girls, but in about 80%. At the same time, it manifests itself in everyone in different ways: if a girl’s PMS is weakly expressed, those around her will most likely not notice any changes either in her appearance or in her behavior.

3. Premenstrual syndrome is not only about emotional changes

Although in pop culture PMS is known primarily “for” the emotional swings of girls prone to the syndrome, it includes a whole range of symptoms, not only emotional, but also physical.

PMS can manifest itself in the form of increased irritability, fatigue, frequent mood swings, as well as rashes, discomfort and breast swelling. Some girls, under the influence of the syndrome, suffer from headaches and bouts of nausea.At the same time, the presence of all symptoms at the same time is not at all necessary, and the form of PMS manifestation can change with age.

Where does the PMS come from

Scientists do not yet know exactly how PMS works and what determines the presence of the syndrome and the degree of its manifestation. So far, doctors agree that the syndrome is primarily associated with hormonal changes in a woman’s body before menstruation. This is confirmed, for example, by the fact that during pregnancy and menopause, when women do not have menstruation, PMS does not manifest itself in any way.However, which hormones are responsible for premenstrual syndrome, scientists have not yet figured out.

PMS has not been adequately studied at all. Firstly, by the fact that the very diagnosis of the syndrome and the study of its manifestations are always made only from the words of a woman who is supposedly suffering from PMS. This method of diagnosis is very subjective, and research results are highly dependent on the individual perception of symptoms by each patient.

Second, it wasn’t until the 1950s that PMS began to be seriously investigated.Before that, medical science had not really dealt with the syndrome, and until the beginning of the 20th century, the syndrome was considered unreal at all – they said that it was women who were simply inventing everything.

Some researchers insist that PMS does not really exist – it is a social construct, and women complain of symptoms mainly due to their susceptibility to ingrained stereotypes about the syndrome. As evidence, supporters of this approach cite, for example, the fact that PMS is most often complained about by residents of Western countries, in whose popular culture the syndrome has traditionally been more covered.

On the other hand, it is possible that the imbalance in the frequency of PMS complaints in Western and Eastern countries is associated not with the influence of cultural stereotypes on the perception of the syndrome, but with the fact that PMS manifests itself differently in women of different races.

But in order to resolve this dispute, it is first necessary to establish exactly what exactly causes PMS, and to develop more objective methods for diagnosing the syndrome than those currently used. Perhaps, studies of the effect of PMS on animals will help in this: zoologists have found that the symptoms of the syndrome are manifested not only in humans, but also in our smaller brothers.

Where did the myth come from that PMS turns girls into “berserkers”

The widespread idea that PMS makes girls completely unbalanced, hysterical, depressed, or, conversely, too aggressive, is probably associated not so much with the syndrome in general as with the most severe variants of its manifestation. As noted above, in about 20% of women, PMS does not manifest itself at all, in the rest, the degree of its severity varies.

The most severe form of PMS stands out as a separate condition – premenstrual dysphoric disorder (PDD), which appears in the world’s most authoritative directory of mental disorders – DSM-V.

In this form, the syndrome occurs only in 3–9% of girls, but it is she who most closely corresponds to the ingrained stereotype.

The main symptoms of PDD: frequent mood swings, depressive emotions or feelings of hopelessness, strong anger at others and increased conflict, irritability and anxiety, decreased interest in normal activities, problems with concentration, fatigue, increased appetite or, conversely, its loss, problems with sleep, swelling and heaviness in the chest, headache, muscle pain.

PDD indicates the presence of at least 5 of these symptoms during the week before menstruation and their disappearance with the onset of menstruation. They must be observed over several menstrual cycles for PDD to be diagnosed.

If you notice the symptoms of PDD, American doctors recommend that you see your doctor to find out exactly whether it is about PDD or some other health problem. True, in the United States, PDD is included in the list of mental disorders, but in Russia it is not.

The exact causes of PDD are unknown, the disorder is associated with an increased effect on the woman’s body of hormonal changes before menstruation, as well as with a lowered level of serotonin. As a therapy, women are offered hormones and antidepressants.

How to relieve PMS and PDD symptoms

If you have persistent PMS or PDD symptoms that seriously interfere with your pre-menstrual period, it is best of course to see your doctor.He will help with the selection of hormone therapy or antidepressants, depending on the severity of your case.

Remember – a conscientious doctor will never prescribe hormonal drugs without preliminary tests, and in general, he will first try to do with less radical means.

