Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

Background

Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders.

Materials and Methods

A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss.

Results

Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia.

Conclusion

We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

Comparison of menstrual disorders between groups

Parameters	Non-TL	TL	Sig
Menstrual irregularities*	14 (10)	34 (24.3)	0.002a
Oligomenorrhea*	12 (8.6)	21 (15)	0.12a
Polymenorrhea*	2 (1.4)	13 (9.3)	0.006a
Hypermenorrhea*	3 (2.1)	17 (12.1)	0. 002a
Metrorrhagia*	9 (6.4)	12 (8.6)	0.64a
Menorrhagia*	31 (22.1)	88 (62.9)	<0.0001a
Menometrorrhagia*	5 (3.6)	22 (15.7)	0.001a
PBLAC score**	87.91 ± 51.06	137.72 ± 90.91	<0.0001b

*; n (%), **; Values are mean ± SD, a; Chi-square test, b; T test, TL; Tubal ligation, and PBLAC; Pictorial blood loss assessment chart.

Full article at:   http://goo.gl/m3gdFa

By:  Shahideh Jahanian Sadatmahalleh, M.Sc,¹ Saeideh Ziaei, M.D,^1,* Anoshirvan Kazemnejad, Ph.D,² and Eesa Mohamadi, Ph.D³

¹Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

²Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

1 Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University,  Tehran, Iran

² Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³ Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

* Corresponding Address:P.O. Box: 1415-111, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,

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The Relationship Between Food Frequency & Menstrual Distress in High School Females - Iran

BACKGROUND:

Nutrition pattern is one of the important factors predicting menstrual distress, which varies among different cultures and countries. The purpose of this study is to determine the relationship between food frequency and menstrual distress in high school girls from Mashhad.

MATERIALS AND METHODS:

This cross-sectional study was conducted in 2012 using a two-stage sampling method on 407 high school female students from Mashhad who met the inclusion criteria. Subjects completed questionnaires of demographic characteristics, food frequency, and Menstrual Distress Questionnaire (MDQ) during three phases of the menstrual cycle (a week before bleeding, during menstrual bleeding period, and a week after menstruation). The collected data were analyzed by statistical tests such as Pearson correlation coefficient test, independent Student's t-test, and one-way analysis of variance (ANOVA).

RESULTS:

Results showed that 87.7% of the students were at moderate economic status, 82.2% were exposed to cigarette smoke, 94.8% had mothers without university education, and 9.4% had working mothers. About 71% of the students reported minor pre-menstruation distress, 81% reported minor distress during bleeding, and 39% reported minor post-menstruation distress. In addition, the mean (SD) values for sweet-fatty foods, salty-fatty foods, fast foods, and caffeine were 3.6, 3.3, 1.3, and 10.2 per week, respectively. In addition, Pearson correlation coefficient test showed no significant correlation between total menstruation distress and food frequency (P > 0.05).

CONCLUSIONS:

With regard to the inappropriate food frequency and high intensity of menstrual distress among high school students and as health care and educational efforts for prevention and health promotion in society are among the duties of health workers, the results of this study can help the officials involved in education to emphasize on nutrition and the menstrual health of students.

Below:  Frequency distribution of age, BMI, and socioeconomic status among female students

Below:  Frequency distribution of nightly and daily sleep, physical activity and length of physical activity, and exposure to smoke among female students

Below:  Frequency distribution of subjects’ nutritional pattern based on the number of weekly consumptions

Full article at:   http://goo.gl/wwlhlH

By:  Mohamadirizi S1, Kordi M2.

• 1Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
• 2Department of Midwifery School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
• Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):689-93. doi: 10.4103/1735-9066.170000. 

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Educational Needs of Adolescents Regarding Normal Puberty and Menstrual Patterns

OBJECTIVE:

The study aimed to determine the level of knowledge and the sources of information about normal puberty and menstrual patterns in Turkish schoolgirls from İstanbul.

METHODS:

The study sample was comprised of 922 randomly chosen schoolgirls. A questionnaire survey of knowledge of normal pubertal development and menstrual patterns was conducted.

RESULTS:

The age of the girls ranged between 10 and 17 years and 82.3% had had menarche. The leading source of pubertal information was the mothers (84.2%). There was no statistically significant relationship between the mothers' education level and the level of knowledge of the students about pubertal development (p>0.05). The main source for 18% of students was their teacher, but only 6% had a preference for their teacher providing education on this topic. 

