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A study of impact of stress: examinations on menstrual cycle among medical students

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Background: Premenstrual Syndrome (PMS), a common problem among adolescent girls, is associated with various physical, mental and behavioral symptoms that lead to social and occupational impairment. Stress has also been hypothesized to be an important etiologic factor. Examination stress may also be responsible for affecting the premenstrual symptoms. The objectives of this study was to study the impact of exam stress on the menstrual cycle and the relationship of perceived stress with the severity of premenstrual symptoms. Methods: This was a cross-sectional observational study conducted among female medical students of final MBBS, who were candidate of upcoming exams. They were assessed on semi structured socio-demographic and menstrual history proforma, ACOG guidelines, DSM-5 criteria, Perceived Stress Scale (PSS) and Premenstrual Symptom Screening Tool (PSST).Results: As per ACOG guidelines, 66% participants had PMS and 6% participants had PMDD according to DSM-5 criteria. On PSST total 88% participants had premenstrual symptoms and out of them 58% had mild/no PMS while 30% had moderate to severe PMS. 5% participants also fulfilled criteria for PMDD on PSST. Stress was found to be mild in 26% and moderate in 74% participants on PSS. PMS was found in 93.75% participants who had painful menstruation (dysmenorrhea) and this association was statistically significant. Data wise 73.1% participants having mild stress had PMS, while 93.2% participants having moderate stress, had PMS and this association was found to be statistically significant. Surprisingly not a single participant consulted to any health care provider for their menstruation related problems.Conclusions: Premenstrual Syndrome is common in adolescent girls and exam stress is an important etiological factor. PMS/PMDD was found significantly higher in participants who had dysmenorrhea and moderate stress. A positive and highly significant correlation was also found between the severity of stress and severity of premenstrual symptoms.
International Journal of Research in Medical Sciences | December 2019 | Vol 7 | Issue 12 Page 4703
International Journal of Research in Medical Sciences
Rathi AK et al. Int J Res Med Sci. 2019 Dec;7(12):4703-4708
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
A study of impact of stress: examinations on menstrual cycle among
medical students
Anant Kumar Rathi1*, Megha Agrawal2, Girish Chandra Baniya3
INTRODUCTION Premenstrual syndrome (PMS) was defined by an NIMH
Consensus workshop group as “A constellation of mood,
1Department of Psychiatry, S. P. Medical College, Bikaner, Rajasthan, India
2Department of Psychiatry, Lady Harding Medical College, New Delhi, India
3Department of Psychiatry, Government Medical College, Barmer, Rajasthan, India
Received: 25 September 2019
Revised: 07 October 2019
Accepted: 31 October 2019
*Correspondence:
Dr. Anant Kumar Rathi,
E-mail: anantkumarrathi@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195542
ABSTRACT
Background: Premenstrual Syndrome (PMS), a common problem among adolescent girls, is associated with various
physical, mental and behavioral symptoms that lead to social and occupational impairment. Stress has also been
hypothesized to be an important etiologic factor. Examination stress may also be responsible for affecting the
premenstrual symptoms. The objectives of this study was to study the impact of exam stress on the menstrual cycle
and the relationship of perceived stress with the severity of premenstrual symptoms.
Methods: This was a cross-sectional observational study conducted among female medical students of final MBBS,
who were candidate of upcoming exams. They were assessed on semi structured socio-demographic and menstrual
history proforma, ACOG guidelines, DSM-5 criteria, Perceived Stress Scale (PSS) and Premenstrual Symptom
Screening Tool (PSST).
Results: As per ACOG guidelines, 66% participants had PMS and 6% participants had PMDD according to DSM-5
criteria. On PSST total 88% participants had premenstrual symptoms and out of them 58% had mild/no PMS while
30% had moderate to severe PMS. 5% participants also fulfilled criteria for PMDD on PSST. Stress was found to be
mild in 26% and moderate in 74% participants on PSS. PMS was found in 93.75% participants who had painful
menstruation (dysmenorrhea) and this association was statistically significant. Data wise 73.1% participants having
mild stress had PMS, while 93.2% participants having moderate stress, had PMS and this association was found to be
statistically significant. Surprisingly not a single participant consulted to any health care provider for their
menstruation related problems.
Conclusions: Premenstrual Syndrome is common in adolescent girls and exam stress is an important etiological
factor. PMS/PMDD was found significantly higher in participants who had dysmenorrhea and moderate stress. A
positive and highly significant correlation was also found between the severity of stress and severity of premenstrual
symptoms.