It has been found that antidepressants, which belong to the group of selective serotonin reuptake inhibitors, are good for women suffering from PDD. These include, for example, “Fluoxetine” and “Paroxetine” (of course, it is better not to self-medicate here – it can get even worse).Previously, they tried to treat PMS with drugs containing progesterone, but then researchers found out that progesterone does not affect the manifestation of the syndrome at all.

If you don’t want to run to a doctor about PMS, there are several fairly simple and safe ways to alleviate the condition.

Vitamin B6 helps to relieve symptoms. You can take it as part of a pharmacy or eat more foods high in B6. These include, for example, turkey, pistachios, tuna, avocados, and seeds.Eating evening primrose oil also helps with PMS. It is also recommended to reduce your salt and caffeine intake and try to get rid of stress by postponing the difficult work and showdown for another week.

Drugs can relieve specific PMS symptoms. For example, if you suffer from headaches, it is recommended that you take non-steroidal anti-inflammatory drugs such as Ibuprofen and paracetamol. “No-shpa” will help with severe pains in the lower abdomen.With puffiness, you can take diuretics that help remove salts and water from the body. Furosemide is a popular diuretic, but it has too many side effects. With severe edema, you can take Diuver one-time, its active ingredient, torasemide, has a longer effect and causes fewer side effects. With PMS, you should never take potassium-sparing diuretics such as Spironolactone, as they can cause menstrual irregularities.

It is better not to take specialized drugs that affect the psychoemotional state without a doctor’s prescription. If you still don’t want to go to the doctor, you can try to do with herbal medicine: buy soothing herbal preparations at the pharmacy, such as St. John’s wort or chamomile, and drink them during PMS. This is the most harmless option in terms of potential side effects.

Sports can alleviate manifestations, but only regular ones. For example, aerobic exercise will help if you give them an hour three times a week for 2 months.Doing yoga with the same regularity can also make this week easier.

Contraceptive hormones can help some women get rid of severe PMS symptoms, but in other cases, they can, on the contrary, increase the symptoms or cause the manifestation of PMS in women who have not previously suffered from the syndrome. If all your life these gender-related torments have been bypassed by you, and then suddenly it began to cover, analyze what else has changed: new oral contraceptives, a strict diet, other changes in well-being – all this could upset the fragile balance of the body.And remember: PMS is exactly the same physical ailment as any other; it can and should be dealt with.

Clinical Study Premenstrual Syndrome (PMS): Jubilance (100 mg Oxaloacetate / 150 mg Ascorbic Acid), Rice Flour (Placebo) – Clinical Trials Registry

90,000 Top 7 Myths About PMS | Kotex

Top 7 Myths About PMS

PMS is surrounded by a myriad of myths and prejudices, as are most questions about women’s reproductive health.

Moreover, there is still no unequivocal agreement among scientists as to whether PMS exists at all, which means that it cannot be considered a medical condition.

Let’s try to figure out what is true and what are just common stories.

1 All women have PMS

Because of the prevalence of this belief, many women attribute many of the symptoms that occur before menstruation to PMS.

If you want a chocolate bar, you have a bad mood or a headache before your period, this does not mean that you have PMS. Doctors count about 150 different PMS symptoms, and some of them are so stereotyped that the very diagnosis of PMS by one of them becomes ridiculous.Many of them can be associated with completely different reasons, such as physical or emotional stress. If your head hurts every time before your period, then it is quite possible that this is already PMS, but you should not write off everything unusual that happens to you before menstruation on PMS.

The results of PMS studies are very different, and many women attribute the symptoms of the approaching menstruation to PMS.

2 PMS is primarily about a bad mood

Public opinion that PMS is necessarily accompanied by a bad mood is not supported by scientific research: for example, women from China and East Asia almost do not report a bad mood, but regularly report greater sensitivity to the cold, and in the case of women from North America and Western Europe, the trend is reversed.The most common symptoms are fatigue, pain and swelling.

Women’s perception of PMS depends on the culture in which they live and is directly related to the expectations that we learn through society.

Often, women simply write off their depressive state as PMS symptoms, and this prevents them from understanding the true causes of what is happening, and after all, only after understanding the true reason, you can take some action to deal with your problems.

3 All negative symptoms before menstruation are associated with hormones and PMS

Hormones play a key role in the functioning of the female reproductive system, but are not the only reason for a possible bad mood before menstruation.

