The Difference Between Subjective Symptoms and Objective Symptom of Edema During the Menstrual Cycle

The Difference Between Subjective Symptoms and Objective Symptom of Edema During the Menstrual Cycle | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Difference Between Subjective Symptoms and Objective Symptom of Edema During the Menstrual Cycle Yuki Takano, Tatuki Shirai, Yudai Tanaka, Kodai Sakamoto, Hirotake Yokota, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6721220/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background This study aimed to elucidate the differences between subjective and objective symptoms of edema during the menstrual cycle in female university students with normal menstruation. Methods The study included 29 female university students with normal menstrual cycles. The menstrual cycle was categorized into the early follicular, mid-luteal, and late-luteal phases, and measurements were taken during each phase. Subjective symptoms were evaluated using body charts and the Menstrual Distress Questionnaire (MDQ) to assess the presence of edema. Objective symptoms were measured using a body composition analyzer to assess body weight, body water content, and regional water content. Results In the evaluation of subjective symptoms of edema using the body chart, no significant differences were observed across cycles. However, when body regions were compared, there were significantly fewer subjective symptoms in the upper arm (Rt/Lt) than in the face and trunk across all phases, while the lower leg (Rt/Lt) had significantly more subjective symptoms. The MDQ (water retention item) showed no marked differences across cycles. For objective evaluations of edema, including body weight and total body water, no significant differences were observed across cycles; however, regional water content was significantly higher in the trunk and right arm during the mid-luteal and late-luteal phases than in the early follicular phase. Conclusion Our findings suggest that the location and timing of subjective edema symptoms may differ from those of objective symptoms. Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors menstrual cycle premenstrual syndrome edema menstrual distress questionnaire Figures Figure 1 Introduction Premenstrual syndrome (PMS) refers to a group of emotional, behavioral, and physical symptoms that emerge during the late luteal phase of the menstrual cycle and subside with the onset of menstruation 1 . Epidemiological studies report that PMS affects a large proportion of women—approximately 80–90% 2 —with around 5% experiencing symptoms severe enough to significantly disrupt daily life, social functioning, and occupational performance, often necessitating medical treatment 3 . According to the American College of Obstetricians and Gynecologists, PMS symptoms include a variety of physical complaints (e.g., increased thirst and appetite, breast tenderness, abdominal bloating, weight gain, headaches, extremity swelling, general aches, fatigue, skin issues, and digestive disturbances) and emotional or psychological symptoms (e.g., depressive moods, anger, irritability, tearfulness, heightened anxiety, mental confusion, social withdrawal, difficulty concentrating, trouble sleeping, excessive daytime sleeping, and altered libido)( https://www.acog.org/womens-health/faqs/premenstrual-syndrome) ༎ Although the precise etiology of PMS remains uncertain, previous research suggests it may be associated with the response of γ-aminobutyric acid (GABA)-A receptors to progesterone metabolites during the luteal phase 4 , as well as altered sensitivity of the serotonergic system 5 . PMS symptoms are generally observed in the late luteal phase, when circulating levels of the ovarian hormone progesterone (P4) are elevated and tend to subside or resolve shortly after menstruation begins—typically within four days. These observations imply that cyclical hormonal variations across the menstrual cycle, particularly fluctuations in progesterone levels, may play a critical role in the manifestation of PMS symptoms ( https://www.acog.org/womens-health/faqs/premenstrual-syndrome ). The menstrual cycle is controlled by dynamic changes in female steroid hormones 6 – 8 . These hormonal variations involve the hypothalamic secretion of gonadotropin-releasing hormone (GnRH), the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland, and the ovarian production of estrogen (E2) and progesterone (P4) 6 . Estrogen promotes the release of vasopressin 9 , 10 , a key hormone in osmotic regulation, leading to an increase in plasma volume 11 . Progesterone also contributes to expanding plasma volume as well as extracellular fluid. Consequently, both E2 and P4 play crucial roles in the regulation of body fluids, and their cyclical fluctuations throughout the menstrual cycle are likely to affect fluid retention-related symptoms such as breast tenderness and abdominal bloating observed in PMS. One method for evaluating PMS is the Menstrual Distress Questionnaire (MDQ) 12 . The MDQ comprises 46 items rated on a five-point scale based on symptom severity. These items are categorized into eight subscales: pain, water retention, autonomic reactions, negative affect, concentration, behavioral change, arousal, and control, allowing for a comprehensive assessment of PMS symptoms. The water retention subscale, which was the focus of this study, assesses four specific symptoms: weight gain, skin problems, breast pain or tenderness, and breast or abdominal bloating. However, the MDQ is based on subjective self-assessment and does not objectively confirm the presence of edema. Objective methods to assess edema typically involve quantifying body water content and its distribution. Among these, bioelectrical impedance analysis (BIA) is a widely utilized, non-invasive technique that estimates parameters such as body fat percentage, fat-free mass, and total body water (TBW). Prior research examining fluctuations in body composition throughout the menstrual cycle using BIA has yielded mixed results, with some studies reporting no significant cycle-related changes 13 – 18 . Conversely, other investigations have documented phenomena such as weight gain during the luteal phase 19 , 20 , weight reduction in the follicular phase 21 , and elevated TBW in the late luteal phase 22 , 23 , reflecting inconsistencies in the literature. Recent advancements in BIA technology have improved its accuracy, allowing detailed evaluation of edema, including segmental water content and extracellular water ratio 24 – 26 . Therefore, this study aimed to elucidate the differences between subjective and objective symptoms of edema across the menstrual cycle in female university students with normal menstrual cycles. Results E2 and P4 concentrations across menstrual cycles The results for E2 and P4 concentrations during each cycle phase are presented in Table 1 . For E2 concentrations, no significant main effects were observed in the repeated-measures analysis of variance. However, for P4 concentrations, a significant main effect of the menstrual cycle on hormone levels was found (F (1.574, 44.067) = 4.752, p = 0.020, partial η² = 0.145, observed power = 0.695). Post-hoc Tukey’s test revealed a significant difference between the early follicular and mid-luteal phases (p = 0.009, mean difference = 140.68, 95% CI [29.91–251.45]). Table 1 Changes in estradiol and progesterone concentration during the menstrual cycle Early follicular phase Middle luteal phase Late luteal phase Total F value P value Partial η² Power Estradiol [pg/mL] 1.3 ± 0.4 1.4 ± 0.6 1.3 ± 0.7 1.3 ± 0.5 (1.616, 45.261) 0.864 0.407 0.030 0.175 Progesterone [pg/mL] 217.7 ± 132.3 358.4 ± 302.3 a 303.7 ± 250.1 293.3 ± 243.3 (1.574, 44.067) 4.752 0.020 0.145 0.695 N = 29 Values are presented as means ± SD. a Statistically significant difference compared with the early follicular phase(p = 0.009, mean difference = 140.68=140.68, 95%CI[29.91–251.45]). Evaluation of subjective symptoms of edema: Body chart and MDQ results The results of the body chart and MDQ (fluid retention items) are presented in Tables 2 and 3 , respectively. In the body chart analysis, Pearson's chi-square test revealed no significant differences across