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Introduction Most women of reproductive age experience premenstrual symptoms before menstruation. Community-based research investigating the prevalence and management of problematic premenstrual symptoms (the premenstrual syndrome or 'PMS') is sparse, especially in the United Kingdom. This study aimed to assess the epidemiology and management of premenstrual symptoms in the community, and identify factors associated with symptom experiences. Methods A systematic review was conducted to identify population-based studies reporting PMS prevalence. In 2014 and 2015 a postal questionnaire was sent to 3,534 women aged 18-50, registered with 20 Scottish general practices. Results Twenty-six population-based studies were included in the systematic review. These reported widely differing prevalences, depending on the definitions of PMS used. The corrected response rate from the survey was 32.1%. Over 95% of women experienced at least one symptom in the previous 12 months. The most frequent moderate to severe symptoms were abdominal cramps: 44.0%; abdominal bloating: 40.9%; irritability: 40.7%; fatigue or lack of energy: 37.6%; and mood swings: 36.8%. The criteria for premenstrual dysphoric disorder (PMDD) and moderate to severe PMS were met by 4.4% and 8.3% of women, respectively; 53.1% reported experiencing PMS, with 10.7% rating this as severe to extreme. Common management strategies used included over-the-counter medication; heat application; exercise; and relaxation or rest. Lifestyle and psychological strategies were more frequently reported than prescribed treatments. The most common associations with different symptom experiences (i.e. moderate to severe PMS/PMDD, self-identified minimal/mild PMS, and self-identified moderate to extreme PMS) related to smoking, self-assessed general health and self-reported current illness/condition. Illness perceptions related to emotional representations and consequences were associated with each of the symptom experiences examined. Current use of most management strategies, a wish for more support from different sources and frequent contact with healthcare professionals were associated with PMS/PMDD and self-identified moderate to extreme PMS.

This thesis considers the use of different psychological research strategies in generating and supporting a theoretical account of the process by which women come to diagnose themselves as suffering from premenstrual syndrome (PMS). Taking an epistemological standpoint informed by recent psychological research into PMS, and the premises of feminist standpoint theory, it is suggested that methodological pluralism may be advantageous in researching a phenomenon grounded both in individual (biological) experience and the social or cultural sphere. Chapter one introduces this research with a reflexive consideration of the researcher and research process. Chapters two and three present a review of physiological and psychological aspects of the menstrual cycle, and traditional approaches to PMS. The rationale for a multi-factor, psychological approach to PMS is presented at the end of chapter three, and chapter four goes on to outline the rationale for methodological pluralism, including adoption of a feminist standpoint approach. Chapter five draws parallels between cognitive approaches to certain emotional disorders (such as panic), and presents a study examining the relationship between attentional bias, attention to body cues, autonomic arousal, stress, and self-reported PMS. Chapter six presents a questionnaire based study of three populations of women, using the Women's Health Questionnaire to investigate the relationship between PMS status and perceived detriment to emotional and physical health. Chapter seven presents a discourse-analytic study of women's accounts of PMS. Semi-structured interviews were conducted with women attending their first appointment at a PMS clinic. The analysis explores ways in which these women discursively constitute their experiences of PMS. This thesis concludes with a discussion of the implications of the results of these studies, in terms of the theoretical framework, in terms of the area of PMS research, and for women who experience premenstrual distress. Recommendations for future research are also given.

The effect of physical exercise on emotional changes throughout the menstrual cycle has remained largely unexplored despite suggestions that it may help to alleviate premenstrual symptoms and symptoms of dysmenorrhea. Three studies were carried out to examine this association. In the first, a sample of 342 women were surveyed to discover how they coped with menstrual cycle changes and how helpful these methods were. Physical exercise was found to be among the most helpful ways of coping. This is consistent with the popular contention that women who exercise experience fewer menstrual cycle related problems. In the second study, a mood adjective checklist was constructed specifically for monitoring mood change in women. This questionnaire was then used to monitor menstrual cycle changes in 143 women who exercise and women who do not for one month. The greatest positive affect was seen in women who exercised 3 or more times a week and the least in sedentary women. Similar findings were revealed for negative affect. The differences between exercise groups were greatest during the premenstrual and menstrual phases suggesting that exercisers are to some extent protected from deterioration of mood before and during menstruation. If these results are due to the effect of exercise, this begs the question: how might this effect be mediated. One mechanism through which the psychological benefits of exercise might be mediated is through an increased resistance to stress. How exercising and non-exercising women respond to a stressful laboratory task during different phases of the menstrual cycle was the subject of investigation in the third study. Results revealed that while the exercise group did indeed have a physiological protection from stress, their psychological responses did not differ from the non-exercisers. The results are discussed in relation to personality differences between exercisers and non-exercisers as well as psychological mechanisms of the exercise effect.

