SYSTEMS AND CYCLES: MOTHER-DAUGHTER
PERCEPTIONS OF INTERACTION ACROSS
THE MENSTRUAL CYCLE
by
Kristynia M. Robinson
A dissertation submitted to the faculty of The University of Utah in partial fullfillment of the requirements for the degree of
Doctor of Philosophy
College of Nursing
The University of Utah
August 1995 Copyright © Kristynia M Robinson 1995
All Right s Reserved THE UNIVERSITY OF UTAH GRADUATE SCHOOL
SUPERVISORY COMMITTEE APPROVAL
of a dissertation submitted by
Kristynia M. Robinson
This dissertation has been read by each member of the following supervisory committee and by majority vote has been found to be satisfactory.
/ Ann Voda
Lee Walker
Edna Rogers
Don Herrin THE UNIVERSITY OF UTAH GRADUATE SCHOOL
FINAL READING APPROVAL
To the Graduate Council of the University of Utah:
I have read the dissertation of Kristynia MRobiDson in its final form and have found that (1) its format, citations and bibliographic style are consistent and acceptable; (2) its illustrative materials including figures, tables, and charts are in place; and (3) the final manuscript is satisfactory to the supervisory committee and is ready for submission to The Graduate School.
Beth Cole Chair,Supervisory Committee
Approved forthe Major Department
Linda K. Amos Chair/Dean
Approved for the Graduate Council
AnnW.Hart Dean of TheGraduate School ABSTRACT
Most--if not all--women experience fluctuations in emotions, perceptions, physical sensations, behavior, and sense of well-being over the menstrual cycle, These perimenstrual symptoms can be positive, negative, or neutral and are highly variable between women and in the same woman from cycle to cycle, Because significant correlation has been found between mothers' and daughters' menstrual cycle characteristics, a mother's peri menstrual experience may be predictive of her daughter's expenence,
This research was designed to describe and compare mothers' and daughters' menstrua] onset, perimenstrual changes, and perceived mother-daughter interaction at different times of the menstrual cycle, Prospective menstrual cycle data were collected from ] 2 mother-daughter pairs utilizing a diary format that included a menstrual record and visual analog scales for conflict, affection, and closeness, Analysis of data supported the following conclusions:
1, Menstrual synchrony between mothers and daughters occurred but not consistently,
2, Mothers and daughters who recorded synchronous cycles reported lower levels of conflict and higher levels of closeness and affection when compared with the asynchronous pairs, Therefore, harmony may be a by-product, not a precursor, of synchronous cycles in mother-daughter pairs, 3. Perimenstrual symptoms or sensations were experienced by both mothers and daughters with mothers reporting significantly more symptoms during the premenstrual and menstrual phases. Although contrary to previous research, these mothers and daughters had few similar cycle-phase specific symptoms.
4. Mothers and daughters had patterned interactions over the cycle that are individual to the dyad and not phase-dependent.
5. Mothers of daughters who did not complete the diary for a full menstrual cycle noted more conflict, less closeness, and decreased affection in the mother-daughter relationship than mothers whose daughters completed the diary. Moreover, these daughters stopped charting during the phase that their mothers reported the highest level of conflict in their relationship or when the daughter perceived a significant decrease in affection from her mother. In loving memory of my grandmother Dorothy Caillet who taught me the splendor of unconditional love and the magic of intimate grandmother-granddaughter interaction T ABLE OF CONTENTS
Page
ABSTRACT...... IV
LIST OF TABLES...... x
LIST OF FIGURES ...... XI
ACKNOWLEDGMENTS...... XII
Chapter
I. INTRODUCTION AND PROBLEM STATEMENT ......
Overview of the Problem...... 2 Theoretical Orientation...... 2 Assumptions ...... 6 Purpose of the Study ...... 7 Research Questions...... 8 Specific Aims...... 8 Definition of Major Variables...... 9 Menstrual Timing ...... ,...... 9 Perimenstrual Symptoms...... 9 Perceptions of Interaction ...... ,' ... ,.. " ... " .. , ...... , .... ,...... , 9 Contribution to Nursing...... 10 Family Nursing ...... , ...... " ...... , .. ,.... 10 Nursing Research and Families...... 13 Specific Contribution to Nursing...... 14 Organization of the Study...... 15
II. REVIEW OF LITERATURE 16
Family Developmental Theory ...... 16 Biopsychosocial Influences ...... 17 Developmental Tasks of Adolescence...... 18 Stress and Families With Adolescent Members...... 20 Perimenstrual Experience...... 22 Biology of Menstruation ...... ,...... '...... 23 Prevalence of Perimenstrual Changes ...... "."...... 28 Perimenstrual Symptomatology and Premenstrual Syndrome...... 30 Perimenstrual Symptoms and Family Relationships...... 32 Adolescents and Perimenstrual Symptoms ...... 35 Menstrual Synchrony ...... 37 Communication ...... '" ...... 40 Communication and Families With Adolescent Members...... 42 Context ...... 44
III. DESIGN AND METHODOLOGy ...... "...... " 46
Procedure ...... 46 Triangulation and View of Phenomena ... , ...... ,...... 48 Design ...... 49 Specific Aims ...... 50 Methodology .. '" ... '" ...... 50 Selection Criteria and Sampling Procedure...... 50 Data Collection Methods...... 51 Data Analysis...... 57
IV. PRESENTATION AND DISCUSSION OF THE FINDINGS...... 61
Sample Characteristics...... 61 Research Question 1: Menstrual Synchrony ...... "...... 65 Bleeding and Ovulatory Patterns...... 65 Research Question 2: Comparison of Mother-Daughter Perimenstrual Symptoms ...... 67 Research Question 3: Interaction Over the Menstrual Cycle...... 69 Differences in Complete and Incomplete Pairs...... 69 Patterned Interaction Over the Menstrual Cycle...... 75 Summary of Findings ...... 75
V. DISCUSSION ...... 82
Overview of the Study Purpose ...... ,...... '" ...... '" 82 Criteria for Family Research...... 83 Criteria for Menstrual Cycle Research ...... 84 Discussion of the Study Results--Chapter IV ...... 85 Sample ...... 85 Bleeding Patterns...... 87 Menstrual Synchrony...... 87 Comparison of Mother-Daughter Perimenstrual Symptoms...... 93 Interaction Across the Menstrual Cycle...... 95
Vln Methodological Limitations of the Study...... 97 Implications for Nursing Research and Practice ...... 98 Nursing Research ...... 98 Nursing Practice...... 100
Appendices
A. CONSENT-ASSENT FORM ...... 102
B. BACKGROUND INFORMATION FORMS ...... 105
C. SAMPLE DIARY WITH INSTRUCTIONS ...... 110
D. DATA: FAMILY CHARACTERISTICS ...... 122
E. DATA: MENSTRUAL SYNCHRONY ...... 127
F. DATA: PERI~1ENSTRUAL SYMPTOMS ...... 133
G. PAIRED DATA: INTERACTION ACROSS THE MENSTRUAL CYCLE ...... 150
H. DATA: GRAPHS OF SYNCHRONOUS AND ASYNCHRONOUS PAIRS ...... 163
REFERENCES...... 172
IX LIST OF TABLES
Table Page
1. Social-Demographic Characteristics of Sample ...... 62
2. Satisfaction With Life ...... 63
3. Comparison of Mothers' and Daughters' Age and Menstrual Cycle Characteristics ...... , ...... 66
4. Conflicting Perimenstrual Symptoms Reported on Different Days of Menstrual Cycle ...... " ... " ...... 68
5. Mothers and Daughters Raw VAS Scores ...... , 73 LIST OF FIGURES
1. Biopsychosocial theoretical model of the mother-daughter perimenstrual experience ...... 3
2. Comparison of sample means with national norms on selected family characteristics ...... 64
3. Comparison of mothers and daughters who did and did not complete data collection over all three cycle phases ...... 71
4. Comparison of mothers' mean V AS from pairs with and without complete data over all three cycle phases ...... , ...... 72
5. Paired interaction over the menstrual cycle for closeness ...... 76
6. Paired interaction over the menstrual cycle for conflict ...... 77
7. Paired interaction over the menstrual cycle for affection ...... 78
8. Paired data over the menstrual cycle for hassles ...... 79
9, Comparison of mothers and daughters who did and did not have synchronous menstrual cycles ... ' ...... ' ...... '" ' ...... , ... . 80 ACKNOWLEDG:MENTS
Many people were instrumental in the completion of this dissertation. First of all, I would like to thank all the mothers and daughters who participated in the study for their time, energy, and help in accomplishing my goal. Second, recognition and appreciation are given to my supervisory committee: thank yous are extended to Beth Cole for your understanding, warmth, and empathy when events emerged that interrupted the flow of my progress, for your emotional and scholastic support, for your belief in me, and for chairing this committee; to Ann Voda, for nurturing my research interest in menstrual health, introducing me to interdisciplinary menstrual scholars and researchers, and enticing me to view menstrual phenomenon from a normative perspective; to Lee
Walker, for your insights in family research and for challenging me to rethink dyadic research measures; to Edna Rogers, for your laughter and sense of humor, for teaching me that the whole is different from the sum of the parts, and for sharing your knowledge about communication and systems with me~ and to Don Herrin, for your warmth, support, and incisive comments and penetrating questions about mothers and daughters and their relationships. Third, a special thank you is given to Imogene Rigdon, my dean, for listening, encouraging, and spurring me on to finish and to Gerrie Barnett, my colleague and mend, for your support, patience, and understanding during this project.
Lastly, my deepest appreciation and love goes to my husband Troy Stone, my son
Michael Robinson, and my grandfather Paul Caillet without whom this project may never have been completed. Thank you, Grandpa, for listening and supporting me. Thank you,
Michael, for your belief and pride in me, for your encouragement and emotional support.
Thank you, Troy--my love and partner--for your everlasting patience, for your emotional and editorial support, for feeding and clothing me during the writing of this dissertation, and for loving me, accepting me at my worst, and illuminating the best in me.
Xlll CHAPTER I
INTRODUCTION AND PROBLEM STATEMENT
Menstruation is my connection to the cycles of the universe --earth, air, sky, spirit. It's one of the most important aspects of my being a woman, for it's not just for propagation, but a time of heightened awareness, insight. (Taylor, 1988, p. 32)
For many women, this process of menstruation may be a rhythmical attunement to diverse internal and external cycles--Iunar, astrological, sexual arousal, sleep-wake and other circadian cycles--or a rhythmical alignment, or synchronization, of menstrual cycles \vith other women. Patterned physiological, psychological, and behavioral
(biopsychosocial) responses develop and change over the menstrual cycle and throughout a woman's menstruating life. Although the physiology of menstruation is easily explained, the variability vvithin the menstrual experience (from cycle to cycle and woman to woman) is not easily understood. Moreover, the menstrual experience--as a biopsychosocial phenomenon--is influenced or mediated by internal and external factors, such as hormonal fluctuation, individual development, family patterns of communication and interaction, stress, and other factors. 2
Overview of the Problem
Theoretical Orientation
Mother-daughter interaction over the menstrual cycle is a complex,
biopsychosocial phenomenon. To study thls phenomenon, I developed a conceptual
orientation or framework blending the biology of menstruation with theories of family
development, mother-daughter role relationship, and communication. (See Figure 1.) A
discussion relating menstrual experience with family and individual development,
mother-daughter interaction, stress, and family characteristics follows.
Emotions, behavior, perceptions, sense ofwell-being, and physical symptoms
(e. g., acne, bloating, cramping, and other aches and pains) fluctuate over the menstrual
cycle, theoretically, in response to changing levels of hormones. These biopsychosocial fluctuations, also known as perimenstrual symptoms or the perimenstrual experience,
may occur before, during, or after menstruation and are experienced to varying degrees by most menstruating adult and adolescent women (Golub, 1980; Golub & Harrington,
1981 ~ Johnson, 1987; McMillan & Pihl, 1987; Mitchell, Woods, & Lentz, 1994; Rossi,
1980; Sveinsdottir & Reame, 1991; Widholm, Frisk, Tenhunen, & Hortling, 1967;
Wilson & Keye, 1989; Woods, Dery, & Most, 1982; Woods, Most, & Dery, 1982;
Woods, Taylor, Mitchell, Lee, & Lentz, 1992). A significant correlation has been found between the characteristics of a woman's and her mother's/ sister's menstrual cycles
(Kantero & Widholm, 1971; Menke, 1983; Mitchell et al., 1994; Strauss et al., 1990;
Wilson, Turner, & Keye, 1991; Woods, 1987; Woods, Lentz, Mitchell, & Taylor, 1989); 3 Family Function and Structure Individual Needs and Goals
.. . . -.. " ".' . -·~lec·
.,. ." .. C~·· . ~ "...... -4
lndividual Needs and Goals Family' Function and Structure
Key Mot:h.er Figure 1. Biopsychosocial theoretical model of the mother-daughter peri menstrual expenence 4 therefore, a mother's perimenstrual experience may be predictive of her daughter's expenence.
Perimenstrual changes consist of a wide range of symptoms that may be perceived as negative, positive, or neutral and may vary from cycle to cycle and from woman to woman. Variability in symptom expression is influenced by expectation of symptom occurrence, change in menstrual pattern, and presence of stress (Aubuchon &
Calhoun, 1985; Chernovetz, Jones, & Hansson, 1979; Klebanov & Jemmott, 1992;
Richardson, 1990). In addition, research has demonstrated a relationship between perimenstrual sympton1s (PS) and family conflict, function, and satisfaction (Abplanalp,
1991~ Brown & Zimmer, 1986~ Cortese & Brown, 1989; Lindow, 1991; Winter, Ashton,
& Moore, 1991 ; Woods et al., 1992), between PS and stress (Brown & Harrington,
1988; Siegal-Louis, 1984~ Schmidt, Grover, Hoban, & Rubinow, 1990; Woods, 1985;
Woods et aI, 1989, 1992), and between PS and the characteristics of a woman's family of origin (Siegal-Louis, 1984).
Furthermore, Abplanalp (1991) has suggested that both self-esteem and stress mediate the severity and duration of perimenstrual symptoms. When a woman perceives
PS as distressing, the quality of her interpersonal relationships declines (Abplanalp;
Brown & Zimmer, 1986; Cortese & Brown, 1989; Lindow, 1991; Winter et aI., 1991;
Woods, 1987; Woods et aI., 1992). This, in turn, may affect her self-image (Keye, 1991;
Woods et aI., 1992).
Within a family, each member affects and is affected by every other family member and the family unit as a whole (Fisher, 1978; Walsh, 1982). Consequently, the 5 changes experienced by a menstruating woman may affect her behavior; and in turn, her behavior may affect individual family members or the family as a whole. Of particular interest, is the complexity of this interdependence when two menstruating females are present in the family system. Thus, this principle of interdependence may account for the link between perimenstrual symptoms and perceived stress, conflict, and changes in close interpersonal relationships.
A particularly stressful time for any family is when there are adolescents in the home (Kidwell, Fischer, Dunham, & Baranowski, 1983~ Olson et aI., 1989). During these years, much of the stress experienced by families arises out of normative life-stage and developmental events and affects families with adolescent members to varying degrees (Bios, 1971; Kidwell et aI., 1983; Steinberg, 1989; Worden, 1991). This is particularly true of mothers and daughters. After daughters' puberty, mothers and their daughters often describe their relationship as distant, dissatisfying, and conflictual
(Collins, 1990; Holmbeck & Hill, 1991; Steinberg, 1989; Ulman, 1992). Given that stress mediates perimenstrual symptoms, it can be speculated that the stress experienced by families with adolescent members can aggravate the perimenstrual experiences of both menstruating mothers and their adolescent daughters. Furthermore, based on the principle of interdependence, mothers' perimenstrual experience may influence and be influenced by the perimenstrual experiences of their adolescent daughters. In turn, these experiences may influence the mother-daughter relationship resulting in a change in mother-daughter interaction. 6
Assumptions
Assumptions that underlie this study:
1. Menstruation is a normal physiologic process of women that starts at menarche (around the age of 12), continues for approximately 40 years, and ends at menopause (about age 51).
2, The duration and frequency of menstruation are variable from month to month and woman to woman. Although the commonly accepted menstrual cycle average is 28 days, rhythmic intervals of21 to 45 days (plus or minus 5 days) are considered norma1.
3. The process of menstruation involves cyclic physiologic, behavioral, and emotional (or biopsychosocial) changes.
4. These changes, sometimes known as perimenstrual symptoms, may be considered positive, negative, or neutral by the woman experiencing them.
5. When perimenstrual symptoms are perceived as distressing, women report negative intrapersonal and interpersonal effects.
6. The frequency and severity of peri menstrual symptoms may be mediated by stress.
7. Stress is experienced frequently by families with adolescents in the home.
8. Mothers' perimenstrua] experiences influence their daughters' perceptions about, as wel1 as their actual, peri menstrual experiences. 7
9. Perceptions of interaction are more important than actual interaction in terms of the mother-daughter relationship: (a) perceptions predict and influence future interaction, and (b) perceptions affect self-esteem.
Purpose of the Study
During adolescence, mother-daughter relationships are characterized by increased aloofness, dissatisfaction, and conflict (Steinberg, 1989). Since stress is considered a mediator of perimenstrual symptoms (Abplanalp, 1991), the relationship stress experienced by an adolescent girl and her mother may influence the severity and duration of perimenstrual symptoms experienced by either the mother or the daughter. Likewise, the mother's perimenstrual experience may influence and be influenced by the daughter's perimenstrual experience. In turn, this interdependence may affect or be affected by mother-daughter interaction.
The change in mother-daughter interaction related to puberty and maturation, the conflict and change within family relationships associated with perimenstrual symptoms, and the severity and duration of peri menstrual symptoms mediated by stress warrant the investigation of the relationship between perimenstrual symptoms and mother-adolescent daughter interaction. Currently, information on the interdependence between biopsychosocial changes associated with the menstrual cycle and mother-daughter interaction is limited. In addition, the majority of information correlating mothers' and daughters' menstrual experience is based on retrospective recall, not prospective charting. For these reasons, the purpose of this research was to describe and explore mothers' and daughters' menstrual experience related to onset of bleeding, peri menstrual 8
changes, and perceived mother-daughter interaction. Three research questions were
generated.
Research Questions
1. What is the timing (in relation to one another) of mothers' and adolescent
daughters' menstrual cycles?
2. What are the similarities and the differences between perimenstrual
symptoms reported by mothers and those symptoms reported by their
daughters?
3. How do perceptions of mother-daughter interaction vary over the
menstrual cycle for the mother and for the daughter?
Specific Aims
As cited earlier, the purpose of this research was to describe and explore mothers'
and daughters' menstrual experiences. The following aims were developed to achieve the
study purpose:
1) to identify menstrual timing and the degree of menstrual synchrony between mothers and their biologic, adolescent daughters
2) to describe the similarities and the differences between perimenstrual
symptoms reported by mothers and those symptoms reported by their daughters during the menstrual, periovulatory, and premenstrual phases of the menstrual cycle
3) to compare mothers' and daughters' perceptions of their interaction during the menstrual, periovulatory, and premenstrual phases of the menstrual cycle 9
Definition of Major Variables
Menstrual timing, perimenstrual symptoms, and perception of mother-daughter interaction were the three major variables investigated in this study. To capture cycle variation, variables were measured during the menstrual (days 3 to 5), periovulatory
(midcycle days -13 to -15), and premenstrual (days -5 to -3) phases of the menstrual cycle. Discussion and definition of each major variable follow.
Menstrual Timing
Menstrual timing is the temporal relationship of a mother's menstruation to that of her daughter's menstruation. Menstrual synchrony, or the determination of synchronous or asynchronous timing, is based upon the difference between the 1 st day of the mother's menstrual cycle and the 1st day of the daughter's menstrual cycle. For this study, cycles were considered synchronous if the difference between a mother's and her daughter's menstruation onset date was 5 or fewer days.
Perimenstrual Symptoms
Perimenstrual symptoms are those biopsychosocial changes experienced by a woman over the menstrual cycle: before, during, and after menstruation. These subjective changes may be considered positive, negative, or neutral.
Perception of Interaction
Interaction is the verbal and nonverbal exchange of behavior between two or more persons and the individual meaning or interpretations of those behaviors.
Communication consists of interaction patterns reflecting the presence of (a) conflict or 10 accord, (b) positive or negative affect, and (c) distance or closeness within a dyadic relationship (Collins, 1990; Jacob, 1987; Kantor & Lehr, 1975; Rogers & Farace, 1975).
Conflict is related to the degree of overt tension that is reflected within a family's interaction (Jacob, 1987) and is experienced along a continuum of harmony or accord
(no conflict) to overt tension (extreme conflict). Affect is that sense of loving and being loved by someone and is experienced along a continuum of the positive to the negative, of good feeling to bad feeling, of friendliness to unfriendliness (Kantor & Lehr, 1987).
Closeness/distance is the degree to which individuals feel separated from or connected to their family (Kantor & Lehr, 1987; Olson et aI, 1985) and is experienced along a continuum of enmeshment (extreme closeness) to disengagement (extreme distance).
For this study, interaction was defined as the perceived degree of closeness, conflict, and affection noted by one member of the mother-daughter pair toward the other.
Contribution to Nursing
Family Nursing
Contemporary nursing embraces the family as client (Friedman, 1992). "The family unit has been an early, continuing, and ever increasing focus of nursing care"
(Whall, 1993, p. 3). Over the past decade, Orem's self-care theory has been extended to accept the family as the recipient of nursing care or unit of service (Friedman; Tadych,
1985; Taylor, 1993). Within the self-care framework,
family health refers to the extent to which the family assists its members to meet their self-care requisites, as well as the extent to which it fulfills its family functions and accomplishes the tasks appropriate to the family's developmental level. (Friedman, p. 9) 11
Family health is defined and redefined in the interactions between and among family merrlbers (Metcoff & Whitaker, 1982). Health-related beliefs and behavior of families influence and are influenced by their individual merrlbers. Consequently, families are more than the context in which health and wellness occur; they are active participants in defining and providing meaning for individual and family health. Accordingly, nurses assert that wellness is maintained and illness occurs and resolves within the context of the family (Gilliss et al., 1991 ; Jones & Dimond, 1982).
The approach most relevant to family health is to consider the dynamic interrelatedness of individual family members and the family unit (Gilliss, 1983). Nursing defines family as "two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of [aJ family" (Friedman,
1992, p. 9). Unlike other small groups, families are responsible primarily for procreation and socialization of new members and are usually involved in all aspects of an individual's life (Friedman, 1992; Minuchin, 1974). Family tasks include meeting the physical, emotional, developmental, and economical needs of each family member and transferring societal, moral, and ethical values to new members. To function, families create rules and roles, learn to adapt and grow, and assist individual members in their development. These features make families malleable to nursing intervention aimed towards protecting or promoting health or preventing illness.
