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Premenstrual Syndrome and Associated Factors among Health Care

Professionals: A Cross-sectional Study

Article in Journal of Clinical and Diagnostic Research · January 2019

DOI: 10.7860/JCDR/2019/43109.13392

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 DOI: 10.7860/JCDR/2019/43109.13392
Original Article

Premenstrual Syndrome and Associated

Psychiatry/Mental
Health Section
Factors among Health Care Professionals:
A Cross-sectional Study
poonam bharti1, Anshu Mittal2, Anshu gupta3, parul Gupta4, Neha Jain5

ABSTRACT with descriptive statistical methods (frequency tables, ANOVA)

Introduction: Premenstrual Syndrome (PMS) is the combination using SPSS 20 version (IBM Inc Chicago) software.
of physical, emotional, physiological and psychological Results: Out of 493 subjects 253 had PMS. The parameters
symptoms felt by females after ovulation of each menstrual which showed significant association with QoL were age
cycle which may affect the quality of life of the professionals. (<0.001), occupation (<0.001), marital status (<0.001), regularity
Aim: To assess the quality of life among Health Care Professionals of cycles (0.02), as well as with the severity (<0.001) of PMS.
(HCP) during PMS. Conclusion: The study outcome showed that QoL is directly
Materials and Methods: This was a cross sectional descriptive affected in Healthcare Professional (HCP) with increase in the
study conducted at MMIMSR, Mullana to assess the quality of severity score on PMS symptoms scale. The QoL is also affected
life among HCPs during premenstrual period. Total 493 subjects with other related socio demographic variables. Proper actions
were enrolled out of 520 after excluding those who didn’t shall be taken to increase the awareness among the women
participate in the study. Subjects were assessed on three scales- regarding the quality of life during PMS. Proper pharmacological
Socio demographic Performa, Premenstrual Symptoms Scale and psychological treatment should be taken which will improve
(PMSS), Quality of Life (QoL-10). The results were computed their quality of life.

Keywords: Menstrual cycle, Ovulation, Premenstrual symptoms scale, Quality of life

INTRODUCTION necessary to identify and provide medical treatment and counselling

Each women usually experiences, physical and psychological for the females to improve their QoL during PMS. The purpose
disturbances during her cyclic change of hormones each month behind the study was to find out whether QoL is being affected or
but intensity varies from mild to severe. It usually ends with the not with PMS.
end of the menstrual flow. PMS falls in psychosomatic disorder.
In reproductive age group, 30-50% suffer from mild to moderate MATERIALS AND METHODS
PMS whereas 3-8% have severe [1]. The most common mood This cross sectional study was conducted on HCPs in Maharishi
symptoms are irritability, depression, crying, oversensitivity and Markandeshwar Institute of Medical Sciences and Research, Mullana
mood swings. Among physical symptoms, fatigue, bloating, breast in Northern India, after taking clearance from Ethical Board of the
tenderness, acne and appetite changes with food cravings are Medical College (IEC- 137D). All female HCP including doctors,
common. Devastating effects of PMS leads to sense of inadequacy nurses, interns, junior residents, senior residents, post graduate
with regard to QoL. Though, less number of women suffer from students, physiotherapist and others (Msc and Bsc medical
severe form of PMS but it have significant deteriorating impact on students) between 20-50 years of age with regular menstruating
the overall QoL. cycle and willing to participate were included in the study. HCPs
who were lactating, with endocrinal, medical or any co-morbid
The WHO defines QoL as an individual’s awareness of their
psychiatry illness or using any birth control and hormonal therapy
situation in life according to the conditions of the social and
at the time of study were excluded from the study. After explaining
cultural systems in which they reside and in relation to other
the aim and objective of the study and with their consent, data was
associated factors [2]. Health professional’s helps in maintaining
collected on three scales: socio demographic proforma, PMSS [4]
health by diagnosing, preventing and treating the disorder with
and QoL-10 [5].
the application of evidence based medicine. This promote overall
health of an individual [3].
Socio Demographic Scale
As PMS possess lot of emotional turmoil, so this disturbs the It consists of seven categories namely name, age, education status,
personal relationships to huge extent leading to have detrimental occupation, type of locality (urban, rural), use of analgesic, family
effect on QoL therefore, proper measures should be taken in order history of PMS, which are further subdivided into categories as per
to decrease the disturbing effects of PMS. There is significant the need of the study.
impact of PMS on the affected women’s life. Despite of the growing
awareness, there remains a considerable deficiency of knowledge Premenstrual Syndrome Scale [4]
about the necessity to consult a doctor or seek treatment for their The PMS scale comprised of 40 questions with three sub-scales
symptoms. PMS symptoms have a negative impact on females by namely, physiological, psychological and behavioural symptoms.
affecting their physiological, behaviour and psychological aspects of The scoring system is according to the responses. Never as “1”,
life as well as on the quality of one’s life. rarely as “2”, sometimes as “3”, very often as “4”and always as
Early diagnosis and knowledge regarding PMS symptoms among “5” points. Total score reached 80 points or above indicates PMS.
females will help in choosing appropriate management required. It is Increase in the score indicate an increase in PMS severity. Five
16 Journal of Clinical and Diagnostic Research. 2019 Dec, Vol-13(12): VC16-VC19
www.jcdr.net Poonam Bharti et al., Study of PMS and Related Variables with QoL among HCP

