The premenstrual syndrome (PMS) continues to be an enigma for many: those women who report PMS, for professionals who attempt to treat premenstrual symptoms, and for researchers attempting to identify PMS and to compare treatments. The present study investigated the responses from 86 subjects between the ages 30-45 for their perceptions of daily stress and coping styles by PMS level. Three levels of PMS were formulated by subject responses to the questionnaire (a) PMS for scores within the criteria, (b) Non-PMS for scores lower than the criteria, and (c) Psy-Non-PMS for certain scores higher than the criteria with a psychological, or neurotic, profile. Hassle intensity (daily stress) and coping style, whether problem-focused (P) or emotion-focused (E), were assessed by questionnaire. In addition, help seeking behavior, i.e., whether a woman sought help from a doctor in the past twelve months, was examined but did not significantly relate to level of PMS, hassle intensity, or coping style. Psy-Non-PMS women reported perceiving significantly more hassles and significantly greater use of four of the E coping styles, Detachment, Focusing on the Positive, Self-blame, and Keep to Self, than the Non-PMS women. PMS women endorsed perception of significantly more hassles and significantly greater use of two of the E coping styles, Detachment and Keep to Self, than the Non-PMS women. These E coping styles are consonant with detached, avoidant, escapist, and self-deriding coping mechanisms, typical of depressed and anxious persons. There was some difficulty in differentiating the PMS group from the Psy-Non-PMS group. Only one coping style, Focusing on the Positive, was endorsed by the Psy-Non-PMS group significantly more than the PMS group. Further statistical analysis of the data could determine psychological/behavioral PMS subtypes as distinct from physiological PMS subtypes, providing more clearly defined PMS groups. Future research involving a carefully controlled study for determining PMS levels and utilizing psychotherapy as well as specified medications for treatment of PMS is indicated.

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Dissertation submitted in partial compliance with the Requirements for the Master's Degree in Technology: Homeopathy, Technikon Natal, 2001. / The purpose of this double -blind placebo-control1ed study was to evaluate the efficacy of a homeopathic complex, Premenstron\xAE, in the treatment of premenstrual syndrome in terms of the patients' perception of the efficacy of the treatment. Thirty-four patients were selected from volunteers who met the diagnostic criteria developed by Dalton (1984: 19). Of these patients thirty completed the study. These patients were divided into two groups according to simple random sampling. Data was collected at the Homeopathic Day Clinic at Technikon Natal. Half of the patients received a placebo and the other half received the homeopathic complex. Patients were treated over a period of approximately two months (three consultations ). The patients completed the Moos Menstrual Distress Questionnaire at each consultation. The questionnaire consists of 47 symptoms grouped into eight subscales. Results were analysed statistically using the Mann Whitney unpaired test (inter-group comparison) and the Wilcoxon's sign rank test (intra-group comparison). When the three questionnaires for each patient were compared, it was found that the placebo group did improve in the second consultation (P= 0.016) but the placebo effect did not last through to the third consultation. The treatment group / M

Data regarding the severity of premenstrual symptoms were collected from three groups of women: women over age 24 years seeking care from a gynecological practitioner, undergraduates at OSU living in student dormitories, and graduate students enrolled at OSU. The symptoms evaluated were depression, tiredness, irritability, anxiety, headache, breast swelling and tenderness, craving for sweets, craving for salty foods, binge eating, and acne. Symptoms were rated on a scale of zero (not present) to three (severe). Multivariate profile analysis was used to evaluate the hypothesis that the profiles formed by the mean vectors of these premenstrual symptoms were parallel with regard to symptom severity, age, consumption of caffeinated beverages and refined sugar, maternal history of premenstrual syndrome (PMS) and recent use of oral contraceptives. Parallel profiles were further evaluated for coincidence. Results of the analysis indicated that in each of the three samples of women studied, the presence of premenstrual symptomatology was indicated by one pattern of symptom severity, and that this pattern remained constant as symptoms became more severe. The variability in the premenstrual symptoms could be explained by the inherent variability of the women studied, a finding which does not support the existence of multiple subtypes of PMS. Evidence of a positive association between age and increasing symptom severity was found only in the graduate student group. High levels of consumption of caffeine were shown to exacerbate premenstrual symptoms among the graduate students, and frequent consumption of refined sugar and "junk food" were shown to exacerbate symptoms among older women. Increased symptom severity of premenstrual symptoms in women whose mothers suffered from PMS was noted only among undergraduate students. No evidence was found to implicate oral contraceptive use in the exacerbation or amelioration of premenstrual symptoms. / Graduation date: 1992

The purpose of this exploratory study was to develop, test, and apply a questionnaire which would be used to determine the possibility of PMS in women being admitted to psychiatric facilities. Although a review of the literature supported the assumption that PMS symptoms and symptoms of psychiatric illness share overlapping features, the evaluation process currently implemented in psychiatric facilities does not allow for the possibility of a diagnosis of PMS. The questionnaire, created to detect PMS symptom changes in intensity and timing, was administered to women newly admitted to psychiatric facilities. Thirty-two percent of the group demonstrated the possibility of having PMS. The results of this study would suggest that women of child-bearing potential, admitted to a psychiatric facility, might be evaluated for the possibility of PMS.

