Objective. To evaluate the impact of premenstrual symptoms on activities of daily life (ADL) of Korean women, and their knowledge and treatment seeking regarding premenstrual syndromes (PMSs). Methods. A population-based online survey regarding premenstrual symptoms was conducted in 1000 Korean women aged 15-49 years. Symptoms were classified according to their intensity, persistence each cycle, and impairment of ADL. Women's knowledge of PMSs and physician consultations were assessed. Results. The approximate prevalence of PMS/premenstrual dysphoric disorder (PMDD) by the WHO's International Classification of Disease (ICD-10), American College of Obstetrics and Gynecology (ACOG), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV[4th edition]) criteria was 98.6, 32.1, and 2.8%, respectively. Among 23 documented symptoms, the most predominant symptoms were joint-muscle-back pain, abdominal pain, and irritability. Physical symptoms were more prevalent than mental symptoms. There was a high correlation between the duration and severity of symptoms. The impact of PMS on ADL and the proportion of women with impaired ADL were significantly associated with the severity of PMS. The proportion of women consulting physicians increased with severity of PMS from 2%, 2.3%, for ICD-10, ACOG PMS to 10.7% for DSM-IV PMDD, respectively. Most of the women (91.5%) had no knowledge regarding terminology pertaining to PMS and PMDD. Conclusion. PMSs occur frequently and have a significant impact on daily life for a proportion of Korean women. However, Korean women have little knowledge about PMSs and only infrequently consult their physicians.

ABSTRACT Introduction. Clinical trial design in female sexual dysfunction (FSD) is an evolving science, with some areas of controversy. Aim. To develop an evidence-based, expert consensus-report on design of FSD clinical research. Methods. Literature review including the Food and Drug Administration (FDA) clinical trial guidelines with critique by six experts from three countries, modified after public presentation and debate. Main Outcome Measure. Expert opinion and recommendations were based on grading of evidence based literature, internal committee dialogue, open presentation, and debate. Results. Design of clinical research for regulatory approval is driven by FDA guidelines. Diagnostic and Statistical Manual-IV definitions and consideration of comorbidity of sexual disorders may complicate patient selection and outcomes. Measures for study end points include satisfying sexual events utilizing a daily diary, sexual distress, and patient-reported outcomes measures of the construct under study. Currently, trial duration is recommended to be 6 months for efficacy trials to allow for modification of behavioral adaptations to changes in desire. Important issues include safety assessments, generalizability, having a representative study population, stratification by reproductive status, partner assessment, contextual and interpersonal factors, symptom duration and severity, management of placebo response, and drug dosing. Statistical analysis should include assessment of change from baseline to end point between study drug and placebo, determination of statistically significant change vs. clinically meaningful effects, linear mapping of all measures of the same construct, and determination of responders and remitters. Conclusions. Future trials should include clear population definitions, direct and indirect measures of the specific FSD construct, and procedures to allow generalizability of diagnosis and treatment to the target population. Clayton AH, Dennerstein LD, Fisher WA, Kingsberg SA, Perelman MA, and Pyke RE. Standards for clinical trials in sexual dysfunction in women: research designs and outcomes assessment. J Sex Med 2010;7:541-560.

The assessment and then treatment of a change in libido, or a change in the desire to partake in sexual activity, during the menopausal transition and beyond has been a challenging and elusive area of clinical research. This is partly due to the multidimensional nature of female sexuality, the difficulties of measuring testosterone in women in a reliable and accurate manner, and the complexity of the neurobiology and neurobehavior of female sexual desire. In addition, there is a lack of evidence for diagnostic specificity of low free testosterone levels for the symptom of low libido in women for whom there are no confounding interpersonal or psychological factors; although, in the symptomatic population of surgically or naturally menopausal women, a low level of free testosterone often accompanies a complaint of reduced desire/libido. The randomized clinical trial research on testosterone replacement for naturally and/or surgically menopausal women with sexual dysfunction has been criticized for a high placebo response rate, supraphysiological replacement levels of testosterone, the perception of modest clinical outcome when measuring objective data such as the frequency of sexual intercourse relative to placebo, and the unknown safety of long-term testosterone replacement in the estrogen-replete surgically or naturally menopausal woman. A careful review of current evidence from randomized, controlled trials lends support to the value of the replacement of testosterone in the estrogen-replete menopausal woman for whom libido and desire has declined. The issue of long-term safety remains to be answered.

