INTRODUCTION
Pre-menstrual
syndrome (PMS) is used to describe the physical, cognitive, affective, and
behavioral symptoms that occur cyclically during the luteal phase of the
menstrual cycle and resolves quickly at or within a few days of the onset of menstruation[1]. These symptoms have
the capability of affecting the social and productivity outcome of young
students [2].
Premenstrual symptoms
are experienced by up to 90% of women of child bearing age[
1,2]. A lesser subset meet the criteria for premenstrual syndrome (PMS)
and a much lesser number of them are diagnosed as having premenstrual dysphoric disorder [PMDD] as stipulated by the American
psychiatric Association. It is indeed common in the younger age group and
therefore represents a public health problem among young girls.
The American College
of Obstetrics and Gynecology [ACOG] published diagnostic criteria for
premenstrual syndrome (PMS). It was considered if at least one of the six
affective and one of the four somatic
symptoms was reported five days prior to the onset of menses in the three prior
menstrual cycles and ceased within four days of onset of menses [5].
Premenstrual syndrome [PMS] can also be diagnosed using the ICD-10 criteria
which stated that one or more symptom
that occur in the luteal phase, peaks before menses and ceases with
menstrual flow[6-8]. The six behavioral symptoms include,
Depression, Angry outburst, Irritability, Anxiety, Confusion and social
withdrawal, while the somatic symptoms include, Breast tenderness, Abdominal
bloating, Headache and swelling of extremities. The differences in the various
criteria have accounted for the wide variations in the prevalence of this
condition across the social cultural regions of the world [3].
The exact cause is
not clearly understood but, various biosocial and psychological causes have
been proposed as the cause of the syndrome, including abnormal serotonin
function, presence of progesterone, altered endorphin modulation of gonadotrophin secretion, exercise habits, smoking, use of
alcohol, altered transcapillary fluid balance and
diet rich in beef or caffeine containing beverages [6]. Accordingly,
while menstruation represents the girl’s entrance to her expected social role
as a mature woman, the previously mentioned cultural perspectives may have an
evident role [9].The University students Community largely have a
young population structure and PMS is particularly common in the younger age
group. However, not so much is known about the extent and severity of
premenstrual syndromes among young women [10-12]. Also, a minority
of women with menstrual problems had sought health care and menstruation was
revealed to be a highly personal and secretive topic in this kind of population
[11].
In study carried out
by Adewuya AO et
al [14] where pattern and correlates of premenstrual
symptomatology amongst Nigeria female undergraduates was studied, it was
recommended that dysmenorrhoea and personality traits
should be taken into consideration when planning and implementing effective
strategy to manage perimenstrual problems in this
region.
METHODOLOGY
Participants
A descriptive cross-sectional survey was
conducted by using a self-administered questionnaire.
Students with current
medical, psychiatric or gynecological problems were excluded from the study including
pregnancies, amenorrhea and significant pelvic pains.
Instrument
Questionnaires were completed by the
participants. Height and weight were taken by the trained researchers.
The questionnaire was adapted from the
premenstrual symptoms screening tool for clinicians and ICD-10 diagnostic
criteria for PMS (WHO 1996) [12]. The first part consisted of
questions on socio-demographics and life style. The second part of the
questionnaire included premenstrual symptoms days prior to their period and
that wanes at the onset of the period. The final portion of questionnaire was
on the severity of PMS and its effects on the day to day activities of the
student.
Sample
size
The sample size was arrived at using Fischers’ formula:
Sample size (n) = (1.96)2
x P (1-P)
D2
Where;
Standard error = 1.96
P= Prevalence of 50% (Adewuya
AO et al. 2009)
Using a prevalence of 50% in Nigeria
D= Desired degree of accuracy; here taken to
be 0.05
Sample size (n) = (1.96)2
x 0.5 (1-0.5)
0.05 x . 0.05
N= 3.84 x 0.5 x
0.5 = 0.96
0.0025 0.0025
= 384
The sample size, was adjusted to compensate
for an attrition rate of 10%
Therefore 10% of 384
= 38.4 ≈ 38.
Minimum sample size = 384 + 38 = 422
Another 10% of 384 because of those that will
not fill the questionnaire = 422 +38 = 460.
·
Sample size of 460 was chosen
·
11 student failed to return their
questionnaire, therefore a total of 449 were sampled
Procedure
Written informed consent was obtained from
the respondents, pre-testing was done among twenty students earlier for
validity and reliability. Questionnaires were administered by the field workers
using simple random technique.
Data were analyzed using the Statistical
Package for Social Sciences version 16 (SPSS Chicago IL USA). Group comparison was
carried out. Regression
analysis done for each group of variables to evaluate the role of the
independent variable on PMS. A P value of < 0.05 at 95% confidence
interval was considered significant.