Families are open to growth and change; the family system may be the most powerful system dedicated to growth (Napier & Whitaker, 1980). This capacity for morphogenesis or growth helps families adjust and adapt during the transition from one 12 developmental stage to another. As families evolve over the life cycle, they face constant demands for change (Walsh, 1982). These demands are triggered by biological, psychological, and sociological or behavioral (biopsychosocial) changes in one or more of its members (Minuchin, 1974). For instance, adolescence is a time of seemingly constant biopsychosocial changes (Char & McDermott, 1987) which may be aggravated by the occurrence of physical, emotional, and behavioral perimenstrual symptoms.
During this stage of the family lifecycle, nursing interventions can help the female adolescent adjust to these maturational or peri menstrual changes or can help the family adapt to the changing needs of the adolescent.
Besides adjusting and adapting to change and growth, families interact in recognizable and recurrent patterns. These recurrent patterns define, sustain, and modify the health and the functioning of the family. Family patterns develop as strategies that enable all family members to manage internal or external stressful events (Kantor &
Lehr, 1975~ Metcoff & Whitaker, 1982). During the stage of the family lifecycle when adolescents are in the home, discrepancies exist frequently between system goals and individual needs. When the needs of one member compete with those of the family system, stress develops (Kantor & Lehr, 1975). Much of this stress arises out of normative life-stage and developmental events. In these instances, nurses can aim intervention at stress management.
Ultimately the goal of family-focused nursing is to maximize the resources and potential of the family system and individual family members in health and illness.
Nursing intervention is targeted deliberately at the level of the family unit (Gilliss, 1989). 13
To accomplish this goal, nurses require a knowledge base relating interaction patterns, stress, developmental demands, and biopsychosocial changes for each stage of the family lifecycle. More specifically, nurses working with adolescent females and their families require a knowledge base interrelating developmental demands, normative life-stage stress, and biopsychosocial changes associated with menstruation that may affect health and well-being.
Nursing Research and Families
Family-focused nursing research is the study of family process or behavior that is predictive of family functioning, health, or wellness (Baker~ 1989; Feetham, 1984). It systematical1y incorporates a family perspective from study conception through final anaJysis (Anderson & Tomlinson, 1992; Feetham, 1984; Gilliss, 1991; Larsen & Olson,
1990). Optimum understanding of developmental and interactional influences on an individuaJ's health occurs when nurses incorporate the view of family-as-the-unit of service with the view of family-as-context.
Currently, there is little nursing research that meets the criteria for family research (Anderson & Tomlinson, 1992; Gilliss, 1991); that is, few nursing studies have integrated the family into the theoretical framework and have utilized the family as the unit of observation and unit of analysis. In addition, because most family research has been conducted with clinical families or families with ill members, there is limited knowledge on healthy or nonclinical families. Moreover, there are rare investigations of the reciprocal influences between adolescents and their parents, scant available information from both parents and their children, and few analyses of same-sex parent- 14
adolescent relations (Gecas & Seff, 1990). Therefore, the identification of relationship
patterns in competent or nonclinical families can help to advance nursing and family
theory development around family strengths and coping (Moriarty, 1990), as well as
adaptation and adjustment to lifecycle transitions.
Nurses are concerned with human (individual or family) response to health and
illness, which includes response to individual or family growth and development, and can
expect dynamic relationships within families over the family lifecycle. Because families
with adolescents have the highest level of stress (Olson et aI., 1989), individual family
members and the family as a whole are at risk for health problems. Based on knowledge
gained through research, family-focused nursing can redefine changes and fluctuations of
behavior in terms of what families with adolescent members can expect, thereby
promoting and protecting family and individual health.
Specific Contribution to Nursing
In sum, this research has the potential to increase knowledge regarding expected biopsychosocial changes and normative behavior during adolescence. With this knowledge, nurses can promote optimum mother-daughter interaction, provide anticipatory guidance, and, possibly, diminish any negative impact of perimenstrual
changes. In addition, although knowledge of individual members or subsystems cannot guarantee knowledge of the family system as a whole, studying patterns within a
subsystem may identify patterns of the whole (Whall, 1981). Identifying relational patterns between menstruating mothers and daughters will increase knowledge about the
reciprocal nature ofbiopiychosocial symptoms. This, in tum, will advance nursing theory 15 around family patterns that may aid adjustment and adaptation during lifecycle transitions.
Organization of the Study
The remainder of the dissertation is divided into four chapters. Chapter II presents an overview of the literature related to (a) family development and changes associated with menarche and adolescence, (b) stress and its relationship to families with adolescent members and the expression of peri menstrual symptoms, (c) the biopsychosocial changes associated with the menstrual cycle, (d) perimenstrual symptoms and their impact on the individual and the family, and (e) communication patterns and families. Chapter III covers methodology, including research design, data collection methods, data analysis, and methodological limitations. Chapter IV contains a description of the study results. The final chapter includes a discussion of the findings and recommendations for nursing practice and research. CHAPTER II
REVIEW OF LITERATURE
There are four purposes of this chapter: (a) to review family development literature pertaining to the stage of family life when adolescents live in the home; (b) to describe perimenstrua] experiences in terms of biopsychosocial changes encountered by adolescent and adult women; (c) to explore communication patterns of families with adolescent members; and (d) to draw conclusions from family, development, communication, and menstrual cycle literature to support the study of mother-daughter interaction over the menstrual cycle.
Family Development Theory
Families grow and develop with each addition and deletion to the family unit and with the growth and development of individual members. Each stage marks a transitional period and is accompanied by specific developmental tasks. As families move through stages, recognizing the changing role-relationships among family members is essential to understanding the temporal aspects offamily life (Jacob, 1987; Steinglass, 1987). During the stage of the family life-cycle when there are adolescents in the home the family must balance freedom with responsibility as teenagers separate and emancipate themselves from the family unit (Duvall & Miller, 1985; Worden, 1991). Family boundaries must be increasingly flexible with a shift in the parent-child relationship to allow movement in and 17 out of the system by the adolescent (Carter & McGoldrick, 1980; Collins, 1990;
Worden, 1991). A lnajor task of adolescence is psychological independence and separation. As such, issues of control plague the parent-child relationship (Martin, 1987).
If families with adolescent members are not flexible and do not allow for changing role relationships, these issues lead to increased conflict and stress.
Biopsychosocial Influences
The capacity for morphogenesis helps the family adjust and adapt during the transition from one developmental stage to another. As the family evolves over the life cycle (Walsh, 1982), it faces constant demands for change. These demands are triggered by biopsychosocial changes in one or more of its members (Minuchin, 1974).
Adolescence is a time of seemingly constant biopsychosocial changes (Char &
McDermott, 1987~ Collins, 1990; Montemayor & Flannery, 1990; Paikoff &
Brooks-Gunn, 1990) that have reciprocal effects. For example, in a longitudinal study of the impact of puberty on family relations (N 204 families with young teen members), puberty was associated with increased conflict between mothers and children, with girls describing their mothers more negatively than boys described their mothers (Steinberg,
1989). In addition, puberty was found to exert a distancing effect on the parent-child relationship that continued throughout adolescence. Conversely, distance in the mother child relationship tended to accelerate pubertal (physiological) development among girls.
(Alternatively, mother-child closeness tended to slow girls' pubertal development.)
Furthermore, female pubertal timing varied as a function of family structure with maturation occurring earlier in nonintact households. 18
Three newer studies support Steinberg's conclusions. In an interactional study of
111 families with firstborn seventh-grade daughters, Holmbeck and Hill (1991) observed a positive correlation between menarche and conflictive engagement between mothers and daughters and an inverse relationship between months since menarche and withdrawal of positive affect in the mother-daughter dyad. No association was found between menarche and the father-daughter relationship. In a study of 205 adolescent girls, Ulman (1992) noted emotional distancing in postmenarcheal girls that was not reported by premenarcheal daughters and their mothers. Although menarche produced an overall sense of closeness between mothers and daughters, it was marked, also, by daughters emotional distancing and decreased ability to discuss intimate matters with their mothers. These findings agree with Steinberg's hypothesis of pubertal emotional distancing between mothers and daughters. Likewise, a 1993 study by Wierson, Long, and Forehand illustrated a relationship between parental divorce and early onset of menarche. In sum, research strengthens the argument that physiological maturation and psychological growth (i.e., separation and individuation) experienced by adolescents are interdependent with the parent-child relationship and conflict (Collins, 1990~
Montemayor & Flannery, 1990; Steinberg, 1989).
Developmental Tasks of Adolescence
The developmental tasks of adolescents are centered around autonomy and self-identity, As children begin the emancipation process, they begin to develop an identity that is increasingly separate from that of their parents. This development of self 19 occurs through relationships with others (Millar & Rogers, ] 987) and is essential for separation and independence (see Harter, 1990). For the adolescent girl, the mother-daughter relationship is associated significantly with the development of self-concept and self-esteem (Boyd, ] 989).
Through repetitive interaction with others identity is created and sustained, redefined and recreated (Millar & Rogers, ] 987). During this process, a sense of belonging is blended with a sense of separateness (Minuchin, 1974). Moreover, the primary system for the development of self is the family (Jones & Dimond, ] 982).
Through interaction with family members, a sense of self and subsequent self-esteem are developed (Bavelas & Segal, ] 982; Rogers, ] 98]; Steinglass, ] 987; Walsh, ] 982;
Watzlawick, Bavelas, & Jackson, ] 967). In essence, every act of affiliation becomes an act of identity formation (Berger & Kellner, ] 964). This is particularly so for the female adolescent.
Research supports the premise that boys and girls approach the process of individuation and separation differently (Char & McDermott, ] 987; Gilligan, ] 982). In general, women define their identity in terms of responsibility and caring for others
(relationships) whereas men define themselves in terms of individual success and achievement (individuation). According to Chodorow (] 974) "feminine personality comes to define itself in relation and connection to other people more than masculine personality does" (p. 44). Young women master relationship skil1s first and then progress toward increased independence. The development of intimacy is fused with identity: a woman comes to know herself as she is known, through her relationships with others 20
(Gilligan, 1982). For the adolescent girl, her affiliation with her mother is particularly important in the development of self-identity.
Yet, adolescence is a time when the mother-daughter role-relationship is changing. As the emancipation process develops, conflict and control are evident in mother-daughter interaction (Danza, 1983; Holmbeck & Hill, 1991; Steinberg, 1989).
The relationship between adolescent daughters and their mothers may become distant, dissatisfying, and conflictual (Collins, 1990; Holmbeck & Hill, 1991; Montemayor &
Flannery, 1990; Steinberg, 1989). Moreover, during the separation-individuation process, adolescents may challenge their parents· values and authority. Conflicts involving dependence/independence and autonomy/conformity issues unfold (Char &
McDermott, 1987)~ contention and communication breakdown may arise (Montemayor
& Flannery, 1991). A discrepancy between the adolescent's needs and goals (e.g., separation, individuation, independence, and autonomy) and the goals of the system may be evident. Often stress accompanies this discrepancy (Kantor & Lehr, 1975).
Furthermore, conflict and issues of control may be aggravated by the emotional, physical, and behavioral changes that accompany adolescence or menstruation.
Stress and Families With Adolescent Members
Families with adolescents find this developmental stage a uniquely stressful time
(Kidwell et aI., 1983; Olson et aI., 1989). During these years, much of the stress experienced by families arises out of normative life-stage and developmental events and affects all families to varying degrees (Bios, 1971; Kidwell et al., 1983; Steinberg, 1989).
Generally conflict and age seem to be related (Montemayor, 1983; Montemayor & 21
Flannery, 1990). Parent-child conflict begins at puberty (Danza, 1983~ Steinberg, 1989), rises during middle adolescence, and, then, declines in late adolescence {Noble, Adams,
& Openshaw, 1989).
Besides developmental demands, the characteristic interaction of family members and the structure of the family system can add to interrelationship stress or conflict
(Kidwell et aI., 1983). In contrast to their parents, adolescents are more likely to report more conflict and less closeness (Steinberg, 1989) and to describe their families as less cohesive and less flexible (Olson et aI., 1989). This perception may be necessary for the adolescent developmental tasks of separation, individuation, and independence (Collins,
1991; Montemayor & Flannery, 1991). Yet, discrepancies in perceptions regarding family issues and dynamics have been related to higher levels of stress in the family system (Olson et aI., 1989). Furthermore, when conflict arises, it is more likely to surface between adolescents and their mothers (Holmbeck & Hill, 1991; Steinberg, 1989).
From their research on 1,000 nonclinical families, Olson and associates (1989) found that
family stressors and strains have an impact on the development of adolescents ... '[YetJ little simjlarity was found between adolescents' and parents' perceptions of stressors within the family. In contrast to their parents, adolescents felt that most of the stress was in dealing with their families .... From the adolescents' perspective the major family stressors were the day to day hassles with their parents. (pp. 227-230)
Furthermore, these researchers concluded that high stress levels and the discrepancies in how parents and adolescents perceive the world were positively correlated.
Consequently, normative tensions in the parent-adolescent relationship were 22 exacerbated. Conversely, good parent-adolescent communication was a characteristic found in low-stress families (Olson et a1., 1989).
In 1989, Noble, Adams, and Openshaw reviewed the current literature on parent adolescent conflict and found support for the conclusions formulated by Olson and colleagues. Although the severity of reported conflict varied among the studies reviewed, conflict that resulted in serious arguments was not uncommon in nonclinical families.
The reasons given for arguments were those related to daily hassles such as completion of chores, disobedience, school performance, social life, and friends. Furthermore, more conflict was reported in distressed parent-adolescent relationships than in nonstressed relationships. During conflict, withdrawal was the most common conflict resolution behavior for adolescents and their parents.
Perimenstrual Experience
Literally, perimenstrual experience means the experience around menstruation.
Discussion of the perimenstrua] experience has been divided into the following subsections: menstruation, prevalence of perimenstrual changes, perimenstrua] symptomatology and premenstrual syndrome, perimenstrual symptoms and family relationships, adolescents and perimenstrual symptoms, and menstrual synchrony.
Background in the process of menstruation is essential to the understanding of the perimenstrual experience~ therefore, it is advantageous to cover the biology of menstruation first. 23
Biology of Menstruation
Menstrual Cycle
A woman's reproductive functioning begins at menarche with the onset of menstruation and ends at menopause with its cessation. Menstruation, the cyclic disintegration and discharge of endometrial tissue, marks the beginning of the menstrual cycle. The menstrual cycle consists of three phases named for ovarian and endometrial
(uterine) changes: the follicular/proliferative, ovulatory, and luteal/secretory phases.
Often menstruation (bleeding) is differentiated as a fourth phase (Robinson, McCance, &
Gray, 1994). Each phase has its own unique endocrine profile; ovarian events are controlled by gonadotropin hormones, whereas endometrial changes are activated by the ovarian hormones, progesterone and estrogen. Gonadotropin hormonal release and ultimately the menstrual cycle are under the control of the hypothalamus.
The first half of the menstrual cycle is termed the follicular or proliferative phase.
During this phase, immature ovarian follicles develop in response to the gonadotropin
FSH. While the follicle is developing, its granulosa cells secrete estrogen. Estrogen, in turn, triggers proliferation of the endometrium. By the time the follicle is mature, the endometrial lining of the uterus is restored. Hence, the proliferative phase of the uterus coincides with the follicular phase of the ovary. "The follicular phase begins on the first day of menses and ends roughly 36 hours before ovulation, with the onset of the
(gonadotropin] LH surge" (Leibenluft, Fiero, & Rubinow, 1994, p. 762). During this phase, progesterone levels are nominal and estrogen levels increase steadily. This first part of the menstrual cycle may be influenced by internal and environmental factors 24
(e.g., emotional or physical stress, body fat, nutrition, illness, exercise, and seasonal variation in sunlight), and therefore, may vary in length. Variability within the follicular/ secretory phase contributes to the variability of overall menstrual cycle length within and between women.
The ovulatory phase occurs over 2 to 3 days and includes the LH surge and ovulation. At the end of the follicular phase, estrogen levels peak. The sudden sharp increase in estrogen lasts for about a day and initiates a surge in the levels of LH; the LH surge, in turn, triggers ovulation or the release of a mature ovum from the ovary. This ovulatory period serves as a bridge between the first half of the menstrual cycle
(follicular phase) and the second half (lutea1 phase).
The second half of the menstrual cycle consists of the luteal phase of ovarian functioning and the corresponding secretory phase of the uterus. After ovulation, the ruptured follicle transforms into the corpus luteum; the corpus luteum secretes high levels of estrogen and progesterone until it atrophies. Progesterone initiates the secretory phase of endometrial development. During this phase, the endometrium becomes nutrient-laden and prepares for implantation of a fertilized egg. In the absence of pregnancy, the corpus luteum degenerates; estrogen and progesterone levels drop precipitously; the endometrium becomes ischemic and disintegrates; and menstruation occurs marking the beginning of another cycle. Unlike the follicular/ proliferative phase that may vary in length, the luteal phase is relatively fixed at 14 days (Robinson et al.,
1994) 25
Cycle Variation
The length of the menstrual cycle and the duration and amount of flow vary
considerably among normal women. The commonly accepted cycle average ranges from
27 to 30 days with rhythnlic intervals of 22 to 40 days (plus or nlinus 5 days) considered
normal (Golub, 1992; Lichtman, & Papera, 1995; Sandler & Kase, 1990). Menstrual
flow usually lasts 3 to 7 days (give or take 1 day) with most of the blood loss occurring
during the first three days of bleeding. Presumably strict control of menses is related to
sequential ovarian secretion of estrogen and progesterone delivered to the endometrium
during an ovulatory cycle (Robinson et al., 1994). In contrast, irregular cycles or periods
of amenorrhea (absence of bleeding) are due often to anovulation (lack of ovulation).
Anovulatory cycles are common at both extremes of the reproductive lifecycle.
At first menstrual cycles are anovulatory and may vary in length from 10 to 60 days or
more. Irregular and anovulatory cycles decrease the 2nd year following menarche with
most young women achieving regular, ovulatory cycles about 5 years after menarche
(Vollman, 1977; Widholm & Kantero, 1971). As adolescence proceeds, regular patterns
of menstruation and ovulation are established at intervals ranging between 30 and 35 days. During adulthood, menstruation continues to recur in a recognizable and
characteristic pattern with the length of the menstrual cycle varying considerably among women. If a woman is to experience regular and predictable menstruation, it usuaJly happens by the third decade. One to two years prior to menopause, women once again
experience anovulatory cycles that contribute to variable cycle length. 26
Menstrual cycle variation among individuals was emphasized by Chiazze and
associates (1968) in their study of 30,655 menstrual cycles contributed by 2,316 women.
Only "13% of the women in this study had a range of cycle lengths less than six days!! (p.
91). The greatest variability of cycle length was documented in women under 25. In
addition, young women aged 15 to 19 experienced the highest average cycle length
(longest cycle) CR 30.8, S12 = 3.38) and women aged 40-44 noted the shortest average
cycle length CR = 28.3, SD = 2.77). These findings have been supported by other cross
sectional, longitudinal, and clinical studies of menstruation. Greatest variability (widest
range) in menstrual cycle length has been reported for women aged 17-24 and 40-50
(Collett, Wertenberger, & Fiske, 1954); before the age of21 and after 39 (Treloar,
Boynton, Behn, & Brown, 1967); and just after menarche and right before menopause
(Vollman, 1977).
Identifying Ovulatory Cycles
For menstrual cycle research, documentation of ovulation during the course of the study and the use of terms that reflect determination of cycle phase are recommended
(Sommer, 1991). Although cycle phase can be defined based on the presence ofvaginal bleeding (e. g., premenstrual, menstrual, or postmenstrual phases), a more exact
determination of cycle phase can be made when ovulation is documented (e.g., follicular, periovulatory, luteal, or menstrual phases). Documentation of ovulation and clear
operational definitions of cycle phases allow (a) comparison among menstrual cycle
research studies and (b) differentiation of the influence of reproductive and gonadotropin 27 hormones on cycle-phase specific events (e. g., behavior, mood, or levels of neurotransmitters or nonreproductive hormones).
As mentioned previously, a history of rhythmic cycles suggests ovulation, whereas infrequent or irregular menses indicates anovulation. In addition to a history of regular cycles, ovulation can be determined in a variety of ways: basal body temperature
(BBT) readings, cervical mucus assessment, hormonal (LH or progesterone) assays, sonography, or endometrial biopsy (Hammond & Steinkampf, 1992). One of the most economical methods of documenting ovulation is charting BBT.
By definition, BBT is the lowest body temperature of a person and is taken in the morning upon awakening. Progesterone, which is secreted upon ovulation, is thermogenic and causes a sustained rise in BBT during the luteal phase of the menstrual cycle. Therefore, BBT undergoes characteristic biphasic changes in ovulatory cycles.
Normally, BBT fluctuates around 98 0 F (370 C) during the follicular phase and increases
OA o to 1.00 F (0.20 to 0.50 C) during the luteal phase (Robinson et aI., 1994). A drop in
BBT sometimes precedes ovulation by 12-24 hours (Hatcher et al., 1994), and BBT may return to follicular-phase levels 1 to 3 days prior to the onset of menstruation. On occasion, women who ovulate may not have an identifiable BBT pattern in a cycle when hormonal assays would clearly document ovulation (Hatcher et al. ~ Leibenluft, Fiero, &
Rubinow, 1994). In addition, this typical biphasic pattern can be disrupted by illness, stress, travel, and interrupted sleep. Accuracy ofBBT readings is dependent on taking temperature first thing in the morning after a minimum of 4 hours of sleep. 28
The timing of ovulation can be determined most conveniently by employing kits that use monoclonal antibodies to detect the high urinary levels of LH that occur during the LH surge (Leibenluft et al., 1995). A number of commercial urinary LH assay kits are available~ but the sensitivity and readability of these assays vary considerably with the manufacturer (Hammond & Steinkampf, 1992).
Prevalence of Peri menstrual Changes
Perimenstrual symptoms occur immediately before, during, and after menstruation and include a variety of psychosocial, behavioral, and physical symptoms.
AIl women seem to experience biopsychosocial changes of differing magnitudes across the menstrual cycle (Sveinsdottir & Reame, 1991~ Woods et aI., 1992). As well, there tends to be a normal distribution of symptoms, which include both positive and negative changes (Golub, 1980~ Woods, 1985~ Woods et aI., 1989). These changes happen in social and personal contexts (Hood, 1992~ Lee & Rittenhouse, 1992~ Mitchell et al.,
1994~ Reame, 1990~ Woods, 1986~ Woods, Most et aI., 1982~ Woods et aI., 1992).
Consequently, an individual's perception and definition or meaning of the symptoms are critical.
