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Premenstrual tension: Symptoms and weight changes related to potassium therapy
Premenstrual
tension: Symptoms and weight
changes related to potassium therapy BILLY
D.
REEVES,
JAMES
E.
GARVIN,
THOMAS Chicago
W.
McELIN,
and Evanston,
M.D.* PH.D.,
M.D.
M.D.,
M.S.
Illinois
With the use of patients with and without evidence of prsmenrtrual tension, a study was done in which comparison of weight changes and symptoms were evaluated during control menstrual cycles, menstrual cycles when a placebo (glucose) was taken, and menstrual cycles when a diuretic (potassium chloride) was taken. It was found that the clinician can make a verifiable diagnosis of premenstrual tension. While the symptoms of this entity could not be correlated with premenstrual weight gain, they could be with lability of weight during the 5 days preceding menses. In fact, in all of the cycles (control, placebo, and diuretic-treated), there was found to be a highly significant gain in weight in the 5 days premenses. The use of oral potassium chloride supplements in gelatine capsules had no effect on symptoms reported by patients with premenstrual tension.
gained.lO-I3 Indeed, the use of exogenous hormones and diuretics as treatment is based upon the general acceptance of this theoretical etiologic pathway. Finally, although no exact frequency figures are available, premenstrual tension is said to be “rather common.“4 This concept has not gone unchallenged. Bruce and Russell2 in a review of the literature and in a study of their own, using emotionally disturbed women, contend that there is no definite correlation between water retention, weight gain, and premenstrual symptoms and that the administration of hormones or diuretics, except on an empiric basis, is without logic. Furthermore, if an attempt is made to use the weight changes of normal women during the premenstrual period as a basis for comparison, no generally acckpted pattern is evident either in the above study2 or in other studies 3p4* I4 or in the texts.lp 4l 7* lo-l3 Reports vary from zero to four pounds weight gain in the premenses of normal women and zero to ten pounds in women with premenstrual tension. With these problems in mind, an experi-
PREMENSTRUAL TENSION, acondition consisting of a variety of mental and physical symptoms which occurs several days before the menses, was first described with reasonable precision by Franks in 1931. Among the symptoms noted are depression, irritability, headache, bloating of the abdomen, swelling of the ankles and hands, stiffness of joints, enlargement of the breasts, and mastodynia. Although numerous etiologic theories have been suggested, the exact cause of this condition is unknown. Most text+ 4l lo-l3 propose a pathophysiologic process as follows: The change in the hormonal milieu near the end of the cycle leads to electrolyte changes with subsequent fluid retention which is reflected in weight gain and the symptoms listed above. Furthermore, the extent to which an individual suffers is thought by some to vary with the amount of weight From the Departments of Obstetrics and Gynecology and Biochemistry of Northwestern University Medical School. and Evanston Hospital: *Present Chicago,
address: Illinois
Rush 60612.
