Women experience more severe gastrointestinal (GI) symptoms compared to men. The onset of puberty and the menstrual cycle may influence these differences. Additionally, health anxiety is an important construct that has been shown to play a role in increased symptomatology across many medical conditions. Using standardized clinical measures often employed to assess disorders of gut-brain interaction (DGBI) we aimed to identify differences of GI functioning across menstrual cycle phases and to evaluate the role of health anxiety in this relationship.

Six hundred three participants completed a survey including functional GI assessment scales (PROMIS-GI®), an abdominal pain scale and map, and a health anxiety measure. They were grouped by menstrual cycle phases (Menses, Follicular, Early-Luteal, and Premenstrual) based on self-reported start date of most recent period. Multivariate analyses of covariance were conducted to identify differences between menstrual cycle phase and scores on the symptom scales. Heath anxiety was included as a covariate in all analyses.

No significant differences were found between menstrual cycle group and PROMIS-GI scores. Higher GI-symptom and pain levels were found as health anxiety increased. Pain in the hypogastric region of the abdomen was significantly higher during the Menses phase when compared to Early-Luteal and Premenstrual phases. A subset of participants with DGBI diagnoses demonstrated significantly higher GI-symptom severity on several PROMIS-GI scales when compared to matched controls who did not have those diagnoses. In addition, participants with DGBI diagnoses reported significantly greater pain across multiple abdominal regions than their non-diagnosed counterparts.

GI symptom levels as measured by the PROMIS-GI scales in otherwise healthy women were not dependent on menstrual cycle phase. Yet, the PROMIS-GI scales were sensitive to symptom differences in women with DGBI diagnoses. Overall, this study demonstrated that the PROMIS-GI measures are unlikely to be affected by gynecological functioning in healthy young women. We argue that the abdominal pain map is an essential addition to classification and diagnosis.

After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health.

A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

The aim of the ISY study was to investigate the prevalence of menstrual-related symptoms prior to and/or during menstrual or withdrawal bleeding among women from 12 European countries.

A 15-min quantitative online survey was conducted in two waves from February to September 2015 among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive, including regular combined oral contraceptives (COCs) (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989).

The prevalence of at least one menstrual-related symptom was high in CHC users (93%) and in non-HC users (95%) (p < .0001) and the average number of symptoms reported was 5.3 vs. 5.9, respectively, (p < .0001). Pelvic pain, bloating/swelling, irritability and mood swing were reported in more than half of the women in both groups. Although generally modest, symptom severity was higher in non-HC users, except for headache. Overall, during the last four cycles, 60-75% of women did not require a treatment for most symptoms but headaches and pelvic pain. Mood swings/irritability, water retention/weight gain, lack of energy/mood swings and lack of energy/irritability were common symptoms that frequently co-occurred. No associations were reported between symptoms and age, educational qualifications or women's desire to reduce the frequency of menstruation.

Premenstrual and menstrual symptomatology was less frequent, less numerous and less severe (except for headache) in women using CHCs; however, it remains a common concern. Reducing the frequency of menstrual periods could reduce withdrawal-related symptoms.

To evaluate the effects of an oral contraceptive containing 3 mg drospirenone (DRSP) and 30 microg ethinyl oestradiol (EE) on somatic and psychological symptoms related to water retention, and on body weight.

This prospective study was performed in 26 centres in Canada over six treatment cycles. The first primary efficacy variable was the individual change in the water retention score of the Moos Menstrual Distress Questionnaire (MDQ) from baseline to the final examination in women with significant somatic symptoms related to water retention (n = 43). The second primary target variable was the change in body weight (n = 305).

Forty-three women met the criteria for the first primary target variable. In the premenstrual phase, the score decreased from 6.49 (SEM 0.45) at baseline to 3.19 (SEM 0.54) at the final examination (p = 0.0001). The data for the menstrual phase were 4.70 (SEM 0.30) at baseline and 2.35 (SEM 0.32) at the final examination (p < 0.0001). Baseline data from 299 women were assessed for the second primary target variable. Body weight did not change significantly, having increased only by 0.14 kg (SEM 0.13) at the final visit (p = 0.3082).

