Do sexually transmitted infections exacerbate negative premenstrual symptoms? Insights from digital health.

Background and objectives: The underlying reasons why some women experience debilitating premenstrual symptoms and others do not are largely unknown. Here, we test the evolutionary ecological hypothesis that some negative premenstrual symptoms may be exacerbated by the presence of chronic sexually transmitted infections (STIs).

Methodology: 34 511 women were recruited through a digital period-tracker app. Participants were asked: (i) Have you ever been diagnosed with a STI? (ii) If yes, when was it, and were you given treatment? Those data were combined with longitudinal cycle data on menstrual bleeding patterns, the experience of pain and emotions and hormonal contraceptive use.

Results: 865 women had at least two complete menstrual cycle data and were eligible for analysis. Before diagnosis, the presence of an infection predicts a ca. 2-fold increase in the odds of reporting both headache, cramps and sadness during the late luteal phase and sensitive emotions during the wider luteal phase. After diagnosis, the odds of reporting negative symptoms pre-menstrually remain unchanged among STI negative individuals, but the odds of reporting sensitive emotions decrease among STI positive individuals receiving a treatment. No relationships between STIs, pain and emotions are observed among hormonal contraceptive users.

Conclusions and implications: The results support the idea that a negative premenstrual experience might be aggravated by the presence of undiagnosed STIs, a leading cause of infertility worldwide. Caution is warranted in extrapolating the results as the data are self-reported, inflammatory levels are unknown and the tracker is biased towards recording negative premenstrual symptoms among Western individuals.