Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

Objective: The aim of this study was to evaluate baccalaureate nursing students’ attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms. Methods: This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0. Findings: The average age of participants was 19.89 ± 1.43. The MAQ’s five subscales’ mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05). Conclusions: The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.     

Measurement of menstrual attitudes in Indian women: a cultural perspective

Menstrual attitudes and perceptions of menstrual and perimenstrual distress vary widely between cultures. Beliefs and attitudes related to menstruation were studied in a group of 48 female nursing students using a modified and abridged version of the Menstrual Attitude Questionnaire (MAQ). All women were in the reproductive age group. Modifications made were those which were culture-specific and which increased comprehension of items by the Indian women. The items were divided into positive/healthy and negative/unhealthy. Four of the original factors in the MAQ were retained. Computation of scores revealed a high loading on positive attitudes and consideration of menstruation as natural and physiological. Scores were low on menstruation being considered as debilitating. The findings of a more positive attitude towards menstruation is discussed in the background of cultural beliefs and attitudes.     

The Effects of a Dysmenorrhea Support Program on University Students Who Had Primary Dysmenorrhea: A Randomized Controlled Study

Study ObjectiveThis study aims to determine the results of a cognitive-behavioral approach in a dysmenorrhea support program that covers the symptoms, acquaintance, and attitudes toward menstruation of university students who had primary dysmenorrhea.Design and SettingThis randomized controlled, prospective, experimental study was carried out in a nursing school using a pretest-posttest design.ParticipantsA total of 682 female nursing students and 584 volunteers from the 2017-2018 academic year participated in a study of the prevalence of primary dysmenorrhea (94.0%). Study subjects were first-year female nursing students who scored severe on a visual analog scale for primary dysmenorrhea. As a result of the analysis, 80 female nursing students were assigned to study and control groups. A total of 60 students, 29 in the study group and 31 in the control group, completed the study.InterventionThe study group participated in a 6-session cognitive-behavioral approach in a dysmenorrhea support program. No intervention was administered to the control group. The control group and the study group were followed by using data collection forms during three menstrual cycles.Outcome MeasuresThe Participant Introductory Form (PIF), Dysmenorrhea Follow-up Form (DFF), Dysmenorrhea Information Form (DIF), Functional and Emotional Dysmenorrhea Scale (FEDS), Visual Analog Scale (VAS), and Menstrual Attitude Questionnaire (MAQ) were used to measure outcomes.ResultsIn the case of primary dysmenorrhea, the use of nonpharmacological methods was higher in the study group than in the control group. In the third cycle, although the rate of analgesics use was 20.7% in the study group, it was 50% in the control group. Primary dysmenorrhea symptoms, pain levels, and analgesic use decreased. No change was observed in the attitude toward menstruation.ConclusionA cost-effective, reliable, cognitive-behavioral approach−based dysmenorrhea support program can be used to relieve symptoms, decrease the use of analgesics, and increase knowledge about primary dysmenorrhea.     

Menstruation: symptoms, management and attitude of female nursing students in Ibadan, Nigeria

This study surveyed 120 student nurses from two schools of nursing in Ibadan, Nigeria to assess the symptoms experienced during menstruation, attitude towards and management of menstruation. The student nurses overall mean age at menarche was 14 years, average duration of menstrual period was five days and mean of menstrual cycle was 28 days. Out of the 120 study participants, 93% were having menstruation regularly. More participants experienced symptoms during premenstrual periods than menstrual periods. Majority (70%) used sanitary pad to manage their menstruation, 93% had positive attitude towards menstruation while only 20% consulted medical doctors whenever they experienced menstrual symptoms. Paracetamol was the drug of choice for many of the participants whenever they experienced menstrual symptoms It was recommended that authorities in schools of nursing should not overlook reproductive health needs of students. Also teaching of reproductive health education early in primary and secondary schools should be encouraged.     

