See also Wikipedia:Featured article review/Menstrual cycle/archive2, continued from Talk:Menstrual cycle/Archive 3
I think this article should mention catamenial epilepsy. That wiki article was created way back in 2009, and barely tweaked since. However, it is quite a significant problem, related to the menstrual cycle. According to this article "Catamenial epilepsy is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy." There are plenty other reviews and such on PubMed, including this one from Cochrane. There's also Catamenial migraine aka Menstrual migraine. Googling has also uncovered Catamenial pneumothorax (and Catamenial hemothorax), which are much rarer. -- Colin° Talk 17:01, 22 March 2021 (UTC)
Thanks again, Graham ( Clayoquot, how's it coming?)
Graham, here are we switching terminology mid-stream? which correspond to the perimenstrual, ovulatory and the luteal phases
? That is, will layreaders know how the word perimenstrual relates to our previously defined terminology for the phases ?
SandyGeorgia (
Talk)
17:29, 24 March 2021 (UTC)
Here's a progress update from my "More expert comments coming" section above. I've been talking with two experts from the Centre for Menstrual Cycle and Ovulation Research. One of them is my friend Jerilynn Prior, Professor of Endocrinology and Metabolism at UBC. They've identified some issues and we're working together on making them into actionable comments with MEDRS sources. We'll probably be done sometime next week. The comments will probably be around 1) adding two or three sentences about anovulation, 2) hormone levels, 3) effects of hormonal birth control, and 4) factual consistency issues.
Clayoquot ( talk | contribs) 19:58, 24 March 2021 (UTC)
Naturally occurring hormones drive the cycles; the cyclical rise and fall of the hormone estrogen prompts the production and growth of oocytes (immature egg cells.. It is more accurate to say that FSH promotes the growth of oocytes. In fact, later in the article it states “Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated.” Clayoquot ( talk | contribs) 06:10, 28 March 2021 (UTC)
The hormone progesterone stimulates the uterus lining to thicken to accommodate an embryo, It’s actually estrogen that thickens the lining. Progesterone causes differentiation into a secretory organ that is receptive to implantation. 05:27, 29 March 2021 (UTC)
Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity., It’s not clear which hormones are being referred to here. Hormones that stop follicles from growing? Clayoquot ( talk | contribs) 05:27, 29 March 2021 (UTC)
The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy. After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle.[38] These hormones also prepare the mammary glands for milk[a] production.[38]Seems like this discussion of the placenta does not belong in this article. Clayoquot ( talk | contribs) 05:27, 29 March 2021 (UTC)
Clayoquot, this edit could be discussed. The text removed was a good summary of a high quality source. SandyGeorgia ( Talk) 05:16, 4 April 2021 (UTC)
These edits introduce estradiol without defining it (or linking it); the text earlier explained that estradiol is an estrogen. SandyGeorgia ( Talk) 05:20, 4 April 2021 (UTC)
In this edit, I am not seeing (?) where in the article this is repeated: “For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.” SandyGeorgia ( Talk) 05:25, 4 April 2021 (UTC)
This edit separated text from its citation. SandyGeorgia ( Talk) 05:28, 4 April 2021 (UTC)
Clayoquot, I don’t understand this edit; this is helpful text. Perhaps the CemCOR people are used to writing for a different audience. Perhaps we could slow this process down and discuss all of their suggestions? SandyGeorgia ( Talk) 05:39, 4 April 2021 (UTC)
It may be better to slow down and make sure we are all on the same page; I am concerned about these edits. Slow and steady wins the race. Tony1 has always set the example for how to work together on fine tuning text, as explained in this article where he is the unnamed language mentor.
Perhaps more querying back-and-forth would help here, as we are losing some critical text, and introducing some confusion. I was thinking that waiting until after the Easter holiday might be a good idea. I’m particularly concerned that we keep text associated with its citation, as this is a featured article. The way Tony1 always worked with me— and that I found very helpful— was via inserting inline hidden comments when there was confusion, so I could consult the sources and clarify. If the problem was larger than could be resolved via inlines, then he would query talk. Maybe we can try some of his style here to make for less work in the longrun? SandyGeorgia ( Talk) 06:08, 4 April 2021 (UTC)
Thanks everyone for the suggestions. What they've done is pasted the article in to a Word document and revised it with Tracked Changes and comments. It sounded like a great idea at a time but trying to triage the changes and convert them back into Wikipedia is kind of horrible. I'll think and talk with them some more about ways to move forward.
Over in my multi-cultural household, we will be marking the end of Passover tonight with pasta. Tomorrow there will be dim sum, an Easter egg hunt, and in the evening my husband and I will probably be congratulating each other on having survived a four-day weekend with two young children :) Clayoquot ( talk | contribs) 19:27, 4 April 2021 (UTC)
Thanks again everyone. I had a good chat with the CeMCOR people today. We've decided the best way forward is to provide Talk page comments, and can do that towards the end of next week if that's OK. They very much appreciate Wikipedia's role as an educational resource and are grateful for the efforts of the volunteers here to provide quality information on women's health. Clayoquot ( talk | contribs) 22:35, 7 April 2021 (UTC)
In trying to set up the Prior citation to be consistent with the other citations, encountering some problems. It is now given as:
For consistency, the citation would be in this format:
but the ISBN needs to be corrected, and we need page numbers for each instance where we are citing it. If we are using an e-book that does not have page nos, then we need section headings. I can set up the sfns to incorporate either page nos or section headings, but first have to get the basic citation fixed. SandyGeorgia ( Talk) 23:08, 29 March 2021 (UTC)
OK, they're in, like this:
You can just substitute the ? with page no. If there is a page range instead, it would look like this:
I don't know if you have worked with sfns before ... when the page number is the same, it automatically works like a named ref and groups them together, so don't worry about the usual named ref issue. Just plug a number in to each instance of Prior. SandyGeorgia ( Talk) 23:31, 29 March 2021 (UTC)
I've run through this subsection. Two things I can't resolve by myself. Experts might guess, but non-experts need greater precision:
(1) "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy."
Does it mean: "During the first few months of pregnancy, the corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation."?
