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It is estimated that up to 85% of premenopausal women experience at least one premenstrual symptom and 15-20% meet clinical criteria for premenstrual syndrome (PMS). PMS has a high morbidity level and reduces the quality of life for many women of reproductive age, with pharmaceutical treatments having limited efficacy and substantial side effects. Physical activity has been recommended as a method of reducing menstrual symptom severity. However, little evidence exists to support a clear relationship between physical activity and PMS. Using a cross-sectional design, we evaluated the relationship between physical activity and PMS and menstrual symptoms among 186 women aged 18-30 who participated in the University of Massachusetts Vitamin D Study. PMS and menstrual symptoms were assessed with a modified version of the Calendar of Premenstrual Experiences. A total of 44 women met established criteria for PMS, while 46 met criteria for controls. Physical activity was assessed using a validated questionnaire and calculated as metabolic equivalent task-hours (METs) per week. Diet and other lifestyle factors were assessed by questionnaire. After adjusting for age and depression diagnosis, we found that each 10 MET-hour/week increase in physical activity was associated with a non-significant 3% increase in prevalence of PMS (95% CI: 0.94-1.14). After adjusting for BMI and percent body fat, results were similar (OR=1.02, 95% CI: 0.93-1.13). We found no evidence that physical activity was associated with the occurrence of specific menstrual symptoms among all 186 women. Results do not support a significant relationship between physical activity and prevalent PMS.

Many women self-report discomfort, depression, mood changes, and irritability in conjunction with menstruation which has been termed Premenstrual Syndrome (PMS). Prior to the creation of the disease/disorder category PMS, disorders with similar symptoms like “hysteria” and “involutional melancholia” were ascribed to women reporting those types of complaints. These diagnoses were based on archaic claims about women’s anatomy and behavior. Modern medical researchers contend that women’s complaints have a physiological basis, yet they cannot definitively tie PMS to any specific physiological etiological pathway, either hormonal or neurological. This thesis explores the argument that the social norms for women’s roles and their associated behaviors are related to the appearance of a disease/disorder category named PMS in the United Kingdom and the United States. Many of women’s complaints may instead be symptoms of social problems (with social remedies) related to role conflict or role strain.

Premenstrual syndrome (PMS) is characterized by the presence of physical and psychological symptoms restricted to the late luteal phase of the menstrual cycle and associated with substantial impairment in life activities. In the U.S. about 8 to 15% of women of reproductive age suffer from PMS. Many micronutrients are potentially involved in the development of this disorder due to their role in the synthesis of neurotransmitters and hormones or in their regulation, but few previous studies have evaluated the effects of micronutrients on PMS. The first study examined the association between B vitamin intakes, and PMS development among women participating in the Nurses' Health Study 2 (NHS2). We found that high thiamin and high riboflavin intake from food sources were associated with lower risk of PMS. There were not significant associations between niacin, vitamin B6, folate, and vitamin B12 dietary intake and incident PMS. Intakes of B vitamins from supplements were not associated with lower risk of PMS. The second study evaluated the association between selected mineral intakes and PMS development in the NHS2. In this study, high iron intakes were associated with lower risk of PMS. Although there was no association between zinc and PMS risk, high intake of zinc relative to copper was associated with lower risk of PMS. There were no associations between of magnesium, copper, and manganese intakes and PMS. We observed a significantly higher risk of PMS in women with high intakes of potassium from food sources. The third study focused on the association between dietary intakes of B vitamins, zinc, magnesium, iron, potassium, and sodium and some biomarkers and PMS prevalence among younger women. In this study, we found an association between zinc intake and lower prevalence of PMS. Each 1 mg/d increase in vitamin B6 from foods was associated with a lower PMS symptom score. Blood magnesium levels were higher in women with PMS compared to women without PMS. We observed that intakes of some micronutrients were associated with lower risk of PMS, but further studies should be conducted. This dissertation contributes to the research on modifiable risk factors for PMS.