Students who attained menarche preferred education about puberty to be given by health professionals and to both genders at the same setting (p<0.01). A total of 31.5% of students thought that the first symptom of puberty was acne. Half (50.7%) of the students did not know the time period between the beginning of puberty and menarche. The girls who had attained menarche were more knowledgeable about puberty, largely through their own experience.

CONCLUSION:

This study shows that schoolgirls have an insufficient level of knowledge about normal puberty. Education programs must be conducted for students and their parents.

Full article at: http://goo.gl/rz6zBH

By:  İşgüven P1, Yörük G, Çizmecioğlu FM.

• 1Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey Phone: +90 216 495 68 26 E-mail: pinarisguven@gmail.com.
• J Clin Res Pediatr Endocrinol. 2015 Dec 5;7(4):312-22. doi: 10.4274/jcrpe.2144. 

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Plants Used During Maternity, Menstrual Cycle & Other Women´s Health Conditions among Brazilian Cultures

ETHNOPHARMACOLOGICAL RELEVANCE:

For innumerous clinical cases related to women's health and precarious medical care in developing countries, a large repertoire of plants have been used as popular medicines in order to fill this gap, which in a certain way creates health risks to users, since pharmacological and toxicological tests are still insufficient to guarantee their efficacy and safety. Besides therapeutic use, abortive plants are broadly used in coutries where abortion is prohibited, increasing that risk even more. In this way, ethnopharmacological studies that register plants used for women's health can contribute not only to the selection of potential bioactives, enriching the repertoire of drugs available to females, above all in public health systems, but also questioning the safety of products that are used without prescription.

AIMS AND OBJECTIVES:

This review aims at determining plants applied by Brazilian cultures in the treatment of conditions related to maternity, menstrual cycle and other women´s health particularities, and to supplement the lack of epidemiological data available to assess the health of indigenous, rural and other populations of Brazilian women.

MATERIALS AND METHODS:

A literature review was conducted of the collection at the Ethnobotanical and Ethnopharmacological Center of the Federal University of São Paulo (period covered: 1965 to 2012). All of the 343 articles were consulted and 31 articles mentioning therapeutic uses of interest were selected. Relevant information was extracted to compose Table 1 - Maternity, Table 2 - Menstrual Cycle and Table 3 - Other Conditions. Data was statistically analyzed in order to generate the discussion about plants used in healing contexts by different Brazilian ethnicities. A bibliographic review was performed using the Scopus database to collect the following information about the most cited plants: ethnobotany/ethnopharmacology of non-Brazilian cultures for women's health conditions, pharmacology, toxicology, and adverse reactions.

RESULTS:

A total of 319 species were cited for 22 indications related to women's health. Ninety-seven species were indicated for conditions related to maternity, 94 to the menstrual cycle and 232 to others. The same species could be present in more than one of these three categories. The most cited family was Fabaceae (13.5%), and the species were Ruta graveolens L. (1.76%) and Strychnos pseudoquina A. St.-Hil (1.76%). The most frequent part utilized, mode of preparation and route of administration were leaves (2.0%), tea (73.38%) and oral (87. 2%), respectively. The indications that showed the highest number of species were: to treat venereal diseases (69 species), abortive (54) and anti-inflammatory for the ovaries and/or uterus (54). According to our bibliographic survey, among the 19 most indicated species in this review, only four are also used by non-Brazilian cultures for conditions related to women's health; 25% of them were pharmacologically investigated and it was possible to validate their ethnopharmacological/ ethnobotanical use, 10.5% have presented well-described adverse reactions and for 42.1% of these species toxicological studies were performed.

CONCLUSION:

The survey raised important data about plants implemented in healing related to women's health conditions by Brazilian cultures and their practices. The compilation presented in this study enables the realization of further investigation regarding the development of herbal medicines and contributes to the incrementation of policies focused on these cultures. Further phytochemical, pharmacological and toxicological studies should be conducted, which will allow the discovery of pharmacological properties, bioactive constituents, and moreover, adequate posology, manner of use and adverse events.

Purchase full article at:   http://goo.gl/lgIsca

By:  Yazbek PB1, Tezoto J2, Cassas F2, Rodrigues E2.

• 1Center for Ethnobotanical and Ethnopharmacological Studies-Institute of Environmental Sciences, Chemical and Pharmaceutical, Universidade Federal de São Paulo (http://www.unifesp.br/), Brazil. Electronic address: pbyazbek@gmail.com.
• 2Center for Ethnobotanical and Ethnopharmacological Studies-Institute of Environmental Sciences, Chemical and Pharmaceutical, Universidade Federal de São Paulo, Brazil.
• J Ethnopharmacol. 2015 Dec 27. pii: S0378-8741(15)30306-8. doi: 10.1016/j.jep.2015.12.054. 

