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Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine

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Background Premenstrual syndrome (PMS) is a cyclic occurring disorder that affects young and middle-aged women mainly. It characterized by group of physical, cognitive, emotional and behavioral symptoms that interfere with daily living activities. PMS is common worldwide, but there is no published research about it in Palestine. The aim of this study is to assess the prevalence of premenstrual syndrome and the degree of its severity among the medical students at An-Najah National University, Palestine Methods A cross-sectional study using a self-administered questionnaire was conducted to collect data from 260 female students. American Congress of Obstetricians and Gynecologists (ACOG) criteria and Shortened Premenstrual Assessment Form (SPAF) were used to measure PMS prevalence and severity of premenstrual symptoms. Results The prevalence of PMS was 71.9%. The most frequently reported complaints were: lower back pain (57.7%), followed by feeling bloated (51.9%) and feeling under stress (50%). Significant relationships were found between the severity of premenstrual symptoms and academic class (rank), regular coffee intake, duration of menstrual cycle and absence from lectures and rotations. Conclusion Premenstrual syndrome is common among female medical students and has negative effect in their academic performance and attendance and should be taken into consideration by university officials. We highly recommend increasing the awareness of PMS among university students and staff and communicating the results with university officials in order to make attendance policy more flexible to adapt this high prevalent problem among female students.
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Jacobs Journal of Community Medicine
Moderate to Severe Premenstrual Syndrome and Contributing Factors among
University Students in Palestine
Zaher Nazzal1*, Nidaa Hasan2, Mulham Al-Sukhon1
1Assistant Professor at the Faculty of Medicine and Health Sciences, An-Najah National University, Palestine
2Faculty of Medicine and Health Sciences, An-Najah National University, Palestine
*Corresponding author: Dr. Zaher Nazzal, Assistant Professor of Community Medicine,An-Najah National University/ Faculty of
Medicine and Health Sciences, Nablus /Palestine, Tel : +(972) (599) 545421; Email: znazzal@najah.edu
Received: 10-13-2015
Accepted: 11-23-2015
Published: 12-10-2015
Copyright: © 2015 Zaher
Research Article
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
Abstract
Background
Premenstrual syndrome (PMS) is a cyclic occurring disorder that affects young and middle-aged women mainly. It characterized
by group of physical, cognitive, emotional and behavioural symptoms that interfere with daily living activities. PMS is common
worldwide, but there is no published research about it in Palestine. The aim of this study is to assess the prevalence of premen-
strual syndrome and the degree of its severity among the medical students at An-Najah National University, Palestine
Methods
A cross-sectional study using a self-administered questionnaire was conducted to collect data from 260 female students. Amer-
ican Congress of Obstetricians and Gynecologists (ACOG) criteria and Shortened Premenstrual Assessment Form (SPAF) were
used to measure PMS prevalence and severity of premenstrual symptoms.
Results
The prevalence of PMS was 71.9%. The most frequently reported complaints were: lower back pain (57.7%), followed by feeling
     
symptoms and academic class (rank), regular coffee intake, duration of menstrual cycle and absence from lectures and rotations.
Conclusion
Premenstrual syndrome is common among female medical students and has negative effect in their academic performance and
   


Keywords: Premenstrual Syndrome; Medical Science Students; An-Najah National University
Introduction
Premenstrual syndrome (PMS) is a cyclic occurring disorder
that affects young and middle-aged women mainly, and char-
acterized by group of physical, cognitive, emotional and behav-
ioral symptoms that consistently occur during the luteal phase
of the menstrual cycle. [1,2]. It is characterized by the presence

days before menses for at least three menstrual cycles in a row.
Many symptoms may be associated with PMS including emo-

increase in appetite, and sensitivity and pain in the breasts [3-
 
predominantly psychological, end of the PMS spectrum [1].