Energy intake (EI) and energy expenditure (EE) across the menstrual cycle (MC), while considering body adiposity, have not been previously evaluated in the same individuals. This study mainly examined the variations in energy balance (EB) across MC. Seventeen women (Body fat-DXA:28.5%) participated in three identical sessions during distinct phases of the MC: Early-follicular, Late-follicular/ovulation and Mid-luteal (confirmed by basal temperature and sex-steroid hormones). EI, resting metabolic rate (RMR), physical-activity EE (PAEE), severity of PMS, leptin and relative-reinforcing value (RRV) of preferred foods were measured during each phase. No differences in body fat, EI, RMR, PAEE, leptin and RRV of food were noted across MC. Trends were noted in preferred snack (p=0.06) and combined snack/fruit (p=0.06) intakes, while differences were noted in severity of PMS (p<0.05) across phases. Changes in EB across the MC were not noted. PMS was more severe, and preferred snack and combined snack/fruit intakes were slightly higher during mid-luteal phase.

Energy intake (EI) and energy expenditure (EE) across the menstrual cycle (MC), while considering body adiposity, have not been previously evaluated in the same individuals. This study mainly examined the variations in energy balance (EB) across MC. Seventeen women (Body fat-DXA:28.5%) participated in three identical sessions during distinct phases of the MC: Early-follicular, Late-follicular/ovulation and Mid-luteal (confirmed by basal temperature and sex-steroid hormones). EI, resting metabolic rate (RMR), physical-activity EE (PAEE), severity of PMS, leptin and relative-reinforcing value (RRV) of preferred foods were measured during each phase. No differences in body fat, EI, RMR, PAEE, leptin and RRV of food were noted across MC. Trends were noted in preferred snack (p=0.06) and combined snack/fruit (p=0.06) intakes, while differences were noted in severity of PMS (p<0.05) across phases. Changes in EB across the MC were not noted. PMS was more severe, and preferred snack and combined snack/fruit intakes were slightly higher during mid-luteal phase.

Energy intake (EI) and energy expenditure (EE) across the menstrual cycle (MC), while considering body adiposity, have not been previously evaluated in the same individuals. This study mainly examined the variations in energy balance (EB) across MC. Seventeen women (Body fat-DXA:28.5%) participated in three identical sessions during distinct phases of the MC: Early-follicular, Late-follicular/ovulation and Mid-luteal (confirmed by basal temperature and sex-steroid hormones). EI, resting metabolic rate (RMR), physical-activity EE (PAEE), severity of PMS, leptin and relative-reinforcing value (RRV) of preferred foods were measured during each phase. No differences in body fat, EI, RMR, PAEE, leptin and RRV of food were noted across MC. Trends were noted in preferred snack (p=0.06) and combined snack/fruit (p=0.06) intakes, while differences were noted in severity of PMS (p<0.05) across phases. Changes in EB across the MC were not noted. PMS was more severe, and preferred snack and combined snack/fruit intakes were slightly higher during mid-luteal phase.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Esta pesquisa visa problematizar a síndrome pré-menstrual (SPM) enquanto entidade biomédica a-histórica tornada evidente a partir do preenchimento de critérios diagnósticos. O ponto de partida é a hipótese de que o modelo biomédico de explicação da SPM incorpora e reproduz os padrões sociais vigentes que insistem em visões estereotipadas dos gêneros em função da diferenciação biológica dos sexos. A partir de uma reflexão sobre a construção do fato científico e da preponderância do discurso biomédico na compreensão dos corpos, emoções e comportamentos femininos, analisamos as mudanças históricas ocorridas nessa visão considerada reducionista. No final do século XVIII e início do XIX, a essência da feminilidade era localizada no útero; a partir de meados do século XIX, os ovários passaram a ser considerados a fonte das doenças das mulheres, inclusive as nervosas e mentais. No início do século XX começou a ocorrer uma mudança nos discursos biomédicos e a essência da feminilidade passou a ser localizada em substâncias químicas denominadas hormônios. Desde então o organismo feminino tornou-se cada vez mais representado como controlado pelos hormônios, reificando a crença de que as mulheres são cíclicas e em determinados períodos, instáveis, irracionais e, portanto, não confiáveis. Essa