Approximately three-quarters of regularly menstruating women experience premenstrual symptoms (Hobel et al., 2015; Safarzadeh et al., 2016). Symptoms vary in severity from mildly disturbing to severely disabling for some women and can be so severe that they interfere with daily functioning and personal relationships (Safarzadeh et al., 2016). A range of physical, psychological, and behavioural symptoms can occur in the late luteal phase of the menstrual cycle, with symptoms abating shortly after the onset of menses (Lee et al., 2022). Various pharmacological and non-pharmacological interventions have shown promising results in reducing premenstrual symptom burden (Itriyeva, 2022; Saglam & Orsal, 2020; Ussher & Perz, 2017). A growing body of evidence suggests lifestyle interventions targeting physical activity, healthy diet, and weight management can reduce the intensity of premenstrual symptoms (Esmaeilpour et al., 2019; Saglam & Orsal, 2020), but the effectiveness of multiple health behaviour change interventions (MHBC) in this population remains largely untested. Previous research in midlife women provides evidence that MHBC interventions are effective in reducing hormone-related symptoms of menopause (Anderson et al., 2015; McGuire et al., 2019). The prototype Younger Women's Wellness Program (YWWP), a 12-week structured MHBC program has been designed and developed for women aged 18-35 years (Anderson et al., 2018), but its effectiveness has not been established. The YWWP aims to change health behaviour and improve health literacy about a range of health issues pertinent to younger women, such as physical activity, weight management, healthy eating, smoking, alcohol consumption, stress management, sleep, and health screening behaviours. The YWWP comprises a self-directed PDF with a step-by-step weekly program, which includes detailed health information, activities and goal setting targeting these behaviours, and is underpinned by social cognitive theory (SCT). Given the likely benefits of health behaviour change on premenstrual syndrome (PMS), it was hypothesised that this intervention would reduce symptoms and enhance health and well-being. To augment this intervention, an mHealth period and premenstrual symptom tracker application was added to increase symptom awareness and improve menstrual health literacy. The Clue period tracker application (CPTA) is one such mHealth application that has shown positive results in increasing participants' awareness and understanding of their menstrual cycle and the timing of their premenstrual symptoms (Krauskopf, 2019). The CPTA also allows users to choose which indicators and symptoms they wish to track or ignore. These include menstrual bleeding, pain, cravings, emotions, energy levels, weight, sleep duration, and changes in digestion, hair, skin, bowel movements, cervical fluid, and body temperature. Self-efficacy is complex and multi-faceted (Museus et al., 2022), and YWWP and CPTA consider different aspects of health behaviour change and self-efficacy that are likely to enhance each other. Specifically, CPTA relates to menstrual health literacy, while YWWP is an MHBC program for improving health and well-being. Although these interventions in isolation might reduce premenstrual symptoms, their combined impact is largely unknown and requires further testing. Given the high impact of premenstrual symptoms, there is a need for rigorously designed non-pharmacological interventions to improve health and reduce the intensity of premenstrual symptoms in young women. Aims: The overarching aim of this two-phased study is to explore the feasibility and acceptability of a multiple health behaviour change intervention for managing premenstrual symptoms in university students aged 18-35 years. The specific aims for each study phase are as follows: Phase 1: - To establish feasibility through composite analysis of eligibility, recruitment, retention, protocol adherence, and missing data of a parallel three-group randomised pilot trial; - To explore the common premenstrual symptoms experienced by university students and explore the preliminary effectiveness of a 12-week intervention on the severity of premenstrual symptoms, physical activity, functional health, and well-being, sleep quality, and self-efficacy; - To establish sample size estimates for a fully powered randomised controlled trial (RCT). Phase 2: - To gain an in-depth understanding of the interventional components that were helpful and acceptable for women and those that were not; - To explore the content and delivery methods likely to yield the maximum likelihood of participant engagement and retention and support self-management of premenstrual symptoms; - To understand the impact of premenstrual symptoms on health-related quality of life and self-efficacy in women. [...]