PMS is quite prevalent among the women of reproductive
age group, especially among the young age groups. Although
reports on the prevalence of PMS are different from study to
study, most of studies conducted in the neighboring countries

it is moderate to severe form [9- 13].
-

higher work, school or college absenteeism and impairment in
their productivity and household activities [2,9]. Students af-
fected with PMS complain of inability to sleep, prolonged rest
need, fatigue and inability to study. Missed meals, lectures and
social commitments are also common complains [9]. Further-
more, as symptoms severity increased, the healthcare utiliza-
tion increased, including emergency room visits, outpatient
visits, radiology services and laboratories [2,14]. In general,
it is concluded that PMS affects the life quality of the affected
females.
Many risk factors for PMS were discussed in the literatures,
among those factors were age, obesity, overall health, stress,
  (15).Obese women with body mass in-

    -
er health problems are at increased risk for PMS, and current
-
orders are common in women with PMS [15].
Searching the literature showed no published data about the
burden of this problem in Palestine, in term of its magnitude,
severity, distribution and risk factors. Therefore, we aimed to
investigate the prevalence of PMS among female students of
The School of Medicine and Health Sciences at An-Najah Na-
its effects on the stu-
dents’ performance and absenteeism.
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
Jacobs Publishers 2
Methodology
Study Design and Setting
A cross – sectional study was conducted at ANNU, the largest
provider of higher education in Palestine, including students

   The study population included
the students of the faculty of medicine and health sciences; the
largest faculty in the university.
Sample Size and Sampling Technique
        
  
          
       
gynecological diseases within the last year, or having chronic

A systematic random sampling technique was used for distrib-
-
   
and, before disseminating the questionnaire, a brief descrip-
tion about the study and its objectives was given to partici-
pants; and then students were selected randomly by starting
           rd
student.
Study Outcomes
The main outcome variables for this study was the PMS which
            
following affective and somatic symptoms, that occurs during

in a row. Affective symptoms are: anger with possible out-
       
withdrawal [16].Somatic symptoms are: abdominal bloating,
  [16].
These symptoms must remit within four days of menses onset,
not recur until at least day 13 of the subsequent cycle, and not
due to any medications including hormones. Symptoms should
also interfere with some of woman’s normal activities [16].
Other studied variables were students’ demographic and back-
ground variables such as academic level, residency, marital
status, smoking status(cigarette or water-pipe smoking), reg-
  -
logical characteristics were studied such as age of menarche,
regularity of menstrual cycle, frequency of menstrual cycle and
intensity of menstrual cycle.
Measurement Tool

study by Hamaideh et al. [10], was used to collect the data. It
was divided into 2 sections;
- Part I about demographic and gynecological characteris-
tics, like academic program, marital status, smoking sta-
tus, regular coffee intake, performing physical activities,
daily sleeping hours, absence from lectures and rotations
due to premenstrual symptoms, weight and height, age at
menarche and regularity, frequency, duration and inten-
sity of menstrual cycle.
- Part II, about PMS which was measured based on the
Diagnostic Criteria adopted by the American Congress
of Obstetricians and Gynecologists (ACOG). The partici-
  
of symptoms present in the ACOG criteria during the last
three previous menstrual cycles.
- The severity of premenstrual symptoms was evaluat-
ed using the Shortened Premenstrual Assessment Form
(SPAF) [17] which is composed of ten items that are 1)
Pain, tenderness, enlargement or swelling of breasts; 2)
Feeling unable to cope or overwhelmed by ordinary de-
mands; 3) Feeling under stress; 4) Outburst of irritability

-
atively steady abdominal heaviness, discomfort or pain;
       
Feeling bloated. The participants had been asked to rate
the severity of changes in symptoms on scale of 1-6 (1=no
-
strual period. Score >30 indicates moderate or severe
PMS symptoms. The Arabic version of SPAF by Hamaideh

To ensure its validity and reliability, the measurement tool was
-
venient sample of 20 students to highlight problems associated
with it and assess the time needed to complete. Cronbach’s alpha
-

