New research shows that women worldwide experience unpleasant premenstrual symtoms, including food cravings (85%) and mood swings or anxiety (64%). Other reported symptoms included fatigue, irritability, bloating, and breast tenderness.1
“One of the things I find most surprising is that most women have mood symptoms, and one-third said it impacted their functioning,” says Jennifer L. Payne, MD, study co-author and professor of psychiatry at UVA Health in Charlottesville, VA.
The symptoms occurred roughly one week before onset of menstruation and resolved within a few days of onset. They were absent in the postmenstrual week.
“The weight of mood symptoms varied by country,” Payne says. “Egypt had the highest reported rate of 74%, and the lowest was Togo at 25.99%.” In the United States, premenstrual mood symptoms are in the 60% range, she adds.
With such a huge difference, researchers might wonder about cultural or environmental differences between countries, or whether cultural expectations of how women handle their menstrual cycles play a role, she notes.
Severe symptoms can increase absenteeism and decreased productivity and is associated with functional impairment in adolescents. “This is a significant public health issue, and more work needs to be done,” Payne adds.
Reproductive health providers should be aware of the prevalence of mood swings, anxiety, and depression symptoms among patients, both assessing for these and providing treatment. For example, some women may find these symptoms are alleviated with the use of hormonal contraception, although their symptom relief might only work with certain types of birth control pills. Providers need to help them find the medication that works best. Other people may need antidepressant or antianxiety medication, including selective serotonin reuptake inhibitors (SSRIs).
“There is a more serious disorder [called] premenstrual dysphoric disorder [PMDD],” Payne explains. “Fifty percent of women with premenstrual dysphoric disorder will respond to SSRIs, and 50% don’t.” PMDD was found in 3% to 8% of women. Another treatment possibility is the Yaz birth control pill that is approved for treating acne and PMDD.2
Payne and colleagues also found that some symptoms were reported more frequently as age increased. “As women approach perimenopause, they have more physical symptoms, but mood symptoms stay steady no matter what the age,” she says. “I’m interested in the underlying biology because we can essentially study mood symptoms triggered by hormonal change. If we can understand underlying biology for that, then we can understand underlying biology for major mood disorders like depression.”
It is not that research has found a direct cause and effect between major depression and hormonal change. But studies show that major depression is twice as common in women during their reproductive years, Payne says.
“There may be a subtype of depression that we call reproductive depression related to hormonal changes women undergo,” she explains. “If we can get to that biology, it will shed light on that type of major depression as well.”
Payne and colleagues conducted the cross-sectional survey study in women aged 18 to 55 years. It was administered to users of the Flo Health mobile app from May 2017 to June 2020, using a chatbot dialogue. Participants answered a PMS survey, which was released in 10 languages and was available to all women using the Flo app.
Survey questions addressed a variety of symptoms, including mood swings or anxiety, absentmindedness, sleep changes, headaches, hot flashes, sweating, fatigue, breast soreness or swelling, food craving, weight gain, increased appetite, swelling, abdominal spasms, low libido, changes in hair, or skin rashes.
Investigators examined data by country and categorized data by age groups of 18-27 years, 28-37 years, 38-47 years, and 48-55 years. The most reported symptoms for every age group were cravings, mood swings and anxiety, fatigue, and increased appetite. The least reported symptoms were skin rashes, hair changes, low libido, and sweating or hot flashes.
“[These were] data in a sample size of 238,000 women from 140 countries,” Payne says. “Premenstrual complaints are very common, and a solid number of women find they impact their functioning on a monthly basis.”
In some cultures, counseling is a taboo subject. But in places like the United States, providers could screen women for mood symptoms in contraceptive counseling sessions, Payne suggests. If needed, providers could refer women to mental health counseling.
“If a woman is having significant symptoms on a monthly basis, bringing this up could be a solution — or at least mitigate some of these symptoms,” she says. “The OB/GYN could ask if their symptoms are impacting their functioning and give them information on how it might be mitigated.”
Women should not have to suffer from premenstrual symptoms, Payne says. “The issue is real, and we get dismissed,” she adds. “Not having to go through that every month would be lovely.”
REFERENCES
- Hantsoo L, Rangaswamy S, Voegtline K, et al. Premenstrual symptoms across the lifespan in an international sample: Data from a mobile application. Arch Womens Ment Health 2022;25:903-910.
- BirthControl.com. Yaz birth control pills. 2023.
New research shows that women worldwide experience unpleasant premenstrual symtoms, including food cravings (85%) and mood swings or anxiety (64%). Other reported symptoms included fatigue, irritability, bloating, and breast tenderness.
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