Psychoneuroendocrinology, 1976, Vol.
1, pp. 213-218. Pergamon Press. Printed in Great Britain
MENSTRUAL CYCLE STATUS AND ADRENOCORTICAL REACTIVITY TO PSYCHOLOGICAL STRESS KATHLEEN T. MARINARI,* ALAN I. LESHNER'~ a n d MAUREEN P. DOYLE Department of Psychology, Bucknell University, Lewisburg, PA 17837, U.S.A.
SUMMARY (1) Women either using or not using oral contraceptives were exposed to the psychological stress of self-evaluation at different stages of the menstrual cycle. (2) Adrenocortical reactivity to psychological stress was significantly greater in women tested during the premenstrual phase of the menstrual cycle than in women tested during the midcycle phase. (3) If women were taking oral contraceptives, however, no such differences were observed in adrenocortical reactivity relative to the phase of the cycle. (4) The subjects' reports of their affective responses to the task did not differ as a function of either menstrual cycle status or oral contraceptive use. (5) It was speculated that physiological reactivity to psychological stress is related to the magnitude of fluctuations in the levels of the gonadal hormones across the menstrual cycle. Key Words--menstrual cycle; adrenocortical reactivity; cortisol; oral contraceptives.
INTRODUCTION MANY psychological mood characteristics appear to vary with the stages of the menstrual cycle. During the premenstrual phase there is a rise in irritability, depression, and anxiety, characteristics of the so-called 'premenstrual syndrome' (Ivey & Bardwick, 1968; Mops, 1968; O'Connor, 1974). Most earlier studies of premenstrual symptomology have focused only on the mood state of the individual (Parlee, 1973), and no studies have examined changes in women's reactivity to psychological stress situations that might correspond with the different menstrual cycle stages. Therefore, this study was designed to begin to examine women's responsiveness to psychologically stressful situations as a function of menstrual cycle status. Adrenocortical functioning is quite sensitive to psychological factors (see Mason, 1968, for review). The types of stresses to which adrenocortical activity has been shown to be most sensitive include anxiety and depression (Bliss, Migeon, Branch & Samuels, 1956; Sachar, Hellman, Fukushima & Gallagher, 1970), predominant characteristics of the premenstrual syndrome. Therefore, adrenocortical reactivity was used in this study as an index of physiological reactivity to psychological stress. Psychological reactivity was evaluated using an adjective rating scale by which subjects could report their reactions to the stressful situation. * Now at the Department of Behavioral Sciences, University of Chicago. 1" Address reprint requests to Dr. Alan I. Leshner. P.N.E.C. 1/3--A
213
214
KATHLEEN T. MARINARI, ALAN I. LESHNER and MAUREEN P. DOYLE
C o m p a r i s o n o f the m o o d characteristics of w o m e n using oral contraceptives with those o f w o m e n n o t using the 'Pill' has shown that w o m e n using the Pill report fewer a n d less intense p r e m e n s t r u a l symptoms ( H a m b u r g , M o o s & Yalom, 1968; Silbergeld, Brast & Noble, 1971). Because the use of oral contraceptives minimizes steroid h o r m o n e changes over the course of the menstrual cycle (Paige, 1971 ; Speroff, Glass & Kase, 1973), the alleviation of the symptoms of the p r e m e n s t r u a l s y n d r o m e m a y be a result of changes in the estrogen a n d progestin characteristics of this m e n s t r u a l cycle phase ( H a m b u r g et aL, 1968; Paige, 1971 ; K u n t n e r & Brown, 1972). Similarly, a n y m e n s t r u a l status differences in stress responsiveness also might be related to the same kind o f g o n a d a l h o r m o n e characteristics. Therefore, w o m e n using a n d n o t using the Pill were examined in this study. METHOD Subjects and design The subjects of this study were 60 undergraduate female volunteers. They were arranged into four groups formed according to a two-way (2 × 2) factorial design. There were two test conditions: the subjects were behaviorally tested (stressed) during either the premenstrual phase