Magnitude of premenstrual dysphoric disorder and its correlation with academic performance among female medical and health science students at University of Gondar, Ethiopia, 2019: a cross-sectional study

Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia

Background

Premenstrual dysphoric disorder (PMDD) is the most prevalent but neglected psychiatric disorder, with somatic symptoms that are severe enough to markedly affect usual daily activities and have a negative impact on mental health and quality of life by affecting female patients' behavior and cognition. Studies regarding premenstrual dysphoric disorder and associated factors among high school students in low- and middle-income countries are limited. Therefore, the aim of this study was to assess the prevalence and associated factors of PMDD among high school students, and this is pivotal in further investigation.

Methods

A school-based cross-sectional study was conducted from March 25 to April 17, 2023 using a simple random-sampling technique to select a sample of 564 participants. Premenstrual dysphoric disorder was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Self-administered standardized questionnaires were used to collect data.

Result

A total of 548 study participants participated, with a 97.2% response rate. The prevalence of premenstrual dysphoric disorder among high school students was found to be 33.03% (95%CI: 29.20-37.09). In a multivariable analysis, irregular menstruation cycle (AOR = 4.242, 95%CI = 2.182-8.246), depression (AOR = 5.272, 95%CI = 2.779-10.002), having greater than 4 days of menstruation bleeding duration (AOR = 2.138, 95%CI = 1.105-4.138), and high perceived stress (AOR = 3.468, 95%CL = 1.217-9.880) were the factors significantly associated with premenstrual dysphoric disorder.

Conclusion

The overall prevalence of PMDD which was one-third among high school students was high. Moreover, long duration of menstruation bleeding, depressive symptoms, irregular menstruation cycle, and high perceived stress were significant factors in PMDD. Therefore, it needs early screening and intervention in primary healthcare settings, especially for those who have high perceived stress, having depression, having a long duration of menstruation bleeding, and having an irregular menstruation cycle, so as to have good academic achievement and psychological wellbeing.

Burden of irregular menstrual cycle and its predictors among reproductive-age women in Ethiopia: Systematic review and meta-analysis

Introduction

Irregular menstrual cycle has negative health and psychosocial repercussions for women of reproductive age worldwide. However, there is no national data for policymakers and health planners in Ethiopia. Therefore, this review aimed to determine the overall burden of irregular menstrual cycle and predictors among reproductive-age women in Ethiopia.

Methods

International databases (SCOPUS, CINAHL, CAB Abstract, EMBASE, PubMed, Web of Science, Google, and Google Scholar) and lists of references were employed to search literature in Ethiopia. The random-effects model was used to calculate the odds ratios of the outcome variable using STATA version 18. The heterogeneity of the studies was measured by computing I 2 and p-values. In addition, sensitivity analysis and funnel plots were performed to test the stability of pooled data in the presence of outliers and publication bias.

Results

The review includes 21 studies and 9109 populations. The overall burden of irregular menstrual cycles among reproductive-age women was 35% (95% CI: 30-41) with I 2 = 96.96%. Sleeping for <5 h a day (AOR: 2.49; 95% CI: 1.49-3.49) and a stressful life (AOR: 3.15; 95% CI: 1.44-4.85) were predictors of irregular menstrual cycles.

Conclusion

More than one in every three reproductive-age women in Ethiopia experience irregular menstrual cycles. Sleeping for <5 h a day and stress increase the likelihood of an irregular menstrual cycle, which can be modified by improving sleeping hours and decreasing stress stimulators through psychotherapy.

Determinants of premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University Southern, Ethiopia, 2023: institution-based cross-sectional study

BACKGROUND

Premenstrual dysphoric disorder (PMDD) is a condition causing severe emotional, physical, and behavioral symptoms before menstruation. It greatly hinders daily activities, affecting academic and interpersonal relationships. Attention is not given to premenstrual disorders among female students in higher education. As a result, students are susceptible to stress, and their academic success is influenced by various factors, including their menstrual cycle, and the long-term outcomes and consequences are poorly researched. Even though PMDD has a significant negative impact on student's academic achievement and success limited research has been conducted in low- and middle-income countries including Ethiopia, especially in the study setting. Therefore, a study is needed to assess premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University.