menstrual cycle phases. However, between the body regions, edema was significantly less frequent in the upper arms (right/left) than in the face and trunk (p < 0.001) and more frequent in the lower legs (right and left) (p < 0.001) across all phases. For the MDQ (fluid retention items), no significant main effects were observed across menstrual cycle phases. Table 2 Changes in subjective assessment of edema (body chart) during the menstrual cycle Early follicular phase Middle Luteal phase Late Luteal phase Face and Trunk 7 (24.1) 6 (20.7) 5 (17.2) Upper arm (Rt) 2 (6.9) a 1 (3.4) e 2 (6.9) i Upper arm (Lt) 3 (10.3) b 2 (6.9) f 1 (3.4) j Lower leg (Rt) 18 (62.1) c 12 (41.4) g 16 (55.2) k Lower leg (Lt) 18 (62.1) d 12 (41.4) h 17 (58.6) l N=29. Number(%) a Statistically significant difference compared with face and trunk in the early follicular phase ( P < .001, adjusted residuals [-3.4, 3.4]). b Statistically significant difference compared with face and trunk in the early follicular phase ( P < .001, adjusted residuals [-2.9, 2.9]). c Statistically significant difference compared with face and trunk in the early follicular phase ( P < .001, adjusted residuals [3.7, -3.7]). d Statistically significant difference compared with face and trunk in the early follicular phase ( P < .001, adjusted residuals [3.7, -3.7]). e Statistically significant difference compared with face and trunk in the middle luteal phase ( P < .001, adjusted residuals [-2.7, 2.7]). f Statistically significant difference compared with face and trunk in the middle luteal phase ( P < .001, adjusted residuals [-2.7, 2.7]). g Statistically significant difference compared with face and trunk in the middle luteal phase ( P < .001, adjusted residuals [2.8, -2.8]). h Statistically significant difference compared with face and trunk in the middle luteal phase ( P < .001, adjusted residuals [2.8, -2.8]). i Statistically significant difference compared with face and trunk in the late luteal phase ( P < .001, adjusted residuals [-2.9, 2.9]). j Statistically significant difference compared with face and trunk in the late luteal phase ( P < .001, adjusted residuals [-3.3, 3.3]). k Statistically significant difference compared with face and trunk in the late luteal phase ( P < .001, adjusted residuals [3.6, -3.6]). l Statistically significant difference compared with face and trunk in the late luteal phase ( P < .001, adjusted residuals [4.1, -4.1]). Table 3 Changes in subjective assessment (Water retention of MDQ) during the menstrual cycle Early follicular phase Middle Luteal phase Late Luteal phase Water retention 3.6 ± 3.1 2.1 ± 2.5 2.8 ± 3.1 Values are presented as means ± SD. SD: Standard Deviation Objective evaluation of edema: InBody measurements results The results for weight (Kg), TBW (L), segmental water content (L), ECW (L), and ECW/TBW ratio are presented in Table 4 . Repeated measures analysis of variance revealed no significant differences across menstrual cycle phases for weight, TBW, ECW, and ECW/TBW ratio. However, significant main effects were observed for segmental water content in the trunk (F (2, 59) = 4.919, p = 0.011, partial η² = 0.149, observed power = 0.786) and right upper arm (F (2, 56) = 5.356, p = 0.007, partial η² = 0.161, observed power = 0.821). Post-hoc Tukey's test revealed that the trunk water content, values were significantly higher in the mid luteal phase than in the early follicular phase (p = 0.034, mean difference = 0.1241, 95% CI [0.0075–0.2408]) and in the late luteal phase than in the early follicular phase (p = 0.017, mean difference = 0.1379, 95% CI [0.0213–0.2546]). In addition, for the right upper arm water content was significantly higher in the mid-luteal phase compared to the early follicular phase (p = 0.023, mean difference = 0.0262, 95% CI [0.003–0.049]) and in the late luteal phase compared to the early follicular phase (p = 0.013, mean difference = 0.0283, 95% CI [0.005–0.051]). Table 4 Changes in objective assessment (in the body) during the menstrual cycle Early follicular phase Middle luteal phase Late luteal phase F value P value Partial η² Power Body Weight(kg) 55.55 ± 7.51 55.40 ± 7.59 55.55 ± 7.66 (2, 56) 0.566 0.571 0.020 0.139 Total Body Water(L) 30.36 ± 4.18 30.53 ± 4.49 30.64 ± 4.27 (2, 056) 2.638 0.080 0.086 0.504 Segmental Body Water(L) Trunk 13.93 ± 1.83 14.05 ± 1.88 a 14.07 ± 1.80 b (2, 59) 4.919 0.011 0.149 0.786 Right Arm 1.50 ± 0.30 1.53 ± 0.31 c 1.53 ± 0.30 d (2, 56) 5.356 0.007 0.161 0.821 Left Arm 1.47 ± 0.29 1.51 ± 0.31 1.49 ± 0.29 (1.285, 35.970) 2.486 0.116 0.082 0.377 Right Leg 5.05 ± 0.76 5.08 ± 0.81 5.10 ± 0.79 (2, 6) 1.960 0.150 0.065 0.389 Left Leg 5.03 ± 0.76 5.07 ± 0.81 5.07 ± 0.78 (2, 56) 1.753 0.183 0.059 0.352 Extracellular Water(L) ECW/TBW 11.45 ± 1.46 0.38 ± 0.01 11.49 ± 1.61 0.37 ± 0.02 11.57 ± 1.51 0.38 ± 0.01 (2, 56) 2.030 (1.037, 29.045) 1.539 0.141 0.226 0.068 0.052 0.401 0.228 Values are presented as means ± SD. ECW/TBW: Extracellular Water to Total Body Water Ratio SD: Standard Deviation a Statistically significant difference compared with the early follicular phase(p = 0.034, mean difference=0.1241, 95%CI[0.0075–0.2408]). b Statistically significant difference compared with the early follicular phase(p = 0.017, mean difference=0.1379, 95%CI[0.0213–0.2546]). c Statistically significant difference compared with the early follicular phase(p = 0.023, mean difference=0.0262, 95%CI[0.003–0.049]). d Statistically significant difference compared with the early follicular phase(p = 0.013, mean difference=0.0283, 95%CI[0.005–0.051]). Discussion Our findings revealed that subjective measurements did not show cyclical changes, with edema more frequently observed in the lower limbs. In contrast, objective measurements revealed significantly higher segmental body water content in the trunk and right upper arm during the luteal phases (mid-luteal and late luteal phases) compared to the early follicular phase. These findings suggest a disconnect between subjective edema symptoms and physiological changes. Subjective symptoms of edema during the menstrual cycle have been frequently reported in studies on PMS and Premenstrual Dysphoric Disorder, often including complaints of edema and abdominal bloating, which typically appear in the late luteal phase of the menstrual cycle and subside with the onset of menstruation 1 , 2 , 12 . However, the results of the MDQ in this study showed no significant changes in fluid retention items across the menstrual cycle. Moreover, the body chart revealed no significant differences between cycles; however, edema was significantly more frequent in the lower legs (Rt/Lt) than in the face and trunk throughout the entire cycle, contradicting the results of previous studies. This discrepancy may reflect not only PMS symptoms but also primary dysmenorrhea-related symptoms such as abdominal bloating and fatigue 27 , 28 . Further, objective evaluations of edema, such as body water content and limb circumference, do not align with subjective symptoms, and while changes in body weight and body water content have been observed, no direct correlation with the sensation of swelling has been reported 19 , 29 . Similarly, this study found increased body water content in the trunk and right upper limb during the mid-luteal and late-luteal phases; however, subjective symptoms remained consistent across cycles, with edema most frequently observed in the lower limbs, indicating a discrepancy between objective and subjective evaluations. This discrepancy may stem from the regulatory effects of estrogen and progesterone on water and electrolyte balance. Stachenfeld et al. 9 – 11 have reported that these hormones affect antidiuretic hormone (AVP) and sodium excretion, leading to changes in plasma and extracellular fluid volumes. In this study, the salivary P4 concentration was significantly higher in the mid-luteal phase compared to the follicular phase. Therefore, body water changes probably occur, but the sensation of edema does not align with them. In addition, Cumberledge et al. 13 and Hicks et al. 14 have noted that body water measurements using BIA have limitations in detecting minor changes in body water caused by hormonal fluctuations, suggesting that the limitations may contribute