Keywords: Premenstrual Syndrome, Premenstrual Dysphoric Disorder, Diagnostic and statistical Manual-5,
Premenstrual Symptom Screening Tool, Perceived Stress Scale, American College of Obstetrician and
Gynaecologists
Rathi AK et al. Int J Res Med Sci. 2019 Dec;7(12):4703-4708
International Journal of Research in Medical Sciences | December 2019 | Vol 7 | Issue 12 Page 4704
behavioral and/or physical symptoms that have a regular
relationship to the luteal phase of menstrual cycle, are
present in most if not all cycles and remit by the end of
menstrual flow with a symptom free interval of at least
one week each cycle.1 Premenstrual syndrome is a
common complication among the women of childbearing
age.2 Epidemiologic surveys have estimated that as many
as 80% of women of reproductive age experience some
symptoms attributed to the premenstrual phase of the
menstrual cycle.3 The American College of Obstetricians
and Gynecologists (ACOG) published a revised practice
bulletin in 2000 for the management of Premenstrual
syndrome.4
A severe form of PMS, called as premenstrual dysphoric
disorder (PMDD), significantly impairs the daily life
activities in women. PMDD is distinguished from PMS
by the severity and number of symptoms as well as the
degree to which the function is impaired.5
Variety of factors such as change in hormone levels,
chemical changes in brain have been hypothesized to be
implicated in the etiology of PMS. Stress has also been
found an important etiologic factor. The level of stress
also relates to the severity of PMS.6 Perceived stress in
college settings may be due to academic stress of
studying for examinations with respect to grade
competition and large amount of content to master in a
small amount of time. Thus it can be seen that the
academic stress experienced by students appearing for
exams may be responsible for affecting their menstrual
symptoms.
Many girls, particularly college going, do suffer from
either new appearance or exacerbation of these symptoms
during examination and there are very few studies about
stress and its relationship with menstrual disorders, hence
this study was planned.
The objectives of this study are to study the impact of
examination stress on menstrual cycle and relationship of
perceived stress with the severity of premenstrual
symptoms.
METHODS
This study was conducted undergraduate female students
of a medical college who were candidate of Final MBBS
exams. This is a cross-sectional observational study.
Convenient sampling method was used. The study was
conducted from 01/06/2019 to 15/06/2019.
Inclusion criteria
Those above 18 years of age
Having attained menarche
Willing to give informed consent
Candidate in university exams and
Able to recall last 3 menstrual cycles.
Exclusion criteria
Pre-existing medical and gynaecological illnesses
(anaemia, diabetes, hypothyroidism, asthma,
migraine, epilepsy, pelvic inflammatory disease,
endometriosis and amenorrhea).
Using medications affecting menses (e.g.,
antidepressants, anticonvulsants or herbal
medicines, hormones and vitamins) within the past
three months.
Presence of any other stressful life event within the
past three months.
Total 137 participants were invited to achieve a desired
number of 100 participants. 12 were unwilling to
participate and 25 were excluded on the basis of
exclusion criteria. Objectives and method of the study
was explained and written informed consent was obtained
after assuring about confidentiality of the data. Socio-
demographic detail and menstrual history was taken from
all the participants in semi structured proforma.
All participants were screened on Premenstrual Symptom
Screening Tool (PSST) by enquiring detail about last 3
menstrual cycles after collecting. Stress was measured in
all participants using Perceived Stress Scale - 10 (PSS-
10).
Structured Clinical Interview was done in presence of a
female Psychiatrist to confirm the diagnosis as per DSM-
5. Data was analyzed using SPSS Version 18 and
expressed in form of mean±standard deviation for
continuous variables and percentage for categorical
variables. Chi square test was used to find out
significance of association and p<0.05 was considered as
statistically significant.
Instruments of the study
Semi-structured proforma - Used for evaluation of the
participants which included socio demographic profile
sheet and menstrual history profile sheet.
Premenstrual Symptom Screening Tool (PSST) - Devised
by Steiner et al, for diagnosis of PMS and PMDD and
very commonly used tool for the same. According to the
study conducted by Yen et al, Cronbach's alpha of the
first and second parts of PSST was 0.96 and 0.61,
respectively.8 The content validity of the first and second
parts of this test was 0.93 and 0.8%, respectively. It is a
19-item instrument consisting of two domains:7
First domain includes 14 premenstrual symptoms
which must start before period and stop within a few
days of bleeding- (1) anger/irritability, (2)
anxiety/tension (3) tearful/increased sensitivity to
rejection, (4) depressed mood/hopelessness, (5)
decreased interest in work activities, (6) decreased
interest in home activities, (7) decreased interest in
social activities, (8) difficulty in concentrating, (9)
Rathi AK et al. Int J Res Med Sci. 2019 Dec;7(12):4703-4708
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fatigue/lack of energy, (10) overeating/food
cravings, (11) insomnia, (12) hypersomnia, (13)
feeling overwhelmed or out of control and (14)
physical symptoms: breast tenderness, headaches,
joint/muscle pain, bloating, weight gain.
