Background : Many women experience menstrual cycle-related exacerbation of various medical and mental health conditions, known as premenstrual exacerbation. This condition should be treated differently from premenstrual syndrome (PMS) or premenstrual dysphoric disorder. We investigated premenstrual exacerbation of psychological disease in women who visited the gynecology clinic. Methods : Participants included 36 women who visited the gynecology clinic for PMS. Premenstrual exacerbation of psychological disease was diagnosed in 7 patients, the "PME" group. The remaining patients were classified in the "others" group. We administered the PMS questionnaire and determined the Hospital Anxiety and Depression Scale (HADS) score. We examined their symptoms and desired treatments according to the PMS criteria. We compared the number of symptoms, HADS score, and desired treatments between the 2 groups. Results : We compared the sum of physical and psychiatric symptoms and found that patients in the PME group had more symptoms than those in the others group. The mean total HADS and anxiety score was significantly higher in the PME group than in the others group. Review of the desired treatments indicated that 4 PME patients wanted to use oral contraceptives ; no patients desired psychiatric medication. Conclusion : Premenstrual exacerbation was diagnosed in almost 20% patients with PMS. Exacerbation patients had more symptoms than the others, and their desired treatment included therapy except psychiatric medication.

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This study aimed to clarify characteristics of menstruation, its accompanying symptoms, and lifestyle factors of patients with premenstrual syndrome (PMS) in Japan. We collected data on premenstrual symptoms, the menstrual cycle, working situation, and lifestyle factors (improvement of eating habits, sleep patterns, regular exercise, smoking habits, drinking habits) for 82 patients with PMS and 162 non-PMS patients. This study identified patients with PMS experienced physical symptoms (swelling of hands and feet, headache, abdominal pain) and psychological symptoms (irritation, depression, emotional instability, staying indoors) significantly more often than non-PMS patients. In non-PMS patients younger than 29 years, the most common symptom around menstruation was abdominal pain. In addition, there was a tendency in non-PMS women to take over-the-counter nonsteroidal anti-inflammatory drugs before menstruation. Patients with PMS tended to practice reasonable lifestyle habits before being diagnosed with PMS and seemed to be more careful about lifestyle factors than the non-PMS group. In addition, the PMS group tended to notice that stress exacerbated symptoms before menstruation.

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We experienced a case of 16-year-old girl "A" with psychogenic deafness caused by a family conflict. "A" had seen the father's domestic violence against the mother with alcoholic inebriation almost daily, and it made tense in her daily life. At her early school age, difficulty of hearing appeared, and got no medical diagnosis which can satisfy the severe unpleasant symptom. On the parents had been divorcing when she was 10 years old and also after divorce, she was forced to play a role of coordinator between the parents, which made her daily life tense more. Therefore, hearing loss appearing in her early school age had been prolonged until her being 16 years old, and the symptom was eventually diagnosed with psychogenic deafness. She had to play a role of domestic coordinator, so that her "not hearing" was thought to work as defense for not manifesting what she truly hoped in front of her parents. In the near future with increase of divorce and other complex family issues, it is thought that more cases with domestic problem may be exhibited as somatization by women and/or children.

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