or the midcycle phase of their menstrual cycles; and two 'Pill' conditions: the subjects were either using oral contraceptives or not using oral contraceptives. Subjects were assigned randomly to the two test conditions within each of the two larger Pill groups. Group PN subjects (n = 16) were tested premenstrually and not taking oral contraceptives, Group MN subjects (n = 17) were tested at midcycle and not taking oral contraceptives, Group PP (n = 13) subjects were tested premenstrually and taking oral contraceptives, and Group MP subjects (n = 14) were tested at midcycle and were taking oral contraceptives. Cycle status was determined from records kept by the subjects on recent menstrual cycles. For the purposes of this study, midcycle was defined as between 12 and 16 days from the onset of the previous menstruation, and the premenstrual period was between 1 and 3 days prior to the onset of the next menstruation. The subjects who were using oral contraceptives were taking either norethindrone with mestranol (OrthoNovum) or norgestrel with ethinyl estradiol (Ovral). Both of these preparations are 'combination pills'. Procedure Each subject reported to the test center twice. During the first visit, a control blood sample was taken from each subject during the midcycle phase of the cycle prior to testing so that baseline cortisol levels could be established. This means of establishing baseline levels was used rather than the technique of repeated sampling during the testing session to control for the marked effects of repeated blood sampling during short intervals. Those subjects tested premenstrually reported back between 1 and 3 days before the onset of menstrual bleeding of the next cycle. During this second visit, they were given a behavioral test which was stress-inducing (see below). After testing they were given a checklist to rate their affective states while performing the task. The checklist included eight adjectives: depressed, confused, embarrassed, confident, cheerful, anxious, excitable and apathetic. Each adjective was to be rated on a 7-point scale from 'very' to 'not at all'. Another blood sample was collected after completion of this checklist. The time elapsing from the beginning of testing to the blood collection was approx. 10 rain. The same procedures were used for the subjects tested at midcycle except that testing was carried out from 12 to 16 days from the first day of menstrual bleeding of the next cycle, rather than during the premenstrual phase. Blood collection and assay techniques
A 200 td sample of blood was collected from a single finger-prick. The blood was centrifuged immediately, and the plasma was frozen at --20°C for later assay. All testing was done between 3:30 and 5:30 p.m. to control for the diurnal rhythm of cortisol secretion. Plasma cortisol was assayed using the microfluorometric technique described by Glick, vonRedlich and Levine (1964). Behavioral test
The behavioral test was modified from one of the several described by Bliss et aL (1956), who have shown this type of task to be stress-inducing, as indexed by changes in plasma 17-hydroxycorticosteroid levels. A casette recorder was placed on a desk in the test room, with a jack and cord plugged into the earphone
MENSTRUAL CYCLE STATUS AND STRESS RESPONSIVENESS
215
terminal. The cord of the tape recorder was extended out of a window and into the window of the next room to give the subject the impression that the taping was being monitored. During the behavioral test, each subject was escorted into the test room, seated at the desk, and read the following set of instructions: For the next 5 rain, I would like you to speak into the microphone and evaluate yourself as a person. This should include material like: (1) How do you measure up to your self-expectations? (2) How do you measure up to the expectations of the people who matter the most to you ? Be sure to be honest and do not deal in superficialities. I will leave you alone but will be monitoring your taping in the next room. I must be there to be sure that you are talking about yourself. The content of the tape will be analyzed by a panel of judges to determine your self-perception and psychological stability. RESULTS Plasma cortisol measures