Second domain includes 5 items which evaluates
impact of symptoms on women’s functioning as
interference with - (a) work efficiency or
productivity, (b) relationships with co-workers (c)
relationships with family, (d) social life activities
and (e) home responsibilities.
Each item is rated on a four point Likert scale as not at
all, mild, moderate and severe in last 12 months duration
during most of the cycles. For diagnosis of PMS, women
must report at least five symptoms as moderate or severe
from first domain where at least one should be from core
symptoms (numbers 1-4). Also, they must report if their
symptoms interfere moderately or severely with their
ability to function in at least one of five items in the
second domain.
While for diagnosis of PMDD, the following criteria
must be present: (a) at least one of the core symptoms (1
to 4) as severe, (b) in addition, at least four of the
symptoms (1 to 14) as moderate to severe from first
domain and (c) at least one of symptom as severe from
second domain.
Perceived Stress Scale-10 (PSS-10) - It was developed by
Cohen and his colleagues and adopted to measure a
global level of perceived stress. There are 10 questions in
this scale asking about your feelings and thoughts during
the last month.9 Each item is rated on a 5-point Likert
scale ranging from never (0) to almost always (4).
Positively worded items (4, 5, 7, and 8) are reverse
scored, and the ratings are summed across all 10 items.
Scores ranging from 0-13 is considered low stress, 14-26
is considered moderate stress while 27-40 is considered
high perceived stress. A higher total score indicates a
higher level of uncontrollable, unpredictable, and
overwhelming feelings.10
ACOG Guidelines - The Key elements of a PMS
identified by ACOG include the following:4
Symptoms consistent with PMS- at least one of each
of the following affective and somatic symptoms
during the 5 days before menses.
Affective: Depression, anger outbursts, irritability,
anxiety, confusion, social withdrawal
Somatic: Breast tenderness, abdominal bloating,
headache, swelling of extremities
Restriction of symptoms to the luteal phase of
menstrual cycle.
Confirmation of symptom pattern by prospective
assessment.
The symptoms cause functional impairment.
Exclusion of other diagnosis that may better explain
the symptoms.
Ethical clearance: First of all, approval was taken from
the ethical committee of the medical college to conduct
the study.
RESULTS
Total 100 participants were analyzed. Mean age of
participants was 20.94 years ranging from 19-24 years,
98% of them were Hindu and 68% belonged to nuclear
family, 60% were hailing from urban locality while rest
were from rural background (Table 1).
Mean age of menarche was 13.43 years ranging from 11-
17 years. Mean duration of cycle was 28.61 days ranging
from 22 - 40 days. Mean duration of flow was 4.69 days.
86% participants had duration of flow between 3-5 days
and the rest had the blood flow for more than 5 days.
Blood flow was reported scanty by 1%, normal by 87%
and heavy by 12% of the total participants.
Dysmenorrhea (painful menstruation) was reported by
64% participants. Intermenstrual bleeding wasn't reported
by any of the participant (Table 2).
Table 1: Distribution of participants according to
socio-demographic profile.
Variable
Range
Age
(19-24
Years)
Religion
Hindu
Non-Hindu
Family
type
Nuclear
Extended
Nuclear
Joint
Locality
Urban
Rural
Statistically 66% participants had PMS according to the
ACOG guidelines (DSM-5) and 6% fulfilled the criteria
for PMDD as per DSM-5. According to the PSST, 88
participants had one or more premenstrual symptoms out
of which 58 had mild/no PMS and 30 had moderate to
severe PMS, 5% participants were diagnosed as PMDD
according to PSST. On Perceived Stress Scale, the stress
was mild in 26% and moderate in 74% of the participants
(Table 3).
Relationship of Premenstrual Syndrome to menstrual
characteristics and perceived stress score. 93.75% of
participants reporting dysmenorrhea were having
Premenstrual syndrome and this association was found to
be statistically significant (p value<0.05). Significant
association was not found between presence of
Rathi AK et al. Int J Res Med Sci. 2019 Dec;7(12):4703-4708
International Journal of Research in Medical Sciences | December 2019 | Vol 7 | Issue 12 Page 4706
premenstrual symptoms and duration of flow, regularity
of cycles, amount of blood flow and duration of cycle (Table 4 and 5).
