Comparison of Scales for Evaluating Premenstrual Symptoms in Women Using Oral Contraceptives
ABSTRACT To compare two scales used in research to evaluate daily premenstrual mood symptoms during use of a monophasic oral contraceptive.
Subanalysis of data from a prospective study.
University-affiliated medical center. SUBJECTS; One hundred two reproductive-aged (18-48 yrs) women taking a monophasic oral contraceptive containing ethinyl estradiol and drospirenone in the standard 21-7 fashion (21 days of hormones followed by 7 days of placebo), and who had self-identified premenstrual symptoms of headache, mood changes, or pelvic pain.
Subjects completed a single-item questionnaire, the Scott & White Daily Diary of Symptoms, and a multiple-item questionnaire, the Penn State Daily Symptom Report (DSR), to assess their premenstrual symptoms. The Scott & White diary used a visual analog scale of 0-10 to assess pelvic pain, headache, and mood (a composite of anxiety, depression, and irritability). The Penn State DSR contained 17 items: 10 behavioral and seven physical components, each rated on a scale of 0-4, with one item that specifically rated mood swings.
Scores from the two scales were compared by using Spearman correlation coefficients, the Kendall W for concordance, and linear regression of ranked sums for study cycles. The Scott & White mood score significantly correlated with the total of the 17 items on the Penn State DSR, as well as the 10 behavioral items, the seven physical items, and the single mood-swing item (p<0.0001); specific coefficients of concordance were 0.44, 0.23, 0.10, and 0.28, respectively, and R2 values were 0.39, 0.39, 0.30, and 0.34, respectively. The daily Scott & White mood score was positively correlated with all 17 elements of the Penn State DSR (0.25-0.57). The greatest correlation was seen with the mood-swing element. Both instruments demonstrated the same patterns during the 21-7 oral contraceptive cycle, with symptoms increasing immediately before and peaking during the 7-day hormone-free interval.
A single-item daily mood score using a rating scale of 0-10 was concordant with a relatively complex 17-element symptom index and demonstrated the same pattern of change during cycles of oral contraception. The simple scoring system offers an advantage, especially in clinical studies of long duration.
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ABSTRACT: To assess bleeding patterns with continuous use of the transvaginal contraceptive ring. We did a prospective analysis of daily menstrual flow during a 21/7 cycle followed by 6 months of continuous use and institution of a randomized protocol to manage breakthrough bleeding/spotting. Seventy-four women completed the baseline 21/7 phase and were randomized equally into two groups during the continuous phase. Group 1 was instructed to replace the ring monthly on the same calendar day with no ring-free days. Group 2 was instructed to use the same process, but if breakthrough bleeding/spotting occurred for 5 days or more, they were to remove the ring for 4 days, store it, and then reinsert that ring. Sixty-five women completed the continuous phase with reduced average flow scores in the continuous phase compared with the 21/7 phase (P<.02). Most patients had no to minimal bleeding during continuous use, with group 2 experiencing a statistically greater percentage of days without breakthrough bleeding or spotting (95%) compared with group 1 (89%) (P=.016). Instituting a 4-day hormone-free interval was more (P<.001) effective in resolving breakthrough bleeding/spotting than continuing ring use. A reduction in bleeding occurred during continuous use with replacement of the transvaginal ring compared with baseline 21/7 use. Continuous vaginal ring use resulted in an acceptable bleeding profile in most patients, reduction in flow, reduction in pelvic pain, and a high continuation rate.Obstetrics and Gynecology 10/2008; 112(3):563-71. DOI:10.1097/AOG.0b013e3181842071 · 5.18 Impact Factor
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ABSTRACT: Many women in their reproductive years experience some mood, behavioral, or physical symptoms in the week prior to menses. Women experiencing mild symptoms may have a wide variability in the level of symptom burden, whereas a minority suffers severe and debilitating symptoms. Severe premenstrual syndrome (PMS) affects 3% to 5% of women of reproductive age and has been classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) as premenstrual dysphoric disorder (PMDD). Both disorders are characterized mainly by symptoms confined to the premenstrual period, which reduce not only patients' quality of life, but also their working activities. Women suffering PMDD experience severe dysphoric mood, and a greater desire and actual intake of certain foods, demonstrating impaired cognitive performance during the luteal phase. Several theories have been proposed to explain the underlying mechanisms of PMS and PMDD with complex bio-psycho-social factors involved. Although precise causes are unknown, the late luteal phase could be associated with diverse psychosomatic and behavioral symptoms appearing premenstrually which should be appropriately treated. Notwithstanding this high prevalence, no specific symptoms or signs appear, nor have any recognizable anatomical factors been identified in women suffering PMS or PMDD, and hence, no universal treatment yet exists. Despite this, therapeutic progress has been reached, although the ideal treatment has not yet been obtained due to the many clusters involved.The Open Psychiatry Journal 08/2009; 3(1):47-57. DOI:10.2174/1874354400903010039
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ABSTRACT: A possible influence of estrogens on the dopaminergic system has been hypothesized and investigated by several studies, and fluctuations in motor symptoms related to the menstrual cycle have been reported in some movement disorders patients. We designed a survey to quantify how frequently female patients with various movement disorders are affected by this phenomenon and its impact on symptom severity. A questionnaire was sent to 104 women between 18- and 60-years-old diagnosed with movement disorders and regularly followed at our centre. From a total of 65 subjects who completed the questionnaire, 54 women reported the onset of their movement disorders before menopause. Twenty of them (37%) experienced changes in their movement disorders during the menstrual cycle. In particular, there was a significant worsening of symptom severity before (p=0.0005) and during menses (p=0.0004). The possible role of such changes should be taken into account when evaluating the efficacy of various therapeutic interventions in movement disorder patients.The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 07/2010; 37(4):478-81. DOI:10.1017/S0317167100010490 · 1.53 Impact Factor