Using Ecological Momentary Assessment to Understand the Psychological Mechanisms Underlying the Premenstrual Exacerbation of Internalizing Symptoms

Premenstrual symptoms are distressing and impairing for individuals and costly to society. While early work has focused on understanding premenstrual disorders as dichotomous diagnoses, these symptoms are heterogeneous within and across people, and they are dimensional, occurring on a spectrum. Furthermore, premenstrual symptoms are inherently dynamic—changing over the menstrual cycle and peaking perimenstrually. While some efforts have been made to understand the dynamics of premenstrual symptoms, two major gaps in the literature remain. First, we lack a solid understanding of the covariation among symptoms over the course of the menstrual cycle. Second, we know remarkably little about the trajectories of these symptoms, and why symptoms might take different courses. To address these gaps, a sample of female undergraduates (N=85) who reported no use of hormonal birth control and regularly occurring menstrual periods were recruited for a four month-long experience sampling study. Participants completed an electronic daily diary of premenstrual symptoms and menstrual status. First, we conducted a multilevel exploratory factor analysis of the daily diary items. We identified six distinct but correlated symptom domains at the within-person level which were affective, cognitive, interpersonal, pain, and somatic. Second, we evaluated the impact of menstrual cycle phase on each symptom domain. We found that symptoms were significantly greater in the perimenstrual phase relative to other phases in all symptom domains but that the relative severity of this effect differed across domains. Somatic symptoms exhibited greater perimenstrual phase exacerbation compared to other domains. Finally, we characterized the trajectories of each symptom domain. Results pointed to the uniqueness of each symptom domain’s trajectory. Taken together, our findings highlight the importance of investigating the differences among symptom domain trajectories and underscore the need for future research to elucidate the unique mechanisms that underly each trajectory.