Table 2: Distribution of participants according to characteristics of menstrual cycle.
Variable
Number of participants (n=100)
Range
Mean age of menarche
13.4 years
(11-17 years)
Mean duration of cycle
28.6 days
(22 - 40 days)
Duration of flow
3-5 days
86
Mean duration of flow = 4.6 days
>5 days
14
Regularity of cycle
Regular
96
Irregular
4
Blood flow
Scanty
1
Normal
87
Heavy
12
Dysmenorrhoea
Present
64
Absent
36
Inter-menstrual Bleeding
Present
0
Absent
100
Table 3: Distribution of participants according to menstrual/psychological problems.
Variable
Number of participant (n=100)
Percent
PMS according to DSM-5 [ACOG criteria]
Yes
66
66 %
No
34
34 %
PMDD according to DSM-5
Yes
6
6 %
No
94
94 %
PMS according to PSST
No symptom of PMS
12
12 %
Mild/No PMS
58
58 %
Moderate/Severe PMS
30
30 %
PMDD according to PSST
Yes
5
5 %
No
95
95 %
Perceived stress on PSS
Mild (≤13)
26
26 %
Moderate (14-26)
74
74 %
PMS - Premenstrual Syndrome PMDD - Premenstrual Dysphoric Disorder, DSM 5 - Diagnostic and statistical Manual 5, PSST -
Premenstrual Symptom Screening Tool PSS - Perceived Stress Scale ACOG - American College of Obstetrician and Gynecologists
Table 4: Distribution of PMS/PMDD patients according to menstrual characteristics.
Menstrual characteristics
PMS/PMDD
[According to PSST]
p value
Present
(n=88)
Absent
(n=12)
Dysmenorrhoea
Present (64)
60 (93.75%)
4 (6.25%)
0.01 Significant
Absent (36)
28 (77.78%)
8 (22.22%)
Duration of flow
3 5 days (86)
75 (87.2%)
11 (12.8)
0.54
> 5 days (14)
13 (92.85%)
1 (7.15%)
Regularity of cycle
Regular (96)
84 (87.5%)
12 (12.5%)
0.45
Irregular (04)
4 (100%)
0 (0%)
Blood flow
≤Normal (88)
78 (88.63%)
10 (11.37%)
0.59
Heavy (12)
10 (83.33%)
2 (16.66%)
Duration of cycle
≤30 days (87)
75 (86.2%)
12 (13.8)
0.15
>30 days (13)
13 (100%)
0 (0%)
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Table 5: Distribution of PMS/PMDD patients
according to Perceived Stress Score.
Perceived
Stress Score
PMS/PMDD
p value
Present
(n=88)
Absent
(n=12)
Mild stress
(≤13)
19(73.1%)
7(26.9%)
0.006
Highly
Significant
Moderate
stress (14-26)
69(93.2%)
5(6.8%)
Among the participants who had mild stress, 73.1% were
having Premenstrual Syndrome, while in participants
with moderate stress, 93.2% were having Premenstrual
Syndrome and this association between stress and
presence of premenstrual symptoms was found to be
statistically significant (p value< 0.05).
A highly significant correlation was found between PSS
score and PSST score (p value=0.006, r=0.235)
explaining that as the stress increases, severity of
premenstrual syndrome also increases (Figure 1).
Figure 1: Distribution of PSST score and PSS score in
participants.
DISCUSSION
The current study has a special aim at assessing the
impact of examination stress on menstrual cycle in young
medical students, when they are more prone to emotional
and psychological burnout. Relationship in severity of
perceived stress with the severity of premenstrual
symptoms was also analyzed.
