Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal study
Introduction
Up to 90% of menstruating women may experience premenstrual syndrome (PMS) (Dennerstein et al., 2012) and approximately 20% to 40% experiences moderate to severe PMS that substantially impair functioning and relationships (Halbreich et al., 2003, Rapkin and Winer, 2009). A small proportion, 3–8%, suffers from premenstrual dysphoric disorder (PMDD), a severe form of PMS (Dennerstein et al., 2012). The core emotional symptoms characterising PMS include depressed mood, anxiety, affective lability, anger or irritability, and feeling out of control; and typical physical symptoms include bloating, breast tenderness and headache (Freeman, 2003).
Compared with women without PMS, decreased work productivity, increased work absenteeism and healthcare utilisation have been reported for women with PMS, resulting in considerable economic losses (Borenstein et al., 2005, Heinemann et al., 2012). Partly due to the repeated occurrence of the symptoms, previous studies have suggested that the health-related quality-of-life burden associated with PMDD is comparable with other chronic conditions such as back pain and depressive disorders (Rapkin and Winer, 2009, Heinemann et al., 2012).
Despite a large body of literature on PMS/PMDD, few population-based longitudinal studies examined the association of PMS with potential lifestyle risk factors, especially drug use. One community study on the trend of PMDD reported on its co-existing conditions, including drug abuse, in 1488 young German women (Wittchen et al., 2002). Despite being part of a longitudinal study, the paper only reported the association in a cross-sectional nature. It detected an increased (OR 2.2), albeit not statistically significant, association between drug abuse or dependence and PMDD. However, the lack of power due to the small number of PMDD cases (n = 74) included in the study may be one of the explanations. Further analysis conducted by the authors revealed a significant association (OR 3.3, p < 0.05) between drug abuse, or dependence, and sub-threshold PMDD, defined as cases short of just one PMDD diagnostic criteria based on modified Diagnostic and Statistical Manual of Mental Disorders—4th Edition. Most cases lacked persistent impairment associated with premenstrual symptoms to be fully classified as PMDD (Wittchen et al., 2002).
PMS is common among Australian women affecting over a third of the women included in a study with large population sample (Ju et al., 2014); however little is known about the association between illicit drug use and PMS. The aim of this longitudinal study is to investigate the association between illicit drug use and PMS among Australian women followed over 13 years. We hypothesise that illicit drug use and early age at first use are associated with PMS.
Section snippets
Population
The 1973–1978 cohort of the Australian Longitudinal Study on Women's Health (ALSWH), a prospective cohort study, formed the study population. ALSWH randomly sampled women registered on the national Medicare database, which includes almost all permanent residents in Australia. The detailed study methods have been previously reported (Brown et al., 1998). The women included in this study, who were aged 18–23 years at baseline (1996), were found to be reasonably representative of Australian women
Results
At baseline, about 65% of the included women reported ever use of any illicit drugs and over 40% used drugs in the last 12 months (Table 1), of which 37% were multiple drug users and 5% exclusive marijuana users (Table 3). The most commonly used drug was marijuana, with more than half of the women reporting ever use at baseline. The other more commonly used drugs were ecstasy/designer drugs, amphetamines and LSD. The mean age at first drug use was earlier for marijuana (17.2 years) than other
Discussion
Nearly every two in three Australian women aged 22–27 reported ever use of illicit drugs in 2000, which increased modestly over the study period and almost 10% first used drug before reaching age 15 years. However use of illicit drugs in the last 12 months decreased considerably over time especially during the earlier surveys. Marijuana was the most commonly used drug, but the majority of women used it together with one or more other drugs. The patterns of recent drug use over time are largely
Role of funding source
The Australian Longitudinal Study on Women's Health (ALSWH) is supported by the Australian Government Department of Health. G.D.M. is supported by the Australian Research Council Future Fellowship (FT120100812). The bodies source have no further role in this study design, data analysis and interpretation, writing of the manuscript, or the decision to submit the manuscript for publication.
Contributors
All authors contributed to and approve of the manuscript.
Conflicts of interest
The authors declare no conflicts of interest.
Acknowledgement
The authors thank all the women who participated in the Australian Longitudinal Study on Women's Health. We thank Dr Andrew Smirnov for providing comments on the manuscript.
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