An oral contraceptive containing 3 mg DRSP and 30 microg EE significantly reduced the clinical symptoms of water retention. Body weight did not change.

Virtual simulation sickness (VSS) is a form of visually induced motion sickness that can result from immersion in a virtual environment (VE). As in their susceptibility to the sickness induced by real motion, women have been reported to be more susceptible than men to VSS, yet the reason for this difference is not known. The aim of the current study was to investigate the influence of the menstrual cycle on susceptibility to VSS in 16 naturally cycling women and to compare the responses of this group with control groups consisting of 1) 16 premenopausal women taking a combined monophasic oral contraceptive and 2) 16 men. All female participants were immersed in a nauseogenic VE on days 5, 12, 19, and 26 of their menstrual/pill cycle. These days were chosen because they fall in line with peaks and troughs of ovarian hormone levels. Menstrual cycle phase was confirmed by salivary estradiol and progesterone levels. A 4-week "pseudo-cycle" was assigned to the male participants. Hormone analysis revealed that 9 participants in the experimental group had been tested at the desired phases of their cycle. These participants exhibited a significant increase in susceptibility to VSS on day 12 of their cycle. The hormone analysis also showed that the cycles of the 7 remaining members of the experimental group had not precisely followed the expected pattern, and so these people had been tested on days that did not coincide with peaks and troughs of ovarian hormone levels. No consistent variation in susceptibility was observed over the cycle in these volunteers. In addition, no change in susceptibility was observed over the pill cycle of the oral contraceptive group nor over the pseudo-cycle applied to the male control group. The authors conclude that susceptibility to VSS varies over the menstrual cycle as a consequence of hormonal variation.

Despite the wide usage of the Moos Menstrual Distress Questionnaire (MDQ) in menstrual cycle research, the factor structure of the questionnaire has received relatively little attention since derived by Moos in 1968. This issue is one of considerable importance given that the methods of data collection used by Moos have since been subject to serious criticism. The aim of the current study was to determine whether Moos' factors could be replicated based on daily and prospective completion of the MDQ in women who were unaware of the study aims. One hundred and eighty-seven women from the general community (mean age 30 years) completed a modified version of the MDQ daily for 70 days. Principal components analysis of the modified MDQ items during the follicular, late luteal and menstrual phases indicated that a six-factor solution similar to that derived by Moos best summarized the data. A number of symptoms, however, loaded highly on more than one factor. This created some instability in the solution and may explain the discrepancies in previous research. Nonetheless, it was concluded that the Moos factors effectively represent the structure of menstrual cycle symptoms.

The aim of this research was to examine the pattern and incidence of premenstrual change in a reliable manner by addressing key methodological issues. One hundred and eighty-one women from the general population (mean age 30 years) completed a modified version of the Moos Menstrual Distress Questionnaire daily for 70 days. All symptom sub-scales fluctuated significantly across the menstrual cycle. Symptoms were at their lowest during the follicular phase and increased premenstrually. Somatic symptoms peaked menstrually and fluid retention peaked premenstrually. In general, however, symptom severity changed little from the premenstrual to the menstrual phase. A very high incidence of premenstrual change was noted, with over 40% of women demonstrating a 30% premenstrual increase in each symptom sub-scale. Close to 50% of women experienced increases in negative affect and over 70% experienced increases in fluid retention. Oral contraceptive (OC) use did not alter the incidence or severity of premenstrual change. Overall differences in symptom severity, however, were noted, with monophasic OC users reporting higher levels of fluid retention and somatic symptoms than the triphasic OC group. The results of this research suggest that women respond to the occurrence of normal neuroendocrine events that are not dependent on the sequelae to ovulation.

