M.Tech. / Premenstrual syndrome (PMS) is a group of physical and psychological symptoms that occur cyclically in females. It is of unknown aetiology. These symptoms occur specifically during the luteal phase (from day 14 to day 1 of the next menstrual cycle) and are resolved over the course or at the onset of menstruation (Indusekhar et al., 2007). The syndrome is characterised by irritability, depression, anxiety, headache, abdominal bloating, breast tenderness, breast swelling, changes in appetite, acne, and weight gain due to oedema. Mild physiological symptoms are experienced by approximately 95% of all women of reproductive age and about 5% of symptomatic women complain of extremely severe symptoms, called premenstrual dysphoric disorder (PMDD), that disrupt their daily living (Wyatt, 1999). Deuster et al., (1999) note that PMS is prevalent in all demographic groups, however differences in races do exist and their research shows that black women are more likely to suffer from PMS than women of other races. The current conventional treatment options are limited, not always effective and sometimes have significant side effects (Ross et al., 2000). Complementary and alternative treatments are said to be beneficial, however sufficient quality trials are required to substantiate their claims to efficacy (Indusekhar et al., 2007). Research into the use of individualised homeopathy in PMS has been shown to have positive results (Yakir et al., 2001). The aim of this four month study was to determine the efficacy of the homeopathic simillimum in the treatment of premenstrual syndrome in white females. This study will eventually provide the material to compare the presentation of PMS, and the effect of the homeopathic simillimum in different race groups. The following symptoms were evaluated 14 days before menstruation: irritability, depression, anxiety, headache, abdominal bloating, breast tenderness, breast swelling, and food cravings (Beers et al., 2003). Volunteers were asked to complete a selection questionnaire, in order for them to take part in the study. If they qualified to take part in this study a full case history was then taken for each participant using the standard homeopathic clinic case form. In this four month case study each of the ten participants completed a PMS chart for each month grading their symptoms on a daily basis and recording their dates of menstruation. A baseline of each participant’s premenstrual symptoms was established by an initial treatment-free month where a PMS chart had to be completed to score the participants’ daily symptoms. Thereafter the participants were treated using homeopathic simillimum treatment for the remaining three months. The chart required each participant to score the severity of the eight different premenstrual symptoms that they experience on a scale of 0 to 5 (0 indicated that the symptom was not present, and 5 indicated that the symptom was very severe). These charts were collected at the end of each cycle. At the end of the trial these PMS charts were submitted for statistical analysis. These results were analysed by using the non parametric Wilcoxon Signed Ranks Test by comparing the severity of symptoms experienced in the premenstrual period (14 days before menstruation) for each of the three months of treatment to the initial treatment-free month. These results showed that the homeopathic simillimum was statistically significant in the treatment of the symptoms of PMS in these white females.

Introduction Most women of reproductive age experience premenstrual symptoms before menstruation. Community-based research investigating the prevalence and management of problematic premenstrual symptoms (the premenstrual syndrome or 'PMS') is sparse, especially in the United Kingdom. This study aimed to assess the epidemiology and management of premenstrual symptoms in the community, and identify factors associated with symptom experiences. Methods A systematic review was conducted to identify population-based studies reporting PMS prevalence. In 2014 and 2015 a postal questionnaire was sent to 3,534 women aged 18-50, registered with 20 Scottish general practices. Results Twenty-six population-based studies were included in the systematic review. These reported widely differing prevalences, depending on the definitions of PMS used. The corrected response rate from the survey was 32.1%. Over 95% of women experienced at least one symptom in the previous 12 months. The most frequent moderate to severe symptoms were abdominal cramps: 44.0%; abdominal bloating: 40.9%; irritability: 40.7%; fatigue or lack of energy: 37.6%; and mood swings: 36.8%. The criteria for premenstrual dysphoric disorder (PMDD) and moderate to severe PMS were met by 4.4% and 8.3% of women, respectively; 53.1% reported experiencing PMS, with 10.7% rating this as severe to extreme. Common management strategies used included over-the-counter medication; heat application; exercise; and relaxation or rest. Lifestyle and psychological strategies were more frequently reported than prescribed treatments. The most common associations with different symptom experiences (i.e. moderate to severe PMS/PMDD, self-identified minimal/mild PMS, and self-identified moderate to extreme PMS) related to smoking, self-assessed general health and self-reported current illness/condition. Illness perceptions related to emotional representations and consequences were associated with each of the symptom experiences examined. Current use of most management strategies, a wish for more support from different sources and frequent contact with healthcare professionals were associated with PMS/PMDD and self-identified moderate to extreme 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. / Arts, Faculty of / Psychology, Department of / Graduate