to the discrepancy between objective and subjective symptoms. Furthermore, the intensity of subjective symptoms is believed to be influenced by psychological factors, and fluctuations in hormone levels are reportedly strongly associated with emotional changes and sensitivity to bodily sensations 3 , 30 . In this study, only salivary levels of E2 and P4 hormones were analyzed; however, hormonal fluctuations throughout the menstrual cycle may affect the perception, potentially leading individuals to misinterpret other symptoms or factors as edema. Our findings are clinically valuable. For example, when young women report edema, it is important not only to evaluate the presence of fluid retention but also to consider the menstrual cycle and psychological state comprehensively. In addition, in exercise instruction and nutritional management, understanding subjective reports of bodily changes and responding appropriately could serve as evidence to guide interventions. This study had some limitations. First, the participants were limited to healthy female university students, and the sample size was relatively small (29 participants); hence, caution is needed when generalizing the results. Second, the phases of the menstrual cycle were classified based on BBT and self-report, and hormone analysis was conducted using saliva samples; however, since no blood tests were performed to measure hormones, an exact match with actual hormonal fluctuations cannot be guaranteed. Third, BIA was used to measure body water; however, this method has limitations in accurately capturing water distribution and subtle changes, meaning that it may not fully reflect localized edema changes. Furthermore, lifestyle factors such as daily activities, fluid intake, and salt consumption may influence body water content and the perception of edema; however, these factors were not adequately controlled in this study. Materials and methods Participants A questionnaire survey was administered to 44 female university students, of whom 29 met the inclusion criteria: a menstrual cycle length of 25–38 days, 31 and no use of oral contraceptives or hormonal agents within the past 6 months 32 . All participants had regular menstruation and provided informed consent to participate in the study (Fig. 1 ). Their characteristics were as follows: age 20.2 ± 0.7 years, height 162.8 ± 5.9 cm, and weight 55.5 ± 7.5 kg. All study protocols were performed according to the Declaration of Helsinki, after receiving approval from the ethics committee at our institution (approval number: 18831–220526). The study content was fully explained to each subject and provided in written form; informed consent was obtained from all subjects prior to participation in the study. Recording of the menstrual cycle Participants were instructed to measure their basal body temperature (BBT) every morning upon waking, beginning 1–2 months prior to the experiment. BBT was measured using a basal thermometer (Citizen Electronic Thermometer CTEB503L, Citizen Systems Co., Ltd.). To estimate the day of ovulation, participants were provided with ovulation test kits (Doctor’s Choice One Step Ovulation Test Clear, Beauty & Health Research Inc.) and were asked to use them daily starting from the day after menstruation stopped and until a positive result was obtained. Participants recorded their daily BBT, menstruation period, and ovulation test results using the ONE TAP SPORTS conditioning management system (Euphoria Co., Ltd.) 33 , 34 . Timing of measurements Measurements were conducted once during each of the phases (the early follicular, mid-luteal, and late-luteal phases), totaling three measurements per participant. The analysis focused on estradiol (E2) and progesterone (P4) levels. The early follicular phase, characterized by low levels of both E2 and P4; the mid-luteal phase, with high levels of both hormones; and the late-luteal phase, with low E2 and high P4 levels, were selected as the periods of interest 6 . The early follicular phase was defined as 2–4 days following the onset of menstruation 35 , the mid-luteal phase was defined as 2–4 days following a positive ovulation test 8 , and the late-luteal phase as 12 days following a positive ovulation test until the day before the next menstruation 30 . To account for diurnal variation, all measurements were conducted between 8:00 AM and 12:00 PM 36 . Measurement methods Concentrations of estradiol and progesterone Salivary concentrations of estradiol (E2) and progesterone (P4) were measured. To minimize potential influences on hormone levels, participants were instructed to strictly adhere to six precautions as described in previous studies 34 : (1) no alcohol consumption within 12 h before sampling; (2) no food intake within 60 min; (3) no tooth brushing within 45 min; (4) no dairy products within 20 min; (5) no intake of sugary, acidic, or caffeinated beverages before sampling; and (6) no saliva collection within 48 h after dental treatment. In addition, participants were instructed to rinse their mouths before the experiment to remove any food residue. To prevent a decrease in hormone levels, saliva was collected at least 10 min after rinsing. Participants held saliva in their mouths for 1 min and then transferred it into a collection vial (Cryovial, SAL) using a dedicated straw (Saliva Collection Aid, SAL). Saliva samples were immediately stored in a freezer at − 80°C. After all samples were collected, hormone analysis was outsourced to Funakoshi Co., Ltd. The concentrations of E2 and P4 were analyzed using the High Sensitivity Salivary 17β-Estradiol Enzyme Immunoassay Kit (SALIMETRICS). The samples were thawed at room temperature, mixed using a vortex mixer, centrifuged at 1500 × g for 15 min, and analyzed using enzyme-linked immunosorbent assay. All samples were analyzed without dilution (i.e., 1× concentration) 33 , 34 . Subjective symptoms of edema Subjective symptoms of edema were assessed using two methods. First, a body chart was used to identify the perceived locations of edema. Participants were asked to check the areas where they experienced symptoms of edema, including the face, trunk, right and left upper arms, forearms, hands (including fingers), right and left thighs, lower legs, and feet (including toes). The checked regions were then grouped and summed as follows: trunk (face and trunk), right and left upper limbs (upper arm, forearm, and hand), and right and left lower limbs (thigh, lower leg, and foot). Second, the MDQ 12 was used to assess four items related to fluid retention associated with PMS: weight gain, skin problems, breast pain/tenderness, and swelling in the breasts or abdomen. Each item was rated on a 5-point scale ranging from 0 to 4, where 0 = not at all, 1 = mild, 2 = moderate, 3 = severe, and 4 = very severe. Higher scores indicated more intense subjective symptoms. Objective symptom of edema Objective symptoms of edema were assessed using the InBody970 (InBody Co., Ltd.). Participants were instructed to follow three pre-measurement guidelines: (1) refrain from eating for at least 2 h before measurement, (2) urinate prior to the assessment, and (3) remove all metal accessories. The parameters measured by the InBody970 included body weight, TBW, segmental water content (trunk, right and left upper limbs, and right and left lower limbs), extracellular water (ECW), and the ratio of ECW to TBW (ECW/TBW). These measurements were conducted during each menstrual cycle phase. Statistical analysis To examine the differences in hormone concentrations, MDQ scores, and InBody measurements (body weight, TBW, segmental water content, ECW, and ECW to TBW ratio) across menstrual cycle phases, a one-way repeated measures analysis of variance (ANOVA) was conducted. When a significant main effect was found, Tukey’s post-hoc test was performed. For subjective edema assessed using the body chart, chi-square tests were used to compare differences across body regions and menstrual phases. The significance level was set at 5%. Conclusion This study examined the differences between subjective symptoms of edema and changes in body water content during the menstrual cycle in healthy female university students with normal menstrual cycles. Our findings