Behavior Genetics

, Volume 17, Issue 4, pp 363–383 | Cite as

Genetic and environmental factors in primary dysmenorrhea and its relationship to anxiety, depression, and neuroticism

  • J. L. Silberg
  • N. G. Martin
  • A. C. Heath


Over 1200 pairs of female monozygotic and dizygotic twins with regular menses reported on the amount of flow, severity of pain, and degree of limitation experienced during menstruation. Fifty-two percent of the women reported moderate or severe menstrual pain and these reports were fairly repeatable (0.62–0.80) over a 3-month interval. Heritabilities were 0.22 for flow, 0.38 for pain, and 0.36 for limitation. Covariations between menstrual symptoms and the symptoms and personality variables of state anxiety and depression and trait neuroticism were shown to be almost entirely genetic in origin. There was also gene action specifically affecting menstrual pain and also menstrual flow, but genetic variation in limitation was entirely due to genes also affecting flow, pain, and personality variables-neuroticism in particular.

Key Words

primary dysmenorrhea genetics anxiety depression neuroticism twins 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abraham, G. E. (1978). Primary dysmenorrhea.Clin. Obstet. Gynecol. 21:139–145.Google Scholar
  2. Akerlund, M. (1979). Pathophysiology of dysmenorrhea.Acta Obstet. Gynecol. Scand. 87:27–32.Google Scholar
  3. Akerlund, M., Anderson, I., and Ingemarsson, E. (1976). Effects of terbutaline on myometrial activity, uterine blood flow, and lower abdominal pain in women with primary dysmenorrhea.Br. J. Obstet. Gynaecol. 83:673–679.Google Scholar
  4. Austin, M. J. F., Martin, N. G., and Heath, A. C. (1985). Detection of genotype × environment interaction in dysmenorrhea.Am. J. Hum. Genet. (Suppl.)37:A3.Google Scholar
  5. Bedford, A., Foulds, G. A., and Sheffield, B. F. (1976). A new personal disturbance scale (DSSI/sAD).Br. J. Soc. Clin. Psychol. 15:387–394.Google Scholar
  6. Berry, C., and McQuirre, F. (1972). Menstrual distress and acceptance of sexual role.Am. J. Obstet. Gynecol. 114:83–86.Google Scholar
  7. Bloom, L. J., Shelton, J. L., and Michaels, A. C. (1978). Dysmenorrhea and personality.J. Personal. Assess. 42:272–276.Google Scholar
  8. Bochm, F. E., and Sarrat, H. (1975). Indomethacin for the treatment of dysmenorrhea.J. Reprod. Med. 15:84–87.Google Scholar
  9. Carey, G. (1986). Sibling imitation and contrast effects.Behav. Genet. 16:319–342.Google Scholar
  10. Chernovety, M. E., Jones, W. H., and Hansson, R. O. (1979). Predictability, attentional focus, sex role orientation and menstrual related stress.Psychosom. Med. 41:383–391.Google Scholar
  11. Chesney, M. A., and Tasto, D. L. (1975). The development of the menstrual symptom questionnaire.Behav. Res. Ther. 13:237–244.Google Scholar
  12. Coppen, A., and Kessel, N. (1963). Menstruation and personality.Br. J. Psychiat. 109:711–721.Google Scholar
  13. Csapo, A. I., Pulkinen, M. O., and Henzl, M. R. (1977). The effect of naproxen sodium on the uterine pressure and menstrual pain of dysmenorrheic patients.Prostaglandins 13:193–195.Google Scholar
  14. Dalton, K. (1976).The Premenstrual Syndrome and Progesterone Therapy, William Heinemann, London.Google Scholar
  15. Doty, R. L., and Silverthorne, C. (1975). Influence of menstrual cycle on volunteering behaviour.Nature 254:139–140.Google Scholar
  16. Eaves, L. J. (1976). A model for sibling effects in man.Heredity 36:205–214.Google Scholar
  17. Eaves, L. J., Last, K. A., Young, P. A., and Martin, N. G. (1978). Model-fitting approaches to the analysis of human behaviour.Heredity 41:249–320.Google Scholar
  18. Eaves, L. J., Martin, N. G., Kendler, K. S., and Heath, A. C. (1987). Testing models for multiple symptoms: An application to the genetic analysis of liability to depression.Behav. Genet. 17:331–341.Google Scholar
  19. Eysenck, H. J., and Eysenck, S. B. G. (1975).Eysenck Personality Questionnaire (Junior and Adult), Hodder and Stoughton Educational, London.Google Scholar
  20. Falconer, D. S. (1981).Introduction to Quantitative Genetics, 2nd. ed., Longman, London.Google Scholar