The mean age of participants was 20.94 years ranging
from 19- 24 years. Premenstrual syndrome (PMS) is quite
prevalent among women of reproductive age. Nisar M et
al. found mean age of participants 21.2 ranging from 18 -
25.11 Most of the participants (52.66%) were from age
group 21 to 24 in a study done by Bakhshani NM et al. 12
Similarly Issa BA et al, in their study found that mean
age of the participant was 21.3 years ranging from 16 - 38
years.13 Nourjah P in a study in university students found
that age of participants ranged from 18 - 24 years.14 Singh
P et al. found mean age of the participants 18.9 years
ranging from 17 to 30 years.15
The mean age of menarche was 13.43 years and mean
duration of cycle was 28.61 days. Mean duration of blood
flow was 4.69 days. Dysmenorrhea (painful
menstruation) was reported by 64% of the total
participants. Statistically significant association was
found between dysmenorrhea and PMS/PMDD (p value<
0.05). Mahin Delara et al, in 2013 also found in their
study in Iranian adolescent girls that those with
dysmenorrhea were more likely to be classified as having
PMS and PMDD.16
Statistically 66% participants had PMS and only 6% had
PMDD according to the DSM-5 criteria. Mishell DR et
al, also estimated that 75-85% of menstruating women
experience some uncomfortable symptoms during the
premenstrual phase of their cycles.17 Banerjee et al,
reported 6.4% prevalence of PMDD in Indian women.18
On PSST, 88% participants reported having premenstrual
symptoms out of which 58% had mild/no PMS and 30%
had moderate to severe PMS. Author are in agreement
with the study by Steiner et al, who reported severe PMS
in 21.3% of adolescent girls, 5% of total participants
were diagnosed as PMDD according to PSST. This study
is in agreement with the study by Steiner et al, who
reported its prevalence to be 8.3%.19 Higher number of
cases of PMS/PMDD by PSST can be due the fact that
even a single positive response of participant categorizes
her into No/mild PMS.
This study reports that mild stress was found in 26% and
moderate stress in 74% of the participants. Among
participants showing mild stress, 73.1% were having
PMS/PMDD while in subjects having moderate stress,
93.2% were having PMS/PMDD and this association
between stress and premenstrual symptoms was found to
be statistically significant (p value<0.05). Czaikowska M
et al, in 2015 also found that stress of competitive sports
and intensity of training are conducive to PMS.20
The study finds highly significant correlation between
PSS score and PSST score (p value= 0.006, r= 0.235)
explaining as the perceived stress increases, severity of
premenstrual symptoms also rises. Lustyk et al, found
significantly more perceived stress in the high symptom
group compared to the low symptom group.21
The study has certain limitations, it included a highly
selective sample of undergraduate medical college
students. Premenstrual symptoms were reported based on
retrospective recall of the participants adding a recall
bias. As there was no prospective diary charting of PMS
symptoms, the prevalence rates are of “provisional
diagnosis” according to DSM-5 criteria. Findings of this
study needs to be replicated by community based large
cross sectional survey to obtain more precision.
0
10
20
30
40
50
010 20 30
PSST Score
Perceived Stress Score p = 0.006
r= 0.235
Rathi AK et al. Int J Res Med Sci. 2019 Dec;7(12):4703-4708
International Journal of Research in Medical Sciences | December 2019 | Vol 7 | Issue 12 Page 4708
CONCLUSION
Premenstrual syndrome is common in adolescent girls.
Highly significant correlation between the severity of
stress of exams and PSST score suggests that stress is
responsible for either increase in the severity or new
appearance of premenstrual symptoms. Statistically
significant correlation between Premenstrual syndrome
and dysmenorrhea suggests that every women reporting
painful menstruation should be thoroughly screened for
presence of Pre-menstrual syndrome or Pre-menstrual
dysphoric disorder.
Final year MBBS students having menstruation related
problems, despite affecting their work efficiency, did not
consult to healthcare provider probably considering it
either as a normal phenomenon or due to their hesitation.
Simultaneously there is a need of orientation of women’s
health care providers about role of stress in Premenstrual
Syndrome or Pre-menstrual dysphoric disorder.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Cite this article as: Rathi AK, Agrawal M, Baniya
GC. A study of impact of stress: examinations on
menstrual cycle among medical students. Int J Res
Med Sci 2019;7:4703-8.
... Furthermore, an argument can be made that the poor level of palliative support provided by African governments to residents of the continent compounds this initial stressor in them. Regardless of what the actual cause of high stress levels are, the fact remains that the crisis-associated stress can disrupt the menstrual cycle and flow in unusual ways (Rathi et al., 2019). However, this disruption should not always be a cause for worry and might not even require any intervention. ...
... However, this disruption should not always be a cause for worry and might not even require any intervention. Also, the crisis can lead to first-time occurrence of stress-associated menstrual disorders such as premenstrual syndrome, premenstrual dysphoric disorder, dysmenorrhea etc. in some menstruators, and increased severity of these disorders in menstruators with previous histories of them (Rathi et al., 2019). The possibility of these unusual outcomes is especially worrisome considering that the crisis has limited the access of menstruators to menstrual-related information. ...
