Estudo populacional de síndrome pré-menstrual Population study of premenstrual syndrome

OBJETIVO: Estudar a prevalência e fatores associados à síndrome pré-menstrual, comparando a freqüência encontrada com a auto-referida. MÉTODOS: Foi realizado um estudo transversal, de base populacional, com 1.395 mulheres de 15 a 49 anos no município de Pelotas, Rio Grande do Sul, em 2003. Foram aplicados questionários para medir a prevalência da síndrome pré menstrual por meio de um escore, construído a partir de cinco sintomas pré-menstruais que interferiam na vida familiar ou levavam à falta ao trabalho ou à escola. Foram investigadas associações entre alguns fatores socioeconômicos, demográficos e comportamentais. A síndrome auto-referida foi investigada quanto à sua sensibilidade e especificidade, considerando o escore como padrão-ouro. As análises estatísticas utilizadas foram chi2 de Pearson, Mantel Haenszel e regressão de Poisson, além do coeficiente de Kappa para verificar concordância de respostas. RESULTADOS: A prevalência encontrada foi de 25,2% (IC 95%: 22,5-27,9) e auto-referida 60,3% (IC 95%: 57,4-63,3). Os principais sintomas pré-menstruais foram: irritabilidade, desconforto abdominal, nervosismo, cefaléia, cansaço e mastalgia, todos acima de 50% de prevalência. Mulheres de melhor nível econômico, maior escolaridade, menores de 30 anos e com pele branca apresentaram risco mais elevado. As usuárias de psicofármacos e as que não usavam anticoncepção hormonal apresentaram maior prevalência. A sensibilidade do teste foi de 94%, a especificidade 51% e a acurácia 62%. CONCLUSÕES: Foi alta a prevalência da síndrome pré-menstrual encontrada. Embora a percepção das mulheres seja maior do que aquela medida com o escore, ainda assim, um quarto das mulheres apresentou esse problema de saúde.<br>OBJECTIVE: To study the prevalence of premenstrual syndrome and the factors associated with this, by comparing the obtained frequency with the self-reported frequency. METHODS:This was a cross-sectional population-based study, involving 1,395 women aged 15 to 49 years old in a medium-sized municipality in Southern Brazil, carried out in 2003. Questionnaires were applied to measure the prevalence of premenstrual syndrome by means of a score based on five premenstrual symptoms that interfered with family life or led to absence from work or school. Associations with socioeconomic, demographic and behavioral variables were investigated. Self-reported syndrome was investigated with regard to its sensitivity and specificity, taking the score as the gold standard. The statistical analyses performed were Pearson chi2, Mantel-Haenszel and Poisson regression, with Kappa coefficients to verify the concordance of the responses. RESULTS: The obtained prevalence was 25.2% (95% CI: 22.5-27.9) and the self-reported prevalence was 60.3% (95% CI: 57.4-63.3). The principal premenstrual symptoms found were: irritability, abdominal discomfort, nervousness, headache, fatigue and breast pain; all of these showed prevalence of over 50%. Higher risk was presented by women of higher socioeconomic level, better schooling level, aged under 30 years and with white skin color. Psychotropic drug users and women who were not using any hormonal contraceptive presented higher prevalence of the syndrome. The sensitivity of the test was 94%, specificity 51% and accuracy 62%. CONCLUSIONS: A high prevalence of premenstrual syndrome was found. Even though the women's perception of the syndrome was higher than the result measured by the symptom score, one quarter of the women presented this health problem

Prevalência de síndrome pré-menstrual em atletas Prevalence of premenstrual syndrome in athletes