General psychological and physical well-being have a much greater impact on mood and well-being before menstruation than the phase of the menstrual cycle.

Hormones can indeed cause a bad mood before menstruation in many women, as they can cause a decrease in serotonin levels and low mood, but this is especially true for women who already have a tendency to depression.

4 This is the same as your period

Although some PMS symptoms persist during your period, they are not the same thing.

The prefix itself in the word “premenstrual” tells us that we are talking about something that happens not during, but before menstruation.

5 Severe PMS is the norm

Many women believe that severe PMS that interferes with everyday life is the norm.

In fact, this is not the case, and if PMS interferes with your normal daily life, then you need to see a doctor, since in fact this condition can be caused by many reasons.

Severe mood swings, depression and anxiety can be signs of a PDS or hormonal disorder.

6 PMS occurs only in humans

In fact, not only people are subject to mood changes under the influence of hormonal changes.

Zoologists have also noted changes in food preferences and behavioral changes in some species that humans associate with PMS: for example, female baboons change their taste preferences in food, and female rhesus monkeys behave more aggressively before menstruation. At the moment, there is no extensive research on this topic, but it seems that the tendency to change behavior before menstruation is characteristic of other primates.

7 Nothing can be done about it

The fact that PMS may be largely the result of a social construct does not negate the fact that a large number of women feel its symptoms.

Since the overall level of mental and physical health affects how difficult PMS is most of all, it makes sense to start right there.

The main components of health are quality sleep and nutrition, as well as physical activity.

Try to get enough sleep and avoid excessive caffeine intake before bed.

Try to move more, walk.

Avoid fried and salty foods – they contribute to a more active course of inflammatory processes in the body.

If your symptoms are very difficult for you, do not hesitate to ask for help!

Menstruation and the symptoms of their approach should not be a hindrance to an active and happy life, and the more you know about your health, the faster you can understand if something suddenly goes wrong and take the necessary measures.

90,000 “What about hormones?” How belief in PMS changed attitudes towards women around the world: Books: Culture: Lenta.ru

“Women are closer to children and savages than to an adult, civilized man,” wrote the French psychologist Gustave Le Bon about a century ago.Women’s brains have been weighed, measured, tested for hormone dependence, and have regularly come to the conclusion that education, politics, and science are not women’s business. Neuroscientist Gina Rippon in Gender Brain. Modern neuroscience debunks the myth of the female brain ”offers a modern perspective on the similarities and differences between men and women. The book will be published soon by Bombora. With the permission of the publishing house “Lenta.ru” publishes a fragment of the study.

In any discussion about sex differences in the human brain, the question often arises: “What about hormones?” The belief that sex differences in behavior are equally related to both the brain and these chemical messengers is firmly entrenched in the popular biology literature, which explains our skills, tendencies, interests, and abilities.Financial success (or failure), leadership, aggression, and even sexual promiscuity have been attributed to high testosterone levels in men, while a woman’s ability to nurture children, remember birth dates, and a talent for sewing have apparently been attributed to high estrogen levels. Indeed, these hormones were directly responsible for the sex differences in the brain, and the effect of testosterone during intrauterine development led to a divergence in the pathways of the formation of men and women.

The first hormone was discovered in the early twentieth century, and since then, chemical behavior management has attracted attention. Scientists measured the sex glands and experimented with them to see how this would affect human behavior.

The French psychologist Charles Brown-Séquard was the first to suggest that there are some kind of chemicals released into the bloodstream and controlling organs at a distance. To test his hypothesis, he mixed a cocktail of crushed testicles of guinea pigs and dogs, and courageously drank it in person.After that, the scientist reported a vivid feeling of vigor and mental clarity. In 1902, the English physician Ernest Starling identified the first such substance, secretin. This happened during his collaboration with psychologist William Bayliss. These scientists discovered that the chemicals we now call hormones (from the Greek for “push to action”) are secreted by the glands of the small intestine and stimulate the pancreas to function. Soon after, many zones of production and action of these chemical regulators, or bioregulators, were discovered.As expected, the study of regulators of sexual behavior and sex differences was at the top of the list of early research projects.

Androgens, estrogens and progestogens, hormones that determine the development of the genitals and control sexual behavior, were discovered in the late 1920s and early 1930s, although the effects of testicle transplantation into various animals were studied as early as the eighteenth century. Likewise, in the late nineteenth century, ovarian extract was found to be effective in treating hot flashes, which indicated the existence of some specific female secretion associated with menstruation.

