Gillian Einstein

Mood and the Menstrual Cycle: A Review of Prospective Data Studies

BACKGROUND The human menstrual cycle (MC) has historically been the focus of myth and misinformation, leading to ideas that constrain womens activities. OBJECTIVES We wished to examine one pervasive idea, that the MC is a cause of negative mood, by studying the scientific literature as a whole. We briefly reviewed the history of the idea of premenstrual syndrome and undertook a systematic review of quality studies. METHODS We searched PubMed, PsycINFO, and article bibliographies for published studies using non-help-seeking samples with daily mood data collected prospectively for a minimum of 1 complete MC. We critiqued their methodologies and tabulated the key findings. RESULTS Of 47 English language studies identified, 18 (38.3%) found no association of mood with any MC phase; 18 found an association of negative mood in the premenstrual phase combined with another MC phase; and only 7 (14.9%) found an association of negative mood and the premenstrual phase. Finally, the remaining 4 studies (8.5%) showed an association between negative mood and a non-premenstrual phase. Considering the only 41 adequately powered studies, the same phase links were reported by 36.6%, 41.5%, and 13.5% of studies, respectively. Their diversity of methods (sampling, instruments, and cycle phase definitions) precluded a meta-analysis. CONCLUSIONS Taken together, these studies failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population. This puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality.

Ovarian hormones and chronic pain: A comprehensive review

Most chronic noncancer pain (CNCP) conditions are more common in women and have been reported to worsen, particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraine headache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except menstrual migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions.

The postconventional body: Retheorising women's health

We propose that womens health-both theory and practice-is a powerful arena in which to re-align and change the modernist theoretical underpinnings of current biomedical paradigms, which limit our understanding both of concepts of health and illness and of the impact of health care technologies on the body. We highlight the necessity of a move to a more dynamic paradigm for health and illness in the clinic, as well as a theoretical fluidity that allows for the real messiness of lived bodies. We argue that postmodernist thought, within wider feminist theory, is one of many perspectives that can contribute to contemporary biomedicine by providing theoretical underpinnings to develop 1) an understanding of bodies in context, 2) an epistemology of ignorance, and 3) an openness to the risk of the unknown. While these all entail a commitment to self-reflection and a willingness to be unsettled, which may not seem practical in the context of medical practice, we argue that self-reflection and unsettledness will provide pathways for grappling with chronic conditions and global bodies. Overall, we suggest that womens health practice can serve as a site in which both sides of the humanistic/scientific divide can engage with a human self in all its corporeal variety, contingency, and instability. More specifically, by providing a space within the clinic to examine underlying ontological, epistemological, and ethical assumptions, womens health can continue to contribute to new forms of biomedical practice.

The role of ovarian steroid hormones in mood.

Fluctuations in ovarian hormones across the menstrual cycle have long been considered a determinant of mood in women. The majority of studies, however, use menstrual cycle phase as proxy for hormone levels. We measured ovarian hormone levels directly in order to examine the relationship between daily hormone levels and mood in non-help-seeking women. Participants (n=19) provided daily information about their positive and negative moods, and collected their first morning-voided urine for 42days, which was analyzed for estrogen and progesterone metabolites (E1G and PdG). The independent contributions of daily E1G, PdG, stress, physical health, and weekly social support, were calculated for 12 daily mood items, and composite measures of positive and negative mood items, using linear mixed models. E1G or PdG contributed to few mood items: E1G measured 2days prior contributed negatively to the model for Motivation, while E1G measured 3days prior contributed negatively to Getting Along with Others, and E1G measured 4days prior contributed negatively to Anxiety. PdG, measured the same day and 1day prior, contributed positively to the models of Irritability, and PdG measured 5days prior contributed positively to Difficulty Coping. By contrast, the variables stress and physical health contributed significantly to all the mood items, as well as both composite positive and negative mood measures. These findings demonstrate that, compared to stress and physical health, ovarian hormones make only a small contribution to daily mood. Thus, fluctuations in ovarian hormones do not contribute significantly to daily mood in healthy women.

From Body to Brain: Considering the Neurobiological Effects of Female Genital Cutting

Female genital cutting (FGC) is an ancient tradition unbounded by religion and practiced primarily in Africa and the regions to which Africans have immigrated. All types of FGC involve cutting neural innervation to the vulva: the clitoris, labia majora and minora. Most types include excision of the clitoris. Since the tissue of the vulva is highly innervated by nerves and their endings, I postulate here that the brain and spinal cord will respond to FGC as it would to any loss of neural targets or inputs: by rearranging neural networks. This, in turn, would affect neural signaling to target structures and modify sensory perception. Most scientific investigations of FGC have focused on its reproductive consequences. To fully appreciate its effects on the lives of women, however, an understanding beyond the reproductive system is necessary. Exploring the potential neural changes of FGC may help explain the mixed responses of the women themselves and identify new directions for research to understand their lives. A neurobiological analysis may also help us understand how cultural practices inscribe meaning on central nervous system structures, affecting mind as well as body.