indicate that subjective and objective symptoms of edema differ in timing and location. Future studies should focus more on diverse age groups, women with different lifestyles, objective hormone level measurements, and precise methods for assessing body fluid distribution. Declarations Ethics approval The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Niigata University of Health and Welfare (approval number: 18831–220526). Consent to participate Information consent was obtained from all subjects. Conflicts of Interest The authors declare no conflict of interest. Funding This study was supported by a Grant-in-Aid for Scientific Research (23H03258) from the Japan Society for the Promotion of Science (JSPS), commissioned by the Japan Sports Agency (Female Athletes Development and Support Projects 2022, 2023), and a Grant-in-Aid program from Niigata University of Health and Welfare. Author contributions Conceptualization, Y.T., and M.E.; methodology, Y.T. and M.E.; validation, Y.T., T.S., Y.T., K.S., H.Y., R.H., T.I., M.K., and M.E.; formal analysis, Y.T. and M.E.; investigation, Y.T., and M.E.; data curation, Y.T. and M.E.; writing—original draft preparation, Y.T. and M.E.; writing—review and editing, Y.T., T.S., Y.T., K.S., H.Y., R.H., T.I., M.K., and M.E.; visualization, Y.T.; project administration, M.E.; funding acquisition, M.E.; supervision, M.E. All authors have read and agreed to the published version of the manuscript. 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Gynecol. 150 , 200–204. https://doi.org:10.1016/s0002-9378(84)80016-2 (1984). Krishnan, S. et al. SHBG and leptin interplay with food craving and intake across the menstrual cycle. Physiol. Behav. 165 , 304–312. https://doi.org:10.1016/j.physbeh.2016.08.010 (2016). Nose-Ogura, S. et al. Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties. Scand. J. Med. Sci. Sports . 29 , 1501–1510. https://doi.org:10.1111/sms.13464 (2019). Shultz, S. J. et al. A comparison of cyclic variations in anterior knee laxity, genu recurvatum, and general joint laxity across the menstrual cycle. J. Orthop. Res. 28 , 1411–1417. https://doi.org:10.1002/jor.21145 (2010). Shagawa, M. et al. Knee Laxity in the Menstrual Cycle after Anterior Cruciate Ligament Reconstruction: A Case Series. Int. J. Environ. Res. Public. Health . 20 https://doi.org:10.3390/ijerph20032277 (2023). Maruyama, S. et al. Menstrual Cycle Changes Joint Laxity in Females-Differences between Eumenorrhea and Oligomenorrhea. J. Clin. Med. 11 https://doi.org:10.3390/jcm11113222 (2022). Maruyama, S. et al. Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle. Orthop. J. Sports Med. 9 , 2325967121993045. https://doi.org:10.1177/2325967121993045 (2021). Shultz, S. J., Gansneder, B. M., Sander, T. C., Kirk, S. E. & Perrin, D. H. Absolute serum hormone levels predict the magnitude of change in anterior knee laxity across the menstrual cycle. J. Orthop. Res. 24 , 124–131. https://doi.org:10.1002/jor.20021 (2006). Additional Declarations No competing interests reported. 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Welfare","correspondingAuthor":false,"prefix":"","firstName":"Tatuki","middleName":"","lastName":"Shirai","suffix":""},{"id":525115254,"identity":"30e0e47b-f922-4f19-b65e-9c3d12d2f550","order_by":2,"name":"Yudai Tanaka","email":"","orcid":"","institution":"Niigata University of Health and Welfare","correspondingAuthor":false,"prefix":"","firstName":"Yudai","middleName":"","lastName":"Tanaka","suffix":""},{"id":525115255,"identity":"e1dea9ad-a3e7-4a17-8348-4a936acc7c2e","order_by":3,"name":"Kodai Sakamoto","email":"","orcid":"","institution":"Niigata University of Health and Welfare","correspondingAuthor":false,"prefix":"","firstName":"Kodai","middleName":"","lastName":"Sakamoto","suffix":""},{"id":525115256,"identity":"128529d2-7f88-4399-8125-4c4938aba0f6","order_by":4,"name":"Hirotake Yokota","email":"","orcid":"","institution":"Niigata University of Health and 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06:13:49","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124016,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6721220/v1/1a304aee0865106e98656200.html"},{"id":93004139,"identity":"50a7379a-ffd6-4072-a307-2c90d913af03","added_by":"auto","created_at":"2025-10-08 06:21:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23918,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for the selection of the female participants.\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-6721220/v1/9dd0582f170e3e78527fe233.png"},{"id":93004914,"identity":"1a031344-0ff8-4f5a-ac59-505d30d68d41","added_by":"auto","created_at":"2025-10-08 06:29:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1045684,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6721220/v1/5664bf0b-1f00-4500-bb42-d7838177320c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Difference Between Subjective Symptoms and Objective Symptom of Edema During the Menstrual Cycle","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePremenstrual syndrome (PMS) refers to a group of emotional, behavioral, and physical symptoms that emerge during the late luteal phase of the menstrual cycle and subside with the onset of menstruation\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Epidemiological studies report that PMS affects a large proportion of women\u0026mdash;approximately 80\u0026ndash;90%\u003csup\u003e2\u003c/sup\u003e\u0026mdash;with around 5% experiencing symptoms severe enough to significantly disrupt daily life, social functioning, and occupational performance, often necessitating medical treatment\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. According to the American College of Obstetricians and Gynecologists, PMS symptoms include a variety of physical complaints (e.g., increased thirst and appetite, breast tenderness, abdominal bloating, weight gain, headaches, extremity swelling, general aches, fatigue, skin issues, and digestive disturbances) and emotional or psychological symptoms (e.g., depressive moods, anger, irritability, tearfulness, heightened anxiety, mental confusion, social withdrawal, difficulty concentrating, trouble sleeping, excessive daytime sleeping, and altered libido)(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acog.org/womens-health/faqs/premenstrual-syndrome)\u003c/span\u003e\u003cspan address=\"https://www.acog.org/womens-health/faqs/premenstrual-syndrome)\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e༎\u003c/p\u003e\u003cp\u003eAlthough the precise etiology of PMS remains uncertain, previous research suggests it may be associated with the response of γ-aminobutyric acid (GABA)-A receptors to progesterone metabolites during the luteal phase\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, as well as altered sensitivity of the serotonergic system\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. PMS symptoms are generally observed in the late luteal phase, when circulating levels of the ovarian hormone progesterone (P4) are elevated and tend to subside or resolve shortly after menstruation begins\u0026mdash;typically within four days. These observations imply that cyclical hormonal variations across the menstrual cycle, particularly fluctuations in progesterone levels, may play a critical role in the manifestation of PMS symptoms (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acog.org/womens-health/faqs/premenstrual-syndrome\u003c/span\u003e\u003cspan address=\"https://www.acog.org/womens-health/faqs/premenstrual-syndrome\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe menstrual cycle is controlled by dynamic changes in female steroid hormones\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. These hormonal variations involve the hypothalamic secretion of gonadotropin-releasing hormone (GnRH), the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland, and the ovarian production of estrogen (E2) and progesterone (P4) \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Estrogen promotes the release of vasopressin\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, a key hormone in osmotic regulation, leading to an increase in plasma volume\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Progesterone also contributes to expanding plasma volume as well as extracellular fluid. Consequently, both E2 and P4 play crucial roles in the regulation of body fluids, and their cyclical fluctuations throughout the menstrual cycle are likely to affect fluid retention-related symptoms such as breast tenderness and abdominal bloating observed in PMS.