Abstract
Background
Premenstrual symptoms at reproductive age resemble menopausal symptoms and have symptomatic commonalities. We hypothesized that women with previous premenstrual syndrome may be more prone to develop menopausal symptoms and aimed to investigate the association of menopausal symptoms and menopausal quality of life with premenstrual symptoms.
Methods
The study included 120 postmenopausal women. We evaluated the current menopausal symptoms with menopause rating scale (MRS) and quality of life with menopause-specific quality of life scale (MSQoL), previous premenstrual symptoms with premenstrual syndrome scale (PMSS) retrospectively and compared the associations statistically.
Results
According to retrospective PMSS, participants were divided into two groups; with and without premenstrual syndrome (PMS). PMS group included 29 (24.2%) participants and 91 (75.8%) participants were in group without PMS. Sociodemographic characteristics of groups were similar. Somatic and psychological symptoms were higher in MRS of PMS group. Evaluating the MSQoL; psychosocial and physical symptoms were impaired in the PMS group. Vasomotor, urogenital and sexual symptoms were similar in both groups.
Conclusion
Premenstrual and menopausal symptoms were related in terms of somatic, and psychosocial symptoms but not in vasomotor, urogenital, and sexual symptoms. It seems that women with previous premenstrual symptoms are more likely to develop menopausal symptoms in some ways. However, a prospective longitudinal study may be needed for more conclusive results.
Keywords: premenstrual syndrome, premenstrual dysphoric disorder, menopausal symptoms, quality of life
Introduction
Premenstrual syndrome (PMS) can be defined as a condition in which women have physical, behavioral, and psychological symptoms that cause disturbance in the luteal phase of each menstrual cycle. PMS affects women throughout their reproductive life and severe premenstrual symptoms can significantly impair their quality of life and working capacity1. 80% of females experience mild symptoms of PMS, and 20% may have moderate to severe symptoms. Severe symptoms are identified as premenstrual dysphoric disorder (PMDD) and are found in 2—8% of women. PMDD is characterized by symptoms of depression, anxiety, and mood changes and is defined as a type of depressive disorder in the DSM-52,3.
In addition, menopause is an inevitable part of every woman's life; about 3 out of 4 women experience some problems during menopause. The most common menopausal symptoms reported are; hot flashes, night sweats, fatigue, decreased libido, and mood changes such as depression, irritability, and emotional responsibility. Other possible complaints are; memory impairment, lack of concentration, insomnia, and musculoskeletal complaints4.
A majority of women experience premenstrual symptoms, menopausal symptoms, or both and physical and psychological symptoms of both situations show similarity1.
The mechanisms explaining the premenstrual and menopausal symptoms are not well known yet, but the onset of symptoms is associated with ovarian hormone levels. Estrogen and progesterone levels change significantly, especially during the menstrual cycle, pregnancy, postpartum, and perimenopause. It has been hypothesized that these women have a high sensitivity to hormonal changes and are therefore more prone than others to experience psychological or physical problems at different reproductive stages5,6. Changes in neuroendocrine transmitters in the central nervous system seem to affect these periods and alterations in the autonomic nervous system are also known to have a role on these different clinical processes7. There are studies in the literature demonstrating that these periods affect each other. However, studies made to find a link between premenstrual and postmenopausal symptoms have reported inconclusive results5,6,8.
While there are many studies in the literature that evaluate the characteristics of both periods separately and compare them with various physical and psychiatric conditions, there are few studies comparing both periods with each other. In line with our search, only a few studies examined the relationship between premenstrual syndrome and menopausal symptoms5,8.
We aimed to evaluate post-menopausal women to find a relationship between current menopausal symptoms, menopausal quality of life and previous premenstrual symptoms and to find whether the presence of premenstrual symptoms at reproductive age is associated with the current menopausal situation.
Methods
Setting
Postmenopausal women who applied to the gynecology and obstetrics outpatient clinic of our hospital over 1 year and agreed to participate in the study were included. Women who have not menstruated for at least 1 year were included in the study. Exclusion criteria included women aged 75 and over years and those who could not read and answer the scales or did not agree to participate.