The most important androgen, testosterone, got its name in 1935 when chemistry professor Fred Koch isolated it from the testicles of a bull. Koch showed (in fact, he did not show anything) that castrated roosters and rats can restore their properties to males if they are injected with this hormone. For example, the scientist demonstrated how the comb, reduced in the capon, was restored to its former greatness. This has spurred some rather bizarre treatments to improve male strength (if you’re curious, look where Steinach’s research led to).

With regard to the so-called female hormones, it was discovered in 1906 that ovarian secretions induce cyclical sexual activity in female animals. These substances were named estrogens, from the Greek terms “estrus” (crazy desire) and “gennan” (to produce). (You can guess what gender was the scientist who coined the term.) In the 1930s, various estrogens (estrone, estriol and estradiol) were isolated, identified as hormones, and synthesized.It also turned out that these substances trigger puberty in female animals and even make male rats behave like females.

Frame: Fight Club movie

It should be noted that although androgens were discovered as male hormones, and estrogens and progestogens as female hormones, they are present in everyone, both men and women. (Although early research suggested that estrogens found in men were actually the result of eating rice and sweet potatoes – thus, it is likely that scientists were trying to attribute the negative qualities of estrogen to only the variant of the hormone found in women) …The levels of each of the hormones differ between men and women. The amount of testosterone is naturally higher in men than in women, and estrogen is the opposite, but do not forget that these hormones are present in both sexes, especially when it comes to interpreting hormone-dependent sex differences in behavior.

As was the case with early brain research, scientists were enthusiastic about the relationship between new discovered chemicals that supposedly controlled behavior and sex differences, especially since “sex” hormones had a clear relationship with well-described elements of animal behavior. namely, with their different roles in procreation.But how can one learn the same thing in a person? The heroic ingestion of testicular or ovarian extracts fortunately soon proved useless and could not be used as evidence. Likewise, it has not been easy to replicate in humans the effects of estrogen-induced early castration of male rats.

Also, what elements of behavior were investigated? If you wanted to explain the status quo, the superiority of successful men over inferior, emotionally unstable women, then a comparison of reproductive practices of both sexes would probably not be as politically revealing as you might have hoped.Attention was drawn to a “well-known” phenomenon, the monthly cycle of rising and falling underlying irrationality and emotional imbalance in women, which, as we saw in the previous chapter, was so enthusiastically studied by male scientists in the nineteenth century. Perhaps Brown-Séquard hadn’t tried a suitable cocktail of female organs, or he would have experienced an obvious loss of clarity of thought? The “uncontrollable hormones” that McGrigor Allan had already alluded to in the nineteenth century when he talked about the menstrual problem, has become a fashionable explanation for why women should not be given any kind of power and authority.

The study of changes in women’s behavior during the menstrual cycle has been a very popular source of such data – and historically, naturally, it has been cited as the reason why women cannot hold any positions of power. In 1931, a gynecologist named Robert Frank laid the scientific foundation for this idea. He suggested a link between recently discovered hormones and the manifestations of “premenstrual syndrome” (or PMS) in his patients. Women committed “stupid and reckless things” just before menstruation.This is how this notorious syndrome (PMS) appeared.

It was only in the 1960s and 70s that the Englishwoman Catherine Dalton, an endocrinologist, defined PMS as a clinical syndrome, adding together many of the physical and behavioral symptoms associated with it. She associated these manifestations with the premenstrual phase and found out the exact biological cause, hormonal imbalance. In Western culture, PMS has become common, and the days before menstruation begin have been hypothesized to be associated with bouts of bad mood, poor grades at school or poor job performance, decreased cognitive performance in general, and increased likelihood of accidents.It was estimated that eighty percent of women in the United States experience premenstrual emotional or physical symptoms. PMS has taken a strong place in popular culture, where there is often surprising consensus about premenstrual insanity and mood swings under the influence of hormones in women who cannot control it and stay in hell for weeks.

Photo: Jumana El-Heloueh / Reuters

Interestingly, the World Health Organization has conducted studies that have found cultural variations in complaints associated with the premenstrual phase.Mood swings were reported almost exclusively by women from Western Europe, Australia and North America; Eastern women, such as Chinese women, were more likely to report physical symptoms, such as swelling, and less often to report emotional problems.