Or does it mean: "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at *ovulation during the first few months of pregnancy*."?
Probably the former, so it could be fixed.
In either case, consider "... at slightly higher levels than those ...".
(2) "After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Backreference ambiguity: is it just hCG that stimulates ..., or is it both "these hormones" and "hCG" that stimulate ...?
To clarify, either: "the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG); these stimulate the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Or: "the placenta secretes high levels of these hormones – along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Tony (talk) 06:54, 4 April 2021 (UTC)
Starting a section to look at what's left to do. SandyGeorgia ( Talk) 15:57, 11 March 2021 (UTC)
Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones. Graham Beards ( talk) 14:19, 8 March 2021 (UTC)
I can't see anything on the menstrual cycle in Alosco and Stern. Graham Beards ( talk) 14:30, 8 March 2021 (UTC)
Where do we stand on this? SandyGeorgia ( Talk) 15:57, 11 March 2021 (UTC)
This might be useful if we can precis the salient conclusions.
- Graham Beards ( talk) 17:53, 11 March 2021 (UTC)
I think it's good that the 80% figure was removed. It was inaccurate as is. Things like tender breasts, cramps, bloating, feeling tired, irritability and mood changes do disrupt most women's lives at one or more points during their cycle. I would think that obvious. Disrupting their daily life and being severe enough to stop them from going about their typical day are two different things. I imagine that is why the Hong Ju, Mark Jones, Gita Mishra source [3] says "severe pain limiting daily activities is less common" and this source [4] (Wendy Biggs and Robin Demuth) says "substantial disruption." These sources use the words "limiting" and "substantial disruption." A woman can have disruption because of her period without it being substantial disruption. And then there's the inconsistency on what qualifies as PMS (also mentioned in the PMS section back up on the page). [5] Regardless, according to these and other sources, most women will get one or more painful symptoms during their cycle/near or during their period. These are enough of an issue for the women to take medication for it. The reality that many women need to take medication for it, most commonly for cramps, is indicative that the symptom has disrupted the woman's daily life. The menstrual health section said, "Painful cramping in the abdomen, back, or upper thighs can occur during the first few days of menstruation. Severe uterine pain during menstruation is known as dysmenorrhea, and it is most common among adolescents and younger women (affecting about 67.2% of adolescents)." That's disrupting daily life, and 67% is not a minority. I know that this information has been reworked, but I'm commenting on the adolescent thing in the case we come about a better source for it.
When we use the words "disrupt daily life", we have to be careful to not report this as occurring in a minority of women. The Wendy Biggs and Robin Demuth source says "without substantial disruption", which is not the same thing as "no disruption." It's just that a minority of women experience symptoms that significantly limit/interfere with their daily activities. So, based on the sources, it's probably more prudent to alter "During their menstrual cycle, some women experience problems that disrupt daily life" so that we have it saying "During their menstrual cycle, many women experience painful symptoms." If we re-add the "no disruption to daily life" phrasing at some point, it should be altered so that we have it saying "no substantial disruption to daily life" or "no significant disruption to daily life." By the way, I think "cramps" should replace "acne" in the introduction. Cramps are the most common of the symptoms. "Acne" (mentioned in this [6] discussion back up on the page) isn't as serious a concern as the others (for most women, I'd say). ApproximateLand ( talk) 23:59, 12 March 2021 (UTC)
so there is no need to get off into medical conditions affecting the minority— particularly when we are sourcing those statements to articles about PMS. SandyGeorgia ( Talk) 13:52, 13 March 2021 (UTC)Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones.Graham Beards (talk) 14:19, 8 March 2021 (UTC)
@ApproximateLand :). Welcome to Wikipedia, and thanks for trying to help here. Graham is right that shorter messages are way more convincing; I'm definitely too tired after a day of work to read long posts like the one you posted above. @Graham; ApproximateLand is new around here; don't bite :) (I do appreciate you may be tired after your heroic work here). FemkeMilene ( talk) 22:36, 14 March 2021 (UTC)
Done, [12] and I standardized journal articles to sentence case, as we had a mix (book titles use title case). SandyGeorgia ( Talk) 00:27, 13 March 2021 (UTC)
I've asked a friend of mine who is an endocrinologist what she thinks of the article now and had the following conversation with her: She said "Looks pretty good! Apart from the “ovulation occurs around day 14” statement. It should be “.. occurs around 14 days before onset of menses” - a different thing!". I replied "I am trying to understand which sentence(s) you are saying needs changing. So I did a word search for "Day " in the article and found it mentioned a few times, e.g. "Around day fourteen, the egg is released from the ovary" Would you argue against the usage of things like Day 1, Day 14 etc. altogether?" Her reply: "It’s fine to use day 1 etc for most things, but the day the egg is released is dependent on how long a women’s cycle is, and is only day 14 if a woman has a 28 day cycle.". So I am wondering if we should clarify this? That the "Day 14" statement only applies to women who have a 28-cycle day? It might otherwise be taken as a given that for all women it's on Day 14. EMsmile ( talk) 04:12, 15 March 2021 (UTC)
I encouraged my endocronologist friend to take a further look at the article, and here is some more feedback from her:
Grammar problem. End with: “or resumption of normal menstrual cycles”. EMsmile ( talk) 12:46, 16 March 2021 (UTC)
It is perchance that I am obtuse, so if I am misunderstanding the posts of others, please spell it out for me Dummies 101 style, but we still seem to have one thing pending.
NikosGouliaros asked for some information on psychological aspects. WhatamIdoing came up with Else-Quest, a 2021 source, [15] which was summarized to two sentences by Graham. Femkemilene pointed out that we are still using sources about menstruation (UNDUE and off-topic here in my opinion, but I digress), and I note that we still haven't used WAID's source which specifically addresses the menstrual cycle (as opposed to menstruation). In that same discussion, Graham produced yet another recent review which explains the variance in menstruation literature (again answering the UNDUE aspect of adding menstruation issues as affected by environmental, cultural, societal factors and comorbidities here), and yet somehow we still never got back to the menstrual cycle source provided by WAID. We seem to have forgotten a piece amid other discussions; or am I missing something?
