PMS is a common health issue in women of reproductive age. It can significantly impact on the regular life activities, education, and respective work performances of female students. In this study, it was tried to find out what kinds of physical, psychological, and behavioral symptoms people experience during PMS and the degree of those symptoms. Also, the impacts of premenstrual syndrome (PMS) on educational activities, social activities, and interpersonal relationships were evaluated by analyzing the primary data that were collected by conducting a survey using a well-prepared questionnaire. This study included 366 female students of different age groups. They completed the questionnaire in the first part. Following the collection of primary data, the data were thoroughly checked and analyzed in the next phase. These data were analyzed by creating corresponding charts, tables, and diagrams for ease of use. The following results were obtained and evaluated after the data were thoroughly checked, analyzed, and studied. Percentages obtained throughout the analysis of the tables and figures were rounded up in some of the discussion parts for more convenience.
Table 1
Demographic characteristics
Elements | Sample Number (n) | Percentage (%) |
Total | 366 | 100 |
Age Group |
13–18 | 25 | 6.83 |
19–24 | 274 | 74.86 |
25–30 | 43 | 11.75 |
31–35 | 23 | 6.28 |
35+ | 1 | 0.27 |
Educational Status |
PSC/JSC | 7 | 1.91 |
Secondary | 15 | 4.10 |
Higher Secondary | 23 | 6.28 |
Under-Graduate | 261 | 71.31 |
Graduate | 55 | 15.03 |
Others | 5 | 1.37 |
Firstly, the demographic conditions of the participants were evaluated in Table 1. In a survey of 15 to 49-year-old women, PMS was found to be highly prevalent in Pakistan and Turkey. While there has been little published research on PMS from Iran, it appears that premenstrual syndrome is general in young girls there (4). Here in our study, most of the respondents (274 participants) were from the age group 19–24 years, which is 75% of the total study population. Another demographic aspect is the educational status of the participants. 261 (71%) out of the 366 participants were ongoing undergraduates, which was the majority. Moreover, all of the study population were educated females.
Information and data regarding PMS and menstruation are demonstrated in Table 2. For most of the subjects (32.24%), the first age of menstruation or 'menarche' was 12. About 25.14% attained menarche before 12. This study found no correlation between the period of menarche and the days of menstrual flow. Previous studies have identified either a positive or no correlation between the onset of menarche and blood flow during menstruation (21). Almost 80% of them have normal blood flow during menstruation (between 3–8 days), and nearly 74% of them have regular menstrual cycle length, which is 21–35 days, which indicates that prevalence of polymenorrhea and oligomenorrhea is less among these students. In contrast, from Table 2, 32 participants have polymenorrhea, which means their menstrual cycle length is less than 21 days; only 3% of participants have oligomenorrhea (menstrual cycle length more than 90 days). According to a study, college students had limited knowledge about premenstrual disorder since the majority of students with PMS and PMDD did not consider their symptoms to be abnormal (21). However, 77% of this study population, which is way more than half, claimed that they were aware of the term 'Premenstrual Syndrome (PMS)' before the study, indicating a high level of awareness among the educated female participants. 38% of participants faced premenstrual syndrome one week before their period. A research article about Premenstrual Syndrome and its prevalence, severity, and impact on the daily life of students demonstrated that fewer than half of the students suffer from mild PMS physical symptoms (22). Furthermore, around one-third of them exhibited mild PMS psychological and behavioral symptoms. More than one-third of the research participants experienced mild overall PMS symptoms, whereas more than a quarter had moderate PMS symptoms. Only 5.8% of them suffer from severe PMS symptoms. Our present study has shown a similarity with that. We can see from our study that 42% of the participants felt the physical symptoms of PMS moderately. On the other hand, psychological and behavioral symptoms were felt somewhat by 43% of participants.