Previous research has suggested a possible link between neuroticism and premenstrual symptom changes. Results, however, are difficult to interpret given methodological problems such as retrospective reporting of premenstrual symptoms, and failure to control for the generalized influence of neuroticism on psychosomatic symptomatology. The present study aimed to address these issues. One hundred and nine women from the general population completed the modified Menstrual Distress Questionnaire daily for 70 days. Neuroticism was assessed using the NEO Personality Inventory Revised. Neuroticism accounted for a significant amount of variation in premenstrual negative affect both before and after controlling for baseline (follicular) symptom levels. The relationship between neuroticism and premenstrual negative affect could not be linked to any particular facet of neuroticism (e.g. anxiety, depression). Oral contraceptive (OC) users had significantly higher levels of neuroticism than the non-oral contraceptive (NOC) group. A significant interaction between OC use and menstrual cycle phase was also noted, with a trend toward OC users experiencing less premenstrual, but more menstrual, negative affect compared with the NOC group. The results are discussed in terms of the contribution of personality factors to the etiology of premenstrual change, and the utility of cognitive-behavioral treatment approaches.

Premenstrual symptoms were assessed in a sample of 267 women (M age 31.4 yr.) using a single self-identification question and the modified Menstrual Distress Questionnaire of Clare and Wiggins. The-self-identification question asked to what degree the women experienced premenstrual symptoms. The responses were 34 (13%) for none, 116 (43%) for slight, 99 (37%) for moderate, and 18 (7%) for severe. The mean score on the questionnaire was 23.5 (SD = 17.5). Correlations indicated significant relationships between self-identification and questionnaire scores (rho = .76, p < .001). When the women were classified according to Clare's (1983) criterion, almost a third of them assessed their symptoms differently, i.e., while they classified themselves as "nonsufferers" on the self-identification question, their responses on the questionnaire identified them as "sufferers."

Three different British ethnic groups were targeted to assess the influence of learned or culturally prescribed symptom reporting behaviour across different phases of the menstrual cycle. Forty-eight Afro-Caribbean, 73 Caucasian and 32 Oriental subjects completed a Positive/Negative Affectivity scale, a Retrospective assessment of premenstrual symptoms and daily symptom reports for 35 days. The results showed a significantly elevated level of symptomatology premenstrually and menstrually in the Caucasian group compared to both others. Analysis of subscales suggested elevated symptom reporting occurred for the psychological mood, body symptoms and pain, but not for the mental performance and social behaviour subscales. Intermenstrual reports of symptoms and Negative Affectivity did not differ between groups. A response bias or underlying trait is therefore unlikely to account for the selective reporting observed. It is suggested that the question of learning variables playing an important role in the reporting of symptoms at different phases of the menstrual cycle may be reopened.

We investigated women's belief that they suffered from premenstrual syndrome (PMS) by monitoring patterns of symptom reporting over a 5-week period in relation to the underlying trait of negative affect. We expected that women reporting high negative affect would be more likely to report menstrual cycle distress than those reporting low negative affect. One hundred twenty-one women rated the typical occurrence and severity of premenstrual changes on a retrospective questionnaire and then made daily ratings of their changes for the duration of one cycle. In addition, they completed a questionnaire measuring positive and negative affect. Data analysis revealed a clear subgroup whose retrospective reports of premenstrual change were not substantiated by the cycle of their daily ratings. Although this subgroup also reported more negative affect, the magnitude of the effect was relatively small. The possible contribution of both negative outlook and the meaning of the self-identified label of PMS are discussed.