I would add something from Else-Quest myself, but google preview only lets me see the first page. I suggest we still need to address the issue raised by NikosGouliaros, and WAID's source is a good one for doing that; would someone add a few sentences under Menstrual health, or alternately, email me the chapter if possible? SandyGeorgia ( Talk) 15:02, 16 March 2021 (UTC)
There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a "very small" increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle.
The culturally communicated belief that the premenstrual time is associated with poor mood or that menstruation is a painful, shameful, or unclean experience may be a self-fulfilling prophecy. The belief can cause women to feel worse. It can also result in people, including the affected woman, attributing a woman's normal and appropriate mood variation to the menstrual cycle, so that a premenstrual woman who feels angry about a real problem can be dismissed by herself and others as merely suffering from hormones.
Non-psychological changes are also small and uncommon. Athletic performance does not vary with hormones. General intellectual performance, including overall academic performance, problem-solving ability, memory, or creative thinking, does not vary during the menstrual cycle. Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.
"Um, of course the menstrual cycle has an effect on psychological status? Because if it didn't, then PMS and PMDD wouldn't be a thing. As for sources that we could use, it's tough. You might consider [The Psychology of Women and Gender reference], which says that mood effects are 'very small', seen in both pre-menstrual and menstrual phases, and that external 'factors such as stress, health, and social support are more important'. There is evidence for a hormonal effect, and it also indicates that the effects that are self-reported might be culturally conditioned (e.g., through movies that say women are 'supposed to' have PMS, through stress caused by menstrual taboos, etc.)"WhatamIdoing quoted part of the source saying,
"There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a 'very small' increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels."WhatamIdoing said,
"Also, it specifically says that while some women are slightly more likely to 'feel like' crying, they are not actually more likely to do it (so, no actual shift in behavior, just in mood for that point)."WhatamIdoing said,
" 'Little evidence' is the wrong approach. There is 'evidence against' mood swings being a general problem."And even so the article tells us that the menstrual cycle affecting women's moods "has not been confirmed by research." Use of "has not been confirmed" is very different from "much of the research is weak" and "very small", especially when we consider that premenstrual dysphoric disorder, which concerns the menstrual cycle, is a real thing that affects women's moods/affects them psychologically. [17] The Psychology of Women and Gender reference also says that "spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.", but this has been left out of the article. The source says "general intellectual performance", not "intellectual performance." It just feels like you focused on "culture may be causing this" speculation even though that is what is unproven.
Conclusion: Graham used WAID's summary and consulted the source to make sure text conformed to source as he adjusted wording and corrected other changes. No other sources have been provided; IMO, it looks good so far. WhatamIdoing how are we doing with this version? SandyGeorgia ( Talk) 23:47, 21 March 2021 (UTC)
WAID, Graham is using the 9th edition and you have the 10th. I added pages= 258 to 61. When you look in, could you confirm that we have the right page nos, and that everything is verifiable from those pages (else add sfns as needed). SandyGeorgia ( Talk) 00:21, 22 March 2021 (UTC)
For those interested in what our Wikipedia page says right now, with the phrasing of "little evidence", vs. what WhatamIdoing said vs. what the source says, this
[27] edition of it (and on page 259) says that "In sum, the results of the research suggest that there are small fluctuations in mood corresponding to the phases of the menstrual cycle, at least in some women, but that factors such as stress, health, and social support are more important."
It also discusses speculation that high levels of estrogen (at ovulation) might be associated with positive moods and that low levels of estrogen and progesterone premenstrually might be associated with negative moods, but that these speculations have a history of being criticized (pointing out, for example, that
correlation does not imply causation). It says that "in other words, the data simply demonstrate a correlation between cycle phase or hormone levels and mood, but they cannot tell us that hormones actually cause or influence the mood."
It says a bunch of other stuff too, including the idea that the reverse may be true (that psychological factors may affect hormone levels and menstrual cycle phase).
Menstrual cycle mood changes are also associated with perimenopause and menopause. Yesterday, I read portions of this [28] ref ("Lewis's Medical-Surgical Nursing EBook: Assessment and Management of Clinical Problems"), all of this [29] ref (Cognition and mood in perimenopause: A systematic review and meta-analysis), this [30] ref (Menopausal Symptoms and Their Management), this [31] ref (Management of the Perimenopause), and this [32] ref (Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms). The last reference (a 2018 review) is more directly about the subject (menstrual cycle mood changes) and has one section dedicated to mood, and it would seem this is all academics know so far about mood in terms of the menstrual cycle and aging. These are the most recent references I've located about mood in terms of the menstrual cycle and aging, but I might have overlooked something. ApproximateLand ( talk) 08:53, 22 March 2021 (UTC)
Just a heads up that in the next few days, I'll be sending some comments on this article from a friend who is an endocrinology professor at UBC. Clayoquot ( talk | contribs) 22:28, 18 March 2021 (UTC)
Clayoquot and Graham; when you are all done working through the CeMCOR comments, I will go back and deal with wikilinking on first occurrence, consistency in citations, etc etc (MOS-y stuff), but for now will stay out of your way so editing can proceed without too many cooks in the kitchen. Let me know when the coast is clear :) SandyGeorgia ( Talk) 16:04, 29 March 2021 (UTC)
I was waiting for work to finish before raising this, as the lead could be changing, but ... Citations in leads raise concerns at FAC. Do we need all of these lead cites? I was going to reduce some, but some of the citations in the lead are not in the body. SandyGeorgia ( Talk) 13:07, 18 April 2021 (UTC)
Here are the remaining comments from CeMCOR. I've put them below verbatim and have done only a cursory checking of sources. References to (Prior, 2020) refer to a book chapter that is already in the article bibliography. Have fun! Clayoquot ( talk | contribs) 01:09, 14 April 2021 (UTC)
References
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I have made these changes [38] in light of these helpful comments. I have not fully taken on board the comments regarding "ovulatory disturbances". I think these would give undue weight in an encyclopedia article. Graham Beards ( talk) 09:23, 14 April 2021 (UTC)
There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles. The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or unclean could be a self-fulfilling prophecy.. If some don’t like the wording, then we can have WhatamIdoing revisit her longer version above, but leaving this content out completely leads us back to the medicalization of a condition which is not problematic for most women, with some of that being influenced by environmental and societal factors. We have a good source on this and should be using it; perhaps we can revisit WAID’s longer version (above) for refining the wording. SandyGeorgia ( Talk) 13:57, 14 April 2021 (UTC)
There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a "very small" increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle. The culturally communicated belief that the premenstrual time is associated with poor mood or that menstruation is a painful, shameful, or unclean experience may be a self-fulfilling prophecy. The belief can cause women to feel worse. It can also result in people, including the affected woman, attributing a woman's normal and appropriate mood variation to the menstrual cycle, so that a premenstrual woman who feels angry about a real problem can be dismissed by herself and others as merely suffering from hormones. Non-psychological changes are also small and uncommon. Athletic performance does not vary with hormones. General intellectual performance, including overall academic performance, problem-solving ability, memory, or creative thinking, does not vary during the menstrual cycle. Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.