Data Entry and Analysis
The completeness and accuracy of the collected data were

Data were coded and edited properly by the second investi-
gator prior to data entry. The data entry and statistical anal-
ysis were performed using the Statistical Package for Social
Sciences (SPSS) version 17. Descriptive statistics were used
to summarize the socio-demographic and clinical charac-
teristics of the study participants. Summary tables, graphs
and charts were used for descriptive purpose.
-
ing the Chi-squared test and t-test as appropriate with the sig-
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
Jacobs Publishers 3
   <0.1
in the univariate analysis were subject to multivariate logistic
regression analysis model to assess the predictor variable(s).
The study was conducted after getting approval from the

from the University administration. Anonymity of the partic-
  
Results
          
questionnaire. The majority of participating students were
single (96.9%). Most of them were non-smokers (95.4%), and
27.3% were regular coffee drinkers. More than half of the par-
        
 
Table 1. Characteristics of the Study Participants.
Variable Frequency (%)
Academic program
Medicine
Pharmacy
Nursing and midwifery


40 (15.4%)
Academic year
1 – 3
4 – 6
136 (52.3%)
124 (47.7%)
Marital status
Single
Married
252 (96.9%)

Body mass index


25 - 29.9 (overweight)

30 (11.5%)
200 (76.9%)
27 (10.4%)
03 (1.2%)
Smoking status
Yes
No
12 (4.6%)

Regular coffee intake
Yes
No
71 (27.3%)

Physically activities
Yes
No
72 (27.7%)

  -
         
duration of 20 to 31 days. About 65.4% reported that their
   
cycle of moderate intensity. Of the total sample, only 2 (0.2%)
had been pregnant at least one time, and only 3 participants
      
of the participants had a sick leave or absent from lecture or
clinical training because of premenstrual symptoms (Table 2).
Table 2. Gynecological Characteristics of the Study Partici-
pants.
Variable Frequency (%)
Age of menarche

12 – 13 years

20 (7.7%)
147 (56.5%)

Menstrual cycle

Irregular


Frequency of the menstrual cycle
Less than 20 days
20 – 31 days
More than 31 days


19 (7.3%)
Duration of the menstrual cycle
< 6 days

170 (65.4%)
90 (34.6%)
Intensity of the menstrual cycle
Light
Moderate
Heavy
24 (9.2%)

19 (7.3%)
Absence from classes
Usually or Always
Sometimes
Never
27 (10.4%)

149 (57.3%)
Prevalence of PMS
The prevalence of PMS among the studied group was 71.9%,
(Figure 1).
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
Jacobs Publishers 4
Figure 1. The prevalence of PMS among participants.
Severity of premenstrual symptoms was measured by SPAF,
where 51% of the students showed moderate to severe symp-
toms. The most frequently reported complaints were lower
back pain (57.7%), followed by feeling bloated (51.9%) and
feeling under stress (50%) (Figure 2).
Figure 1. Frequency of Premenstrual Symptoms among Study Participants.
57.7%
51.9%
50%
48.5%
48.5%
46.9%
36.5%
31.2%
25.8%
21.2%
0% 10% 20% 30% 40% 50% 60% 70%
Lower back pain
Feeling bloated
Feeling under stress
Irritability
Abdominal pain
Feeling sad or depressed
Feeling unable to cope
Breast pain
Weight gain
Odema and swilling
Figure 2. Frequency of Premenstrual Symptoms among Study Partic-
ipants.
-
sociated with academic class, regular coffee intake, duration of
menstrual cycle and absence from classes (Table 3).
Predictors of Severe Premenstrual Symptoms
Logistic regression analysis was applied to all variables with
p-value <0.1 in univariate analysis. Predictors of severity of
premenstrual symptoms were academic class, regular coffee
intake, duration of menstrual period, Perception of health in
general and Absence from lectures and rotations due to pre-
menstrual symptoms (Table 4).
ab
Figure 1. The prevalence of PMS in female students.
71.9%
28.1%
Yes No
Variables Mild Mod - Severe p- value
Collage program
Medicine  
0.06®
Pharmacy  
Nursing and midwifery 27 (67.5%) 13 (32.5%)
Academic class
1 – 3  56 (41.2%)
0.03®
4 – 6 55 (44.4%) 69 (55.6%)
Smoking status
No 130 (52.4%)  0.47®
Yes 5 (41.7%) 