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The COVID-19 crisis has unprecedentedly altered the course of life of majority of Africans. Menstrual health and wellbeing is a key altered aspect. The manifestation of this is apparent in the reduction/elimination of access to Menstrual Hygiene Management products and facilities, adoption of unhygienic menstrual management practices even by healthcare workers, decrease in access to menstrual-related knowledge, increase in the risk of occurrence and severity of several stress-related menstrual disorders, and a shift of public focus from menstrual health and wellbeing promotion. This disruption, in turn, leads to increased risk of predisposition to several other diseases/illnesses; prevalence of medical negligence and error, morbidity and mortality; and development lag in the continent. Prevention of these possible negative outcomes is only feasible through continued and reinforced menstrual health and wellbeing promotion facilitated by the African government and other stakeholders. This paper, thus, aim to redraw their attention to this urgent need.
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Aim: The academic performance of the students decreases due to menstrual symptoms. Anxiety stands as a notable determinant influencing menstrual symptoms. Therefore, the aim of the study to examine students’ anxiety levels and dysmenorrhea variables during lecture and exam periods. Method: Menstrual symptoms and anxiety levels were measured the Menstruation Symptom Scale and State and Trait Anxiety Inventory in female students (age: 21.09±1.70 years). The differences between academic periods and the relationship between anxiety and menstrual symptoms were analysed. Results: Anxiety and menstrual symptoms increased during the exam period, when compared to the lecture period (p<0.05). Menstruation symptoms and anxiety were found to be correlated in the exam period (p<0.05). Conclusion: It has been reported that students experience more severe menstrual symptoms and anxiety during exam periods compared to regular semesters. Future interventions should aim to reduce the negative impact of exam-related anxiety on menstrual symptoms. There is a need for further research to address these barriers in academic settings for female students.
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Background: Premenstrual syndrome (PMS) is a cyclic phenomenon which is associated with behavioral, psychological and physical symptoms. It is caused by dysregulation of hypothalamic-pituitary axis (HPA axis) which leads to impaired mental status, high level of stress level among females. Physical activity is beneficial to improve PMS symptoms, so present study was conducted to find out the relationship of PMS with mental status, physical activity, stress level among college going females. Method: A cross-sectional study was conducted among college going females. Data was collected with online google form. Total 216 students age between 18-25 participated in the study. To assess physical activity, stress, mental state, and premenstrual symptoms, we employed standard questionnaires, including the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Perceived Stress Scale (PSS), the General Health Questionnaire-12 (GHQ-12), and the Premenstrual syndrome scale questionnaire. Result : Results shows that PMS is significantly correlated with stress level with p value of 0.030 and with mental status it is showing weak correlation with p value of 0.963. PMS is significantly correlated with physical activity with p value of 0.023. Conclusion-PMS is correlated with physical activity, stress level and mental status of college going females.
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Background: Stress is an unwelcome yet necessary aspect of all our lives which dictate our quality of life. This emotion is particularly unwelcome in the period of exams which is why this research was conducted, and for females specifically. Premenstrual Syndrome is a collection of symptoms occurring one week to ten days prior to a menstrual cycle involving but not limited to, fatigue, abdominal cramps, and restlessness. These symptoms can lead to disruption in their lives and a negative effect on the academic performance of female medical students. Objective: To determine the effect of examination stress on Premenstrual Syndrome in Pakistani medical students and to see if there is any correlation present. Methods: This was a cross-sectional study which was conducted between March and September of 2022 in CMH Lahore where 177 females were enrolled, prior to their exams with an exclusion criterion of females on antiepileptic medication, antipsychotics or birth control. Non-probability convenient sampling was used. Two pre-tested questionnaires were used to measure stress and Premenstrual Syndrome simultaneously, the Student Stress Inventory (SSI) and Premenstrual Syndrome Scale (PMSS), consensually and anonymously. Chi-squared test was utilized with a P-value less than 0.05 was taken as significant. Results: Out of 177 female students, for SSI, 53 had mild stress, 115 had moderate stress while 5 had high stress. As for PMSS, 2 students had no symptoms, 34 had mild symptoms, 63 had moderate symptoms, 57 had severe symptoms and 17 had very severe symptoms. We found a statistically significant link between pre-modular stress and its detrimental effects on premenstrual syndrome. Both the PMSS and the SSI had a p value of 0.004, which established a noteworthy association. Conclusion: A strong link was found between pre-examinational stress and menstrual irregularities in this research.