FYI, I've pointed CeMCOR to this discussion and they are looking for secondary sources to fill the gaps that have been identified. Thanks everyone for all the fantastic work. Clayoquot ( talk | contribs) 06:19, 15 April 2021 (UTC)
Just got some emails from the CeMCOR people. They are OK with re-adding the sentence "There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles." Regarding The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or
unclean could be a
self-fulfilling prophecy
, they agree with the general idea but found the wording jarring and incongruous with the rest of the article. They've suggested as a replacement (which we could of course play around with), "There are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding."
Clayoquot (
talk |
contribs)
21:39, 16 April 2021 (UTC)
FWIW, the full thing that CeMCOR said was "I would add to the bit about mood that there are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding. In addition, it is easier for women as well as others to have “something safe to blame” when they are irritated or anxious or depressed related to the stresses of their dual or triple role “jobs,” are deeply troubled by negative sex biases in the workplace or society, or are also dealing with things like cramps or headaches that increase premenstrually. In adolescence and in perimenopause, there is evidence that the hormonal changes of the menstrual cycle (in particular, higher estradiol and lower progesterone levels) are related to women’s tendency to be moody. In addition, in perimenopause, rapid downward swings of estradiol (that are common and also associated with hot flushes/flashes or night sweats) are now being associated with increased anxiety and depression... If you want a reference for a review of the association of downward swings in estradiol on VMS and mood, here it is. [39]"
I didn't bring this comment forward earlier because 1) There are some things in it that are not 100% in the sources that were provided or any source I'm familiar with, and 2) The source provided for most of this was a book chapter from 2002 - if the date doesn't bother you I can provide quotes and/or email the file. The gist of this that's important is that premenstrual mood changes are both society/culture and biology/physiology. Clayoquot ( talk | contribs) 21:32, 21 April 2021 (UTC)
@ Graham Beards, Colin, Clayoquot, and WhatamIdoing:, concerned that we still need to use our best source (Else-Quest) to better incorporate User:NikosGouliaros comments, I have combined various iterations of WhatamIdoing's posts, our previous text, our previous objections, and my own reading of Else-Quest to the following proposal (to replace the entire second paragraph of Menstrual health). SandyGeorgia ( Talk) 00:29, 22 April 2021 (UTC)
Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. [1] Changes to the brain have also been observed throughout the menstrual cycle [2] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. [3] Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle. [4]
There are common culturally communicated beliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. These beliefs can result in a woman's normal and appropriate mood variation being attributed to the menstrual cycle in a self-fulfilling prophecy. Much of the research is weak, but there appears to be a very small increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle.
[4] Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance.
[5] Changes to the brain have also been observed throughout the menstrual cycle
[6] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity.
[7] Any improvements in
spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle.
[4] There are similar cultural beliefs about women's mood and personality during menopause; other than
hot flashes and sleep difficulties, evidence does not support the stereotypes about symptoms during menopause.
[8]
There are common culturally communicated misbeliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. Often a woman's normal mood variation is falsely attributed to the menstrual cycle. Much of the research is weak, but there appears to be a very small increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. [4] Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. [9] Changes to the brain have also been observed throughout the menstrual cycle [10] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. [11] Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle. [4]
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The added text might be fine, but it now contradicts the earlier part the section (repeated in the lead), which state firmly that "irritability, mood changes" are part of the cycle. That is sourced to a fact sheet. And contradicts later part of the section, which says "When menstruation begins, symptoms of PMS such as breast tenderness and irritability generally decrease", which is sourced to a "for teens" fact page on WebMD. -- Colin° Talk 16:32, 22 April 2021 (UTC)
Clayoquot, the new graph adds uncited content in the caption (also content that is not covered anywhere in the article). I am uncertain if that content belongs in this article so leave it to Graham. SandyGeorgia ( Talk) 12:43, 22 April 2021 (UTC)
I am ready to recommend Close without FARC; anything else? SandyGeorgia ( Talk) 18:12, 22 April 2021 (UTC)
See also Wikipedia:Featured article review/Menstrual cycle/archive2, continued from Talk:Menstrual cycle/Archive 3
I think this article should mention catamenial epilepsy. That wiki article was created way back in 2009, and barely tweaked since. However, it is quite a significant problem, related to the menstrual cycle. According to this article "Catamenial epilepsy is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy." There are plenty other reviews and such on PubMed, including this one from Cochrane. There's also Catamenial migraine aka Menstrual migraine. Googling has also uncovered Catamenial pneumothorax (and Catamenial hemothorax), which are much rarer. -- Colin° Talk 17:01, 22 March 2021 (UTC)
Thanks again, Graham ( Clayoquot, how's it coming?)
Graham, here are we switching terminology mid-stream? which correspond to the perimenstrual, ovulatory and the luteal phases
? That is, will layreaders know how the word perimenstrual relates to our previously defined terminology for the phases ?
SandyGeorgia (
Talk)
17:29, 24 March 2021 (UTC)
Here's a progress update from my "More expert comments coming" section above. I've been talking with two experts from the Centre for Menstrual Cycle and Ovulation Research. One of them is my friend Jerilynn Prior, Professor of Endocrinology and Metabolism at UBC. They've identified some issues and we're working together on making them into actionable comments with MEDRS sources. We'll probably be done sometime next week. The comments will probably be around 1) adding two or three sentences about anovulation, 2) hormone levels, 3) effects of hormonal birth control, and 4) factual consistency issues.