No 107 (56.6%)  0.01®
Yes  43 (60.6%)
Physical activity
No  97 (51.6%) 0.07®
Yes 44 (61.1%) 
 21.61 (21.1 – 22.12)  0.54*
 7.31 (7.1 – 7.52)  0.1*
Age of menarche
 11 (55%) 9 (45%)
®
12 – 13 years 69 (46.9%) 
 55 (59.1%) 

Irregular  26 (54.2%) 0.35®
 113 (53.3%) 99 (46.7%)
Frequency of menstrual cycle
Less than 22 days 4 (40%) 6 (60%)
0.27®
From 20 – 31 days 124 (53.7%) 107 (46.3%)
More than 31 days  12 (63.2%)
Duration of menstrual cycle
Less than 6 days  72 (42.4%) 0.01®
6 days and more 37 (41.1%) 
Intensity of menstrual cycle
Light 15 (62.5%) 9 (37.5%)
0.40®
Moderate 112 (51.6%) 
Heavy  11 (57.9%)
Perception of health in general
  35 (42.2%)
®
Very good 76 (52.4%) 69 (47.6%)
Good 11 (34.4% 21 (65.6%)
Absence from classes
Never
Some times
Usually or Always
92 (61.7%)
30 (35.7%)


54 (64.3%)
14 (51.9%)
0.01®
®Chi-squared test * independent T-test
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
Jacobs Publishers 5
Table 3.
Variables Odd ratio CI #p- value
Collage program
Medicine *
Pharm. D and pharmacy 1.361 0.71 - 2.6 0.36
Nursing and midwifery .511 0.2 - 1.3 0.17
Academic class
1 – 3 *
2.047 1.2 - 3.6 0.01
4 – 6
Income level

Very good  0.63 - 3.5 
Good or Acceptable 0.99 0.4 - 2.5 0.90
Regular coffee intake
No *
2.11 1.14 - 3.9 0.02
Yes
Physically active
No
1.44 0.76 - 2.7 0.26
Yes*
Duration of menstrual cycle
Less than 6 days *
2.10

0.01
6 days and more
Perception of health in general

Very good
Good
1.390
4.517
0.74-2.6
1.6-12.6
.311
.004
Absence from classes
Never*
Some times
Usually or Always

2.05
1.6-5.3

0.01
0.13
#
Discussion
        to assess PMS and
related factors in Palestine. The prevalence of PMS was 71.9%,
congruent with the result of most studies in the region that



        
[10,11,13]. The medical science students are all the time in ac-

The severity and frequency of premenstrual symptoms were
different from one study to another. The most frequently re-
       
Jacobs Publishers 6
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
of physical and psychological complaints such as: lower back
pain (57.7%), feeling bloated (51.9%), feeling under stress
-
         
-
  
         
49.2% for irritability and 46.9%for feeling overwhelmed
[10]. These results may be due to common socio-cultural
     
Severity of premenstrual symptoms in the current study in-
crease with academic class of the participants and clinical
year students have more severe symptoms than basic year
Table 4. Multivariable Analysis of Characteristics Associated with the Severity of Premenstrual symptoms.
ones. This may be due to the fact that senior students are in
more academic stress and are involved in clinical rotations
in different hospitals and clinics which require more physi-
         
study which found that severity of premenstrual syndrome
was positively correlated with students level of training [12].
Coffee consumption was considered a behavioral risk factor
        
the fact that caffeine is a stimulant and increase stress, emo-
tional liability and irritability [6]. In our study it was found
      -
ly associated with more coffee consumption. Additionally,
Pinar et al. [13] showed that the frequency of PMS is higher
in those who consume more coffee.
In our study, we found that severity of premenstrual symp-
toms was higher in students with longer duration of men-
strual cycle. A similar result reported by Deuster et al [6].
          -

         -
         
 
 -
menstrual symptoms and student’s absence from lectures and
     
of many studies conducted in different population; like the
 
and the Indian medical college students(9). This association is

the student and decreases their concentration, so they tend
to miss their classes at this period.
Some limitations of this study warrant consideration. First-
ly,           -
cine and Health Sciences at ANNU which may limit its gener-
alizabilty. Secondly, using a self administered questionnaire
to study such sensitive topic makes it liable to information
bias as some students might not want to disclose their per-
sonal problems, although we tried our best to ensure the
privacy of the participants. In addition, using a prospective
study design to be able to log of symptoms by the partici-
pants could be the ideal methods; however, this was impos-
sible as a matter of budget constraint, because this study
       