The sample size of the study consisted of 120 postmenopausal women. A sociodemographic information form prepared by the researcher was recorded by asking the participants and the Menopausal Rating Scale (MRS), Menopause specific quality of life scale (MSQoL), and the Premenstrual Syndrome Scale (PMSS) in relation to past periods were self-applied.
Sociodemographic characteristics and the relationship between past premenstrual symptoms and current menopausal symptoms and menopausal quality of life were evaluated.
The study protocol was accepted by the ethical committee of our university (2020-10/31). A written informed consent form was signed by all participants prior to data collection.
Measures
Sociodemographic Data Form
It was prepared by the researcher on the basis of literature information, including women's age, marital status, educational status, employment status, smoking-alcohol use, number of pregnancies, gynecological history, systemic diseases, drugs used, menopausal characteristics, and psychiatric history. It consists of 21 questions, 9 of open-ended and 12 of are closed-ended.
Premenstrual Syndrome Scale (PMSS)
It is a 44-item five-point Likert-type scale (Never, Rarely, Sometimes, Often, Continuously) measuring the severity of premenstrual symptoms. The implementation of PMSS is done by evaluating the person retrospectively, taking into account the “being within the period one week before the period”. The lowest score that can be obtained from the scale is 44, and the highest score is 220. It recommends evaluating the results of the PMSS in terms of the presence of PMS, according to the condition that the total and subscale scores exceed 50% (110 points) of the highest possible score. Turkish validity and reliability study was conducted by Gencdogan9,10.
Menopause Rating Scale (MRS)
The Menopause Rating Scale was developed to measure the severity of menopausal symptoms and their effect on the quality of life. In the Likert-type scale, which consists of a total of 11 items including menopausal complaints, for each item; 0: None, 1: Mild, 2: Moderate, 3: Severe, and 4: Very severe. The total score of the scale is calculated based on the scores given for each item. While the minimum score that can be taken from the scale is “0”, the maximum score is “44”. The 11-item scale including menopausal complaints consists of 3 sub-dimensions. Somatic complaints sub-dimension (items 1, 2, 3, and 11), psychological complaints subdimension (items 4, 5, 6, and 7) and urogenital complaints sub-dimension (items 8, 9, and 10)11,12.
Menopausal-Specific Quality of Life Scale (MSQoL)
It was developed to create a life quality scale specific to menopausal health status, with psychometric properties based on women's experiences. Each sub-domain score is listed from 1 to 8 in MSQoL. The scale consists of four domains: vasomotor, psycho-social, physical, and sexual13.
Statistical Analysis
The data were evaluated using the SPSS 21.0 statistical package program. One-Sample Test was used to examine the suitability of numerical variables to normal distribution.
In the comparison of normally distributed quantitative variables between women with and without PMS, a multivariate linear regression analysis was performed to predict MSQoL variables using the categorical data PMS and MRS total score variables. In the study, p<0.05 was statistically significant. In order to determine which statistical analysis was to be used, it was first determined whether the completed data displayed normal distribution, identified through the kurtosis skewness coefficient, the Kolmogorov-Smirnov test, and graphic analysis. Student's t-test for comparison of normally distributed quantitative variables between women with and without PMS. The Chi-square test was used for the comparison of categorical data.
The numerical variables were provided as average±standard deviation, and the categorical variables were provided as frequency and percentages after the descriptive analysis was carried out, in order to examine the socio-demographic characteristics of the participants. Statistical inference is based on 95% confidence intervals (CIs), and the significance level was set at 0.05.
Correlation analysis for variables with normal distribution was performed using the Pearson test. A Spearman correlation analysis was performed for variables that did not show a normal distribution. A linear regression analysis was performed to predict the MSQoL and MRS total score variables using the PMSS total scores. Binary regression analysis was performed to asses the association of menopausal and PMS symptoms.
Results
The PMSS results according to the previous premenstrual symptoms of 120 participants were evaluated and those with a score above the cut-off point of 110 were grouped as with PMS, and those with a score below the cut-off score of 110 were grouped as without PMS. The group with PMS consisted of 29 (24.2%) participants and the mean age was 54.2 ± 8.1 years. The group without PMS consisted of 91 (75.8%) participants and the mean age was 53.5 ± 6.5 years. There was no significant difference between the two groups according to their other sociodemographic characteristics and smoking-alcohol use, the number of pregnancies, gynecological history, systemic diseases, drugs used, psychiatric diagnosis and treatment history (p>0.05 in all). Menopausal characteristics were also asked and menopause duration, seeking a doctor for menopause and hormonal replacement treatment, natural or sugical menopause initiation were not different between the groups (p>0.05 in all).