This study was designed to address several issues related to PMS. One purpose was to compare women who say they have PMS with those who say they do not have PMS and to compare women diagnosed with PMS with those not diagnosed as having it. Forty-eight women and 11 men (included for comparison) who had a mean age of 34 years, were not students, and met other screening criteria, volunteered to keep daily charts for 120 days (prospective daily data). They did not know the menstrual purpose of the study. Each participant's daily reports were examined individually for PMS patterns according to strict criteria, and they were accordingly assigned to one of five groups. Only six women (12.5%) met the diagnostic criteria for premenstrual syndrome, but 62.5% said they had PMS. Fourteen women and 2 men (randomly assigned to menstrual cycles), 28% of the total sample, had diagnosable "downs" in other phases. The greater proportion of diagnosable downs in phases other than the premenstrual phase calls into question the appropriateness of a singular focus on PMS rather than on general cyclicity in adults' day-to-day experiences. Indeed, 74% of all participants in this study(including 73% of the men) had one or more diagnosed cyclic patterns in at least one of the three (menstrual, day of week, lunar) cycles studied. Participants also recalled (retrospective data) their menstrual (women only), weekday, and lunar moods. When prospective and retrospective data were compared, analyses revealed that participants may have used menstrual and day of week stereotypes to assist in their recall. Both parametric (normative) and nonparametric (idiographic)analyses were conducted, with sometimes contrasting results. These contradictions and their implications are discussed. It was concluded that it may be inappropriate to refer to a premenstrual syndrome, that the proposed inclusion of Late Luteal Phase Dysphoric Disorder (LLPDD) in the Psychiatric Diagnostic and Statistics Manual (DSM) is questionable, and that more needs to be known about healthy cyclical changes before conclusions about unhealthy cyclic changes can be drawn.

This dissertation explored factors related to heterosexual women's use of the label "PMS" and the question of why so many women who say that they have PMS do not meet prospectively-based researcher criteria. Participants were recruited through Vancouver city newspapers and posters for a study of emotional, behavioural, and health patterns. They were screened for hysterectomies, ovariectomies, pregnancy, and chronic illnesses. The 58 women in this study (mean age=34.5) provided daily prospective data over a mean of 15 weeks for 15 variables representing 4 different types of symptoms: mood, relationship, concentration and work performance, and physical and activity symptom types. At the beginning of the study, they completed the Beck Depression Inventory. During a final interview they completed various questionnaires regarding romantic relationships, stress, history of abuse, and attitudes toward menstruation. During her final interview, each woman was asked whether she had ever had PMS and, if so, what she believed caused it. Only 16% of the women met researcher-designated criteria for PMS and 9% met researcher-criteria for PDD (Premenstrual Dysphoric Disorder, APA, 1994), but 60% believed that they currently had PMS. There was very little match between researcher-designations and self-designations for any of the 15 prospective variables. Instead, consistent with schematic theories of PMS, it was women's attitudes toward menstruation that were most strongly related to self-designation. Women who said that they currently had PMS were more likely to view menstruation as debilitating, natural, and predictable. They had higher depression scores and reported more frequent and enduring experiences of anger. More of these women reported having been emotionally abused as an adult, emotionally abused as a child, and physically abused by a past or current romantic partner. Although women who said that they had never had PMS perceived menstruation as more bothersome, they believed that women should be able to ignore it. Current-Say and Never-Say women did not significantly differ for other forms of abuse, partner satisfaction, or daily uplifts. Daily hassles did not reach statistical significance at the multivariate level, but univariate significance indicated that Never-Say women might experience fewer daily hassles than Current-Say women. The prospective data were analyzed idiographically using prediction analyses. Current-Say women demonstrated more uncharacteristic cyclicity during the midcycle phase across the 15 variables and 4 symptom types. Never-Say women showed more uncharacteristic cyclicity during the postmenstrual phase. No differences were found for other phases. These findings, and other results, argue against the use of simple premenstrual-postmenstrual and premenstrual-intermenstrual difference measures in diagnosing PMS or PDD. It was concluded that, although the women's self-designations did not match their prospective data, they could not be explained simply as a mislabelling of negative cyclicity in other phases. There was also mixed evidence for the hypothesis that women's reports of having "PMS" were part of a generalized over-reporting of symptomatology or dissatisfaction. Possible explanations for women's self-designations are discussed, including schematic representations of both menstruation and general illness and a "contrast hypothesis" modified from the version proposed by McFarlane and Williams (1994). This contrast hypothesis suggests that cyclical changes occurring during a particular non-premenstrual phase are related to women's self-designations according to (a) the timing of these changes relative to the visible and salient menses, in conjunction with (b) their attitudes toward menstruation. Close to half (45%) the women who said that they had experienced PMS attributed their perceived PMS to a bidirectional model of physiology and environment, and 58% of the women saying that they had PMS believed that it happened occasionally rather than inevitably. Overall, the women's representations of menstrual cyclicity were neither simple reflections of cultural stereotypes nor pervasively negative, but rather diverse and complex. The results that link depression, anger, and specific forms of abuse to self-designations suggest that women saying that they have PMS are indicating difficulties that may or may not be menstrually-related. Researchers and other professionals need to assess the nature of those difficulties in women presenting with "PMS".

M.Tech.