Conclusion and Recommendations
Premenstrual syndrome is common among female medical and
health science students with prevalence of 71.9%. The most
frequently reported complaints were lower back pain, followed
by feeling bloated and feeling under stress. Sever PMS have
negative effect in students academic and social performance
Jacobs Publishers 7
Cite this article: Nazzal Z. Moderate to Severe Premenstrual Syndrome and Contributing Factors among University Students in Palestine. J J Commun Med. 2015, 1(2): 016.
and attendance which may lead to poor quality of life. Higher
academic class, regular coffee intake, longer duration of men-
strual period found to predict the occurrence of severs PMS.
        
         -
lem and provide appropriate, physical and emotional support
as well as giving more attention to psychological methods as
       
highly recommend increasing the awareness of PMS symp-
toms and coping strategies among university students and

high prevalent problem among female students.
Acknowledgements
 
this study possible. In particular, we would like to thank the
study participants for their time and efforts.
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... Other several studies on the PMS prevalence in Middle Eastern countries had been conducted in the past 20 years. For instance, PMS percentages among university students were 71.9% in Palestine [9], 92.3% in Jordan [10], 80.2% in Egypt [11], and 63% in Lebanon [12]. ...
... Among them 232 (58.3%) and 68 (17.1%) had moderate and severe PMS symptoms respectively. These results are higher than those obtained from a Palestinian study on the prevalence of PMS among university students (71.9%) [9]. This difference might be resulted from the different diagnostic tool used in the study and the fact that the selected sample included students from Medicine and Health Sciences College only. ...
... The effect of PMS on behavior was represented in the significant (p < 0.05) correlation between PMS and the absence from university in a Palestinian previous study. It was found that 48.1% of students with mild PMS symptoms and 51.9% with moderate or severe symptoms often or always missed classes because of PMS symptoms [9]. 77.7% university students in UAE were found to have behavioral symptoms, and 20% and only 2% had moderate and severe behavioral symptoms, respectively [7]. ...
Article
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Background Premenstrual Syndrome (PMS) is a very common problem with symptoms that can negatively affect normal daily life. This cross-sectional study aimed to investigate the prevalence of PMS symptoms and their relationship with psychosocial status and lifestyle of female students at An-Najah National University in Palestine. A sample of 398 female students was randomly selected to participate in the study. Arabic Premenstrual Scale (A-PMS) was used for PMS assessment. Psychosocial variables were determined using the DASS-21 Arabic version, and dietary habits were measured using a 24 item self-reported questionnaire. Data was analyzed by one-way ANOVA and Chi-square tests using SPSS software version 23. Results The 398 participants (100%) suffered from some kind of PMS symptoms; 398 (100%) had physical symptoms, 397 (99.7%) had psychological symptoms, and 339 (85.2%) had behavioral PMS symptoms. All PMS symptoms were significantly associated with student psychosocial status ( p < 0.01). Preferring a certain type of food during menstruation was significantly related to psychological PMS symptoms ( p < 0.001), and physical symptoms ( p < 0.01). Following a diet was significantly related to physical symptoms ( p < 0.05) and behavioral symptoms ( p < 0.001). Moreover, drinking herbal tea was significantly related to physical symptoms ( p < 0.001) and behavioral symptoms ( p < 0.05). Conclusion The findings of the study revealed a relatively high prevalence of PMS syndrome with a significant relationship with dietary habits and psychosocial status.
... In a similar vein, over the past 20 years, several surveys on the prevalence of PMS in Middle Eastern nations have been conducted. For example, the PMS rate among university students was 71.9% in Palestine [22], 92.3% in Jordan [23], and 63% in Lebanon [24]. Moreover, the worldwide prevalence of PMS was found to be 99.6% for Jima university students in Ethiopia [25], 98% for university students in Thailand [26], and 91% for Turkish medical students [27]. ...
... This discrepancy may be attributed to the recent rise in young women's empowerment and genderaffirming attitudes in Egypt as a result of society's rapid development, which has increased perception and awareness. The high prevalence of severe PMS in adole- (22) www.fizjoterapiapolska.pl scent girls may also be caused by a lack of awareness among college students regarding the causes and treatments of PMS. Furthermore, the long study sessions caused them a lot of stress [31], which could negatively impact the intensity of PMS symptomatology through affecting their eating habits and inducing them to skip breakfast. ...