In 1970, Dr. Edgar Berman, then a member of the Democratic Party’s National Priorities Committee, declared that women were unsuitable for managerial positions due to imbalances due to “uncontrolled hormones.”As he explained, women who have not yet started their periods due to age, or after menopause, can be free from monthly bouts of irrationality. Imagine, said Dr. Berman, a woman president of a bank “who makes loans during this special period. Or, even worse, a woman during menopause, who makes the decision to land a landing, or experiences hot flashes and keeps her finger on the nuclear button. ” Initially, the space program was closed to women, as it was believed that it would be undesirable to have a person in such a “temperamental psychophysiological state” on board the spacecraft.

In the West, the concept of ICP was so widely accepted that it became a kind of “inevitably coming true prediction.” PMS was used to explain, or blamed for events that might just as well be related to other factors. One study found that women were much more likely to associate their period with being in a bad mood, even when other factors clearly interfered. Another study found that if a woman was fooled into showing her physiological parameters indicative of premenstrual period, she was much more likely to report negative symptoms than a woman who believed it was not time for PMS.

But what is premenstrual syndrome? How do you know that you have it? And what caused it? The answers to these questions are ambiguous. As for the definition, it should be called “vague and vague.” There seems to be no consensus on what behavior changes should be studied. In total, a hundred or more (wow!) “Symptoms” were identified: some were physical, such as “pain” or “swelling.” Other symptoms were emotional – “anxiety” or “irritability.”Cognitive symptoms were even identified – “decreased performance”, or such poorly defined signs as “impaired judgment.” Nevertheless, negative phenomena were strongly emphasized. Indeed, the most commonly used questionnaire for data collection is simply called the Muu Menstrual Distress Questionnaire (the name “Muu” refers to the author of this questionnaire, not to those who complete it). In this questionnaire, women are asked to rate forty-six symptoms on a scale ranging from “not experienced” to “complete or partial disability.”Nearly all of the symptoms were behavioral, such as “forgetfulness,” “absent-mindedness,” or “confusion,” and only five were positive: “energized,” “ordered,” and “feeling well.” Interestingly, when filling out the questionnaire, those people who never had a period gave answers that were indistinguishable from menstruating women.

Photo: Mike Segar / Reuters

In addition, it turns out that retrospective measurements by no means provide reliable data, especially if the context of the questions is known to those who answer them.A more reliable approach is to measure daily, prospectively, behavioral change, at least over one complete cycle. This avoids the obvious focus on the premenstrual phase and its “reputation”. Ideally, interviewees should not know the purpose of the questions at all, or only receive the minimum information they need. Recently, a study was conducted on a methodology to study the relationship between mood and the menstrual cycle. The aim of the study was to identify those experiments in which scientists avoided such pitfalls.Of the 646 studies studied, only 47 fulfilled the conditions for prospective measurements during at least one cycle. Of these works, only 7 reported on the classic patterns of manifestation of bad mood in the premenstrual phase. In eighteen works using this technique, no connection was found at all.

And here is another study, according to the results of which it can be assumed that there is a connection between female hormones and positive changes in behavior (which, of course, would not have been the focus of attention of the followers of the Gustave Le Bon school, J.McGrigor Allan and Edgar Berman). Scientists are now increasingly agreeing that the strongest evidence points to improvements in cognitive performance and emotion during and after ovulation, rather than a perceived deficit that appears to occur before menstruation. Recently, a large-scale study of cognitive function and emotional state during the menstrual cycle was carried out using fMRI and hormone analysis. It turned out that increased levels of estradiol are associated with improvements in verbal and spatial short-term memory.Emotional changes, such as the accuracy of emotion recognition and improved emotional memory, were found precisely at high levels of estrogen and progestogen. This has been linked to increased reactivity in the amygdala, the part of the brain that processes emotions. I think it’s time for the Euphoria during Ovulation questionnaire!

This whole PMS story is a perfect example of the influence of an inevitably fulfilling prophecy, especially when it comes to the relationship between biology and behavior.A vaguely comprehensible phenomenon, determined mainly on the basis of patients’ words, becomes a useful hook on which to suspend certain behaviors that are unfoundedly called “symptoms”, and, moreover, highlights the problems that these symptoms can cause in women (and in those around them). What seemed like the perfect way to establish cause and effect by tracking behavioral changes associated with changes in hormone levels during the menstrual cycle was a prime example of how stereotypes turned into such strong beliefs that even those to whom they belonged believed them.