OBJECTIVES: Determine women's experiences of premenstrual symptoms. STUDY DESIGN: Cross-sectional survey. Sample In all, 4085 women aged 14-49 years recruited by random telephone digit dialing in France, Germany, Hungary, Italy, Spain, UK, Brazil and Mexico. Main outcome measures Telephone interview checklist of 23 premenstrual symptoms, sociodemographic variables and lifestyle variables. RESULTS: The most prevalent symptoms were abdominal bloating, cramps or abdominal pain, breast tenderness, irritability and mood swings. Severity of symptoms is directly proportional to duration (R = 0.79). Hierarchical clustering found the following mental and physical domains and a typology:'Mild' type (40.8%) with minimal symptoms;'Moderate M' type (28.7%) with moderately severe, mostly mental symptoms;'Moderate P' type (21.9%) with moderately severe, mostly physical symptoms; and 'Severe' type (8.6%) with severe intensity of both mental and physical symptoms. Multiple stepwise regression found significant effects on symptom duration severity index of age (linear and quadratic effects), current smoking and country. CONCLUSIONS: Further research is needed on the impact of premenstrual symptoms on quality of life, and whether a brief symptom list could be developed as a valid and reliable tool globally.

OBJECTIVE: To assess impact of premenstrual symptoms on activities of women's daily lives (ADL). DESIGN: Cross-sectional population-based survey. SETTING: Market research company. PATIENT(S): A total of 4,085 women aged 14-50 years recruited by random telephone digit dialing in France, Germany, Hungary, Italy, Spain, the United Kingdom, Brazil, and Mexico. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): A telephone interview checklist of 23 premenstrual symptoms, sociodemographic and lifestyle variables, and ADL effects (global question and seven areas). Stepwise multiple linear regression explored the effect of each symptom, symptom domain, and symptom dimension on ADL. Stepwise regression measured the effect of premenstrual symptoms and sociodemographic factors on ADL. RESULT(S): Symptoms and symptom domains (physical and mental) had similar negative effects on ADL. Activities of daily life were predominantly affected by symptom severity. Income level, age, and country also significantly affected ADL. In all, 2,638 women (64.6%) were minimally affected in ADL, 981 (24%) were moderately affected, and 454 (11.1%) were severely affected. CONCLUSION(S): Both physical and mental premenstrual symptoms have significant impact on quality of life, assessed as ADL. Up to 35% of women of reproductive age in Europe and Latin America were moderately or severely affected in ADL by cyclical premenstrual symptoms.

ABSTRACT Introduction. Limited published data address the impact of low sexual desire and interest on multiple domains of women's partnered relationships. Aim. To investigate associations between sexual interest and attitudes toward and frequency of partner interactions in women with reduced sexual desire. Methods. A cross-sectional study was conducted using market research databases to recruit women from the general community in the United States, Germany, and Italy. Telephone interviews screened women to obtain a sample aged 18-65 years, in a relationship, and upset/bothered by decreased sexual desire. A 60-minute face-to-face questionnaire was conducted in participants' homes. Main Outcome Measures. Attitudes Toward Partner Interactions (ATPI) index measured sexual and nonsexual partner interactions. Higher scores indicated more positive attitudes and a higher frequency of partner interactions. Sexual interest was assessed on a 6-point scale. Results. One thousand four hundred two of the 8,000 women screened met the inclusion criteria and agreed to participate (USA N = 600, Germany N = 402, Italy N = 400). A high percentage of participants reported that their sexual interest was absent to very weak (45%) or somewhat weak (43%). Mean ATPI scores increased significantly across sexual interest categories, from absent to very weak (3.7, 95% confidence interval [CI] 3.4 to 4.0) to somewhat weak (5.3, 95% CI 5.0 to 5.6) to somewhat strong or greater sexual interest (7.8, 95% CI 7.3 to 8.4)(one-way analysis of variance, effect size = 0.129, P = 0.001). Higher reported sexual interest was significantly associated with comparatively positive ATPI scores (above the median)(Phi-Kraemer, K = 0.194 P < 0.001). Conclusion. Clinicians need to be aware that women suffering from characteristics of hypoactive sexual desire disorder have more negative patterns of partner interactions. Dennerstein L, Hayes R, Sand M, and Lehert P. Attitudes toward and frequency of partner interactions among women reporting decreased sexual desire. J Sex Med **;**:**-**.

