Premenstrual syndrome (PMS) was originally coined to describe the various changes that many women experience the days before their period. Today, we understand PMS as a complex phenomenon that not only involves the materiality of the body, but also discursive ideas and cultural mythology around women and femininity. The field of PMS-research is fragmented and includes a medical, a social constructivist, and, more recently, a material-discursive-intrapsychic perspective. This study takes its starting point in the latter approach, which allows for a multidimensional analysis of both material, discursive, and psychological aspects of PMS. To avoid pathologization, the use of premenstrual change, rather than -syndrome when discussing material experiences of menstrual cycle-related experiences, is supported and encouraged. Theoretical concepts such as bio-power, the body politic, and sexual difference, are used to make sense of the material which consists of three semi-structured group discussions and one interview with seven German women between 21 and 30. The study centers around how these women negotiate and make deliberate choices around PMS and menstruation, including embracing and/or resisting PMS as a material-discursive concept. The study aims at gaining insight into how we can make sense of PMS as a social and embodied phenomenon. Findings suggest that rather than considering premenstrual change as disempowering or as splitting menstruators lives into bad days and normal days, it can be viewed as a translator between the needs of body, psyche, and being. Premenstrual change, together with menstrual cycle-related pain, can furthermore form the basis for a supportive sisterhood.

M.A. (Psychology) / Since Frank (1931) first published an article on premenstrual symptoms a considerable amount of research has been undertaken and published on the topic. Women have always been aware of experiencing certain intermittent physiological and psychological symptoms, but few have realised that these are often cyclical and relate to the menstrual cycle. In recent years there has been a move towards identifying these symptoms and seeking help and treatment in overcoming their sometimes debilitating effects. Previously women did not speak about their experiences and attributed them to various psychosocial stressors, but today women areacknowledging the fact that a syndrome or disorder does exist. This syndrome or disorder became known as the Premenstrual Syndrome (PMS) (Dalton, 1984). More recently a classification for premenstrual symptoms has appeared under Appendix A of the' DSM III-R. This is the section that deals with proposed diagnostic categories needing further study. In this classification premenstrual symptoms are termed Late Luteal Phase Dysphoric Disorder (LLPDD)...

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.

We report on 3 subjects with premenstrual magnification of major depression (PMMD) treated with nefazodone who benefited from a supplement of additional nefazodone premenstrually. During the 6-month study, subjects were given supplements of either additional nefazodone or placebo prior to the expected onset of menses (double-blind crossover design). Symptoms were assessed during the late luteal and follicular phases. All subjects showed significant improvement for the months in which they received nefazodone supplements, but not when given placebo. Premenstrual dose increase is a clinically promising intervention for women who experience PMMD.

The Daily Assessment Form (OAF) retrospectively assessed symptoms of late luteal phase dysphoric disorder (LLPDD), both at the beginning and at the end of a 2-month time interval. Ninety-four women between the ages of 18 and 45 entered the study. Half of the subjects viewed a negative-case, stereotypic presentation of LLPDD prior to the pretest. sixty-eight subjects qualified on the pretest to complete the study. Half of the remaining no-case subjects and half of the remaining negative-case subjects completed 8 weeks' prospective ratings via the OAF. Forty-eight subjects remained to complete the posttest at the end of that time interval. Pretest Total and Pretest Criteria scores revealed significant main effects for case-presentation condition (E[l,63] = 7.08, R = .01) and (E[l,63] = 8.34, R = .01) and completion level (E[l,63] = 6.76, R = .01) and (E[l,63] = 3.76, R .06). Effect sizes equalled 0.48 and 0.45 for case presentation and 1.92 and 1.98 for completion.

