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131 Evaluating the Association between Premenstrual Syndrome and Hematologic Parameters ... June 2012 close to the normal values. Estrogen has an influence over plasma fasting blood glucose levels and this may lead to different responses against hypoglycemia. Glucose levels have been shown to be lower during the luteal phase compared with the follicular phase [33] . Decreased glucose levels and an increased appetite for sweets during the luteal phase may indicate the metabolic need for sugar. This may be the reason why people with elevated sugar levels are affected less by fatigue. The women with low iron levels were found to have higher scores for changes in sleeping habits compared with the ones with high iron levels. Pittori et al found that having low values for anemia-related parameters (serum ferritin, complete blood count) caused excessive weakness, fatigue, sleep disorders, headache, anxiety, hair loss, and nail breakage [34] . As a result of impaired monoamine oxidase activity, iron deficiency is associated with apathy, drowsiness, irritability, reduced attention and concentration, and memory loss [35] . The individuals with a normal or low MCHC levels were found to have higher anxiety levels compared with those with high MCHC values. Maes et al found that examination stress significantly reduced hemoglobin, hematocrit, MCV, MCH, and MCHC levels [36] . In this study, the individuals with higher neutrophil levels were observed to experience anxiety, fatigue, and PMS more frequently compared with the ones with normal and high neutrophil values. Stress, anxiety or negative emotions were thought to affect hematologic parameters in a negative way. The stress-related changes in hematologic parameters were observed to be more frequent among people experiencing stress-related anxiety. This suggests that personality traits may be influential in stress-related hematologic responses. CONCLUSION Our study shows that women with low serum iron levels, low and normal MCHC, and normal fasting blood glucose, as well as those with elevated BMI experience the symptoms of PMS more frequently. Women with a high neutrophil count during the LL phase suffer PMS more frequently, as well. The raised values of leukocyte count prior to the menstruation suggest that menstrual cycle is associated with inflammation. Moreover, menstrual cycle is thought to be a serious source of stress for young women. Our study reveals the importance of controlling BMI, anemia, and blood sugar with regard to alleviation of PMS symptoms. ACKNOWLEDGEMENTS This study was not supported by any financial grant. We thank our subjects for participating in the study. REFERENCES 1. Reid LR, Van Vugt DA. Physiology of the menstrual cycle. O’brein Sauhn PM, Rapkin JA, Schmidt JP, editors. In: The Premenstrual Syndromes: PMS and PMDD. 2007; 63-68. 2. Petersen JL. Obstetric and Gynecology. Stoudemire A, Fogel BS, editors. Principles of Medical Psychiatry, Second Edition, London, Grune-Stratton 1987; 619-622. 3. Rapkin A. A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology 2003; 28:39-53. 4. Lane T, Francis A. Premenstrual symptomatology, locus of control, anxiety and depression in women with normal menstrual cycles. Arch Womens Ment Health 2003; 6:127-138. 5. Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: A clinical primer for practitioners. Obstet Gynecol 2004; 104:845-859. 6. Karadag F. Premenstual dysphoric disorder. Psychiatry World 2001; 5:11-14. 7. Mishell DR Jr. Premenstrual disorders: epidemiology and disease burden. Am J Manag Care 2005; 11:473- 479. 8. Adiguzel H, Taskin EO, Danaci AE. The symptomatology and prevalence of symptoms of premenstrual syndrome in Manisa, Turkey, Turk Psikiyatri Derg 2007; 18:215- 222. 9. Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med 2007; 8:613-622. 10. Gunes G, Pehlivan E, Genc M, Egri M. Prevalence of premenstrual syndrome among high school students in Malatya.J Turgut Özal Med Cen1997; 4:403-406. 11. Ince N. Premenstrual syndrome in adolescence. Turkish Clin J Med Sci 2001; 21:369-373. 12. Demir B, Algul LY, Guvendag ESG. The Incidence and the contributing factors of premenstrual syndrome in healthy working women. J Turk Soc Obstet Gynecol 2006; 3:262-270. 13. Tasci KD. Evaluatıon of nursıng students’ premenstrual symptoms. Prev Med 2006; 5:434-442. 14. Yucel U, Bilge A, Oran N, et al. The prevalence of premenstrual syndrome and its relationship with depression risk in adolescents, Anadolu Psikiyatri Derg 2009; 10:55-61. 15. Clancy KB, Nenko I, Jasienska G. Menstruation does not cause anemia: Endometrial thickness correlates positively with erythrocyte count and hemoglobin concentration in premenopausal women. Am J Hum Biol 2006;18:710-713. 16. Hunt JR, Penland JG. Iron status and depression in premenopausal women: an MMPI study. Minnesota Multiphasic Personality Inventory. Behav Med 1999; 25:62-68. 17. Devries MC, Hamadeh MJ, Phillips SM, Tarnopolsky MA. Menstrual cycle phase and sex influence muscle glycogen utilization and glucose turnover during moderate-intensity endurance exercise. Am J Physiol Regul Integr Comp Physiol 2006; 291:1120-1128. 18. Umapthy E, Reid HL. Heamotological changes during the menstrual cycle of Nigerian females. Nig J Phsiol Sci 1986; 3:98-100.
