Changes and heterogeneity in premenstrual symptom burden after postpartum menstrual resumption: A cohort study in China

Premenstrual symptoms may vary across reproductive transitions, but few studies have examined changes, heterogeneity, and correlates of premenstrual symptom burden from recalled prepregnancy to postpartum after menstrual resumption.

Among 821 women recruited postpartum at two hospitals in China, 329 completed follow-up after menstrual resumption. Premenstrual symptoms were assessed using the Premenstrual Symptoms Screening Tool for recalled prepregnancy and postpartum symptoms; depressive symptoms were assessed at 6 weeks postpartum. Paired tests, baseline-adjusted linear regression, exploratory factor analysis, latent profile analysis, and latent transition analysis were conducted.

The median 14-item symptom score increased from 5.00 to 6.00 (P = 0.002), and the median number of endorsed symptoms increased from 4.00 to 6.00 (P = 0.007). Two prepregnancy and three postpartum profiles were retained. Based on most likely assignments, 67.8% of women had descriptively corresponding profiles, whereas 21.3% shifted toward more symptomatic profiles and 10.9% toward a lower-symptom profile. After adjustment for recalled prepregnancy burden and covariates, each one-point increase in Edinburgh Postnatal Depression Scale score was associated with a 0.52-point higher postpartum symptom score (95% CI, 0.39-0.65); dysmenorrhea affecting daily life was associated with a 2.77-point higher score than no pain (95% CI, 0.59-4.94). Depressive symptoms and severe dysmenorrhea were also associated with postpartum profile destination (P < 0.001 and P = 0.039, respectively).

Premenstrual symptom burden increased modestly after menstrual resumption, with substantial heterogeneity. Early postpartum depressive symptoms and severe prepregnancy dysmenorrhea may identify women more likely to report greater symptom burden after childbirth.