categories were graded as “no symptoms” (range 1-40), “mild” (41- Character Categery n Mean SD p-value
80), “moderate” (81-120), “severe” (121-160), and “very severe”
Graduate 368 2.27 0.63
(161-200). Education 0.47
Postgraduate 125 2.22 0.72
Faculty 128 2.15 0.7
The Quality of Life 10 (Qol-10) [5]
The 10-item QoL10 questionnaire is used for measuring self-rated Interns 93 2.14 0.69

physical and mental health of the subjects. It takes 10 minutes Occupation Nursing background 205 2.28 0.58 <0.001
to administer, collect and analyse per patient. This QoL-10 Physiotherapy background 44 2.67 0.64
battery with 10 key questions helps the patient to report their Other 23 2.29 0.67
overall quality of their life. It is five point likert scale and total score Rural 117 2.23 0.51
ranges between 1-5 after calculating the score with the formula Locality 0.115
Urban 376 2.26 0.69
mentioned below.
Married 136 2.05 0.61
Marital status <0.001
Equation for final score Score Unmarried 357 2.34 0.65
({Health} ((Q1+Q2).2)+{QoL} ((Q Yes 66 2.31 0.69
10)+(Q3+Q4+Q5):3):2)+[ability] Higher the score means bad QoL Family H/O 0.46
((Q6+Q7+Q8+Q9):4)):3 No 427 2.25 0.65
[Table/Fig-2]: Socio demographic profile of the subjects.
ANOVA test was applied
Interpretation: 1 is great, 2 is normal, 3 is bad for QoL1 and very
bad for QoL5 and QoL10,4 is very bad for QoL1 and deadly for
Character Categery n Mean SD p-value
QoL5 and QoL10, 5 is dying for QoL1, QoL5 and QoL10 - you
cannot survive for very long with this low rating. Irregular 50 2.46 0.7
Regularity 0.021
Regular 443 2.23 0.65
Statistical Analysis Yes 134 2.26 0.73
Use of analgesics 0.99
Data was analysed by using Statistical Packages of Social Sciences No 359 2.26 0.62
version-20 (SPSS v20) and Descriptive statistics (frequency tables [Table/Fig-3]: Other related variables associated with PMS.
and ANOVA testing) was used. ANOVA test was applied

