Premenstrual Syndrome : A Study of Change in Cyclicity , Severity and Sexuality

Premenstrual Syndrome: A Study of Change in Cyclicity, Severity and Sexuality Ulla-Britt Ekholm Department of Obstetrics and Gynecology and Physiology University of Umeå, Sweden 82 women seeking help for the Premenstrual syndrome (PMS) were successively recruited into a research project on PMS. All of them performed daily self-ratings during one menstrual cycle and 54 of them during two cycles. Including the patients with two rated cycles the change between cycles in cyclicity and preovulatory symptoms was studied. They were diagnosed and subgrouped as having ”Pure PMS” with significant cyclicity and only premenstrual symptoms, ”PM aggravation” with significant cyclicity but with additional preovulatory symptoms or ”Non-PMS” without cyclicity. 78% showed the same cyclical pattern in both cycles and 65% were allocated to the same subgroup. The presence or absence of preovulatory symptoms was a more stable factor than the occurence of cyclicity. The cycle more resembling an ”ideal PMS pattern” better separated groups of patients regarding neurotic personality and psychiatric history. When all 54 patients were investigated together there was no change in severity between the two cycles when the whole cycles were compared, and using the premenstrual phase only difference in one symptom. When divided into subgroups it was found that the ”Pure PMS” group felt worse during the first rated cycle while the ”PM aggravation” group felt better during the first cycle. A method for estimating the severity of PMS was developed and tried. A severity-score was calculated and ± 1 SD was used to subdivide the patients into severity-groups giving 20% classified as having mild PMS, 61% as moderate and 19% as severe. The symptoms with the highest correlation to the severity-score were anxiety, tension and irritability. The validity of the severity-score was studied by comparing it with other ways of estimating severity of PMS. There was very good agreement between the severity-score and the prospective rating of influence on family, work and social life, fairly good between the result of a Moos Menstrual Distress Questionaire (MDQ) and the severity-score and also between the retrospective rating of influence and the severity-score. There was good agreement when the severity-score from two rated cycles was compared. Sexual parameters and the relationship to androgen levels and SHBG were studied. All sexual parameters showed cyclical change except the parameter ”unpleasant sexual thoughts” in the group with high levels of androstenedione, testosterone and SHBG when using combined p-value. The patients with a low level of androstenedione had more days with maximum ratings of the parameters ”sexual feelings” and ”pleasant sexual thoughts”. Patients with ”Pure PMS” had a lower level of testosterone compared with the ”PM aggravation” group. Four different methods for diagnosis of PMS, a nonparametric test, effect size, run test and 30% change were compared. Results showed high agreement except for the method of using 30% of the scale as condition for cyclicity, which resulted in fewer patients with cyclicity than the other methods used.