Perimenstrual changes are reported to vary from cycle to cycle (Klebanov &
Jemmott, 1992~ Mitchell et aI., 1994~ Shaver & Woods, 1985~ Sveinsdottir & Reame,
1991, Walker, 1994~ Woods, Most et aI., 1982~ Woods et aI., 1992) and with age
(Freeman, Sondheimer, & Rickels, 1988~ Richardson, 1990; Shaver, Woods,
Wold-Wilets, & Heitkemper, 1987). Variability of symptom expression is influenced by changes in menstrual patterns, by expectation of the symptoms to occur, and by stress 29
(Aubuchon & Calhoun, 1985; Chernovetz et aI., 1979; Fradkin & Firestone, 1986;
Freeman et al., 1988; Johnson, 1987; Klebanov & Jemmott, 1992; Olasov & Jackson,
1987; Woods, 1985; Woods, Dery et at, ] 985; Woods et aI., 1985, 1992). Although women report both positive and negative changes over the menstrual cycle, most research focuses on the negative changes in mood and well-being occurring in the premenstrual or luteal phase of the cycle, known as premenstrual syndrome (PMS) or late luteal phase dysphoric disorder (LLPDD) (Walker, 1994).
Through independent research on nonclinical women, Gallant (1991), Golub,
(1980) and Rossi (1980) depicted an increase in negative moods--depression, unhappiness, anxiety--and a decrease in positive moods during the luteal phase of the menstrual cycle. Premenstrually, women were more likely to describe themselves as anxious, dull, impatient, intolerant, nervous, quarrelsome, talkative, and tense. In contrast, the same women felt warm and peaceable more often during their intermenstrual phase.
Although both clinical (Siegal, Myers, & Dineen, 1987) and nonclinical women
(Woods et al., 1989) have reported experiencing positive feelings premenstrually and menstrually, various other populations have reported the opposite. McMillan and Pihl
(1987) reviewed 10 research studies that documented a premenstrual or menstrual increase in negative affect. Study populations included college students (in 1968, 1976), nonclinical women over 30 years (two studies in 1976), women complaining of premenstrual tension (in 1969, 1980, 1983), women with a hysterectomy sans 30 oophorectomy (in 1981), psychiatric populations (in 1970), and depressed psychiatric populations (in 1982).
Further support for symptom variation over the menstrual cycle is documented in a series of research investigations of nonclinical women by Woods and her associates
(1982, 1985, 1989, 1992). For example, in a recent study of randomly sampled women from King County, Washington, 91 % of the women experienced distressing symptoms before or during menses or both, and most (79%) reported that these symptoms had worsened or stayed the same over time. Turmoil was the most bothersome symptom group identified (Woods et aI., 1992); symptoms included hostility, tension, anger, anxiety, irritability, mood swings, impatience, depression, feeling out of control, and tearfulness. In three other studies, Johnson (1987) noted that women commonly reported a premenstrual decrease in self-confidence and work efficiency without a change in objective measurement of performance.
Perimenstrual Symptomatology and Premenstrual Syndrome
Premenstrual Syndrome can be defined as the cyclic recurrence (in the luteal phase of the menstrual cycle) of physical, psychologic, or behavioral changes distressing enough to impair interpersonal relationships or interfere with usual activities (Reid,
1985). Past theories ofPMS etiology have utilized a biomedical model,
in which, both "normal" and "abnormal" premenstrual experiences are hypothesized to be related to hormonal fluctuations within the hypothalamic-pituitary-ovarian (H-P-O) axis, even if mediated by some other mechanism. (Walker, 1994, p. 272) 31
The problem with a biomedical model that infers biological destiny (i. e., inferring a faulty H-P-O axis as the cause of distressing premenstrual symptoms) is that intercycle inconsistency occurs in women with regular ovulatory cycles that do not experience distressing or severe premenstrual mood or behavioral changes. Furthermore, inconsistency in the severity and duration of symptoms from cycle to cycle is compounded with the inconsistency in the reporting of phase-related symptoms (that is, not all menstruating women designate the premenstruum as the most negative or distressing time of the menstrual cycle). In contrast,
feminist-standpoint biopsychosocial models (of the perimenstrual experience) can explain cycle inconsistency, because hormonal status is considered to be only one of the factors that might influence premenstrual mood and well-being in any cycle. (Walker, p. 273)
In other words, it is thought that PMS is the end result of abnormal tissue response (i.e., nervous, immunologic, vascular, and gastrointestinal among others) to the normal hormonal fluctuations related to the menstrual cycle. This biological response may be triggered by fluctuating estrogen and progesterone levels and is important but not sufficient to produce PMS (Keye, 1991). Other mediating factors exist.
In sum, PMS is a term that connotes a negative change in behavior and moods.
Yet (a) perimenstrual symptoms are experienced to some degree by all adolescent and adult women and are more likely to occur throughout all menstrual phases, (b) the presence and severity of symptoms in anyone woman may be inconsistent from month to month, and (c) menstrual phase for peak symptom severity may differ depending on the population studied (Brown & Lewis, 1993: Woods et aI, 1989~ York, Freeman, Lowery,
& Strauss, 1989). Therefore, biopsychosocial changes that accompany the menstrual 32 cycle may be normative. Because perimenstrual symptom expression is variable and not necessarily negative, the term perimenstrual experience or peri menstrual symptoms (PS) is a better descriptor of the changes that a woman can expect to experience over the menstrua] cycle and will be used in this study.
Peri menstrual Symptoms and Family Relationships
When peri menstrual changes are reported as distressing, family relationships are affected and family conflict, stress, and adverse communication patterns, such as yelling or hitting, are reported (Brown & Zimmer, 1986~ Cortese & Brown, 1989; Lindow,
1991; Winter et aI., 1991; Woods, 1987; Woods et aI., 1989; Woods et aI., 1992). In tum, environmental stressors, including social stress and level of daily hassles, exacerbate the frequency and severity of perimenstrual symptoms (Abplanalp, 1991; Brown &
Harrington, 1988; Freeman et aI., 1988; Siegal-Louis, 1984; Woods, 1985; Woods et al.,
1985) and create conflict or change in family relationships (Woods et aI., 1989; Woods et a1., 1992).
After reviewing the literature, Abplanalp (1991) concluded the following:
(a) stress is a mediator of peri menstrual symptoms; as stress increases so does the frequency, intensity, and duration of symptoms; (b) self-esteem is inversely correlated with symptoms; (c) change in quality of relationships occurs when women are symptomatic.
The relationship between stress and perimenstrual symptoms is supported by research (Brown & Harrington, 1988; Brown & Lewis, 1993; Freeman et a1., 1988;
Mills, 1991; Siegal-Louis, 1984; Woods, 1985; Woods et aI., 1985). In a study of 104 33 women, Brown and Lewis (1993) concluded that women with higher premenstrual symptom severity "experienced significantly greater perceptions of stress ... and significantly lower perceptions of uplifts during the premenstrual phase of the cycle than the postmenstrual phase" (p. 427). Furthermore, in the King County study cited earlier, women described perimenstrual symptoms as negatively affecting their lives (Woods et aI., 1989; Woods et aI., 1992). "Effects were contingent on the nature of the symptoms"
(p. 424). Perimenstrual turmoil, the most frequently experienced symptom group, produced (a) conflict or negative change in family relationships, (b) family stress, (c) negative reaction from family members, and (d) behavior such as negative communication pattern (yelling or hitting), argumentativeness, avoidance of issues, or social isolation (withdrawal from others). Social stressors (e.g., relationship problems and conflict, works stress, or stress pile-up and schedule disruption) and sensitivity to social environment (e.g., children, noise, daily events or hassles) exacerbated turmoil symptoms. In turn, severe perimenstrual turmoil was correlated with increased numbers of conflicted relationships.
Similarly, the negative impact of perimenstrual symptoms is supported by other research (Brown & Zimmer, 1986~ Cortese & Brown, 1989; Lindow, 1991 ~ Mills, 1991 ~
Siegal-Louis, 1984). In a study of personal and family impact of premenstrual symptoms,
Brown and Zimmer (1986) asked men who attended a premenstrual syndrome lecture open-ended questions about the effects of their partner's symptoms on family life.
Responses were content analyzed and several recurrent themes emerged. These themes included (a) increased conflict and disrupted communication among family members, 34 including children; (b) decreased family participation in enjoyable family activities; (c) decreased performance of household tasks; (d) withdrawal and decreased contact among family members; and (d) decreased family cohesion, Descriptions of marital discord and relationship dissatisfaction by women and their spouses can be found in other research as well (Keye, Hammond, & Strong, 1986; Ryser & Feinhauer, 1994),
Mills (1991) used a stress-illness paradigm based on Hill's ABCX family crisis framework to study the impact of stress on 100 women and 96 of their partners, The results demonstrated that women's and men's stress, family resources, and couple hardiness are additively predictive of the severity of premenstrual syndrome (PMS),
Conversely, "stressful events can markedly exacerbate premenstrual symptoms" (Rose &
Abplanalp, 1983, p, 181); and women, both clinical and nonclinical, perceive stressful events occurring during the premenstrual phase as more distressing than during other times of their cycle (Matteo, 1987; Schmidt et aI., 1990). Furthermore, Siegal-Louis
( 1984) demonstrated a relationship between characteristics of family of origin and women with complaints of premenstrual symptoms. In this retrospective study, premenstrual distress was correlated with a rigid and disengaged family of origin, parental overprotection, and familial problems without conflict resolution. In summary, studies of adult women have shown a relationship between perimenstrual symptoms and family interaction, between stress and the presence of symptoms, and between perception of distressing events or distressing symptoms and cycle phase.
One potential area of stress that has not been assessed is the association between an adolescent's PS and family interaction. Although, the association between PS 35 experience and interpersonal relationships has not been studied in families with adolescent daughters, findings may be similar for the following reasons: (a) a strong correlation exists between a mother's menstrual experience and her daughter's experience
(Brooks-Gunn & Matthews, 1979~ Freeman et aI., 1988; Kantero & Widholm, 1971 ~
Lipman-Blumen, 1972; Menke, 1983; Mitchell et aI., 1994; Nadelson, Notman, & Ellis,
1983; Strauss, Appelt, Daub, & de Vries, 1990; Whitehead, Busch, Heller, & Costa,
1986; Wilson, 1990); (b) perimenstrual symptoms are common in adolescents (Johnson,
1987; Widholm, 1979; Widholm, Frisk, Tenhunen, & Hortling, 1967) and often are present at menarche (Flug, Largo, & Prader, 1985 ~ Norris & Sullivan, 1983); ( c) mother daughter relationships change and conflict increases when the daughter begins to menstruate (Collins, 1990; Danza, 1983; Holmbeck & Hill, 1991; Steinberg, 1989), suggesting a possible relationship between menstruation and familial interaction.
Adolescents and Perimenstrual Symptoms
The focus of the majority of research on adolescents and menstruation is on the menarcheal experience and the acquisition of menstrual beliefs and attitudes (see
Brooks-Gunn & Ruble, 1982~ Golub, 1983). Few studies focus on the prevalence or impact of perimenstrual symptoms with little or no available research investigating the relationship of peri menstrual symptoms and family interaction in families with adolescents daughters.
Estimates of the prevalence of perimenstrual symptoms in adolescents range from
30-50% (Johnson, 1987; Wid holm et aI., 1967). In contrast, Wilson and Keye (1989) reported that 91 % (80/88) of adolescents in their study reported premenstrual symptoms. 36
Moreover, these symptoms, along with dysmenorrhea, significantly affected school performance and caused absenteeism (Wilson & Keye, 1989).
A discrepancy in the reported occurrence of symptoms may be related to the frequency of ovulatory cycles in any given population of adolescents. During the first year after menarche, up to 500/0 of cycles can be anovulatory (Vollman, 1977).
Anovulatory cycles decrease over the next 10 - 12 years with regularity in menstrual cycles (consistent ovulation) occurring between 25 and 35 years of age. In a large study
(N 5,485) of menstruating girls, Widholm and Kantero (1971) reported that 5 years after menarche abnormally long (>31 days) or short «21 days) cycles decreased to 16%.
Vollman noted the same trend in his study of 691 women over 31,645 menstrual cycles.
In their second large study, Kantero and Widholm (1971) noted a significant correlation between Finnish mothers' and daughters' recall of menstrual traits. Seventy percent of daughters who experienced premenstrual fatigue and irritability had mothers who reported similar premenstrual experiences. In a more recent study of mothers and daughters, Wilson and associates (1991) discovered that (a) daughters reported more symptoms during the menstrual phase (days 1-5) than mothers~ (b) the severity of perimenstrual symptoms was not significantly different between adults and adolescents regardless of cycle phase; and (c) daughters of mothers with PMS were more likely to experience luteal phase symptoms (i.e., from ovulation to first day of bleeding) than daughters of mothers without PMS. In addition, retrospective recall of premenstrual symptoms was highly correlated (r = .90) with prospective charting for both mothers and daughters. For adult women, Woods and associates (1989) reported an association 37 between a woman's own experience and both her mother's and her sister's experience.
Several other correlational studies and anecdotal reports link mothers' and daughters' perimenstrual experience (Brooks-Gunn & Matthews, 1979~ Freeman, Sondheimer, &
Rickels, 1988; Menke, 1983; Nadelson, Notman, & Ellis, 1983; Strauss, Appelt, Daub,
& de Vries, 1990; Widholm, 1979). Missing from the literature are reports of the impact of adolescents' perimenstrual symptoms or perceptual changes on interpersonal relationships and observations of mother-daughter interaction over the menstrual cycle.
It is unknown if the data collected on regularly menstruating women can be extrapolated to adolescents. The paucity of research in this area denotes a need for further investigation. Of interest, is the relationship between menstrual timing, the expression of perimenstrual symptoms, and perceived mother-daughter interaction.
Menstrual Synchrony
Anecdotal reports suggest that women who live or work together, cycle together.
This phenomenon, known as menstrual synchrony, has been explained by a variety of theories that are not mutual1y exclusive, such as soicobiological and natural selection
(Wilson, 1992), pheromonal (McClintock, 1978; Preti, et aI., 1986; Russell, Switz, &
Thompson, 1980), environmental (Little et al., 1989; Quadagno, et at., 1981), psychosocial (Jarett, 1984), and personality theories (Goldman & Schneider, 1987;
Jarett, 1984). Menstrual synchrony has been found among roommates, cohabitating lesbians, close friends, and women co-workers. Five studies of undergraduate students and one study of young women (18 to 24 years) living in hostels in India indicated that the best predictor of menstrual synchrony was time spent together during waking hours 38
(Graham & McGrew, 1980; Jarett, 1984; Little, Guzick, Malina, & Ferreira, 1989;
McClintock, 1971; Quadagno, Shubeita, Deck, & Francoeur, 1981; Skandhan, Pandya,
Skandhan, & Mehta, 1979). In a more recent investigation of 80 Scottish nurses residing in hospital housing, degree of interaction--not necessarily time spent together--predicted menstrual synchrony (Graham & McGrew, 1992). Similarly, job interdependency between female co-workers has been related to menstrual timing (Matteo, 1987); conversely, high levels of job stress for co-workers and reported stress in college students decreased tendency for menstrua] synchronization. Besides time spent together during daylight hours and close interaction or job interdependency, friendship, mutual activities, and menstrual regularity seem to influence synchrony (Weller & Weller, 1992,
1993). Because families with adolescent members report more stress than any other family stage and because adolescents spend more waking time with their peers than they do with their mothers, it cannot be assumed that mother-daughter dyads that live together will cycle together.
At this time only three studies of menstrual synchrony in mother-daughter pairs have been published. Even though methodological problems were found in all three studies, one of the studies did note significant menstrual synchrony between mothers and daughters who lived in the same home.
In the first study, dormitory women in India were asked to recall their last menstrual period (LMP) along with the LMP of their friends and relatives (Skandhan et aL 1979). In this study, the researchers relied on the participants' recollection and estimation of friends' and relatives' menstrua] onset dates to determine synchrony. Recall 39 of another's menstrual onset date is not considered a valid indicator of menstrual synchrony (Weller & Weller, 1993). Therefore, the findings from this study are often dismissed in discussions of menstrual synchrony. A second study of mothers and daughters was conducted by Weller and Weller (1992). These researchers examined menstrual synchrony in a kibbutz where mothers and daughters did not live together but spent 3 hours a day together. This study relied on recall of LMP and included dyads in which one member used oral contraceptives. No synchrony was found. In this case, it is difficult to say whether the data collection methods or the living conditions of the sample or some other variable contributed to the absence of menstrual synchrony. In contrast, synchrony was found in a third study of mothers and daughters who lived together. Yet this study was plagued by the same methodological concerns that plagued the second study (Weller & Weller, 1993). It seems that inconsistent results in menstrual synchrony research is not uncommon.
In a critical analysis of 16 different menstrual synchrony studies, Weller and
Weller (1993) concluded (a) that "menstrual synchrony occurs often, but not always"
(p. 431) and (b) that time spent together was the greatest predictor of synchrony. In their analysis, two major methodological problems were identified: (a) dependence on retrospective data or data collected at one point in time and (b) the inclusion of oral contraceptive users. If pheromones playa role in menstrual synchrony (which is highly plausible according to Weller and Weller; see also McClintock, 1971), levels of pheromones would correspond to fluctuating gonadotropin or reproductive hormone levels found in ovulatory cycles. Therefore, menstrual synchrony would be dependent on 40 synchrony of ovulation and inclusion of women whose menses are artificially controlled I would be pointless. Out of the 16 studies reviewed, only one study that demonstrated menstrual synchrony used prospective data collection, had women track their menstrual cycles over a period of time (7 months), and excluded oral contraceptive users (see Little et aI., 1989). Another issue related to the inconsistent findings on menstrual synchrony is the atheoretical nature of the majority of studies in this area. Although most researchers mention a possible pheromonal or environmental explanation for menstrual synchrony, few, if any, have included a contextual framework for their research. Missing in most research on menstrual synchrony is a conceptual or explanatory model using systems, interactional, family, stress, communication, or individual! family development theories or any biopsychosocial approach as a framework for the study.
Communication
Communication has been accepted by family researchers and therapists as a crucial facet of interpersonal relationships (Olson et aI., 1985). The Palo Alto Mental
Research Institute (MRI) group describes three components of communication
(Steinglass, 1987). The first component, syntax, refers to the ways in which information is transmitted. The second component, semantics, focuses on the meaning of the communication act. The last and the most important component is the pragmatic aspect of communication. Pragmatics, which is based on systems theory, refers to the behavioral
lOra] contraceptiYes prevent o\ulation. Through the administration of s~nthetic honnones, a constant but low honnonalleyel is maintained for 3 out of 4 weeks. During the 4th week, no pills are taken and honnone leyels drop: this, in tum causes \\ithdrawal bleeding or a pseudo-period. 41
effects of cornmunication (Fisher, 1987; Watzlawick et ai., 1967). The MRI group
suggests that attention to the "pragmatic aspect of communication is all that one need
take into consideration in order to describe and define the rules of behavior that exist
within a particular family" (Steinglass, 1987, p. 56). Because the family tends to interact
in repetitious sequences, behavior consists of a relatively small set of patterned and
predictable rules that regulate family transactions. In other words, people with a shared history and future follow patterned redundant ways of behavior (Bavelas & Segal, 1982;
Walsh, 1982; Watzlawick et at., 1967).
Communication experts propose that the development of the self occurs through relationships with others. Besides transmitting information back and forth between family members, communication defines relationships (Bavelas & Segal, 1982; Rogers, 1981;
Steinglass, 1987; Walsh, 1982). Within an interaction, individuals express themselves in relation to others and experience another in relation to themselves (Kantor & Lehr,
1975). It is within the patterns of communication, particularly control patterns, that the self is defined in terms of another (Rogers, 1981; E. Rogers, personal communication,
Spring 1990, University of Utah). AJthough communication relays information back and forth between family members, more importantly, communication defines, monitors, and reinforces the nature of the relationships between and among members. Descriptions of exchanges and transactions among family members provide information" about the interactions, affect, and perceptions and cognitions pertaining to the relationship and the individuals who comprise it" (Collins, 1990, p. 87). 42
Communication and Families With Adolescent Members
Communication is essential in the negotiation process adopted by families to meet the developmental changes and growth of individual members (Olson et aI., 1985).
This may be especially so during adolescence when developmental tasks center on separation, independence, and identity formation. According to Satir (1988)
"communication is the greatest single factor affecting a person's health and his relationship to others" (p. 79). In turn, effective communication facilitates movement to and maintenance of systems at desired or balanced levels of cohesion and adaptability
(Olson et at., 1985, 1989). Yet, on these two characteristics, adolescents perceive family interaction different than their parents. In a study of nonclinical families, Olson and associates (1989) reported that adolescents described their families as less cohesive
(more disengaged) and less flexible (more rigid) than their parents. This "general incongruency between parents' and adolescents' actual and presumed views of each other, their relationships, and family functioning has been widely documented" (Collins,
1990, p. 90). It is unknown whether this discrepancy is the result of communication patterns that have been established between the adolescent and the parent or whether it is a reflection of the adolescent's developmental task to achieve independence. What is known is that patterns of parent-child and family interaction do change during adolescence.
Communication is considered a family strength for all stages of the family lifecycle. Yet, families with adolescents seem to have problems with communication.
Lack of communication may be a factor or a result of the stress experienced by these 43
families (McCubbin & Patterson, 1983; Olson et aI., 1989). Although, in their study,
there were no significant family life stage differences in regard to communication, Olson
and associates identified a trend impacting the quality of the marital communication.
During the time when adolescents were in the home, couple satisfaction declined
regarding (a) comfort with sharing information, (b) perception of partner's style of
communication, and (c) perception of adequacy of communication. In addition,
adolescents viewed communication less open and more problematical than their parents.
The discrepancy was less for adolescents and mothers than adolescents and fathers.
In conclusion, communication is a crucial factor in interpersonal relationships and
can ameliorate or aggravate stress and negative behavior. Communication is created through repetitive sequencing and patterning of interactions and is meaningful only in context (Bateson, 1967). For the adolescent girl, the formation of a separate identity occurs within the changing role-relationship of the mother-daughter pair and the resultant communication patterns. Perception of self and others and, therefore, communication patterns may be altered based on the mother's or the daughter's perimenstrual experience. Furthermore, a daughter's ability to separate from her mother and develop a unique sense of self may be compromised by the degree of change in self perception and family interaction experienced over the menstrual cycle.
As discussed previously, a woman's perimenstrual experience influences and is influenced by stress and family interaction. Distressing perimenstrual symptoms may contribute to negative communication and increased family stress (Brown & Zimmer,
1986; Woods et al., 1992). In turn, negative emotion and communication may impede 44
family problem-solving (Forgatch, 1989) and stress may amplify parental explosive and
irritable behavior, two severe forms of negative communication (Patterson & Dishion,
1988). The situation may be further complicated, iffamilies of origin are rigid and
disengaged and have difficulty with conflict resolution (see Siegal-Louis, 1984).