Medical
College, 1036
Volume Number
109 7
ment was designed which attempted to determine : (1) if individuals previously diagnosed as having premenstrual tension do indeed, when recording their symptoms day by day, report more symptoms than a control group, (2) if any pattern in premenstrual weight change could be established which distinguished the control, placebo, or supplement groups, (3) if any correlation could be made between a weight change pattern and symptoms, and (4) if those symptoms could be altered by the use of an exogenous diuretic. Experimental design For this purpose, 20 patients from the office of one of the authors (T. W. M.) volunteered to participate in this study. Ten were patients who had few, if any, complaints related to their menstrual cycle. Ten had been previously diagnosed and treated for the symptoms associated with premenstrual tension. Each of the patients was given a balance scale and instructed in its use. Each was given a set of charts for maintenance of daily records and instructed in their use. Each chart provided space for daily recording of day of cycle, day of week and month, morning and evening weight, if a capsule was taken, swollen ankles, increase in breast size, breast tenderness, bloating, headache, irritability, stiffness of joints, bleeding gums, bruising easily, excess exercise, and number of pads used. A separate chart was used for each cycle. Each patient was seen monthly to check the records and recordings and to be given a bottle of “medication” capsules. The exogenous diuretic chosen for this study was potassium chloride. It was selected for 3 reasons. First, in the experience of one of us (J. E. G.), it had been effective for alleviating the symptoms of a case of cyclical edema. Second (and the basis for its selection in the patient with cyclical edema), an experimental study8 had shown that a deficiency of this ion had been correlated with edema. Third, this salt in gelatine-coated capsules is advocated for treatment of premenstrual tension by a standard text on menstrual disorderslO Therefore, capsules
Premenstrual
tension
1037
containing one gram of salt were prepared. Simultaneously, similar capsules were prepared containing glucose as a placebo. Both were prepared and bottled by the University pharmacy. Each bottle was number coded. The code was not revealed to the authors until the study was completed. Each subject was asked to record the information requested for 5 menstrual cycles. These 5 cycles consisted of a control cycle (no medication), 2 cycles in which potassium chloride was taken, and 2 cycles in which a placebo was administered. Except for the control cycle which came first, neither the subject nor the authors knew the order in which the potassium or the placebo were taken. The patient took one capsule after each meal. With this experimental design, we had not only double-blind control subjects for comparison but also a control cycle for each subject in the study. If there was any question about the data and the accuracy thereof, if the patient became pregnant, if she could not tolerate the potassium supplement, if she had to make a major diet change or begin other medication, the chart was discarded. Management
of data
At the conclusion of the study, which required 8 months, 6 subjects in the premenstrual tension group and 5 subjects without tension had contributed acceptable data for 38 complete cycles. Of these, 10 were control cycles, 13 were placebo cycles, and 15 were potassium cycles. Seventeen of the cycles were derived from patients without premenstrual tension and 21 from patients with premenstrual tension. To determine if a trend in weight gain existed for each cycle, the information for each cycle in each patient was transferred from the raw-data chart to a conversion chart. Fig. 1 represents a conversion chart for a control cycle of one patient. The statistical handling of raw data for the daily weights has been a problem for each of the previous investigators.‘* 3p 5l I* Each has used a different method, and each has obtained
1038
Reeves,
Gorvin,
and
McElin Amer.
150149-
El B
146---J
--
z : 9
147-
I
146-
14%
1 ‘2’3’4’5’6’7’6’9’10’11‘12’13’14’15’16’17’16’~9’20’~‘22’23’24‘~’~‘27’1 DAY
Fig. 1. A sample of the bars represent the daily half of the cycle are 2 post ovulation and the direction of these lines the number of symptoms
OF
CYCLE
‘2’3’4’
(MENSES
recorded
on
weight of one (+) . The checked for each of the the flow was added, and each cycle was recorded. to arrive at an average of symptoms recorded menstrual
period
(Table
UNDERLINED)
0
0
+
+
+2
(No. of symptoms
5 days
premenses)
way in which patients’ data were made ready for analysis. The vertical high (P.M.) and low (A.M.) weight. Beneath the weights in the iast broken lines which represent trends in weight change for the 9 days last 5 premenstrual days. The statistical method for quantitation and is described in the text. Beneath the last 5 days of the cycle is noted (in pluses) the patient experienced.
different results. The method used in this study is the method of averages as described by Daniels6 This is a standard method for determining the slope of a line. In effect, it averages all slopes between individual points and gives each slope an equal weight. In our calculations, we employed the average of the morning and evening weights as the point for the day. Thus, it is possible to arrive at a quantitated trend (or slope) for each of the time periods and express the trend in positive or negative amounts. The results of these calculations for each cycle showed that most cycles were positive (82 per cent), i.e., showed a weight gain, for the 5 day premenstrual slope. For all cycles, this weight gain averaged 1.25 pounds. In order to quantitate symptoms, each symptom
1, 1971 Gynec.