Table I presents the means and standard errors o f the baseline (midcycle) and the test cortisol levels for each group. Differences a m o n g groups in baseline cortisol levels were analyzed by analysis o f variance. Subjects taking oral contraceptives had significantly higher baseline cortisol levels than subjects not taking oral contraceptives (F(1,56) = 5.04, p < 0.05). Changes in cortisol levels as a function o f the test situation were analyzed as a percentage difference score. This percentage difference score was calculated as the absolute difference between baseline and test cortisol levels divided by the baseline level. Means and standard errors for each g r o u p on this percentage difference score are presented in Fig. 1. TABLE I. MEANS AND STANDARD ERRORS OF THE CORTISOL MEASUREMENTS AND THE FACTOR ANALYSIS SCORE
Group
n
Baseline cortisol (/~g/100ml)
Test cortisol ~g/100 ml)
No Pill-pre-menstrual No Pill-midcycle Pill-pre-menstrual Pill-midcycle
16 17 13 14
14.84-1.5 16.14-1.8 20.54-1.4 19.64-2.8
22.04-1.6 17.34-1.9 24.34-2.6 22.94-2.1
Factor analysis score 0.1904-0.31 --0.3264-0.24 0.1884-0.44 0.0984-0.37
Analysis o f variance revealed a significant interaction o f the effects o f the main variables (F(1,56) -----4.05, p < 0.05). Examination o f this interaction showed that those subjects tested premenstrually and not taking oral contraceptives ( G r o u p PN) responded to the task with a significantly greater increase in cortisol levels than those subjects in the other groups, which did not differ f r o m each other. In order to be certain that the differences on this measure did n o t reflect an inappropriate weight being given to the baseline values o f the P N group, the data were also analyzed by analysis o f covariance. This analysis yielded a similar significant interaction between the main effects (F(1,55) ---- 4.51, p < 0.05). Behavioral measures
Analyses o f variance were performed on the scores f o r each adjective o f the adjective checklist individually. There were no significant effects for any o f the adjectives. The scores
216
KATHLEENT. MARINARI,ALANI. L~HNERand MAUR~ENP. DOYLE 140.
I•No
Pill
120,
~Pill 100.
~80
60 (J 40 ¸
20
Premenst rual
Midcycle
FIG. 1. Meansand standard errors of cortisol per cent difference. on the adjective checklist were then subjected to factor analysis. This analysis revealed two salient factors. Factor 1 was correlated highly negatively with the ratings of confusion, embarrassment, and anxiety, and Factor 2 was correlated highly positively with the ratings on depression and apathy, and negatively with cheerfulness. Analyses of variance on both the Factor 1 and Factor 2 scores revealed no significant effects of the main variables of time of test or Pill condition. The Factor 2 score was then subtracted from the Factor 1 score to create a composite factor analysis score (FAS). Table I presents the means and standard errors for each group in this FAS. Analysis of variance revealed no significant effects of the independent variables on this measure either. DISCUSSION Women tested premenstrually exhibited greater adrenocortical reactivity to psychologica stress than those tested at midcycle. The women who were taking oral contraceptives however, did not exhibit this premenstrual increase in physiological reactivity to psychological stress. In addition, although premenstrual women showed increased physiological reactivity to the stress of self-evaluation, all subjects reported approximately equivalent affective responses to the task, regardless of menstrual cycle status or use of oral contraceptives. Because many earlier studies have reported general increases in negative affect during the premenstrual phase of the cycle (e.g. Ivey & Bardwick, 1968; Moos, 1968; Paige, 1971; Janowski, Berens & Davis, 1973), it was surprising that the present study found no differences in the subjects' reports of their affective reactions to this stressful task as a function of menstrual cycle status. These other studies, however, have all used either free associative samples 0vey & Bardwick, 1968; Paige, 1971), questionnaires of premenstrual symptomology (Moos, 1968), or subjects' daily ratings of their affective states (Janowski et al., 1973), techniques which yield measures of nonspecific or non-directed affect. In the present