Measuring estrogens and progestagens in humans: an overview of methods.

Estrogens and progestagens (ovarian steroids) not only play an important a role in sexual behavior and reproduction, but they are involved in the development, regulation, and function of all body systems, including aging, sleep, pain, pharmacodynamics, immune response, and cognition. They are essential to the maintenance of cardiovascular, renal, mental, and bone health. Often, their effects are positive and their absence, negative. However, in certain contexts they can promote the development of cancers and neurologic conditions. Finally, ovarian steroids can even affect the response to pharmacologic treatments for many diseases. Given their central role in human biology, it is essential to be able to accurately determine the circulating levels of these hormones. To facilitate such endeavors, this review provides a comprehensive overview of the role of ovarian steroids in normal and abnormal physiology, primarily in women. It discusses the sensitivity, specificity, and precision of the most commonly used assays for estrogens and progestagens: bioassay, immunoassay, and mass spectrophotometry. Examples of how each of these assays has been used with samples taken from serum, urine, and saliva are provided. Strengths and limitations of each method are discussed.

Mood and the Menstrual Cycle

Background: Premenstrual mood symptoms are considered common in women, but such prevailing attitudes are shaped by social expectations about gender, emotionality and hormonal influences. There are few prospective, community studies of women reporting mood data from all phases of the menstrual cycle (MC). We aimed (i) to analyze daily mood data over 6 months for MC phase cyclicity and (ii) to compare MC phase influences on a woman’s daily mood with that attributable to key alternate explanatory variables (physical health, perceived stress and social support). Method: A random sample of Canadian women aged 18–40 years collected mood and health data daily over 6 months, using telemetry, producing 395 complete MCs for analysis. Results: Only half the individual mood items showed any MC phase association; these links were either with the menses phase alone or the menses plus the premenstrual phase. With one exception, the association was not solely premenstrual. The menses-follicular-luteal MC division gave similar results. Less than 0.5% of the women’s individual periodogram records for each mood item showed MC entrainment. Physical health, perceived stress and social support were much stronger predictors of mood (p < 0.0001 in each case) than MC phase. Conclusions: The results of this study do not support the widespread idea of specific premenstrual dysphoria in women. Daily physical health status, perceived stress and social support explain daily mood better than MC phase.

The Hermunculus: What Is Known about the Representation of the Female Body in the Brain?

The representation of the body in the brain, the homunculus, was posited by Wilder Penfield based on his studies of patients with intractable epilepsy. While he mapped both male and female patients, Penfield reports little about the females. The now iconic illustration of the map is clearly male with testicles, penis, and no breasts. In order to bring attention to this omission and to stimulate studies of female somatosensory cortex (SS), we discuss what is known about the map of the female body in the brain, including Penfields findings in his female patients and subsequent work by others exploring the human female SS. We reveal that there is much we do not know about how the entire female body is represented in the brain or how it might change with different reproductive life stages, hormones, and experiences. Understanding what is and is not currently known about the female SS is a first step toward fully understanding neurological and physiological sex differences, as well as producing better-informed treatments for pain conditions related to mastectomy, hysterectomy, vulvodynia, and fibromyalgia. We suggest that the time is ripe for a full mapping of the female brain with the production of a hermunculus.

Integrating topics of sex and gender into medical curricula—lessons from the international community

In the era of individualized medicine, training future scientists and health-care providers in the principles of sex- and gender-based differences in health and disease is critical in order to optimize patient care. International successes to incorporate these concepts into medical curricula can provide a template for others to follow. Methodologies and resources are provided that can be adopted and adapted to specific needs of other institutions and learning situations.

Sleep quality and the menstrual cycle

OBJECTIVE This study aimed to assess the temporal relationship of subjective sleep quality to menstrual cycle phase in a community (non help-seeking) sample of adult women over six months. Previous work has produced contradictory results and often used student samples. PARTICIPANTS/METHODS PATIENTS/METHODS This was a cohort study, using daily electronic data collection in the Greater Toronto Area, Ontario, Canada; 76 women aged 18-42 years recruited by random digit telephone dialing, recorded mood, sleep quality, and other health variables on a daily basis for 24 weeks. RESULTS Using linear mixed models, we assessed the relationship between subjective sleep quality and three menstrual cycle phases (menses, premenstrual and midcycle) over 395 cycles. Premenstrual sleep quality was poorer than during the rest of the cycle, with a mean difference of 1.32 between premenstrual and midcycle reference phase, on a 1-100 quality scale (higher score denotes poorer quality). This difference held when the independent variables of daily exercise and physical health were added to the model; it became non-significant when perceived stress and later, social support were also added to the model. CONCLUSIONS Sleep quality in adult non-help seeking women is statistically poorer in the premenstruum but the size of the difference is of little clinical significance and was no longer statistically significant with inclusion of the potentially confounding variables, perceived stress and social support.