-. w 1
151--
0”
April J. Obstet.
a chart
was
given
a
number of symptoms 5 days just preceding the total number for It was thus possible total for the number in the 5 day preI). In this way it
Table I. Average number 5 days of cycle
of symptoms
last
Control group Placebo group Potassium grou# (Avg.) (Avg.) (A 4 Patients with no premenstrual tension 1.57 2.75 3.6 Patients with premenstrual tension 12.3 9.5
12.6
was possibleto give some quantitative value to the report of subjective symptoms. Results
and
Comment
Comparison of numbers of symptoms reported by the premenstrual tension groups with numbers of symptoms reported by control group. Fig. 2 compares the average number of symptoms reported by the premenstrual tension group with the average number of symptoms reported by the individuals in the control group (without premenstrual tension) during the last 5 days in 3 categories: control, placebo, and potassiumsupplement cycles. The figure shows that strikingly larger numbers of symptoms were
Volume Number
109 7
Premenstrual
SYMPTOM
tension
1039
CORRELATION
.
CONTROL-
.POTASS
NO
PREMENSTRUAL
PREMENSTRUAL
Fig. 2. This upon
symptoms.
figure shows that * = Determined
neither the placebo by Student’s t test.
reported by the premenstrual tension group in all 3 categories and that the differences are statistically significant. Thus, for the placebo category the difference is highly statistically significant (p < 0.001) ; for the potassium-supplement category the differences are also highly statistically significant (0.001 > p > 0.01)) and for the control category the difference is statistically significant (0.02 > p > 0.05).
TENSION TENSION
nor
the
diuretic
had
any
apparent
effect
These data confirm the value of the “clinical diagnosis” of premenstrual tension in delimiting 2 verifiable groups. Thus any subsequent comparisonsmade in this paper between the groups have added weight. Comparison of weight gain in the 5 days before onset of mensesfor control, placebo, and potassium-supplement groups. In Table II is listed the average weight gain per day for each group in the premenstrual phase of
1040
Reeves,
Garvin,
Table II. Average
and
weight
McElin
Amer.
gain during
0.26
Standard
0.13
P value
error
1, 1971 Gynec.
last 5 days before onset of menstruation
( Control group 1 Average (pounds/day)
April J. Obstet.
Placebo
(10)
0.05
the cycle, For each group are also listed the standard error and its statistical significance. Note that only all groups taken together show a statistically significant weight gain premenstrually, These p values were obtained when the slope of the 5 days premenstrual period weight change was compared with the slope of the 9 day postovulatory period by use of the t test of Student. Table II also shows that there was an average weight gain of from 0.19 to 0.26 pounds per day over the last 5 days before the onset of menses. This gain in weight occurred in 82 per cent of cycles averaging a gain of 1.25 pounds. In 7 cycles there was no weight gain or else a loss of weight. It is evident that there was no difference between the 3 groups, and we must conclude that, when the data for normal individuals and those with premenstrual tension are pooled, an effect of the placebo and potassium supplements cannot be detected. On the other hand, the premenstrual gain in weight appears to be a statistically highly significant occurrence since, when all cycles were pooled, the p value was less than 0.001.
Correlation of symptoms reported with weight gain. Regarding the relationship of the amount of weight gained to the symptoms expressed, 2 attempts were made to correlate the method-of-average slopes for each of the 38 cycles versus the total number of symp-
0.19
grouj (13)
Potassium 0.21
group (15)
1 Total
of all groups 0.22
0.09
0.09
0.06
0.05
0.04
0.001
(38)
toms recorded for each in the last 5 days. Neither with graphs nor by applying the statistical method of regression correlation could any significant correlation between weight gain and symptoms be shown. If, however, all of the signs of the slopes were changed to positive, there would be a definite regression correlation between the amount of weight change and symptoms. This would be significant to a P value of 0.01. Hence, the only statistically significant correlation appears to be between number of symptoms reported and lability of premenstrual weight. It is important here to distinguish between gain in weight for the total body and gain in weight in certain compartments. It seems possible that accumulation of liquid in certain compartments could be hormonally determined but need not be reflected in a gain in total body weight. Needless to say, studies of the kind reported here could not distinguish such phenomena.
Effect of placebo and potassium suppIemerits on symptoms reported. Fig. 2 shows that in the premenstrual tension group there was no reduction in symptoms reported by the placebo or potassium-supplement categories when compared to the control category. The possibility that edema resulting from a marginal potassium status is responsible for the symptoms reported appears to be excluded.