\u003c/p\u003e\u003cp\u003eOne method for evaluating PMS is the Menstrual Distress Questionnaire (MDQ) \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The MDQ comprises 46 items rated on a five-point scale based on symptom severity. These items are categorized into eight subscales: pain, water retention, autonomic reactions, negative affect, concentration, behavioral change, arousal, and control, allowing for a comprehensive assessment of PMS symptoms. The water retention subscale, which was the focus of this study, assesses four specific symptoms: weight gain, skin problems, breast pain or tenderness, and breast or abdominal bloating. However, the MDQ is based on subjective self-assessment and does not objectively confirm the presence of edema.\u003c/p\u003e\u003cp\u003eObjective methods to assess edema typically involve quantifying body water content and its distribution. Among these, bioelectrical impedance analysis (BIA) is a widely utilized, non-invasive technique that estimates parameters such as body fat percentage, fat-free mass, and total body water (TBW). Prior research examining fluctuations in body composition throughout the menstrual cycle using BIA has yielded mixed results, with some studies reporting no significant cycle-related changes\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Conversely, other investigations have documented phenomena such as weight gain during the luteal phase\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, weight reduction in the follicular phase\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, and elevated TBW in the late luteal phase\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, reflecting inconsistencies in the literature. Recent advancements in BIA technology have improved its accuracy, allowing detailed evaluation of edema, including segmental water content and extracellular water ratio\u003csup\u003e\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTherefore, this study aimed to elucidate the differences between subjective and objective symptoms of edema across the menstrual cycle in female university students with normal menstrual cycles.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eE2 and P4 concentrations across menstrual cycles\u003c/h2\u003e\u003cp\u003eThe results for E2 and P4 concentrations during each cycle phase are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. For E2 concentrations, no significant main effects were observed in the repeated-measures analysis of variance. However, for P4 concentrations, a significant main effect of the menstrual cycle on hormone levels was found (F (1.574, 44.067)\u0026thinsp;=\u0026thinsp;4.752, p\u0026thinsp;=\u0026thinsp;0.020, partial η\u0026sup2; = 0.145, observed power\u0026thinsp;=\u0026thinsp;0.695). Post-hoc Tukey\u0026rsquo;s test revealed a significant difference between the early follicular and mid-luteal phases (p\u0026thinsp;=\u0026thinsp;0.009, mean difference\u0026thinsp;=\u0026thinsp;140.68, 95% CI [29.91\u0026ndash;251.45]).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in estradiol and progesterone concentration during the menstrual cycle\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly follicular phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMiddle luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLate luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial η\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePower\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEstradiol [pg/mL]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(1.616, 45.261)\u003c/p\u003e\u003cp\u003e0.864\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.175\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProgesterone [pg/mL]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e217.7\u0026thinsp;\u0026plusmn;\u0026thinsp;132.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e358.4\u0026thinsp;\u0026plusmn;\u0026thinsp;302.3\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e303.7\u0026thinsp;\u0026plusmn;\u0026thinsp;250.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e293.3\u0026thinsp;\u0026plusmn;\u0026thinsp;243.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(1.574, 44.067) 4.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.695\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eN\u0026thinsp;=\u0026thinsp;29\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with the early follicular phase(p\u0026thinsp;=\u0026thinsp;0.009, mean difference\u0026thinsp;=\u0026thinsp;140.68=140.68, 95%CI[29.91\u0026ndash;251.45]).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEvaluation of subjective symptoms of edema: Body chart and MDQ results\u003c/h3\u003e\n\u003cp\u003eThe results of the body chart and MDQ (fluid retention items) are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, respectively. In the body chart analysis, Pearson's chi-square test revealed no significant differences across menstrual cycle phases. However, between the body regions, edema was significantly less frequent in the upper arms (right/left) than in the face and trunk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and more frequent in the lower legs (right and left) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) across all phases. For the MDQ (fluid retention items), no significant main effects were observed across menstrual cycle phases.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in subjective assessment of edema (body chart) during the menstrual cycle\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly follicular phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMiddle Luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLate Luteal phase\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFace and Trunk\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (20.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (17.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUpper arm (Rt)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.9) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3.4) \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.9) \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUpper arm (Lt)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (10.3) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (6.9) \u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.4) \u003csup\u003ej\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLower leg (Rt)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (62.1) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (41.4) \u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (55.2) \u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLower leg (Lt)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (62.1) \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (41.4) \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (58.6) \u003csup\u003el\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eN=29.