  21. Halbreich, U., and Endicott, J. (1985). The relationship of dysphoric premenstrual changes to depressive disorders.Acta Psychiat. Scand. 71:331–338.Google Scholar
  22. Halbreich, U., Endicott, J., and Nee, J. (1982). The diversity of premenstrual changes as reflected in the Premenstrual Assessment Form.Acta Psychiat. Scand. 65:46–65.Google Scholar
  23. Hannah, M. C., Hopper, J. L., and Mathews, J. D. (1985). Twin concordance for a binary trait. II. Nested analysis of ever-smoking and ex-smoking traits and unnested analysis of a “committed smoking” trait.Am. J. Hum. Genet. 37:153–165.Google Scholar
  24. Harman, H. H. (1976).Modern Factor Analysis, University of Chicago Press, Chicago.Google Scholar
  25. Heath, A. C., Martin, N. G., Eaves, L. J., and Loesch, D. (1984). Evidence for polygenic epistasis in man?Genetics 106:719–727.Google Scholar
  26. Heath, A. C., Berg, K., Eaves, L. J., Solaas, M. H., Sundet, J., Nance, W. E., Corey, L. A., and Magnus, P. (1985). No decline in assortative mating for educational level.Behav. Genet. 15:349–369.Google Scholar
  27. Heath, A. C., Martin, N. G., Gibson, J. B., Kendler, K. S., and Eaves, L. J. (1987). Effects of life-style, personality, symptoms of anxiety and depression, and genetic predisposition on subjective sleep disturbance and sleep pattern. Unpublished manuscript.Google Scholar
  28. Hirt, M., Kurtz, R., and Ross, W. E. (1967). The relationship between dysmenorrhea and selected personality variables.Psychosomatics 11:219–225.Google Scholar
  29. Jardine, R. (1986). Unpublished Ph.D. thesis, University of Canberra, Canberra, Australia.Google Scholar
  30. Jardine, R., and Martin, N. G. (1984). Causes of variation in drinking habits in a large twin sample.Acta Genet. Med. Gemellol. 33:435–450.Google Scholar
  31. Jardine, R., Martin, N. G., and Henderson, A. S. (1984). Genetic covariation between Neuroticism and the symptoms of anxiety and depression.Genet. Epidemiol. 1:89–107.Google Scholar
  32. Jay, S. M., and Taylor, W. (1981). Primary dysmenorrhea: Current concepts.Am. Family Phys. 24:29–34.Google Scholar
  33. Jeffcoate, T. N. A. (1975).Principles of Gynaecology, Butterworth, London.Google Scholar
  34. Joreskog, K. G. (1978). Structural analysis of covariance and correlation matrices.Psychometrika 43:443–477.Google Scholar
  35. Kantero, R.-L., and Widholm, O. (1971). Correlations of menstrual traits between adolescent girls and their mothers.Acta Obstet. Gynaecol. Scand. (Suppl.)14:30–36.Google Scholar
  36. Kashwagi, T., McClure, J. M., and Wetzel, R. D. (1976). Premenstrual affective syndrome and psychiatric disorder.Dis. Nerv. Syst. 37:116–119.Google Scholar
  37. Kendler, K. S. (1983). overview: A current perspective on twin studies of schizophrenia.Am. J. Psychiat. 140:1413–1425.Google Scholar
  38. Kendler, K. S., Heath, A. C., Martin, N. G., and Eaves, L. J. (1986). Symptoms of anxiety and depression in a volunteer twin population: The etiologic role of genetic and environmental factors.Arch. Gen. Psychiat. 43:213–221.Google Scholar
  39. Kendler, K. S., Heath, A. C., Martin, N. G., and Eaves, L. J. (1987). Symptoms of anxiety and depression: Same genes, different environments?Arch. Gen. Psychiat. 44:451–457.Google Scholar
  40. Kistner, R. W. (1972).Gynecology: Principles and Practice, 2nd ed., Year Book Medical, Chicago.Google Scholar
  41. Kulig, J. W. (1972). Primary dysmenorrhea pathogenesis and therapy.Conn. Med. 46:123–125.Google Scholar
  42. Levitt, E. E., and Lubin, B. (1967). Some personality factors associated with menstrual compliance and menstrual attitude.J. Psychosom. Res. 11:267–270.Google Scholar
  43. Lykken, D. T., Tellegen, A., and DeRubeis, R. (1978). Volunteer bias in twin research: The rule of two thirds.Soc. Biol. 25:1–9.Google Scholar
  44. Martin, N. G., and Eaves, L. J. (1977). The genetical analysis of covariance structure.Heredity 38:79–95.Google Scholar
  45. Martin, N. G., and Jardine, R. (1986). Eysenck's contribution to behavior genetics. In Modgil, S., and Modgil, C. (eds.),Hans Eysenck: Consensus and Controversy, Falmer Press, Lewes, Sussex.Google Scholar
  46. Martin, N. G., and Wilson, S. R. (1982). Bias in the estimation of heritability from truncated samples of twins.Behav. Genet. 12:467–472.Google Scholar