Premenstrual experiences were studied in 112 non-complaining women using the Premenstrual Assessment Forms I (for positive experiences), II (for distressing experiences) and the bi-directional Visual Analog Scale. Overall, 27% of women reported no or minimal changes, 20% reported predominantly negative experiences, and 18% predominantly positive feelings. However, the commonest experience was a mixed picture with coexisting positive and negative feelings in 35% of the subjects. Severe premenstrual changes were noted in only nine (8%) of the women. None had a late luteal phase dysphoric disorder. The 26 items of the Premenstrual Assessment Forms I and II were factor analyzed by the principal components method using a varimax rotation. Four factors were derived. Factor I had 12 items indicating negative experiences. Factor II had seven items indicating positive feelings. The other two factors have vegetative features (like sleep and bowel changes) and sexual feelings. The findings also indicated that research needs to be directed towards understanding the mixed group of symptoms rather than the excessive emphasis on negative feelings.

The Premenstrual Syndrome (PMS) remains a controversial issue. As a clinical concept it is surrounded by confusion. Attempts to establish a consensus definition have resulted in the majority of women seeking help for such problems excluded from the diagnosis. Furthermore, there is no consensus about how such problems should be treated, with a variety of methods being advocated usually on very uncertain scientific grounds. The issue also has its political implications; there are those who see PMS as a way of reducing the status of women, by linking the normal ovarian cycle to a phenomenon which, on the face of it, impairs women's ability to cope. Yet there are a substantial number of women who experience significant negative changes which vary with the menstrual cycle, and produce long-term effects on their well being and family relationship which can be serious. There is also a real possibility that recurrent perimenstrual mood changes of this kind may increase the likelihood of chronic depressive illness in susceptible individuals. In most respects the features of depression which occurs perimenstrually are essentially similar to those of major depressive disorder, except for the short duration and recurrent pattern. PMS, therefore, remains an issue not only of clinical importance, but of considerable potential relevance to our understanding of major depressive disorder, which is substantially more common in women of reproductive age than in their male counterparts. In this review the concept of PMS, and some prominent operational definitions of it, are critically evaluated; it is now questionable whether the concept, as currently applied, still carries any heuristic or clinical value. Some current theoretical and aetiological issues are considered: e.g. the role of the corpus luteum, the effects of hormonal regimes which block ovulation, such as oral contraceptives, and the possibility that cyclical mood change represents an entrained rhythm in the brain. The conclusions reached at this stage in the review lead to a 'paradigm shift' with the proposal of a three-factor model to account for the complexities of menstrual cycle-related problems.(ABSTRACT TRUNCATED AT 400 WORDS)

Symptoms during the premenstrual and menstrual phases of the female reproductive cycle were assessed in 827 pairs of female same-sex twins from a population-based registry. By conventional factor analysis, premenstrual and menstrual symptoms were relatively independent of one another and of baseline 'neurotic' symptoms (i.e. anxiety, depression and somatization). Familial resemblance for menstrual and premenstrual symptoms was due solely to genetic factors with heritability estimates of 39.2% and 35.1%, respectively. Multivariate genetic analysis revealed distinct genetic and environmental factors for menstrual, premenstrual and neurotic symptoms. The genes and individual-specific experiences that predispose to premenstrual symptoms appear to be largely distinct from those which predispose either to menstrual or to neurotic symptoms. The generalizability of these results may be limited because only a modest number of premenstrual and menstrual symptoms were assessed, all by retrospective self-report.

In a study of 144 women, mainly self-designated PMS sufferers, the premenstrual depression experienced was, apart from its shorter duration, quantitatively and qualitatively similar to major depressive disorder for a substantial proportion of subjects. The associations with previous history of depression were complex: the severity of premenstrual depression was related to previous history of postnatal depression, whereas its duration (i.e., whether it persisted through longer) was related to a history of treatment with antidepressants. Two independent dimensions are proposed. (i) A menstrual cycle-related factor which in vulnerable women can results in severe and disabling premenstrual dysphoria, and which may be aetiologically related to a subgroup of postnatal depression. (ii) In a minority of women a more general propensity for depressive illness evidence as a tendency for any premenstrual depression to be prolonged.