MENSTRUAL CYCLE STATUS AND STRESS RESPONSIVENESS
217
study, the subjects were asked to rate their reactions to a particular task, rather than their general affective states, and when Little and Zahn's (1974) subjects completed mood adjective checklists upon completion of simple tasks (i.e. time estimation and reaction time tests), those investigators found no cyclical changes in negative mood scales. Thus, unless adjective checklists are generally too insensitive to be useful in determining differences in perceived reactions to specific tasks, the results of Little and Zahn's study and this study suggest that although there may be menstrual status differences in women's perceptions of their general affective states, there may be no menstrual status differences in women's perceived reactions to specific tasks. Because cortisol secretion rates appear to be relatively stable over the course of the menstrual cycle (Aubert, Lemarchand-Beraud, Deguillaume & Desaulles, 1971; Saxena, Dusitsin & Lazarus, 1974; Genazzani, Lemarchand-Beraud, Aubert & Felber, 1975), it seems probable that the greater adrenocortical responsivity observed in the premenstruallytested women of this study is indicative of heightened physiological reactivity to stress. As a further check of the constancy in plasma cortisol levels we measured the baseline cortisol levels of two additional groups (n = 15 in each case) of women, at midcycle and premenstrually. There were no differences in plasma cortisol levels between these groups (premenstrual group ---- 13.8i2.6/zg/100 ml; midcycle group = 16.9_-k_2.4/zg/100 ml). In addition, it is unlikely that the elevated baseline cortisol levels observed in women using the Pill (cf Silbergeld et al., 1971; Daly & Elstein, 1972) affected or limited adrenocortical reactivity in this study, because other studies (Speroff, Glass & Kase, 1973) have discerned no abnormalities in the functioning of this endocrine subsystem in response to various physiological challenges in women using oral contraceptives. Thus, the present study suggests that there is a premenstrual increase in physiological reactivity to psychological stress in normally cycling women that does not occur in women using oral contraceptives. This difference in adrenocortical reactivity to psychological stress between those women using oral contraceptives and those women not using the Pill suggests that the premenstrual rise in physiological reactivity may be related to the particular gonadal hormone changes prior to, or during, this menstrual cycle phase. Women not taking oral contraceptives experience greater changes in the levels of the gonadal hormones immediately prior to, and during, the premenstrual phase than do women taking the Pill (Speroff et al., 1973). Although there are, of course, a number of social and/or cultural factors which might contribute to the reactivity differences between women using and not using oral contraceptives, the relationship observed here between the magnitude of premenstrual hormonal change and the magnitude of stress responsiveness suggests that changes in gonadal hormone characteristics may somehow be related to the premenstrual rise in physiological reactivity to psychological stress. This research was a portion of an honors thesis completed by the first author for the A.B. degree at Bucknell University. Supported in part by Grants No. M H 23870 from N I M H and No. BMS 75-08120 from NSF, and by a grant from the Bucknell University Research Council. The authors thank E. K. Adkins and G.R. Levin for their valuable comments and criticisms of an earlier version of this paper. REFERENCES AUBERT, M. L., LEMARCHAND-BERAUD,T., DEGUILLAUME, R. & DESAULLES, P. A. (1971) Cortisol secretion during the normal menstrual cycle. Acta endocr., Copenh. 155, 78.
218