To evaluate the menopausal symptoms and menopausal life quality; MRS and MSQoL scales were used. Cronbach α coefficients of the PMSS, MRS and MSQoL scales were 0.973, 0.780 and 0.927 respectively. The mean PMSS total score was 78.05±35.9, the mean MRS total score was 18.21±8.62, and the mean MSQoL score was 61.11±33.
MRS subscores and MSQoL subscores of the two groups were compared and according to the MRS sub-scale scores; somatic and psychological symptoms sub-scores and total scores were significantly higher in the with PMS group, but urogenital symptoms did not differ between the groups. According to the MSQoL assessment of groups; psychosocial and physical symptoms sub-scores, and total scores were significantly impaired in the with PMS group, but vasomotor and sexual symptoms were not different between the groups. The relation of MRS and MSQoL sub-scores of the with PMS and without PMS groups was illustrated in Table 1.
Table 1.
Relation of MRS and MSQoL sub-scores of groups
| Relation of MRS and MSQoL sub-scores of groups | |||||
| Subscale total scores | With PMS (N=29) |
Without PMS (N=91) |
p | t | Effect size |
| MRS somatic | 8.82 ± 2.81 | 6.68 ± 3.38 | .003 | 3.085 | 0.69 |
| MRS | 10.31 ± 3.10 | 5.60 ± 4.08 | .000 | 5.698 | 1.29 |
| MRS urogenital | 4.86±3.10 | 4.08 ± 3.22 | .258 | 1.137 | 0.24 |
| MRS Total | 24.00 ± 6.63 | 16.37 ± 8.39 | .000 | 4.463 | 1.00 |
| MSQoL vasomotor | 10.24 ± 5.85 | 8.51 ± 6.27 | .193 | 1.309 | 0.28 |
| MSQoL | 21.79 ± 10.06 | 9.23 ± 9.13 | .000 | 6.279 | 1.30 |
| MSQoL Physically | 47.89 ± 17.20 | 29.37 ± 17.75 | .000 | 4.917 | 1.05 |
| MSQoL Sexual | 7.06 ± 6.18 | 5.47 ± 6.44 | .243 | 1.173 | 0.25 |
| MSQoL Total | 87.00 ± 29.88 | 52.68 ± 30.55 | .000 | 0.973 | 1.13 |
PMS: Premenstrual Syndrome MRS: Menopause Rating Scale MSQoL: Menopause Specific Quality of Life Scale
Effect size=Cohen's d (0.2-small. 0.5-medium and 0.8-large effect size)
Symptoms of depressive mood, depressive thoughts, anxiety, and irritability in PMSS were classified as psychological symptoms (PMSS-Psy) and pain, appetite changes, fatigue, sleep changes, and swelling were classified as somatic symptoms (PMSS-Som). According to this clssification; subscores of MRS and MSQoL were compared to PMSS subscores. MRS somatic symptoms and urogenital symptoms were correlated significantly with both somatic and psychological symptoms of PMSS in most symptoms and in total, but MRS psychological symptoms were associated moderately with somatic and psychological symptoms of PMSS. In comparison with MSQoL; psychosocial and physical symptoms of MSQoL were correlated significantly with both somatic and psychological symptoms of PMSS in most symptoms and in total when vasomotor and symptoms were correlated moderately. Interestingly sexual symptoms of MSQoL were not correlated with any symptoms of PMSS. The correlation of PMSS sub-scores with MRS and MSQoL sub-scores was illustrated in Table 2.
Table 2.