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Introduction: Women with bipolar disorder (BD) have higher rates of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). The primary goal of this thesis was to examine the neural correlates of bipolar disorder and comorbid PMDD and identify changes in brain structure or function that may mediate emotional and cognitive dysregulation in the late luteal phase. Results: In healthy women with no history of PMDD, absolute levels of estradiol, progesterone, allopregnanolone and dehydroepiandrosterone sulfate (DHEAS) were correlated with patterns of functional coupling in multiple regions associated with emotional and cognitive processes, in the mid-follicular and late luteal menstrual phases. A systematic review of the literature on resting state functional connectivity (Rs-FC) in BD during euthymia highlighted consistent patterns of resting state functional connectivity (Rs-FC) using ICA and SBA; including stability of the default mode network (DMN), salience network (SN) and fronto-parietal network (FPN) relative to controls. Available literature largely failed to control for sex, menstrual cycle phase or menstrual cycle disorders. Thus, we conducted the first fMRI studies to control for menstrual cycle phase in BD. During the mid-follicular phase, we found increased Rs-FC between critical nodes of the default mode and frontoparietal networks in BD compared to controls and increased functional connectivity between the somatosensory cortex and the insular cortex, inferior prefrontal gyrus and frontal orbital cortex in BD compared to controls. Voxel based morphometry analysis showed decreased gray matter in the somatosensory cortex in the same population compared to controls. Finally, women with BD and co-morbid PMDD displayed different patterns of Rs-FC using the right and left hippocampi as seed regions than women with BD without comorbid PMDD and controls with PMDD. Differences in cortical thickness between controls with and without PMDD and with and without BD were also found in regions central to emotional regulation and cognitive processing. Conclusions: Results highlight the influence of sex hormones on Rs-FC and support the need to control for menstrual phase and PMDD diagnosis. Differences in structural and functional connectivity, and the clinical profile of women with BD and those with BD and co-morbid PMDD highlights the impact of PMDD on BD and the need for future research in this area. / Thesis / Doctor of Philosophy (PhD)

Introduction: Sleep and biological rhythms have not been investigated in women with comorbid Bipolar and Premenstrual Dysphoric Disorder in the context of the menstrual cycle. We explored whether menstrual cycle phase causes increased disturbances in sleep, biological rhythms and mood symptoms. Additionally, we explored whether these women have worse illness outcome than women diagnosed with either Bipolar or Premenstrual Dysphoric Disorder, and healthy women. Methods: In this post-hoc analysis, participants were split into four groups: those with a Bipolar and comorbid Premenstrual Dysphoric Disorder diagnosis (n = 17, BDPMDD), those with a Bipolar Disorder diagnosis (n = 16, BD), those with a Premenstrual Dysphoric Disorder diagnosis (n = 19, PMDD), and women with no history of psychiatric diagnosis (n = 25, HC). The primary outcome variable was biological rhythm disruption as measured by the Biological Rhythms Interview and Assessment in Neuropsychiatry (BRIAN). The secondary outcome variables were depressive symptoms (Montgomery-Asberg Depression Scale, MADRS; Hamilton Depression Rating Scale, HAMD), manic symptoms (Young Mania Rating Scale, YMRS), and sleep quality (Pittsburgh Sleep Quality Index, PSQI). All variables were collected at both mid-follicular and late-luteal stages of the menstrual cycle. Results: The BDPMDD group did not have significantly higher disruptions in biological rhythms than the BD or PMDD groups at the luteal phase; however, there were significant disruptions and mood symptoms in comparison to the HC group, especially at the follicular stage, which point to markedly higher disruptions in these areas that seem to persist beyond the symptomatic luteal phase. Conclusion and Future Directions: Women diagnosed with a BD and PMDD comorbidity experience a higher illness burden then women diagnosed with either BD or PMDD. A relatively small sample size, not excluding for participants who were taking medications that affect sleep and relying solely on subjective measures of biological rhythms may explain some of the null results. Future studies should employ objective measures of sleep such as actigraphy to complement subjective measures like the BRIAN, as well as recruit a larger sample of participants. More importantly, more studies surrounding this topic must be done in order to create a robust body of evidence that can be used to compare results across studies and identify specific biological rhythms domains that can be targets for treatment. / Thesis / Master of Science (MSc) / Sleep disruptions are common in women diagnosed with Bipolar Disorder and in those diagnosed with Premenstrual Dysphoric Disorder. Illness burden has been shown to be greater in women diagnosed with a comorbidity of the above disorders in terms of clinical variables such as number of comorbidities, episode relapse, rapid cycling and mixed mood states. This thesis aims to investigate whether women diagnosed with Bipolar and comorbid Premenstrual Dysphoric Disorder have greater biological rhythms disruptions than women diagnosed with either disorder. Biological rhythms will be evaluated at both the follicular and late-luteal stages. The overall goal of this work is to add to the currently scant literature on the clinical presentation of a Bipolar and Premenstrual Dysphoric Disorder comorbidity.

