Purpose Dysmenorrhea affects quality of life and contributes to absenteeism from school and work diminishing opportunities for successful psychosocial and cognitive development during adolescence. In adults, depression, anxiety, and smoking have an impact on menstrual cycles and dysmenorrhea. Associations between these potential problems have not been examined in adolescents. The purpose of this study was to examine relationships between depressive symptoms and anxiety with menstrual symptoms. Smoking was examined as a moderator of this relationship. Methods This study enrolled 154 post-menarcheal girls from a sample of 207 girls age 11, 13, 15, and 17 years [M = 15.4 years (± 1.9)]. Self-reported measures included the Menstrual Symptom Questionnaire (MSQ), Children’s Depression Inventory (CDI), State-Trait Anxiety Inventory, and smoking behavior. Generalized linear regression modeled MSQ outcomes separately for depressive symptoms and anxiety. Results More depressive symptoms/anxiety were related to higher numbers of menstrual symptoms (r = 0.23–0.44, p < .05). Smoking status (ever) was related to higher MSQ scores. Moderating effects of smoking and depressive symptoms or anxiety on menstrual symptoms were consistent across most MSQ factors where effects were stronger in never smokers. Conclusion This is the first study in adolescents showing smoking status and depressive symptoms/anxiety are related to menstrual symptoms and that the impact of depressive symptoms/anxiety on menstrual symptoms is stronger in never smokers. The dynamic and complex nature of smoking, moods, and dysmenorrhea cannot be disentangled without longitudinal analyses. Efforts to reduce menstrual symptoms should begin at a young gynecological age and include consideration of mood and smoking status.

Objective Stress and stress-related concomitants, including hypothalamic-pituitary-adrenal (HPA) axis activation, are implicated in obesity and its attendant co-morbidities. Little is known about this relationship in adolescents. To begin to address this important knowledge gap, we studied HPA axis activity in 262 healthy adolescent girls aged 11, 13, 15, and 17. We hypothesized that obesity would be correlated with increased HPA axis activity and reactivity. Methods Measures of HPA axis activity included 3 blood samples obtained mid-day (between 1300 and 1400) over the course of 40 minutes and overnight urine free cortisol (UFC), and cortisol levels 0, 20, and 40 min after venipuncture (cortisol reactivity). Measures of adiposity included BMI, BMI-Z, percent body fat, and fat distribution (central adiposity) assessed by dual energy X-ray absorptiometry. Results Daytime levels of serum cortisol were inversely associated with BMI-Z and central adiposity (p < 0.05). The UFC excretion rate was positively correlated with BMI, BMI-Z, and central adiposity. There was blunting of cortisol response to venipuncture with increasing adiposity. Conclusions Our results suggest that there may be reduced cortisol levels during the day and increased levels at night with increasing degree of adiposity. This study provides preliminary findings indicating an alteration of the circadian rhythm of cortisol with obesity. We conclude that obesity is associated with altered HPA activity in adolescent girls. The clinical implications of our findings require further investigation.

The purpose of this study is to evaluate the association between anxiety and depressive symptoms and obesity among adolescent females using objective measures of adiposity, and evaluate for moderating effects of race and age. This is a cross-sectional analysis of 198 females ages 11, 13, 15, and 17 years (mean 14.6, SD 2.2). Adiposity measures include BMI, BMI Z-score (BMI-Z), percent body fat from Dual Energy X-ray Absorptiometry (DXA), and fat distribution (fat mass upper vs. lower body regions from DXA). Symptoms of anxiety were measured with the State-Trait Anxiety Inventory; depressive symptoms with the Children's Depression Inventory. Trait anxiety and depressive symptoms were positively associated with BMI and percent body fat. No interaction of anxiety/depressive symptoms with race or age on measures of adiposity was detected. Symptoms of anxiety and depression are associated with percent body fat among adolescent females, linking psychological distress with a physiological measure of adiposity.