This dissertation consists of two related studies using the same survey and participants. As such, the studies share some related information. Study One examined perceptions of menstrual changes, menstrual management strategies, relations between select demographic factors and menstrual management strategies, and sources of information for menstrual management strategies. Study Two examined menstrual pain symptoms, strategies to manage menstrual pain, relations between select demographic factors and menstrual pain management strategies, sources of information for menstrual pain relief, and overall success of menstrual pain management. Abstract for Study OneBackground. A majority of women experience some premenstrual symptoms. This study examined the associations among demographic factors of race, location, age and the three most reported menstrual management strategies for menstruators. Menstrual history, perceptions of menstrual changes, and sources of information regarding strategies were also explored. Methods. A 22-item survey was developed to assess the aforementioned categories. The recruitment information and survey were posted to several Facebook groups and listservs. Results. About 87% of the participants (n = 504) reported cramps with menstruation. The top three menstrual management strategies were rest, pain medication, and heat. Logistic regression models for rest and pain medication were significant, whereas the model for heat was not significant. Menstruators who were in the racial minority group and those without a college degree were more apt to use rest as a strategy. Furthermore, menstruators without a college degree were more likely to use pain medication. Family members, friends, and the internet were cited as primary sources of information. Conclusions. This study provided additional insight into adult menstruators’ use of menstrual management strategies. Because differences in the use of popular strategies were found according to race and level of education, additional research is needed to explore reasons for these differences. Abstract for Study TwoBackground. This study examined the relations among the demographic factors of race, location, age and the three most reported menstrual pain management strategies. Menstrual history, perceptions of menstrual changes, sources of information regarding pain management, and perception of success of pain management were also examined. Methods. A 22-item survey (same survey used in Study One) was posted online to several Facebook groups and listservs. Results. Five-hundred and six surveys were included in the analyses (same sample as Study One). Multiple pain symptoms (i.e., cramps, breast tenderness/soreness, body aches, and headache/migraine) were reported by a majority of respondents; and 15.4% reported unsuccessful management of menstrual pain. Rest, over-the-counter (OTC) pain medication, and heat were identified as the top three pain management strategies. Logistic regression models for rest and OTC pain medication were significant. Participants in racial minority groups were more likely to use rest and those without a college degree were more likely to use OTC pain medication. Conclusions. This study provided further information on adult menstruators’ experiences of menstrual changes, use of pain management strategies, sources of information for menstrual pain relief, and success of pain management. Further research is indicated to understand these group differences and explore additional pain management strategies.