ênfase nos hormônios coincide com a primeira descrição, em 1931, do que era chamado tensão pré-menstrual. Na década de 1950, a terminologia mudou para síndrome pré-menstrual. Inicialmente foi compreendida como diretamente produzida pelos hormônios femininos, mas não há evidência empírica que comprove esta hipótese. Após 80 anos de pesquisas, não se encontrou um marcador biológico ou teste bioquímico que possa ser utilizado para o diagnóstico. Os próprios critérios diagnósticos não são consensuais entre os pesquisadores, pois foram descritos mais de 200 sintomas que incidem de forma variada e inconstante. Não se conhece ainda o mecanismo etiopatogênico e alguns autores questionam a própria existência da síndrome enquanto entidade biomédica e apresentam visões feministas e sócio-culturais para a compreensão do fenômeno. Muitas mulheres, entretanto, afirmam ter TPM (nomenclatura mais comum nos meios leigos). Para aprofundar esta questão e ampliar nossa compreensão, a análise de artigos biomédicos recentes (2000 a 2011) sobre a SPM foi confrontada com a experiência direta ou indireta da TPM em mulheres de camadas médias da população. Com este objetivo, foram analisados artigos científicos sobre a SPM selecionados a partir de um levantamento no PubMed, ferramenta de buscas online, e realizadas entrevistas individuais em profundidade, abertas, semi-estruturadas com mulheres em idade reprodutiva selecionadas através do sistema de amostragem conhecido como bola de neve (snow ball). Após a análise tanto dos artigos científicos quanto das entrevistas, concluímos que apesar de pressupostos comuns que a biologia determina diferenças de gênero naturais e universais entre homens e mulheres a SPM dos artigos biomédicos e a TPM das mulheres não coincidem. Sem desconsiderar as sensações desagradáveis, os problemas e o sofrimento das mulheres que afirmam ter TPM, os resultados deste estudo apontam para uma realidade complexa que enseja mais pesquisa em direção a descrições menos reducionistas destas experiências femininas / This research aims at putting in doubt the premenstrual syndrome (PMS) problem as an ahistorical biomedical entity made evident from the fulfilling of diagnostic criteria. The starting point is the hypothesis that the biomedical model for the explanation of PMS incorporates and reproduces the existing social patterns that insist in stereotypical views of genders due to the biological differentiation of sexes. Upon reflecting about the construction of the scientific fact and the prevalence of the biomedical statement in the understanding of the female body, emotion and behavior, we analyzed historical changes of this vision, regarded as reductionist. At the end of the 18th century and the beginning of the 19th century, the essence of womanhood was located in the womb; from the mid 19th century, the ovaries began to be considered the root of womens diseases, including nervous and mental ones. At the beginning of the 20th century a change in the biomedical statements started to happen and the essence of womanhood was then located in chemical substances denominated hormones. Since then the female body became more and more represented as one controlled by hormones, reifying the belief that women are cyclical and in some moments, unstable, irrational and, therefore, not trustworthy. This emphasis on hormones coincides with the first description, in 1931, of what was called premenstrual tension. In the 1950s, the terminology changed to premenstrual syndrome. Initially, it was understood as being directly produced by the female hormones, but there is no empirical evidence that proves this hypothesis. After 80 years of research, no biological marker or biochemical test that could be used for this diagnosis has been found. The very diagnostic criteria are not consensual among researchers, as more than 200 symptoms that take place in a variable and inconstant manner have been described. The etiopathogenic mechanism is still not known and some authors question the very existence of the syndrome as a biomedical entity and present feminist and socio-cultural views for the understanding of the phenomenon. A great number of women, however, claim to have PMT (most common nonprofessional nomenclature). In order to expand this subject and increase our understanding, the analysis of recent biomedical articles (2000 to 2011) about PMS was confronted with the direct or indirect experience of PMT in women of the average general population. With this in mind, scientific articles about