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNumber(%)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the early follicular phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-3.4, 3.4]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the early follicular phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-2.9, 2.9]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the early follicular phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [3.7, -3.7]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the early follicular phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [3.7, -3.7]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ee\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the middle luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-2.7, 2.7]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ef\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the middle luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-2.7, 2.7]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003eg\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the middle luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [2.8, -2.8]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003eh\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the middle luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [2.8, -2.8]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the late luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-2.9, 2.9]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ej\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the late luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [-3.3, 3.3]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ek\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the late luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [3.6, -3.6]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003el\u003c/em\u003e\u003c/sup\u003eStatistically significant difference compared with face and trunk in the late luteal phase (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, adjusted residuals [4.1, -4.1]).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in subjective assessment (Water retention of MDQ) during the menstrual cycle\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly follicular phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMiddle Luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLate Luteal phase\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWater retention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: Standard Deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eObjective evaluation of edema: InBody measurements results\u003c/h3\u003e\n\u003cp\u003eThe results for weight (Kg), TBW (L), segmental water content (L), ECW (L), and ECW/TBW ratio are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Repeated measures analysis of variance revealed no significant differences across menstrual cycle phases for weight, TBW, ECW, and ECW/TBW ratio. However, significant main effects were observed for segmental water content in the trunk (F (2, 59)\u0026thinsp;=\u0026thinsp;4.919, p\u0026thinsp;=\u0026thinsp;0.011, partial η\u0026sup2; = 0.149, observed power\u0026thinsp;=\u0026thinsp;0.786) and right upper arm (F (2, 56)\u0026thinsp;=\u0026thinsp;5.356, p\u0026thinsp;=\u0026thinsp;0.007, partial η\u0026sup2; = 0.161, observed power\u0026thinsp;=\u0026thinsp;0.821). Post-hoc Tukey's test revealed that the trunk water content, values were significantly higher in the mid luteal phase than in the early follicular phase (p\u0026thinsp;=\u0026thinsp;0.034, mean difference\u0026thinsp;=\u0026thinsp;0.1241, 95% CI [0.0075\u0026ndash;0.2408]) and in the late luteal phase than in the early follicular phase (p\u0026thinsp;=\u0026thinsp;0.017, mean difference\u0026thinsp;=\u0026thinsp;0.1379, 95% CI [0.0213\u0026ndash;0.2546]). In addition, for the right upper arm water content was significantly higher in the mid-luteal phase compared to the early follicular phase (p\u0026thinsp;=\u0026thinsp;0.023, mean difference\u0026thinsp;=\u0026thinsp;0.0262, 95% CI [0.003\u0026ndash;0.049]) and in the late luteal phase compared to the early follicular phase (p\u0026thinsp;=\u0026thinsp;0.013, mean difference\u0026thinsp;=\u0026thinsp;0.0283, 95% CI [0.005\u0026ndash;0.051]).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in objective assessment (in the body) during the menstrual cycle\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly follicular phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMiddle luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLate luteal phase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial η\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePower\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Weight(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e55.55\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.55\u0026thinsp;\u0026plusmn;\u0026thinsp;7.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 56) 0.566\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Body Water(L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e30.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 056) 2.638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSegmental Body Water(L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrunk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 59) 4.919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.786\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight Arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 56) 5.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft Arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(1.285, 35.970) 2.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight Leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 6) 1.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft Leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 56) 1.753\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.352\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtracellular Water(L)\u003c/p\u003e\u003cp\u003eECW/TBW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e\u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(2, 56) 2.030\u003c/p\u003e\u003cp\u003e(1.037, 29.045) 1.539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.141\u003c/p\u003e\u003cp\u003e0.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.401\u003c/p\u003e\u003cp\u003e0.228\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eECW/TBW: Extracellular Water to Total Body Water Ratio\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eSD: Standard Deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003eStatistically significant difference compared with the early follicular phase(p\u0026thinsp;=\u0026thinsp;0.034, mean difference=0.1241, 95%CI[0.0075\u0026ndash;0.2408]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003eStatistically significant difference compared with the early follicular phase(p\u0026thinsp;=\u0026thinsp;0.017, mean difference=0.1379, 95%CI[0.0213\u0026ndash;0.2546]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ec\u003c/sup\u003eStatistically significant difference compared with the early follicular phase(p\u0026thinsp;=\u0026thinsp;0.023, mean difference=0.0262, 95%CI[0.003\u0026ndash;0.049]).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ed\u003c/sup\u003eStatistically significant difference compared with the early follicular phase(p\u0026thinsp;=\u0026thinsp;0.013, mean difference=0.0283, 95%CI[0.005\u0026ndash;0.051]).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings revealed that subjective measurements did not show cyclical changes, with edema more frequently observed in the lower limbs. In contrast, objective measurements revealed significantly higher segmental body water content in the trunk and right upper arm during the luteal phases (mid-luteal and late luteal phases) compared to the early follicular phase. These findings suggest a disconnect between subjective edema symptoms and physiological changes.\u003c/p\u003e\u003cp\u003eSubjective symptoms of edema during the menstrual cycle have been frequently reported in studies on PMS and Premenstrual Dysphoric Disorder, often including complaints of edema and abdominal bloating, which typically appear in the late luteal phase of the menstrual cycle and subside with the onset of menstruation\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, the results of the MDQ in this study showed no significant changes in fluid retention items across the menstrual cycle. Moreover, the body chart revealed no significant differences between cycles; however, edema was significantly more frequent in the lower legs (Rt/Lt) than in the face and trunk throughout the entire cycle, contradicting the results of previous studies. This discrepancy may reflect not only PMS symptoms but also primary dysmenorrhea-related symptoms such as abdominal bloating and fatigue\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFurther, objective evaluations of edema, such as body water content and limb circumference, do not align with subjective symptoms, and while changes in body weight and body water content have been observed, no direct correlation with the sensation of swelling has been reported\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Similarly, this study found increased body water content in the trunk and right upper limb during the mid-luteal and late-luteal phases; however, subjective symptoms remained consistent across cycles, with edema most frequently observed in the lower limbs, indicating a discrepancy between objective and subjective evaluations. This discrepancy may stem from the regulatory effects of estrogen and progesterone on water and electrolyte balance. Stachenfeld et al. \u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e have reported that these hormones affect antidiuretic hormone (AVP) and sodium excretion, leading to changes in plasma and extracellular fluid volumes. In this study, the salivary P4 concentration was significantly higher in the mid-luteal phase compared to the follicular phase. Therefore, body water changes probably occur, but the sensation of edema does not align with them. In addition, Cumberledge et al.