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Premenstrual syndrome among college students and its relation to their study activities

 Department of Psychiatric Nursing, LGBRIMH, Tezpur, Assam, India

Date of Submission11-May-2021
Date of Acceptance15-Aug-2021
Date of Web Publication03-Feb-2022

Correspondence Address:
Nurnahar Ahmed,
Department of Psychiatric Nursing, 3rd Floor, New Academic Building, LGBRIMH, P.O.: Tezpur - 784 001, Sonitpur, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmhhb.jmhhb_113_21


Aim: The study was conducted to assess Premenstrual Syndrome (PMS) among college students and its relation to their study activities in a selected college. Methods: Nonexperimental Quantitative research approach was used in the present study. Data were collected from 229 female students studying degree courses in a selected college of Tezpur. The college for the study was selected by purposive sampling and the participants were selected with the systematic random sampling method. A sociodemographic pro forma and self-structured questionnaires were used to collect the data. Results: The data analyses were performed using SPSS version 20. Descriptive analyses showed that 21% of the female students had irregular menstrual cycles and 12.2% had heavy menstrual flow. Among the participants, 45.9% of the female students had menstruation-related problems. Use of substance, family history of menstruation-related problems, regularity of menstrual cycles, menstruation flow, presence of any menstrual problems were found to be associated with PMS. In the present study, PMS was found to be positively correlated with impact on study activities (r = 0.542 and P = 0.000). Conclusion: At the end of the study, the investigators found that PMS is an important issue which is affecting the study behavior or habit of the female degree students.

Keywords: Effect on study activities, menstruation, premenstrual syndrome, prevalence

How to cite this URL:
Talukdar P, Ahmed N, Sarkar S. Premenstrual syndrome among college students and its relation to their study activities. J Mental Health Hum Behav [Epub ahead of print] [cited 2023 Jun 5]. Available from: https://www.jmhhb.org/preprintarticle.asp?id=337223

  Introduction Top

Menstruation is a normal physiological phenomenon in each woman's life in their reproductive age. During menstruation, there is periodic discharge of blood and cellular debris from the female genital tract every month. There are changes noticed in mood, behavior and also the appearance of some abnormal vague symptoms during the second half of the cycle. Sometimes, the symptoms are severe enough to disturb the day-to-day life of a woman and requiring medical help, and this situation is called premenstrual syndrome (PMS). PMS is a broad diagnostic concept first proposed by Greene and Dalton as the “presence of recurrent symptoms during the premenstrual phase or the first few days of menses and complete absence of these symptoms in the postmenstrual phase.”[1]

The symptoms of PMS vary from women to women. In a study conducted by Naeimi[2] among university students, the mood symptoms found were fatigue and lethargy (72.6%), mood variability (64.7%), change in appetite (53.7%), persistent anger or personal clashes (21.9%), etc. Moreover, among somatic symptoms, lower back pain (65.2%), abdominal pain (62.7%), joint and muscle pain (55.3%), and gaining weight (17.4%) was found among the participants.

The exact etiology of PMS is currently unknown, but it may be a result of an interaction between steroids, hormones and neurotransmitters. Various biopsychosocial causes have been proposed as the cause of the syndrome, including abnormal serotonin function, presence of progesterone, altered endorphin modulation of gonadotrophins secretion, exercise habits, smoking, use of alcohol, altered transcapillary fluid balance, and a diet rich in beef or caffeine-containing beverages.[3]

Although PMS is not life-threatening; but it can seriously decrease the quality of life of many women and affect their mental health and their productivity.[4] PMS is associated with reduction in health-related quality of life and women with PMS have greater work productivity impairment than women without it. It is a commonly encountered complaint among women and may affect women's quality of life and reduce their occupational productivity.[5] Research studies conducted regarding the affect of PMS symptoms on various aspects of a woman in their reproductive age suggest that PMS has a negative impact on study activities. A study conducted among nursing students by Haji and Najib[6] showed that 78.02% of participants had difficulty to continue clinical training and 60.43% of them had difficulty to study.

Somatic symptoms such as fatigability, lower backache, tiredness, breast tenderness etc., and some of the psychological symptoms such as irritability, loneliness, and anger outburst had a negative impact on the study as well as in other aspects of life. This causes difficulty in carrying out day-to-day activities along with difficulty in concentrating in classes. This necessitates finding out the extent to which the PMS affects the students so that necessary action can be taken to reduce it.

  Methods Top

Research approach for the present study was a nonexperimental quantitative approach and cross-sectional descriptive research design was adopted. The female students of the selected college of Tezpur, who were 18 years and above and were menstruating every month for last 6 months (irrespective of days of menstruation flow) were included in the study. The students diagnosed with any psychological, gynecological disorder or currently using hormonal treatment were excluded. In the present study, the college was selected purposively and the sample size was 229. To attain the sample size, at first, the major subjects (departments) of all the three streams, i.e., Arts (15 departments), Science (9 departments) and Commerce (3 departments) were arranged in alphabetical order. From the list, every 5th department was selected and every 2nd female student from the resister of the selected departments fulfilling the sampling criteria was included in the study.