Table 2
Data and information regarding menstruation & PMS
Elements | Sample Number (n) | Percentage (%) |
Total | 366 | 100 |
Age of first menstruation/period (Menarche) Age of your first menstruation/period (Menarche)? Age of your first menstruation/period (Menarche)? |
< 9 years | 5 | 1.37 |
9 years | 6 | 1.64 |
10 years | 18 | 4.92 |
11 years | 63 | 17.21 |
12 years | 118 | 32.24 |
13 years | 85 | 23.22 |
14 years | 48 | 13.11 |
15 years | 19 | 5.19 |
> 15 years | 4 | 1.09 |
Duration of your menstrual bleeding Duration of your menstrual bleeding |
1–2 days | 12 | 3.28 |
3–4 days | 134 | 36.61 |
5–6 days | 158 | 43.17 |
7–8 days | 48 | 13.11 |
> 8 days | 14 | 3.83 |
Menstrual cycle length |
21–35 days | 270 | 73.77 |
35–90 days | 51 | 13.93 |
< 21 days | 32 | 8.74 |
> 90 days | 13 | 3.55 |
Being aware of the term ‘Premenstrual Syndrome (PMS)’ |
Yes | 282 | 77.05 |
No | 31 | 8.47 |
Maybe | 53 | 14.48 |
How long before period do PMS start |
1 week before period | 140 | 38.25 |
2 weeks before period | 32 | 8.74 |
4–5 days before period | 119 | 32.51 |
2–3 days before period | 65 | 17.76 |
Other | 10 | 2.73 |
Degree of feeling the Physical symptoms of PMS |
Mild | 129 | 35.25 |
Moderate | 152 | 41.53 |
Severe | 63 | 17.21 |
No | 22 | 6.01 |
Degree of feeling the Psychological & Behavioral symptoms of PMS |
Mild | 97 | 26.50 |
Moderate | 159 | 43.44 |
Severe | 86 | 23.50 |
No | 24 | 6.56 |
PMS Physical Symptoms |
Swollen or tender breasts | 96 | 26.23 |
Headache or backache | 219 | 59.84 |
Constipation or diarrhea | 81 | 22.13 |
Bloating or a gassy feeling | 124 | 33.88 |
Cramping | 259 | 70.77 |
Pimples/Acne | 193 | 52.73 |
Hunger | 124 | 33.88 |
Other | 16 | 4.37 |
PMS Psychological & Behavioral Symptoms |
Feeling tired | 259 | 70.77 |
Sleep problems (sleeping too much or too little) | 203 | 55.46 |
Trouble with concentration or memory | 156 | 42.62 |
Irritability or hostile behavior | 189 | 51.64 |
Depression, feelings of sadness, or crying spells | 228 | 62.30 |
Mood swings | 293 | 80.05 |
Tension or anxiety | 185 | 50.55 |
Angry outbursts | 208 | 56.83 |
Others | 1 | 0.27 |
PMS is making several other health issues worse |
Yes | 109 | 29.78 |
No | 156 | 42.62 |
Maybe | 101 | 27.60 |
Health problems that worsen due to PMS |
Asthma | 22 | 6.011 |
Allergies | 53 | 14.481 |
Migraine | 108 | 29.508 |
Not prefer to Answer | 213 | 58.197 |
Other | 14 | 3.825 |
Home Remedy/Treatment during PMS |
Avoid rich food | 92 | 25.14 |
Avoid excessive salt, caffeine, and alcohol | 104 | 28.42 |
Exercise | 78 | 21.31 |
Get enough sleep | 248 | 67.76 |
Track your moods and symptoms in a journal | 55 | 15.03 |
Others | 21 | 5.74 |
Medicines that have been taken during PMS |
Pain killer | 196 | 53.55 |
Medicine for acidity/gastric | 100 | 27.32 |
Anti-vomiting | 17 | 4.64 |
Anti-depressant | 24 | 6.56 |
Vitamin, Mineral, or other supplements | 73 | 19.95 |
Birth control or oral contraceptive pills | 7 | 1.91 |
Others | 17 | 4.64 |
From whom help is gotten most of the time during PMS |
Mother | 223 | 60.93 |
Friends | 101 | 27.60 |
Teacher | 3 | 0.82 |
Siblings | 77 | 21.04 |
Other family members | 33 | 9.02 |
None | 92 | 25.14 |
Others | 5 | 1.37 |
Knowledge about the impact of food on menstruation |
Yes | 162 | 44.26 |
No | 145 | 39.62 |
Maybe | 59 | 16.12 |
Visiting a doctor, clinician, or any hospital for the PMS problem |
Yes | 99 | 27.05 |
No | 267 | 72.95 |
Participation in social awareness activity regarding Premenstrual Syndrome (PMS) |
Yes | 41 | 11.20 |
No | 95 | 25.96 |
Have seen but never taken part | 46 | 12.57 |