Mexican Adolescents' Experience of Menarche and Attitudes Toward Menstruation: Role of Communication Between Mothers and Daughters

ObjectivesFirst, to explore the kind of information that Mexican mothers give their daughters about menstruation before their menarche, and to study the impact of this communication on how prepared the daughters felt when they experienced their menarche. Second, to investigate the influence of the menarcheal experience on attitudes toward menstruation.DesignCross-sectional survey.SettingsSample of adolescents attending 3 different public schools.Participants405 Mexican postmenarcheal adolescents, aged 12-15 years.InterventionParticipants answered a questionnaire that had 3 parts: (a) General data, (b) topics related to menses that participants had discussed with their mothers prior to menarche, and (c) menarcheal experience. They also answered a questionnaire about menstrual attitudes.ResultsAlthough most of the participants knew what they should do when they experienced their menarche, only 39% stated they had felt prepared to start menstruating. Regarding menstrual attitudes, adolescents scored highest on Negative Feelings and Secrecy rather than on Positive Feelings. Participants who had previously discussed the emotional aspects of menses with their mothers were more likely to claim they had felt prepared to start menstruating when they got their first period (OR = 3.45). The fact that adolescents felt prepared to start menstruating predicted positive attitudes toward menstruation (β = .19)ConclusionsDiscussing the emotional aspects of menses prior to menarche is crucial to being prepared for menarche, and to holding positive attitudes toward menstruation. Information on biological knowledge and practical aspects of menses needs to be supplemented with emotional issues.     

Premenarcheal Mexican girls' expectations concerning perimenstrual changes and menstrual attitudes

The objective of this study was to determine both the perimenstrual changes that Mexican premenarcheal girls expect to experience and their attitudes toward menstruation. A total of 750 premenarcheal girls in fifth and sixth grade were studied. Participants completed a Perimenstrual Change Checklist, which listed 20 negative possible perimenstrual changes and ten positive ones, and a Spanish version of the Adolescent Menstrual Attitude Questionnaire. The results showed a set of mostly negative perimenstrual expectations, the most common being discomfort, cramps or abdominal pain and mood swings. Concerning menstrual attitudes, the girls scored highest on secrecy, followed by negative feelings and by positive feelings. The girls who perceived menstruation as a negative event and with secrecy, expected more negative perimenstrual changes, while those who perceived menstruation as a positive event expected more positive perimenstrual changes. We believe premenarcheal girls, with no personal experience, must be more influenced by cultural stereotypes which are of a negative nature.     

Psychological aspects of premenstrual syndrome

Premenstrual syndrome (PMS) is a group of psychological and physical symptoms which regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called premenstrual dysphoric disorder (PMDD). The exact aetiology of PMS is not known. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. The increased sensitivity may be due to neurotransmitter (mainly serotonin) dysfunction. The key diagnostic feature is that the symptoms must be absent in the time between the end of menstruation and ovulation. Prospective symptom rating charts are used for this purpose. Treatment is achieved by suppression of ovulation or reducing progesterone sensitivity with selective serotonin re-uptake inhibitors. In this chapter, the authors describe the aetiology, symptoms, diagnosis and evidence-based management of premenstrual syndrome.     

Premenstrual Syndrome in Thai Nurses

Objective. To investigate prevalence of premenstrual syndrome (PMS) and its associated factors among Thai nurses.

Methods. The study was conducted in 423 nurses in a university hospital during October 2005 to March 2006. Prevalence of PMS was determined using a validated Thai version of Premenstrual Symptoms Screening Tool (PSST). Factors associated with PMS were analyzed using Student t-test and Chi-square test.

Results. The prevalence of PMS in Thai nurses was 25.1%. Nurses with younger age, nulligravida, lower income, more coffee consumption, dysmenorrhea, and negative attitude toward menstruation had higher prevalence of PMS. After multiple logistic regression analysis, the significant factors associated with PMS were coffee consumption >1 cups/day and negative attitude toward menstruation; odds ratios (95% confidence interval) were 2.322 (1.257 to 4.288) and 5.768 (2.096 to 15.872), respectively.

Conclusion. According to the Thai PSST, 25.1% of Thai nurses are suffering from PMS. The significant associated factors were more coffee consumption and negative attitude toward menstruation.     