Data were collected by a sociodemographic data sheet and a self-structured questionnaire having two parts; Part A: Tool to assess PMS and Part B: Tool to assess the impact of PMS on study behavior/habit. Part A consists of 52 items assessing both somatic and emotional/psycho behavioral symptoms. All the items carries 2 score for “Always present” response, 1 score for “Sometimes present” response and 0 score for “Not present” response. Higher the score represent high PMS. In Part B, there are 16 items in total with two response options, i.e., Yes (Score 1) or No (Score 0). Higher the score represent the high impact of PMS on study behavior/habit. The self-structured tool was validated by experts from the field of Psychiatry, Obstetrics, Psychiatric Nursing, and Obstetrical Nursing. The reliability in the form of internal consistency of Part A and Part B of the Self-structured Tool was found to be 0.790 and 0.714 (Spearman-Brown Coefficient) by split-half method, respectively.

Ethical clearance for the study was obtained from Institutional Ethics Committee and the research proposal was approved by the Scientific Advisory Committee of LGB Regional Institute of Mental Health, Tezpur, Assam. Formal permission was obtained from the Principal of the College to conduct the study in the setting. Data were collected after obtaining the informed consent.

The data were analyzed with descriptive and inferential statistics using SPSS version 25 (SPSS SOUTH ASIA Private Limited, Bangalore, Karnataka, India) as per the objectives of the study.

  Results Top

In the current study, the most common somatic symptom was found to be “Tiredness, oversleeping or taking naps” which was found in 78.2% of participants. The most common Emotional/psycho-behavioral symptom was found “becoming less interested than usual in hobbies and daily activities” in 75.5% of the participants. The most common impact found was “not able to sit steadily for long in class” which was found in 67.3% of the participants.

Chi-square test was applied to find the association of PMS with selected socio-demographic variables of female college students. The calculated mean PMS score (i.e., 33.13) was used to make groups for the Chi-square table.

In the present study, PMS was found to be positively correlated with impact on study activities at 0.01 level of significance (r = 0.542 and P = 0.000). The data presented also showed positive correlation between somatic symptoms and emotional/psycho-behavioral symptoms of PMS with impact on study activities.

  Discussion Top

Discussion of the socio-demographic variables of the female college students [Table 1] and [Table 2]
Table 1: Mean and standard deviation of selected continuous sociodemographic variables of the female college students (n=229)

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Table 2: Frequency and percentage distribution of selected sociodemographic variables of the female college students (n=229)

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Age-wise distribution of female degree students showed that the mean and standard deviation of the age was 19.08 ± 1.014 years. This could be because in the present study the female degree students were taken. The students enroll in the degree course by the age of 18–19 years after completion of the Higher Secondary course. In the study done by Nisar et al.,[7] mean age was 21.2 ± 1.9 years.

The present study results revealed that a maximum of the respondents, i.e., 79% had a regular menstrual cycle. In the present study, it was found that 54.1% of the students were not having menstrual problems which may be a reason that maximum had regular menstrual cycle. Azaria et al.[8] conducted a cross-sectional study where it was found that the majority of the participants (69%) had regular menstrual cycles.

Discussion of premenstrual syndrome among female college students [Table 3]
Table 3: Mean and standard deviation of premenstrual syndrome scores and impact of premenstrual syndrome on study activities scores of the female college students (n=229)

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In the present study, the most common somatic symptom was found to be “Tiredness, oversleeping or taking naps.” The menstrual blood loss in normal women ranges from 6.55 ml to 178.69 ml with an average of 50.55 ml.[9] The amount of iron lost in the form of hemoglobin ranged from 5 to 26 mg, with an average of 12 mg per period.[10] This blood and iron loss might cause fatigability in females with PMS.

In a study conducted by Forrester et al.,[11] it was found that there was a considerable percentage of women who reported both moderate PMS (11%) and major depression or severe PMS (25%) and major depression. This might be the reason that in the current study majority of the students had reported being less interested than usual in hobbies and daily activities.

Discussion on the affect of premenstrual syndrome on study behaviour/habit

The most common impact found was “not able to sit steadily for long in class” which was found in 67.3% of the participants. In the current study, it was found that lower backache and abdominal cramps were the second- and the third-most common somatic symptom found among college students. The presence of these symptoms might be the cause of not being able to sit steadily for long in class. This study result is contradictory to the study done by Azaria et al.[8] where it was found that the most common academic performance impairment was cessation or interruption of studying which was reported by 90.5% of those diagnosed with PMS.

Discussion on association of premenstrual syndrome with the selected sociodemographic variables [Table 4]
Table 4: Chi-square values showing the association between selected sociodemographic variables with the premenstrual syndrome of the female college students (n=229)

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In the present study, significant association was found between family history of menstruation-related problems and PMS. In a study conducted by Condon,[12] it was found that the PMS score for the correlation coefficient of monozygotic twins was double to that of the dizygotic twins; which explained that PMS scores might be a reflection of neuroticism which is genetically determined. This might be the reason that in the current study family history of PMS was found associated with PMS.

