Women who feel stressed early on during their menstrual cycle are more likely to have more severe symptoms during and before menstruation, says a report conducted by researchers at the NIH (National Institutes of Health, USA) and other centers. The researchers say that this link increases the possibility that being stressed during one menstrual cycle could exacerbate symptoms related to PMS (premenstrual syndrome) and menstruation in the following cycle too.
Premenstrual syndrome (PMS) occurs around the time of ovulation and may continue into the first few days of menstruation. Symptoms include anger, mood swings, irritability, anxiety, depression, tiredness (fatigue), problems focusing, swelling and tenderness of the breasts, general aches and pain, and abdominal bleeding.
This study involved researchers from NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the University of Massachusetts-Amherst, and the State University of New York, Buffalo.
The study has been published in the Journal of Women’s Health.
Audra Gollenberg, Ph.D., postdoctoral fellow in NICHD’s Division of Epidemiology, Statistics and Prevention Research, said:
We were interested in identifying factors that might predict who might be most at risk for having more severe symptoms. It may be possible to lessen or prevent the severity of these symptoms with techniques that help women to cope more effectively with stress, such as biofeedback, exercise, or relaxation techniques.
This analysis was part of the BioCycle Study, a NICHD study, led by Enrique Schisterman, Ph.D., who was also co-author of the report. The BioCycle Study is examining the ovarian functioning during the menstrual cycle in healthy females. The investigators gave questionnaires to 259 women, aged 18 to 44 years, who had no chronic (long-term) health conditions, and who were not taking oral contraceptives or any other hormonal formulations.
Each participant was given a fertility monitor to track the phases of their monthly cycle – the monitors were used at home. The females completed questionnaires about their levels of stress during each week of their menstrual cycle. The questionnaires asked about:
- How often they felt incapable of controlling the important things in their life
- How often they felt nervous or stressed recently
- How often they were capable of controlling interruptions in their life
Responses were ranked on a sliding scale from never to fairly often. The questionnaires also asked about the women’s symptoms during the week they ovulated, plus the following week, and during menstruation. The majority of the 250 women participated in the study for two whole menstrual cycles (9 took part in just one cycle).
The researchers found that women who said they had felt stressed were more likely to experience moderate or severe levels of psychological symptoms, including depression or sadness, episodes of crying, anger, anxiety, and irritability associated with menstruation.
Women who had reported feeling stressed appeared to have a higher risk of experience moderate of severe physical symptoms, including general body aches, abdominal bloating, fatigue, lower back pain, headache, abdominal cramping, and cravings (sweet or salty foods).
In general, women with high levels of stress were two to four times more likely to experience moderate to severe physical and psychological symptoms during menstruation compared to women who did not have high stress levels.
Among the women who participated in the study for two menstrual cycles, the researchers found that stress levels during one cycle could influence symptom severity during the following cycle. In other words, a woman who had high stress levels during Cycle 1, but normal stress levels during Cycle 2, had a high risk of experiencing more pronounced symptoms during that second cycle.
The investigators also report that women who experienced high stress levels during both cycles were 25 times more likely to have moderate to severe symptoms compared to women who reported low stress levels during the two cycles.
It is possible that anticipation of symptoms and pain may add to a woman’s stress, leading to more severe symptoms. However, they sought to counteract for this likelihood by giving the questionnaires on stress early on, during the symptom-free parts of the women’s cycles, when the risk that they might be anticipating severe symptoms was smaller.
Study author Mary Hediger, Ph.D, also of the Division of Epidemiology, Statistics and Prevention research, said that a number of drugs are given to treat premenstrual syndrome symptoms, including diuretics, pain killers, oral contraceptive pills, drugs that suppress ovarian function, and antidepressants.
Dr. Hediger said:
Each woman is an individual, and some women may experience severe symptoms that require medications. However, future studies may show that stress reduction techniques can prevent or reduce the severity of premenstrual syndrome, which might provide a cost effective alternative to medications for some women.
“Perceived Stress and Severity of Perimenstrual Symptoms: The BioCycle Study”
Audra L. Gollenberg, Mary L. Hediger, Sunni L. Mumford, Brian W. Whitcomb, Kathleen M. Hovey, Jean Wactawski-Wende, Enrique F. Schisterman.
Journal of Women’s Health. May 2010, 19(5): 959-967. doi:10.1089/jwh.2009.1717.
Written by Christian Nordqvist