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The Menstrual Cycle Influences the Gastric Emptying of Alcohol

We previously reported that ingestion of 60 mL of red wine or vodka prior to the ingestion of a pancake significantly inhibited the gastric emptying of the pancake in male subjects, but not in female subjects, and that the retention times of wine and vodka were significantly longer than those of the congener of red wine and mineral water in male subjects, whereas in female subjects the retention times of these four drinks did not differ significantly from one another. 

We hypothesized that the menstrual cycle may influence the gastric emptying of alcohol beverages. Here, we determined and compared the retention times of vodka and water in the stomach during the luteal phase and the follicular phase. Ten female healthy volunteers were studied. They recorded their basal body temperatures every day, and participated in the following experiments: each volunteer drank mineral water or vodka containing 14% alcohol (60 mL) during the low-temperature (follicular) phase as well as during the high-temperature (luteal) phase. The retention time of vodka was significantly longer than that of mineral water during the follicular phase, but no significant differences between the retention times of the two drinks were observed during the luteal phase. 

In conclusion, the menstrual cycle influences the gastric emptying rate of alcohol.

Full [PDF] article at:   https://goo.gl/ByRbg9

By:   Kaibara N1, Kobori A, Sekime A, Miyasaka K.

• 1Department of Physiology, Tokyo Kasei University Graduate School of Human Life Sciences.
• Biomed Res. 2015;36(6):411-5. doi: 10.2220/biomedres.36.411. 

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Characteristics of the Menstrual Cycle in 13-Year-Old Flemish Girls & The Impact of Menstrual Symptoms on Social Life

ABSTRACT

This study aimed to investigate the characteristics of symptoms related to the menstrual cycle and their impact on social activities in young teenage girls. Between March and June 2009, all girls born in 1996 who were residents of eight regions in Flanders (Belgium) received a semi-structured questionnaire, including questions about the age of menarche, characteristics of the menstrual cycle, and its impact on social activities. 

Participants were 792 13-year-old girls (15.7 % of the target population). Out of 363 (47.2 % of participants) postmenarcheal girls, 41.6 % (95 % confidence interval (CI) 36.4-47.0 %) reported painful menstruations. 

The proportion of girls with painful menstrual periods decreased approximately 16 % with each year the age at menarche increased (relative risk (RR) = 0.84; 0.73-0.98; p < 0.05) and was positively correlated with the amount of blood loss (RR = 0.33; 0.16-0.67; p < 0.05 when little and 1.85; 1.49-2.31; p < 0.001 when abundant, compared to average). 

One in four (25.4 %) postmenarcheal girls indicated a negative impact of menstruation on social activities, but this proportion was significantly higher in girls who experienced menstruation as painful (41.3 %) compared to those who did not (14.2 %).

CONCLUSION:

Early menstrual complaints are common in young adolescent girls and the likelihood of pain increased significantly with lower menarcheal age. 

What is Known? 

• Menstrual cycle-related symptoms may negatively interfere with school absence and social activities. 
• Early menarche and severe dysmenorrhea are correlated with endometriosis. 

What is New? 

• In this large population-based study on the characteristics of the menstrual cycle in young teenage girls at or shortly after menarche, painful menstruation was highly prevalent (41.7 %), but related school absenteeism was low (3.2 %). The likelihood of pain increased significantly with lower menarcheal age.
• The findings support the need for a systematic evaluation of the characteristics of the menstrual cycle shortly after menarche.

Purchase full article at:   http://goo.gl/RKfelw

By:   Hoppenbrouwers K1, Roelants M2, Meuleman C3, Rijkers A4, Van Leeuwen K5, Desoete A6, D'Hooghe T7.

• 1Centre of Environment and Health, Department of Public Health and Primary Care, University Leuven, Kapucijnenvoer 35, block d, 7001, 3000, Leuven, Belgium. karel.hoppenbrouwers@med.kuleuven.be.
• 2Centre of Environment and Health, Department of Public Health and Primary Care, University Leuven, Kapucijnenvoer 35, block d, 7001, 3000, Leuven, Belgium. mathieu.roelants@med.kuleuven.be.
• 3University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. christel.meuleman@uzleuven.be.
• 4University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. lian.rijkers@uzleuven.be.
• 5Parenting and Special Education Research Group, University Leuven, 3000, Leuven, Belgium. karla.vanleeuwen@ppw.kuleuven.be.
• 6Department of Experimental Clinical and Health Psychology, University Ghent, 9000, Ghent, Belgium. annemie.desoete@ugent.be.
• 7University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. thomas.dhooghe@uzleuven.be. 