METHODS

An institutional-based cross-sectional study was conducted among 374 regular undergraduate female students at Hawassa University, College of Medicine and Health Sciences. A self-administered structured premenstrual symptoms screening tool for adolescents was used to assess premenstrual dysphoric disorder. The collected data were loaded into a statistical package for the social science version 25 and analyzed using it. Both bivariate and multivariate logistic regression were used to identify factors associated with premenstrual dysphoric disorder. Each independent variable was entered separately into bivariate analysis, and a variable with a p-value less than 0.25 were included in the multivariate analysis to adjust the possible confounders. Statistically significant was declared at a 95% confidence interval when variable with a p-value less than 0.05 in the multivariate analysis with premenstrual dysphoric disorder.

RESULTS

The magnitude of premenstrual dysphoric disorder in this study was 62.6% (95% CI 57.4-67.5). Having severe premenstrual pain (AOR = 6.44;95%CI 1.02-40.73), having irregular menstrual cycle (AOR = 2.21; 95% CI 1.32-3.70), students who had poor social support (AOR = 5.10;95%CI, (2.76-12.92) and moderate social support (AOR = 4.93;95%CI (2.18-11.18), and students who used contraception (AOR = 3.76;95%CI, 2.21-6,40) were statistically significant factors with the outcome variable.

CONCLUSION

The prevalence of premenstrual dysphoric disorder was high as compared to other studies. There was a strong link between irregular menstrual cycle, severe menstrual pain (severe dysmenorrhea), poor social support, and contraception use with premenstrual dysphoric disorder. This needs early screening and intervention to prevent the complications and worsening of the symptoms that affect students' academic performance by the institution.

Prevalence of premenstrual syndrome and its associated factors in Africa: a systematic review and meta-analysis

Background

Clinical research and epidemiological studies have shown that many women experience physical and behavioral symptoms that begin during the luteal phase of the menstrual cycle and terminate around the onset of menses; this is called premenstrual syndrome. The reviews stated that the pooled prevalence of premenstrual syndrome was around 50 percent. However, there has been no review done on premenstrual syndrome in Africa. Therefore, the aim of this systematic review and meta-analysis was to summarize the most recent data evidence on the pooled prevalence of premenstrual syndrome and its pooled effect of associated factors in Africa.

Method

We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023414021). The publications were identified from PubMed/Medline, EMBASE, Scopus databases, and other grey searches. The included papers were the original data that reported the prevalence of premenstrual syndrome and associated factors published, in English, and papers available online from January 1, 2000, to May 30, 2023. The data was extracted in Microsoft Excel, and then it would be imported into STATA 11.0 for analysis.

Results

We have included 16 studies conducted in African countries with 6530 study participants. In this meta-analysis, the pooled prevalence of premenstrual syndrome among the reproductive-age participants in Africa was 46.98 (95% CI: 28.9-65.06%). Further, in subgroup analysis, the pooled prevalence of premenstrual syndrome was 57.32% in Nigeria, 43.8% in Ethiopia, and 38.6% among university students and 66.04% among secondary school students. Among associated factors, the early age of menarche was significantly related to premenstrual syndrome.

Conclusion

In this review, the pooled prevalence of premenstrual syndrome in Africa was high. Among factors, the early age of menarche was a risk factor for premenstrual syndrome. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address prevention, early screening, and management of PMS among reproductive-age women, and to give attention to more vulnerable bodies.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023414021.