Clayoquot ( talk | contribs) 19:58, 24 March 2021 (UTC)
Naturally occurring hormones drive the cycles; the cyclical rise and fall of the hormone estrogen prompts the production and growth of oocytes (immature egg cells.. It is more accurate to say that FSH promotes the growth of oocytes. In fact, later in the article it states “Through the influence of a rise in follicle stimulating hormone (FSH) during the first days of the cycle, a few ovarian follicles are stimulated.” Clayoquot ( talk | contribs) 06:10, 28 March 2021 (UTC)
The hormone progesterone stimulates the uterus lining to thicken to accommodate an embryo, It’s actually estrogen that thickens the lining. Progesterone causes differentiation into a secretory organ that is receptive to implantation. 05:27, 29 March 2021 (UTC)
Under the influence of several hormones, all but one of these follicles will stop growing, while one dominant follicle in the ovary will continue to maturity., It’s not clear which hormones are being referred to here. Hormones that stop follicles from growing? Clayoquot ( talk | contribs) 05:27, 29 March 2021 (UTC)
The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy. After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle.[38] These hormones also prepare the mammary glands for milk[a] production.[38]Seems like this discussion of the placenta does not belong in this article. Clayoquot ( talk | contribs) 05:27, 29 March 2021 (UTC)
Clayoquot, this edit could be discussed. The text removed was a good summary of a high quality source. SandyGeorgia ( Talk) 05:16, 4 April 2021 (UTC)
These edits introduce estradiol without defining it (or linking it); the text earlier explained that estradiol is an estrogen. SandyGeorgia ( Talk) 05:20, 4 April 2021 (UTC)
In this edit, I am not seeing (?) where in the article this is repeated: “For an individual woman, the follicular phase often varies in length from cycle to cycle; by contrast, the length of her luteal phase will be fairly consistent from cycle to cycle.” SandyGeorgia ( Talk) 05:25, 4 April 2021 (UTC)
This edit separated text from its citation. SandyGeorgia ( Talk) 05:28, 4 April 2021 (UTC)
Clayoquot, I don’t understand this edit; this is helpful text. Perhaps the CemCOR people are used to writing for a different audience. Perhaps we could slow this process down and discuss all of their suggestions? SandyGeorgia ( Talk) 05:39, 4 April 2021 (UTC)
It may be better to slow down and make sure we are all on the same page; I am concerned about these edits. Slow and steady wins the race. Tony1 has always set the example for how to work together on fine tuning text, as explained in this article where he is the unnamed language mentor.
Perhaps more querying back-and-forth would help here, as we are losing some critical text, and introducing some confusion. I was thinking that waiting until after the Easter holiday might be a good idea. I’m particularly concerned that we keep text associated with its citation, as this is a featured article. The way Tony1 always worked with me— and that I found very helpful— was via inserting inline hidden comments when there was confusion, so I could consult the sources and clarify. If the problem was larger than could be resolved via inlines, then he would query talk. Maybe we can try some of his style here to make for less work in the longrun? SandyGeorgia ( Talk) 06:08, 4 April 2021 (UTC)
Thanks everyone for the suggestions. What they've done is pasted the article in to a Word document and revised it with Tracked Changes and comments. It sounded like a great idea at a time but trying to triage the changes and convert them back into Wikipedia is kind of horrible. I'll think and talk with them some more about ways to move forward.
Over in my multi-cultural household, we will be marking the end of Passover tonight with pasta. Tomorrow there will be dim sum, an Easter egg hunt, and in the evening my husband and I will probably be congratulating each other on having survived a four-day weekend with two young children :) Clayoquot ( talk | contribs) 19:27, 4 April 2021 (UTC)
Thanks again everyone. I had a good chat with the CeMCOR people today. We've decided the best way forward is to provide Talk page comments, and can do that towards the end of next week if that's OK. They very much appreciate Wikipedia's role as an educational resource and are grateful for the efforts of the volunteers here to provide quality information on women's health. Clayoquot ( talk | contribs) 22:35, 7 April 2021 (UTC)
In trying to set up the Prior citation to be consistent with the other citations, encountering some problems. It is now given as:
For consistency, the citation would be in this format:
but the ISBN needs to be corrected, and we need page numbers for each instance where we are citing it. If we are using an e-book that does not have page nos, then we need section headings. I can set up the sfns to incorporate either page nos or section headings, but first have to get the basic citation fixed. SandyGeorgia ( Talk) 23:08, 29 March 2021 (UTC)
OK, they're in, like this:
You can just substitute the ? with page no. If there is a page range instead, it would look like this:
I don't know if you have worked with sfns before ... when the page number is the same, it automatically works like a named ref and groups them together, so don't worry about the usual named ref issue. Just plug a number in to each instance of Prior. SandyGeorgia ( Talk) 23:31, 29 March 2021 (UTC)
I've run through this subsection. Two things I can't resolve by myself. Experts might guess, but non-experts need greater precision:
(1) "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation during the first few months of pregnancy."
Does it mean: "During the first few months of pregnancy, the corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at ovulation."?
Or does it mean: "The corpus luteum continues to secrete progestoerone and estrogens at levels slightly above those at *ovulation during the first few months of pregnancy*."?
Probably the former, so it could be fixed.
In either case, consider "... at slightly higher levels than those ...".
(2) "After this and for the rest of the pregnancy, the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Backreference ambiguity: is it just hCG that stimulates ..., or is it both "these hormones" and "hCG" that stimulate ...?
To clarify, either: "the placenta secretes high levels of these hormones along with human chorionic gonadotropin (hCG); these stimulate the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Or: "the placenta secretes high levels of these hormones – along with human chorionic gonadotropin (hCG), which stimulates the corpus luteum to secrete more progesterone and estrogens, blocking the menstrual cycle."