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Women’s Experiences with Medication for Menstrual Regulation in Bangladesh

Menstrual regulation has been legal in Bangladesh since 1974, but the use of medication for menstrual regulation is new. In this study, we sought to understand women’s experiences using medication for menstrual regulation in Bangladesh. 

We conducted 20 in-depth interviews with rural and urban women between December 2013 and February 2014. All interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. The majority of women in our study had had positive experiences with medication for menstrual regulation and successful outcomes, regardless of whether they obtained their medication from medicine sellers/pharmacies, doctors or clinics. Women were strongly influenced by health providers when deciding which method to use. 

There is a need to educate not only women of reproductive age, but also communities as a whole, about medication for menstrual regulation, with a particular emphasis on cost and branding the medication. Continued efforts to improve counselling by providers about the dose, medication and side-effects of medication for menstrual regulation, along with education of the community about medication as an option for menstrual regulation, will help to de-stigmatise the procedure and the women who seek it.

Full article at: http://goo.gl/wCK1xD

By: Heather M. Marlow^a*, Kamal Biswas^b, Risa Griffin^a & Jamie Menzel^a

^a Department of Research and Evaluation, Ipas, Chapel Hill, NC, USA

^b Department of Research and Evaluation, Ipas Bangladesh, Dhaka, Bangladesh

  

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“I Spent a Full Month Bleeding, I Thought I Was Going to Die…” A Qualitative Study of Experiences of Women Using Modern Contraception in Wakiso District, Uganda

There is high unmet need for family planning (FP) in Uganda as well as high contraceptive discontinuation rates. These contribute to the high fertility rates that in part are due to unplanned pregnancies. There are gaps in knowledge about experiences that couples go through while using contraceptives in their lives. This study explored women’s experiences during the course of their contraceptive use.

We conducted a qualitative study involving 30 women who had used modern contraception for at least one year in Wakiso district, central Uganda. We used in-depth interviews to obtain their personal accounts. Index women were approached through health officers at four health centres in the district. All ethical approvals and informed consent were obtained. We used conventional content analysis; identifying codes through open coding, on which basis categories were developed and grouped into overarching themes.

Women’s accounts were summarised in the following themes: negative experiences with modern contraceptive use, motivation to continue using FP in spite of these negative experiences, the role of influential people, and discontinuation of use. Negative accounts dominated the experiences of most women but they expressed strong desire to continue using modern contraception even amidst all challenges. Health workers emerged as the most influential people that played a vital role in women’s decisions.

Varied negative experiences with modern contraception and misperceptions exist amidst a determination to continue use. Partner engagement, health service strengthening to improve side effects management and health worker skills, and engaging older women that have successfully used contraception as community champions, are potential strategies to support women’s contraceptive decisions.

Below:  Example of the coding Framework used to arrive at themes

Full article at: http://goo.gl/qbjz5u

By: 

Simon P. S. Kibira, Justine N. Bukenya, Lynn M. Atuyambe

Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Simon P. S. Kibira

Centre for International Health, Department of Global Public Health and Primary care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

Christine Muhumuza

Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

  

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Prevalence Of & Risk Factors for Bacterial Vaginosis among Women of Reproductive Age Attending Cervical Screening in Southeastern Brazil

To determine the prevalence of and risk factors for bacterial vaginosis.

A cross-sectional study of women aged 14-54 years attending 18 primary healthcare units in Botucatu, Brazil, for cervical screening was undertaken between September 1, 2012, and January 31, 2013. Data on sociodemographics, sexual behavior, and medical history were obtained by interview. Vaginal swabs were taken to classify the vaginal flora according to the Nugent scoring system. Candida sp. hyphae and infection by Trichomonas vaginalis were also evaluated by microscopy and culture, respectively. Stepwise logistic regression analysis was performed to identify risk factors independently associated with bacterial vaginosis.

Among 1519 women included in analyses, 30.1% had bacterial vaginosis. Variables independently associated with bacterial vaginosis were a single marital status, partner infidelity, abnormal discharge in the previous year, and concurrent trichomoniasis. Current use of hormonal contraception, luteal phase of menstrual cycle, higher income, and vaginal candidiasis all had protective effects.

