Approximately 80% of reproductive age women experience physical or emotional symptoms prior to onset of menses. Of these women, approximately 20% experience symptoms severe enough to interfere with social functioning and life activities and meet criteria for premenstrual syndrome (PMS). More than 100 different symptoms are associated with PMS, the most common of which include breast tenderness, headache, anger, and depression. Symptom groupings tend to be stable within an individual but can vary distinctly between women. Potential differences in the etiology of symptoms suggest that PMS should not be considered a single condition in research or clinical studies, but rather may represent distinct entities that group by symptom patterns. The primary goal of this study was to identify symptom patterns using factor and cluster analysis. Analysis included: 1) a cohort of healthy women aged 18-30 (n =414); and 2) the subgroup of women meeting established criteria for PMS (n=80). All participants provided information on the occurrence and severity of 26 menstrual symptoms by validated questionnaire. Four distinct symptom patterns emerged: Emotional, Psychological, Physical, and Consumption. Cronbach’s alpha levels demonstrating reliability were high in both the total population (0.71 – 0.90) and in the PMS subset (0.69-0.80). Additionally, cluster analysis identified 4 clusters in both the total population and PMS subset. These symptom patterns were consistent with those identified in prior studies in diverse populations. These observations suggest that distinct subtypes of PMS may exist, and should be considered when recommending treatments and evaluating risk factors.

Master of Music / Throughout the 20th Century, female operatic singers in most of the major European opera houses were given “grace days” (where they were not required to sing) in recognition of the effect of hormonal changes on the singing voice. Financial constraints in professional companies have resulted in a reduction of such considerations, but to date, there has been no systematic study of the effects of hormonal fluctuations on the quality of the female singing voice, or of its potential adverse effects on the vocal apparatus for singers who are affected by pre-menstrual syndrome. This study investigated the effects of hormonal fluctuations on young professional female classical singers. Female and male professional singers in training (students) at the Sydney Conservatorium of Music, University of Sydney, were asked to participate as volunteers in the study by keeping daily diaries. The female singers kept a diary for two separate months beginning on the first day of menstruation, in which they recorded their daily basal temperature, mood, voice state and physical well being. The male control subjects kept daily diaries for one month. Acoustic analysis of two vocal samples taken during the second month, on days 1 and 14 of the cycle, were completed on the six most severely affected female subjects, who were identified through their diary ratings of changes in vocal quality during menstruation. The selected students assessed their own vocal samples, presented in random order, to determine whether they could reliably identify which of their samples were affected by menstruation. Vocal staff at the Conservatorium (pedagogues), who were blind to the purpose of the study, also assessed recordings presented randomly. Results indicated that self-perceived vocal quality varied over the course of the menstrual cycle, particularly during the first seven days of the cycle, that negative changes in mood affected the voice, and that fatigue, effort, hoarseness, weakness & peak performance were the most frequently affected vocal states. A surprising finding was that male self-perceived voice quality also varied over the course of one month of diary keeping. There was no consistent change in direction of scores during menstrual and non-menstrual phases. Five of the six most affected singers correctly identified their performance during menstruation but pedagogues were not consistently able to do so.. These results indicate that perceived quality of the voice through changes in the menstrual cycle may not be as obvious to a highly trained observer even though they were reliably perceived by the singer. This study demonstrates that menstruation has a discernible impact on the self-perception of female singers’ vocal quality and implies that the premenstrual or menstrual female may not feel able to present her peak performance at these times of hormonal fluctuation. Further detailed research in this area may be warranted on a larger scale to elaborate a more precise clinical management of the problem.