Body image concerns are a prominent issue among women, with detrimental consequences for mental health and well-being. Women’s body shame and body dissatisfaction is heightened during the premenstrual phase of the cycle, associated with premenstrual distress. Body management behaviours also fluctuate across the menstrual cycle, manifested by premenstrual food cravings and reduced exercise. However, the meaning and consequences of premenstrual body dissatisfaction and changes to body management remains underexplored. How women construct and negotiate negative premenstrual embodiment in relation to cultural discourse, and factors contributing to premenstrual body shame and dissatisfaction, require further examination. The purpose of the research presented in this thesis was to explore how women who report premenstrual body dissatisfaction construct and experience their premenstrual bodies. A mixed method design was employed, utilising a survey and the arts-based method body-mapping, followed by an interview. In the statistical analysis of standardised survey scales, body shame was associated with higher premenstrual distress and self-objectification. Self-objectification was associated with higher premenstrual emotional/reactivity. Women who reported disordered eating attitudes reported lower premenstrual distress, body shame and self-objectification. Thematic analysis of qualitative data identified that negative physical and emotional premenstrual changes were interrelated, associated with construction of the premenstrual body as abject, out of control, separate to the self, and to blame for women’s distress. Drawing on cultural discourse associated with feminine embodiment, constructions of the abject body as fat and leaking were associated with increased self-policing and body scrutiny. Premenstrual changes disrupted women’s usual strict management of their bodies, associated with negative feelings towards the premenstrual body and the self. Many women demonstrated agency and resistance of negative cultural discourses around premenstrual embodiment. Participants critiqued and challenged cultural discourses that negatively construct the premenstrual body, dressed for comfort rather than fashion premenstrually and took a break from restrictive eating and rigorous exercise practices during this phase. Findings of this thesis provide insight into women’s subjective experiences of negative premenstrual embodiment. These findings emphasize the need to acknowledge changes in body dissatisfaction and body management across the menstrual cycle, and the consequences for women’s feelings about the body and the self. The broader implications of these findings suggest that premenstrual body dissatisfaction is complex and multi-layered and plays a role in women’s premenstrual distress.

Primary dysmenorrhea is the most common gynaecological complaint amongst adolescents. It affects up to three quarters of women at some stage of their reproductive life. Primary dysmenorrhea is also responsible for a significant number of days absent from work or school each month. Women often do not seek medical attention for primary dysmenorrhea and instead use self-care to manage their symptoms. If they do consult a medical practitioner, women are usually advised to take non-steroidal anti-inflammatory (NSAIDs) medication or go on the oral contraceptive pill (COC), however, for at least a quarter of all women there is a lack of efficacy with these medications. Traditional Chinese medicine (TCM) acupuncture has shown promise in the treatment of primary dysmenorrhea, however, several important questions remain. The overarching aim of this thesis is to examine the treatment of primary dysmenorrhea in contemporary clinical acupuncture practice, and examine the therapeutic effects of acupuncture treatment on the symptoms of primary dysmenorrhea. A mixed methods research (MMR) approach was used to undertake four studies. Quantitative methods were used for an online and postal practitioner survey examining how gynaecological conditions were treated in contemporary clinical practice and a randomised controlled trial (RCT) examining the effect of timing and mode of stimulation of acupuncture on primary dysmenorrhea. Qualitative methods, using thematic analysis, were used for practitioners in the form of semi-structured interviews and focus groups discussing treatment of primary dysmenorrhea in the community, and for trial participants in the form of semi-structured interviews examining their experiences as part of the RCT. NIVO was used to manage and code these datasets. These methods were used to answer five research questions. The first research question examined how acupuncture treatment for primary dysmenorrhea was delivered in clinical practice in New Zealand and Australia. The survey of 377 New Zealand and Australian acupuncture practitioners found use of a variety of methods when treating primary dysmenorrhea in clinical practice, with diet and lifestyle advice being rated by practitioners as an important adjunct to acupuncture and moxibustion itself. The second research question explored what components of the acupuncture treatment do practitioners and patients consider important for successful treatment? Analysis of data from two focus groups and semi-structured interviews of nine practitioners and 12 study participants found both practitioners and study participants strongly valued the partnership that occurred, characterised by trust, support and shared decision making. Both moxibustion and self-care advice were recommended by practitioners and participants commented on the therapeutic benefits they received from these co-interventions. The third study question examined the effect of changing the timing of treatment or the mode of acupuncture stimulation on pain and quality of life for women with primary dysmenorrhea,? A pilot randomised controlled trial of 74 women with primary dysmenorrhea was performed with four groups: 1) low frequency manual acupuncture (LF–MA), 2) high frequency manual acupuncture (HF–MA), 3) low frequency electro-acupuncture (LF–EA) and 4) high frequency electro-acupuncture (HF–EA). Participants were randomly assigned to one of the four groups (LF–MA n=19, HF–MA n=18, LF–EA n=18, HF–EA n=19). Twelve treatments were performed over three menstrual cycles, either once per week (LF groups), or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. Primary outcomes found the reduction in peak and average menstrual pain measured via numeric rating scale at one, two, three and four months from trial entry. At four months post-trial entry all groups showed statistically (p