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and Hicks et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e have noted that body water measurements using BIA have limitations in detecting minor changes in body water caused by hormonal fluctuations, suggesting that the limitations may contribute to the discrepancy between objective and subjective symptoms.\u003c/p\u003e\u003cp\u003eFurthermore, the intensity of subjective symptoms is believed to be influenced by psychological factors, and fluctuations in hormone levels are reportedly strongly associated with emotional changes and sensitivity to bodily sensations\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In this study, only salivary levels of E2 and P4 hormones were analyzed; however, hormonal fluctuations throughout the menstrual cycle may affect the perception, potentially leading individuals to misinterpret other symptoms or factors as edema.\u003c/p\u003e\u003cp\u003eOur findings are clinically valuable. For example, when young women report edema, it is important not only to evaluate the presence of fluid retention but also to consider the menstrual cycle and psychological state comprehensively. In addition, in exercise instruction and nutritional management, understanding subjective reports of bodily changes and responding appropriately could serve as evidence to guide interventions.\u003c/p\u003e\u003cp\u003eThis study had some limitations. First, the participants were limited to healthy female university students, and the sample size was relatively small (29 participants); hence, caution is needed when generalizing the results. Second, the phases of the menstrual cycle were classified based on BBT and self-report, and hormone analysis was conducted using saliva samples; however, since no blood tests were performed to measure hormones, an exact match with actual hormonal fluctuations cannot be guaranteed. Third, BIA was used to measure body water; however, this method has limitations in accurately capturing water distribution and subtle changes, meaning that it may not fully reflect localized edema changes. Furthermore, lifestyle factors such as daily activities, fluid intake, and salt consumption may influence body water content and the perception of edema; however, these factors were not adequately controlled in this study.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA questionnaire survey was administered to 44 female university students, of whom 29 met the inclusion criteria: a menstrual cycle length of 25\u0026ndash;38 days,\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and no use of oral contraceptives or hormonal agents within the past 6 months\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. All participants had regular menstruation and provided informed consent to participate in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Their characteristics were as follows: age 20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years, height 162.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 cm, and weight 55.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5 kg. All study protocols were performed according to the Declaration of Helsinki, after receiving approval from the ethics committee at our institution (approval number: 18831\u0026ndash;220526). The study content was fully explained to each subject and provided in written form; informed consent was obtained from all subjects prior to participation in the study.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRecording of the menstrual cycle\u003c/h3\u003e\n\u003cp\u003eParticipants were instructed to measure their basal body temperature (BBT) every morning upon waking, beginning 1\u0026ndash;2 months prior to the experiment. BBT was measured using a basal thermometer (Citizen Electronic Thermometer CTEB503L, Citizen Systems Co., Ltd.). To estimate the day of ovulation, participants were provided with ovulation test kits (Doctor\u0026rsquo;s Choice One Step Ovulation Test Clear, Beauty \u0026amp; Health Research Inc.) and were asked to use them daily starting from the day after menstruation stopped and until a positive result was obtained. Participants recorded their daily BBT, menstruation period, and ovulation test results using the ONE TAP SPORTS conditioning management system (Euphoria Co., Ltd.) \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eTiming of measurements\u003c/h3\u003e\n\u003cp\u003eMeasurements were conducted once during each of the phases (the early follicular, mid-luteal, and late-luteal phases), totaling three measurements per participant. The analysis focused on estradiol (E2) and progesterone (P4) levels. The early follicular phase, characterized by low levels of both E2 and P4; the mid-luteal phase, with high levels of both hormones; and the late-luteal phase, with low E2 and high P4 levels, were selected as the periods of interest\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The early follicular phase was defined as 2\u0026ndash;4 days following the onset of menstruation\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, the mid-luteal phase was defined as 2\u0026ndash;4 days following a positive ovulation test\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, and the late-luteal phase as 12 days following a positive ovulation test until the day before the next menstruation\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. To account for diurnal variation, all measurements were conducted between 8:00 AM and 12:00 PM\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMeasurement methods\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eConcentrations of estradiol and progesterone\u003c/h2\u003e\u003cp\u003eSalivary concentrations of estradiol (E2) and progesterone (P4) were measured. To minimize potential influences on hormone levels, participants were instructed to strictly adhere to six precautions as described in previous studies\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e: (1) no alcohol consumption within 12 h before sampling; (2) no food intake within 60 min; (3) no tooth brushing within 45 min; (4) no dairy products within 20 min; (5) no intake of sugary, acidic, or caffeinated beverages before sampling; and (6) no saliva collection within 48 h after dental treatment. In addition, participants were instructed to rinse their mouths before the experiment to remove any food residue. To prevent a decrease in hormone levels, saliva was collected at least 10 min after rinsing. Participants held saliva in their mouths for 1 min and then transferred it into a collection vial (Cryovial, SAL) using a dedicated straw (Saliva Collection Aid, SAL). Saliva samples were immediately stored in a freezer at \u0026minus;\u0026thinsp;80\u0026deg;C. After all samples were collected, hormone analysis was outsourced to Funakoshi Co., Ltd. The concentrations of E2 and P4 were analyzed using the High Sensitivity Salivary 17β-Estradiol Enzyme Immunoassay Kit (SALIMETRICS). The samples were thawed at room temperature, mixed using a vortex mixer, centrifuged at 1500 \u0026times; g for 15 min, and analyzed using enzyme-linked immunosorbent