Master of Music / Throughout the 20th Century, female operatic singers in most of the major European opera houses were given “grace days” (where they were not required to sing) in recognition of the effect of hormonal changes on the singing voice. Financial constraints in professional companies have resulted in a reduction of such considerations, but to date, there has been no systematic study of the effects of hormonal fluctuations on the quality of the female singing voice, or of its potential adverse effects on the vocal apparatus for singers who are affected by pre-menstrual syndrome. This study investigated the effects of hormonal fluctuations on young professional female classical singers. Female and male professional singers in training (students) at the Sydney Conservatorium of Music, University of Sydney, were asked to participate as volunteers in the study by keeping daily diaries. The female singers kept a diary for two separate months beginning on the first day of menstruation, in which they recorded their daily basal temperature, mood, voice state and physical well being. The male control subjects kept daily diaries for one month. Acoustic analysis of two vocal samples taken during the second month, on days 1 and 14 of the cycle, were completed on the six most severely affected female subjects, who were identified through their diary ratings of changes in vocal quality during menstruation. The selected students assessed their own vocal samples, presented in random order, to determine whether they could reliably identify which of their samples were affected by menstruation. Vocal staff at the Conservatorium (pedagogues), who were blind to the purpose of the study, also assessed recordings presented randomly. Results indicated that self-perceived vocal quality varied over the course of the menstrual cycle, particularly during the first seven days of the cycle, that negative changes in mood affected the voice, and that fatigue, effort, hoarseness, weakness & peak performance were the most frequently affected vocal states. A surprising finding was that male self-perceived voice quality also varied over the course of one month of diary keeping. There was no consistent change in direction of scores during menstrual and non-menstrual phases. Five of the six most affected singers correctly identified their performance during menstruation but pedagogues were not consistently able to do so.. These results indicate that perceived quality of the voice through changes in the menstrual cycle may not be as obvious to a highly trained observer even though they were reliably perceived by the singer. This study demonstrates that menstruation has a discernible impact on the self-perception of female singers’ vocal quality and implies that the premenstrual or menstrual female may not feel able to present her peak performance at these times of hormonal fluctuation. Further detailed research in this area may be warranted on a larger scale to elaborate a more precise clinical management of the problem.

Introdução: O diagnóstico da Síndrome Pré-menstrual (SPM) é um desafio. O uso de questionários estruturados está bem estabelecido, e a ferramenta mais aceita é o DRSP, um questionário prospectivo auto preenchido por ao menos dois meses. O PSST é um questionário retrospectivo de autoaplicação, preenchido em um único momento. Objetivo: comparar estes dois instrumentos (PSST e DRSP) para o diagnóstico da SPM. Método: Um estudo transversal com 127 mulheres entre 20 a 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, altura, Índice de Massa Corporal (IMC). Após exclusão de casos de depressão através do Prime-MD, as pacientes completaram o PSST e foram orientadas a preencherem o DRSP durante dois meses. A concordância entre os dois questionários foi avaliado pelo cálculo de Kappa (k) e valores do coeficiente PABAK. Resultados: Do total de mulheres que atenderam ao chamado, 282 (74%) preencheram os critérios de elegibilidade e responderam o PSST. Entre estas 282 mulheres, somente 127 (45%) completaram o questionário diário (DRSP) por dois ciclos. O percentual das mulheres com diagnóstico de SPM através do DRSP foi de 74,8%, e pelo PSST foi 41,7%. O percentual das mulheres com diagnóstico de TDPM pelo DRSP foi de 3,9%, e pelo PSST foi de 34,6%. Assim, verificou-se uma maior prevalência de SPM com o DRSP do que com o PSST. De outra parte a TDPM foi mais dignosticada pelo PSST do que com o DRSP. O número de pacientes consideradas “normais” foi semelhante com os dois instrumentos. Na avaliação entre os dois instrumentos verificou-se não haver nenhuma concordância (Kappa = 0,12) nos resultados do diagnóstico de SPM e TDPM (Coeficiente Pabak resultou = 0,39). Para a trigem de SPM/TDPM o PSST tem uma sensibilidade de 79% e especificidade de 33,3%. Conclusão: O PSST deve ser considerado como uma ferramenta de triagem diagnóstica. Conclui-se que os casos SPM/TDPM do PSST devem ser sempre melhor avaliados pelo DRSP. / Background: The diagnosis of Premenstrual Syndrome (PMS) is a challenge. The use of structured questionnaires is well established and the most accepted is the DRSP, a prospectively self-administered questionnaire that needs two months at least to be completed. The PSST is a retrospective self-scale questionnaire, filled at a single time. Aim: To compare these two instruments (PSST and DRSP) to diagnosis PMS. Methods: A cross-sectional study with 127 women between 20 and 45 years with PMS complaints. The women were evaluated about weight, high, Body Mass Index (BMI). After the exclusion of depression by the Prime-MD Questionnaire, the PSST was completed and the women were oriented to complete the DRSP for two months. The agreement between the two questionnaires was assessed by calculating the Kappa (k) and PABAK values. Results: 282 (74% of all the women) women met eligibility criteria and answered the PSST. Only 127 (45% of the 282 women) completed the daily questionnaire (DRSP) for two cycles. The percentual of women with PMS diagnosis by the DRSP was 74.8%, and by PSST was 41.7%. The percentual of women with PMDD diagnosis by the DRSP was 3.9%, and by the PSST was 34.6%. The number of patients considered “normal” (with the symptoms above the necessary for the diagnostic the PMS) was similar with both questionnaires. We found no agreement between the two instruments (Kappa = 0.12) in the diagnosis of PMS and PMDD (Pabak coefficient keep this result = 0.39). For screening PMS/PMDD the PSST has a sensitivity of 79% and a specificity 33.3%. Conclusion: The PSST should be considered as diagnostic screening tool. We concluded that positive PMD/PMDD cases of PSST should be ever better evaluated by DRSP.