June 2012 KUWAIT MEDICAL JOURNAL 132 19. Gencdogan B. A new scale for premenstrual syndrome. Psychiatry in Turkiye 2006; 8:81-87. 20. BMI Classification, World Health Organization, 2004 (Accessed April, 10, 2011, http://apps.who.int/bmi/ index.jsp?introPage=intro_3.html) 21. Jabbour HN, Sales KJ, Catalano RD, Norman JE. Inflammatory pathways in female reproductive health and disease. Reproduction 2009; 138:903-919. 22. Salamonsen LA, Lathbury LJ. Endometrial leukocytes and menstruation. Hum. Reprod Update 2000; 6:16-27. 23. Salamonsen LA, Woolley DE. Menstruation: induction by matrix metalloproteinases and inflammatory cells. J Reprod Immunol 1999; 44:1-27. 24. White HD, Crassi KM, Givan AL, et al. CD3+CD8+CTL activity within the human female reproductive tract. J Immunol 1997; 158:3017-3027. 25. Campbell SE, Angus DJ, Febbraio MA. Glucose kinetics and exercise performance during phases of the menstrual cycle: effect of glucose ingestion. Am J Physiol Endocrinol Metab 2001; 281:817-825. 26. Suh S, Casazza GA, Horning MA, Miller BF, Brooks GA. Effects of oral contraceptives on glucose flux and substrate oxidation rates during rest and exercise. J Appl Physiol 2003; 94:285-294. 27. Zderic TW, Coggan AR, Ruby BC. Glucose kinetics and substrate oxidation during exercise in the follicular and luteal phases. J Appl Physiol 2001; 90:447-453. 28. Tanrıverdi G, Selçuk E, Okanlı A. Prevelance of premenstrual syndrome in university students. J Anatolıan Nurs Health Sci 2010; 13:52-57. 29. Bertone-Johnson ER, Hankinson SE, Willett WC, Johnson SR, Manson JE. Adiposity and the development of premenstrual syndrome. J Womens Health (Larchmt). 2010; 19:19:55-62. 30. Davidsen L, Vistisen B, Astrup A. Impact of the menstrual cycle on determinants of energy balance: a putative role in weight loss attemps. Int J Obes Relat Metab Disord 2007; 31:1777-1785. 31. Henry CJK, Lightowler HJ, Marchini J. Intra-individual variation in resting metabolic rate during the menstrual cycle. Br J Nutr 2003; 89:811-817. 32. Day DS, Gozansky WS, Van Pelt RE, Schwartz RS, Kohrt WM. Sex hormone suppression reduces resting energy expenditure and β-adrenergic support of resting energy expenditure. J Clin Endocrinol Metab 2005; 90:3312- 3317. 33. Bolli GB, Gottesman IS, Cryer PE, Gerich JE. Glucose counterregulation during prolonged hypoglycemia in normal humans. Am J Physiol 1984; 247:206-214. 34. Pittori C, Buser A, Gasser UE, et al. A pilot iron substitution programme in female blood donors with iron deficiency without anaemia. Vox Sang 2011; 100:303-311. 35. Bourre JM.Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients.J Nutr Health Aging 2006; 10:377-385. 36. Maes M, Van Der Planken M, Van Gastel A, et al. Influence of academic examination stress on hematological measurements in subjectively healthy volunteers. Psychiatry Res 1998; 80:201-212.
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