Vol 44 # 2 June 2012 - Kma.org.kw

June 2012
KUWAIT MEDICAL JOURNAL 130
Depressive feeling subscale scores of the
underweight patients (15.24 ± 5.7) were lower than
those of the normal weight patients (20 ± 6.37, p
< 0.001). Depressive thought subscale scores were
observed to be lower in underweight subjects (13.36 ±
5.27) than in normal weight (16.44 ± 6.17) and Class
1 obesity subjects (24 ± 1.41), whereas overweight
subjects were found to show lower depressive thought
subscale scores (16.11 ± 5.97) than Class 1 obese subjects
(p < 0.05). Swelling scores were lower in underweight
subjects (8.4 ± 3.29) than in normal weight (10.41 ± 3.52)
and overweight subjects (11.11 ± 3.02, p < 0.05).
The comparison of PMSS scores with TIBC, serum
ferritin, leukocyte, eosinophil, basophil, monocyte,
erythrocyte, hemoglobin, hematocrit, thrombocyte,
MCH, RDW, and MCV values during the LL phase,
revealed no statistically significant difference (p > 0.05,
Table 1).
The subjects with an elevated fasting blood glucose
level during the LL phase were found to display lower
fatigue scores compared with the individuals with a
normal fasting glucose value during the same phase
(p < 0.01). The subjects with a normal serum iron
level were found to exhibit lower anxiety scores than
those with reduced serum iron levels (p < 0.05). The
subjects with a raised MCHC level were observed
to demonstrate lower anxiety scores compared with
the subjects showing normal or lower MCHC levels,
whereas the subjects with an increased neutrophil
count were determined to exhibit higher anxiety
scores compared with the subjects with a low or
normal neutrophil level. Also, they were observed to
demonstrate higher fatigue and total scores compared
with the subjects with low neutrophil count (p < 0.05,
Table 2).
DISCUSSION
In the current study, leukocyte and neutrophil
levels were elevated during the LL phase compared
with the EF phase, whereas lymphocyte values
demonstrated an increase during the EF phase.
Reproductive mechanisms such as menstruation,
ovulation, and implantation are believed to trigger
the inflammation process. Endometrium undergoes
a regeneration during each menstrual cycle. This
regeneration process involves the differentiation of
a new lining in place of the existing functional layer
in order to allow the implantation of the embryo.
Mediators involved in the inflammatory response
such as cytokines, chemokines, and prostanoids,
have been shown to be activated throughout the
menstrual cycle in synch with the accumulation of
leukocytes in the endometrium [21] . Both estrogen
and progesterone have been shown to bear potential
proinflammatory and anti-inflammatory effects. The
elevated leukocyte count in the endometrium during
the late secretory phase is followed by a decline
in progesterone concentration [22] . Salamonsen and
Wooley showed raised neutrophil counts as well
as elevated lymphocyte levels in the endometrium
during the 26 th and 28 th days of the menstrual cycle
compared with the values before the menstruation [23] .
Lymphocytes continue to be active throughout the
proliferative phase of the uterus, however, this activity
shows a decrease during the secretory phase which
is thought to be associated with progesterone [24] . No
significant difference was observed in fasting blood
glucose levels before and after the menstruation.
The changes occurring in estrogen and progesterone
concentrations throughout the follicular and luteal
phases are thought to cause a difference between
the phases with regard to energy consumption [25,26] .
Glucose consumption and carbohydrate oxidation
have been shown to decrease during the early luteal
phase compared with the follicular phase [27] . In this
study, 57.6% of the study population were determined
to have PMS according to the PMSS. Tanriverdi et
al found the prevalence of PMS in their study as
67.5% [28] . When the scores of the subdimensions were
evaluated: anxiety, depressive thoughts, and changes
in sleeping habits demonstrated no significant change,
whereas depressive feeling, fatigue, irritability, pain,
changes in appetite, and swelling exhibited significant
changes.
In the current study, underweight women were
observed to experience no PMS, whereas normal
weight and overweight women were found to suffer
from PMS. In addition, scores of depressive feeling,
depressive thoughts, and swelling subdimensions
were also determined to have a positive correlation
with BMI. Bertone-Johnson et al found that there was
a strong relationship between BMI and PMS, while
they associated raised BMI with many physical and
emotional symptoms such as swelling in extremities,
back pain, abdominal cramps, diarrhea, emotional
fluctuations, and increased appetite [29] . Women
experience a desire to eat more frequently and choose
foods with rich fat or energy content during the
luteal phase of the menstrual cycle compared with
the follicular phase; this has been shown to be due to
increased energy consumption during this period [30] .
The changes involving regulation of appetite are
also known to be associated with the homeostasis of
the fasting blood glucose. Although studies in this
field produce contradictory results, it is reported that
insulin response is regulated by sex hormones and
insulin sensitivity is lower during the luteal phase
compared with the follicular phase [31-32] . In this study,
women with elevated fasting blood glucose levels
were found to have lower fatigue scores compared
with those with a reduced fasting blood glucose value.
Elevated fasting glucose levels were observed to be