The prevalence of bacterial vaginosis in the study population is high. The epidemiological data provide evidence of the sexual transmissibility of bacterial vaginosis.

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By: Marconi C1, Duarte MT2, Silva DC3, Silva MG4.

• 1Department of Pathology, Botucatu Medical School, Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
• 2Department of Nursing, Botucatu Medical School, Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
• 3Department of Health of Botucatu Prefecture, Botucatu, São Paulo, Brazil.
• 4Department of Pathology, Botucatu Medical School, Univ Estadual Paulista, Botucatu, São Paulo, Brazil. Electronic address: mgsilva@fmb.unesp.br.  

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"Bitten By Shyness": Menstrual Hygiene Management, Sanitation, and the Quest for Privacy in South Africa

Little is known about how menstruation is managed in low-income settings and whether existing sanitation systems meet women's needs. Using the 'Photovoice' method with 21 women in participatory workshops and in-depth interviews, we collected data on menstrual hygiene management in three sites in Durban, South Africa. 

All women reported using disposable sanitary pads. Although they were aware that disposable pads were non-biodegradable, incompatible with water-borne flush systems, and fill up pit latrines, they had little experience with reusable products. Considerable energy was devoted to concealing and containing 'menstrual waste', and women expressed concern about inadequate privacy during menstruation. All sites lacked discreet disposal options and reliable water access, while outdoor sanitation facilities were considered unsafe. 

Findings highlight the need for advocacy to improve safety and privacy of facilities for women in this setting.

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By: Scorgie F, Foster J, Stadler J, Phiri T, Hoppenjans L, Rees H, Muller N.

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Menstrual Patterns & Disorders among Secondary School Adolescents in Egypt. A Cross-Sectional Survey

Background

To our knowledge, no large population – based studies have been performed on the topic of menstrual patterns among Egyptian adolescent in recent years. The aims of this study were to identify menstrual patterns and associated disorders as well as the sources of menstrual health knowledge among Egyptian adolescents.

Methods

A cross-sectional survey. A total of 800 questionnaires were administered to post-menarcheal Egyptian adolescents attending secondary schools in Giza, Egypt, from September 1, 2012, to December 1, 2013. Participants were asked to respond to a semi-structured questionnaire on menstrual health awareness. The questionnaire included items on girl’s socio-demographic and menstrual pattern characteristics, concerning their age at menarche, menstrual cycle length and regularity, duration and amount of flow, type and severity of pain related to menstruation, need for analgesia; and symptoms suggestive of premenstrual syndrome (PMS) Main Outcome Measure: description of menstrual patterns, disorders and source of knowledge.

Results

Four hundred twelve (51.5%) out of 800 adolescents completed the questionnaire. The mean age of the girls was 14.67 ± 1.7 years. Mean age at menarche was 12.49 ± 1.20 years. 382 respondents reported various menstrual disorders, giving a prevalence rate of 95%. Dysmenorrhea was the most prevalent (93%) menstrual disorder in our sample, followed by PMS (65%), and abnormal cycle lengths (43%). Menstrual disorders interfered with social and academic life of 33 and 7.7% of respondents respectively. Most participants lacked menstrual health knowledge and only 8.9% of girls reported consulting a physician.

Conclusion

To the best of our knowledge, this is one of the largest studies on menstrual pattern and disorders among Egyptian adolescent girls. Our Findings of the present study are consistent with other studies and reported higher than expected prevalence of menstrual disorders.

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Menstrual Cycle Effects on Attitudes toward Romantic Kissing

Via:   http://ht.ly/PaELB  HT @UniofOxford

Hormonal changes associated with the human menstrual cycle have been previously found to affect female mate preference, whereby women in the late follicular phase of their cycle (i.e., at higher risk of conception) prefer males displaying putative signals of underlying genetic fitness. Past research also suggests that romantic kissing is utilized in human mating contexts to assess potential mating partners. The current study examined whether women in their late follicular cycle phase place greater value on kissing at times when it might help serve mate assessment functions. Using an international online questionnaire, results showed that women in the follicular phase of their menstrual cycle felt that kissing was more important at initial stages of a relationship than women in the luteal phase of their cycle. Furthermore, it was found that estimated progesterone levels were a significant negative predictor for these ratings.

Below:  Importance of kissing during initial relationship stages (grey markers, dashed line) versus established relationship phases (black markers, solid line) across the menstrual cycle. Day 0 represents reverse-day-count estimated day of ovulation, trend curves fitted using Loess curve estimation, 65% points fit, Epanechnikov kernel