PMS, selected from cited research in PubMed - an online search engine tool - were analyzed, and in depth, open and semi-structured individual interviews were performed with women in reproductive age, who were selected by using the sampling system known as snow ball. After analyzing the articles, as well as the interviews, we conclude that in spite of common assumptions that biology determines natural and universal gender differences between men and women the PMS of the biomedical articles and womens PMT do not match. Without undermining the unpleasant sensations, the problems, and the suffering of women that claim to have PMT, the results of this study point to a complex reality which requires more research aiming at reaching less reductionist descriptions of these female experiences

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Esta pesquisa visa problematizar a síndrome pré-menstrual (SPM) enquanto entidade biomédica a-histórica tornada evidente a partir do preenchimento de critérios diagnósticos. O ponto de partida é a hipótese de que o modelo biomédico de explicação da SPM incorpora e reproduz os padrões sociais vigentes que insistem em visões estereotipadas dos gêneros em função da diferenciação biológica dos sexos. A partir de uma reflexão sobre a construção do fato científico e da preponderância do discurso biomédico na compreensão dos corpos, emoções e comportamentos femininos, analisamos as mudanças históricas ocorridas nessa visão considerada reducionista. No final do século XVIII e início do XIX, a essência da feminilidade era localizada no útero; a partir de meados do século XIX, os ovários passaram a ser considerados a fonte das doenças das mulheres, inclusive as nervosas e mentais. No início do século XX começou a ocorrer uma mudança nos discursos biomédicos e a essência da feminilidade passou a ser localizada em substâncias químicas denominadas hormônios. Desde então o organismo feminino tornou-se cada vez mais representado como controlado pelos hormônios, reificando a crença de que as mulheres são cíclicas e em determinados períodos, instáveis, irracionais e, portanto, não confiáveis. Essa ênfase nos hormônios coincide com a primeira descrição, em 1931, do que era chamado tensão pré-menstrual. Na década de 1950, a terminologia mudou para síndrome pré-menstrual. Inicialmente foi compreendida como diretamente produzida pelos hormônios femininos, mas não há evidência empírica que comprove esta hipótese. Após 80 anos de pesquisas, não se encontrou um marcador biológico ou teste bioquímico que possa ser utilizado para o diagnóstico. Os próprios critérios diagnósticos não são consensuais entre os pesquisadores, pois foram descritos mais de 200 sintomas que incidem de forma variada e inconstante. Não se conhece ainda o mecanismo etiopatogênico e alguns autores questionam a própria existência da síndrome enquanto entidade biomédica e apresentam visões feministas e sócio-culturais para a compreensão do fenômeno. Muitas mulheres, entretanto, afirmam ter TPM (nomenclatura mais comum nos meios leigos). Para aprofundar esta questão e ampliar nossa compreensão, a análise de artigos biomédicos recentes (2000 a 2011) sobre a SPM foi confrontada com a experiência direta ou indireta da TPM em mulheres de camadas médias da população. Com este objetivo, foram analisados artigos científicos sobre a SPM selecionados a partir de um levantamento no PubMed, ferramenta de buscas online, e realizadas entrevistas individuais em profundidade, abertas, semi-estruturadas com mulheres em idade reprodutiva selecionadas através do sistema de amostragem conhecido como bola de neve (snow ball). Após a análise tanto dos artigos científicos quanto das entrevistas, concluímos que apesar de pressupostos comuns que a biologia determina diferenças de gênero naturais e universais entre homens e mulheres a SPM dos artigos biomédicos e a TPM das mulheres não coincidem. Sem desconsiderar as sensações desagradáveis, os problemas e o sofrimento das mulheres que afirmam ter TPM, os resultados deste estudo apontam para uma realidade complexa que enseja mais pesquisa em direção a descrições menos reducionistas destas experiências femininas / This research aims at putting in doubt the premenstrual syndrome (PMS) problem as an ahistorical biomedical entity made evident from the fulfilling of diagnostic criteria. The starting point is the hypothesis that the biomedical model for the explanation of PMS incorporates and reproduces the existing social patterns that insist in stereotypical views of genders due