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Introduction:Premenstrual discomfort of variable severity is commonly encountered among females of child bearing age.These discomforts lead to significant distress & adversely affects overall quality of life.This study was thus planned to explore the presence of these symptoms & associated dysfunction in the premenstrual period in young college going females. Method: A cross sectional survey was carried out on college girls(n=148), where questionnaire consisting of 11 items, prepared on the basis of DSM-IV-TR criteria for Premenstrual Dysphoric Disorder(PMDD) was applied.Analysis of the data was done using statistical software SPSS17. Results: 86% of subjects reported at least one premenstrual symptom;around 19% fulfilled criteria for probable PMDD & another 34% for probable premenstrual syndrome(PMS). Most common symptom reported by those not reporting any impairment in their routine functioning was irritability (42%) while a feeling of tiredness & low energy (72%) were the most common complaints in those reporting the impairment. Conclusion: Findings of the present study highlight the presence & emphasise the importance of identification of premenstrual distress in college students either in the form of PMS or PMDD.
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BACKGROUND AND OBJECTIVE: Premenstrual syndrome (PMS) is the most common complication among women at the reproductive age, which may adversely interfere with daily activities. Due to the high prevalence of PMS in Iran, identification of rapid and effective diagnostic tools is paramount for the correct recognition of this syndrome. This study aimed to compare the predictive values of the Premenstrual Symptoms Screening Tool (PSST) and Daily Record of Severity of Problems (DRSP) in the diagnosis of PMS. METHODS: This cross-sectional study was conducted on 230 female students above 18 years, who were selected using convenience sampling. PSST and DRSP questionnaires were completed on a daily basis during two menstrual cycles of the subjects. FINDINGS: In this study, rate of the correct classification of PMS symptom severity (mild to severe) by PSST was estimated at 83.9%. Sensitivity and specificity of PSST were 66.3% and 85.6%, respectively. In addition, positive and negative predictive values of PSST were reported to be 96.2% and 33%, respectively. Also, there was a moderate, significant correlation between PSST and DRSP (r=0.38, p
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Premenstrual disorders usually refer to Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). This study was designed to find out the frequency of premenstrual disorders and evaluate the associated factors in a sample of Iranian adolescents. This study was conducted to investigate the frequency of premenstrual disorders (PMS and PMDD) based on Premenstrual Assessment Scale (PAS) and also to determine the association of some demographic and menstrual characteristics with these disorders in adolescent girls. This was a cross sectional study. A sample of adolescent school girls aged between 14 and 19 years were included in the study. Diagnostic assessments were based on Premenstrual Assessment Scale (PAS). The data were analyzed in a descriptive fashion and were compared among subgroups of the study sample. In addition, demographic and menstrual factors associations with premenstrual disorders were assessed. In all 1379 female students were included in the study. About 99.5 % of the students reported at least one premenstrual symptom. Of these, 66.3% was mild, 31.4% moderate and 2.3% severe. A total of 814 girls (59%) met the diagnostic criteria for premenstrual dysphoric disorder (PMDD). Most frequently reported symptoms were back pain, lethargy, fatigue and anxiety. Early menarche, lower education was associated with higher scores on PAS. Premenstrual disorders are common in adolescent girls. Preventive and treatment strategies are highly recommended.
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The objective of the current study was to translate and test psychometric properties of the Premenstrual Symptoms Screening Tool (PSST) in Iran. Using a standard "forward-backward" procedure, the English version of PSST was translated into Persian. A random sample of university students aged 18 years and over completed the questionnaire in Tehran, Iran. Psychometric properties of the Iranian version of PSST were assessed by performing reliability (internal consistency) and validity analyses [Content Validity Ratio (CVR) and Content Validity Index (CVI)]. In all, 925 female students took part in the study. Of these, 284 (30.7 %) had premenstrual syndrome (PMS) and 119 (12.9 %) had premenstrual dysphoric disorder (PMDD). Reliability of the PSST as measured by internal consistency was found to be satisfactory (Cronbach's alpha coefficient, 0.93). The content validity as assessed by CVR and CVI were desirable (0.7 and 0.8, respectively). The Iranian version of PSST seems to be a reliable and valid measure of detecting PMS and PMDD in Iranian young female populations.
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This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the North-Central State of Nigeria. PMDD is the severest form of premenstrual symptoms and is associated with impairment of social and role functioning. A cross-sectional study of female medical students of the University of Ilorin College of Health Sciences (n=208), which involves completing a questionnaire to elicit socio-demographic and gynecological information as well as the GHQ-12 questionnaires. They were later interviewed with DSM-IV PMDD instrument. Seventy-five (36.1%) of the respondents met the criteria for the diagnosis of PMDD. Sixty-five (%) of the PMDD cases reported having pain during menses among whom 14 (21.5%) reported mild, 32 (49.2%) moderate and 19 (29.2%) severe form of menstrual pain. Forty-two persons (20.2%) were categorized as having probable psychiatric morbidity using a cut-off of >or= 3 on GHQ 12. There was neither a causal relationship between psychiatric morbidity (>or= 3 score), and PMDD, nor any association between gynecological factors and PMDD. However, menstrual pain was significantly associated with PMDD (P=0.019). The rate of PMDD in this study is high. Dysmenorrhoea of moderate/severe intensity correlated significantly with the possibility of having PMDD. Efforts should therefore be made to alleviate the pain associated with menses. In addition, the College's health-care providers should take into account the issues of dysmenorrhoea and its management more seriously by intensifying health education on dysmenorrhoea and PMDD in order to improve the quality of life of the students.
