Premenstrual syndrome and its effect on quality of life of preclinical medical students
Tenzin Thoesam, Chinawat, Fasinee Arunrodpanya.
5th Year Medical Students, Faculty of Medicine Naresuan University Hospital, Naresuan University, Thailand
Abbreviation
PMS: Premenstrual syndrome
WHOQOL: World Health Organization –Quality of life
QOL: Quality of life
PSST: Premenstrual Syndrome Screening Tool
BMI: Body Mass Index
Abstract
Objective: The purpose of the study was to identify the relationship between effect on quality of life and risk factors of PMS in preclinical medical students.
Method: A cross sectional study was conducted amongst a total number of 188 preclinical medical students of Naresuan university.Questionnaire which composed of list of risk factors of PMS, screening tests of PMS and assessment of quality of life was distributed to the students. Data collected were analyzed using Student t-test and Chi-square test.
Results:The effect of PMS on quality of life in preclinical medical students was found to have a statistical value of p<.05. There was evident relationship between risk factors of PMS and its symptoms. The students with maternal history of PMS had higher prevalence of PMS by 2.20 times when compared with the students without a maternal history of PMS.
Conclusions: The significant associated factor on quality of life of the students was maternal history with PMS. Proper management and knowledge of PMS should be given to the students for reducing its effect on quality of life.
Background
Premenstrual Syndrome (PMS) which was designated by Frank for the first time in 1931 is a combination of psychological, physical and behavioral symptoms which is seen in the late luteal phase of menstrual cycle in women at the age of sexual maturity[1].Premenstrual syndrome (PMS) is characterized by the cyclical appearance of one or more symptoms just prior to menses, occurring to a degree that lifestyle or work is affected, followed by a period of time entirely free of symptoms. The presence of one or more symptoms such as; breast engorgement tenderness, pelvic pain, back ache, or emotional mood swings helps in the diagnosis of PMS.Women may use medications to help relief discomfort due to PMS and at times, the severity of the syndrome can have a huge effect on the quality of life. Study report from Baskent University, Turkey concluded that 72.1% of their female medical students had PMS. A report from Poland showed that 76.39% of the female population in reproductive age had PMS and similarly a report conducted by the researchers in Siriraj Hospital, Mahidol University, Thailand found that 25.1% of the nurses working in the hospital had PMS.
Purpose
The purpose of the study was to identify the relationship between effect on quality of life and risk factors of PMS in preclinical medical students.
(Since reports across the world showed a variation in prevalence percentage, and involvement of different factors; this research was conducted amongst preclinical medical students of Naresuan University inorder to find the effect it has on the quality of life. Above all, since these medical students will become doctors in the future, it is very important that these students understand the importance of PMS and that they would be able to educate their patients in the future.)
Methods
A cross sectional study amongst female Preclinical Medical Students of Faculty of Medicine, Naresuan University was conducted. The study was conducted in accordance with the ethical principles stated in the 2003 version of the Declaration of Helsinki. The study protocol was approved by the Faculty of Medicine, Naresuan University Hospital, Naresuan University.
Participants were female Preclinical Medical Students of Faculty of Medicine, Naresuan University. A total of 188 students were involved in this research. Students were asked to complete and return a questionnaire within a period of 2 days. The questionnaire consisted of 3 parts, basic information data, severity of PMS and a Thai version of PSST. There was a notification to inform the participants that they were anonymous but could confidentially contact the researchers by telephone or in person if they needed help regarding their symptoms. Analysis was performed in the completed questionnaires from the participants who fulfilled all of the following eligibility criteria: reproductive age, understood the questionnaire and PMS, regular menstruation, not being pregnant, and not taking hormonal or psychotropic medications.
The questionnaire comprised of the following data:
- Basic information data on age, BMI, exercise, caffeine consumption, alcohol consumption, Menarche and Family history of PMS.
- Severity of PMS amongst students was categorized into:
a) Moderately-Severely Affected Category with a presence of at least 1 of the symptoms such as emotional mood swings, depressive affection, anxiety/stress, fatigue, nervousness and depressive thoughts.
b) Moderately-Severely Affected Category with at least 4 of the symptoms.
c) Moderately-Severely Affected Category and affecting at least 1 of the followings such as poor work efficiency, ill effects on relationship between family members or work mates and effects on social life.
