This article provides an overview of information on the prevalence of perimenstrual symptoms. Overall, at least 40% of women experience some cyclical perimenstrual symptoms. Although most women rate their symptoms as mild, approximately 2%-10% report severe symptoms. Prospective studies of perimenstrual symptoms indicate that retrospective reports are reasonably accurate among women who experience moderate to severe symptoms. However, among the majority of women with few or minimal symptoms, retrospective reports may amplify the cyclicity of variation in comparison to concurrent reports. A variety of risk factors are associated with patterns of symptom reporting and may provide clues to the etiology of perimenstrual symptoms and help to identify women most vulnerable to them. A woman's age and cycle characteristics are predictors of the type and severity of perimenstrual symptoms she experiences. In addition, a history of affective illness may be associated with increased reporting of perimenstrual symptoms. Future research should focus on developing new diagnostic criteria for subtypes of perimenstrual syndromes, exploring positive symptoms and experiences associated with the menstrual cycle, and formulating holistic treatment approaches that view perimenstrual syndromes as psychosomatic conditions.

Perimenstrual symptoms: prevalence and risk factors.

Menstrual cycle phase and psychiatric admissions.

The premenstrual syndrome is discussed in relation to prevalence, symptomatology, severity, and time course. Methodologic problems common to the study of the menstrual cycle are presented. The research on psychologic and physiologic etiologies is reviewed, and results of studies on various treatment modes are discussed. Newer theories suggesting a combined psychophysiologic etiology and concomitant nonpharmaceutical treatment modes encompassing self-care and stress management skills are included.

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Premenstrual tension syndrome.

The premenstrual phase of cycle has long been associated with a constellation of health symptoms for women. However, there has been no recent quantitative review of severe mental health outcomes as a function of the menstrual cycle. We examine cycle influences on completed suicides, suicide attempts, suicidal ideation, and psychiatric admissions, and contrast these with non-suicide deaths. We conducted a meta-analysis of 32 papers, with an N of 3,791. We find 26% greater risk of suicide deaths, 17% greater risk of suicide attempts, and 20% greater risk of psychiatric admissions at menstruation. We also observe 13% greater risk of psychiatric admissions during the premenstrual phase. Suicidal ideation was unrelated to the stage of menstrual cycle. Available evidence finds serious and consequential mental health outcomes in the menstrual and premenstrual phases.

Menstrual Cycle Effects on Mental Health Outcomes: A Meta-Analysis

Psychotic disorders can be exacerbated by the hormonal changes associated with childbirth, but the extent to which exacerbations occur with the menstrual cycle is unclear. We addressed this issue by conducting a systematic review. Embase, Medline, and PsychINFO databases were searched for studies that measured exacerbations of psychotic disorders in relation to the menstrual cycle. We extracted exacerbation measure, definition of menstrual cycle phase, and measurement of menstrual cycle phase. Standard incidence ratios were calculated for the perimenstrual phase based on the observed admissions during this phase divided by the expected number of admissions if the menstrual cycle had no effect. Random effects models were used to examine pooled rates of psychiatric admission in the perimenstrual phase. Nineteen studies, comprising 1193 participants were eligible for inclusion. Eleven studies examined psychiatric admission rates, 5 examined symptoms scores, 2 examined self-reported exacerbation, and 1 examined both admission rates and symptom scores. A random effects model demonstrated the rate of admissions during the perimenstrual phase was 1.48 times higher than expected (95% CI: 1.31-1.67), with no significant heterogeneity detected. Four of six symptom score studies reported perimenstrual worsening, but lack of consistency in timepoints precluded meta-analysis. Two studies examining self-reported menstrual exacerbations reported prevalences ranging from 20% to 32.4%. Psychiatric admission rates are significantly higher than expected during the perimenstrual phase. There is some evidence that a worsening of psychotic symptoms also occurs during this phase, but further research with more precise measurement of the menstrual cycle and symptomatology is required.

Exacerbation of Psychosis During the Perimenstrual Phase of the Menstrual Cycle: Systematic Review and Meta-analysis.

Menstrual symptomatology and psychiatric admission

A video tape test of general psychiatry, previously reported1 to discriminate third year students finishing different programs (wards) was applied to a group of second year students following their courses in basic psychiatry. In contrast to earlier attempts in the literature this test could discriminate second year from post clerkship students (P <.0001). Discriminate function analysis yielded a subset of 10 questions which would select second from third year students with 96 percent accuracy, and seven video tape based items could predict 91 percent accurately. Thus the authors conclude that video tape test material can be used to assess clinical training and compare program (clerkship) efficacy.

Arthur T. Meyerson

Papers

Menstrual symptomatology and psychiatric admission

Differentiating Pre- and Postclerkship Students with a Video Tape Exam