Symptoms and distress across the menstrual cycle in a representative sample of Austrian and German people who menstruate: a cross-sectional study

Background. People who menstruate may experience a range of symptoms, which, fluctuating throughout the different cycle phases, can interfere with their normal functioning. To date, research mostly investigated pain and psychological changes in the menstrual and premenstrual phases. Objectives. This survey aimed to broaden the understanding of the frequency and interference with daily living (i.e., distress) of a wider array of symptoms (e.g., gastrointestinal, physiological) throughout the cycle, including the intermenstrual phase. Design. Cross-sectional online survey of representative samples (in terms of education, gender and age).Methods. Menstruating participants (N = 336) from Germany and Austria reported the frequency and distress of 25 symptoms occurring in the three cycle phases and rated how often the symptoms impaired their daily functioning. Results. The symptom distress remained modest across all phases. Nevertheless, a repeated-measures ANOVA showed that distress was higher during menstruation (M = 1.41, SD = 0.62) compared to the other two phases (ps <.001), F(1.79, 526.15) = 91.19, p < .001, η²ₚ = .24. The psychological-cognitive, discomfort and physiological symptom clusters were the most frequent across all phases. Pain predicted impairment of daily functioning in the premenstrual and menstrual phase, together with discomfort. Age, contraception use, and gynaecological conditions were not related to changes in distress. Conclusion. A broad range of symptoms occurred, going beyond symptoms typically studied, such as discomfort with vaginal bleeding, feeling dirty, concentration impairment. Although with minimal interference, symptoms stereotypically linked to the (pre-)menstrual phase may occur throughout the cycle, emphasising the need for research to encompass the entire menstrual cycle and to examine a broader range of symptoms.