In summary, the literature supports the hypothesis that menstruating mothers and
daughters tend to have similar physical, psychosocial, and behavioral perimenstrual
changes. When these changes are labelled as distressing, they have been associated with
family stress and adverse communication patterns. Given that stress mediates
perimenstrual symptoms, it can be speculated that the stress experienced by families with
adolescent members can aggravate the peri menstrual experiences of both menstruating
mothers and their adolescent daughters. Moreover, based on the principle of
interdependence, it is hypothesized that the peri menstrual experience of the mother
influences and is influenced by the peri menstrual experience of the adolescent. In turn, these experiences may influence mother-daughter interaction.
Context
No subsystem can attain its own equilibrium in isolation from others (Watzlawick et aI., 1967). As such, family behavior and interaction between and among family members have meaning only when viewed within the framework of the family (Metcoff
& Whitaker, 1982). Likewise, the meaning of a function or event, such as perimenstrual symptoms, is not contained in itself but in its relationship to context (Bateson, 1967).
Therefore, studying context may lead to understanding behavior that accompanies a biological event. For this reason, menstrual cycle researchers suggest framing the study 45 of the biology of women within psychosocial or sociocultural context (Lewis, 1991 ~
McClintock, 1981 ~ Parlee, 1981 ~ Reame, 1990). With this in mind, it is hypothesized that mothers' and daughters' behavior and patterns of communication, within the framework of the family system and the mother-daughter subsystem, may affect their perceptions and reactions to perimenstrual physical, emotional, and behavioral changes, Thus, it is essential to (a) study peri menstrual changes in the context of the menstrual cycle,
(b) study perimenstrual changes in the context of mother-daughter interaction, (c) study mother-daughter interaction in the context of individual growth and development, and
(d) study mother-daughter interaction in the context of such family characteristics as developmental stage, structure, and function,
Combining quantitative and qualitative research methods can aid contextual representation of phenomena, in this case mother -adolescent daughter interaction over the menstrual cycle, Jick (1983) proposes that triangulation captures
a more complete, holistiC, and contextual portrayal of the (phenomena) under study .... Qualitative measures, in particular, can play an especially prominent role by eliciting data and suggesting conclusions to which other methods may be blind. (Therefore) elements of the context are illuminated. In this sense, triangulation may be used not only to examine the same phenomenon from multiple perspectives, but also to enrich our understanding by allowing for new or deeper dimensions to emerge. (p. 138)
In this study, theoretical and methodological triangulation has been used in an attempt to illuminate the interdependence of mother-daughter interaction and mothers' and daughters' perimenstrual experiences. CHAPTER III
DESIGN AND METHODOLOGY
In this chapter research design, methodology, and data analysis are described.
The chapter begins with a detailed account of the study procedure.
Procedure
The review committee for Research with Human Subjects Institutional Review
Board, University of Utah, approved this research project March 22, 1993, with yearly reapproval. During April written permission for use and duplication of family measures was obtained and diaries were printed. Advertising began in May 1993 and the first mother-daughter pair was enrolled the following July. Data collection continued over a period of 18 months until January 1995. During that time, interested women were initially contacted and screened by telephone. Once inclusion criteria were established, home interviews were arranged at the convenience of each mother-daughter pair.
At the initial interview, the study was explained in detail and questions were answered. Confidentiality and anonymity of study results were assured: individual names were purposely omitted from diaries and any other identifying information (e.g., background information packets). Informed consent was obtained from mothers for themselves and their daughters and informed assent was obtained from the daughters. 47
Mother-daughter pairs received detailed instructions on the use of the diary, basal body
temperature charting, and completion of paper-and-pencil background measures.] Each
mother and daughter received an electronic thermometer with a digital temperature
readout and memory. The use of the thermometer was demonstrated and participants
returned the demonstration.
Mothers and daughters were instructed to begin the diary portion of data
collection the following day and to continue diarying until both mother and daughter
completed a full menstrual cycle--from the 1st day of bleeding of one cycle to the 1 st day
of bleeding of the next cycle. Then, participants were given an opportunity to talk about their relationship2 and complete their background information packets. During the time that participants diaried, periodic telephone calls were made to each mother and
daughter to note progress and to answer questions or concerns. When diaries were completed, a tina] interview was conducted and diaries were collected. During the final
interview, moms and daughters were given a chance to debrief and to discuss their expenence.
ISee Appendix A for a copy of the consent-assent form. Appendix B for background information packets, and Appendix C for sample diary with \,ntten instructions.
:!Intefyiew data were not utilized in answering the research questions for this study. These data will be analyzed and reported elsewhere. 48
Triangulation and View of Phenomena
Triangulation is the purposeful blending of different methodological approaches.
Since qualitative and quantitative research methods produce different kinds of knowledge, combining approaches contributes to the discovery of unique information.
Whereas, qualitative research is used to describe processes, quantitative methods provide outcome data or statistics on the representativeness of the sample studied (Hinds and
Young, 1987). Both correct, clarify, expand, and stimulate each other and in combined form "triangulate unto truth" (Cook & Reichardt, 1979, p. 21 as cited by Hinds &
Young). Hence, the purpose of using both quantitative and qualitative methods is to generate a rich and comprehensive picture of the studied phenomena (Patton, 1987).
One assumption underlying triangulation is that the weaknesses in a single method will be compensated by the counter-balancing strengths of another (Jick, 1983).
Furthermore, some unique variance which otherwise may have been neglected by a single method may be uncovered. For example,
... qualitative methods, in particular, can play an especially prominent role by eliciting data and suggesting conclusions to which other methods would be blind. Elements of the context are illuminated. In this sense, triangulation may be used not only to examine the same phenomenon from multiple perspectives but also to enrich our understanding by allowing for new or deeper dimensions to emerge. (Jick, 1983, p. 138)
Correspondingly, quantitative instruments can be used to verify data collected during observations or interviews. In sum, by blending quantitative and qualitative methods, a more complete and expanded understanding and contextual representation of the phenomenon under study can emerge (Duffy, 1987; Jick, 1983; Miles & Huberman,
1984). 49
Qualitative research is oriented toward exploration, discovery, and inductive
logic. It provides an in-depth and detailed study of phenomena; usually, a wealth of
information about a small number of people is collected and analyzed. As data collection
and analysis progress, patterns emerge reflective of the world as viewed by the study
participants. The purpose of qualitative research is understanding of this perceived view.
In contrast, the purpose of quantitative research is objective verification of broad,
generalizable findings. Quantitative methods are used to measure the response of a great
number of subjects to limited questions, thus facilitating comparison and statistical
aggregation of data.
Design
An exploratory-descriptive research design, triangulating qualitative and
quantitative methods, was chosen to answer the research questions posed in this study. A
qualitative approach to data collection was selected (a) to describe mothers' and daughters' peri menstrual experiences and (b) to elicit their perceived view of their relationship over the menstrual cycle. In-depth information from a small sample of mother-daughter dyads was collected and analyzed. To capture dyadic characteristics a visual display of perceptions was used to analyze data. In addition, quantitative measures were used (a) to collect demographic and background data for comparison between the different mother-daughter dyads and (b) to support conclusions regarding the mother-daughter relationship. 50
Specific Aims
As cited earlier, the purpose of this research was to describe mothers' and daughters' biopsychosocial changes and their perceptions of interaction over the
menstrual cycle. The foHowing aims were developed to achieve the study purpose:
1. to identify menstrual timing and the degree of menstrual synchrony between mothers and their biologic, adolescent daughters;
2. to describe the similarities and the differences between perimenstrual symptoms reported by mothers and those symptoms reported by their daughters during the menstrual, periovulatory, and premenstrual phases of the menstrual cycle; and
3. to compare mothers' and daughters' perception of their interaction during the menstrual, periovulatory, and premenstrual phases of the menstrual cycle.
Methodology
Selection Criteria and Sampling Procedure
Purposeful sampling was used. "The power of purposeful sampling lies in selecting information-rich cases for study in depthll (Patton, 1987, p. 51). To locate information-rich informants, volunteers were solicited through advertisements in
Network, a local newspaper with a large female readership, and The Green Street, a diversified suburban newspaper that reached the most populous areas of the Salt Lake metropolitan area. In addition, display ads were posted at several local businesses with a large female employee base (i. e., two hospitals and one factory) or patronage (i. e., three specialty bookstores and one woman-oriented exercise club). Snowball or chain 51 sampling then occurred through word of mouth. A homogenous sample was recruited from volunteers that met inclusion criteria:
1. Biological mother-adolescent daughter dyads lived in the same household
2. Both mothers and daughters had a history of regular menstrual cycles
(every 22 to 40 days)~ and daughters had a gynecological age of at least 1 year.
3. Neither member of the dyad used hormonal forms of contraception or other reproductive hormones.
4. Mother-daughter pairs spoke and wrote English.
Data Collection Methods
Menstrual timing, perimenstrual symptoms, and perception of mother-daughter interaction were the major variables investigated in this study. Because stress and family characteristics have been correlated with perimenstrual symptoms and interpersonal interaction, these variables were investigated also. Variables are defined in Chapter 1.
Data Collection
A questionnaire specifically designed for this study was used to collect social-demographic information and menstrual history (see Appendix B). Mothers and daughters answered questions related to (a) age; (b) household structure (size and configuration); (c) annual income (mothers only); (d) education (current level of education for daughters and completed level of education for mothers); (e) employment status (outside of the home); and (f) menstrual characteristics (age at menarche, usual length and duration of menstrual cycle, noticeable symptoms or problems associated with 52 menstruation, last menstrual period). In addition, ethnicity was observed and a I-item
Likert scale was used to measure overall satisfaction with life.
Perceptions of interaction and communication were collected using two methods.
Baseline data regarding family communication patterns, specifically parent-adolescent communication, were collected at the initial visit Both mothers and daughters conlpleted the Barnes & Olson Parent-Adolescent Communication Scale (© 1992), parent and adolescent versions respectively. Participants assessed interaction daily using visual analog scales for the communication dimensions of conflict, affection, and closeness. In addition, baseline information regarding family satisfaction and family cohesion! adaptability were gathered at the time of enrollment
To obtain data regarding menstruation and perimenstrual symptomatology, mothers and daughters charted prospectively using a diary format similar to that used by
Woods and her associates (see Woods et aI., 1989, 1992). Menstrual cycle phases were determined by menstrual bleeding and ovulatory function. Based on Sommer's recommendations (1991), menstrual phases were operationalized as follows: ( a) the first day of bleeding was considered day 1 of the menstrual cycle; (b) the menstrual phase was defined as cycle days 3 to 5; (c) the periovulatory phase as day of ovulation + or - 1 day;
(d) and the premenstrual phase as days -5 to -3 ( 3 to 5 days prior to the onset of menstruation). Ovulation was determined by phasic changes in BBT. If ovulation could not be determined by BBT readings, than the periovulatory phase was defined as midcycle days -1 5 to -13. 53
Instruments
Family Characteristics
Family communication was assessed using the parent and adolescent forms of the
Barnes & Olson Parent-Adolescent Communication Scale (©] 992). This form was developed for the purpose of exploring positive and negative communication patterns between parents and adolescents. Different yet similar forms are used to retrieve subjective information from parents and adolescents. High reliability and validity of this instrument have been reported (Olson et aI., ] 985, ] 989). Measures of family satisfaction and family characteristics were obtained through the use of Olson & Wilson Family
Satisfaction Scale (© ]982) and FACES II: Family Version (© 199]) respectively. High reliability and validity have been reported for these tools, too (Olson et aI., 1985, ] 989).
Basal Body Temperature
Each mother and daughter received a ®B-D Digital Fever Thermometer. The
®B-D Digital Fever Thermometer is
an electronic temperature measurement device utilizing a liquid crystal display (LCD) to indicate the temperature reading ... ,[It) is a predictive thermometer that has been calibrated to give results consistent with a glass thermometer read at 3 minutes. (Becton-Dickinson, 1993)
Participants were instructed to take and record an oral temperature every day:
(a) temperatures were to be taken upon awakening in the morning and prior to getting out ofbed~ (b) the BBT reading was to be recorded in the diary in the space provided for that day~ and (c) because the thermometer had a memory, the temperature could be 54
recorded at the time it was taken or later in the day. Use of the electronic thermometer
was demonstrated and participants returned demonstration.
Diary
The diary method has been used successfully in estimating perimenstrual distress
(Mitchell et aI., 1994~ Woods et aI., 1989, 1992~ Woods, Most et aI., 1982) and in
assessing marital relationships (KirchIer, 1989). Using a diary format allows for prospective data collection and eliminates the problems associated with recall. Memory
and selective recall are biased by cultural expectations and current attitudes about the phenomena being investigated (McFarland, Ross, & DeCourville, 1989~ Richardson,
1990). In addition, a woman's recall of past peri menstrual experiences may be influenced by current cycle phase. For example, McFarland and associates (1989) found that
"women who were menstruating were more likely than those who were not to exaggerate retrospectively the positivity of their intermenstrual emotional state" (p. 529).
Similarly, many women who present with PMS exaggerate their premenstrual experience on recall. With prospective charting, these women tend to report fewer and less intense perimenstrual symptoms (Endicott & Halbreich, 1982~ Severino & Moline, 1990;
Woods, Most et aI., 1982).
Use of a diary format has other advantages: daily recordings support both individual and pair analysis (Woods et at, 1992) and facilitate pattern recognition. For this research project, the dynamic nature of the variables studied (perimenstrual symptoms and perception of interaction) and the dyadic focus of analysis (i.e., the mother-daughter pair as the unit of analysis) required a data collection method that 55
facilitated recognition of patterns over time and analysis of paired data. The diary
method met these criteria.
Each participant received an 8 Y2 in. x 11 in. bound diary that was constructed specifically for this study. Visual analog scales (V AS) and questions were individualized to reflect mother or daughter input regarding interaction with one another. (Sample diary days for mothers and daughters are located in Appendix C.) Diaries were color-coded (a) to differentiate between those issued to mothers and those issued to daughters and (b) to mark the end of one day and the beginning of the next. Mothers received a blue bound diary with alternating days indicated by grey or blue sheets, and daughters received a purple bound diary with alternating days indicated by fushcia and purple sheets.
Instructions were included with the diary (see Appendix C).
Participants were asked to complete the diaries (a) by themselves and (b) at about the same time every day to establish an approximate 24-hour interval between entries. Mothers and daughters logged BBT readings and recorded information about their bleeding patterns, perimenstrual changes, and personal perceptions of their relationship with one another. A list of possible perimenstrual changes was provided.
These changes included negative, neutral, and positive descriptors reported by women over the menstrual cycle. In the oral instructions, participants were given permission to use other terms or their own words to describe their experience. A space for anecdotal comments was provided also.
Mothers and daughters recorded five physical, emotional, and behavioral symptoms or sensations experienced daily. In addition, both mothers and daughters 56
included up to five adjectives describing themselves that day in their diaries. Because the
logged adjectives were similar to the perimenstrual symptoms listed in the literature, the
mother's and daughter's recorded symptoms and adjectives were combined prior to
analysis.
Visual Analog Scale
The VAS is a reliable, valid, and sensitive self-report device for studying subjective experiences and for following change in subjective phenomenon over time
(Folstein & Luria, 1973). In nursing, the VAS has been used extensively to measure subjective sensations, such as mood, fatigue, nausea, and pain. It has been used also to compare severity of perimenstrual symptoms over the menstrual cycle (Caspar & Powell,
1986; Rubinow et aI., 1986; Walker, 1994) and cigarette craving over time (Wewers,
Rachfal, & Ahijevych, 1990).
The V AS is a 100 mm straight line with anchors at each end to indicate the extremes of the sensation under study. Although vertical and horizontal visual analog scales have been shown to be equally valid measures, the vertical scale is more sensitive, produces higher scores, and is easier for subjects to use (Gift, 1989). When compared to graphic and Likert scales, the V AS has been found to be a more sensitive measure of subjective ratings (Gift~ Wewers et aI., 1990). On the other hand, sensitivity is reduced if gradations are used on the vertical VAS (Gift).
Both validity and reliability have been demonstrated (Caspar & Powell, 1986;
Gift, 1989; Lee & Kieckhefer, 1990; Wewers et aI., 1989). Validity has been established through criterion, content, and construct validity assessments in studies of (a) pain, 57
(b) mood and physical symptoms associated with the menstrual cycle, and (c) cigarette craving. Similarly, equivalence and test-retest reliability for the VAS have been reported in studies of the same concepts (Caspar & Powell~ Gift; Lee & Kieckhefer; Wewers et al.). Conversely, "internal consistency has seldom been documented because of the tendency to use only one bipolar scale (per variable)" (Lee & Kieckhefer, p. 131); multiple bipolar scales measuring a single concept are necessary to establish internal consistency.
For this study, conflict, affection, closeness, and daily hassles each were measured using a 100 mm vertical VAS. To prevent external1y constrained responses
(Lee & Kieckhefer, 1989), end anchors were bipolar antonyms representing the entire range of sensations related to each variable under study (see Appendix C). Research participants were asked to mark a point on the scale that corresponded to the amount of sensation (i. e., conflict, closeness, affection) experienced at the time. Verbal and written instructions for visual analog scales were given to each participant at the time of enrollment.
Data Analysis
Family and Social-Demographic Characteristics
Descriptive statistics were utilized to analyze social-demographic variables (e. g., age, household, education, and menstrual characteristics (see Appendix B). A I-item
Likert scale was used to measure overall satisfaction with life. A Mann-Whitney U test was calculated to detennine if mothers and daughters differed significantly in their ranking of life satisfaction. 58
Menstrual Synchrony
From the menstrual record portion of the diary, menstrual onset dates for mothers and their daughters were determined. Presence of synchrony was determined by calculating the difference in number of days between mothers' and their daughters' onset of menses (or bleeding). First day of bleeding (versus spotting) was used as day one of the menstrual cycle or the onset of menses. Cycles were considered synchronous if the difference between a mother's and her daughter's menstruation onset date was 5 or fewer days.
Perimenstrual Symptoms
Similarities and differences between menstrual experiences were determined by comparing reported perimenstrual changes or symptoms during the menstrual, periovulatory, and premenstrual phases of the menstrual cycle. Prior to mother-daughter comparison, participants' perimenstrual symptoms and self-descriptive adjectives were identified for each phase. When participants recorded more than one premenstrual, postmenstrual, or periovulatory phase~ descriptors for all phases were used. Then, descriptors were grouped based on menstrual phase~ and similar adjectives were dropped or combined. Terminology was not changed. For example, if a participant used the terms anger, angry, and mad over one phase, it was listed as one descriptor: angry; mad. After being grouped, the perimenstrual symptoms of each mother-daughter pair were content analyzed for phase-specific similarities and differences. Grouping of like adjectives and content analysis of phase-specific similarities and differences were confirmed independently by a non-nursing graduate student and by two nursing colleagues. 59
Perceptions of Interaction and Daily Hassles
To evaluate mother-daughter interaction at different times of the menstrual cycle, mothers' premenstrual, menstrual, and periovulatory phases were set as the days for comparison of mothers' and daughters' perceptions of interaction. Prior to comparison, mothers' and daughters' perceptions of closeness, affect, conflict, and daily hassles were identified for each menstrual phase. Intensity of sensation was scored by measuring the distance (in nun) from the low end of the scale to the marked point. For consistency of rating, the length of each scale was verified at 100 nun prior to distribution and again at time of analysis. Employing ®Omniscan SE and the ®A VEC 2400 Colour scanner, visual analog scales were scanned into an IBM compatible personal computer. Then, using ®Corel Draw 5, precise measurement of the variable was accomplished with computerized gridlines and a 100 mm ruler. If the participant used a cross to mark the
VAS, the juncture of the two lines was used as the magnitude of the response.
Cycle phase response was determined by averaging individual VAS scores; data were averaged over 3 days of each phase to increase representativeness of cycle phase variability and to decrease reflection of daily changes in interaction. Mother and daughter mean scores for each cycle phase were plotted (see Appendix D). Then, graphs were analyzed for recognizable intrapair and between pair patterns. Patterns were confirmed independently by a non-nursing graduate student and by two nursing colleagues.
Menstrual cycle phases were determined as outlined in Chapter 1. An exception was made for pair 5. Daughter 5 charted for two cycles but missed using the visual analog scales during her mother's premenstrual days -3 to -5. This daughter did have 60 visual analog data for day -7 of mom's cycle. When compared to other mother-daughter pairs, daughter 5 was most like the other daughters who had completed one or more cycles of charting. Therefore, a decision was made to use day -7 as representative of the premenstrual phase for this dyad. CHAPTER IV
PRESENTATION AND DISCUSSION OF THE FINDINGS
In this chapter, the analysis of data from 12 mother-daughter pairs is presented.
The chapter is divided into four sections. In the first section, demographic information about the study participants is described. In the remaining three sections, the research questions, as outlined in Chapter I, are addressed.
Sample Characteristics
During the period of data collection, 14 dyads qualified for enrollment. Two pairs dropped out of the study because of time constraints. The remaining 12 pairs represented
10 different families.
% Mother-daughter pairs were predominantly white (90 ) with half reporting an annual family income over $35,000. For the most part, mothers were well educated
(900/0 had completed a college degree or had some college education) and currently married (800/0). Only 1 mother was a full-time homemaker; 7 (70%) worked outside the home; and another 2 (200/0) were full-time students. Mean age was 40.1 years for mothers and 14.8 years for daughters. Social-demographic characteristics are summarized in Table 1. 62
Table 1
Social-Demographic Characteristics of Sample (n = 10 Families)
Characteristic n Percent
Household type Traditional 7 70 Blended 1 ]0 Single Parent 2 20
Annual family income $51-99,000 3 30 $35-50,000 2 20 $20-34,000 4 40 $10-19,000 1 10
Ethnicity Caucasian 9 90 J apanese-American 1 10
Mothers' employment status Full-time outside the home 3 30 Part -time outside the home 4 40 Full-time homemaker 10 Full-time student 2 20
Mothers' completed educational status Co]]ege graduate 6 60 Some col1ege 3 30 High school graduate 10
Daughters' current educational enrollment a ]2th grade 1 8,33 11 th grade 2 16,67 10th grade 4 33,33 9th grade 3 25,00 8th grade 2 16,67 an = 12 daughters 63
Although a greater percentage of daughters (580/0) reported mixed or lower satisfaction with life, as measured by a I-item Likert scale, than their mothers (30%), the difference was not statistically significant (U=52, 12 > .05) (see Table 2). Likewise, mothers and daughters reported similar levels of family satisfaction on the Olson &
Wilson Family Satisfaction scale. Conversely, mothers and daughters differed in their perceptions offamily communication and family cohesion! adaptability, as measured by
Barnes & Olson Parent-Adolescent Communication and FACES II respectively. Study sample means and national sample means are compared in Figure 2. (See, also, Appendix
D for more details.)