Premenstrual syndrome and associated symptoms in adolescent girls

OBJECTIVE: To investigate the frequency of premenstrual syndrome (PMS) associated symptoms and effects of nutrition on PMS in adolescent girls. PATIENTS AND METHODS: One hundred and seventy-one adolescent girls who had menstrual cycles were included in this study. They were given a questionnaire on criteria for PMS, dysmenorrhea and regularity of menstrual cycle. Modified Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used for the diagnosis of PMS. We also investigated which nutritional supplements affect the PMS-associated symptoms and signs. RESULTS: One hundred and five adolescent girls out of 171 (61.4%) met DSM-IV criteria for PMS. There was an association between dysmenorrhea and PMS in 60 (57.1%). Half of the girls, i.e. 52 (49.5%) had mild, 39 (37.1%) had moderate and 14 (13.4%) had severe PMS. The most common symptom of PMS was negative affect particularly in the form of stress (87.6%) and nervousness (87.6%). There was a statistically significant negative relationship between milk consumption and the following: abdominal bloating, cramps, craving for some foods and increased appetite. CONCLUSION: PMS and dysmenorrhea are frequently overlapping. We also found that PMS is associated with dietary habits.     

Correlates of Dysmenorrhea

A study was conducted to explore the relationship of demographic variables, gynecologic history variables, and menstrual attitudes to three measures of dysmenorrhea derived from the Menstrual Distress Questionnaire. One hundred ninety-three women, 18 to 35 years old, from five neighborhoods in a large, metropolitan city comprised the sample population. The strongest correlates found were attitudes toward menstruation, though associations between dysmenorrhea and items reflecting traditional/feminist dimensions were absent. Further precision in defining dysmenorrhea and a comprehensive, health-oriented approach to dealing with menstrual distress is indicated. Recommendations about the nurse's role in counseling dysmenorrheic women and promoting more positive menstrual attitudes are discussed.     

Attitudes towards and experience of the menstrual cycle across different cultural and religious groups

The aim of this study was to explore the impact of culture on menstrual attitudes and experience by distinguishing the separate issues of ethnicity and religious cultural identity. A total of 170 women living in Britain aged 13–85 (M = 36, SD = 16) participated in the study; 76 (44.7%) were culturally Christian, 48 (28.2%) culturally Muslim and 46 (27.1%) culturally Hindu. Respondents completed the Menstrual Attitudes Questionnaire (MAQ) and Menstrual Distress Questionnaire (MDQ). MANCOVA (controlling for the language of completion) showed no significant main effects of age group (over versus under 30) and no significant interaction between age and religious group, but did show a significant main effect of religious group on both MAQ (F(10, 314) = 5.1, p<0.01) and MDQ (F(16, 310) = 3.2, p<0.01) scores. Between‐subject effects for the MAQ were significant for four of the five attitude subscales and Bonferroni t'‐tests indicated that Hindus were significantly different to both Christians and Muslims. Between‐subject effects for the MDQ were significant for five of the eight subscales. Bonferroni t'‐tests showed that whilst Muslims scored higher than both Hindus and Christians on the ‘control’ subscale, Hindus scored significantly higher on ‘pain’ than Christians and significantly lower on ‘arousal’ than both Muslims and Christians. The results are consistent with a bio‐psychosocial model of menstrual cycle experience but also demonstrate that culture should be defined not only in terms of ethnicity but also in terms of other cultural factors such as religious heritage. The similarity between Christians and Muslims may be explained by the shared roots of these faiths, in contrast with the very different beliefs of Hindus.     