KATHLEENT. MARINARI,ALANI. LEsi-i~g and MAtmEENP. DOYLE
BLISS, E. L., MIGEON,C. J., BRANCH, C. H. & SAMt~tS, L. T. (1956) Reaction of the adrenal cortex to emotional stress. Psychosom. Med. 18, 56-76. DALY,J. R. & ELSa'EIN,M. (1972) Hypothalamo-pituitary-adrenalfunction during oral contraceptive therapy with combined oestrogen-progestogen and progestogen only preparations. J. Obstet. Gynaec. Br. Commonw. 79, 544-549. G~NAZZAr,a,A. R., LI~MARCHANI>BE~AUD,TH., AUB~RT,M. L. & F~LBER,J. P. (1975) Pattern of ACTH, hGH and cortisol during menstrual cycle. J. clin. Endocrinol. Metab. 41,431-437. GLIC•, D., vONP~DUCH, D. & LEVaNE,S. (1964) Fluorometric determination of corticosterone and cortisol in 0.02-0.05 milliliters of plasma or submilligram samples of adrenal tissue. Endocrinology, 74, 653-655. HAMBURG,D. A., MOPS, R. H. & YALOM,I. D. (1968) Studies of distress in the menstrual cycle and the postpartum period. In Endocrinology and Human Behaviour, R. P. Michael (Ed.). Oxford Univ. Press, London. IVEY,M. E. & BARDWICK,J. M. (1968) Patterns of affective fluctuations in the menstrual cycle. Psychosorn. Med. 30, 336-345. JANOWSKI,D. S., BERENS,S. C. & DAVIS,J. M. (1973) Correlations between mood, weight, and electrolytes during the menstrual cycle: a reninangiotensin-aldosternnehypothesis ofpremenstrual tension. Psychosom. Med. 35, 143-154. KtrNTr~ER,S. J. & BROWN,W. L. (1972) Types of oral contraceptives, depression and premenstrual symptoms. J. herr. ment. Dis. 155, 153-162. LIttLE, B. C. & ZAnN, T. P. (1974) Changes in mood and autonomic functioning during the menstrual cycle. Psychophysiology 11, 579-590. MASON, J. W. (1968) A review of the psychoendocrine research on the pituitary-adrenal cortical system. Psychosom. Med. 30, 576-607. Moos, R. H. (1968) The development of a menstrual distress questionnaire. Psychosom. Med. 30, 853-867. O'CONNOR, J. F. (1974) Secondary rhythms related to the menstrual cycle: behavioral changes. In Biorhythms and Human Reproduction, M. Ferin, F. Halberg, R. Richart & R. VandeWeile (Eds). Wiley, New York. PAIOE, K. E. (1971) Effects of oral contraceptives on affectiv¢ fluctuations associated with the menstrual cycle. Psychosom. Med. 33, 515-537. PARLEE, M. B. (1973) The premenstrual syndrome. Psychol. Bull. 80, 454-465. SACI-IAR,E. J., HELLMAN,L., Ftr~usmMA,D. K. & GALLAGHER,T. F. (1970) Cortisol production in depressive illness. Archs gen. Psychiat. 23, 289-298. SAXENA,B. N., DusrrstN, N. & LAZARUS,L. (1974) Human growth hormone, thyroid stimulating hormone and cortisol levels in the serum of menstruating Thai women. J. Obstet. Gynaec. Br. Commonw. 81, 563567. SILnEROELD,S., BRAST,N. & NOBLE,E. P. (1971) The menstrual cycle: a double-blind study of symptoms, mood, and behavior, and biochemical variables using enovid and placebo. Psychosom. Med. 33, 411-428. SPEROFE,L., GLASS,R. H. & KASE,N. G. (1973) Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, Baltimore.
1, pp. 213-218. Pergamon Press. Printed in Great Britain
MENSTRUAL CYCLE STATUS AND ADRENOCORTICAL REACTIVITY TO PSYCHOLOGICAL STRESS KATHLEEN T. MARINARI,* ALAN I. LESHNER'~ a n d MAUREEN P. DOYLE Department of Psychology, Bucknell University, Lewisburg, PA 17837, U.S.A.
SUMMARY (1) Women either using or not using oral contraceptives were exposed to the psychological stress of self-evaluation at different stages of the menstrual cycle. (2) Adrenocortical reactivity to psychological stress was significantly greater in women tested during the premenstrual phase of the menstrual cycle than in women tested during the midcycle phase. (3) If women were taking oral contraceptives, however, no such differences were observed in adrenocortical reactivity relative to the phase of the cycle. (4) The subjects' reports of their affective responses to the task did not differ as a function of either menstrual cycle status or oral contraceptive use. (5) It was speculated that physiological reactivity to psychological stress is related to the magnitude of fluctuations in the levels of the gonadal hormones across the menstrual cycle. Key Words--menstrual cycle; adrenocortical reactivity; cortisol; oral contraceptives.