assay. All samples were analyzed without dilution (i.e., 1\u0026times; concentration) \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSubjective symptoms of edema\u003c/h2\u003e\u003cp\u003eSubjective symptoms of edema were assessed using two methods. First, a body chart was used to identify the perceived locations of edema. Participants were asked to check the areas where they experienced symptoms of edema, including the face, trunk, right and left upper arms, forearms, hands (including fingers), right and left thighs, lower legs, and feet (including toes). The checked regions were then grouped and summed as follows: trunk (face and trunk), right and left upper limbs (upper arm, forearm, and hand), and right and left lower limbs (thigh, lower leg, and foot). Second, the MDQ\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e was used to assess four items related to fluid retention associated with PMS: weight gain, skin problems, breast pain/tenderness, and swelling in the breasts or abdomen. Each item was rated on a 5-point scale ranging from 0 to 4, where 0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;mild, 2\u0026thinsp;=\u0026thinsp;moderate, 3\u0026thinsp;=\u0026thinsp;severe, and 4\u0026thinsp;=\u0026thinsp;very severe. Higher scores indicated more intense subjective symptoms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eObjective symptom of edema\u003c/h2\u003e\u003cp\u003eObjective symptoms of edema were assessed using the InBody970 (InBody Co., Ltd.). Participants were instructed to follow three pre-measurement guidelines: (1) refrain from eating for at least 2 h before measurement, (2) urinate prior to the assessment, and (3) remove all metal accessories. The parameters measured by the InBody970 included body weight, TBW, segmental water content (trunk, right and left upper limbs, and right and left lower limbs), extracellular water (ECW), and the ratio of ECW to TBW (ECW/TBW). These measurements were conducted during each menstrual cycle phase.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eTo examine the differences in hormone concentrations, MDQ scores, and InBody measurements (body weight, TBW, segmental water content, ECW, and ECW to TBW ratio) across menstrual cycle phases, a one-way repeated measures analysis of variance (ANOVA) was conducted. When a significant main effect was found, Tukey\u0026rsquo;s post-hoc test was performed. For subjective edema assessed using the body chart, chi-square tests were used to compare differences across body regions and menstrual phases. The significance level was set at 5%.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined the differences between subjective symptoms of edema and changes in body water content during the menstrual cycle in healthy female university students with normal menstrual cycles. Our findings indicate that subjective and objective symptoms of edema differ in timing and location. Future studies should focus more on diverse age groups, women with different lifestyles, objective hormone level measurements, and precise methods for assessing body fluid distribution.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Niigata University of Health and Welfare (approval number: 18831\u0026ndash;220526).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by a Grant-in-Aid for Scientific Research (23H03258) from the Japan Society for the Promotion of Science (JSPS), commissioned by the Japan Sports Agency (Female Athletes Development and Support Projects 2022, 2023), and a Grant-in-Aid program from Niigata University of Health and Welfare.\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eConceptualization, Y.T., and M.E.; methodology, Y.T. and M.E.; validation, Y.T., T.S., Y.T., K.S., H.Y., R.H., T.I., M.K., and M.E.; formal analysis, Y.T. and M.E.; investigation, Y.T., and M.E.; data curation, Y.T. and M.E.; writing\u0026mdash;original draft preparation, Y.T. and M.E.; writing\u0026mdash;review and editing, Y.T., T.S., Y.T., K.S., H.Y., R.H., T.I., M.K., and M.E.; visualization, Y.T.; project administration, M.E.; funding acquisition, M.E.; supervision, M.E. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available because of limitations of ethical approval involving patient data and anonymity but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGreene, R. \u0026amp; Dalton, K. The premenstrual syndrome. \u003cem\u003eBr. Med. 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Res.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 124\u0026ndash;131. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1002/jor.20021\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1002/jor.20021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2006).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"menstrual cycle, premenstrual syndrome, edema, menstrual distress questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-6721220/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6721220/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study aimed to elucidate the differences between subjective and objective symptoms of edema during the menstrual cycle in female university students with normal menstruation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe study included 29 female university students with normal menstrual cycles. The menstrual cycle was categorized into the early follicular, mid-luteal, and late-luteal phases, and measurements were taken during each phase. Subjective symptoms were evaluated using body charts and the Menstrual Distress Questionnaire (MDQ) to assess the presence of edema. Objective symptoms were measured using a body composition analyzer to assess body weight, body water content, and regional water content.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn the evaluation of subjective symptoms of edema using the body chart, no significant differences were observed across cycles. However, when body regions were compared, there were significantly fewer subjective symptoms in the upper arm (Rt/Lt) than in the face and trunk across all phases, while the lower leg (Rt/Lt) had significantly more subjective symptoms. The MDQ (water retention item) showed no marked differences across cycles. For objective evaluations of edema, including body weight and total body water, no significant differences were observed across cycles; however, regional water content was significantly higher in the trunk and right arm during the mid-luteal and late-luteal phases than in the early follicular phase.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOur findings suggest that the location and timing of subjective edema symptoms may differ from those of objective symptoms.\u003c/p\u003e","manuscriptTitle":"The Difference Between Subjective Symptoms and Objective Symptom of Edema During the Menstrual Cycle","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 06:13:44","doi":"10.21203/rs.3.rs-6721220/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-10T05:14:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T18:09:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60452236496713037812426725457614420212","date":"2026-01-06T13:11:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T08:58:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25030422466383524242930536581411088490","date":"2025-10-01T01:16:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-26T05:05:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T12:54:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-28T09:09:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-26T04:15:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-26T04:14:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf29a86a-4e61-427f-b470-d57475616990","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55802684,"name":"Health sciences/Health care"},{"id":55802685,"name":"Health sciences/Medical research"},{"id":55802686,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-25T13:25:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 06:13:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6721220","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6721220","identity":"rs-6721220","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}