RESULT
Of the 449 students sampled, prevalence of
PMS was diagnosed in 425 of them (94.7%) using the ICD-10 diagnosis criteria of
PMS
Using the ICD-10 criteria and the
premenstrual symptoms screening tool (PSST), the occurrence of PMS were categorized
into mild, moderate and severe cases which were calculated to be 63.3%, 31.2%
and 5.6% respectively (Table 1).
Table 1. Severity of PMS among female undergraduates
|
Severity
|
Frequency
|
Percent
|
|
|
|
|
Not at
all/mild
|
284
|
63.3
|
|
Moderate
/severe
|
140
|
31.2
|
|
PMDD
|
25
|
5.6
|
|
Total
|
449
|
100.0
|
Premenstrual symptoms were presented in Table
2. The frequencies of somatic symptoms were; breast tenderness (77.1%),
joint/muscle pain (59.7%), headache (50.1%), and weight gain (38.5%) abdominal
bloating (29%).Whereas the distribution of affective symptoms were; social withdrawal (69.3%),
Anger/irritability (59%), confusion/ difficulty in concentrating (56.3%),
Depressed mood(53.7%), anxiety (51.7%), tearfulness (41.4%).
DISCUSSION
PMS was diagnosed in
94.7% of cases, distributed as 63.03% mild or none, 31.2% moderate and 5.3%
severe. Social withdrawal and breast tenderness were more prevalent in the PMS
with values of 69.3% and 77.1% respectively.
PMS affect work efficiency and productivity in 68.9% of student.
Limitations of activities were more prevalent among severe cases.
The prevalence of PMS
in the study was 94.7%. This was closely related to the work of Rasheed and Al-sowielem [15]
in Saudi Arabia who reported prevalence rate of 96.6% and Steinerm
et al,[16]
from western Europe reported prevalence of 85%. In Egypt, El-Defrawi
et al[17] prevalence of
69-9%.
Although, Ahizechukwu et al[22]
in Nigeria had reported a higher severity rate
of 31% in 2011, the severity rate reported in Maiduguri and Lagos were
6.5% and 3.1% respectively. Also severity rate of 2.9% was reported in Akron,
United States [23]. Several factors are responsible for the
variation in severity. Such factor includes cultural disparity, study
population, dietary differences, recent increase in empowerment and positive
gender attitude of young women in the society as well as increased the
perception and awareness of PMS.
The most commonly
reported symptom varied due to different cultural and socio-demographic
variables. In our study the most common somatic symptom was breast tenderness
(77:1%) and most common affective symptom was social withdrawal (69.3%). Magdy et al
reported abdominal bloating to be commonest (75.3%), Derman
et al{21} reported
stress and nervousness to be commonest. Ahizechukwu et al reported that 50% experience
physical and mental stress.
PMS in this study
showed a significant relationship with marital status as it tended to be higher
in women that are single than the married. This could be as a result of the
unmarried been more expose to stressful conditions as
they lack adequate family support. This explains why 66.6% of the single ladies
experienced PMS as opposed to 36.1% of the married ones.
For those who did
physical exercise daily and weekly, 63.3% and 74.0% respectively experienced
pre menstrual symptoms while those with stressful life style daily and weekly,
79.2% and 76.9% respectively experienced pre menstrual symptoms. These findings
were closely related to the report by Freeman et al[25].
Clecknedr-Simth et
al[26]
found that symptoms were significantly related to age and more with
16-18year group compared to the 13-15year group. Age was not a significant
predictor from our study, which was not consistent with previous findings by
some other investigators [2, 15, 20]
Limitations
The study included a
highly selected sample comprising undergraduates from one academic institution
instead of multi centered study.
Despite the fact that
the students included in the study were based on absence of medical chronic
disorders, they were not screened for other possible medical diagnosis at the
time of reporting PMS symptoms.
We depended on the
retrospective analysis using questionnaire as it was inherently difficult to
use the prospective approach.
CONCLUSION
Premenstrual syndrome
problems have assumed a public health dimension amongst young students in this
part of the world. Severe PMS was associated with more premenstrual symptoms,
impairment of daily activities including classroom lectures and psychological
distress symptoms. Stressful life style and increased exercises could be
considered as predictors for PMS. Further studies on large sample population is
recommended to validate this
findings as well as the introduction of
a reproductive health components into college health education program that
could help in providing information, education and support to the young
Nigerian Students.
Conflict
Of Interest:
There was no conflict of interest.
Acknowledgement:
Mother, Baby and Adolescent Care Global
Foundation
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