The correlation of PMSS sub-scores with MRS and MSQoL scores
| MRS and MSQoL sub-scores | PMSS sub-scores | ||||||||||||
| Depressive mood | Anxiety | Fatigue | Irritability | Depressive thoughts | Pain | Appetite change | Sleep changes | Swelling | Psychological Total | Somatic Total | PMSS TOTAL | ||
| MRS somatic | r | .468*** | .448*** | .456*** | .427*** | .437*** | .307*** | .403*** | .495*** | .386*** | .481*** | ||
| MRS psychologi cal | r | .180* | .212* | .205* | |||||||||
| MRS urogenital | r | .330*** | .319*** | .246** | .346*** | .290*** | .349*** | .249** | .356*** | .287** | .349*** | ||
| MRS Total | r | .432*** | .399*** | .385*** | .430*** | .370*** | .352*** | .377*** | .452*** | .342*** | .436*** | ||
| MSQoL vasomotor | r | .179* | .186* | .238** | .198* | .198* | |||||||
| MSQoL psychosoci al | r | .485*** | .404*** | .396*** | .386*** | .448*** | .228* | .281** | .208* | .482*** | .360*** | .465*** | |
| MSQoL Physically | r | .446*** | .395*** | .444*** | .373*** | .396*** | .359*** | .314*** | .448*** | .377*** | .451*** | ||
| MSQoL Sexual | r | ||||||||||||
| MSQoL Total | r | .463*** | .393*** | .432*** | .397*** | .406*** | .325*** | .308*** | .183* | .462*** | .383*** | .462*** | |
PMSS:Premenstrual Syndrome Scale MRS: Menopause Rating Scale MSQoL: Menopause Specific Quality of Life Scale
(*p<0.05, **p<0.01, ***p<0.001)
The correlation between the PMSS total scores and the MRS total scores (r=436**, p<.01) and the correlation between the PMSS total scores and the MSQoL total scores (r=436**, p<.01) were shown in Figure 1.
Figure 1.
Correlations of the total PMSS scores with the overall MRS scores and the overall MSQoL scores
Binary regression analysis was performed to asses the association of menopausal and PMS symptoms.
In Model 1; MRS and MSQoL total scores were found to significantly predict the presence of PMS symptoms (respectively p=0.046 and p=0.026*). In the Model 2; analysis was also applied for sociodemographic characteristics of the women and it was determined that low education and high school and above education levels did not predict the PMS symptoms, while the secondary education level significantly predicted the presence of PMS symptoms (p=0.034*). The values of the regression coefficients and their statistical significance obtained by ‘Enter logistical regression method’ were included in Table 3.
Table 3.
Binary logistic model of the association of menopausal symptoms, menopausal quality of life and PMS symptoms
| Model 1 | Coefficient estimate | S.E. | Wald | 95% C.I. for EXP(B) | OR | p | ||
| Lower | Upper | |||||||
| MRSTotal | .046 | .042 | 1.231 | .965 | 1.136 | 1.047 | .046 | |
| MSQoLTotal | .026 | .010 | 6.330 | 1.006 | 1.048 | 1.027 | .026* | |
| Constant | -3.877 | .772 | 25.191 | .000 | .021* | |||
| Diagnostics | ||||||||
| (LR) Chi-square | 24.826 | .000*** | ||||||
| Hosmer & Lemeshow test | 6.203 | .625 | ||||||
| Model 2 | ||||||||
| MRSTotal | .048 | .042 | 1.299 | .966 | 1.140 | 1.049 | .254 | |
| MSQoLTotal | .030 | .011 | 7.606 | 1.009 | 1.053 | 1.030 | .006** | |
| Education status | 5.215 | .074 | ||||||
| Education status(1) | 1.735 | .819 | 4.484 | 1.138 | 28.245 | 5.669 | .034* | |
| Education status(2) | .722 | .748 | .931 | .475 | 8.915 | 2.058 | .335 | |
| Marital status | 1.145 | 1.132 | 1.022 | .342 | 28.890 | 3.141 | .312 | |
| Constant | -6.175 | 1.563 | 15.610 | .002 | .000*** | |||
| Diagnostics | ||||||||
| (LR) Chi-square | 31.647 | .000*** | ||||||
| Hosmer & Lemeshow test | 8.980 | .344 | ||||||
* p < .05;** p <.01. ;*** p <.001
Model 1;N=120, CRC:78.0 R2=0.282(Nagelkerke)
PMS/nonPMS=.030. MSQoLTotal+1.735.education
Linear regression analysis was applied to evaluate the effect of somatic and psychological symptoms of PMS on menopausal symptoms and menopausal quality of life, and it was found that both somatic and psychological symptoms significantly predicted menopausal symptoms and menopausal quality of life. The linear regression models for MRS levels according to PMSS-Psy and PMSS-Som and for MSQoL levels according to PMSS-Psy and PMSS-Som were illustrated in Table 4.