Presence of all three categories placed the students under “Moderate- Severe PMS”. If either one of the categories were not present, students were placed under “No PMS- Mild PMS”.
- Quality of life of preclinical medical students by using Thai version of WHOQOL.
Quality of Life has a score starting from 26-130 points and they can be categorized as the following:
26 – 60 pointsPoor quality of life
61 – 95 pointsModerate quality of life
96 – 130 pointsGood quality of life
The following points can be placed in this order:
Contents / Poor QOL / Moderate QOL / Good QOL1. Physical / 7 – 16 / 17 – 26 / 27 - 35
2. Psychological / 6 – 14 / 15 – 22 / 23 - 30
3. Social / 3 – 7 / 8 – 11 / 12 - 15
4. Environment / 8 – 18 / 19 – 29 / 30 – 40
Total points on QOL / 26 – 60 / 61 – 95 / 96 - 130
Results
1.Basic information data
Questionnaire data collected on basic information were as follows:
The age group for the 188 participants ranged from 17-30 years, giving an average age of 20.75 years. Weight ranged from 35-76 kg with average weight of 51.55kg. Height ranged from 146-176 cm with an average height of 161cm. BMI ranged from 14.57-30.83kg/m2 with an average BMI of 19.89kg/m2. Menarche ranged from 10-16 years with an average menarche of 12.68 years. (details explained in table 1)
96 participants were found to be active and indulging in exercises showing an average of 51.06%. 92 participants were not active and not indulging in exercises, thereby giving an average of 48.94%. 48.94% of the participants reported that they consume caffeine and its products. 71 participants consume caffeine everyday, giving an average of 37.77% and 117 participants do not consume everyday, giving an average of 68.7%.1 participant reported to consume alcohol occasionally, thereby giving an average of 0.53%. Average for those who did not take alcohol was 99.47%. 104 participants had a positive family history of PMS where as 84 did not have, thereby giving an average of 44.68% for participants without a positive family history.( details explained in table 2)
2. Symptoms of PMS
Most common symptom associated with PMS was emotional mood swings. 164 participants reported it. Second most common symptom was increased appetite along with fatigue sensation. (details explained in table 3 and 4)
3. Quality of Life
No participants reported to have poor quality of life. 88 participants reported to have moderate quality of life, with an average of 46.81% and 100 participants reported to have good quality of life with an average of 53.19%. ( details explained in table 6) Score on quality of life ranged from 68-127 points with an average of 95.97%. (details explained in table 8) Further details are explained in the tables.
4. PMS and its associated data
The Association of PMS with Quality of Life score (Table - 9). The results showPMS with moderate to severe symptoms associated with “Poor” Quality of Life score.
These results can be divided into 5 parts:
- An overview part on the Quality of Life score in No PMS and PMS with mild symptoms where results found anaverage PMS score of 97.50, CI 95 = 95.72 - 99.29 and p < .05. Quality of Life score in PMS with moderate to severe symptoms with an average PMS score of 90.81, CI 95 = 87.53 – 94.09 and p < .05.
- The physical part on Quality of Life score in No PMS and PMS with mild symptoms with an average PMS score of22.63, CI 95 = 22.16 – 23.10 and p < .05.Quality of Life score in PMS with moderate to severe symptoms with average PMS score of 20.28, CI 95 = 19.44 – 21.11and p < .05.
- The psychological part on Quality of Life score in No PMS and PMS with mild symptoms with an average PMS score of 23.10 , CI 95 = 22.62 – 23.58 and p < .05. Quality of Life score in PMS with moderate to severe symptoms with an average PMS score of 21.37, CI 95 = 20.33 – 22.41and p < .05.
- The social part on Quality of Life score in No PMS and PMS with mild symptoms with an average PMS score of 11.65, CI 95 = 11.39 – 11.91 and p < .05.Quality of Life score in PMS with moderate to severe symptoms with an average PMS score of 10.98, CI 95 = 10.45 – 11.50 and p < .05.
- The environmental part on Quality of Life score in No PMS and PMS with mild symptoms with an average PMS score of28.63, CI 95 = 27.92 – 29.33 and p < .05.Quality of Life score in PMS with moderate to severe symptoms with an average PMS score of 27.21, CI 95 = 26.00 – 28.42 and p < .05.