Table 2
Satisfaction With Life
Mothers Daughters Degree of Satisfaction (n = 10) (n 12) n Percent n Percent
Delighted Pleased 2 20 3 25 Mostly satisfied 5 50 2 17 Mixed8 3 30 6 50 Mostly dissatisfied 1 8 Unhappy Terrible
8 equally satisfied!dissatisfied Parent-Adolescent Communication Family sat1sfacffon FACESII: Cohesion FACESII: Adaptability (pculble score 20-100) (possible score 14-70) (possible score 16-80) (possible score 14-70) national sanple study sample national sanple study semple naHonal sanple study semple national sample study sample 80.4
66.6 64.8 64.9 64.6
56.3 53.6 47 49.9 49.7 45 45,4 _ 46.3 42.9 41.3
M ~ M A p A M D p A M D p A M D
M Mo1hers A ::;: Adolescents P = Parents 0 = Da.V'lters
a "'" adolescents re: their mathen;
Figure 2~Comparison of sample means with national norms on selected family characteristics
~ 65
Research Question 1: Menstrual Synchrony
What is the timing (in relation to one another) of mothers' and daughters' menstrual cycle?
During the study, participants recorded 15 cycles in their diaries. Three cycles
(20%)--Mother-Daughter Pairs 4, 9, and 12--were synchronous. Based on recall ofLMP at the time of enrollment in the study, another 3 out of 12 cycles (25%)--pairs 1, 6, and
10--were synchronous. (A graph of mother-daughter timing of menstrual onset is located in Appendix E.) When recall and prospective cycle data were combined, 6 out of 27 cycles were synchronous (22%) with half of the mother-daughter pairs experiencing menstrual synchrony within a 2- month period. Of interest is that no mother-daughter pair experienced two consecutive synchronous cycles.
Bleeding and Ovulatory Patterns
Menstrual cycle variability was noted between menstrual data obtained (recalled) during the first interview and actual characteristics recorded in menstrual diary. For example, menstrual cycle length based on recall varied from actual (or prospectively recorded) length for both mothers and daughters. Mothers recalled menstrual cycles averaging 26.9 days (median and mode of26) with actual lengths averaging 26.7 days
(median of 26.3 and mode of 29). Mean cycle lengths reported by daughters were 29.3 days (median and mode of 30) and recorded lengths averaged 28.1 days (median of 28, mode of 22). For both recalled and actual cycles, 10 out of 12 daughters had menstrual cycle lengths longer than their mothers; the reverse was true for the 2 remaining daughters. A summary of menstrual cycle characteristics is located in Table 3. 66
Table 3
Comparison of Mothers' and Daughters' Age and Menstrual Cycle Characteristics
Age and Menstrual Characteristics Mothers Daughters (n=10) (n=12)
M SD Range ~ SD Range
Age 40.1 2.64 37-46 14.8 1.25 13-17
Age at menarche 13.1 1.17 11-15 12 0.41 9-13
Cycle characteristics Reported lengtha 26.9 1.69 25-30 29.3 3.98 21-35 Actuallengthb 26.7 3.2 22.5-33 28.1 4.71 22-35 Reported bleeding daysc 4.35 0.88 3-6 5.25 0.31 3-6.5
Perimenstrual symptomsd Menstrual 20.7 5.4 13-30 11 5.78 2-21 Periovulatory 15.1 3.82 10-22 13.5 5.04 6-23 Premenstrual 21.5 8.0 9-35 10.8 4.02 6-20
Number of similar symptoms Menstrual 3.55 2.50 1-8 Peri ovulatory 4.13 1.81 1-6 Premenstrual 3.75 2.14 2-8
a- When participants reported range in cycle length. the average was used for calculations. b- When two or more cycles were recorded. the average was used for calculations. c- When range was reported. the average was used for calculations. d- Number of different S)IDptoms reported over a 3 day period. 67
Nine out of the 10 mothers enrol1ed in this study had biphasic temperature changes typical of ovulation. The temperature pattern of the 10th mom suggested a biphasic pattern, but missing temperature recordings made definitive determination difficult. Four out of 12 daughters also had biphasic temperature changes indicative of ovulation. However, the remaining daughters had irregular temperature recordings making assessment of ovulation based on basal body temperature impossible.
Research Question 2: Comparison of Mother-Daughter
Perimenstrua1 Symptoms
What are the similarities and the differences between peri menstrual symptoms reported by mothers and those symptoms reported by their daughters?
Ten mothers and 12 daughters recorded perimenstrua1 changes over the menstrual cycle. Most mothers reported more symptoms and sensations at each phase of the menstrual cycle than their daughters. The difference was notable during the premenstrua] and menstrual phases when mean number of symptoms reported by mothers was almost double daughters' reported mean. Of particular interest is that mothers and daughters reported few similar phase-specific symptoms. (See Table 3 for a summary of reported perimenstrual symptoms and Appendix F for a list comparing specific cycle-phase descriptors used by mothers and daughters.) Furthermore, it was not uncommon for mothers and daughters to report contrary or conflicting symptoms during the same phase, and sometimes, during the same day. For example, mother 5 reported feeling both "tired" and "energetic" with the onset of menstruation, whereas daughter 5 68 recorded feeling "happy" and "sad" on day one of her cycle. This same pair consistently reported conflicting symptoms at each phase of the menstrual cycle (see Table 4).
As a group, mothers reported the highest level of turmoil and feeling-on-top-of- the-world during the menstrual phase, while daughters noted the highest level of these symptoms during the periovulatory phase or midcycle. On the average, mothers listed more pain and physical sensations, binge and bulge symptoms, and sleep disruptions then daughters did during all three phases. Conversely, daughters reported more hermit-like behavior than mothers did during the menstrual phase.
Table 4
Conflicting Perimenstrual Symptoms Reported on Different Days of Menstrual Cycle
Ovulation Pair 5 Days 3 to 5 + or - 1 Day Days -5 to -3
Mother .[ excited; anxious; .[ irritable; stretched~ .[ angry; impatient; hurried; stressed foggy-scattered; distracted .[ calm~ confident~ .[ productive; .[ happy; friendly pleasant satisfied; happy sociable; focused
Daughter .[ happy; thrilled~ .[ happy; pleased; .[ happy excited delighted; free .[ anger; mad; .[ frantic; sad; not .[ disappointment; disappointed feeling understood misunderstood; annoyed; sad 69
Research Question 3: Interaction Over the Menstrual Cycle
How do perceptions of mother-daughter interaction vary over the menstrual cycle for the mother and for the daughter?
Eight of the 12 daughters enrolled (from pairs 3, 4, 5, 6, 7, 8, 9, and 11) had
comparison data for all three phases of the menstrual cycle. The remaining 4 daughters
had incomplete or insufficient information. Three daughters (from pairs 1, 2, and 10) had
data for two phases, the menstrual and periovulatory phases. The fourth daughter (from
pair 12) had information for the premenstrual phase only; this daughter noted her
bleeding pattern over 24 days but completed charting for only 8 days. In contrast,
mothers had data for all phases.
Differences in Complete and Incomplete Pairs
Some distinct differences were noted between the mother-daughter pairs that
reported data for all three phases (designated as complete pairs) and those that did not
(incomplete pairs). First of all, daughters 1, 2, and 10 stopped charting sometime during
their mother's luteal phase and daughter 12 stopped during her mother's follicular phase.
When data were combined, these daughtersl perceived that their mothers expressed less
affection towards them during the menstrual and periovulatory phases than the daughters
who continued to chart ( 3, 4, 5, 6, 7, 9, and] 1). Similarly, mothers of incomplete pairs
reported less closeness and more conflict in the mother-daughter relationship and
perceived that their daughters expressed less affection towards them during this same
IDaughter 12 had no data oyer the menstrual and perio,ulatory phases: therefore pair 12 was omitted from the analysis in Figure 2. 70 time period (see Figure 3) and over the entire cycle than the mothers of complete pairs
(see Figure 4). In addition, mothers 1,2, 10, and 12 indicated more hassles in their life at all phases of the menstrual cycle.
Second, when individual scores were assessed, mothers 1 and 2 reported conflict that increased over the entire cycle, with the highest level noted during the premenstrual phase, It was during this latter time period that daughters 1 and 2 had stopped charting,
Similarly, mother 12 reported increasing conflict between the menstrual and peri ovulatory phases or the time period her daughter stopped charting. Although mother-daughter Pair 10 noted little to no conflict in their relationship (rating of 0-1 for mother and 0-6 for daughter on a 100 nun VAS), this daughter perceived a significant decrease in affection (from 38 to 6) from her mother just prior to the time that she stopped recording data. (V AS raw scores are located in Table 5,)
Lastly, anecdotes relating to the negative nature of the mother-daughter relationship were made from mother 1 and daughter 12 at the exit interview. Pair 1 mother remarked that it was "difficult to look at the relationship with her daughter (every day J when not doing well," Likewise, daughter 10 remarked that she "hated to chart ... hated thinking about the answers." Conversely at the exit interview, mothers and daughters from the complete pairs made positive remarks about the mother-daughter relationship or the benefits of diarying. On the other hand, when dyadic discrepancy and mother-daughter mean scores related to family characteristics were compared for complete and incomplete pairs, little difference was seen. (Comparison graphs for dyadic measures offamily adaptability/ cohesion using FACES II can be found in Appendix D.) Comparison of Grouped Means Complete & Incomplete Pairs
r-
+- ~ -~ -t-Lu'""-----j conflict affection hassles
mothers--complete pairs _ daughters--complete pairs mothers--incomplete pairs II daughters--incomplete pairs
Figure 3: Comparison of mothers and daughters who did and did not complete data collection over all three cycle phases -..J Comparison of Mothers' Mean VAS for Complete and Incomplete Pairs
80 -,------"-
60 a - Q)
EQ) 40
~o 20
o ---I._---!- __ L closeness conflict affection hassles
r---___.=-_------_- ....------ill I[J Complete pairs (n=8) [] Incomplete pairs (n=4)
...... Figure 4: Comparison of mothers' mean V AS from pairs with and without complete data over all three cycle phases N 73
Table 5
Mothers and Daughters Raw VAS Scores Mother Scores Daughter Scores Men a Ovb Prec Mena Ovb Pre c
Extremely close to extrenlely distant (100 mm to 0 mnl) Pair 1d 42 67 68 52 74 Pair 2d 56 25 49 81 77 Pair 3 81 84 73 85 90 76 Pair 4 74 59 79 89 54 90 Pair 5 53 66 83 43 30 63 Pair 6 76 56 95 58 8 82 Pair 7 79 75 87 33 40 47 Pair 8 75 82 75 75 82 68 Pair 9 96 59 66 85 83 44 Pair 10d 37 78 78 56 27 Pair 11 58 63 87 60 43 Pair 12d 61 51 69 77
Lots of conflict to no conflict (100 rnm to 0 mm) Pair 1d 29 32 38 25 17 Pair 2d 17 34 46 35 32 Pair 3 12 7 69 15 49 48 Pair 4 2 37 3 8 36 4 Pair 5 15 13 30 14 27 85 Pair 6 4 0 6 25 5 14 Pair 7 1 1 7 4 50 15 32 Pair 8 29 16 24 35 33 75 Pair 9 32 31 17 82 Pair 10d 0 6
Pair 11 90 21 49 27 Pair 12d 49 68 49 42 74
Table 5 continued I\f1other Scores Daughter Scores Men a Ovb Pre C Mena (Arb Prec
Expressed affection constantly to never (1 OOmm to Omm) Pair 1d 16 50 46 79 39 Pair 2d 29 45 36 52 70 Pair 3 74 72 65 68 78 50 Pair 4 61 13 75 79 65 91 Pair 5 49 50 58 29 46 47 Pair 6 69 56 68 51 44 76
Pair 7 16 12 12 6 3 4 Pair 8 61 74 74 55 49 50 Pair 9 88 81 86 81 92 51 Pair 10d 87 84 97 38 6 Pair 1 1 94 44 97 74 52 25 Pair 12d 6'3 49 63 77 Lots of hassles to no hassles (100 mm to 0 mm)
Pair 1d 30 76 46 13 17 Pair 2d 74 75 57 59 50 Pair 3 23 21 80 27 41 76
Pair 4 48 62 20 46 60 72 Pair 5 51 26 15 14 41 31 Pair 6 16 97 5 22 10 19 Pair 7 42 82 61 22 55 53
Pair 8 40 43 26 56 68 39 Pair 9 72 66 44 32 42 67 Pair lOd 72 66 44 69 19 Pair II 72 66 44 32 34 75 Pair I2d 52 50 48 40 a= Menstrual phase days +3 to + 5 h= Periovulatorv phase ovulation day + or - I day (days -13 to -15) c = Premenstrual phase days -3 to -5 - .. d= Designated in the text as incomplete pairs 75
Patterned Interaction Over the Menstrual Cycle
When mother-daughter data were analyzed over the menstrual cycle for complete pairs, individual dyadic patterns of interaction emerged for perceived closeness, conflict, and affection. The direction and magnitude of changes were unique to each dyad; that is, there was no one pattern of mother-daughter interaction over the menstrual cycle.
Conversely, a more random interaction between mothers and daughters was seen with hassles. Thus, as expected, hassles seems to be more an individual characteristic than a dyadic one (see Figures 5-8 for paired interaction over the menstrual cycle).
When complete pairs were divided into synchronous and asynchronous pairs, no distinguishing patterns of interaction for individual dyads emerged between the groups.
On the otherhand, when data were grouped statistically synchronous mother-daughter pairs reported lower levels of conflict and higher levels of closeness and affection when compared with the asynchronous pairs (see Figure 9). Comparison graphs for synchronous and asynchronous pairs are located in Appendix H.
Summary of Findings
In summary, based on the analysis of data collected from mother-daughter pairs in this study, the following conclusions were drawn:
1. The phenomenon of menstrual synchrony between mothers and daughters was inconsistent.
2. Menstrual cycle length varied between mothers and daughters and in the same woman from month to month. Closeness -- Complete Pairs VAS Scores
Q) pair 3 pair 4 pair 5 pair 6 pair 7 pairS pair 9 pairll ~ 100 13 ~ • Q) 80 .1Il E .j .~ \. ~ '\ ~ 60 .....o
~..... 40 uC/) z
~Q) 20 E ~ x 0 -+-f-+ W mov p m~p m~p m~p m~p m~p m~p m~p Cycle Phase r-,------:1 1___ --- mothers -R-- daughters I m=menstruaJ ov=periovulatory p=premenstruaJ
-J Figure 5: Paired interaction over the menstrual cyc1e for c10seness (J\ Conflict -- Complete Pairs VAS Scores pair 3 pair 4 pair 5 pair 6 pair 7 pair 8 pair 9 pair II
1 00 -.------.,-----~--~~--~-
~ ;:;:: § 80 o '0 2 60 o
.....o .2 40 ;:;:: c o o 20 zo o m~p m~p m~p m~p m~p m~p m~p m~p Cycle Phase I ------, 1----mothers --R daughters m=menstrual ov=periovulatory p=premenstrual
-l Figure 6: Paired interaction over the menstrual cycle for conflict -l Affection -- Complete Pairs VAS Scores pair 3 pair 4 pair 5 pair 6 pair 7 pair 8 pair 9 pair II c 100 .~.~...... o -- U ~ co 80 "C Q) ,.. (I) en Q) j C. 60 ,. x Q) ~ • ,Ii ~-E '-Q) K 1:C) 40 :::J co "C 1:: ~ 20 (5 • E ... >- ~ 0 Lt-+-f-+· +.. -+-~--+ +.+-l t---t·+-+--+····t- -+---f--1----I--#-l-.--+---l---f---I--+--f--1 m ov p m ov p m ov p m ov p m ov p m ov p m ov p m ov p [----'·'--'·----·-1Cycle Phase --11-- mothers --R-- daughters
m=rnenstrual ov=periovuJatory p=premenstrual
-....J Figure 7: Paired interaction over the menstrual cycle for affection 00 Hassles -- Complete Pairs VAS Scores pair 3 pair 4 pairS pair 6 pair 7 pairS pair 9 pair 11 100
en CD Ci) en 80 l'U ..c ,. •
-~ 60 ...... Q 0 !i' ..... d\ 1r~ en 40 .~\<. CD \~\. Ci) 1 en ttl J ..c 20 z0 o 1+-1-+_++-1-f--+-++-+- t----\--++ movp movp movp movp movp movp movp movp Cycle Phase
1---mothers ---K- daughters]
m=menstrual ov==periovulatory p=premenstruaJ
Figure 8: Paired data over the menstrual cycle for hassles ...... :a\0 Mean Score Comparison for Mothers (M) & Daughters (D)
closeness conflict affection hassles 80 ..---- en 1 [--I--- Q.) r- f -- f-- 060o en t--- en 40 ~ c:: co 20 r_r-- Q.) ~ o +_LLLt-L1y- M 0 M 0 M 0 M D
I0 synchronous L':'-Iasynchrono~sl
00 Figure 9: Comparison of mothers and daughters who did and did not have synchronous menstrual cycles o 81
3. Peri menstrual symptoms or sensations were experienced by both mothers and daughters with mothers reporting significantly more symptoms during the premenstrual and menstrual phases. Mothers and daughters reported few similar cycle-phase specific symptoms,
4. Mothers' and daughters' patterned interactions over the cycle were individual to the dyad rather than phase-dependent. These patterned interactions were noticeable for perceptions of closeness, conflict, and affection,
S, No noticeable pattern emerged between hassles and the dyadic characteristics of closeness, conflict, and affection,
6. When data were grouped together, differences in perceptions of closeness, conflict and affection between complete and incomplete pairs and between synchronous and asynchronous pairs were found, CHAPTER V
DISCUSSION
Chapter V begins with an overview of the study purpose. Afterwards, a discussion of conclusions drawn from this study is followed by the identification of the study's methodological limitations. The implications for nursing practice and future research are then examined.
Overview of Study Purpose
Currently, information on the interdependence between biopsychosocial changes associated with the menstrual cycle and mother-daughter interaction is limited. Prior to beginning this research project, the majority of information correlating mothers' and daughters' menstrua] experiences was based on retrospective recall, not prospective charting. Although anecdotal reports and research findings have suggested an interdependent relationship between perimenstrual symptoms and family characteristics, little research has been designed to include the family, or a family subsystem, as the unit of analysis. Up until now, researchers have utilized the view of one family member
(usually the woman or her spouse) to describe the impact of a woman's perimenstrual experience on the marital relationship or family functioning. Correspondingly, this research was designed to describe and compare mothers' and daughter's menstrual experiences related to menstrual onset, peri menstrual changes, and perceived 83 mother-daughter interaction. An attempt to capture the dynamic interdependence between family members was made by collecting prospective data over one menstrual cycle from both mothers and daughters and by using the dyad as the unit -of-observation and unit-of-analysis.
Criteria for Family Research
This research met some, but not all, criteria for family research (see F eetham,
1984). First, family was conceptually defined in terms of structure, function, and development~ the stage of family development (family with adolescent children) and the family subsystem that was observed (mother-daughter dyad) were operationally defined.
Second, the unit of observation and analysis was the dyad, which was consistent with the theoretical orientation of this study. Third, a theoretical model was developed to explain the interdependence of mother, menstruating biological daughter, and mother-daughter interaction. Inherent in the theoretical model was the importance of context to perceptions and interaction~ that is, the meaning and interpretation of family behavior and interaction (between and among family members) are filtered by individuals' psychosocial and sociocultural backgrounds. Therefore, the family system and the mother-daughter subsystem were recognized as the context in which mothers and daughters interpreted and placed meaning on their interaction with one another. In addition, perceptions of interaction were investigated as a means of exploring the interdependence between mother-daughter interaction and mothers' and daughters' perimenstrual experience. Last, and perhaps the most important criterion of family research--the potential to contribute knowledge about family functioning, family 84 structure, or family roles--was met by describing and exploring the mother-daughter relationship over the menstrual cycle. Missing from this research were two other criteria offamily research: (a) the examination of the impact of natural or man-made environment on family or subsystem functioning and development and (b) the exploration of the family or the mother-daughter subsystem as mediator between the individual and society (Anderson & Tomlinson, 1992 ~ F eetham, 1984; Gilliss, 1991).
Inclusion of these last two criteria was beyond the scope of this research project.
Criteria for Menstrual Cycle Research
In addition to satisfying many of the criteria for family research, this study met the following criteria necessary for rigorous menstrual cycle research
1. Similar to research on families, menstrual cycle research needs to be grounded in psychosocial or sociocultural context, more so, because menstruation is externally, as well as internally, regulated. Therefore, this study on the perimenstrual experience of mothers and daughters was framed within the context of mother-daughter interaction, developmental stage of the family, daily stress, and menstrual synchrony.
2. The interpretation of menstrual synchrony, mothers' and daughters' perimenstrual symptom expressions, and perceptions of interaction over the menstrual cycle was based on prospective, daily reporting of menstruation, BBT, symptoms, hassles, and individual perceptions of affection, closeness, and conflict experienced within mother-daughter interaction. 85
3. Cycle phase was defined based on Sommer's recommendations (1991).
Therefore, the menstrual, periovulatory, and perimenstrual phase definitions used in tills study are similar to those used by other menstrual cycle researchers.
4. Prospective documentation of ovulation allowed biological grounding of findings and description of menstrual phase based on an indirect indicator of progesterone hormone level.
S. Inclusion criteria for sample choice allowed for a homogenous selection of menstruating mothers and daughters with regular ovulatory cycles.
Discussion of Study Results-Chapter IV
Sample
Locating participants who met the inclusion criteria was difficult. Although several women inquired about the study, few mother-daughter pairs qualified for enrollment. Many potential participants either had had a hysterectomy, were currently using ora] contraceptives, or had daughters who were on birth control pills or did not have regular menstrual cycles. Advertising in local newspapers was expensive and futile~ after 4 months of advertising, only one woman had responded. A different scenario may have occurred if reimbursement or remuneration were attached to study participation,
Thus, difficulty in accessing a germane population led to a small sample size.