Table 4.
Linear regression models for MRS levels and MSQoL levels according to PMSS-Psy and PMSS-Som
| B | Std. Error | Beta | t | p | Zero-order | Partial | Tolerance | VIF | |
| *(Constant) | 11.282 | 1.885 | 5.986 | .000 | |||||
| 1 PMSPSY | .170 | .047 | .452 | 3.586 | .000 | .453 | .317 | .436 | 2.296 |
| PMSSOM | .001 | .071 | .002 | .018 | .985 | .342 | .002 | .436 | 2.296 |
| **(Constant) | 30.508 | 7.330 | 4.162 | .000 | 0.292 | ||||
| 1 PMSPSY | .599 | .184 | .410 | 3.248 | .002 | .466 | .434 | 2.303 | |
| PMSSOM | .166 | .278 | .075 | .597 | .552 | .383 | .056 | .434 | 2.303 |
Discussion
In our study; we investigated the presence of premenstrual symptoms at reproductive age in a group of postmenopausal women. Our primary aim was to detail whether menopausal symptoms have a relationship with previous premenstrual symptoms.
Premenstrual symptoms were common in our study population of postmenopausal women (24.2%) and were consistent with the prevalence of PMS in the general population in the literature2. The comparison of menopausal complaints of women with and without a history of PMS in the present study resulted that those with a history of PMS being more likely to experience somatic complaints, physical complaints, psychological complaints, and worse quality of life than women without a history of PMS.
Our data reveal a finding that a history of premenstrual symptoms is related to somatic, physical, and psychological menopausal complaints and worsened menopause-specific quality of life (MSQoL) in menopause. These findings were in line with some previous studies showing an association between a history of PMS and menopausal symptoms5,14. In the PMS group, the quality of life seemed worsened especially in terms of physical and psychosocial symptoms, but not in terms of vasomotor symptoms similar to the results of another previous study6.
Contrary to expectations, these relationships did not differ according to sociodemographic variables that were significantly associated with both PMS and menopausal symptoms, and were consistent with results of another study reporting that menopausal symptoms were not affected by sociodemographic variables6 but different from some others showing a relationship between sociodemographic variables and menopausal symptoms4,15. Similar to some sub-types of depressive disorders, as in an old-defined depression sub-type endogenous depression, it can be thought that PMS/PMDD and menopausal symptoms may occur, regardless of sociodemographic variables, and biological factors may be more effective than other factors16.
Participants with PMS history were likely to report psychological and psychosocial complaints in both menopausal scales. Some studies have reported that women with a history of PMS, were more likely to report mood symptoms around menopause17. It is known that estradiol (E2) variability has been associated with menopausal symptoms. E2 fluctuations in the transition to menopause are associated with depressive mood and a highly characteristic E2 pattern, which changes with age, and significantly predicts psychological and somatic complaints18,19. One mechanism that has been suggested to contribute to premenstrual symptoms is a deficiency or abnormal functioning of neurotransmitters in the central nervous system, such as serotonin and y aminobutyric acid20.
Gonadal hormone levels or their fluctuations during the menstrual cycle, and abnormal functioning of neurotransmitters at menopause may explain the occurrence of various premenstrual symptoms21,22 and contribute to a reduced MSQoL at menopause. In a study, the relationship between steroid hormone levels and menopausal symptom severity was evaluated and it was demonstrated that the severity of psychological, urogenital and total MRS scores were related to low progesterone and high testosterone levels23. Somatic and physical complaints were also significant in those with a history of PMS. Especially deterioration in the quality of life may be associated with these symptoms. Changes in autonomic nervous system regulation have been associated with both premenstrual symptoms and the transition to menopause20,21. Mood changes, sleep disturbances, and symptoms such as weakness and fatigue are conditions that most affect the quality of life and known to be affected by the autonomic nervous system7. One of the factors affecting menopausal symptoms and quality of life is metabolic syndrome (MetS), and particularly results of some studies showing the relationship between MetS and menopausal symptoms determine this situation. In one of these studies; it was shown that menopausal symptoms such as sleep problems, depressive symptoms and bladder problems were more common in those with MetS, and vasomotor symptoms were also partially affected by MetS24. In another study; hyprelipidemia was correlated with severe somatic symptoms and low Bone Mineral Density (BMD) levels that both conditions are factors that significantly affect quality of life25.