to the biological differentiation of sexes. Upon reflecting about the construction of the scientific fact and the prevalence of the biomedical statement in the understanding of the female body, emotion and behavior, we analyzed historical changes of this vision, regarded as reductionist. At the end of the 18th century and the beginning of the 19th century, the essence of womanhood was located in the womb; from the mid 19th century, the ovaries began to be considered the root of womens diseases, including nervous and mental ones. At the beginning of the 20th century a change in the biomedical statements started to happen and the essence of womanhood was then located in chemical substances denominated hormones. Since then the female body became more and more represented as one controlled by hormones, reifying the belief that women are cyclical and in some moments, unstable, irrational and, therefore, not trustworthy. This emphasis on hormones coincides with the first description, in 1931, of what was called premenstrual tension. In the 1950s, the terminology changed to premenstrual syndrome. Initially, it was understood as being directly produced by the female hormones, but there is no empirical evidence that proves this hypothesis. After 80 years of research, no biological marker or biochemical test that could be used for this diagnosis has been found. The very diagnostic criteria are not consensual among researchers, as more than 200 symptoms that take place in a variable and inconstant manner have been described. The etiopathogenic mechanism is still not known and some authors question the very existence of the syndrome as a biomedical entity and present feminist and socio-cultural views for the understanding of the phenomenon. A great number of women, however, claim to have PMT (most common nonprofessional nomenclature). In order to expand this subject and increase our understanding, the analysis of recent biomedical articles (2000 to 2011) about PMS was confronted with the direct or indirect experience of PMT in women of the average general population. With this in mind, scientific articles about PMS, selected from cited research in PubMed - an online search engine tool - were analyzed, and in depth, open and semi-structured individual interviews were performed with women in reproductive age, who were selected by using the sampling system known as snow ball. After analyzing the articles, as well as the interviews, we conclude that in spite of common assumptions that biology determines natural and universal gender differences between men and women the PMS of the biomedical articles and womens PMT do not match. Without undermining the unpleasant sensations, the problems, and the suffering of women that claim to have PMT, the results of this study point to a complex reality which requires more research aiming at reaching less reductionist descriptions of these female experiences

abstract: This is a project about medicine and the history of a condition called premenstrual syndrome (PMS), its “discovery” and conceptual development at both scientific and socio-cultural levels. Since it was first mentioned in medical literature, PMS has been explored empirically as a medical condition and conceptually as non-somatic cultural phenomenon. Many attempts have been made to produce scientific, empirical evidence to bolster the theory of PMS as a biological disease. Some non-medical perspectives argue that invoking biology as the cause of PMS medicalizes a natural function of the female reproductive system and shallowly interrogates what is actually a complex bio-psycho-social phenomenon. This thesis questions both sides of this debate in order to reveal how criteria for PMS were categorized despite disagreement surrounding its etiology. This thesis illustrates how the concept of PMS developed and was informed by the discovery of hormones and the resulting field of endocrinology that provided a framework for conceptualizing PMS. It displays how the development of the medical diagnostic category of PMS developed in tandem with the emergence of the field of endocrinology and was legitimized and effectively medicalized through this connection. The diagnosis of PMS became established though the diagnostic techniques like questionnaires in spite of persistent disagreement over its definition. The thesis shows how these medical concepts and practices legitimated the category of PMS, and how it has become ubiquitous in contemporary culture. / Dissertation/Thesis / Masters Thesis Biology 2016