RESULTS Category Frequency Percent

Maximum population belonged to the age group of 20-24 years. No PMS 10 2
Mean value on QoL of the same age group was 2.33 which was Mild 230 46.7
highest among all other groups, this means that this age group Moderate 182 36.9
showed bad QoL as compared to other age group and significant
Severe 61 12.4
association was seen with QoL [Table/Fig-1].
Very severe 10 2
Character Category n Mean SD p-value Total 493 100
20-24 221 2.33 0.66 [Table/Fig-4]: Distribution of HCPs according to the scores of PMS.
ANOVA test was applied
25-29 200 2.24 0.6
30-34 47 2.13 0.83
Character Category n Mean SD p-value
Age groups 35-39 10 2.14 0.64 0.03
No 10 1.89 0.3
40-44 11 1.72 0.41
Mild 230 2.05 0.49
45-49 3 1.85 0.35
Severity of Pms Moderate 182 2.32 0.68 <0.001
50 and above 1 2.02 0.65
Severe 61 2.73 0.66
[Table/Fig-1]: Age distribution of the subjects with QoL.
Very severe 10 3.39 0.85
ANOVA test was applied
[Table/Fig-5]: Severity of PMS with QoL.
ANOVA test was applied
The unmarried females had high mean score value on QoL than
married females and reported to have bad QoL. There was
significant association seen among occupation and marital status
DISCUSSION
The PMS issue is most neglected and untreated among females.
with QoL [Table/Fig-2].
Even as this study was performed among HCP of medical stream.
The women with regular menstrual cycles had lower mean score Still there were seven subjects who refused to give information
value (2.23) on QoL showing good QoL than those with irregular regarding PMS. Many females avoid talking about PMS. If we
cycles (2.46) and significant association was seen with regularity talk about general public, lot of hesitancy and stigma is attached
and QoL [Table/Fig-3]. regarding these issues. And hence, PMS might go unaddressed.
Out of total 493 subjects enrolled in the study, 10 (2%) As per results of this study, prevalence of PMS is 51.3%. It is
subjects had no premenstrual symptoms, maximum subjects observed that maximum population belonged to the age group of
230 (46.7%) showed mild symptoms, whereas 182 (36.9%) had 20-24 years with mean score value on QoL (2.33). This age group
moderate and subjects showing severe symptoms were 61 (12.4%), showed bad QoL as compared to other age groups. The reason
10 (2%) subjects showed very severe premenstrual symptoms for this might be that as this age is close to the onset of menarche
[Table/Fig-4]. so they are not well adaptive to these physiological changes which
The mean score value on the QoL is increasing with the increase in may lead to bad QoL. As the age increases, adaptation to PMS
severity of PMS, showing that there is deterioration of QoL among improves further improving the QoL of the subjects.
HCPs with the increase in severity of PMS and it shows significant The graduate population had the higher mean value than post
association between severities of PMS with QoL (p-value <0.001) graduates showing that they had bad QoL. Among different
[Table/Fig-5]. occupations, it was physiotherapists who had highest mean value
Journal of Clinical and Diagnostic Research. 2019 Dec, Vol-13(12): VC16-VC19 17
 Poonam Bharti et al., Study of PMS and Related Variables with QoL among HCP www.jcdr.net