Considering the existence of studies showing the relationship between PMS and MetS26, it can be thought that these common aspects may play a role in the effect of the presence of PMS on menopausal symptoms and menopausal life quality.
One of the aspects expected to be particularly affected and may affect the quality of life during menopause is sexual functions. While the decrease in estrogen production directly affects sexual function, a decrease in libido may be expected27. There are many studies sharing data on sexual dysfunction in the climacteric period28,29. Other symptoms of menopause and sexual symptoms were positively correlated in these studies. In our study, scores related to sexual problems were low in both groups and there was no significant difference between the groups. Our data showing that women with PMS history, may be vulnerable to hormonal fluctuations during menopause, showed different results from previous studies on this subject. This situation can be interpreted as the participants' unwillingness to share their sexual problems and their cultural disapproval. Our results on this subject were also consistent with the data of another study that some of the participants evaluated sexual intercourse in the postmenopausal period as shameful-inappropriate or unnecessary28. It may also mean a very important problem, which means ‘no sex, no problem’.
A good understanding of premenstrual disorders is important for managing menopause. It is also true that managing PMS needs to understanding the mechanisms and management of menopause. For many women, premenstrual syndrome and natural menopause seem to be close to each other30. Maybe in the future according to many biological evidences, a mood disorder subtype just valid for the female sex might be defined and a diagnosis may arise as menopausal syndrome/ menopausal dysphoric disorder just as premenstrual syndrome/dysphoric disorder.
Limitations of the study
Our study has some limitations. First, we did not make a proper psychiatric examination of the participants. But the fact that there is no difference between the groups in the history of psychiatric diagnosis may enable the independent evaluation of other symptoms. Also, it may be thought that a prospective assessment of premenstrual symptoms would be more representative because of the memorizing difficulty. However, because premenstrual symptoms are often very disturbing, women can easily remember them. Furthermore, several international statements agree that premenstrual symptoms can be reliably evaluated retrospectively when a representative research tool such as PMSS is used21.
Secondly, it can be assumed that we are evaluating individual premenstrual symptoms rather than addressing clinical diagnoses ( PMS/PMDD). Women are diagnosed with PMS when their symptoms are strong and significantly impair work capacity or social life. Only women with the most severe premenstrual symptoms are diagnosed with PMDD29,31.
Evaluating the effect of symptoms on the quality of life of the women is a strength of our study. Because the fact that a condition affects the quality of life and functionality of the person for a disorder is an important criterion according to the diagnostic category.
Conclusion
Menopausal symptoms and premenstrual symptoms are related in terms of physical and psychosocial symptoms. Considering premenstrual syndrome and its severe form premenstrual dysphoric disorder is a chronic condition that occurs during every menstrual period and may continue and become chronic after menopause. This continuity may be partially deformed and the mild form may turn into menopausal syndrome and the severe form into menopausal dysphoric disorder. However, long-term and prospective longitudinal studies on larger populations may provide more evidence.