REFERENCES
Brewer, J. I.: Textbook of Gynecology, ed. 4, Baltimore, 1967, The Williams & Wilkins Company. Bruce, J., and Russell, G. F. M.: Lancet 2: 267, 1962. Chesley, L. C., and Hellman, L. M.: AMER. J. OBSTET. GYNEC. 74: 582, 1957. Danforth, D. N.: Textbook of Obstetrics and
5. 6.
Gynecology, New York, 1966, Paul B. Hoeber Inc., Medical Book Division of Harper & Row, Publishers. Danforth, D. N., Bayer, P. K., and Graff, S.: Endocrinology 39: 188, 1946. Daniels, F.: Mathematical Preparations for Physical Chemistry, New York, 1928, McGraw-Hill Book Company, Inc., p. 235.
Volume Number
7.
8. 9. 10.
Premenstrual
109 7
Eastman, N. J., and Hellman, L. M.: Williams Obstetrics, ed. 13, New York, 1966, AppletonCentury-Crofts, Inc. Fourman, P., and Harvey, G. R.: Clin. Sci. 14: 75, 1958. Frank, R. T.: Arch. Neurol. Psychiat. 26: 1053, 1931. Israel, S. L.: Menstrual Disorders and Sterility, ed. 5, New York, 1967, Paul B. Hoeber, Inc., Medical Book Division of Harper & Row, Publishers, p. 158.
11.
12.
13.
14.
tension
1041
Jeffcoate, T. N. A.: Principles of Gynaecology ed. 3, Washington, D. Cl., 1967, Butterworth & Co., Ltd. Novak, E. R., and Jones, G. S.: Novak’s Textbook of Gynecology, ed. 7, Baltimore, 1965, The Williams & Wilkins Company. Parsons, L., and Sommers, S. C.: Gynecology, ed. 1, Philadelphia, 1962, W. B. Saunders Company. Thorn, G. W., Nelson, K. R., and Thorn, D. W.: Endocrinology 22: 155, 1938.
tension: Symptoms and weight
changes related to potassium therapy BILLY
D.
REEVES,
JAMES
E.
GARVIN,
THOMAS Chicago
W.
McELIN,
and Evanston,
M.D.* PH.D.,
M.D.
M.D.,
M.S.
Illinois
With the use of patients with and without evidence of prsmenrtrual tension, a study was done in which comparison of weight changes and symptoms were evaluated during control menstrual cycles, menstrual cycles when a placebo (glucose) was taken, and menstrual cycles when a diuretic (potassium chloride) was taken. It was found that the clinician can make a verifiable diagnosis of premenstrual tension. While the symptoms of this entity could not be correlated with premenstrual weight gain, they could be with lability of weight during the 5 days preceding menses. In fact, in all of the cycles (control, placebo, and diuretic-treated), there was found to be a highly significant gain in weight in the 5 days premenses. The use of oral potassium chloride supplements in gelatine capsules had no effect on symptoms reported by patients with premenstrual tension.
gained.lO-I3 Indeed, the use of exogenous hormones and diuretics as treatment is based upon the general acceptance of this theoretical etiologic pathway. Finally, although no exact frequency figures are available, premenstrual tension is said to be “rather common.“4 This concept has not gone unchallenged. Bruce and Russell2 in a review of the literature and in a study of their own, using emotionally disturbed women, contend that there is no definite correlation between water retention, weight gain, and premenstrual symptoms and that the administration of hormones or diuretics, except on an empiric basis, is without logic. Furthermore, if an attempt is made to use the weight changes of normal women during the premenstrual period as a basis for comparison, no generally acckpted pattern is evident either in the above study2 or in other studies 3p4* I4 or in the texts.lp 4l 7* lo-l3 Reports vary from zero to four pounds weight gain in the premenses of normal women and zero to ten pounds in women with premenstrual tension. With these problems in mind, an experi-
PREMENSTRUAL TENSION, acondition consisting of a variety of mental and physical symptoms which occurs several days before the menses, was first described with reasonable precision by Franks in 1931. Among the symptoms noted are depression, irritability, headache, bloating of the abdomen, swelling of the ankles and hands, stiffness of joints, enlargement of the breasts, and mastodynia. Although numerous etiologic theories have been suggested, the exact cause of this condition is unknown. Most text+ 4l lo-l3 propose a pathophysiologic process as follows: The change in the hormonal milieu near the end of the cycle leads to electrolyte changes with subsequent fluid retention which is reflected in weight gain and the symptoms listed above. Furthermore, the extent to which an individual suffers is thought by some to vary with the amount of weight From the Departments of Obstetrics and Gynecology and Biochemistry of Northwestern University Medical School. and Evanston Hospital: *Present Chicago,
address: Illinois
Rush 60612.