This thesis aimed to examine men’s constructions of Premenstrual Syndrome (PMS) and premenstrual women, and to explore how men’s constructions impact upon their responses to their partner premenstrually. This thesis also aimed to determine what impact a man’s involvement in a couple-based PMS intervention would have on such constructions and responses. Two qualitative studies were conducted, in which men’s accounts of PMS and premenstrual changes were examined. In the first study, men’s online posts from the website PMSbuddy.com were collected and analysed using a thematic discourse analysis. Results from this study showed that the majority of men positioned premenstrual change as having a detrimental impact upon themselves, their partner and their intimate relationship. Most men constructed the premenstrual phase and women’s premenstrual changes as confusing, complicated and illogical. To make sense of premenstrual change, men drew upon cultural discourses that positioned premenstrual change as a disorder necessitating treatment and premenstrual women as mad, bad and dangerous. Although some men positioned premenstrual change as a natural experience and acknowledged the importance of being empathetic and supportive to their partner premenstrually, such instances were scarce. In the second study, a Foucauldian discourse analysis was used to analyse in-depth interviews conducted with 12 male partners prior to, and following, their participation in a couple-based psychological intervention for moderate-severe premenstrual distress. Results from this study showed that men took up several subject positions in relation to their premenstrual partners, which included: the ‘Naïve Partner’, the ‘Expert’, the ‘Supportive Partner’, the ‘Critical Partner’, the ‘Victim’ and the ‘Knowledgeable Partner’. The majority of men who struggled to make sense of premenstrual change took up the Naïve Partner position. By contrast, a small number of men positioned themselves as ‘experts’ in relation to PMS, constructing premenstrual change as predictable and measurable. All but one of the men positioned their partner’s premenstrual changes as a source of strain in their lives, with a small number of men taking up the Victim position to emphasise their suffering and their unjust experiences. Most of these men also adopted the Critical Partner position, as they focused on the negative aspects of premenstrual change and positioned their partner’s premenstrual distress as disruptive and illegitimate. Following the men’s participation in the couple intervention, most men reported that the intervention helped them to develop an enriched understanding and awareness of their partner’s premenstrual experiences. Through this enriched understanding, men positively redefined their experiences with premenstrual change and further resisted the Victim and Critical Partner position. This resistance enabled men to adopt supportive practices that they claimed to help their partner better cope with premenstrual distress. These findings strengthen the notion that premenstrual change is experienced and negotiated within a relational context, and suggest a need for further research on the impact of partners’ constructions of PMS on women’s premenstrual distress and coping.

Premenstrual syndrome is a common disorder troubling many women during their reproductive years. The Chinese have been using herbal medicines to treat menstrual cycle related symptoms for centuries. Traditional Chinese medicine provides the aetiology and pathogenesis of the symptoms of this disorder by applying Pattern Identification to diagnose the signs and symptoms of individual patients and to design individualised treatments which seek to address the entire pattern/s of disharmony. It follows that PMS, which has many symptoms and an idiosyncratic nature, is precisely an area for which Chinese medicine is most suitable. The aim of this study is to scientifically evaluate the effectiveness of Chinese herbal medicine on Australian women for the treatment of PMS within the theoretical frame-work of TCM. A double-blind randomized placebo-controlled crossover clinical trial was conducted by a qualified Chinese herbal practitioner and pharmacist. Following two months confirmatory assessment, sixty-one subjects were assigned randomly into two groups within different TCM patterns of Liver Qi Stagnation, Liver and Kidney Yin Deficiency, Liver and Spleen Disharmony and Heart and Spleen Deficiency. Herbal medicine (n=31) and placebo (n=30) were provided sequentially for a period of three months. There were significant differences (p < .01) in scores after three months of treatment between Chinese herbal medicine and placebo in premenstrual physical and psychological symptoms, depression, anxiety and anger, but with no difference in perceived stress (p > .05). There were highly significant reductions (p < .001) in all assessments in both groups except that a significant result (p < .05) was recorded on perceived stress only in the treatment-first group between baseline and the end of the third herbal treatment month. Also, there was no significant difference on treatment effects shown between TCM patterns. No adverse effects were reported by any participant. The results support the hypothesis that the symptoms occurrence and severity of PMS can be effectively reduced by the use of Chinese herbal medicine. On this basis, it is considered that Chinese herbal medicine may offer an alternative treatment method to western drugs for PMS sufferers who either do not accept the current treatment options or are having unwanted side-effects with their current treatment.