INTRODUCTION MANY psychological mood characteristics appear to vary with the stages of the menstrual cycle. During the premenstrual phase there is a rise in irritability, depression, and anxiety, characteristics of the so-called 'premenstrual syndrome' (Ivey & Bardwick, 1968; Mops, 1968; O'Connor, 1974). Most earlier studies of premenstrual symptomology have focused only on the mood state of the individual (Parlee, 1973), and no studies have examined changes in women's reactivity to psychological stress situations that might correspond with the different menstrual cycle stages. Therefore, this study was designed to begin to examine women's responsiveness to psychologically stressful situations as a function of menstrual cycle status. Adrenocortical functioning is quite sensitive to psychological factors (see Mason, 1968, for review). The types of stresses to which adrenocortical activity has been shown to be most sensitive include anxiety and depression (Bliss, Migeon, Branch & Samuels, 1956; Sachar, Hellman, Fukushima & Gallagher, 1970), predominant characteristics of the premenstrual syndrome. Therefore, adrenocortical reactivity was used in this study as an index of physiological reactivity to psychological stress. Psychological reactivity was evaluated using an adjective rating scale by which subjects could report their reactions to the stressful situation. * Now at the Department of Behavioral Sciences, University of Chicago. 1" Address reprint requests to Dr. Alan I. Leshner. P.N.E.C. 1/3--A
213
214
KATHLEEN T. MARINARI, ALAN I. LESHNER and MAUREEN P. DOYLE
C o m p a r i s o n o f the m o o d characteristics of w o m e n using oral contraceptives with those o f w o m e n n o t using the 'Pill' has shown that w o m e n using the Pill report fewer a n d less intense p r e m e n s t r u a l symptoms ( H a m b u r g , M o o s & Yalom, 1968; Silbergeld, Brast & Noble, 1971). Because the use of oral contraceptives minimizes steroid h o r m o n e changes over the course of the menstrual cycle (Paige, 1971 ; Speroff, Glass & Kase, 1973), the alleviation of the symptoms of the p r e m e n s t r u a l s y n d r o m e m a y be a result of changes in the estrogen a n d progestin characteristics of this m e n s t r u a l cycle phase ( H a m b u r g et aL, 1968; Paige, 1971 ; K u n t n e r & Brown, 1972). Similarly, a n y m e n s t r u a l status differences in stress responsiveness also might be related to the same kind o f g o n a d a l h o r m o n e characteristics. Therefore, w o m e n using a n d n o t using the Pill were examined in this study. METHOD Subjects and design The subjects of this study were 60 undergraduate female volunteers. They were arranged into four groups formed according to a two-way (2 × 2) factorial design. There were two test conditions: the subjects were behaviorally tested (stressed) during either the premenstrual phase or the midcycle phase of their menstrual cycles; and two 'Pill' conditions: the subjects were either using oral contraceptives or not using oral contraceptives. Subjects were assigned randomly to the two test conditions within each of the two larger Pill groups. Group PN subjects (n = 16) were tested premenstrually and not taking oral contraceptives, Group MN subjects (n = 17) were tested at midcycle and not taking oral contraceptives, Group PP (n = 13) subjects were tested premenstrually and taking oral contraceptives, and Group MP subjects (n = 14) were tested at midcycle and were taking oral contraceptives. Cycle status was determined from records kept by the subjects on recent menstrual cycles. For the purposes of this study, midcycle was defined as between 12 and 16 days from the onset of the previous menstruation, and the premenstrual period was between 1 and 3 days prior to the onset of the next menstruation. The subjects who were using oral contraceptives were taking either norethindrone with mestranol (OrthoNovum) or norgestrel with ethinyl estradiol (Ovral). Both of these preparations are 'combination pills'. Procedure Each subject reported to the test center twice. During the first visit, a control blood sample was taken from each subject during the midcycle phase of the cycle prior to testing so that baseline cortisol levels could be established. This means of establishing baseline levels was used rather than the technique of repeated sampling during the testing session to control for the marked effects of repeated blood sampling during short intervals. Those subjects tested premenstrually reported back between 1 and 3 days before the onset of menstrual bleeding of the next cycle. During this second visit, they were given a behavioral test which was stress-inducing (see below). After testing they were given a checklist to rate their affective states while performing the task. The checklist included eight adjectives: depressed, confused, embarrassed, confident, cheerful, anxious, excitable and apathetic. Each adjective was to be rated on a 7-point scale from 'very' to 'not at all'. Another blood sample was collected after completion of this checklist. The time elapsing from the beginning of testing to the blood collection was approx. 