Medical
College, 1036
Volume Number
109 7
ment was designed which attempted to determine : (1) if individuals previously diagnosed as having premenstrual tension do indeed, when recording their symptoms day by day, report more symptoms than a control group, (2) if any pattern in premenstrual weight change could be established which distinguished the control, placebo, or supplement groups, (3) if any correlation could be made between a weight change pattern and symptoms, and (4) if those symptoms could be altered by the use of an exogenous diuretic. Experimental design For this purpose, 20 patients from the office of one of the authors (T. W. M.) volunteered to participate in this study. Ten were patients who had few, if any, complaints related to their menstrual cycle. Ten had been previously diagnosed and treated for the symptoms associated with premenstrual tension. Each of the patients was given a balance scale and instructed in its use. Each was given a set of charts for maintenance of daily records and instructed in their use. Each chart provided space for daily recording of day of cycle, day of week and month, morning and evening weight, if a capsule was taken, swollen ankles, increase in breast size, breast tenderness, bloating, headache, irritability, stiffness of joints, bleeding gums, bruising easily, excess exercise, and number of pads used. A separate chart was used for each cycle. Each patient was seen monthly to check the records and recordings and to be given a bottle of “medication” capsules. The exogenous diuretic chosen for this study was potassium chloride. It was selected for 3 reasons. First, in the experience of one of us (J. E. G.), it had been effective for alleviating the symptoms of a case of cyclical edema. Second (and the basis for its selection in the patient with cyclical edema), an experimental study8 had shown that a deficiency of this ion had been correlated with edema. Third, this salt in gelatine-coated capsules is advocated for treatment of premenstrual tension by a standard text on menstrual disorderslO Therefore, capsules
Premenstrual
tension
1037
containing one gram of salt were prepared. Simultaneously, similar capsules were prepared containing glucose as a placebo. Both were prepared and bottled by the University pharmacy. Each bottle was number coded. The code was not revealed to the authors until the study was completed. Each subject was asked to record the information requested for 5 menstrual cycles. These 5 cycles consisted of a control cycle (no medication), 2 cycles in which potassium chloride was taken, and 2 cycles in which a placebo was administered. Except for the control cycle which came first, neither the subject nor the authors knew the order in which the potassium or the placebo were taken. The patient took one capsule after each meal. With this experimental design, we had not only double-blind control subjects for comparison but also a control cycle for each subject in the study. If there was any question about the data and the accuracy thereof, if the patient became pregnant, if she could not tolerate the potassium supplement, if she had to make a major diet change or begin other medication, the chart was discarded. Management
of data
At the conclusion of the study, which required 8 months, 6 subjects in the premenstrual tension group and 5 subjects without tension had contributed acceptable data for 38 complete cycles. Of these, 10 were control cycles, 13 were placebo cycles, and 15 were potassium cycles. Seventeen of the cycles were derived from patients without premenstrual tension and 21 from patients with premenstrual tension. To determine if a trend in weight gain existed for each cycle, the information for each cycle in each patient was transferred from the raw-data chart to a conversion chart. Fig. 1 represents a conversion chart for a control cycle of one patient. The statistical handling of raw data for the daily weights has been a problem for each of the previous investigators.‘* 3p 5l I* Each has used a different method, and each has obtained
1038
Reeves,
Gorvin,
and
McElin Amer.