Tony (talk) 06:54, 4 April 2021 (UTC)
Starting a section to look at what's left to do. SandyGeorgia ( Talk) 15:57, 11 March 2021 (UTC)
Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones. Graham Beards ( talk) 14:19, 8 March 2021 (UTC)
I can't see anything on the menstrual cycle in Alosco and Stern. Graham Beards ( talk) 14:30, 8 March 2021 (UTC)
Where do we stand on this? SandyGeorgia ( Talk) 15:57, 11 March 2021 (UTC)
This might be useful if we can precis the salient conclusions.
- Graham Beards ( talk) 17:53, 11 March 2021 (UTC)
I think it's good that the 80% figure was removed. It was inaccurate as is. Things like tender breasts, cramps, bloating, feeling tired, irritability and mood changes do disrupt most women's lives at one or more points during their cycle. I would think that obvious. Disrupting their daily life and being severe enough to stop them from going about their typical day are two different things. I imagine that is why the Hong Ju, Mark Jones, Gita Mishra source [3] says "severe pain limiting daily activities is less common" and this source [4] (Wendy Biggs and Robin Demuth) says "substantial disruption." These sources use the words "limiting" and "substantial disruption." A woman can have disruption because of her period without it being substantial disruption. And then there's the inconsistency on what qualifies as PMS (also mentioned in the PMS section back up on the page). [5] Regardless, according to these and other sources, most women will get one or more painful symptoms during their cycle/near or during their period. These are enough of an issue for the women to take medication for it. The reality that many women need to take medication for it, most commonly for cramps, is indicative that the symptom has disrupted the woman's daily life. The menstrual health section said, "Painful cramping in the abdomen, back, or upper thighs can occur during the first few days of menstruation. Severe uterine pain during menstruation is known as dysmenorrhea, and it is most common among adolescents and younger women (affecting about 67.2% of adolescents)." That's disrupting daily life, and 67% is not a minority. I know that this information has been reworked, but I'm commenting on the adolescent thing in the case we come about a better source for it.
When we use the words "disrupt daily life", we have to be careful to not report this as occurring in a minority of women. The Wendy Biggs and Robin Demuth source says "without substantial disruption", which is not the same thing as "no disruption." It's just that a minority of women experience symptoms that significantly limit/interfere with their daily activities. So, based on the sources, it's probably more prudent to alter "During their menstrual cycle, some women experience problems that disrupt daily life" so that we have it saying "During their menstrual cycle, many women experience painful symptoms." If we re-add the "no disruption to daily life" phrasing at some point, it should be altered so that we have it saying "no substantial disruption to daily life" or "no significant disruption to daily life." By the way, I think "cramps" should replace "acne" in the introduction. Cramps are the most common of the symptoms. "Acne" (mentioned in this [6] discussion back up on the page) isn't as serious a concern as the others (for most women, I'd say). ApproximateLand ( talk) 23:59, 12 March 2021 (UTC)
so there is no need to get off into medical conditions affecting the minority— particularly when we are sourcing those statements to articles about PMS. SandyGeorgia ( Talk) 13:52, 13 March 2021 (UTC)Else-Quest and Hyde have a short (two pages) section on Psychological Aspects of the Menstrual Cycle. It says that MC effects on mood are a common perception, but there is little evidence to support it. It adds that reported correlations with hormones do not prove causation. The authors have more, much more, to say on cultural influences than hormones.Graham Beards (talk) 14:19, 8 March 2021 (UTC)
@ApproximateLand :). Welcome to Wikipedia, and thanks for trying to help here. Graham is right that shorter messages are way more convincing; I'm definitely too tired after a day of work to read long posts like the one you posted above. @Graham; ApproximateLand is new around here; don't bite :) (I do appreciate you may be tired after your heroic work here). FemkeMilene ( talk) 22:36, 14 March 2021 (UTC)
Done, [12] and I standardized journal articles to sentence case, as we had a mix (book titles use title case). SandyGeorgia ( Talk) 00:27, 13 March 2021 (UTC)
I've asked a friend of mine who is an endocrinologist what she thinks of the article now and had the following conversation with her: She said "Looks pretty good! Apart from the “ovulation occurs around day 14” statement. It should be “.. occurs around 14 days before onset of menses” - a different thing!". I replied "I am trying to understand which sentence(s) you are saying needs changing. So I did a word search for "Day " in the article and found it mentioned a few times, e.g. "Around day fourteen, the egg is released from the ovary" Would you argue against the usage of things like Day 1, Day 14 etc. altogether?" Her reply: "It’s fine to use day 1 etc for most things, but the day the egg is released is dependent on how long a women’s cycle is, and is only day 14 if a woman has a 28 day cycle.". So I am wondering if we should clarify this? That the "Day 14" statement only applies to women who have a 28-cycle day? It might otherwise be taken as a given that for all women it's on Day 14. EMsmile ( talk) 04:12, 15 March 2021 (UTC)
I encouraged my endocronologist friend to take a further look at the article, and here is some more feedback from her:
Grammar problem. End with: “or resumption of normal menstrual cycles”. EMsmile ( talk) 12:46, 16 March 2021 (UTC)
It is perchance that I am obtuse, so if I am misunderstanding the posts of others, please spell it out for me Dummies 101 style, but we still seem to have one thing pending.
NikosGouliaros asked for some information on psychological aspects. WhatamIdoing came up with Else-Quest, a 2021 source, [15] which was summarized to two sentences by Graham. Femkemilene pointed out that we are still using sources about menstruation (UNDUE and off-topic here in my opinion, but I digress), and I note that we still haven't used WAID's source which specifically addresses the menstrual cycle (as opposed to menstruation). In that same discussion, Graham produced yet another recent review which explains the variance in menstruation literature (again answering the UNDUE aspect of adding menstruation issues as affected by environmental, cultural, societal factors and comorbidities here), and yet somehow we still never got back to the menstrual cycle source provided by WAID. We seem to have forgotten a piece amid other discussions; or am I missing something?
I would add something from Else-Quest myself, but google preview only lets me see the first page. I suggest we still need to address the issue raised by NikosGouliaros, and WAID's source is a good one for doing that; would someone add a few sentences under Menstrual health, or alternately, email me the chapter if possible? SandyGeorgia ( Talk) 15:02, 16 March 2021 (UTC)
There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a "very small" increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle.