References
- 1.Stoner R, Camilleri V, Calleja-Agius J, Schembri-Wismayer P. The cytokine-hormone axis – the link between premenstrual syndrome and postpartum depression. Gynecological Endocrinology. 2017;33(8):588–592. doi: 10.1080/09513590.2017.1318367. [DOI] [PubMed] [Google Scholar]
- 2.Kadian S, O'Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18(2):43–47. doi: 10.1258/mi.2012.012. doi: [DOI] [PubMed] [Google Scholar]
- 3.American Psychiatric Association, author. Diagnostic and Statistical Manual of Mental Health Disorders: DSM-5. 5th ed. American Psychiatric Publishing; 2013. [Google Scholar]
- 4.Al-Musa HM, Ahmed RA, Alsamghan AS, Abadi S, Al-Saleem MAS, Alsabaani AAM, et al. The prevalence of symptoms experienced during menopause, influence of socio-demographic variables on symptoms and quality of life among women at Abha, Saudi Arabia. [November 5, 2016];Biomedical Research. 2017 28:6. [Google Scholar]
- 5.Freeman EW, Sammel SD, Rinaudo PJ, Sheng L. Premenstrual Syndrome as a Predictor of Menopausal Symptoms. Obstetrics & Gynecology. 2004;103:960–966. doi: 10.1097/01.AOG.0000124804.81095.7f. doi:10.1097/01.AOG.0000124804.81095.7f. [DOI] [PubMed] [Google Scholar]
- 6.Hautamaki H, Haapalahti P, Peltonen HS, Tuomikoski P, Ylikorkala O, Mikkola T. Premenstrual symptoms in fertile age are associated with impaired quality of life, but not hot flashes, in recently postmenopausal women. Menopause. 2014;21:1287–1291. doi: 10.1097/GME.0000000000000247. doi:10.1097/GME.0000000000000247. [DOI] [PubMed] [Google Scholar]
- 7.Baker FC, Colrain IM, Trinder J. Reduced parasympathetic activity during sleep in the symptomatic phase of severe premenstrual syndrome. J Psychosom Res. 2008;65:13–22. doi: 10.1016/j.jpsychores.2008.04.008. doi: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Morse CA, Dudley E, Guthrie J, Dennerstein L. Office for Gender Relationships between premenstrual complaints and perimenopausal experiences. J Psychosom Obstet Gynaecol. 1998;19:182–191. doi: 10.3109/01674829809025696. doi: [DOI] [PubMed] [Google Scholar]
- 9.Sut HK, Mestogullari E. Effect of premenstrual syndrome on work-related quality of life in Turkish nurses. Safety and health at work. 2016;7(1):78–82. doi: 10.1016/j.shaw.2015.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Gencdogan B. A new scale for premenstrual syndrome. Psychiatry in Turkey. 2006;8(2):82–86. [Google Scholar]
- 11.Heinemann K, Ruebig A, Potthoff P, Schneider HPG, Strelow F, Heinemann LAJ, et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes. 2004;2:45. doi: 10.1186/1477-7525-2-45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Yanikkerem E, Goker A, Çakir O, Esmeray N. Effects of physical and depressive symptoms on the sexual life of Turkish women in the climacteric period. Climacteric. 2018;21(2):160–166. doi: 10.1080/13697137.2017.1417374. [DOI] [PubMed] [Google Scholar]
- 13.Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 1996;24:161–175. doi: 10.1016/0378-5122(96)01038-9. doi: [DOI] [PubMed] [Google Scholar]
- 14.Chung SH, Kim TH, Lee HH, Lee A, Jeon DS, Park J, et al. Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Perimenopausal Women. Journal of Menopausal Medicine. 2014;20(2):69–74. doi: 10.6118/jmm.2014.20.2.69. doi: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Saied NH, Ahmmad MM, Ali NK. Prevalence of menopausal symptoms and its relationship with socio-demographic factors among women above 45 years in Mosul, Iraq. Revista Latinoamericana de Hipertensiôn. 2021;16(1):1–11. doi:10.5281/zenodo.5095348. [Google Scholar]
- 16.Liao J, Mi X, Zeng G, Wei Y, Dai X, Ye Q, et al. Circuit-wide proteomics profiling reveals brain region-specific protein signatures in the male WKY rats with endogenous depression. Journal of Affective Disorders. 2022;320:98–107. doi: 10.1016/j.jad.2022.09.086. doi: [DOI] [PubMed] [Google Scholar]