10 rain. The same procedures were used for the subjects tested at midcycle except that testing was carried out from 12 to 16 days from the first day of menstrual bleeding of the next cycle, rather than during the premenstrual phase. Blood collection and assay techniques
A 200 td sample of blood was collected from a single finger-prick. The blood was centrifuged immediately, and the plasma was frozen at --20°C for later assay. All testing was done between 3:30 and 5:30 p.m. to control for the diurnal rhythm of cortisol secretion. Plasma cortisol was assayed using the microfluorometric technique described by Glick, vonRedlich and Levine (1964). Behavioral test
The behavioral test was modified from one of the several described by Bliss et aL (1956), who have shown this type of task to be stress-inducing, as indexed by changes in plasma 17-hydroxycorticosteroid levels. A casette recorder was placed on a desk in the test room, with a jack and cord plugged into the earphone
MENSTRUAL CYCLE STATUS AND STRESS RESPONSIVENESS
215
terminal. The cord of the tape recorder was extended out of a window and into the window of the next room to give the subject the impression that the taping was being monitored. During the behavioral test, each subject was escorted into the test room, seated at the desk, and read the following set of instructions: For the next 5 rain, I would like you to speak into the microphone and evaluate yourself as a person. This should include material like: (1) How do you measure up to your self-expectations? (2) How do you measure up to the expectations of the people who matter the most to you ? Be sure to be honest and do not deal in superficialities. I will leave you alone but will be monitoring your taping in the next room. I must be there to be sure that you are talking about yourself. The content of the tape will be analyzed by a panel of judges to determine your self-perception and psychological stability. RESULTS Plasma cortisol measures
Table I presents the means and standard errors o f the baseline (midcycle) and the test cortisol levels for each group. Differences a m o n g groups in baseline cortisol levels were analyzed by analysis o f variance. Subjects taking oral contraceptives had significantly higher baseline cortisol levels than subjects not taking oral contraceptives (F(1,56) = 5.04, p < 0.05). Changes in cortisol levels as a function o f the test situation were analyzed as a percentage difference score. This percentage difference score was calculated as the absolute difference between baseline and test cortisol levels divided by the baseline level. Means and standard errors for each g r o u p on this percentage difference score are presented in Fig. 1. TABLE I. MEANS AND STANDARD ERRORS OF THE CORTISOL MEASUREMENTS AND THE FACTOR ANALYSIS SCORE
Group
n
Baseline cortisol (/~g/100ml)
Test cortisol ~g/100 ml)
No Pill-pre-menstrual No Pill-midcycle Pill-pre-menstrual Pill-midcycle
16 17 13 14
14.84-1.5 16.14-1.8 20.54-1.4 19.64-2.8
22.04-1.6 17.34-1.9 24.34-2.6 22.94-2.1
Factor analysis score 0.1904-0.31 --0.3264-0.24 0.1884-0.44 0.0984-0.37
Analysis o f variance revealed a significant interaction o f the effects o f the main variables (F(1,56) -----4.05, p < 0.05). Examination o f this interaction showed that those subjects tested premenstrually and not taking oral contraceptives ( G r o u p PN) responded to the task with a significantly greater increase in cortisol levels than those subjects in the other groups, which did not differ f r o m each other. In order to be certain that the differences on this measure did n o t reflect an inappropriate weight being given to the baseline values o f the P N group, the data were also analyzed by analysis o f covariance. This analysis yielded a similar significant interaction between the main effects (F(1,55) ---- 4.51, p < 0.05). Behavioral measures
Analyses o f variance were performed on the scores f o r each adjective o f the adjective checklist individually. There were no significant effects for any o f the adjectives. The scores
216
KATHLEENT. MARINARI,ALANI. L~HNERand MAUR~ENP. DOYLE 140.
I•No
Pill
120,
~Pill 100.
