Living near green spaces improves premenstrual syndrome symptoms
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Women who live around more green space throughout their lives are less likely to experience PMS symptoms than women living in areas that are less green, according to a study published in Environment International.
Up to 20% of women of reproductive age experience clinically relevant physical and psychological symptoms with PMS, said the researchers, who also noted a growing body of evidence associating natural environments with general and reproductive health benefits.
“Earlier on, we found an association between menopause and residential green space, which gave the first indication that the environment and reproductive events might be associated,” author Kai Triebner, Dipl.-Ing, PhD, a researcher in the department of clinical science at the University of Bergen in Norway, told Healio.
This study, which the researchers called the first to analyze the relationship between green space and PMS, aimed to determine whether living near urban green space could have a positive effect on PMS symptoms and if BMI, air pollution or physical activity mediated this association.
The researchers gathered data between 2013 and 2015 from 1,069 women aged 18 to 49 years in Bergen, Norway, and Gothenburg, Umeå and Uppsala in Sweden participating in the multicenter, population-based European RHINESSA cohort.
A questionnaire asked participants about lifestyle factors, physical activity and reproductive health as well as if they experienced any of eight common PMS symptoms: irritability, anxiety or tension, tearfulness or increased sensitivity, depression or hopelessness, difficulty sleeping, abdominal pain, breast tenderness or abdominal bloating and headaches.
The Normalised Difference Vegetation Index served as a proxy for green space in the vicinity of the participants’ homes. Also, the researchers estimated residential exposure to air pollution based on nitrogen dioxide and particulate matter (PM2.5 and PM10). BMI was analyzed as well.
Women who lived in neighborhoods with more green space experienced fewer PMS symptoms (risk ratio = 0.94; 95% CI, 0.91-0.99).
They also were less likely to experience anxiety (OR = 0.82; 95% CI, 0.7-0.95), depression (OR = 0.84; 95% CI, 0.73-0.98), difficulty sleeping (OR = 0.82; 95% CI, 0.68-1) and breast tenderness or abdominal bloating (OR = 0.84; 95% CI, 0.71-0.99).
“We found that three out of the four examined psychological symptoms were associated with residential surrounding greenspace. Results were significant, but not very surprising,” said Triebner, adding that the researchers already knew that contact with nature helps reduce stress and improve mental health.
The researchers added that their findings underscore the importance of long-term exposure to green space, which is where benefits against PMS symptoms were found. Stress can worsen PMS symptoms and increase cortisol levels, Triebner said, which could be associated with an increased release of progesterone, which in turn has been linked to PMS symptom occurrence.
But while previous research also has associated natural spaces with increased physical activity and decreased exposure to air pollution, the researchers said, the new study did not find a mediatory role for either of these factors.
The study also did not examine the features of these green spaces.
“Unfortunately, we were not able to assess the quality of the green areas. But I believe it is fair to assume that green areas that can be actively used for exercising, gardening or other activities might have a stronger influence than inaccessible green areas, which of course also do have their benefits,” said Triebner.
Still, the researchers said, more studies are showing that green space benefits health, though many cities don’t have enough of it, or it may not be close to where the population lives.
“Doctors should inform women about these benefits. However, the main message should go to city planners and governments to bring more trees to women rather than trying to bring the women to the trees,” Triebner said.
Next, the researchers aim to investigate the physiologic mechanisms behind this relationship between green spaces and health in detail.
“This, however, is tedious, as green space is affecting us in many ways,” Triebner said.
Reference:
Perspective
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Mary Jane Minkin, MD
In the new paper “Lifelong exposure to residential greenspace and the premenstrual syndrome: A population-based study of Northern European women,” the authors show that women who have more exposure to green space suffer less symptomatology.
The diagnosis of PMS includes both psychological and physical criteria, whereas premenstrual dysphoric disorder has a greater proportion of psychological symptoms. Of course, no one really knows the exact etiology of these disorders, although we do know that serotonin is involved.
Therefore, it is not surprising that women who likely can get out and presumably be more active would suffer less than those confined to an indoor or at most more dismal outdoor environment.
Most practitioners encourage women with PMS and PMDD to maintain regular exercise. In this type of study, we do not know the diagnostic criteria used by their health care providers and what therapy their individual providers recommended.
One could even suppose that women who live in places with more residential green space might get better intervention for a presumed diagnosis of PMS by dealing with practitioners who feel more comfortable with making a diagnosis of an entity without an ironclad diagnostic test.
This is one of those studies for which we can echo that living in places with residential green space is a much more comfortable existence in the long run, with no significant downside. So why not do it?
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