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Many women of childbearing age experience a variety of symptoms related to the menstrual cycle that may be limited to mild discomfort or extend to premenstrual syndrome or, depending on the degree of emotional and somatic impairment, to the most severe premenstrual dysphoric disorder (PMDD). With PMDD, women experience markedly compromised quality of life and ability to function in several settings, leading to higher direct medical costs for increased physician visits and laboratory tests, and higher indirect costs to employers through lower productivity at work. Diagnostic criteria established for premenstrual disorders may now enable physicians to evaluate their patients' complex symptoms more precisely and recommend a form of treatment that can alleviate the original complaint and improve healthcare for women.
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Discusses the psychological, somatic, and behavioral changes that may accompany the premenstrual phase in at least 20% and as many as 80% of all women. Parallels exist between symptomatology reported in premenstrual change (PMC) and that reported in affective disorders. There are a variety of biomedical theories to explain PMC, but the present authors suggest that no one neurochemical system is alone responsible. Patients complaining of PMC should receive a thorough clinical evaluation that includes a psychiatric history and mental status examination, a family history of affective disorders, and a personal reproductive-related history across the life cycle. Treatment may be administered in the form of hormones, lithium, or other drugs. Some women who have experienced PMC and sought psychotherapy as a cure have discovered that problems attributed to PMC were actually problems of passivity and control that were not limited to a few days a month. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The aim of this study was to determine the association between academic stress and menstrual disorders among female undergraduates in Uyo, South Eastern Nigeria. Three hundred and ninety-three (393) female students of the University of Uyo, ages between 16 and 35 years were randomly selected from different departments in the University, and studied during the 2009/2010 academic session. Menstrual history and Student's Stress Assessment Questionnaire (SSAQ) were used for this assessment. They were distributed for participants to fill out. Prevalence of menstrual disorder among participants was 34.6%. A direct association between menstrual disorder and academic stress was observed. Commonest menstrual disorder was menorrhagia (37.5%). Others were: Pre-menstrual Syndrome (PMS 33.1%), Oligomenorrhea 19.9%, and amenorrhea 5.9%. Those who experienced academic stress had about 2 times chances of having menstrual disorders (OR : 2.0, C.I = 1.224-2.837) This study demonstrated a significant association between academic stress and menstrual disorder among females undergraduate in Uyo, South Eastern Nigeria.
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This study evaluates working memory deficit among women with premenstrual dysphoric disorder (PMDD) and whether such a deficit and its premenstrual aggravation is associated with difficulty in concentrating, irritability, and impaired daily function or not. Sixty women with PMDD (PMDD group) and 60 women without PMDD (control group) completed the assessment. Severity of irritability, difficulty concentrating, total symptoms, and functional impairment of PMDD were evaluated by the Premenstrual Symptoms Screening Tool. All participants performed N2 and N3 back tasks to assess working memory in both luteal and follicular phases. The PMDD group had significantly poorer performance on N2 and N3 back tasks than the control group did in the luteal phase but not in the follicular phase. Compared to the control group, the PMDD group also exhibited more deterioration in performance of N3 back task in the luteal phase. Performance of N2 and N3 back tasks in luteal phase was significantly associated with irritability, symptom severity, and functional impairment by PMDD. Working memory deficit is aggravated in the luteal phase among women with PMDD. Appropriate interventions are needed to prevent negative consequences of working memory deficit.
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The Premenstrual Symptoms Screening Tool was modified for use in adolescents and piloted in 578 girls at three international sites. Nearly one third (29.6%) reported experiencing severe PMS or PMDD, with irritability being the most commonly reported symptom. Rates of menstrual-related pain were high, particularly in those with severe PMS or PMDD. Severe PMS and PMDD present with similar rates and symptoms in adolescents as in adults, and the Premenstrual Symptoms Screening Tool modified for adolescents is a fast, reliable tool to screen for these syndromes in adolescents.