~80
60 (J 40 ¸
20
Premenst rual
Midcycle
FIG. 1. Meansand standard errors of cortisol per cent difference. on the adjective checklist were then subjected to factor analysis. This analysis revealed two salient factors. Factor 1 was correlated highly negatively with the ratings of confusion, embarrassment, and anxiety, and Factor 2 was correlated highly positively with the ratings on depression and apathy, and negatively with cheerfulness. Analyses of variance on both the Factor 1 and Factor 2 scores revealed no significant effects of the main variables of time of test or Pill condition. The Factor 2 score was then subtracted from the Factor 1 score to create a composite factor analysis score (FAS). Table I presents the means and standard errors for each group in this FAS. Analysis of variance revealed no significant effects of the independent variables on this measure either. DISCUSSION Women tested premenstrually exhibited greater adrenocortical reactivity to psychologica stress than those tested at midcycle. The women who were taking oral contraceptives however, did not exhibit this premenstrual increase in physiological reactivity to psychological stress. In addition, although premenstrual women showed increased physiological reactivity to the stress of self-evaluation, all subjects reported approximately equivalent affective responses to the task, regardless of menstrual cycle status or use of oral contraceptives. Because many earlier studies have reported general increases in negative affect during the premenstrual phase of the cycle (e.g. Ivey & Bardwick, 1968; Moos, 1968; Paige, 1971; Janowski, Berens & Davis, 1973), it was surprising that the present study found no differences in the subjects' reports of their affective reactions to this stressful task as a function of menstrual cycle status. These other studies, however, have all used either free associative samples 0vey & Bardwick, 1968; Paige, 1971), questionnaires of premenstrual symptomology (Moos, 1968), or subjects' daily ratings of their affective states (Janowski et al., 1973), techniques which yield measures of nonspecific or non-directed affect. In the present
MENSTRUAL CYCLE STATUS AND STRESS RESPONSIVENESS
217
study, the subjects were asked to rate their reactions to a particular task, rather than their general affective states, and when Little and Zahn's (1974) subjects completed mood adjective checklists upon completion of simple tasks (i.e. time estimation and reaction time tests), those investigators found no cyclical changes in negative mood scales. Thus, unless adjective checklists are generally too insensitive to be useful in determining differences in perceived reactions to specific tasks, the results of Little and Zahn's study and this study suggest that although there may be menstrual status differences in women's perceptions of their general affective states, there may be no menstrual status differences in women's perceived reactions to specific tasks. Because cortisol secretion rates appear to be relatively stable over the course of the menstrual cycle (Aubert, Lemarchand-Beraud, Deguillaume & Desaulles, 1971; Saxena, Dusitsin & Lazarus, 1974; Genazzani, Lemarchand-Beraud, Aubert & Felber, 1975), it seems probable that the greater adrenocortical responsivity observed in the premenstruallytested women of this study is indicative of heightened physiological reactivity to stress. As a further check of the constancy in plasma cortisol levels we measured the baseline cortisol levels of two additional groups (n = 15 in each case) of women, at midcycle and premenstrually. There were no differences in plasma cortisol levels between these groups (premenstrual group ---- 13.8i2.6/zg/100 ml; midcycle group = 16.9_-k_2.4/zg/100 ml). In addition, it is unlikely that the elevated baseline cortisol levels observed in women using the Pill (cf Silbergeld et al., 1971; Daly & Elstein, 1972) affected or limited adrenocortical reactivity in this study, because other studies (Speroff, Glass & Kase, 1973) have discerned no abnormalities in the functioning of this endocrine subsystem in response to various physiological challenges in women using oral contraceptives. Thus, the present study suggests that there is a premenstrual increase in physiological reactivity to psychological stress in normally cycling women that does not occur in women using oral contraceptives. This difference in adrenocortical reactivity to psychological stress between those women using oral contraceptives and those women not using the Pill suggests that the premenstrual rise in physiological reactivity may be related to the particular gonadal hormone changes prior to, or during, this menstrual cycle phase. Women not taking oral contraceptives experience greater changes in the levels of the gonadal hormones immediately prior to, and during, the premenstrual phase than do women taking the Pill (Speroff et al., 1973). Although there are, of course, a number of social and/or cultural factors which might contribute to the reactivity differences between women using and not using oral contraceptives, the relationship observed here between the magnitude of premenstrual hormonal change and the magnitude of stress responsiveness suggests that changes in gonadal hormone characteristics may somehow be related to the premenstrual rise in physiological reactivity to psychological stress. This research was a portion of an honors thesis completed by the first author for the A.B. degree at Bucknell University. Supported in part by Grants No. M H 23870 from N I M H and No. BMS 75-08120 from NSF, and by a grant from the Bucknell University Research Council. The authors thank E. K. Adkins and G.R. Levin for their valuable comments and criticisms of an earlier version of this paper. REFERENCES AUBERT, M. L., LEMARCHAND-BERAUD,T., DEGUILLAUME, R. & DESAULLES, P. A. (1971) Cortisol secretion during the normal menstrual cycle. Acta endocr., Copenh. 155, 78.
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KATHLEENT. MARINARI,ALANI. LEsi-i~g and MAtmEENP. DOYLE
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