The prevalence of common premenstrual symptoms and menstrual period pain were studied in a cohort of 545 Israeli adolescent girls aged 16 to 21 years, and their correlation with biological, behavioral, and sociocultural traits were analyzed. A high proportion of the girls (80%) commonly experienced at least one premenstrual symptom. About 70% experienced menstrual pain in the past and 25% reported pain which severely interfered with daily activities during the last three cycles. Premenstrual symptoms and menstrual pain were positively associated. Oral contraceptive use appeared to reduce the prevalence of menstrual pain, and among smokers who had menstrual pain, heavier smokers experienced more pain. Girls of Asian or African ethnic origin reported consistently higher perimenstrual distress than those of Israeli or Western origin, suggesting that social expectations may affect the perception and reporting of these symptoms.

Data on the general well-being and premenstrual symptoms of military wives were collected on two occasions one year apart. The women's general well-being and premenstrual symptoms were highly correlated on both occasions, but an even higher correlation was found between the presence of premenstrual symptoms at time 1 and the presence of premenstrual symptoms at time 2. Further analyses revealed that women with higher scores on general well-being and premenstrual symptoms were older and reported fewer cognitive depressive symptoms than women with lower scores on general well-being and premenstrual symptoms. At the one-year follow-up, the women with lower scores on general well-being who complained of premenstrual symptoms were more depressed than those who did not.

Fifty-one subjects completed a modified version of the Moos Menstrual Distress Questionnaire daily for 8 weeks. The true purpose of the study was not revealed. These prospective data showed no pattern of increase in symptoms of negative affect during the premenstrual or menstrual phases, although the majority of women retrospectively reported having experienced premenstrual tension during the study. Explanations for this discrepancy in terms of an information processing bias and the popularising of internal hormonal explanations are offered. A number of demographic and menstrually related variables are investigated and found to show no relationship to the experience of PMT in this sample. No evidence is found to suggest that older women are more likely to experience PMT.

This study considers primary dysmenorrhea from a biopsychosocial perspective in examining the relationship between physical exercise and menstrual pain. Despite widespread claims of the benefits of exercise for perimenstrual symptoms, the evidence seems weak. Stronger evidence indicates that exercise helps relieve stress and elevates mood and that stress heightens menstrual discomfort. Student nurses (n = 176) completed a questionnaire disguised as a general health survey that contained these measures. The hierarchial regression analysis demonstrated that, contrary to the expected, regular exercise increased with the severity of menstrual symptoms, after controlling for medications, disposition, perceived stress, and mood. The findings suggest that exercise presents a tradeoff; it relieves the stress that may intensify dysmenorrhea, yet it may aggravate these same symptoms.

Changes in perceptual asymmetry between the premenstrual and postmenstrual phases of the menstrual cycle were assessed in 39 women. Perceptual asymmetry was measured with fused, single response dichotic listening tests. The usual right ear advantage (REA) for auditory language-related stimuli was significantly greater in the postmenstrual phase of the cycle. Subjects with repressive personality styles were less likely to show a change in REA with the cycle. These neuropsychological findings are related to previously described physiological and psychological features of the menstrual cycle and the repressive personality style.

Forty-eight female nursing students who were in the reproductive age group were evaluated for cognitive, affective and somatic changes in the premenstrual phase. A retrospective rating method was used with measurements on numerical and visual analogue scales. The visual analogue scale was used for bidirectionality of measurement. Ratings on 17 items were compared during the premenstrual phase and the rest of the cycle. Significant changes were seen in three of the distressing items. A Premenstrual Syndrome, the late luteal phase disorder of DSM-IIIR criteria, was identified in 6% of the women. The varying patterns of premenstrual changes and their prevalence are discussed in a sociocultural context.

Ten women with DSM-III-defined panic attacks (five with and five without agoraphobia) had symptom severity rated daily, weekly, and retrospectively through one full menstrual cycle. Substantial fluctuations in retrospective ratings of severity were observed, with the premenstrual week being rated as most severe. Daily and weekly ratings showed much smaller fluctuations in the predicted direction. Possible reasons for this outcome are considered.