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". / Arts, Faculty of / Psychology, Department of / Graduate

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by Chau Pak Chun, Janita. / Includes questionaire in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 124-139). / Chapter 1. --- INTRODUCTION AND LITERATURE REVIEW --- p.1 / Introduction --- p.1 / Major Objectives of the study --- p.3 / Literature review --- p.4 / Overview of PMS --- p.4 / Definition of PMS --- p.4 / Categories of PMS --- p.5 / The prevalence of PMS symptoms among female adolescents --- p.6 / PMS experience in Chinese --- p.9 / Proposed etiological factors and factors affecting PMS --- p.12 / Biological factors --- p.11 / Personal factors --- p.13 / Demographic variables in relation to PMS --- p.13 / Lifestyle practice in relation to PMS --- p.14 / Psychological factors in relation to PMS --- p.14 / The relationship between stress and PMS --- p.15 / Findings related to stress and anxiety --- p.17 / Sociocultural factors in relation to PMS --- p.18 / The impact ofPMS --- p.20 / Impact of PMS on adolescents --- p.21 / Treatment options for PMS --- p.21 / Pharmacological treatment --- p.21 / Interventions related to self care --- p.23 / Education and support --- p.23 / Exercise --- p.23 / Dietary changes --- p.25 / Stress management --- p.26 / Effectiveness of proposed self care interventions --- p.26 / Theoretical background for the study --- p.29 / Theoretical framework for the self care deficit theory --- p.30 / Self care for PMS --- p.31 / Empowerment --- p.33 / The concept of empowerment --- p.33 / Application of the concept of empowerment --- p.35 / Empowerment outcomes --- p.35 / Health education --- p.36 / Overview of health education --- p.36 / Evaluation in health education --- p.37 / Chapter 2. --- METHOD --- p.40 / Hypotheses --- p.40 / Operational definitions --- p.41 / Research design --- p.42 / Sample --- p.43 / Sample size --- p.43 / Sampling procedures --- p.45 / Sample characteristics --- p.46 / Instruments and techniques for measurement --- p.47 / Chapter 1. --- Instrument to assess PMS --- p.47 / Chapter 2. --- Instrument to assess knowledge --- p.53 / Chapter 3. --- Instrument to assess trait anxiety --- p.55 / Chapter 4. --- Interview --- p.57 / Treatment --- p.57 / Data collection procedures --- p.61 / Method of data analysis --- p.64 / Chapter 3. --- RESULTS --- p.67 / Response rate --- p.67 / Demographic findings --- p.67 / Pre-intervention premenstrual and menstrual symptoms findings --- p.70 / The incidence of PMS and menstrual symptoms --- p.70 / The prevalence of PMS --- p.73 / The impact of PMS on activities and performance --- p.75 / Reliability of MSQ --- p.75 / Pre-intervention PMS knowledge --- p.76 / Pre-intervention trait anxiety --- p.78 / Correlational analyses --- p.80 / Relationship of trait anxiety to PMS and menstrual symptoms --- p.80 / Relationship of PMS knowledge to premenstrual and menstrual symptoms --- p.82 / Relationship of demographic variables to premenstrual and menstrual symptoms --- p.82 / Relationship of demographic variables to four PMT subgroups --- p.84 / Relationship of lifestyle variable to PMS and menstrual symptoms --- p.84 / Relationships between self reported impact of PMS symptoms with PMS --- p.85 / Dietary information --- p.86 / Effectiveness of the educational program --- p.90 / Group comparability --- p.90 / Effects of educational program on the incidence and severity of PMS --- p.94 / PMS findings for the control group --- p.94 / Effects of education program on PMS knowledge --- p.97 / Chapter 4. --- DISCUSSION AND CONCLUSION --- p.99 / Overall benefits of education --- p.99 / The profile of PMS --- p.108 / Limitations --- p.119 / Implications and Recommendations for further research --- p.120 / Conclusion --- p.122 / REFERENCES --- p.124 / APPENDICES --- p.140 / APPENDIX I: Letter to schools --- p.140 / APPENDIX 11: Menstrual Symptom Questionnaire --- p.143 / APPENDIX III: Menstrual Symptom Questionnaire (Chinese version)… --- p.146 / APPENDIX IV: Premenstrual Syndrome Knowledge Questionnaire --- p.149 / APPENDIX V: Premenstrual Syndrome Knowledge Questionnaire (Chinese version) --- p.151 / APPENDIX VI: Trait-anxiety Inventory --- p.153 / APPENDIX VII: Trait-anxiety Inventory (Chinese version) --- p.155 / APPENDIX VIII: Cover letter to reviewer --- p.156 / APPENDIX IX: Parental consent form --- p.157

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

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