150149-
El B
146---J
--
z : 9
147-
I
146-
14%
1 ‘2’3’4’5’6’7’6’9’10’11‘12’13’14’15’16’17’16’~9’20’~‘22’23’24‘~’~‘27’1 DAY
Fig. 1. A sample of the bars represent the daily half of the cycle are 2 post ovulation and the direction of these lines the number of symptoms
OF
CYCLE
‘2’3’4’
(MENSES
recorded
on
weight of one (+) . The checked for each of the the flow was added, and each cycle was recorded. to arrive at an average of symptoms recorded menstrual
period
(Table
UNDERLINED)
0
0
+
+
+2
(No. of symptoms
5 days
premenses)
way in which patients’ data were made ready for analysis. The vertical high (P.M.) and low (A.M.) weight. Beneath the weights in the iast broken lines which represent trends in weight change for the 9 days last 5 premenstrual days. The statistical method for quantitation and is described in the text. Beneath the last 5 days of the cycle is noted (in pluses) the patient experienced.
different results. The method used in this study is the method of averages as described by Daniels6 This is a standard method for determining the slope of a line. In effect, it averages all slopes between individual points and gives each slope an equal weight. In our calculations, we employed the average of the morning and evening weights as the point for the day. Thus, it is possible to arrive at a quantitated trend (or slope) for each of the time periods and express the trend in positive or negative amounts. The results of these calculations for each cycle showed that most cycles were positive (82 per cent), i.e., showed a weight gain, for the 5 day premenstrual slope. For all cycles, this weight gain averaged 1.25 pounds. In order to quantitate symptoms, each symptom
1, 1971 Gynec.
-. w 1
151--
0”
April J. Obstet.
a chart
was
given
a
number of symptoms 5 days just preceding the total number for It was thus possible total for the number in the 5 day preI). In this way it
Table I. Average number 5 days of cycle
of symptoms
last
Control group Placebo group Potassium grou# (Avg.) (Avg.) (A 4 Patients with no premenstrual tension 1.57 2.75 3.6 Patients with premenstrual tension 12.3 9.5
12.6
was possibleto give some quantitative value to the report of subjective symptoms. Results
and
Comment
Comparison of numbers of symptoms reported by the premenstrual tension groups with numbers of symptoms reported by control group. Fig. 2 compares the average number of symptoms reported by the premenstrual tension group with the average number of symptoms reported by the individuals in the control group (without premenstrual tension) during the last 5 days in 3 categories: control, placebo, and potassiumsupplement cycles. The figure shows that strikingly larger numbers of symptoms were
Volume Number
109 7
Premenstrual
SYMPTOM
tension
1039
CORRELATION
.
CONTROL-
.POTASS
NO
PREMENSTRUAL
PREMENSTRUAL
Fig. 2. This upon
symptoms.
figure shows that * = Determined
neither the placebo by Student’s t test.
reported by the premenstrual tension group in all 3 categories and that the differences are statistically significant. Thus, for the placebo category the difference is highly statistically significant (p < 0.001) ; for the potassium-supplement category the differences are also highly statistically significant (0.001 > p > 0.01)) and for the control category the difference is statistically significant (0.02 > p > 0.05).
TENSION TENSION
nor
the
diuretic
had
any
apparent
effect
These data confirm the value of the “clinical diagnosis” of premenstrual tension in delimiting 2 verifiable groups. Thus any subsequent comparisonsmade in this paper between the groups have added weight. Comparison of weight gain in the 5 days before onset of mensesfor control, placebo, and potassium-supplement groups. In Table II is listed the average weight gain per day for each group in the premenstrual phase of
1040
Reeves,
Garvin,
Table II. Average
and
weight
McElin
Amer.
gain during
0.26
Standard
0.13
P value
error
1, 1971 Gynec.
last 5 days before onset of menstruation
( Control group 1 Average (pounds/day)
April J. Obstet.