Introdução: O diagnóstico da Síndrome Pré-menstrual (SPM) é um desafio. O uso de questionários estruturados está bem estabelecido, e a ferramenta mais aceita é o DRSP, um questionário prospectivo auto preenchido por ao menos dois meses. O PSST é um questionário retrospectivo de autoaplicação, preenchido em um único momento. Objetivo: comparar estes dois instrumentos (PSST e DRSP) para o diagnóstico da SPM. Método: Um estudo transversal com 127 mulheres entre 20 a 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, altura, Índice de Massa Corporal (IMC). Após exclusão de casos de depressão através do Prime-MD, as pacientes completaram o PSST e foram orientadas a preencherem o DRSP durante dois meses. A concordância entre os dois questionários foi avaliado pelo cálculo de Kappa (k) e valores do coeficiente PABAK. Resultados: Do total de mulheres que atenderam ao chamado, 282 (74%) preencheram os critérios de elegibilidade e responderam o PSST. Entre estas 282 mulheres, somente 127 (45%) completaram o questionário diário (DRSP) por dois ciclos. O percentual das mulheres com diagnóstico de SPM através do DRSP foi de 74,8%, e pelo PSST foi 41,7%. O percentual das mulheres com diagnóstico de TDPM pelo DRSP foi de 3,9%, e pelo PSST foi de 34,6%. Assim, verificou-se uma maior prevalência de SPM com o DRSP do que com o PSST. De outra parte a TDPM foi mais dignosticada pelo PSST do que com o DRSP. O número de pacientes consideradas “normais” foi semelhante com os dois instrumentos. Na avaliação entre os dois instrumentos verificou-se não haver nenhuma concordância (Kappa = 0,12) nos resultados do diagnóstico de SPM e TDPM (Coeficiente Pabak resultou = 0,39). Para a trigem de SPM/TDPM o PSST tem uma sensibilidade de 79% e especificidade de 33,3%. Conclusão: O PSST deve ser considerado como uma ferramenta de triagem diagnóstica. Conclui-se que os casos SPM/TDPM do PSST devem ser sempre melhor avaliados pelo DRSP. / Background: The diagnosis of Premenstrual Syndrome (PMS) is a challenge. The use of structured questionnaires is well established and the most accepted is the DRSP, a prospectively self-administered questionnaire that needs two months at least to be completed. The PSST is a retrospective self-scale questionnaire, filled at a single time. Aim: To compare these two instruments (PSST and DRSP) to diagnosis PMS. Methods: A cross-sectional study with 127 women between 20 and 45 years with PMS complaints. The women were evaluated about weight, high, Body Mass Index (BMI). After the exclusion of depression by the Prime-MD Questionnaire, the PSST was completed and the women were oriented to complete the DRSP for two months. The agreement between the two questionnaires was assessed by calculating the Kappa (k) and PABAK values. Results: 282 (74% of all the women) women met eligibility criteria and answered the PSST. Only 127 (45% of the 282 women) completed the daily questionnaire (DRSP) for two cycles. The percentual of women with PMS diagnosis by the DRSP was 74.8%, and by PSST was 41.7%. The percentual of women with PMDD diagnosis by the DRSP was 3.9%, and by the PSST was 34.6%. The number of patients considered “normal” (with the symptoms above the necessary for the diagnostic the PMS) was similar with both questionnaires. We found no agreement between the two instruments (Kappa = 0.12) in the diagnosis of PMS and PMDD (Pabak coefficient keep this result = 0.39). For screening PMS/PMDD the PSST has a sensitivity of 79% and a specificity 33.3%. Conclusion: The PSST should be considered as diagnostic screening tool. We concluded that positive PMD/PMDD cases of PSST should be ever better evaluated by DRSP.