A síndrome pré-menstrual (SPM) é um conjunto de sintomas emocionais e físicos que afeta negativamente as atividades diárias das mulheres durante o período pré-menstrual. Embora seja um tema bastante estudado na população em geral, existe uma lacuna na literatura a respeito da presença de SPM em atletas. Dessa forma, o objetivo do estudo foi analisar a prevalência de SPM em atletas. Foi desenvolvido um estudo do tipo inquérito, com 57 atletas, com idade entre 18 e 47 anos, de 11 modalidades esportivas. Para identificar a presença de SPM, utilizou-se uma ficha autoaplicável baseada nos critérios do American College of Obstetricians and Gynecologists (ACOG, 2000); a confirmação diagnóstica foi feita através do preenchimento de um diário de sintomas durante dois ciclos menstruais consecutivos (baseado no ACOG, 2000). Para análise dos dados utilizou-se teste de Shapiro-Wilk e teste exato de Fisher, adotando P < 0,05. A prevalência de SPM estimada de forma retrospectiva foi de 68%, enquanto a avaliada pelo acompanhamento com os diários foi de 48%. Mastalgia, explosão de raiva, ansiedade e irritabilidade foram os sintomas mais citados. Foram observadas associações significativas entre SPM e volume de treinamento semanal (P = 0,041), número de sintomas totais (P < 0,0001), número de sintomas físicos (P = 0,004), mastalgia (P = 0,028) e desconforto abdominal (P = 0,015). A prevalência de SPM em atletas foi considerada alta e a análise retrospectiva a superestimou em relação ao acompanhamento diário. A alta prevalência, bem como a associação entre SPM e maior volume de treinamento semanal, instiga que o treinamento esportivo pode ter algum impacto na prevalência de SPM em atletas.<br>The premenstrual syndrome (PMS) is a set of emotional and physical symptoms that adversely affects the daily activities of women during the pre-menstrual period. Despite being a theme quite discussed in the general population, there is still a gap in the literature concerning the presence of PMS in athletes. Thus, the objective of the study was to analyze the prevalence of PMS in athletes. An inquiry study with 57 athletes age range of 18 and 47 years from 11 sport modalities was developed. A self-applicable sheet based on the American College of Obstetricians and Gynecologists criteria (ACOG, 2000) was used to identify the presence of PMS ; the diagnostic confirmation was performed through the answer of a symptoms diary during two consecutive menstrual cycles (based on ACOG, 2000). Shapiro Wilks test and Fisher's exact test, adopting a P<0.05 were used for the data analysis. The prevalence of PMS retrospectively estimated was of 68% while the estimated prevalence through the follow-up with the diaries was of 48%. Breast soreness, anger burst, anxiety and irritability were the mostly frequent mentioned symptoms. Significant associations were observed between PMS and weekly training volume (P = 0.041), total amount of symptoms (P < 0,0001), amount of physical symptoms (P = 0,004), breast soreness (P = 0,028) and abdominal discomfort (P = 0,015). The prevalence of PMS in athletes was considered high and the retrospective analysis overestimated the prevalence of PMS in relation to the daily follow-up. The high prevalence as well as the association between PMS and the higher volume of weekly training suggest that the sports training may have some impact in the prevalence of PMS in athletes

Hormonal contraceptive use and prevalence of premenstrual symptoms in a multiethnic Canadian population

Abstract Background Hormonal contraceptive use may be associated with a reduction in some premenstrual symptoms, however, the evidence remains equivocal. The objectives of the present study were to investigate the associations between ethnicity and hormonal contraceptive use with premenstrual symptoms. Methods One thousand one hundred two women participating in the Toronto Nutrigenomics and Health Study provided data on their premenstrual symptoms and hormonal contraceptive use. Severity of symptoms was classified as none, mild, moderate, or severe. Prevalence of premenstrual symptoms was determined in the total population and among major ethnic groups. Logistic regressions were used to determine the association between ethnicity and prevalence of premenstrual symptoms. Logistic regressions were used to determine the associations between hormonal contraceptive use, and premenstrual symptoms, adjusting for ethnicity and other covariates. Results Prevalence of individual symptoms varied, and the most commonly reported were cramps (75%), bloating (75%), mood swings (73%), increased appetite (64%), and acne (62%). Prevalence of cramps differed between ethnic groups with East Asians reporting a lower prevalence than Caucasians and South Asians (p < 0.05). Use of hormonal contraceptives was associated with a lower RR (95% CI) of experiencing moderate/severe: cramps (0.82, 0.72-0.93), clumsiness (0.22, 0.07-0.73), confusion (0.22, 0.09-0.54) and desire to be alone (0.45, 0.28-0.73). Hormonal contraceptive use was not associated with the risk of premenstrual symptoms at mild severity. Hormonal contraceptive use was not associated with symptoms of anxiety, bloating, mood swings, increased appetite, acne, fatigue, sexual desire, depression, nausea, headache and insomnia. Conclusion This study demonstrates that East Asians may be at a lower risk of experiencing premenstrual cramps and that hormonal contraceptive use is associated with a lower risk of experiencing many, but not all, premenstrual symptoms at moderate/severe severity

Female dominance over males in primates: self-organisation and sexual dimorphism

The processes that underlie the formation of the dominance hierarchy in a group are since long under debate. Models of self-organisation suggest that dominance hierarchies develop by the self-reinforcing effects of winning and losing fights (the so-called winner-loser effect), but according to ‘the prior attribute hypothesis’, dominance hierarchies develop from pre-existing individual differences, such as in body mass. In the present paper, we investigate the relevance of each of these two theories for the degree of female dominance over males. We investigate this in a correlative study in which we compare female dominance between groups of 22 species throughout the primate order. In our study female dominance may range from 0 (no female dominance) to 1 (complete female dominance). As regards ‘the prior attribute hypothesis’, we expected a negative correlation between female dominance over males and species-specific sexual dimorphism in body mass. However, to our surprise we found none (we use the method of independent contrasts). Instead, we confirm the self- organisation hypothesis: our model based on the winner-loser effect predicts that female dominance over males increases with the percentage of males in the group. We confirm this pattern at several levels in empirical data (among groups of a single species and between species of the same genus and of different ones). Since the winner-loser effect has been shown to work in many taxa including humans, these results may have broad implications