Placebo
(10)
0.05
the cycle, For each group are also listed the standard error and its statistical significance. Note that only all groups taken together show a statistically significant weight gain premenstrually, These p values were obtained when the slope of the 5 days premenstrual period weight change was compared with the slope of the 9 day postovulatory period by use of the t test of Student. Table II also shows that there was an average weight gain of from 0.19 to 0.26 pounds per day over the last 5 days before the onset of menses. This gain in weight occurred in 82 per cent of cycles averaging a gain of 1.25 pounds. In 7 cycles there was no weight gain or else a loss of weight. It is evident that there was no difference between the 3 groups, and we must conclude that, when the data for normal individuals and those with premenstrual tension are pooled, an effect of the placebo and potassium supplements cannot be detected. On the other hand, the premenstrual gain in weight appears to be a statistically highly significant occurrence since, when all cycles were pooled, the p value was less than 0.001.
Correlation of symptoms reported with weight gain. Regarding the relationship of the amount of weight gained to the symptoms expressed, 2 attempts were made to correlate the method-of-average slopes for each of the 38 cycles versus the total number of symp-
0.19
grouj (13)
Potassium 0.21
group (15)
1 Total
of all groups 0.22
0.09
0.09
0.06
0.05
0.04
0.001
(38)
toms recorded for each in the last 5 days. Neither with graphs nor by applying the statistical method of regression correlation could any significant correlation between weight gain and symptoms be shown. If, however, all of the signs of the slopes were changed to positive, there would be a definite regression correlation between the amount of weight change and symptoms. This would be significant to a P value of 0.01. Hence, the only statistically significant correlation appears to be between number of symptoms reported and lability of premenstrual weight. It is important here to distinguish between gain in weight for the total body and gain in weight in certain compartments. It seems possible that accumulation of liquid in certain compartments could be hormonally determined but need not be reflected in a gain in total body weight. Needless to say, studies of the kind reported here could not distinguish such phenomena.
Effect of placebo and potassium suppIemerits on symptoms reported. Fig. 2 shows that in the premenstrual tension group there was no reduction in symptoms reported by the placebo or potassium-supplement categories when compared to the control category. The possibility that edema resulting from a marginal potassium status is responsible for the symptoms reported appears to be excluded.
REFERENCES
Brewer, J. I.: Textbook of Gynecology, ed. 4, Baltimore, 1967, The Williams & Wilkins Company. Bruce, J., and Russell, G. F. M.: Lancet 2: 267, 1962. Chesley, L. C., and Hellman, L. M.: AMER. J. OBSTET. GYNEC. 74: 582, 1957. Danforth, D. N.: Textbook of Obstetrics and
5. 6.
Gynecology, New York, 1966, Paul B. Hoeber Inc., Medical Book Division of Harper & Row, Publishers. Danforth, D. N., Bayer, P. K., and Graff, S.: Endocrinology 39: 188, 1946. Daniels, F.: Mathematical Preparations for Physical Chemistry, New York, 1928, McGraw-Hill Book Company, Inc., p. 235.
Volume Number
7.
8. 9. 10.
Premenstrual
109 7
Eastman, N. J., and Hellman, L. M.: Williams Obstetrics, ed. 13, New York, 1966, AppletonCentury-Crofts, Inc. Fourman, P., and Harvey, G. R.: Clin. Sci. 14: 75, 1958. Frank, R. T.: Arch. Neurol. Psychiat. 26: 1053, 1931. Israel, S. L.: Menstrual Disorders and Sterility, ed. 5, New York, 1967, Paul B. Hoeber, Inc., Medical Book Division of Harper & Row, Publishers, p. 158.
11.
12.
13.
14.
tension
1041
Jeffcoate, T. N. A.: Principles of Gynaecology ed. 3, Washington, D. Cl., 1967, Butterworth & Co., Ltd. Novak, E. R., and Jones, G. S.: Novak’s Textbook of Gynecology, ed. 7, Baltimore, 1965, The Williams & Wilkins Company. Parsons, L., and Sommers, S. C.: Gynecology, ed. 1, Philadelphia, 1962, W. B. Saunders Company. Thorn, G. W., Nelson, K. R., and Thorn, D. W.: Endocrinology 22: 155, 1938.