The association of PMS and risk factors (Age, BMI, Menarche, Exercise, Caffeine, Family history of PMS). This study shows that PMS with moderate to severe symptomsis related with Family history of PMS. It was found that the group with a maternal history of PMS had a higher chance of being affected by PMS by more than 2.20 times than group without a maternal history of PMS(CI 95=1.06 – 4.58, p< .05)
(Table - 10)
Table – 1 Age, Body weight, Height, BMI, Menarche
Risk factors / Min / Max / Mean / SDAge / 17 / 30 / 20.75 / 3.35
Body weight (kilograms) / 35 / 76 / 51.55 / 7.17
Height (centimeters) / 149 / 176 / 161 / 0.05
Body mass index (kg/m2) / 14.57 / 30.83 / 19.89 / 2.38
Menarche(years) / 10 / 16 / 12.68 / 1.27
Table – 2 Exercise, Caffeine, Alcohol beverage, Family history of PMS
General and Gynecologic data / Numbers / PercentageExercise
Yes
No
96
92 / 51.06
48.94
Caffine consumption (>= 1 cup/day)
Yes
No
71
117 / 37.77
62.23
Alcohol baverage (more than 1 times / week)
Yes
No
1
187 / 0.53
99.47
Family history
Yes
No
104
84 / 55.32
44.68
Table – 3 The frequency of severity of PMS symptoms
Symptoms / Not at all / Mild / Moderate / SevereIrritability / 24 / 94 / 51 / 19
Anxiety / 45 / 91 / 44 / 8
sensitive to dinial / 93 / 44 / 40 / 11
depressed mood / 107 / 63 / 16 / 2
Less efficiency at work / 74 / 83 / 26 / 5
Lack of household care / 87 / 81 / 16 / 4
lack of social activities / 72 / 88 / 23 / 5
Concentration difficulty / 63 / 95 / 27 / 3
Fatigue / 44 / 69 / 52 / 23
Food craving / 28 / 62 / 53 / 45
Insomnia / 143 / 40 / 5 / 0
Hypersomnia / 46 / 69 / 46 / 27
Being overwhelmed / 128 / 40 / 14 / 6
Mastalgia / 45 / 77 / 45 / 21
Headache / 75 / 66 / 35 / 12
Myalgia / 61 / 75 / 38 / 14
Bloating / 78 / 57 / 35 / 18
Weight gain / 66 / 71 / 37 / 14
Irritability / 24 / 94 / 51 / 19
Table – 4 The frequency of effect on daily life of PMS
Effects / Not at all / Mild / Moderate / SevereEffect on work efficiency / 43 / 99 / 36 / 10
Effect on relationship with work mates / 92 / 70 / 23 / 3
Effect on relationship with family members / 107 / 60 / 16 / 5
Effect on social life / 70 / 86 / 29 / 3
Effect on family responsibility / 87 / 82 / 17 / 2
Table – 5 The prevalence of PMS
Severity / Numbers / PercentageNo symptoms to mild symptoms / 43 / 22.87
Moderate to severe symptoms / 145 / 77.13
Table – 6 Quality of Life
Quality of Life / Numbers / PercentagePoor / 0 / 0.00
Neither poor nor good / 88 / 46.81
Good / 100 / 53.19
Table - 7 The quality of life divided in each part.
Part / Numbers / PercentagePhysical part
Poor
Not poor
4
184 / 2.13
97.87
Psychological part
Poor
Not poor
4
184 / 2.13
97.87
Social part
Poor
Not poor
4
184 / 2.13
97.87
Environmental part
Poor
Not poor
3
185 / 1.60
98.40
Table – 8 The quality of life score divided in each part.
