Research in Nursing and zyxwvutsrqpo Health, zyxwvutsrqp 1982, zyxwvuts 5, 123- 136 zyxwvuts Toward a Construct of Perimenstrual Distress Nancy Fugate Woods, Ada Most, and Gretchen Kramer Dery Recent research findings contradict the notion that premenstrual and menstrual symptoms constitute zyxwvut two mutually exclusive categories of perimenstrual distress. The purposes of this study were to describe the prevalence of distress associated with menstruation in a community population and to determine whether perimenstrual distress could be regarded as a single construct. Nonpregnant women zyxw (N = 193) between 18 and 35 were selected from five neighborhoods in a southeastern city in a way that allowed for variability in race and income. The women were interviewed in their homes and 179 were asked to complete the Moos Menstrual Distress Questionnaire (MDQ). At least 30% of the women reported weight gain, skin disorders, backache, painful or tender breasts, irritability, depression, headache, cramps, fatigue, swelling, mood swings or tension in the perimenstruum. Cycle phase differences were not found for 31 MDQ symptoms, but were found for: weight gain, crying, lowered school or work performance, taking naps, headache, skin disorders, cramps, anxiety, backache, fatigue, painful or tender breasts, swelling, irritability, mood swings, depression, and tension. Although there were significant differences between the premenstrual and menstrual phases for certain symptoms, the magnitudes of the mean differences were small (< .3) except for cramps, weight gain, and fatigue. Furthermore, premenstrual and menstrual reports of the same symptoms were highly correlated. Thus, it appears reasonable to study perimenstrual distress as a single construct. In studies conducted during the sixties and seventies on a variety of populations of women, a wide range in estimates was revealed and there was little agreement on how perimenstrual dis- tress should be defined. Moreover, there have been no published studies of the prevalence of perimenstrual distress in nonstudent or noninstitutionalized populations of American women. Perimenstrual distress commonly has been assumed to reflect two discrete sets of symptoms, one occurring premenstrually and the other during the menstrual flow. Indeed, most investigators report the incidence of symptoms for the premenstruum and menstruum separately, leading one to conclude that the constructs being measured are two mutually exclusive classes of phenomena. During the last two decades, Dalton's (1964) theory of spasmodic and congestive dys- menorrhea has influenced profoundly menstrual cycle research, and probably is responsible for the notion that premenstrual and menstrual dis- tress are discrete phenomena. In 1964, Dalton proposed that there were two discrete forms of perimenstrual distress, spasmodic and congestive dysmenorrhea, and that each was mediated by different hormonal influences. Spasmodic dys- menorrhea occurred at the time of menstruation; the site of pain followed the uterine and ovarian nerve distribution (suprapubic, back, and inner- thigh areas). Usually, spasmodic dysmenorrhea did not begin until about zyx 2 years after menarche, was present only in ovulatory cycles, and most commonly affected women 15 to 25 years of age. Dr. Nancy Fugate Woods zyxwvuts IS an associate professor in the School of Nursing of the University of Washington, Seattle. Dr. Ada Most and Ms. Gretchen Krarner Dery are associate professors in the School of Nursing, Duke University, Durham, Nonh Carolina. This research is part of a larger study, "Distribution and Determinantsof PerimenstrualDistress," funded by a Sigma Theta Tau grant to Dr. Nancy Fugote Woods. This article was received August 26, 1980. was revised, and on January 15, 1982, was accepted for publication. Requests for reprints may be addressed to Dr. Nancy Fugate Woods, University of Washington, Seattle, WA 98195. @ 1982 Wiley 0160-6891/82/030123-14 $01 00 123