The culturally communicated belief that the premenstrual time is associated with poor mood or that menstruation is a painful, shameful, or unclean experience may be a self-fulfilling prophecy. The belief can cause women to feel worse. It can also result in people, including the affected woman, attributing a woman's normal and appropriate mood variation to the menstrual cycle, so that a premenstrual woman who feels angry about a real problem can be dismissed by herself and others as merely suffering from hormones.
Non-psychological changes are also small and uncommon. Athletic performance does not vary with hormones. General intellectual performance, including overall academic performance, problem-solving ability, memory, or creative thinking, does not vary during the menstrual cycle. Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.
"Um, of course the menstrual cycle has an effect on psychological status? Because if it didn't, then PMS and PMDD wouldn't be a thing. As for sources that we could use, it's tough. You might consider [The Psychology of Women and Gender reference], which says that mood effects are 'very small', seen in both pre-menstrual and menstrual phases, and that external 'factors such as stress, health, and social support are more important'. There is evidence for a hormonal effect, and it also indicates that the effects that are self-reported might be culturally conditioned (e.g., through movies that say women are 'supposed to' have PMS, through stress caused by menstrual taboos, etc.)"WhatamIdoing quoted part of the source saying,
"There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a 'very small' increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels."WhatamIdoing said,
"Also, it specifically says that while some women are slightly more likely to 'feel like' crying, they are not actually more likely to do it (so, no actual shift in behavior, just in mood for that point)."WhatamIdoing said,
" 'Little evidence' is the wrong approach. There is 'evidence against' mood swings being a general problem."And even so the article tells us that the menstrual cycle affecting women's moods "has not been confirmed by research." Use of "has not been confirmed" is very different from "much of the research is weak" and "very small", especially when we consider that premenstrual dysphoric disorder, which concerns the menstrual cycle, is a real thing that affects women's moods/affects them psychologically. [17] The Psychology of Women and Gender reference also says that "spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.", but this has been left out of the article. The source says "general intellectual performance", not "intellectual performance." It just feels like you focused on "culture may be causing this" speculation even though that is what is unproven.
Conclusion: Graham used WAID's summary and consulted the source to make sure text conformed to source as he adjusted wording and corrected other changes. No other sources have been provided; IMO, it looks good so far. WhatamIdoing how are we doing with this version? SandyGeorgia ( Talk) 23:47, 21 March 2021 (UTC)
WAID, Graham is using the 9th edition and you have the 10th. I added pages= 258 to 61. When you look in, could you confirm that we have the right page nos, and that everything is verifiable from those pages (else add sfns as needed). SandyGeorgia ( Talk) 00:21, 22 March 2021 (UTC)
For those interested in what our Wikipedia page says right now, with the phrasing of "little evidence", vs. what WhatamIdoing said vs. what the source says, this
[27] edition of it (and on page 259) says that "In sum, the results of the research suggest that there are small fluctuations in mood corresponding to the phases of the menstrual cycle, at least in some women, but that factors such as stress, health, and social support are more important."
It also discusses speculation that high levels of estrogen (at ovulation) might be associated with positive moods and that low levels of estrogen and progesterone premenstrually might be associated with negative moods, but that these speculations have a history of being criticized (pointing out, for example, that
correlation does not imply causation). It says that "in other words, the data simply demonstrate a correlation between cycle phase or hormone levels and mood, but they cannot tell us that hormones actually cause or influence the mood."
It says a bunch of other stuff too, including the idea that the reverse may be true (that psychological factors may affect hormone levels and menstrual cycle phase).
Menstrual cycle mood changes are also associated with perimenopause and menopause. Yesterday, I read portions of this [28] ref ("Lewis's Medical-Surgical Nursing EBook: Assessment and Management of Clinical Problems"), all of this [29] ref (Cognition and mood in perimenopause: A systematic review and meta-analysis), this [30] ref (Menopausal Symptoms and Their Management), this [31] ref (Management of the Perimenopause), and this [32] ref (Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms). The last reference (a 2018 review) is more directly about the subject (menstrual cycle mood changes) and has one section dedicated to mood, and it would seem this is all academics know so far about mood in terms of the menstrual cycle and aging. These are the most recent references I've located about mood in terms of the menstrual cycle and aging, but I might have overlooked something. ApproximateLand ( talk) 08:53, 22 March 2021 (UTC)
Just a heads up that in the next few days, I'll be sending some comments on this article from a friend who is an endocrinology professor at UBC. Clayoquot ( talk | contribs) 22:28, 18 March 2021 (UTC)
Clayoquot and Graham; when you are all done working through the CeMCOR comments, I will go back and deal with wikilinking on first occurrence, consistency in citations, etc etc (MOS-y stuff), but for now will stay out of your way so editing can proceed without too many cooks in the kitchen. Let me know when the coast is clear :) SandyGeorgia ( Talk) 16:04, 29 March 2021 (UTC)
I was waiting for work to finish before raising this, as the lead could be changing, but ... Citations in leads raise concerns at FAC. Do we need all of these lead cites? I was going to reduce some, but some of the citations in the lead are not in the body. SandyGeorgia ( Talk) 13:07, 18 April 2021 (UTC)
Here are the remaining comments from CeMCOR. I've put them below verbatim and have done only a cursory checking of sources. References to (Prior, 2020) refer to a book chapter that is already in the article bibliography. Have fun! Clayoquot ( talk | contribs) 01:09, 14 April 2021 (UTC)
References
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I have made these changes [38] in light of these helpful comments. I have not fully taken on board the comments regarding "ovulatory disturbances". I think these would give undue weight in an encyclopedia article. Graham Beards ( talk) 09:23, 14 April 2021 (UTC)
There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles. The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or unclean could be a self-fulfilling prophecy.. If some don’t like the wording, then we can have WhatamIdoing revisit her longer version above, but leaving this content out completely leads us back to the medicalization of a condition which is not problematic for most women, with some of that being influenced by environmental and societal factors. We have a good source on this and should be using it; perhaps we can revisit WAID’s longer version (above) for refining the wording. SandyGeorgia ( Talk) 13:57, 14 April 2021 (UTC)
There is a common belief that the menstrual cycle affects women's moods. Much of the research is weak, but there appears to be a "very small" increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. The amount of change experienced by any individual may be none, small, or larger. When these changes are caused by the menstrual cycle, it is due to changes in hormone levels. However, the effect of overall stress levels, in non-menstrual health, and in how much the person feels supported by others is a much more significant factor in the mood variation than the menstrual cycle. The culturally communicated belief that the premenstrual time is associated with poor mood or that menstruation is a painful, shameful, or unclean experience may be a self-fulfilling prophecy. The belief can cause women to feel worse. It can also result in people, including the affected woman, attributing a woman's normal and appropriate mood variation to the menstrual cycle, so that a premenstrual woman who feels angry about a real problem can be dismissed by herself and others as merely suffering from hormones. Non-psychological changes are also small and uncommon. Athletic performance does not vary with hormones. General intellectual performance, including overall academic performance, problem-solving ability, memory, or creative thinking, does not vary during the menstrual cycle. Spatial reasoning ability increases during the menstruation phase; this is likely due to the lower levels of estrogen and progesterone at that time.