Introdução: O diagnóstico da Síndrome Pré-menstrual (SPM) é um desafio. O uso de questionários estruturados está bem estabelecido, e a ferramenta mais aceita é o DRSP, um questionário prospectivo auto preenchido por ao menos dois meses. O PSST é um questionário retrospectivo de autoaplicação, preenchido em um único momento. Objetivo: comparar estes dois instrumentos (PSST e DRSP) para o diagnóstico da SPM. Método: Um estudo transversal com 127 mulheres entre 20 a 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, altura, Índice de Massa Corporal (IMC). Após exclusão de casos de depressão através do Prime-MD, as pacientes completaram o PSST e foram orientadas a preencherem o DRSP durante dois meses. A concordância entre os dois questionários foi avaliado pelo cálculo de Kappa (k) e valores do coeficiente PABAK. Resultados: Do total de mulheres que atenderam ao chamado, 282 (74%) preencheram os critérios de elegibilidade e responderam o PSST. Entre estas 282 mulheres, somente 127 (45%) completaram o questionário diário (DRSP) por dois ciclos. O percentual das mulheres com diagnóstico de SPM através do DRSP foi de 74,8%, e pelo PSST foi 41,7%. O percentual das mulheres com diagnóstico de TDPM pelo DRSP foi de 3,9%, e pelo PSST foi de 34,6%. Assim, verificou-se uma maior prevalência de SPM com o DRSP do que com o PSST. De outra parte a TDPM foi mais dignosticada pelo PSST do que com o DRSP. O número de pacientes consideradas “normais” foi semelhante com os dois instrumentos. Na avaliação entre os dois instrumentos verificou-se não haver nenhuma concordância (Kappa = 0,12) nos resultados do diagnóstico de SPM e TDPM (Coeficiente Pabak resultou = 0,39). Para a trigem de SPM/TDPM o PSST tem uma sensibilidade de 79% e especificidade de 33,3%. Conclusão: O PSST deve ser considerado como uma ferramenta de triagem diagnóstica. Conclui-se que os casos SPM/TDPM do PSST devem ser sempre melhor avaliados pelo DRSP. / Background: The diagnosis of Premenstrual Syndrome (PMS) is a challenge. The use of structured questionnaires is well established and the most accepted is the DRSP, a prospectively self-administered questionnaire that needs two months at least to be completed. The PSST is a retrospective self-scale questionnaire, filled at a single time. Aim: To compare these two instruments (PSST and DRSP) to diagnosis PMS. Methods: A cross-sectional study with 127 women between 20 and 45 years with PMS complaints. The women were evaluated about weight, high, Body Mass Index (BMI). After the exclusion of depression by the Prime-MD Questionnaire, the PSST was completed and the women were oriented to complete the DRSP for two months. The agreement between the two questionnaires was assessed by calculating the Kappa (k) and PABAK values. Results: 282 (74% of all the women) women met eligibility criteria and answered the PSST. Only 127 (45% of the 282 women) completed the daily questionnaire (DRSP) for two cycles. The percentual of women with PMS diagnosis by the DRSP was 74.8%, and by PSST was 41.7%. The percentual of women with PMDD diagnosis by the DRSP was 3.9%, and by the PSST was 34.6%. The number of patients considered “normal” (with the symptoms above the necessary for the diagnostic the PMS) was similar with both questionnaires. We found no agreement between the two instruments (Kappa = 0.12) in the diagnosis of PMS and PMDD (Pabak coefficient keep this result = 0.39). For screening PMS/PMDD the PSST has a sensitivity of 79% and a specificity 33.3%. Conclusion: The PSST should be considered as diagnostic screening tool. We concluded that positive PMD/PMDD cases of PSST should be ever better evaluated by DRSP.