Although the sample size was small, it had one main advantage. The small number of mother-daughter dyads enrolled in the study allowed time for an in-depth paired analysis of menstrual synchrony, similarity of perimenstrual experiences, and interaction over the menstrual cycle. Even though the sample was restricted to 10 86 mothers and 12 daughters, the sample was comparable to other mothers and daughters across the country on selected family characteristics. Mothers and daughters that participated in this study reported descriptions of family satisfaction, family communication, and family cohesion! adaptability similar to those reported by parents and adolescents in a large national study by Olson and associates (1989). As is typical of
American parents and adolescents, these mothers and daughters differed in their perceptions of family communication and cohesion! adaptability as measured respectively by the Barnes & Olson Parent-Adolescent Communication scale and FACES II. That is, daughters noted lower levels of dyadic communication and family cohesion! adaptability than their mothers noted. Analogous to the national study, mothers and daughters reported similar levels of family satisfaction. Therefore, despite the small sample size, the typicalness of the mother-daughter pairs, as compared to a national sample, lends credence to the possibility that the trends found in these pairs could be found in other mother-daughter pairs. In addition, this sample had similar nlenstrual characteristics to
20 Utah mother-daughter pairs studied by Wilson et al. (1991).
On the other hand, because of sample size and incomplete information provided by 4 daughters, insufficient information was available to determine whether interaction patterns of mothers' and daughters' who completed diaries for one full menstrual cycle were similar to mother-daughter pairs who did not complete the diaries. Even so, it can be speculated that daughters who stopped charting may have had difficulty looking at or writing about their relationships during times of increasing mother-daughter conflict. 87
Bleeding Patterns
Findings from this study support (a) that variability is the norm in relation to
menstrual cycle lengths and (b) that menstrual cycle characteristics based on recall do not
necessari1y correlate with menstrual characteristics that are prospectively charted
(Snowden & Christian, 1983~ see also, Chiazze et aI., 1968~ Vollman, 1977). Overall
mothers tended to overreport cycle lengths and daughters seemed to underreport
frequency of menstrual cycles. Although mothers' cycle lengths based on the recall of
menstrual cycles (g = 26.9 days) were similar to those recorded in the diary (~ = 26.7),
variance increased in the mode by 3 days, the range by 5.5 days, and the standard
deviation by 1.5 days. 1 On the other hand, daughters had less variance in the range and
standard deviation and more in the mean cycle lengths when recalled cycles (~ = 29.3
days) were compared with actual cycles (~= 28.1 days). Of interest, is that findings in
this study are similar to those found by Wilson et al. (1991) in their study of 20 mother
daughter pairs from the same metropolitan area in Utah.
~enstrual synchrony
After reviewing nine independent studies on menstrual synchrony (five that
demonstrated menstrual synchrony and four that did not), Wilson (1992) concluded that
menstrual synchrony does not exist as a separate phenomenon but as a chance
occurrence. This author-researcher speculated that lI{given a 28-day cycle} a probable
one half of the pairs in (any) sample synchronize by chance" (p. 567) and that the onset
IMenstruaJ cycle characteristics are reported in Table 3, Chapter 4. 88 of menstrual cycles for any pair would diverge and converge over time. Wilson's conclusions were based ( a) on the expected variability of menstrual cycle length in women under 25 years of age and (b) on the knowledge that the majority of menstrual synchrony research critiqued utilized samples of college-aged women living in dormitories or campus housing. Weller and Weller (1993) noted that Wilson's arguments regarding the absence of synchrony may apply to studies using prospective data collection, but not those that demonstrated synchrony using retrospective data or recall of menstrual onset dates.
Conversely, in a critical analysis of 16 studies, Weller and Weller (1993) concluded that "menstrual synchrony occurs often, but not always" (p. 431) with the greatest predictor being time spent together. After studying lesbian women living together (N = 29 pairs; age range 22 - 48 years) without finding synchrony, Trevathan,
Burleson, and Gregory (1993) also concluded that menstrual synchrony is not a stable trait.
This research supports the conclusions of both Wilson (1992) and Weller and
Weller (1993), Menstrual synchrony occurred in 20-25%) of the dyads but not consistently, The most likely explanation is related to the difference in menstrual cycle lengths reported by mothers and daughters. The average cycle length for study daughters was 28, 1 days ( 13-day range) as compared to the average 26.7 days (10. 5-day range). prospectively recorded by mothers. Typically, adolescents experience longer cycles than their mothers, that is, than women in their late 30s and early 40s. Therefore, menstrual onset dates could be expected to converge and diverge as suggested by Wilson (1992). 89
In other words, menstrual synchrony may be a menstrual characteristic that is just as variable as menstrual length or cycle frequency~ and occurrence of synchrony between mothers and daughters is variable but predictable.
On the other hand, just because menstrual synchrony does not recur in consecutive cycles does not mean that it is not a significant event. In this study, there were some distinct differences between mother-daughter pairs who experienced synchronous cycles and those that did not. Both mothers and daughters of asynchronous pairs reported higher levels of conflict over the menstrual cycle, as well as an increase in conflict between the mother's menstrual and periovulatory phases. In addition, 2 out of 4 daughters that had incomplete information for a full menstrual cycle had had synchronous cycles with their mothers the month prior to starting the study. A 3rd daughter, who had failed to complete charting for both the periovulatory and menstrual phases of her mother's cycle, was in sync with her mother at the time enrolled but moved out of sync within 3 weeks: (a) the dyad was enrolled on day -8 for daughter and day -10 for mother; (b) the daughter started her menses 2 days before her mother; (c) on day 1 of her cycle, which was day -2 of her mother's cycle, daughter stopped charting everything but her temperature and presence of bleeding; (d) the daughter, who typically had 35-day cycles, did not menstruate a second time during her participation in the study whereas the mother prospectively recorded a 23-day cycle,
Likewise, some distinct differences were noted between the mother-daughter pairs that reported data for all three phases (designated as complete pairs) and those that did not (incomplete pairs), First, when data were combined, these daughters of 90 incomplete pairs perceived that their mothers expressed less affection towards them than the daughters who continued to chart. Second, mothers of incomplete pairs reported less closeness and more conflict in the mother-daughter relationship and perceived that their daughters expressed less affection towards them than the mothers of complete pairs.
Lastly, daughters tended to stop charting during the time of the menstrual cycle when mothers noted the highest level of conflict or when the daughter perceived a significant decrease in affection from her mother. Since withdrawal is the most common conflict resolution technique utilized by adolescents and their parents (Noble et aI., 1989), it is not surprising that these daughters stopped charting during a time of increased mother-daughter conflict.
Further data suggest that daughters' periovulatory or midcycle experience may be a critical time period for mother-daughter interaction. When data were viewed from the perspective of the daughters' cycle phases, all four daughters who quit charting had some data for their pre- and postmenstrual phases but had no information related to their midcycle or periovulatory phases. Moreover, daughters who reported data over a complete menstrual cycle experienced higher levels of turmoil-like symptoms midcycle than during any other phase.
Other menstrual synchrony research indicates time spent together and degree of affiliation are predictors of menstrual synchrony. Unsolicited comments from some of the mothers supported the perception of greater synchrony during summer months when mothers spent more time with daughters who did not attend school. Conversely, the results from this study suggest that the feelings of affection, closeness, and decreased 91 conflict noted in synchronous pairs may be a result of cycling together; that is, affection, closeness and decreased conflict are harmonious outcomes of synchrony and not necessarily contributing or predicting factors. Women who cycle together may feel more in tune with one another. This harmony is reflected in the terms used to describe the relationship by the dyads who experienced synchrony. For example, during the menstrual phase] daughter described her relationship with her mother as "like mother-daughter friends .. .like your dream mother-daughter relationship should be." During the same time period, the mother of this dyad described her relationship with her daughter as
"extremely close, friendly, interdependent, supportive." Another daughter, who was in sync with her mother, described the relationship during the menstrual phase as "she indulged me ... .1 could be with her. ... she was like a teen ... totally understood me."
Although the mother of this pair was positive, she did not seem to notice much difference in her relationship with her daughter. This mother characterized the relationship as "caring, medium, status quo" during the same time her teen expressed enthusiasm in her interaction with her mother. Therefore, it can be speculated that menstrual synchrony may impact daughters to a greater extent than it affects mothers. In addition, it is important to note that menstrual cycles that coincide are reflective of the end of a synchronous cycle and not the beginning of one.
Two other observations regarding the measurement of menstrual synchrony may be partly responsible for the inconsistent findings related to menstrual synchrony. In this study, menstrual synchrony was observed by assessing and determining exact difference in onset dates for each individual pair. In other research, menstrual synchrony has been 92 calculated based on the mean difference of onset dates at two different points in time using a Wilcoxin sign test for dependent pairs. If this statistical approach had been used, no evidence for menstrual synchrony would have been found in this study. Thus, statistical measures using group means may be insensitive to differences in individual pairs. Second, Ita phenomenon is unexplainable as long as the range of observation is not wide enough to include the context in which the phenomenon occurs" (Watzlawick et aI., ] 967, p. 20). Thus, the inconsistent findings related to menstrual synchrony may be related to the absence of a theoretical framework and, hence, inclusion of context, in the majority of menstrual synchrony research studies (Weller & Weller, ] 993).
Lastly, it may be worthwhile to rethink and redefine menstrual synchrony. If divergent and convergent cycles between mothers and their biological teen-age daughters are predictable, the definition of menstrual synchrony could be (should be) expanded to include the individual mother-daughter menstrual cycle pattern that would emerge over time. In other words, a pattern of concomitant menstrual bleeding could occur every 3 months for some mother-daughter pairs and every 10 to 12 months for other pairs. A longitudinal study is needed to determine (a) patterning of convergent and divergent menstrual cycles in mother-daughter pairs who live together and (b) the reciprocal nature of this pattern in regards to mother-daughter interaction and perimenstrual symptoms.
In contrast to other menstrual cycle characteristics, the menstrual synchrony findings from this study conflict with those reported by Wilson et al. (199]). Wilson and colleagues studied perimenstrual symptom expression in 20 mother-adolescent daughter pairs from the Salt Lake nletropolitan area. Although the focus of the study was not 93 menstrual synchrony, these researchers did collect data over two menstrual cycles for each participant and were surprised to find a mean 7 -day phase difference between mothers' and daughters' onset dates and no evidence of menstrual synchrony in 19 out of
20 pairs in their sample, This is especially curious in the light that mothers' mean cycle lengths (8: = 26,8, range = 11 days) were about the same as their daughters' mean cycle lengths (~ = 26.5, range 12 days). The authors did not describe how synchrony was assessed nor did they speculate about the reason for their findings.
Comparison of f\.10ther -Daughter Peri menstrual Symptoms
Contrary to research based on recall (Kantero & Widholm, 1971; Woods et ai.,
1989) and prospective charting (Wilson et aI., 1991), the mothers and daughters in this study had dissimilar menstrual experiences. Although the majority of PS reported by mothers and daughters fell into the turmoil and feeling-on-top-of-the-world categories
(as described by Woods and colleagues, 1989, 1992), daughters reported the most symptoms midcycle, whereas mothers reported the majority of symptoms during their menstrual and premenstrual phases.
Mothers' PS reflected patterns similar to those reported by Woods et a1. (1989,
1992):
1 . Feelings of turmoil were most prevalent during the menstrual phase but were also reported during the premenstrual and periovulatory phases.
2. Women reported positive--on-top-of-the-world--feelings over all three phases of the menstrual cycle, with the highest level reported during the menstrual phase. 94
3. Women reported sensations that fell into four other categories described by Woods. et aL--pain and physical sensations, binge-and-bulge-related symptoms, sleep disruption, and hermitlike qualities. Once again, these symptoms were experienced over the menstrual cycle, with mothers reporting (a) highest levels of hermit behavior and binge and bulge symptoms premenstrually, (b) majority of sleep problems during the periovulatory phase, and (c) pain and physical sensations equally high during the menstrual and premenstrual phases.
Daughters also experienced turmoil, feeling-on-top-of-the-world, binge and bulge symptoms, pain and physical sensations, sleep disturbance, and hermitIike behavior over all menstrual phases but to a lesser degree than their mothers. Unlike their mothers, daughters reported highest levels of all categories during the periovulatory time. Thus, it can be speculated that adolescents may be more responsive to surging gonadotropin
(FSH and LH) and estrogen levels than women in their 30s and early 40s.
Although mothers and daughters had dissimilar perimenstrual experiences, the variability of perimenstrual symptom expression in this sample supports the conclusions of other researchers (Gallant, Popiel, & Hoffinan, 1994~ Walker, 1994~ see series of research by Woods et a1.): cyclic changes in physical sensations, emotions, perceptions, and behavior are normative. Also, the difference in number of mothers' and daughters' reported symptoms may be related to development. Certainly, as women age, they become more comfortable and more knowledgeable about their bodies and their health.
Thus, the higher number of reported perimenstrual changes by mothers may be due to an increased awareness of their bodies that comes with age. On the other hand, perception 95 of changes in emotions and physical sensations may be due to the aging process and a decrease in the number of inhibitory neurons (K. P. Jones, personal communication,
1994). In other words, older women may be more in tune with their bodies or may be more sensitive to biopsychosocial changes experienced over the menstrual cycle.
Interaction Over the Menstrual Cycle
Like other menstrual cycle characteristics, interaction over the menstrual cycle was found to be variable between and within dyads. Recognizable patterns of mother-daughter interaction were apparent, yet no one pattern emerged that reflected differences found in mother-daughter interaction during the menstrual, periovulatory, and premenstrual phases. Perhaps, different patterns would have surfaced if data were assessed in another way (e.g., using the daughter's menstrual cycle phases as points for comparison or utilizing the entire menstrual cycle). Moreover, interaction patterns, or perceptions of interaction, differed between those mother-daughter pairs that had information for all phases of the menstrual cycle and those that did not. Of interest is that when mothers and daughters were asked to supply adjectives describing their relationship, they often chose terms that reflected their perception of the other's behavior and not necessarily the relationship itself. For example, the mother from pair 2 defined the relationship as "she was busy with friends ... JsheJ showed concern for me ... better attitude between us ... cooperative ! " There were also times for every mother-daughter pair, except one, when there was a discrepancy between the mother's and the daughter's perception of the relationship. For example, one mother described the mother-daughter relationship as "impatient, frustrated, abrupt, tense" on the same day that her daughter 96 saw the relationship as "wonderful, nonconflicting, outgoing"; another mother described her relationship with her daughter as "calm, normal, routine" on a day when her daughter perceived the relationship as "argumentative, yelling, listening, fun, not-there." Based on the research by Olson et aI., periodic discrepant accounts of the mother-daughter relationship would be expected. In this study, discrepant descriptions of the mother daughter relationship varied among the different pairs. Although the majority of pairs had about 4 days with discrepant reports, 1 pair had 14 days of discrepancies and another had none.
Although, observation of the mother-daughter relationship was obtained from both mothers and daughters and the data were analyzed visually together, dyad analysis was limited. A true dyadic analysis would consist of analyzing one response or observation representative of the dyad instead of comparing individual responses. This could be done by calculating mother-daughter discrepancy scores or summation scores for perceptions of contlict, closeness, and affection. Because this had not been done before, interpretation of discrepant or summations scores would be difficult. A more plausible method would be to describe patterned interaction over the menstrual cycle in terms of symmetry or complementarity.
Symmetry and complementarity are terms used by communication researchers to describe relationships based on equality or difference. "Symmetrical interaction .. .is characterized by equality and minimization of difference, while complementary interaction is based on the maximization of difference" (Watzlawick et al., 1967, pp. 68-
69). Within ongoing interactional systems, such as the family or the mother-daughter 97 subsystem, relationships are negotiated within each communication act. Each member of the system "seeks to determine the nature of the relationship .... Similarly, each responds with (a) definition of the relationship, which may confirm, reject, or modify that of the other" (p. 133). Over time ongoing relationships stabilize. Relationship rules develop and a redundant pattern of symmetrical or complementary interaction evolves. In this study, symmetry was observed in pair 4 for closeness, conflict, and affection over all phases of mother's menstrual cycle. In contrast, pair 11 experienced (a) symmetry for conflict over all phases of the menstrual cycle and (b) complementarity for closeness and affection during mother's premenstrual phase. (See Appendix G.) Further development of the use symmetry and complementarity as measures of mother-daughter interaction over the menstrual cycle is needed along with a longitudinal study of mother and daughter interaction.
Methodological Limitations of the Study
When interpreting the findings of this study, the reader should consider the following methodological limitations:
1. The major limitations in this study are the small sample size ~ 12 mother-daughter pairs) and the selection bias that accompanies volunteer participants.
Because of time constraints and the difficulty encountered finding mother-daughter pairs that met inclusion criteria, it was not feasible to solicit volunteers nor to continue data collection past January 1995.
2. Other drawbacks of the study include the inconsistent charting of basal body temperatures by several participants and the abrupt cessation of charting by 4 98
daughters. Inconsistent recording ofBBT led to inconsistent documentation of ovulation
in daughters; this, in turn, affected the reliability of periovulatory phase determination.
Likewise, the premature ending of data collection by 4 daughters (a) contributed to the
small sample size and (b) restricted data analysis of mother-daughter interaction over the
menstrual cycle to 8 pairs.2
3. Analysis of cycle-related interaction is limited further because only the
mothers' cycle was used as the reference point for defining cycle phase. Different findings
might arise from analyzing interaction based on daughters' menstrual phases. Likewise,
interaction findings may be limited because analysis was based on only 9 days of the
menstrual cycle and not the entire cycle.
4. Also, missing from this research design was the influence of other cycles--
weekly, monthly, seasonal--on expression of perimenstrual changes and reports of
interaction.
Implications for Nursing Research and Practice
Nursing Research
This research on the perimenstrual experience of mothers and daughters was
conducted to increase our understanding of menstruation as a biopsychosocial
phenomenon. The results of this research created more questions and issues than answers
and solutions concerning menstrual synchrony, variability ofPS, and patterned
interaction over the menstrual cycle. Further research that (a) intertwines theories from
2Data from 12 mother-daughter pairs were used to answer research questions 1 and 2: data from 8 mother-daughter pairs were used to answer the third research question. 99 behavioral and natural sciences, (b) utilizes dyadic and family measures, and (c) incorporates the family and family subsystems as the units of analysis is needed to understand human behavior and the biopsychosocial nature of health, including menstrual or reproductive health, To advance nursing knowledge regarding menstrual cycle phenomenon, the following are recommended:
1. investigation of mother-daughter interaction over the menstrual cycle based on daughters' menstrual phases with close observation of mother-daughter interaction and individual response during the daughter's periovulatory phase;
2. assessment of mother-daughter interaction and perimenstrual symptom expression over an entire cycle or the use of five cycle phases to enhance pattern discrimination based on hormonal changes;
3. utilization of simpler and more accurate methods of determining ovulation, such as urinary LH kits, and collection of data on mother-daughter interaction over a longer time period~
4. assessment of the impact of the day of the week, the lunar cycle, and season on fluctuations in mood, physical sensations, perceptions, and behavior and discrimination between these changes and those related to the menstrual cycle;
5, exploration of interaction among all menstruating merrlbers in household and changes in family interaction over the menstrual cyc1e~
6. incorporation of context and theoretical orientation into future studies of menstrual synchrony; 100
7. redefinition of menstrua) synchrony to include patterning of divergent and convergent menstrual cycles~
8. development of the use symmetry and complementarity as measures of mother-daughter interaction over the menstrual cycle.
Nursing Practice
The ubiquitous nature of perimenstrual symptoms and the potential impact of symptomatoJogy on interpersonal and family relationships support the value of family research in this area. Although the negative impact of distressing perimenstrual symptoms has been described in the literature, no research has focused on the positive nature of the perimenstrual experience. It stands to reason that if distressing symptoms are correlated to negative personal and interpersonal outcomes, then uplifting symptoms should be correlated with positive outcomes.
Nurses can utilize the findings from this study in their work with adolescents and their families. Changes in mother-daughter interaction and in physical well-being, emotions, perceptions, and behavior over the menstrual cycle need to be normalized.
This can be done (a) by discarding a biomedical model or a pathological orientation to developmental and physiological change and (b) by utilizing a holistic, biopsychosociaJ approach to maintaining or improving individual and family health. An ideal model would incorporate theories related to individual and family development, communication, and systems. When working directly with mothers and adolescents, nurses should explore mothers' and daughters' expectations of the mother-daughter relationship and the perimenstrual experience; dispel or correct any myths or misperceptions related to 101 adolescent development, mother-daughter interaction, and menstrual cycle phenomenon; provide education, counseling, and anticipatory guidance regarding the individual nature and variability of relationships and the perimenstrual experience; give permission to mothers and daughters to feel what they feel and to experience what they experience.
All women need to learn how to recognize the positive side of menstruation and to rejoice in the dynamic nature of the menstrual experience. More specifically, for mothers and daughters who are experiencing difficulty in their relationship, it may help to have them begin a menstrual and relationship diary. If either mother or daughter is having difficulty charting, it may be an indicator of conflict in the relationship that may need to be mediated by an objective professional. In addition, diarying could help the dyad recognize strengths and problem areas in their relationship and may enhance communication between the mother-daughter pair. APPENDIX A
CONSENT-ASSENT FORM 103
ID# M------
ID # D------
My name is Kris Robinson. I am a doctoral graduate student in nursing at the University of Utah. The focus of my dissertation study is "the interaction of mothers and daughters over the menstrual cycle."
You are being asked to participate in the study entitled: Systems and Cycles: Patterns of Mother-Daughter Perceptions of Interaction across the Menstrual Cycle. Your participation will include filling out some initial questionnaires, being interviewed by me, and then filling out a daily diary, which you will give to me for analysis. You will also take your temperature daily.
The initial interview will be scheduled at your convenience, and can take place in your own home if you wish. It will take 1 to 2 hours. The daily diaries will normally require no more than 15 minutes each day to fill out.
Risks to you could include inconvenience, as well as the time commitment necessary to take a daily ora] temperature and to complete the diary. There is no cost to participate in the study~ you will be supplied with an electronic oral thermometer and a diary.
Benefits to you will include gaining knowledge about your menstrual experience and knowledge about your interaction with you mother or daughter. This could increase your understanding of your body and strengthen your relationship with your mother or daughter. Participating in the research study may increase communication and provide a sense of closeness between mothers and daughters.
All information will remain confidential and only the researcher, Kris Robinson, will read the diaries. There wi11 be no names on the diaries, only an ID number. Kris will call you every few days to see if there are any problems and will collect the diaries about every 2 weeks. Also, Kris Robinson can be reached at 485-5626 by answering machine 24 hours a day. If you have questions regarding your rights as a research subject, or if problems arise which you do not feel you can discuss with the investigator, please contact the Institutional Review Board office at (801) 581-3655. 104
ID# M------
ID# D------
I have read and received a copy of the consent from and agree to participate (and give permission for my daughter to participate) in the above described study.
Mother's signature ______
Witness signature ______
I have read and received a copy of the consent fonn and agree to participate with my mother in the above described study.
Daughter's signature ______
Witness signature
Date: APPENDIXB
BACKGROUND INFORMATION FORMS 106
ID#M------
Background Information--Mother's Form
THE INFORMATION YOU PRO~'7DE ON THIS FORM WILL REMAIN CON}7DENTIAL.
