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Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 396-399  

Premenstrual syndrome: Prevalence, symptoms, and associated risk factors among adolescent girls in Aligarh, Uttar Pradesh

1 Assistant Professor, Department of Community Medicine, Mamta Academy of Medical Sciences, Bachupally, Hyderabad, India
2 Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
3 Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India

Date of Submission31-Mar-2021
Date of Decision06-Oct-2021
Date of Acceptance19-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Farha Tarannum
Department of Community Medicine, Mamta Academy of Medical Sciences, Bachupally, Hyderabad - 500 090, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_985_21

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Premenstrual syndrome (PMS) is a collection of physical, cognitive, affective, and behavioral cyclically occurring symptoms during the luteal phase of the menstrual cycle which resolves later. The study aims to find the prevalence and symptoms of PMS and risk factors associated with it among school-going adolescent girls in Aligarh. A total of 422 girls (Class 6th to 12th) were taken by systematic random sampling with probability proportionate to size. 37.7% (159) of the girls reported PMS with abdominal bloating (35.2%) as the most common somatic symptom and social withdrawal (69.2%) as the most common effective symptom. The multivariable analysis showed that occurrences of PMS were significantly associated with age, adjusted odds ratio (AOR) (95% confidence interval [CI]): 2.19 (1.22–3.93); education status of participants, AOR (95% CI): 2.97 (1.37–6.45); mothers who are graduate and above, AOR (95% CI): 2.59 (1.40–4.77); working mothers, AOR (95% CI): 1.81 (1.04–3.14); long menstrual cycle (>35 days), AOR (95% CI): 0.40 (0.19–0.85); and irregular cycle, AOR (95% CI): 2.83 (1.48–5.38). Cox and Snell R2 was 0.2 and Nagelkerke R2 was 0.3.

Keywords: Adolescent girls, menstrual cycle, premenstrual syndrome

How to cite this article:
Tarannum F, Khalique N, Eram U. Premenstrual syndrome: Prevalence, symptoms, and associated risk factors among adolescent girls in Aligarh, Uttar Pradesh. Indian J Public Health 2021;65:396-9

How to cite this URL:
Tarannum F, Khalique N, Eram U. Premenstrual syndrome: Prevalence, symptoms, and associated risk factors among adolescent girls in Aligarh, Uttar Pradesh. Indian J Public Health [serial online] 2021 [cited 2022 Jan 22];65:396-9. Available from:

Adolescence is a period of transition from childhood to adulthood, occurring between the ages of 10 and 19 years.[1] Menarche is the most significant milestone in a girl's life. Menstrual complications are considered to be the main gynecological problem, among others, particularly in adolescent females.[2] Premenstrual syndrome (PMS) refers to a group of expectable physical, cognitive, affective, and behavioral symptoms that are observed cyclically during the luteal phase of the menstrual cycle and resolve immediately in a few days at the beginning of menstruation.[3] The pathophysiology of PMS remains unclear multifactorial, complex, and yet to be fully clarified and may include various sociobiological and psychological factors such as hormonal change, diet, and lifestyle. The PMS is common in the younger age groups and therefore represents a significant public health problem in young girls. Premenstrual symptoms are more common and more severe among high-level educated women than noneducated women, with a possible association of stress with PMS.[4],[5],[6],[7] PMS results in significant psychosocial dysfunctions as the symptoms often coexist with anxiety and other psychological symptoms.[8],[9]

Menstrual problems like PMS affect not only adolescent girls but also family, social, and national economics as well. However, population studies on PMS and associated risk factors are very less for school students in Aligarh. Therefore, this study will come up with the magnitude of PMS and associated risk factors at high school and interschool levels.

In this context, the present school-based study was conducted in Aligarh, Uttar Pradesh, with the following objective to study the prevalence and symptoms of PMS among study subjects and to find out risk factors associated with PMS.

The present study was a community-based cross-sectional study conducted in Secondary and Higher Secondary Schools (Girls) of Aligarh Muslim University (AMU), Aligarh, from January 2016 to July 2016. The study was conducted among the students of Class 6th to 12th standard from each of the university girl schools, namely Senior Secondary School Girls, AMU Girls High School, and AMU ABK High School (Girls), using systematic random sampling with population proportionate to size.

The sample size was calculated by using the single population proportion formula with the assumptions of 95% confidence interval (CI), 5% margin of error, the anticipated prevalence 50%,[10] and 10% nonresponse rate. Based on this, our final calculated sample size was 420. For the selection of 422 students, the population proportionate to size technique was used to calculate the required sample from each of the school and respective classes. Out of total of 422, 97 girls were taken from Senior Secondary School Girls, 200 from AMU Girls High School, and 125 from AMU ABK High School Girls. In different classes, every 8th (sampling interval) student was taken. In case that student was absent, then the next one was taken.

All students studying in Class 6th to 12th standard from the selected schools and who had attained menarche as well as a student who gave consent were included in the study, whereas students who were absent on the day of data collection were excluded from the study.

A predesigned and pretested questionnaire was used for data collection in a face-to-face interview. Weight and height were used to calculate body mass index (BMI) using the formula: BMI = weight in kg/height in m2. BMI was classified into four groups based on the cutoff points recommended by the World Health Organization.[11] Pattern of menstruation was assessed by length of menstrual cycle and duration of menstruation. Cycle with an average rhythm of 28 ± 7 days and 3–6 days of bleeding is a regular menstruation.[12] Pictorial blood assessment chart was used to assess heavy menstrual bleeding.[13] ACOG criteria were used for assessment of PMS. It contains six affective and four somatic symptoms. Symptoms must also meet the following criteria: (i) be relieved within 4 days of the onset of menses, without recurrence until at least cycle day 13; (ii) be present in the absence of any pharmacologic therapy, hormone ingestion, or drug or alcohol use; (iii) be causing identifiable dysfunction in social or economic performance; and (iv) occur reproducibly during two cycles of prospective recording.[14]

Data were entered and analyzed using (IBM SPSS version 20 Armonk, NY) Descriptive statistics such as frequency and percentages for categorical variables were used. Both bivariate and multivariable logistic regression analyses (backward stepwise) were used to determine factors associated with premenstrual syndrome. P ≤ 0.05 was considered statistically significant.