Although many women report negative symptoms, the perimenstrual phase also is associated with enhanced mood and performance among some women. However, research on perimenstrual concomitants reflects a sterotypic negative bias that does not encompass the complexity of the phenomena. This paper tries to redress that balance by documenting the prevalence of positive perimenstrual changes. Overall, about 5-15% of women experience increased excitement, energy, and well-being in the perimenstrual phase. Many women also report increased activity, heightened sexuality, and improved performance on certain types of tasks during the perimenstrual phase. Future research should examine why some women report positive perimenstrual changes, the extent to which individual variations in hormone levels can account for differences in women's perimenstrual experience, and how much women differ in their responsiveness to changing hormone levels. The influence of menstrual-related beliefs and expectations on the changes a woman reports also needs to be clarified.

Information about menstrual cycle variables was obtained by questionnaire using 462 female twin pairs. The twins were either members of the Institute of Psychiatry Volunteer Twin Register, or of the Birmingham Population-based Register. The two samples were analysed separately using univariate and multivariate methods so that an independent replication was obtained. Maximum likelihood estimation was used to fit simple models of genetic and environmental variation to these data. The results suggest that age of menarche, menstrual cycle regularity and premenstrual symptom reporting may be heritable, whereas menstrual cycle length is not. The result should be interpreted with caution as not all variables were replicated in the smaller sample, and the method of retrospective menstrual cycle data collection has been questioned.

To assess the effect of the menstrual cycle on a measure of brain physiology known to be affected in psychiatric illness, auditory-evoked electroencephalographic potentials were recorded from 12 women on the day prior to menstruation and nine days after the initiation of their cycle. Eight were normal college students, and four were patients in a premenstrual syndrome clinic. The women showed significant changes in self-ratings of mood between the two recordings. The P50 wave of the auditory-evoked response was evaluated in a conditioning-testing paradigm, in which stimuli were presented in pairs, allowing assessment of putative excitatory and inhibitory processes involved in the gating of central nervous system sensory responsiveness to auditory stimuli. The auditory-evoked potentials were unchanged between the two recording periods. There was also no difference between the women and age-matched male controls. The data suggest that these central nervous system functions are not responsive to hormonal fluxes in menstruation. Since inhibitory gating of the P50 wave is lost in the manic phase of manic-depressive illness, the data also suggest that premenstrual mood changes in normal women do not share electrophysiological properties of mania.

The predictive validity of subjects' self-reports of the severity of four groups of symptoms associated with the premenstrual syndrome (PMS) was assessed by canonical correlation of retrospective self-reports of usual symptom severities with prospectively obtained symptom severity scores from the next two cycles. Prospective scores from the second cycle were then correlated with retrospective recall scores obtained after the end of that cycle. A measure of inter-cycle variability was obtained by correlation between two consecutive sets of prospective scores. The symptoms studied were tension, depression, cognitive and physical ('water retention') symptoms. It was found that subjects' recall of a particular cycle predicted 72% of the variance in that cycle's prospective severity scores, indicating that the subjects correctly interpreted the severity of premenstrual symptoms and distinguished them from symptoms present in the follicular part of the cycle. Retrospective reports of usual PMS symptomatology predicted 21% of the variance in symptom scores in the next menstrual cycle and 12% of the variance in the following one. Despite this decrease, averaging the scores from the two prospective cycles improved the prediction to 23%. Prospective scores from one cycle predicted only 14% of the variance in prospective scores from the next, suggesting a high degree of inter-cycle variability. Women's self-reports of their usual PMS symptomatology reflect their experience more accurately than has been thought. The finding of marked inter-cycle variability suggests that arguments for the use of a single cycle of prospective data in PMS evaluation are fallacious and that retrospective self-report may be clinically useful and relatively valid.