Date of Birth: Age:
Do you work outside the home? yes ___ no --- If yes, what type of work do you do 'J
Do you work full time or part time? yes ___ no ---
Years of education: Less than 12 ---
High School Graduate ___
Some College ___
College Graduate ___
Economic status: Less than $10, OOO/year ___
$10-19,000/year __
$20-34,000/year __
$35-50,000/year __
More than $50,000/year ___
More than $100, OOO/year ___
List family members and others who live with you:
Besides you and your daughter, are there any other menstruating females living in your home?
Who do you spend the most time with? 107
ID#M------
Age at menarche:
First day of last menstrual period (LMP):
Usual length of menstrual cycle (from first day of one period to first day of next period):
Usual length of periods (number of days of bleeding):
Usual symptoms or problems experienced before, during, or after your period?
How do you feel about your life as a whole at this time? Circle a number from 1 to 7.
2 3 4 5 6 7 Terrible Unhappy Mostly Mixed Mostly Pleased Delighted Dissatisfied About Satisfied Equally Satisfied and Dissatisfied
Could you briefly explain why you selected the answer that you did?
List any current health problems:
Do you use any prescription medication or over the counter medicine (for example, hormones, birth control pills, vitamins, alcohol, aspirin or ibuprofen)? yes __ no If yes, please list:
Do you use alcohol or any street drugs? yes __ no __ If yes, please list frequency and amount:
Do you smoke? yes __ no If yes, how many cigarettes do you smoke per day'> __ How long have you smoked? ___ 108
ID#D------
Background Information--Daughter's Form
THE INFORMATION YOU PROVIDE ON THIS FORM WILL REMAIN CONFIDENTIAL.
Date of Birth: Age:
Do you go to school? yes __ no If yes, what grade are you in?
Do you work') yes __ no __ If yes, what type of work do you do?
Do you work full time or part time? ____
Who do you spend the most time with?
List family members and others who live with you:
Age at menarche:
First day of last menstrual period (LMP):
Usual length of menstrual cycle (from first day of one period to first day of next period):
Usual length of periods (number of days of bleeding):
Usual symptoms or problems experienced before, during, or after your period? 109
ID#D------How do you feel about your life as a whole at this time? Circle a number from 1 to 7.
2 3 4 5 6 7 Terrible Unhappy Mostly Mixed Mostly Pleased Delighted Dissatisfied About Satisfied Equally Satisfied and Dissatisfied
Could you briefly explain why you selected the answer that you did?
List any current health problems:
Do you use any prescription medication or over the counter medicine (for exa~ple, hormones, birth control pills, vitamins, alcohol, aspirin or ibuprofen)? yes __ no If yes, please list·
Do you use alcohol or any street drugs? yes __ no __ If yes, please list frequency and amount:
Do you smoke") yes __ no __ If yes, how many cigarettes do you smoke per day? __ How long have you smoked? ___ APPENDIXC
SAMPLE DIARY WITH INSTRUCTIONS 111
Diary
Instructions: Complete the diary by yourself at about the same time every day. Pick a specific time to fill out at your diary so that there is about 24 hours between each entry. At times it may not be possible to complete the diary at the usual time. Remember it is more important to fill out the diary every day than to fill it out at the same time each day.
The information in this diary is confidential between you and me. I assume that the information in the diary is your perception of the relationship for a particular day. If you want to share your perceptions with one another do so ~ you have answered the questions for that day. Be sure to complete the diary independently.
You must take your temperature every day. Take it when you first wake up, before you get out of bed, and write down what it is.
A list of bodily and emotional sensations that women may experience during the menstrual cycle is listed below. These sensations or symptoms may be considered positive or negative or neutral by anyone woman. Please list what you experienced for that day. Rate each sensation on a scale from 1 to 5, with one (1) being the least that you have ever felt the sensation and five (5) being the most.
Common physical and emotional sensations experienced by women at different times of the menstrual cycle. increased energy increased activity positive feeling of well-being hostility tension moodiness anger anxiety impatient irritability guilty teary depressed out of control food cravings lonely lowered desire to talk difficulty concentrating increased sleep desire to be alone painful breasts crampmg acne hot flashes bloating decreased appetite increased appetite weight gain diarrhea difficulty falling asleep difficulty making decisions headache backache awaken early mellow 112
ID#M------
Date: ------Temperature: ______
Are you bleeding today? yes __ no spotting? yes __ no
On the fo]Jowing scales, place a X on the point on the scale that best describes the type of interaction that you experienced today with your daughter.
I FELT: I SPENT: extremely close lots of time
extremely distant no time 113
ID#M------
THERE WAS: MY DAUGHTER LISTENED TO :ME: lots of conflict all the time
no conflict not at all
MY DAUGHTER MY DAUGHTER VERB ALL Y UNDERSTOOD ME: EXPRESSED AFFECTION: entirely constantly
not at all not at all ID #M------On the following scales, place an X on the point on the scale that On the following scale, place an X on the point on the scale that best describes the type of day that you had. best describes how you feel about your life as a whole.
CALM NO HASSLES NOT STRESSFUL DELIGHTED
HECTIC LOTS OF HASSLES STRESSFUL TERRIBLE
~ 115
ID # M- ______
List any physical or emotional sensations (positive, negative, or neutral) that you experienced today. Rate each sensation on a scale from 1 to 5, with one (1) being the least that you have ever felt the sensation and five (5) being the most. Circle the number below each listed sensation.
2 3 4 5
2 3 4 5
2 3 4 5
2 3 4 5
2 3 4 5
Think of yourself as you have been today, and write down five words that best describe you.
List five words that describe your relationship with your daughter today. 116
ID#M------
How would your daughter describe you today?
How does what other people (such as your daughter) think of you differ from what you think of yourselfJ
Other comments: 117
ID#D------
Date: ------Temperature: ______
Are you bleeding today? yes __ no spotting? yes __ no
On the following scales, p1ace a X on the point on the scale that best describes the type of interaction that you experienced today with your daughter.
I FELT: I SPENT: extremely c10se lots of time
extreme1y distant no time 118
ID #D------
THERE WAS: MY DAUGHTER LISTENED TO ME: lots of conflict all the time
no conflict not at all
MY DAUGHTER MY DAUGHTER VERBALLY UNDERSTOOD ME: EXPRESSED AFFECTION: entirely constantly
not at all not at all ID# D-
On the fo11owing scales~place an X on the point on the scale that On the following scale, place an X on the point on the scale that best describes the type of day that you had. best describes how you feel about your life as a whole.
CALM NO HASSLES NOT STRESSFUL DELIGHTED
HECTIC LOTS OF HASSLES STRESSFUL TERRIBLE
\0 120
ID # D------
List any physical or emotional sensations (positive, negative, or neutral) that you experienced today. Rate each sensation on a scale from 1 to 5, with one (1) being the least that you have ever felt the sensation and five (5) being the most. Circle the number below each listed sensation.
2 3 4 5
2 3 4 5
2 3 4 5
2 3 4 5
2 3 4 5
Think of yourself as you have been today, and write down five words that best describe you.
List five words that describe your relationship with your daughter today. 121
ID # D------
How would your daughter describe you today?
How does what other people (such as your daughter) think of you differ from what you think of yourself?
Other comments: APPENDIXD
DATA: FAMILY CHARACTERISTICS Family Characteristics
Family Measure Study Sample Data National Sample Data
Mothers Daughters (g. (g. 12) Parent Adolescent M SD range M SD range M SD rane.e M SI) range
Family satisfaction scaleR 42.9 10.79 27-5841.25 7.00 33-55 47.0 45.0 b Satisfaction with cohesion subscale 25.6 5.30 16-34 23.92 3.45 20-33 26.5 26.5 Satisfaction with adaptability subsea Icc 18.0 5.10 11-26 17.17 4.37 11-26 19.5 18.5
Parent-adolescent communication scaled 80.4 8.54 63-97 64.75 7.21 51-7675.4711.12 41-9666.56 Problems in family communication subscalec 38.4 5.08 29-47 28.03 5.20 21-37 f Open family comnnmication subscale 42.1 4.28 35-50 36.67 4.91 28-44 FACES II: Family Version
Cohesion subscak.~ 64.6 7.65 66-7953.58 14.56 33-77 64.9 8.4 16-80 56.3 Adaptability subscaleh 49.7 5.38 42-58 46.33 7.92 34-57 49.9 6.6 16-80 45.4
possible score: 14-70 hIolal JXJssible score: 8-40 'Total possible score: 6 .-. N W Comparison of Family Characteristics Complete and Incomplete Pairs 70 60 50 40 30 20 10 g'd discrepance score mId mean cohesion mId mean adaptability Mean of Complete Pairs _ Mean of Incomplete Pairs ..- IV ~ FACES II: Family Version Complete Pairs 80 Q) 860 (f) '-Q) ...... r:::. g40 oco ~ Q) .r:::. (520 ~ o +tOlEl+_ ~__ +~I_-..:J i r.&l_+_--+.t.~I I f~,,- Pair 3 Pair 4 Pair 5 Pair6 Pair? Pair 8 Pair 9 Pair 11 1~~~M/Drnsc~;p~Y-Score.MID MeanC~sion• MID Mean Adaptability N"""'" Vl FACES II: Family Version Incomplete Pairs 80 ~60 o CJ) '-Q) ...... c g40 oco ~ Q) .r::..... ~ 20 o Pair 1 Pair 2 Pair 10 Pair 12 l~MIDDiscrepancy Score. MID Mean Co-~~n--.-MtDMean AdaptabilitYl ...... N 0"1 APPENDIX E DATA: MENSTRUAL SYNCHRONY 128 Menstrual Synchrony Pairs 2, 9, and 12 are synchronous~ that is, the onset of mother's menstruation fell within 5 days of the daughter's onset of menstruation. Ovulation was determined by BB T readings. Bleeding is marked by an "X," spotting by an "S," and ovulation by an "0. " Boxes outline the length of the mother's cycle. A "?" at the end of the box indicates expected menstruation; these mothers or daughters had stopped charting before noting the onset of the next menstrual cycle. A "?" within the box for Pair] 0 designates that the daughter did not mark bleeding during those days. Menstrual Synchrony Days of Mother's Cycle -10 -9 -8 -7-6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 1314 15 16 17 18 19 20 21 22 23 24 25 26 27 29 28 30 31 32 33 P . Mother - Cycle One S 8·8---- X X air 1 Daughter- Cycle One X X X X Days of Mother's Cycle ·10 ·9 -8 ·7 -6 ·5 -4 -3 ·2 -1 1 234 567 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2526 2728 29 30 31 32 33 . Mother - CYfle One ~X X- -- ~ -0 ----~ X X Pair 2 Daughter- Cycle One L X X X X S Days of Mother's Cycle -10 -9 -8 ·7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1920 21 22 23 24 25 26 27 28 30 29 31 32 33 · Mother - Cycle One /XXX Xx·------XX Pair 3 Daughter- Cycle One L ____~ S X X X X X Days of Mother's Cycle -10 -9 -8-7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 2425 26 27 2829 30 31 32 33 Pair 4 Mother - Cycle One ~XXX85--- l X X Daughter- Cycle One l X X X X X X Days of Mother's Cycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1819 20 21 22 2324 2526 27 28 29 30 31 32 33 · Mother - Cycle One XX-X X -X~rS----. ------X Pair 5 Daughter- Cycle One L X S ______X X X X X.______------> Days of Mother's Cycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1819 20 21 22 23 24 2526 27 28 29 30 31 32 33 Mother - Cycle Two S X Daughter- Cycle Two X X X X X Days of Mother's Cycle -10 -9 -8 -7 -6 -5 -4 -3 -2-1 1 2 3 4 5 6 7 8 9 10 11 12 13 1415 16 1718 19 20 21 22 23 24 25 26 27 30 28 31 29 32 33 · 6 Mother - Cycle One XS ------X X Pair Daughter- Cycle One S X X X X X X X_~_~_~ Days of Mother's Cycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 19 21 22 2324 25 26 2729 28 30 31 32 33 Mother - Cycle Two lX-XX ~d X X Daughter- Cycle Two X X X X S S S:S 0 N L. __ ~._ •. __.. -~--- \CI Daysof Mother'sCycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1718 19 20 21 22 23 24 2527 2628 2930 31 32 33 Pair 7 Mother- Cycle One ~5 Daysof Mother'sCycle -10 -9 -8 -7-6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 19 21 22 23 24 25 2627 28 29 30 31 32 33 , Mother- CycleOne XX----- 0---- I X X Pair 8 Daughter- CycleOne X X X X X ______ Daysof Mother'sCycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17 16 18 19 20 21 22 2324 25 26 27 2829 30 31 32 33 ~~~Trt~r~y8~,~wfworxXX-~ ______LX)(1 X ~ Daysof Mother'sCycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 2324 2526 27 28 2930 31 32 33 Pair 9 Mother- CycleOne IX.X xXS-SSS X Daughter- CycleOne 1 ___ X X X X X~ SOX Daysof Mother'sCycle -10 -9 -8 -7 -6 -5 -4 -3 -2-1 1 2 3 4 5 6 7 8 9 10 11 12 1314 15 16 17 18 19 20 21 22 23 24 2526 27 28 2930 31 32 33 Pair 10 Mother- CycleOne X)(xs-s-ss---~ 6--- -- X Daughter- CycleOne ? ? ? S -~------ Daysof Mother'sCycle ·10 ·9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 1314 1516 17 18 19 20 21 22 2324 2526 27 2829 30 31 32 33 Pair 11 Mother- CycleTwo rX..-.X5fX X..-SS 8-S------CflX. X Daughter- CycleTwo l ______~__ .9 X X X X X S SI Daysof Mother'sCycle -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 1314 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Pair12 Mother- CycleOne ~XX)CS-SS ~-cY?- X X Daughter- CycleOne X Xl~ _~_XX X__ ~ ____ ~______ ~ey U~___I", Mother's Cycle x ==Bleeding S ==Spotting 0 ==l)ocumented Ovulation ..- _. __ ~ ___ J w o 131 Daughter to Daughter Synchrony In 3 families, mothers requested that all daughters participate in the study. In all, 4 additional daughters who did not meet the research criteria--two nonmenstruating, one irregular menstruating, and one nonbiological--completed diaries. Although data from these daughters were excluded from the main data analysis, the relationship of menstrual timing of other young women in the household is of interest and is mentioned here. One out of five prospectively recorded cycles and two out of four cycles based on the recall ofLMP were synchronous, When both retrospective and prospective cycles were combined, three out of nine cycles (33.3%) were synchronous. 1, Daughters from the first family enrolled were step-sisters; these young women reported a synchronous cycle based on LMP and experienced a 6-day difference in start when bleeding recorded. Although the young women reported different cycle lengths (#01-1 reported 30-day cycle length while #01-2 reported 40-day cycle length), both had 35-day cycles as measured from LMP to first day of recorded bleeding. 1 Neither daughter nor step-daughter cycled with mother (#01). 2. The first daughter from family four (#04-1) cycled with her mother; the second daughter (#04-2) did not menstruate during the time that she participated in study, 3. Two daughters from family 9 (daughters member of pairs IO and II) had a 2-day difference in recorded bleeding start dates but reported 19-day difference in start lIt is not uncommon for women to report cycle lengths and duration that differ from cycles that are prospectively recorded (Chiazze, 1968; Snowden & Christian, 1983). 132 dates based on LMP. Neither daughter cycled with her mother based on prospective bleeding. Yet) according to LMP) 1 daughter (Pair 10) reported a 4-day difference in menstruation start date from her mother. These 2 daughters reported 30-day cycle lengths~ but recorded a 27-day cycle and a 22-day cycle respectively. The 3rd daughter (a) did not report usual cycle length) (b) had an II-day difference in start date when compared with I st daughter and a 13 -day difference in start date when compared with 2nd daughter, and (c) had a synchronous cycle with her mother (I-day difference in recorded start dates). APPENDIX F DATA: PERIMENSTRUAL SYMPTOMS Comparison of Mother and Daughter Peri menstrual Symptoms by Phase Pair I Menstrual Phase Menstrual Phase Penovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or I day days -5 to -3 -2 to Mother Daughter Mother Daughter Mother Mother Mother -cramping* -cramplng* -calm; mellow; -mellow; -breasts. -breasts, -anxious -stressed* -tense* relaxed; un- -desire to be tender* - r appetite -sad* -teary* stressed* alone -mellow* -awaken early -desire to be -sense of -tlred* -disappOinted r appetite -alone; -bloated alone -angry -fatigued -bloated deserted -breasts, -bored -frustrated -controlling -depressed tender -efficient -lost -fun -happy r appetite -klutzy -effiCient; -busy -moody -mellow; -happy -insulted -busy -motivated organized -over- relaxed -loud -lost -concerned -organized -distant scheduled -obnoxious -mad -controlled -stressed -irntable r energy -tired -tired -successful energy -judging r relaxed -tired -limited • energy -misunderstood -loving -focused -not knowing -organized -frustrated what 11m -proud -intense doing -responsible -not knowing -tired -involved what to think -other directed -sad -parental -tense -prompt -strong 1t -vulnerable ..- w .a::.. Pair 2 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to -3 days -2 to -I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -backache- -very crampy- -happr- -happy- -anxiety; -nervous- -had fun;- -fun- -crampy -tired- -tired- -acne -confused anxious -sad- -happier;happy- -happy; glad- -excited -acne -grumpy -r activity; -enjoyed -teary- -scared- -achy;backache -excited -grumpy -busy -happy energy -excited -fearful- -angry; mad -angry;angry wi -helpful -happy -content -lazy -busy -hate -achy -confused daughter -kind -hurt -impatience -dingy -love -cheerful -dramatic -busy -loving -hyper -sensitive -diarrhea -mad -difficulty -hurt; heart- -coping -sad -lazy -shakes (need to -difficulty -misunderstood concentr ating broken -food cravings eat) concentr ating -depressed -loved -frustrated -discouraged -discouraged -misunderstood -mellow; relaxed -dizzy -hopeful -tense -pleasant -efficient -lethargic -positive, more; -headache -positive, more positive -nervous; -resigned -pressured anxious -r sleep -r sleep -pleasant -sleepy; tired -felt slow -positive -slow -tired -quiet -worked hard -rushed -sensitIve to noise -separate -sleepy -talkative -upset (evening) -water, losing -worried -tilW Pair 3 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or I day days -5 to -3 days -2 to I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -angry* -angry* -angry* angry; mad· -excited- -excited· -angry- -angry; mad· -easily angered; -angry; mad· -ready to cry; -sad- -cheerful; cheerful; happy· nervous· -nervous· -calm, some· -calm· angry -hateful- -depressed· teary* -happy happy· up· (mom -happy· -unhappy (not -sad- -do\Nll; -sad· -bland -lost -positive, up· proud· hyphenated) -stressed· happy)· -excited depressed- -blast; fun -bloating -proud -carried myself excited -happy· -angry; mad -acne (some -free -teary; ready to -disappointed -breasts, sore well· scared -stressed· -disappointed facial) -happy; joyful cry* -excited -cloudy thoughts -acne talkative -busy -good -want to be -loved -accomplished -happy -cramping -accomplished -mostly calm -helpful alone -scared hard task -lost -craving salt & a lot -drained; ! -loving - T appetite -vvild -want to be -proud sweet -bloating going energy(end of -sad -backache: alone; want to -diarrhea away; thinner the day) -sick crampy hide -dizzy -body feels -energy -unliked -bloated -anxiety;nervous -do\Nll good; feel -happy & -breast pain -backache; -headache good unsettled -crushed cramping -moody -busy; hectic -headache -depressed -bland -so-so -calm; mellow; -0. K. -disappointed -bloated ! desire to talk relaxed -organized -dont want to -breasts sore -tired, very -compassionate -positive; up do things -busy -too much to -cramping -relieved -not much -cloudy thoughts handle -energy, lots of -supportive energy -food cravings; -uptight -headache -tired -feel like hungry -leave me alone; -humbling swearing -diarrhea want to hide -in control; on -food cravings -dizzy top of things -hateful; cant -emotional ; -loving stand things!