The study was approved by the Institutional Ethics Committee, JNMCH, AMU, Aligarh. In addition, written informed consent from the participating schools and informed oral assent were taken from all the participants, after explaining the purpose of the study, and prior consent from parents was taken.

Out of total, 196 (46.4%) respondents were in early adolescence and the rest half 226 (53.6%) in late adolescence. Nearly one-third of the respondents were students of Class 6th to 8th (33.6%), whereas the remaining students were studying in 9th–10th (41.5%) and 11th–10th (24.9%). Almost two-fifth of the respondents' mothers (41.2%) had completed graduation, whereas 29.1% of the respondents' mothers were educated till high school.

More than one-third (38.4%) of the respondents experienced early menarche, before celebrating their 12th birthday. Out of the total study population, 63 (14.9%) girls had a menstrual cycle length shorter than 21 days, 119 (28.2%) had cycle longer than 35 days, and 240 (56.9%) had a cycle length between 21 and 35 days. Majority (215, 50.9%) of the subjects experienced a normal duration of bleeding (3–5 days), 16 (3.8%) reported a shorter duration of bleeding (<3 days), and 191 (25.8%) had a longer duration of bleeding (>5 days). It was observed that majority (237, 56.2%) experienced regular cycle whereas 185 (43.8%) reported irregular cycle. Nearly two-fifth (40.8%) of the participants reported excessive bleeding during menstruation.

According to the ACOG definition, 37.7% of the participants had PMS during their preceding two consecutive cycles, as shown in [Table 1]. Social withdrawal (69.2%) and abdominal bloating (35.2%) were the most frequently observed affective and somatic symptoms, respectively.
Table 1: Prevalence and symptoms of premenstrual syndrome

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During the multivariate analysis of PMS in relation to all exploratory variables, only six of the most contributing factors remained to be statistically significant and independently associated with the presence of PMS (at 0.05 level of significance). In this study, the existence of PMS had a statistically significant association with age, adjusted odds ratio (AOR) (95% CI): 2.19 (1.22, 3.93); studying in Class 9th and 10th, AOR (95% CI): 2.97 (1.37, 6.45); mothers of the respondents who are graduate and above, AOR (95% CI): 2.59 (1.40, 4.77); working mothers of respondents, AOR (95% CI): 1.81 (1.04, 3.14); long menstrual cycles (>35 days), AOR (95% CI): 0.40 (0.19, 0.85); and irregular cycle, AOR (95% CI): 2.83 (1.48, 5.38) [Table 2]. Cox and Snell R2 was 0.2 and Nagelkerke R2 was 0.3.
Table 2: Bivariate and multivariable analysis of risk factors associated with premenstrual syndrome

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In the present study, the prevalence of PMS was estimated as 37.7%, which was lower as compared to other studies from India. Singh et al. in 2008[15] reported that 60.5% of the medical students suffered from PMS, Lakshmi et al. in 2011[16] found the prevalence of PMS to be 67% whereas Thakre et al.[17] reported prevalence of PMS as 55.8%, Ramya et al.[18] reported the prevalence of PMS in urban girls as 40.9% and in rural girls as 51.6%, and Sarkar et al. (2016)[19] reported prevalence of PMS as 61.5%. Some of the studies conducted outside india by Abeje et al[20] and shiferaw et al[21] found the prevalance to be 81.3% and 72.8% respectively in Ethiopia. Two studies conducted in Sistan and Baluchistan University,[22] Iran, and Zahedan University, Iran,[23] reported a lower prevalence of 36.3% and 16%, respectively, as compared to the present study. The variation in prevalence rates can be attributed to the difference in study designs, age of the study group, sample size, and cultural and geographical influence considered by the investigators of respective studies.

PMS was 2.19 times more in late adolescence (15–19 years) in the present study. While some authors reported that PMS was increasing with age,[24] others failed to find such correlation.[25] Cleckner-Smith et al.[26] found that symptoms were more intense in the 16–18 years' age group compared to the 13–15 years' age group. Bakhshani et al.[23] found that the 18–20-year-old age group had the highest figures.

The occurrence of PMs in this study had a statistically significant association with long menstrual cycles (>35 days). This is supported by a study in West Bengal,[19] India, which identified menstrual cycle intervals and amount of blood flow during menstruation as important predictors of PMS.

Menstrual regularity was one of the factors associated with the presence of PMS, which may be due to fluctuation of steroidal hormones. The participants who had irregular menstruation were 2.83 times more likely to have PMS compared to students who had regular menstruation (AOR = 2.83, 95% CI: 1.48, 5.38). This finding was consistent with a study in Saudi Arabia[27] (P < 0.001) and Bahir Dar University, Ethiopia,[21] and differs from a study of college students in Japan[28] which had found no significant association between irregular menstruation and PMS.

The prevalence of PMS is in general high among school-going adolescent girls in AMU, with a prevalence of 37.7%. It really affects the educational, social, and emotional well-being of young adolescent girls. Proper counseling and treatment should be provided to them in order to cope up with various somatic and affective symptoms.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]


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