Mood Swing during Menstruation: Confounding Factors and Drug Use

Background

Premenstrual syndrome (PMS) is a physiologic process in women where mood swing is one of the symptoms influencing the psycho-emotional, physical, and behavioral reactions exhibited by women during menstruation. This study elucidates the effect of mood swing, confounding factors and healthcare-seeking behaviors of women in an educational environment.

Methods

Exactly 328 women who were within reproductive ages 16 and 35 years participated in this study. A survey method was adopted; validated and standardized questionnaires were administered to confidentially assess the effect of mood swing via PMS. All data were analyzed with SPSS 25.0; descriptive method was adopted and results were expressed in percentages.

Results

Mood swing was discovered as a symptom overlapping with psycho-emotional, physical, and behavioral symptoms during menstruation. The overall PMS prevalence was 67.4% while PMDD prevalence was 25.6%. Psycho-emotional symptoms: anger, irritability, depression. Physical symptoms: coldness, paleness, food craving, breast tenderness, digestive changes. Behavioral symptoms: social withdrawal, nocturnal social activity, absenteeism, poor work or academic performance, increased libido. Confounding factors include stress, gynecological conditions such as endometriosis, uterine fibroid, ovarian cyst, pelvic adhesion, and polycystic ovarian syndrome. Also, 22.9% had a family history of bipolar disorder (BD) while 30.2% had previous diagnosis. Severe pain was a major factor for seeking treatment; Paracetamol, and Piroxicam were frequently used drugs.

Conclusions

Severe PMS triggers mood swing and can badly affect academic or work activities; victims either endure the pain due to socio-cultural and financial factors or take unsuitable medications where abuse is inevitable.

Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis

Background

The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing.

Objective

The impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms.

Methods

A database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included “menstrual disturbances” and “medical students,” “prevalence” OR “symptoms” of “Premenstrual syndrome” OR “Premenstrual dysphoric disorder” OR “Dysmenorrhea” in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS).

Results

Initially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms.

Conclusions

The current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.

Effect of Foot Reflexology Protocol on Premenstrual Syndrome Symptoms in Nursing Students: a Pre-Post Pilot Study

Background:

Premenstrual syndrome is a highly prevalent cyclical disorder among women of childbearing age which interferes with daily activities, mood, and quality of life.

Purpose:

To evaluate the effects of a foot reflexology protocol on relieving premenstrual syndrome symptoms in nursing students.

Setting:

Nursing School, São Paulo University, Brazil.

Participants:

A convenience sample of 17 nursing students, diagnosed with moderate-to-severe premenstrual syndrome as assessed by the Premenstrual Symptoms Screening Tool (PSST).

Research design:

A pre–post pilot intervention study.

Intervention:

The intervention consisted of eight reflexology sessions lasting 30 minutes for eight weeks.

Main Outcome Measure:

Evaluation of the participants by the PSST applied at the beginning and at the end of the study.

Results:

The participants had an average age of 21.7 (±2.6) years, ranging from 19 to 28 years; all were single, and most were in the third year of the course (58.8%); 75.6% lived with their family; 82.4% do not use contraceptives; 64.7% reported regular menstrual flow with an average duration of 5.1 (±1.1) days, and an average menstrual cycle interval of 29.3 (±4.9) days. The intervention significantly reduced the premenstrual symptoms assessed by the PSST (p<.017) with a pre–post difference of 10.2 points in the overall score, and the items score decreased between 1.2 to 3.4 for difficulty concentrating, insomnia, hypersomnia, feeling overwhelmed, muscle/ joint pain, bloating, weight gain; and between 3.5 to 5.2 to anger/irritability, anxiety/ tension, tearful, depressed mood, decreased interest in daily activities, fatigue, overeating, and breast tenderness. There was a significant decrease regarding the functional impact of premenstrual symptoms domain in the overall score with a pre–post difference of 10.7, and between 1.7 and 3.0 for all of the items (p<.04), except for the item “your home responsibilities”.

Conclusion:

Foot reflexology has shown promising results in reducing premenstrual syndrome symptoms.