Clinical interest in PMS has existed for more than one and a half centuries. There is still no consensus about its frequency, seriousness, etiology or treatment. Its impact on marital relationships has not been an area of research interest, even though one woman in twenty, or even one every ten, may be so afflicted that her life is disrupted premenstrually month after month. This study was designed to explore this research area through the use of prospective self-reporting measuring instruments completed on a daily basis by both husband and wife in six couples over a time period of one complete menstrual cycle. The husband's perception of his wife's negative affect was one independent variable. The wife's perception of her own negative affect was the other. Six dependent variables were measured: The husband's and wife's self rating of own marital satisfaction; the husband's and the wife's perceptions of the spouse's displeasing behaviors; and the husband's and the wife's perceptions of the spouse's pleasing behaviors. A case study approach was used and, in addition to time series analysis of the daily ratings, a semi-structured exit interview was conducted with each couple so that anecdotal material could be compared and evaluated along with the quantifiable data. Because of the nature of the study, self-definition and diagnosis of PMS was chosen as the admission criterion. In addition, the wife could not be using oral contraceptives, nor could she be taking over-the-counter or prescribed medication for her PMS. Decreases in the husband's marital satisfaction were found to be associated with increases in his perception of his wife's negative affect in five of the six cases. In four of the six cases, the husband perceived an increase in displeasing behaviors by his wife when he perceived an increase in her symptoms. / Ph. D.

The purpose of this investigation was to determine the effect of premenstrual edema (water retention) on measurements of percent body fat (%BF) in ovulating women during the menstrual cycle utilizing bioelectrical impedance. Specifically, this study was designed to investigate the difference between bioelectrical impedance measurements of %BF recorded during day 1 of menses, day 7, day -1 midcycle, midcycle, day 21, and days -3, -2, and -1 premenses. Determinations of impedance were made in 26 regularly menstruating women aged 20.23±0.74 yr using an electrical impedance analyzer with a four-electrode arrangement that induces a painless signal ( 800 !microamps at 50 kHz) into the body. Internal consistency reliability estimates made approximately 5 min apart during each test day ranged from R = .96-.99 for the impedance measurements of %BF, and the stability reliability correlation coefficients ever the eight observation days ranged from r = .92-.97 for the impedance measurements of %BF. The reliability analyses indicated that %BF esitimated from bioelectrical impedance was measured reliably. Specific days of the menstrual cycle did not significantly affect impedance measurements of %BF. Analysis of variance with repeated measures also indicated that day during the menstrual cycle did not significantly affect weight (Wt), %BF, resistance (Re), or total body water (TBW) measurements. However, urine osmolality (Osm) and basal body temperature (BBT) were significantly affected across days of the menstrual cycle (p < .01). A dramatic decline in Osm was noted at midcycle followed by a rise which peaked at day -3 premenses. After day -3 premenses, Osm rapidly declined at menses. The dramatic decline in Osm at midcycle may reflect changes in urine concentration due to actions of elevated estrogen associated with ovulation. BBT dropped prior to midcycle and then began to rise until day -3 of the next menses and then it dropped slightly. The drop prior -co midcycle may be also reflected by changes in the hormonal concentration of estrogen. The biphasic BBT response was considered to be presumptive evidence that ovulation had occurred. A 2 x 2 factorial analysis of variance with repeated measures demonstrated that there was a significant interaction between cycle length and activity level on measurements of Wt, %BF, and BBT (p < .05). As light activity subjects with average cycle lengths became moderately active, their %BF decreased from 26.51±0.63% to 21.11±0.50% followed by a dramatic increase to 29.40±0.62% as they became highly active. On the otherhand, as light activity subjects with above average cycle lengths became more and more active, their %BF dropped drastically from 35.11±1.44% to 18.72±0. 75%. The data support the hypothesis that bioelectrical impedance measurements of %BF recorded during the normal menstrual cycle are not significantly different. However, a larger population is required to validate the applicability of these results. / M.S.