Periodic fluctuations in women's emotions during the menstrual cycle have been a continuing topic of research and discussion. The current study was designed to determine if premenstrual syndrome conditions in female teachers have any effect on reported classroom misbehavior and infractions. Subjects were twenty-one faculty members presently employed in the capacity of teachers in a public middle school. By utilizing a teacher's daily behavioral checklist, along with student misconduct reports, the changes in teachers' moods and behavioral symptoms over the menstrual cycle were studied in relation to reported student infractions. Based on the results of this study, it appears that menstrual cycle fluctuations have no recognizable impact upon a female's classroom demeanor and her ability to discipline in a professional manner.

The premenstrual syndrome (PMS) continues to be an enigma for many: those women who report PMS, for professionals who attempt to treat premenstrual symptoms, and for researchers attempting to identify PMS and to compare treatments. The present study investigated the responses from 86 subjects between the ages 30-45 for their perceptions of daily stress and coping styles by PMS level. Three levels of PMS were formulated by subject responses to the questionnaire (a) PMS for scores within the criteria, (b) Non-PMS for scores lower than the criteria, and (c) Psy-Non-PMS for certain scores higher than the criteria with a psychological, or neurotic, profile. Hassle intensity (daily stress) and coping style, whether problem-focused (P) or emotion-focused (E), were assessed by questionnaire. In addition, help seeking behavior, i.e., whether a woman sought help from a doctor in the past twelve months, was examined but did not significantly relate to level of PMS, hassle intensity, or coping style. Psy-Non-PMS women reported perceiving significantly more hassles and significantly greater use of four of the E coping styles, Detachment, Focusing on the Positive, Self-blame, and Keep to Self, than the Non-PMS women. PMS women endorsed perception of significantly more hassles and significantly greater use of two of the E coping styles, Detachment and Keep to Self, than the Non-PMS women. These E coping styles are consonant with detached, avoidant, escapist, and self-deriding coping mechanisms, typical of depressed and anxious persons. There was some difficulty in differentiating the PMS group from the Psy-Non-PMS group. Only one coping style, Focusing on the Positive, was endorsed by the Psy-Non-PMS group significantly more than the PMS group. Further statistical analysis of the data could determine psychological/behavioral PMS subtypes as distinct from physiological PMS subtypes, providing more clearly defined PMS groups. Future research involving a carefully controlled study for determining PMS levels and utilizing psychotherapy as well as specified medications for treatment of PMS is indicated.

Premenstrual syndrome (PMS) is a common syndrome experienced by women during their reproductive years. Up to 95% of women experience PMS with 30% experiencing moderate to severe symptoms and in 5-10% of women, the symptoms of PMS often result in work and/or social impairment which disrupts the quality of their lives. The aetiology of PMS from a Western medical perspective still remains unclear even though numerous theories has been proposed. Although some pharmacological agents have proven effective and are widely used to treat the disorder, at present there are no approved medications for this disorder. In addition, most of these agents have adverse effects which limits their use in some patients. On the other hand, the aetiology of PMS from a Traditional Chinese Medicine (TCM) point of view is quite clear. However, until now, there have been no rigorous TCM clinical trials on PMS. Many clinical trials in acupuncture are seriously flawed by methodological problems. This study was designed to evaluated the efficacy of Traditional Chinese Acupuncture for the treatment of PMS. Twenty-six subjects were grouped according to age and then the TCM pattern of disharmony. The subjects within each age and TCM pattern group, were then randomly assigned to a treatment group which received real acupuncture treatment or to a control group which received sham acupuncture treatment.