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Background. During the luteal phase of the menstrual cycle, a set of clinically significant physical and psychological symptoms known as premenstrual syndrome (PMS) emerge. This condition can be extremely distressing and hinder females’ ability to work. Purpose. To calculate the prevalence and severity of PMS and its biopsychosocial symptoms in female physiotherapy students in Eastern Delta and to investigate the relationship between various socio-demographic and reproductive factors. Methods. At Delta University for Science and Technology in Gamasa, Egypt, 396 female physiotherapy students participated in an exploratory cross-sectional survey with a mean age of 20.23±1.07 years and BMI with a mean of 28.86 ± 5.05 kg/m2. The premenstrual syndrome scale (PMSS) was adopted to assess the prevalence of PMS and related symptoms, and a self-administered questionnaire was used to gauge sociodemographic and reproductive data. Results: Three hundred ninety-six females of 438 females completed the study. In 85% of cases, PMS predominated research calculations. The PMS group displayed symptoms of fatigue, cramping in the abdomen, tension, mood fluctuations, and decreased productivity more overtly. According to a multiple linear regression analysis, living in a rural area, hitting menarche earlier, having a higher BMI, and having a family history were all significantly linked to PMS (p < 0.05). Conclusion. Female students have a high prevalence of PMS and its biopsychosocial symptoms. Therefore, adoption of preventive reproductive health and counseling services should be implemented as a standard component of routine clinical treatment for university students.
... them had PMS symptoms of variable severity; 58.3% had moderate PMS whereas 17.1% had severe PMS symptoms in one study [10] while the other Palestinian study reported a rate of 71.9% [11]. ...
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Background: Premenstrual syndrome is one of the common problems affecting female in different age groups and could affects the academic performance of students. Aims of this study were to estimate the prevalence of premenstrual syndrome and determine its effect on school performance among university medical students. Material and Methods: It was a cross-sectional study done in Al-Madinah city, Saudi Arabia including all female medical students from level 2 to 5, enrolled at Taibah University. Data were collected through self-administrated questionnaire. It contains 4 main parts: socio demographic characters of the students, menstrual and premenstrual characteristics, and premenstrual syndrome scale. Results: The study included 257 students, with a response rate of 70.8%. Their age ranged between 18 and 29 years with an arithmetic mean of 21.8 years and a Standard Deviation (SD) of 1.8 years. According to the premenstrual syndrome scale score with a cut-off level of 111, the prevalence of PMS among female medical students was 65.4%. PMS was not significantly associated with students` academic performance. However, it is associated with premenstrual or menstrual pain (p<0.001), family history of premenstrual syndrome (p=0.016), dysmenorrhea (p=0.002) and severe back pain or cramps (p<0.001 and p=0.007, respectively). Conclusion: Premenstrual tension syndrome is a prevalent alarming health problem affecting a great sector of female medical University students, Taibah University, Al-Madinah, Saudi Arabia. It affected the daily work of a considerable proportion of students. However, it did not impact their academic performance.
Article
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Premenstrual syndrome (PMS) involves a variety of physical, emotional and psychological symptoms experienced by some women during the late luteal phase of menstrual cycle (7-14 days prior to menstruation). The symptoms of PMS seem to worsen as menstruation approaches and subside at the onset or after days of menstruation, and a symptom-free phase usually occurs following menses. The group of women with the severest premenstrual symptoms and impairment of social and role functioning often meet the diagnostic criteria for premenstrual dysphoric disorder (PMDD), a severe form of PMS. Objectives: To determine the prevalence of premenstrual syndrome (PMS) between university medical students, and to evaluate the impact of the condition on their quality of life (QOL). Methodology: A cross-sectional study included unmarried medical students aged 18-25 years with regular