(2.67) reflecting to have bad QoL among all other categories. The relationship was seen between both the parameters (p<0.05).
probable reason behind this may be as they have more of physical Similar concordance results were seen in index study, that severity
activities and are more involved with long standing procedures. of PMS affects the QoL by worsening it.
As seen in the results, mean value was higher among unmarried In a study by Goker A et al., it was reported that the frequency of
(2.34) than married (2.05) reflecting that the QoL of married females PMS was 91.8% while in present study it was 51.3% [12]. Goker A
is much better than unmarried. The probable reason may be as et al., reported that family history significantly affected QoL scores.
married females have better emotional support from their partners In present study also, QoL was bad more in population having
and able to consult their respective doctors for their symptoms positive family history.
more openly as compared to unmarried women. The mean value As in present study other identified factors which showed significant
of the patients having family history of PMS was (2.31) and had bad association with the QoL in PMS includes age, occupation, marital
QoL than those not having any family history as genetics as it play a status and regularity of cycles. These all variables had significant
major role among the etiological factors in PMS. impact on QoL. But there was scarce data available related to
The women who had regular cycles with mean value (2.23) had these variables, so comparison was not possible with any previous
better QoL than one with irregular cycles with mean value (2.46). literature. So further more studies should be planned at different
There is lot of distress associated with irregular cycles which directly places to find the impact of QoL on HCP females using these
affects ones QoL. related factors.
According to a study by Kahyaoglu Sut H and Mestogullari E, [6]
the prevalence of PMS was 38.1%. When the PMSS total score
LIMITATION
As this study was conducted on highly selective female HCPs only,
increased there was decrease in Work Related Quality of Life
more over many of the senior faculty could not be included because
(WRQoL) score in the nurses with PMS. While in our study the
of their busy schedules, hence the data may not be the true
prevalence of PMS was 51.3 %. Similar results were seen in this
presentation of the population of HCPs. Moreover in India, unmarried
study that as the severity of the PMS increases there was decline in
subjects find this topic sensitive to talk and difficulty revealing their
the QoL of life of HCPs.
menstrual symptoms due to which we may had biased findings .
It was reported in a study by Farrokh-Eslamlou H et al., that 60.6% Studies must be taken up to find whether the population affected by
of girls had mild, 25.1% had moderate symptoms and 14.2% severe symptoms of PMS could able to manage their professional
showed severe PMS [7]. As per present study results maximum work or not during this period.
subjects 230 (46.7%) had mild symptoms, whereas 182 (36.9%)
had moderate and 61 (12.4%) had severe symptoms. The students CONCLUSIOn
with family history of PMS in their first degree relatives and those The results of this study suggest that PMS poses its effect on QoL
who take medicine to relieve PMS symptoms had significant high of affected women having physical, psychological, behavioural
PMS symptoms (p<0.05). In this study concordance results were and family-social consequences therefore, it is necessary to take
seen in regard with the family history, but it was not found to be a more general approach to women care beyond treating physical
statistically significant. In the present study, there was use of symptoms only. Women s must be encouraged to express their
analgesics by 134 subjects but mean score value did not show any QoL status during PMS.
significant variation.
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the relationship between QoL and PMS was evaluated and inverse

18 Journal of Clinical and Diagnostic Research. 2019 Dec, Vol-13(12): VC16-VC19

www.jcdr.net Poonam Bharti et al., Study of PMS and Related Variables with QoL among HCP

PARTICULARS OF CONTRIBUTORS:
1. Associate Professor, Department of Psychiatry, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India.
2. Professor, Department of Community Medicine, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India.
3. Professor, Department of Pharmacology, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India.
4. Postgraduate Student, Department of Psychiatry, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India.
5. Clinical Psychologist, Department of Psychiatry, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: PLAGIARISM CHECKING METHODS: [Jain H et al.] Etymology: Author Origin
Dr. Poonam Bharti, • Plagiarism X-checker: Oct 25, 2019
Guru Nanak Colony, Street Number 6, House Number 73, Opp Medical College, • Manual Googling: Nov 16, 2019
Faridkot, Punjab, India. • iThenticate Software: Dec 03, 2019 (11%)
E-mail: [email protected]

Author declaration:
• Financial or Other Competing Interests: No Date of Submission: Oct 24, 2019
• Was Ethics Committee Approval obtained for this study? Yes Date of Peer Review: Nov 21, 2019
• Was informed consent obtained from the subjects involved in the study? Yes Date of Acceptance: Nov 28, 2019
• For any images presented appropriate consent has been obtained from the subjects. NA Date of Publishing: Dec 01, 2019

Journal of Clinical and Diagnostic Research. 2019 Dec, Vol-13(12): VC16-VC19 19

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