The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers

Objective  The aim of this study was to: (1) establish the typical experience of menstruation for senior high school girls and (2) determine how many experience considerable menstrual disturbance that could require further investigation and management of underlying pathology.
Design  Cross-sectional study.
Setting  Senior High Schools in the Australian Capital Territory (ACT), Australia.
Population  A total of 1051 girls aged between 15 and 19 years.
Methods  Data based on a quantitative survey.
Main outcome measures  Self-reports of menstrual bleeding patterns, typical and atypical symptoms and morbidities.
Results  Typical menstruation in adolescence includes pain (93%), cramping (71%), premenstrual symptoms (96%) and mood disturbance (73%). Highly significant associations were found between increasing severity of menstrual pain, number of menstrual-related symptoms, interference with life activities and school absence. These associations indicate that approximately 25% of the sample had marked menstrual disturbance: 21% experienced severe pain; 26% school absence; 26% suffering five or more symptoms; ≥24% reporting moderate to high interference with four out of nine life activities. Approximately 10% reported atypical symptoms associated with menstruation. Diagnosis of menstrual pathology in the sample was low, even though 33% had seen a GP and 9% had been referred to a specialist.
Conclusions  Menstrual pain and symptoms are common in teenagers. Girls indicating moderate to severe pain in association with a high number of menstrual symptoms, school absence and interference with life activities should be effectively managed to minimise menstrual morbidity. Those girls who do not respond to medical management should be considered for further investigation for possible underlying pathology, such as endometriosis.     

Hormonal management of premenstrual syndrome

Premenstrual syndrome (PMS) is a psychological and somatic disorder of unknown aetiology. The symptoms of PMS regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called 'premenstrual dysphoric disorder'. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced progesterone sensitivity. This enhanced sensitivity may be due to neurotransmitter dysfunction. Treatment is aimed at suppressing ovulation or reducing progesterone sensitivity. This chapter will describe the role of hormones and hormonal treatments in PMS.     

An overview of premenstrual syndrome

Premenstrual syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle. It is characterized by intense physical, psychological, and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women. Premenstrual syndrome is believed to affect 75% of women of childbearing age. Because no tests can confirm PMS, the diagnosis should be made on the basis of a patient-completed daily symptom calendar and the exclusion of other medical disorders. PMS symptoms occur during the luteal phase of the menstrual cycle and remit with the onset of menstruation or shortly afterward. The aetiology of PMS is still unknown uncertain, but are likely associated with aberrant responses to normal hormonal fluctuations during the menstrual cycle. A wide range of therapeutic interventions has been tested in the treatment of premenstrual symptoms. Most non-pharmacological interventions that have been proven efficacious require a series of interventions. If non-medical approaches are ineffective, drug therapy may be appropriate. Several pharmaceutics agents have been shown to relieve symptoms. Calcium carbonate and selective serotonin reuptake inhibitors have demonstrated excellent efficacy.     

Premenstrual syndrome (PMS) in adolescents: severity and impairment

OBJECTIVES: Identify the presence of patients with premenstrual syndrome (PMS) in an adolescent gynecology practice, and evaluate the reported severity, impairment and timing of the symptoms in the menstrual cycle. METHODS: Adolescents ages 13-18 years completed a symptom questionnaire, functional impairment ratings, and a brief medical history questionnaire during an office visit. Teens who responded that they had PMS and reported a premenstrual symptom score at least 50% greater than the postmenstrual score and rated moderate to severe impairment in one or more domains comprised the "PMS" group. Teens who responded that they had PMS but did not meet the symptom and impairment criteria were termed "PMS not supported." Teens who responded that they did not have PMS and did not meet the PMS symptom and impairment criteria were termed "No PMS." RESULTS: Study participants (n = 94) had a mean age of 16.5 years (+/-1.3 SD); 31% met the criteria for the PMS group, 54% said they had PMS but did not meet criteria, and 15% clearly had no PMS. In the PMS group, the most severe symptoms were mood swings, anxiety, and irritability, with the greatest impairment in the home/family domain. Dysmenorrhea and the duration of PMS were significantly associated (P < 0.01) with PMS in univariate and multivariate analyses. CONCLUSIONS: The reports of premenstrual symptoms, their severity, timing and impairment suggest that PMS is common in adolescents. Further study is warranted to confirm these results with prospective assessment of PMS and to evaluate treatments for adolescents who have clinically significant PMS.     