ABSTRACT Introduction. Insufficient documentation exists regarding the prevalence of hypoactive sexual desire disorder (HSDD) in surgically menopausal (SM) women in European countries. Women who have undergone hysterectomy and bilateral oophorectomy experience a loss of ovarian hormones. Inclusion of these women in an epidemiological study provided the opportunity to study biological and cultural impacts on sexual function. Aim. The aim of this study was to compare the prevalence of HSDD among SM women in France, Germany, Italy, and the United Kingdom, as well as the relationship between low sexual desire and sexual activity or behavior, and sexual or partner relationship satisfaction. Methods. Cross-sectional survey of a convenience sample of 427 SM women aged 20-70 years. Main Outcome Measures. The desire domain of the Profile of Female Sexual Function (PFSF) to identify women with low sexual desire, Personal Distress Scale (PDS) to measure distress caused by low sexual desire, and a sexual activities measure. Women with low sexual desire who were distressed were classified as having HSDD. Results. SM women having low sexual desire ranged from 35%(United Kingdom) to 44%(Italy); of these women, 16%(Germany) to 56%(France) were distressed because of their low sexual desire. Overall, SM women classified with HSDD ranged from 7%(Germany) to 22%(France). A strong positive correlation was observed between sexual desire and arousal, orgasm, and sexual pleasure in all countries (P < 0.001). Low sexual desire leads to less sexual activity, more dissatisfaction with sex life and partner relationship, and more negative emotional or psychological states, than normal desire in each country. Conclusions. A similar percentage of SM women with low sexual desire were found across countries suggesting the role of biological factors (i.e., losing ovarian hormones) in determining sexual desire. Differences in the percentage of SM women with HSDD suggest a role for cultural factors in determining how low sexual desire is perceived. Graziottin A, Koochaki PE, Rodenberg CA, and Dennerstein L. The prevalence of hypoactive sexual desire disorder in surgically menopausal women: An epidemiological study of women in four European countries. J Sex Med **;**:**-**.

OBJECTIVE:: Vasomotor symptoms adversely affect the quality of life and functional status of most women during the menopausal transition, but little is known about how long these symptoms last. The most effective treatment, hormone therapy (HT), carries risks and benefits that depend on the timing and duration of use. In this study we sought to estimate the duration of vasomotor symptoms in a longitudinal study. METHODS:: We reanalyzed primary data from 438 women in the longitudinal cohort of the population-based Melbourne Women's Midlife Health Project. Two hundred and five women who had completed 13 years of follow-up were included in the analyses. The onset and cessation of vasomotor symptoms were reported, stratifying analyses according to ever use of HT. Symptom duration was calculated as the time between the first and last bothersome hot flush reported. RESULTS:: The mean (SD) duration of bothersome menopausal symptoms for women who completed 13 years of follow-up and who never used HT was estimated to be 5.2 (3.8) years (median, 4 years). If women who used HT were included, the mean (SD) duration was 5.5 (4.0) years (median, 4 years). The estimated duration of symptoms varied according to the duration of longitudinal follow-up, with a mean estimate of 3.4 years (median, 3 years) when only 8 years of follow-up data were analyzed. The only factor associated with duration of hot flushes was regular exercise-more exercise was associated with shorter symptom duration. CONCLUSIONS:: The average duration of vasomotor symptoms in this sample is more than 5 years, substantially longer than had been previously reported.

OBJECTIVE:: Across a woman's lifetime, variations in hormone levels are known to influence mood and well-being. Whether absolute or changes in hormone levels over time are associated with depression among postmenopausal women remains unclear. METHODS:: The Melbourne Women's Midlife Health Project is a longitudinal population-based study of women who were followed through the menopausal transition. This analysis is based on data collected from 138 postmenopausal women in years 11 and 13 of the study, who were assessed for the presence of depressive symptoms using the Center for Epidemiological Studies Depression Scale. Logistic regression models were developed to determine whether absolute or changes in hormone levels were associated with depression. RESULTS:: No significant associations were found between depressive symptoms and the absolute levels of sex hormone-binding globulin, testosterone, free androgen index, estradiol, free estradiol, or follicle-stimulating hormone (FSH). On the other hand, women with a decline in total serum estradiol over the 2-year period had a more than threefold increased risk of depressive symptoms (odds ratio, 3.5; 95% CI, 1.2-9.9). A large increase in FSH levels over this period was also associated with depressive symptoms (odds ratio, 2.6; 95% CI, 1.0-6.7). These associations remained even after adjustment for initial depression score, as well as a range of potential confounding factors. CONCLUSIONS:: Changes in estradiol and, to a lesser extent, in FSH levels are associated with an increased risk of depressive symptoms in postmenopausal women. These results further support a role for fluctuating rather than absolute hormone levels in depression in later life.