FYI, I've pointed CeMCOR to this discussion and they are looking for secondary sources to fill the gaps that have been identified. Thanks everyone for all the fantastic work. Clayoquot ( talk | contribs) 06:19, 15 April 2021 (UTC)
Just got some emails from the CeMCOR people. They are OK with re-adding the sentence "There is limited evidence to support the common belief that the menstrual cycle affects women's moods, but this cultural belief can cause women and others to blame their normal mood variations on their menstrual cycles." Regarding The belief that the premenstrual phase causes depression or that menstruation is painful, shameful, or
unclean could be a
self-fulfilling prophecy
, they agree with the general idea but found the wording jarring and incongruous with the rest of the article. They've suggested as a replacement (which we could of course play around with), "There are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding."
Clayoquot (
talk |
contribs)
21:39, 16 April 2021 (UTC)
FWIW, the full thing that CeMCOR said was "I would add to the bit about mood that there are many contributions to notion that negative moods are related to menstrual cycles and especially the time (called premenstrual) just before the period starts. One important variable is the societal stigma and negative ideas (in general) about women’s menstrual bleeding. In addition, it is easier for women as well as others to have “something safe to blame” when they are irritated or anxious or depressed related to the stresses of their dual or triple role “jobs,” are deeply troubled by negative sex biases in the workplace or society, or are also dealing with things like cramps or headaches that increase premenstrually. In adolescence and in perimenopause, there is evidence that the hormonal changes of the menstrual cycle (in particular, higher estradiol and lower progesterone levels) are related to women’s tendency to be moody. In addition, in perimenopause, rapid downward swings of estradiol (that are common and also associated with hot flushes/flashes or night sweats) are now being associated with increased anxiety and depression... If you want a reference for a review of the association of downward swings in estradiol on VMS and mood, here it is. [39]"
I didn't bring this comment forward earlier because 1) There are some things in it that are not 100% in the sources that were provided or any source I'm familiar with, and 2) The source provided for most of this was a book chapter from 2002 - if the date doesn't bother you I can provide quotes and/or email the file. The gist of this that's important is that premenstrual mood changes are both society/culture and biology/physiology. Clayoquot ( talk | contribs) 21:32, 21 April 2021 (UTC)
@ Graham Beards, Colin, Clayoquot, and WhatamIdoing:, concerned that we still need to use our best source (Else-Quest) to better incorporate User:NikosGouliaros comments, I have combined various iterations of WhatamIdoing's posts, our previous text, our previous objections, and my own reading of Else-Quest to the following proposal (to replace the entire second paragraph of Menstrual health). SandyGeorgia ( Talk) 00:29, 22 April 2021 (UTC)
Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. [1] Changes to the brain have also been observed throughout the menstrual cycle [2] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. [3] Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle. [4]
There are common culturally communicated beliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. These beliefs can result in a woman's normal and appropriate mood variation being attributed to the menstrual cycle in a self-fulfilling prophecy. Much of the research is weak, but there appears to be a very small increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle.
[4] Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on many aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance.
[5] Changes to the brain have also been observed throughout the menstrual cycle
[6] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity.
[7] Any improvements in
spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle.
[4] There are similar cultural beliefs about women's mood and personality during menopause; other than
hot flashes and sleep difficulties, evidence does not support the stereotypes about symptoms during menopause.
[8]
There are common culturally communicated misbeliefs that the menstrual cycle affects women's moods, causes depression or irritability, or that menstruation is a painful, shameful or unclean experience. Often a woman's normal mood variation is falsely attributed to the menstrual cycle. Much of the research is weak, but there appears to be a very small increase in mood fluctuations during the luteal and menstrual phases, and a corresponding decrease during the rest of the cycle. [4] Changing levels of estrogen and progesterone across the menstrual cycle exert systemic effects on aspects of physiology including the brain, metabolism, and musculoskeletal system. The result can be subtle physiological and observable changes to women’s athletic performance including strength, aerobic, and anaerobic performance. [9] Changes to the brain have also been observed throughout the menstrual cycle [10] but do not translate into measurable changes in intellectual achievement – including academic performance, problem-solving, memory, and creativity. [11] Any improvements in spatial reasoning ability are probably caused by the lower levels of estrogen and progesterone during the menstruation phase of the cycle. [4]
References
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The added text might be fine, but it now contradicts the earlier part the section (repeated in the lead), which state firmly that "irritability, mood changes" are part of the cycle. That is sourced to a fact sheet. And contradicts later part of the section, which says "When menstruation begins, symptoms of PMS such as breast tenderness and irritability generally decrease", which is sourced to a "for teens" fact page on WebMD. -- Colin° Talk 16:32, 22 April 2021 (UTC)
Clayoquot, the new graph adds uncited content in the caption (also content that is not covered anywhere in the article). I am uncertain if that content belongs in this article so leave it to Graham. SandyGeorgia ( Talk) 12:43, 22 April 2021 (UTC)
I am ready to recommend Close without FARC; anything else? SandyGeorgia ( Talk) 18:12, 22 April 2021 (UTC)