· moody -negativity, some -headache -excited -O.K.; so-so -hostility W -Q'\ Pair 3 continued Mother Mother Mother -sick n' tired -miserable* -explosive;out of -dppnina better -moody control -negative -hateful -stressed -not O.K. -headache -supportive -O.K. -tired -ornery -mellowed out -upset -O.K. -wanted to be -somewhat w/daughters -so-so reheved -stressed; -tired -unexplainable (cant sleep) -unkind -so-so -unloved -stressed; uptight -up - 1 desire to talk -upset -tired. very -unheard* -wanted to be home .... W-l Pair 4 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to -3 days -2 to Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -emotional. -caring· -loving· -competent· -on task· -calm· -mellow* slight -happy· -happy* -friendly· -SOCIal· -tired· -tired· -eyes scratchy: -satisfIed; -want to be -happy* -happy· -achy - f activity eyes hurt pleased; alone -irritable· -irritability· -chills; ill; sick; -busy -fine content -angry; physical -angry -acne flu -happy -kind -busy anger -busy -care free -cough -hostility -pleasant; nice -cough -calm; relaxed; -distant; -excited; hyper -depressed; - fairly -teary -fun peaceful 'Nithdrawn -frustrated dO\Ml responsible -tired -ignoring kids -excited -fatigued; tired -hostility -distracted -teary -work -nIce -frustr ated -fIrm (wi -loved -dizzy -outgoIng -headache discipline) -relaxed -do nothing -polished -hurt -fun -spiritual -helpless -pressured; -both -good -tired -OK stressed responsible & -guilty -productive -sick irresponsible -hardworking -weak -unfinished -responsible -loving; kind -worried -sleepy; tired -thorough -communICative -trying hard -1 desire to -upset talk -teary ... w IX) Pair 5 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day days 3 to 5 ovulation + or - I day days -5 to -3 days -2 to I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -achy* -achy* -excited· -excited· -happy* -happy· -angry* -anger; mad· -crabby: -annoyed· -happy* -happy· -happy* -happy* -impatient; -annoyed· -anticipating· -suspense· irritable: -backache· -irritable; -exasperated· -hurried· -frantic· irritable· -stressed· -happy· -happy- grouchy· -excited- impatient- -tired- -knee pain· -shoulder pain· -pressured; -pleased- -impatient; -annoyed- -crampy* -happy* -tired· -excited -stressed· -stress· stretched· -wanting to get irritable· -stressed· -excited- -hot· -busy -sad -thrilled- -thrilled· -satisfied· things done- -pushed· -tired· -happy* -sense of -cold s/sx -stressed -tired· -tired· -task-oriented· -tired· -tired· -upset· -hot flashes· accomplish- -crampy -worried -worried· -worried· -tired· -achy -upset· -worried· -productive- ment· -diarrhea -achy -annoyed; -amused -bored -worried· -backache -tired· -tired· -energetic -anticipation disturbed -anticipating -concerned; -accomplishing -cold -achy -defensive -motivated -anxious -cold -cough interested -achy; achy & -disappointed· -busy -hurt; pride -O.K. -busy -cramping -busy -delighted; stiff; sore -excited -calm injured -calm -feeling sorry -foggy; exuberant; -anxious -hungry -clumsy -mad -confidence -mad scattered wonderful -busy -interested -cold sx -sad -guilty -not feeling -frustrated -disappointment -clumsy -discouraged -stressed -headache understood -headache -energetic -diarrhea -foggy -Vvilling -interested -sad -isolated -excited -didn't sleep -guilty -worried -O.K. -upset -learning -free well -headache -pleasant -lov1ng -gassy -discouraged· -indecisive -pleasure -productive -mad; angry -down -interesting -sick -responsible -misunderstood -distracted -inward -restless -proud -focused -restless legs -tolerant -sad -foggy -satisfied -sharing -friendly; -slept poorly -no stress sociable -steady -upset -guilty -worried -hurried \,.o.j -\0 Pair 5 continued Mother days -3 to -5 -motivated -organized -patient -relaxed ;calm -scared -sharp; short- tempered -studious -talkative -unmotivated ...... +:>.o Pair 6 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to-3 days -2 to -I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -cramping; -cramping- -awaken early* -awaken early- -awaken early* -difficulty -acne- -acne- -acne- -acne- backache- -crabby* -food cravings- -food cravings- -difficutty staying -awaken early- -awaken early* r energy; - T activity* -impatient- -positive feeling -impatient- -impatient; sleeping- asleep- -backache- -cramping- active- -irritability; -positive feeling of well-being- -moodiness- irritable; -impatient- -difficulty falling -painful - painful -impatient- crabby* of well-being- - T activity -tired- ornery· -mellow; asleep- breasts- breasts- -melloW- -calm; melloW- -acne -acne -moody* relaxed· -irritability -content -calm ;mellloW- T energy; -positive feeling -good; positive -bloated -bloating -tired; worn- -tension· (annoyed by melloW- -irritability; hyper of well-being- feeling of -friendly -fun out -tired- peers); -irritability; crabby· -desire to be -desire to be well-being- -fun -judgmental -desire to be -acne crabby* impatient; -patient; alone alone -awaken early -funny -kind alone -backache -calm (family); perturbed- tolerant- -anxiety -crazy 1 appetite -hard working -listless -cramps -breast melloW- -patient· -tired- -assertive -depressed -busy -helpful -loving -depressed tenderness -tension- -tired· -desire to be -busy -food cravings -delighted; -hostility -difficulty -lonely -busy -tired; worn -anxiety alone; -cheerful; -hot flashes happy -loving sleeping; -sleepy -cheerful; out· -cheerful; hermitish happy; joyful -in the way -depressed -organized unable to fall 1 desire to happy -anger (social happy; -busy -content -lonely -excited -sensitive to asleep talk -contemplative problems) joyful -hot flashes -difficulty -mad -food cravings noise -teary -content; -crazy -difficulty -difficutty falling concentrating -neutral -in deep -supportive -understanding positive -daring; wild concentrating asleep -easy going -obnoxious thought -teary -weight gain feeling of -food cravings -encouraging - T sleep -fat -one of the -lonely well- -lonely (social - T energy -friendly norm -mellow; quiet being problems) -food cravings -fun -out of control -nice -frustrated -moodiness -friendly -grippy -sad desire to -1 -fun; silly -not with it -fun -hard working -difficulty falling talk -productive -outgoing -giving -headache asleep -sedentary -patient (family) -headache -moodiness - T sleep -willing to -sick -industrious -supportive -tired learn - T sleep -lonesome -ugly "-' .,J::.. Pair 6 continued Mother days -5 to -3 -loving -moodiness; temperamen tal -organized -positive feeling of well-being -proud -stressed -tension tv+:0. Pair 7 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to -3 days -2 to - Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -bloating· -bloating· -angry; mad· -anger· -mad· -anger; mad· -anger; mad· -anger· -angry; mad· -angry; mad· -cramping* -cramping· -calm; relaxed; -relaxed· -confused· -confused· -happy; -happiness· -shoulder pain· -pain· -tired· -tired· mellow* -frustration· -frustrated· -frustration· satisfied· -tired· t appetite -anxiety -busy -anger; mad -frustrated· -happy* -happy* -happy* -tired; worn -annoyance -busy -confusion -diarrhea -anxiety -happy· -annoyance; -headache· -headache· out· -depression -felt taken -grateful -frustrated - T appetite; -impatient· impatience; -tired· -tired· - 1 appetite -disappointed advantage -happy -guilty hunger -stressed· irritability· -painful breasts -anxious -busy -embarrassment -frustrated -hurting -hard working -confusion -acne -stress· -busy T appetite; -food cravings -excited; -guilty -scared -nice -excited -bloating -desire to be - being cheated hunger -frustrated exhilarated -hard working -stomach ache -shoulder pain -friendly -busy alone -cramp (lower -embarrassed -guilty -headache -headache -thoughtful -sick -happy -guilty - T appetite abdomen) -fat -hard working -hyper -nice -isolated -jealous -backache; -guilty -impatience -loving -sleepiness -stressed -sad -nice cramps - hard working -jealousy; -mellow; -strong -satisfied -bored -nice; too envious relaxed -shoulder pain -confused nice -out -of-place -negative. very -understanding -different -shoulder pain -shy -nice - 1 energy -sick -sore throat -thoughtful -excitement; -regret exhilarated -spiritual -friendly -stressed -loneliness; -1 desire to lonely talk -moodiness -teary -proud -understanding -sleepy -thoughtful -tired "'-' ~ w Pair 8 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to-3 days -2 to I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -cramps· -cramps· -depressed· -poopy· -happy* -happy* - T appetite; - T appetite· -comforting· -under- -happy· -happy* -energy level -energy· -irritability· -irritable· hungry* -moody· -excited· standing· -busy - t appetite high· -happy* -tired· -tired· -emotional· -happy· -happy* -excited· -fearful -disappointed -happy· -irritability* -busy -anxious -happy* -calm· -allergy Sx -happy* -relieved -frustrated -irritability; -good· -compassion- -bored -mellow* -bored -sore breasts -anxiety grumpy· ate -energetic; -irritable - t appetite -allergies t energy; -disappointed -daring -feeling of well- -feel fat hyper -fat -energetic -O.K. -food craving -tender breasts hyper; being· -festive -organizer -irritable, a little -stressed -bored -busy excited -agitated -nervous -tired -cramps t hassles -supportive -gossipy -attentive -excited -interested -worried -grouchy; -O.K. -disagreeable -stressed -O.K. -loved impatient; -feel good -tired -pained -reflective irritable about -stressed -relaxed -hot decisions -self-assured -mad -glad to be a -difficulty falling -O.K. parent asleep -pained -nausea -tension -polite -professional -thoughtful -poopy -sad -reluctant -slow -sunburned -teary -tired -a little understanding -~ ~ Pair 9 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or I day days -5 to -3 days -2 to -I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter - 1 appetite· -munchies· -happy; -happy* -analyzing -depressed· -bummed· -hard working· -hard working· -teary· -teary* cheerful· - 1 energy; -angry -stressed· -stressed· -Ionely* -Ionely* -tired· -tired· -wired· hyper; -anXIous -worn out· -tired· -alone -acne -abdominal -need to be -angry excited· -concentr ating -wierd· -wierd· -anxious -bored distention; alone -anxious -cramps -fragmented -accepting -annoyed; - T appetite -difficulty bloated -boring ! appetite -depressed -friendly -adequate bothered -caring concentrating -anxious -cramps -assertive -distant; -hard working 1 appetite -cheezy -concerned -excited -emotional -out of control -distant -frustrated -busy withdravvn 1 appetite -confused -giddy; -held others at -relaxed; at -excited cheerful -hard working -calm exterior; -1 energy -assertive -depressed a distance peace -lonely -groggly -lonely in control -feisty -calm -fat -stressed -moody -happy -out of control - 1 sleep -capable; -hard working -constipated -forgetful -used; victim -sad -impatient; -secure efficient -honest & - fun -frustrated -worried irritability -self-reflective -concerned crtical -giving -can't sleep; -in love can't sleep -frustrated -hostile -hives; rash trouble -independent -awaken early -fun -irritated; little -intelligent sleeping -willing to -introspective patience -keep going -giving accept -lonely -moody; -loving; -grateful -stressed emotional compassionate -hurt inside responsibilities -nausea -positive feeling -mad -out of control of others -overwhelmed of well-being -non-defensive -sad -awaken early -rebellious -successful; -stressed -sleepy; tired -silly competent -ugly -stuffing feelings -teary -thoughtful; -worried -talkative kind -tense -torn -unwanted -ugly -used -unappreciated -weird -Vl..J:>. Pair 10 Menstrua! Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to -3 -2 to - Mother Daughter Mother Mother Mother Mother -abdominal -happy -anxlous* -scared* -alone distention; -fun* -fun* -anxIous bloated cheerful* -tlred* -worn out* -tired/awake* -anxIous tlred* -over -reactor -wired -r ClIJIJC::ULC:: -concerned -angry -angry -adequate breasts -confused -anXJOUS -1 appetite -happy -depressed -nervous -assertive - T appetite -fat -scared -out of control -assertive -forgetful -friendly -secure -calm exterior; -calm -frustrated -hard working -self-reflective in control -constipated -can't sleep; -out of control -cant -capable; -giving trouble -relaxed; at -awaken early efficient -hives; rash sleeping -teary -concerned peace -stressed -tired -frustrated -keep going -fun -used; VIctim -Introspective -hurt inside -lonely -mad -stressed -non -defen sive -out of control -nausea -stressed -sad -overwhelmed -successful; -stressed -awaken competent -ugly feelings -thoughtful; -worried -talkative kind -tense -torn -unwanted -unappreciated -used -weird -.+;:.. C'\ Pair II Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I 3 to 5 ovulation + or - -5 to -3 days -2 to I Mother Daughter Mother Mother Mother Daughter Mother Daughter -abdominal good* -relaxed; at -relaxed* -stressed* -stressful* -depressed* distention; cheerful* -nice peace* -awaken early -worn out* -tired* -stressed* -stressful; bloated -angry -analyzing -accepting -contention -alone stressed out* -anXlOUS -anxIous -angry -adequate -fighting, lots of -anxious -terrible - 1 appetite -1 appetite -anxIous -cold -1 appetite -mean - T appetite -concentrating -emotronal -sensitive -frustrated -assertive 1 appetite -caring -fragmented -food craving -hard working -assertive -concerned -friendly -fun -calm exterior; -calm -confused -out of control in control -hard working -headache -fat -out of control -kind; nice -secure -capable; -depressed -forgetful -stressed -self-reflective effiCient -fun -frustrated -used: victim -pretty good - cant -concerned -giving -cant sleep; -tired -awaken early -frustrated -hives; rash trouble -fun sleeping -tired -introspective -giving -lonely -grateful -stressed compassionate -hard working -nausea -mad -hurt inside -overwhelmed -non-defensive -lonely -awaken -successful; -out of control -sleepy; tired competent -sad feelings -thoughtful: -ugly -talkative kind -worried -tense -torn -unwanted -used -unappreciated ~ -weird -....J Pair 12 Menstrual Phase Menstrual Phase Periovulatory Phase Premenstrual Phase Premenstrual Phase day I days 3 to 5 ovulation + or - I day days -5 to -3 days -2 to -I Mother Daughter Mother Daughter Mother Daughter Mother Daughter Mother Daughter -anger -angry -anger -eager; -excited· -fear; worried· -anxious· -anticipation -attractive -apprehension; excited· -pretty good· -excited· -excited· -bloated -bloated worried -happy; -anxious· -anger -confused -dependent -cold -busy cheerful; -okay -attentive; -pretty cool; -depressed -cooperative -dependable good· -sad conscientious; terrific; -disappoint -cranky -despair -worried· -smart; reliable neato ment -dependable -empathetic -angry talented -bored -pretty -excited -depressed; -energetic -attentive; -terrified -busy -talented -frustrated do'Ml -excitement concern -cold -helpful -disgust -faint -cold -contentment -pensive -dumb -faith -competent; -depression -pleasant; -emotional -happiness; dependable -dumb positive -empathetic cheerful -complaining -fair -realistic -fat -humorous -empathetic -understanding -sadness -frustration -hunger -energetic -full -slow -gratitude -love -fat; plump -happiness; -SOB; vvheezy -happy; -nice -frustr ation cheerful -thankful positive; -patience -gratitiude -helpful -worry cheerful -realistic -helpful -hungry -hard worker; -relief -hungry -nice; pleasant competent; -sleepiness -love -plain thorough -spiritual -pain -quiet -helpful -teachable -persistant -reassured -hunger -thorough -prompt -rushed -hurt -relieved -sorrowful; -impatience -sleepy; tired weepy -kind; nice -slow -spiritual ...... +::0. 00 Pair 12 continued Mother Mother Mother days +3 to +5 days -2 to -I days -2 to -I -loved -teasing -tired -loving; com- -thoughtful passionate -patient -sadness; unhappy -slow -teachable -tired -worried ..\0 APPENDIXG PAIRED DATA: INTERACTION ACROSS THE MENSTRUAL CYCLE - Pair 1 closeness conflict affection hassles 100 90 80 LJ 70 . /;;:-. 60 50 il \ •.-~ I V --• 40 - .. / /' /" • 30 _-8 .---[ 20 - j 10 0 t- men ov pre men ov pre men ov pre men ov pre [·III~mot·her--·L;daughierJ -v. 152 Q) '-c. / ,/ Cf) /-- Q) .~/ > I 0 Cii \ Cf) m I, c .c. Q) • E s- c.~ ...... ,Q) I C • .c. 0 > C> +=i 0 0 :::s • c ell ~ Q) m "11 -C N E s.... -- ~ s- I c. Q) ea .c. ....2 > ...... , 10... I;:: IJ" 0 0 c '" 0 " " c 0 "" Q) E '. E ,I ~ Cf) I, c. Cf) I ~, Q) c "~, > Q) 0 Cf) 0 ~ c (3 .~ Q) E 0 0 0 0 0 0 0 0 0 0 0 0 a> CO I"- CO LC') ..q- ('t") N -,:- -,:- 153 a> o.t..- CJ) a> > 0 enCJ) to c:: .r:. a> • E '- ~ Q.) • ---D 0...... , c:: ~_// ..c: 0 > C> t$ ~ . 0 ::::l 'i~ CO I ~ ! "\ c:: I to ..'-- a> "'C E 1M I I L- a> t..- '- \-- I o. Q.) ICO ..... I ..c: .2 I ...... , c;::::: > 10.. c:: 0 0 0 (.) c:: E ~I a> E • a> CJ) t..- CJ) fl- 0. a> / .' c:: a> > CJ) 0 0 (.) c:: a> E 0 0 0 0 0 0 0 0 0 0 0 0 0') CO f'... CO LO ..q- M N ~ ~ Pair 4 closeness conflict affection hassles 100 90 /J 80 70 '\',/ C1 . 60 1//1 /,:? 50 ~/ 40 30 20 1~ ____~-_-\_« ___ ----~.----t -i t-- men ov pre men ov pre men ov pre men ov pre [--~~-moth-er----:~:-dau9hterJ Vl -..a::.. ------<- 155 0>..... c. (J) ~ > (J) o (J) CO c: ..c. 0> E I.- 0> Q) ..... '+oJ c: C. .r::. 0 C) ~ i~ ::J "~I 'I ~ i c: m CO 0> \ -C • E I A. LO y I- 0> I.- -- Q.\Q) • I m I .r::. 0 > '+oJ q:: o 0 a. c: 0 ~ / c: E 0 0>, ~. E • (J) 0> (J) --!- ..... 0> C. c: 0> > (J) o o 13 c: 0> E 00000000000 O(j)COI'-COL()~(f')N~ ~ - .. ~.-- .- Pair 6 closeness conflict affection hassles 100 -- 90 80 J 70 I 60 .'"" 1/· I 50 I,"·' "LJ 40 30 20 10 ..- •• o .-- +-~-~~:.--~--+--- --_···t men ov pre men ov pre men ov pre men ov pre r -'-----~-'------._------.--- 1 1-,mother-LI- daughter Vl -0\ .--.-. --- --_ .... - 157 Q) n L- '--' I C. (f) I 0.> /~ (i) ,.1, > (f) 0 m c: .J::. L~, Q) L..J E t- ~~ a> c. iE c: •I 0 I C') :.;:::; > 0 0 ::l /• ~ / c: m m Q) I -C .. : I E r- I I'- "f I '- Q) t- -- L- • c. a> ea ~ / I.e:. ti= > I+-' c.. c: 0 0 0 • f c: 0 Q) E • E I •I Q) (f) L- (f) C. 0.> • c: I> 0.> 'ny (f) I to \ 0 !• \ i \ 0 h '----' l~ I •! I I I I I IE 0 0 0 0 0 0 0 0 0 0 0 0 (j) CO l"- CC LO V ('t') C\I -,:- -,:- -~ Pair 8 closeness conflict affection hassles 100 90 80 70 • .--'. 60 • 50 ~TJ--- -{-.J 40 -----\ 30 • "\ . 20 \', II' 10 o men ov pre men ov pre men ov pre men ov pre 1-"mother -{l daughter-l Vl -00 159 -~ ~ a. C/J 0> 7i) • . I _c- ~ / :\ C/J ~ / \ "- CO \ C .c:. h L.J 0> • I E '- 0> Q) -- a.L- .... c :~~~ .J:::. 0 C) +=i [( -- ~ 0 . ::J '/ ~ i C CO CO 0> -C 0) • E ~ .....J I L. -- .0> '- m L.J ta. Q) •I ! ....., I .J:::. 0... • I .+> .... .~ -~"'- : 0 0 ti: '>. I C ''>'-" . C 0 E 0 ~/-0> ~ E I > o c 0> E 00000000000 o m ~ ~ ID ~ V M N ~ ~ Pair 10 closeness conflict affection hassles 100 • 90 - / .----./ 80 ,. -. -- •L r~- 70 • 60 \ 50 \ .. 40 30 [J 20 10 J ~J ______rr~~~::c-. 0 ,I I men ov pre men ov pre men ov pre men ov pre ["mot-her--:'~da-ughler] 0'\ -0 Pair 11 closeness conflict affection hassles 100 •I 90 - 80 \ I \ 70 I • 60 50 40 30 20 10 0 men ov pre men ov pre men ov pre men ov pre r-~·----·~------1 1---mother -D- daughter -0'\ Pair 12 closeness conflict affection hassles 100 90 80 [J [J 70 • • 1/ • • 60 • "- I " "-" I /\ " ' .. 50 .I \.. ""II' .-----.--. [J 40 LJ 30 20 10 0 men ov pre men ov pre men ov pre men ov pre r-';:-moiher-0- daughterl 0\ tv APPENDIXH DATA: GRAPHS OF SYNCHRONOUS AND ASYNCHRONOUS PAIRS 164 .....Q) y 0- / \ > ur ~ 0 0'> ..... ~// .a; e 0- ./ ~ Q) E en en r- en eo a.. 1- Q) (]) (f) en co C ::J .r::. 0 0- (]) r:: Q) 0 en r- 13 U') 0 ..c: u~ r- 0 a> ()- r:: .s::::...... , >- --r 0 I en "¢ E ...... a; \Q) 0- ~ ..... 10- • • I -.-> !o Ie -.-Q) • E 0 0 0 0 0 0 0 eX) CD ..q- C\I ~ ·-·--C-'oseness Asynchronous Pairs pair 3 pair 5 pair 6 pair 7 pair 8 pair 11 100 I /)~ • • ... 801~/·\ . .,/ / . \ . .. ~.J 60 I / Ii / 40 [j 20 +- o men ov pre men ov pre men ov pre men ov pre men ov pre men ov pre Cycle phase - ..------.- ..--. - ...---- ·-----······-1 [. a· mothers -.[,=1- daughters 0'\ -Vt 166 o> U) s- Q) rn r tJ) ..... (L I m i .c u U) 0- -1- -- :::s Q) -\f- 0 C c: ~ ~ 0 t) 0 s- CLl .r::. .r::...., O 0 o c: E en>- "I:t Oro.... c. o o o o o o o ex:> CO V N ~ Conflict Asynchronous Pairs pair 3 pair 5 pair 6 pair 7 pair 8 pair 11 100 80 60 Il' 40 •\ / '\ 20 r f\ .. . {;J • I -- .....,. ~·-+:::'·.-:..-+-~_t_---t--. t--1----t- I-- +--+----1- 0 menov pre men ov pre men ov pre men ov pre men ov pre men ov pre Cycle phase • mothers -daug-htersI ...... 0\ -....l Affection Synchronous Pairs c pair 4 pair 9 o u 100 a> 16 .--- -g 80 LJ' -. . en en •! a> / / ~ 60 / a> . L- \ / a> \ I ~ 40 \ I ::J ('0 '\, / "U L:::: a> 20 J.::..... V o E --1- - >- o + E men ov pre men ov pre Cycle phase [';mothers---daughtersl -(J'\. 00 Affection Asynchronous Pairs pair 3 pair 5 pair 6 pair 7 pair 8 pair 11 § 100 u Q) :t: ~ 80 !:;l Q) .- (J) I . (J) Q) d/\ II a.x 60 Q) • '- Q) • lr--•[,1] '. ~ 40 :::J «J j "'0 'i::: ~ 20 .....o • E •• ~ E 0 ~... ~---t-- +--+--+--+- +---I--t-+ -t- +---+----j--t---+- men ov pre men OV pre men OV pre men OV pre men OV pre men OV pre Cycle Phase r~-m()ihers--~;:-daughters I --"".--- CJ\ -\0 170 a> • a.L- \ \ \ 0> ..... 0> *(6 • : en c.. L- ..,a.> I I c:: .r:::. en -+-a> C) L- • E ::J ro a> I CO (/) -0 i en a.. CO I I .r::. Q.) en 1- a. :J a> -en 0 (3 c: ~ en 0 u rn L- a> L- .r::. L..y ~ ./ a. 0 ~/ J: / \ // c: / \ / >. / / en / ~ t:/ +0I> ..... \ '(6 I c.. c:: a> -= E 0 0 0 0 0 0 0 co co ~ N ~ Hassles Asynchronous Pairs pair 3 pair 5 pairS pair 7 pair 8 pair 11 100 80 60 \ 40 V i<: merov pre merov pre merov pre merov pre merov pre merov pre Cycle phase c .- mothers }- daughters 1 -...... REFERENCES 173 Abplanalp, J. M. (1991). Psychological research on PMS--Past and current research, and future directions. In A. M. Voda & R. 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