A study showed that, In PMS patients, the most common physical symptom was abdominal bloating, which was experienced by 89.5% of the students, while the most common emotional symptom was irritation (88.3%). According to et al., breast tenderness was the most common physical issue, affecting 35.5% of Nigerian university students. In a survey of Lebanese medical students, breast tenderness was the most common symptom, with a rate of 65%, followed by abdominal bloating and headache (23). However, in this present study, we can see from Fig. 1 that the most frequent physical symptoms were cramping (219 responses), and the second most chosen symptom was headache or backache; 219 people chose it. Also, mood swings (293) were the most frequent psychological and behavioral symptoms, according to the data from Fig. 2. According to research, PMS was found to be substantially correlated with a variety of educational issues, including lack of concentration, lack of ambition, poor individual or group task performance, and low test scores (3). Another study showed that, among university students, mood states (dysphoria) showed a substantial negative connection with academic achievement. As a result, their academic performance is more likely to decline (24). A study about "The effect of PMS symptoms on daily life activities Korean women" stated that the more severe the woman's PMS symptoms were, the more unfavorable her influence on everyday life activities was. Furthermore, somatic symptoms had the most significant impact on basic life activities (25). Similarly, we can see in this study that 241 respondents (65.85%), which means more than half of the students face a lack of concentration on educational activities due to premenstrual syndrome (PMS). As the majority of the participants faced a lack of concentration on education, their academic performance was also affected. One hundred forty of them claimed that their academic performance was affected mildly due to PMS. More than half of the population (59.56%) claimed that they face difficulties in working and other activities due to PMS. Their relationship with others (30.87%) and their social activities (31.42%) were affected mildly. More than one-third of the population claimed that PMS does not make several health issues worse, while some participants thought that it does make them worse (101 participants), and the rest of them (109 participants) were unsure about it, and these two numbers were quite close. Here, migraine was the most common (108 responses ) health issue, while there were some other issues pointed out by them, such as Asthma (22 responses), allergies (53 reactions), etc., that also get worse. However, a majority of participants preferred not to answer this question.
To alleviate PMS symptoms, several home remedies/treatments were taken by the participants, which are demonstrated in Fig. 3. The majority of them (248 participants) got adequate sleep. One hundred four participants avoided rich foods, caffeine, and alcohol during PMS. To treat PMS symptoms, Painkillers were taken by 196 respondents to treat cramping, headache, and backache. Some other drugs like Medicine for acidity/gastric (100 participants), Vitamins, Mineral or other supplements (73 participants), Anti-vomiting (17 participants), anti-depressants (24 participants), etc. were also taken by them during PMS according to Fig. 4. The majority of the participants (223 participants) sought help from their mothers during PMS. 44% of students had an idea about how their food habits can impact their menstrual health, while almost a similar number of participants (40%) didn’t have any idea about that. Many studies showed that foods like dairy products, caffeine, rich foods, etc., can worsen the symptoms of PMS. That is why we saw that 104 participants avoided these kinds of foods during PMS. From Table 2, it was found that more than half of the participants, 73% (267 participants), had never visited a doctor, clinician, or any hospital for the PMS problem. However, we have found that they take several kinds of medicines. Therefore, it can be self-medication, which is quite highly prevalent in Bangladesh, according to a recent study (26). So, there is definitely some unawareness present among the majority of these people. Most of them (52%) said that they had never participated in or seen any social awareness program like seminars, discussions, or even any online activity about Premenstrual Syndrome (PMS).