Rett syndrome and menstruation

ObjectiveDescribe the experience that girls with Rett syndrome have with menstruation including menstrual hygiene, dysmenorrhea, premenstrual syndrome (PMS), and attempts at treatment.DesignAnonymous web-based survey.SettingConvenience sample recruited from Rett syndrome LISTSERV in July of 2009.ParticipantsMothers of girls with Rett syndrome between the ages of 10–25 who have had at least one menses.Main Outcome MeasuresPrevalence, frequency, and severity of dysmenorrhea and PMS; hygiene concerns; and treatments attempts and perceived effectiveness.ResultsDysmenorrhea and PMS are common problems among young women with Rett syndrome. Despite their frequency and severity they do not routinely limit activities. Multiple treatment attempts are common. Hormonal contraception is used mostly for menstrual cycle control with oral contraceptive pills the most commonly used method.ConclusionsYoung women with Rett syndrome have standard symptoms of dysmenorrhea and PMS as well as autism spectrum specific PMS symptoms. Hormonal contraception is commonly used for menstrual management.     

Characteristics of premenstrual syndrome

To characterize the symptoms associated with premenstrual syndrome (PMS), the menstrual symptom calendars of 100 women diagnosed with PMS were factor-analyzed. Scores on 18 symptoms were recorded daily for one menstrual cycle prior to the women's first clinic visits. Two factors were found to predominate throughout the cycle: The first included emotional and behavioral symptoms and the second included physical and cognitive symptoms. The two factors were constant throughout all the phases of the menstrual cycle. Emotional symptoms clustered together throughout the menstrual cycle and were the dominant symptoms on factor I. However, they loaded (correlation of the variable with the factor) on factors I and II during the postmenstrual phase. Behavioral symptoms loaded on factor I throughout the menstrual cycle; however, they were prevalent predominantly in the later half of the intermenstrual and the premenstrual phases. Physical symptoms loaded predominantly on factor II and were less prevalent than the emotional symptoms. The cognitive symptoms loaded on factor II during the premenstrual phase. These findings are relevant for defining PMS criteria for women who seek treatment.     

Physical symptoms in premenstrual syndrome are related to plasma progesterone and desoxycorticosterone.

Somatic symptoms in the premenstrual syndrome (PMS) may have an etiology separate from that of the mental symptoms. A disturbance in mineralocorticoid action has been discussed, as mineralocorticoids regulate water balance. Desoxycorticosterone (DOC) is interesting, as it has mineralocorticoid effects and is a precursor to the neurosteroid 5 alpha-pregnan-3 alpha,21-diol-20-one (THDOC). THDOC is a steroid with direct benzodiazepine-like effects on the GABA-A receptor in the brain that is metabolized from DOC within the brain and in the periphery. Ten women with PMS having swelling as a major symptom and eight controls were recruited. They marked, on a validated visual-analog scale, three physical symptoms every evening during one menstrual cycle in conjunction with giving blood samples for progesterone and DOC measurements. DOC showed menstrual cycle-linked variation correlating with progesterone. There was no difference in plasma DOC concentrations between patients and controls. The symptoms reached a maximum 1-3 days before the onset of menstruation, with a delay of 3-6 days after the hormone peak. DOC was less strongly correlated with the symptoms than progesterone. These results do not support the hypothesis that DOC is involved in the etiology of physical symptoms in PMS or that physical and mental symptoms have separate etiologies.     

Premenstrual tension syndrome with periodic bulimia nervosa: report of a case and review of the literature.

Premenstrual tension syndrome (PMS) is well known in its epidemiology, etiology, symptomatology and treatment. However, PMS characterized by bulimic episodes is rare. We report a case of a 20-year-old university student who suffered from uncontrollable binge eating premenstrually for six months before visiting our clinic. She was obese without any other notable family or medical history except the PMS noted for two years. A daily food diary for two consecutive menstrual cycles showed that the mean differences in caloric intake between premenstrual and postmenstrual days of two menstrual cycles were 679 and 703 calories, respectively. The greater peaks in caloric level were noted within the third to fifth days prior to the onset of menstruation. All binge episodes occurred in the premenstrual period, especially within five days prior to menstruation. In this report, we will also review the literature on the relationship between PMS and dietary intake, as well as bulimia nervosa.