Part / Min / Max / Average / SDOver view part / 68 / 127 / 95.97 / 11.15
Physical part / 15 / 30 / 22.09 / 2.98
Psychological part / 14 / 30 / 22.70 / 3.12
Social part / 6 / 15 / 11.49 / 1.63
Environmental part / 16 / 39 / 28.30 / 4.24
Table – 9 The Association of PMS and Quality of Life score
Quality of Life score / Not have symptom to mild symptoms / Moderate to severe symptomsOver view part
Mean
SD
95% Confidence Interval
P-Value
97.50 / 90.81
10.87 / 10.66
95.72 - 99.29
0.0005 / 87.53 - 94.09
0.0005
Physical part
Mean
SD
95% Confidence Interval
P-Value
22.63 / 20.28
2.85 / 2.71
22.16 - 23.10
0.0000 / 19.44 - 21.11
0.0000
Psychological part
Mean
SD
95% Confidence Interval
P-Value
23.10 / 21.37
2.93 / 3.38
22.62 - 23.58
0.0013 / 20.33 - 22.41
0.0013
Social part
Mean
SD
95% Confidence Interval
P-Value
11.65 / 10.98
1.58 / 1.71
11.39 - 11.91
0.0175 / 10.45 - 11.50
0.0175
Environmental Part
Mean
SD
95% Confidence Interval
P-Value
28.63 / 27.21
4.29 / 3.92
27.92 - 29.33
0.0537 / 26.00 - 28.42
0.0537
Table – 10 The association of risk factors and moderate to severe symptoms of PMS
Risk factors / Odds Ratio / 95% Confidence Interval / P - ValueAged / 0.95 / 0.85 – 1.07 / 0.387
BMI / 0.94 / 0.80 – 1.10 / 0.434
Menarche / 0.85 / 0.63 – 1.14 / 0.272
Exercise / 0.88 / 0.43 – 1.79 / 0.721
Caffeine / 1.26 / 0.62 – 2.58 / 0.518
Family history of PMS / 2.20 / 1.06 – 4.58 / 0.035
Table – 3 showing the frequency of severity of PMS symptoms being changed its to the chart form in
Chart – 1.
In Table – 4 showing the frequency of effect on daily life of PMS being changed its to the chart from in
Chart – 2.
Discussion
There have been many studies about causes of PMS and it is believed that the pathophysiology of PMSis due to ovarian steroid abnormalities, neuroendocrine system dysfunction and neurotransmitter system abnormalities. Some studies also showed that inadequate exercise, poor nutrition, alcohol consumption, caffeine consumption and stress might have some influence on PMS.
This study found that 22.8% of the volunteers had PMS. This finding is lower than the previous information on western women who tended to have higher prevalence of PMS. Prevalence of PMS in Poland women was found to be 76.39%(1)while 72.1%(1) in Turkish women. The prevalance of PMS in Thai Nurses was found to be at 25.1%(3) which is not different than the current study.
The differencescan probably be due to different lifestyle habits between the Thai people and other western people. For example, Thai people, especially medical personnel do not consider it to be abnormal and have more ability to detect and properly manage PMS before it has drastic effects on the quality of life.
This study showed that medical students with maternal history of PMS had a higher prevalence of PMS. The association between this factor and PMS was also reported in previous studies. However, the higher prevalence reports could not be explained by any mechanism in previous studies. The present study shows that negative attitude towards menstruation is also associated with PMS. Negative attitude of the mother on menstruation may affect on the perception of the daughter when she starts having her first cycle.
In the previous studies; women of younger age, earlier age of menarche, high coffee consumption, higher BMI and lower exercise habits had a higher prevalence of PMS. The association between the first two factors and PMS was reported with exposure to more ovulatory cycles. This mechanism could partially explain higher prevalence of PMS. However after multiple logistic regression analysis, it was found that the only significant factor associated with PMS in our participants was maternal history of PMS.
The study on the quality of life of preclinical medical students was measured by using WHOQOL. Moderate to severe severity of PMS was related with score of quality of life; physical, psychological and social well being. It has been found that both psychological and social well being were affected by PMS.
Conclusion
The limitation of the present study were indefinite diagnosis and lack of prospective PMS studies in Thai women. Complete screening method of PMS required atleast three months in previous studies while the paticipants in this study were only given 30 minutes to fill in the questionnaire.
The information about maternal history of PMS should be completed by giving the screening tool to each mother of the participants.
It can be concluded that PMS has high effect on quality of life of preclinical medical students but however, the real prevalence in our population is still not available and needs further study. We suggest that the information on PMS should be more publicized for better understanding of its facts and rectifying its misconceptions in our society. It may take a certain period of time to change our view on PMS before any interventional study regarding this problem can be carried out in our society.
Acknowledgements
The researchers would like to acknowledge the following people:
- Surachai Dejarkom, M.D. Dept. of Obstetrics and Gynecology, Faculty of Medicine Naresuan University Hospital, Naresuan University, Phitsanulok, Thailand.
- Suwit, M.D. Dept. of Community Family and Occupational Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
- Staffs of the Dept. of Community Family and Occupational Medicine.
- Preclinical medical students of Faculty of Medicine, Naresuan University.
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