  47. Martin, N. G., Eaves, L. J., Kearsey, M. J., and Davies, P. (1978). The power of the classical twin study.Heredity 40:97–116.Google Scholar
  48. Martin, N. G., Eaves, L. J., Heath, A. C., Jardine, R., Feingold, L., and Eysenck, H. J. (1986). The transmission of social attitudes.Proc. Natl. Acad. Sci. 83:4364–4368.Google Scholar
  49. Martin, N. G., Kendler, K. S., Heath, A. C., Handelsman, D., and Eaves, L. J. (1987). A twin study of the psychiatric side-effects of oral contraceptives (submitted for publication).Google Scholar
  50. McClintock, M. K. (1971). Menstrual synchrony and suppression.Nature 229:244–245.Google Scholar
  51. Menninger, K. A. (1939). Somatic correlations with the unconscious repudiation of femininity in women.J. Nerv. Ment. Dis. 89, 514–529.Google Scholar
  52. Moos, R. H. (1985).Perimenstrual Symptoms: A Manual and Overview of Research with the Menstrual Distress Questionnaire, Department of Psychiatry, Stanford University, Palo Alto, Calif.Google Scholar
  53. Moos, R. H. (1968). The development of the menstrual distress questionnaire.Psychosom. Med. 30:853–857.Google Scholar
  54. Olsson, U. (1979). Maximum likelihood estimation of the polychoric correlation coefficient.Psychometrika 44:443–460.Google Scholar
  55. Olsson, U., Drasgow, F., and Dorans, N. J. (1982). The polyserial correlation coefficient.Psychometrika 47:337–347.Google Scholar
  56. Pulkinen, M. O., and Csapo, A. I. (1978). The effect of ibuprofen on the uterine pressure and menstrual pain of dysmenorrheic women.Prostaglandins 15:1055–1057.Google Scholar
  57. Pearson, K. (1990). Mathematical contributions to the theory of evolution. VII. On the correlation of characters not quantitatively measurable.Phil. Trans. Roy. Soc. Ser. A 195:1–47.Google Scholar
  58. Rose, R. J., and Monroe, M. J. (1985). Aggregation of menstrual attitudes and symptoms among female relatives.Behav. Genet. 15:608.Google Scholar
  59. Rosenwaks, Z., and Seegan-Jones, G. (1980). Menstrual pain: Its origins and pathogenesis.J. Reprod. Med. 4:207–212.Google Scholar
  60. Sainsbury, P. (1960).Advances in Psychosomatic Medicine, Vol. 1, Karger, Basel.Google Scholar
  61. Schunck, M. (1951). Pain and pain relief in essential dysmenorrhea.Am. J. Obstet. Gynecol. 62:559–567.Google Scholar
  62. Shrader, R. E., and Ohly, J. I. (1970). Premenstrual tension, femininity, and drive.Med. Asp. Hum. Sexual. 4:421–453.Google Scholar
  63. Siegel, J. M., Johnson, J. H., and Sarason, I. G. (1970). Life changes and menstrual discomfort.J. Hum. Stress 5:41–46.Google Scholar
  64. Silberg, J. L. (1984).The Relationship Between Life-Stress and Dysmenorrhea: A Study of Relevant Mediating Variables, Unpublished master's thesis, Virginia Commonwealth University, Richmond.Google Scholar
  65. Silberg, J. L., and Farrell, A. D. (1984). The role of coping strategies and cognitive appraisal of life events in primary dysmenorrhea. Paper presented at the annual convention of the Association for the Advancement of Behavior Therapy, Philadelphia.Google Scholar
  66. Tallis, G. M. (1962). The maximum likelihood estimation of correlation from contingency tables.Biometrics 18:342–353.Google Scholar
  67. Taylor, J. W. (1979). The timing of menstrual related symptoms assessed by a daily symptom rating scale.Acta Psychiat. Scand. 60:87–105.Google Scholar
  68. Wilcoxon, L. A., Schrader, S. L., and Sherif, C. W. (1976). Daily self-report on activities, life events, and moods, and somatic changes during the menstrual cycle.Psychosom. Med. 38:399–417.Google Scholar
  69. Wittkower, E., and Wilson, A. T. (1940). Dysmenorrhea and sterility: Personality studies.Br. Med. J. 2:586–589.Google Scholar
  70. Yliklorkala, O., and Daywood, M. Y. (1978). New concepts in dysmenorrhea.Am. J. Obstet. Gynecol. 130:833–847.Google Scholar

Copyright information

© Plenum Publishing Corporation 1987

Authors and Affiliations

  • J. L. Silberg
    • 1
    • 2
  • N. G. Martin
    • 1
  • A. C. Heath
    • 1
  1. 1.Department of Human Genetics, MCV Station, Medical College of VirginiaVirginia Commonwealth UniversityRichmond
  2. 2.Department of PsychologyVirginia Commonwealth UniversityRichmond

Personalised recommendations