menstrual period for the last 6 months. Socio-demographic data, DSM-IV (Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association) criteria questionnaire for PM/PMDD as well as the daily record of the severity of PMS problems scale (DRSP) was collected for each student for two prospective cycles. Health-related quality of life (HRQOL) data questionnaire was collected on medical outcome study Short Form 36 (SF-36) after taking informed consent from the students. Results: The prevalence of PMS among the studied group was 78.5%, of them, 5.9% had severe form of PMS. This study showed that the burden of PMS/PMDD on health-related quality of life was on mental and emotional health-related quality of life domains beside on physical health-related quality of life domains as the students with PMS reported a poorer health-related quality of life as measured by SF-36 than those without PMS. Conclusion: PMS/PMDD is a prevalent, yet undertreated, disorder among medical students in KSA, which adversely affected their quality of life.
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The symptomatology associated with the menstrual cycle in women ranges broadly in severity. Molimina is the subclinical symptomatology affecting up to 90% of all women. Premenstrual Dysphoric Disorder (PMDD) is the most severe form of premenstrual syndrome (PMS). PMDD is debilitating and consists mainly of affective symptomatology that interferes with quality of life (QOL). While the etiologies of PMS/PMDD remain unknown, symptoms are both physiological and psychological and as such an interdisciplinary biopsychosocial approach is needed to investigate the burden and decreased QOL in sufferers. This burden is considerable as up to 30% of women suffer from PMS and 5–6% have PMDD with nearly 4 years of projected disability for the latter. Published treatment guidelines recommend behavioral modifications as first-line therapeutic interventions for PMS with effective pharmacological options approved for PMDD. However, the efficacies for behavioral interventions are not well established, in part due to weaknesses in the research methods used to test a treatment effect, and resultant inconsistencies in findings. In addition, some strategies involving daily effort (e.g., Cognitive-Behavioral Therapy) may be impractical in the face of the unique characteristics of cyclic symptoms. Other strategies such as aerobic exercise may be effective, but require motivation to perform during a period of time when sufferers feel particularly poor. As such, aerobic exercise by itself may be an unrealistic treatment option. Treatments that can reduce and/or manage stress, elevate mood, and curb physical discomforts are needed. However, it may be impracticable to expect therapeutic success in all of these areas from a single intervention. Current research is therefore investigating complementary combinations of pharmacological and behavioral treatments as possible management strategies for PMS/PMDD.
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To survey the prevalence and severity of premenstrual symptoms and compare premenstrual symptom clusters of younger (13-15-year-old) and older (16-18-year-old) adolescents, based on both chronological and gynecological age. Physical, emotional, and behavioral premenstrual symptoms were assessed by self-report using the Premenstrual Assessment Form (PAF), in a sample of 75 adolescents. Analyses were performed to determine differences in premenstrual symptom clusters in younger and older adolescents. The participants had a mean age of 14.8; 96% identified themselves as Caucasian, 3% as African-American, and 1% as Asian. All participants reported at least one premenstrual symptom of minimal severity. Many reported symptoms that they considered moderate (88%), severe (73%), or extreme (56%). The symptoms most commonly reported were food cravings, breast swelling, abdominal discomfort, mood swings, stressed feeling, and dissatisfaction with appearance. Other symptoms, such as missing time at school, becoming violent with people or things, and "thinking of what it would be like to do something to self" (such as crash the car), wishing to go to sleep and not wake up, or having thoughts of death or suicide, were less frequently reported. The younger teens (13-15 years old) had significantly less intense symptoms than the older teens (16-18 years old). Premenstrual symptoms reported as being moderate or greater in severity were found to be quite prevalent (88%) in this sample of adolescents. Specifically those adolescents at 41 months postmenarche or greater reported specifically more intense premenstrual symptoms. In addition, a subset of adolescents expressed that they experienced aberrant behavior and passive suicidal ideations as premenstrual symptoms.