In the present study, a significant association was found between the regularity of menstrual cycles and PMS. It is found that irregularity of the menstrual cycle and PMS are related to hormonal imbalances.[3] This might be the reason that both were found to be associated. In a study conducted by Yamamoto et al.[13] it was found that irregular menstrual cycle is independently associated with PMS, implying changes in the functional potentiality of women.

In the present study, significant association was found between menstruation flow and PMS. The study result is in contrast with the study done by Haji and Najib[6] where it was found that there was no significant association between the menstruation flow and PMS.

In the present study, significant association was found between any menstrual problems and PMS. In the present study, 45.9% of the respondents had menstrual related problems, i.e., backache, irritability, abdominal cramps which might be attributed as PMS symptoms.

Discussion of the relationship between premenstrual syndrome and study activities among female college students

In the study, the data showed that there was a significant positive correlation between PMS with study activities. The somatic symptoms of PMS such as low backache, abdominal cramps, low appetite, and tiredness and psychobehavioral symptoms such as irritability, increased anger, feeling of hopelessness, worthlessness affects the individual's well-being, which in turn affect the study behavior. The present study result was consistent with the study done by Azaria et al.[8] where it was found that PMS is related to academic effects, i.e., interruption of studying (P < 0.001), missed class (P = 0.007), missed exam (P = 0.001).

To summarize the study will add on to the evidence for the relationship between PMS and student's study activities. However, the index study was limited by small sample size, self-reporting tools and a retrospective memory error as the subjects were asked regarding their menstruation cycle in the last 6 months (For inclusion criteria).

  Conclusion Top

The study findings revealed that a high percentage of college students had PMS and that affect their study activities. Therefore, it is necessary to provide necessary information to them. For this female college students were provided with an information booklet to enhance their knowledge on PMS and its management. Still, further awareness programs can be conducted to increase awareness on PMS and other menstruation-related issues.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Greene R, Dalton K. The premenstrual syndrome. Br Med J 1953;1:1007-14.  Back to cited text no. 1
Naeimi N. The prevalence and symptoms of premenstrual syndrome under examination. J Biosci Med 2015;3:1-8. Available from: https://file.scirp.org/pdf/JBM_2015011613512765.pdf. [Last accessed on 2017 Aug 12].  Back to cited text no. 2
Khella AK. Epidemiologic study of premenstrual symptoms. J Egypt Public Health Assoc 1992;67:109-18.  Back to cited text no. 3
McHichialami KH, Tahiri SM, Moussaoui D, Kadri N. Assessment of premenstrual dysphoric disorder symptoms: Population of women in Casablanca. Encephale 2002;28:252-30.  Back to cited text no. 4
Zaka M, Mahmood KT. Premenstrual syndrome – A review. J Pharm Sci Res 2012;4:1684-91. Available from: http://www.jpsr.pharmainfo.in. [Last accessed on 2017 Nov 20].  Back to cited text no. 5
Haji FA, Najib BM. Premanstrual syndrome among college of nursing students. Zanco J Med Sci 2010;14:170-5. Available from: https://www.zjms hmu.org/files/articles/080311032211.pdf. [Last accessed on 2017 Nov 10].  Back to cited text no. 6
Nisar N, Zehra N, Haider G, Munir A, Sohoo NA. Frequency, intensity and impact of premenstrual syndrome in medical students. J Coll Physicians Surg Pak 2008;18:481-4.  Back to cited text no. 7
Azaria E, Mehari M, Kiros N, Woldu F, Solomon E, Weldebruk F. The prevalence and effects of premenstrual syndrome among female health science students in Eritrea. Eur J Clin Biomed Sci 2016;2:1-5. Available from: article.sciencepublishinggroup.com/html/10.11648.j. [Last accessed on 2017 Aug 10].  Back to cited text no. 8
Barer AP, Fowler WM. The blood loss during normal menstruation. Am J Obstet Gynaecol 1936;31:979-86. Available from: http://www.ajog.org/article/S0002-9378(36)90820-7/[Last accessed on 2017 Jan 20].  Back to cited text no. 9
Baldwin RM, Whalley PJ, Pritched JA. Measurements of menstrual blood loss. Am J of Obstet Gynaecol 1961;81:739-42. Available from: https://www.popline.org/node/509947. [Last accessed on 2017 Jan 22].  Back to cited text no. 10
Forrester C, Stutz EZ, Weiss C, Tschudin S. The interrelation between premenstrual syndrome and major depression: Results from a population- based sample. BMC Public Health 2011;11:795.  Back to cited text no. 11
Condon JT. The premenstrual syndrome: A twin study. Br J Psychiatry 2018;162:481-6.  Back to cited text no. 12
Yamamoto K, Okazaki A, Sakamoto Y, Funatsu M. The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students. J Physiol Anthropol 2009;28:129-36.  Back to cited text no. 13


  [Table 1], [Table 2], [Table 3], [Table 4]


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