- 17.Schmidt PJ, Dor RB, Martinez PE, Guerrieri GM, Harsh VL, Thompson K, et al. Effects of estradiol withdrawal on mood in women with past perimenopausal depression: A randomized clinical trial. JAMA Psychiatry. 2015;72(7):714–726. doi: 10.1001/jamapsychiatry.2015.0111. doi:10.1001/jamapsychiatry.2015.0111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Gordon JL, Sander B, Moul TAE, Tottenham LS. Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition. Psychological medicine. 2021;51(10):1733–1741. doi: 10.1017/S0033291720000483. [DOI] [PubMed] [Google Scholar]
- 19.Wei SM, Schiller CE, Schmidt PJ, Rubinow DR. The role of ovarian steroids in affective disorders. Curr. Opin. Behav. Sci. 2018;23:103–112. doi:10.1016/j.cobeha.2018.04.013. [Google Scholar]
- 20.Yen JY, Wang PW, Su CH, Liu TL, Long CY, Ko CH. Estrogen levels, emotion regulation, and emotional symptoms of women with premenstrual dysphoric disorder: The moderating effect of estrogen receptor 1a polymorphism. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;82:216–223. doi: 10.1016/j.pnpbp.2017.11.013. doi: [DOI] [PubMed] [Google Scholar]
- 21.Slopien R, Pluchino N, Szymankiewicz AW, Sajdak S, Luisi M, Drakopoulos P, et al. Allopregnanolone and Depressive Symptoms in menopausal transition Correlation between allopregnanolone levels and depressive symptoms during late menopausal transition and early postmenopause. Journal of Gynecological Endocrinology. 2018;34:144–147. doi: 10.1080/09513590.2017.1371129. doi: [DOI] [PubMed] [Google Scholar]
- 22.McEvoy K, Osborne LM. Allopregnanolone and reproductive psychiatry: an overview. Journal International Review of Psychiatry. 2019;31:237–244. doi: 10.1080/09540261.2018.1553775. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Kaya C, Cengiz H, Yesil A, Ekin M, Yasar L. The relation among steroid hormone levels, lipid profile and menopausal symptom severity. J Psychosom Obstet Gynaecol. 2017;38(4):284–291. doi: 10.1080/0167482X.2017.1321633. doi: 10.1080/0167482X.2017.1321633. [DOI] [PubMed] [Google Scholar]
- 24.Cengiz H, Kaya C, Caypinar SS, Alay I. The relationship between menopausal symptoms and metabolic syndrome in postmenopausal women. J Obstet Gynaecol. 2019;39(4):529–533. doi: 10.1080/01443615.2018.1534812. doi: 10.1080/01443615.2018.1534812. [DOI] [PubMed] [Google Scholar]
- 25.Alay I, Kaya C, Cengiz H, Yildiz S, Ekin M, Yasar L. The relation of body mass index, menopausal symptoms, and lipid profile with bone mineral density in postmenopausal women. Taiwanese Journal of Obstetrics & Gynecology. 2020;59(1):61–66. doi: 10.1016/j.tjog.2019.11.009. DOI: 10.1016/j.tjog.2019.11.009. [DOI] [PubMed] [Google Scholar]
- 26.Hashemi S, Tehrani FR, Mohammadi N, Dovom MR, Torkestani F, Simbar M, et al. Comparison of metabolic and hormonal profiles of women with and without premenstrual syndrome: A community based cross-sectional study. International journal of endocrinology and metabolism. 2016;14(2) doi: 10.5812/ijem.28422. doi: 10.5812/ijem.28422. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Aslan E, Pocan GA, Dolapcioglu K, Savas N, Bagis T. The influence of hormonal status and socio-cultural determinants on postmenopausal sexual dysfunction. Turk J Obstet Gynecol. 2008;5(4):263–268. [Google Scholar]
- 28.Ikeme ACC, Okeke TC, Akogu SPO, Chinwuba N. Knowledge and perception of menopause and climacteric symptoms among a population of women in Enugu, South East, Nigeria. Annals of Medical and Health Sciences Research. 2011;1(1):31–36. [PMC free article] [PubMed] [Google Scholar]
- 29.O'Brien PM, Backstrom T, Brown C, Dennerstein L, Endicott J, Epperson CN, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14:13–21. doi: 10.1007/s00737-010-0201-3. doi: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Dar SA, Wani ZA, Bhat BA, Sheikh S, Nabi J, Khanam A, et al. Anxiety and Depression in Menopausal Transition: A Hospital Based Study from Kashmir. Medical Journal of Dr. D.Y. Patil Vidyapeeth. 2022;13:37–42. doi:10.4103/mjdrdypu.mjdrdypu_68_19. [Google Scholar]
- 31.Baker LJ, O'Brien PM. Premenstrual syndrome (PMS): a perimenopausal perspective. Maturitas. 2012;72:121–212. doi: 10.1016/j.maturitas.2012.03.007. doi: [DOI] [PubMed] [Google Scholar]