Table 3
Association of PMS on Educational Activities & Regular Life of Students
Elements | Sample Number (n) | Percentage (%) |
Lack of concentration on Educational Activities |
Yes | 241 | 65.85 |
No | 44 | 12.02 |
Maybe | 81 | 22.13 |
Effects of PMS on Academic Performance |
Mild | 140 | 38.25 |
Moderate | 113 | 30.87 |
Severe | 38 | 10.38 |
No | 75 | 20.49 |
Difficulties in working & other activities due to PMS |
Yes | 218 | 59.56 |
No | 81 | 22.13 |
Maybe | 67 | 18.31 |
Effects of PMS on relationship with others |
Mild | 113 | 30.87 |
Moderate | 97 | 26.50 |
Severe | 51 | 13.93 |
No | 105 | 28.69 |
Effects of PMS on Social Activities |
Mild | 115 | 31.42 |
Moderate | 106 | 28.96 |
Severe | 42 | 11.48 |
No | 103 | 28.14 |
The impact of PMS on education and the regular lives of students is detailed in Table 3. From the table mentioned above, we can see that students were asked if they faced a lack of concentration on ‘Educational Activities’ due to Premenstrual Syndrome (PMS). Among 366 respondents, 241 students (65.85%) reported a lack of concentration on their education due to PMS. Only 44 students (12.02%) stated that they did not face a lack of concentration due to PMS. On the other hand, 81 students (22.13%) were not sure if they faced a lack of concentration on educational activities due to PMS. A study which was done in Jordan demonstrated that PMS and premenstrual dysphoric disorder (PMDD) symptoms have a severe impact on the academic performance of female students (24). In our study, the students were asked if PMS had any effect on their ‘Academic Performance.’ Out of 366 respondents, 140 respondents (38.25%) reported that they had ‘Mild’ PMS effects on their academic performance. Consequently, 113 (30.87%) students responded that they had ‘Moderate’ effects of PMS on their academic performance. Only 38 students (10.38%) had severe effects, and 75 students (20.49%) reported that PMS did not interfere with their academic performance. According to the findings of a study conducted at Foundation University Medical College, Islamabad, Premenstrual Syndrome was identified in the majority of the students, and the majority of students agreed that it had an impact on academic achievement (27). Next, we can see in Table 3 that the participants were asked if they had faced any difficulties in working and other activities due to PMS. A majority of the participants, 218 of them, answered affirmatively (59.56%). Hence, 81 participants (22.13%) did not face any difficulties in working and other activities due to PMS, and 67 participants (18.31%) were not sure if they encountered any difficulties due to PMS. A previous study also showed that the impact of PMS symptoms on women's workdays and their productivity is a serious problem (28). According to Table 3, the students were then asked about the effects of PMS on relationships with others. One hundred fifteen participants (31.42%) out of 366 reported that PMS mildly affects their relationships with others. Then, 97 participants (26.50%) stated that they had moderate effects, 51 participants said severe effects, and 105 participants (28.69%) reported having no effects of PMS on their relationships with others. Another relevant study showed that PMS symptoms had a negative impact on female students’ academic performance and mental well-being, and there was also a significant reduction in work productivity and social life functioning (29). Furthermore, in Table 3, we can see that students were asked if they had faced any effects of PMS on their Social Activities. Only 103 participants (28%) reported no effects on their social activities due to PMS. While 115 participants (31.42%) reported mild, 106 participants (28.96%) reported moderate, and 42 participants (11.48%) reported severe effects of PMS on their social life activities.
However, this study also has some limitations, which put forward some questions for future researchers in this field. As we have seen here, the majority of our participants (73%) had never visited a doctor, clinician, or any hospital for the PMS problem. However, we have found that they take several kinds of medicines. Therefore, it can be self-medication practice which is highly prevalent in Bangladesh (26), and more rigorous studies are needed to asses it’s limits, benefits, and risks in terms of PMS. In addition to that, since the participants self-reported their symptoms and information via the questionnaire, we cannot ultimately ensure we gathered all the relevant data without any erroneous response. Although it is challenging to remove it in questionnaire-based studies, this kind of bias can affect some of the findings. The findings of this study are limited in their generalizability due to the small sample size and short time frame. To further understand this issue, future research should focus on both urban and rural areas and include patients as much as feasible.