A Study on the prevalence of Pre-menstrual

syndrome and its impact on teenage girls between 16

and 19 years in Visakhapatnam District
[1] Kodukula Venkata Lakshmi Prudhvila
[1] Andhra University
[1] prudhvilakodukula99@gmail.com

Abstract: Pre-menstrual syndrome as a psychosomatic problem is faced by every reproductive woman in the late luteal phase of the
menstrual cycle. Menstruation is a cyclic process that includes physiological, psychological, and behavioral changes in females that
affect their daily living. The objective of the research is to measure the severity and prevalence of Pre-menstrual syndrome in
reproductive females grouped under two categories 16-17 and 18-19 years in the Visakhapatnam District. There are 250 samples
collected using the purposive sampling method. The tool used for data collection was the Pre-Menstrual Syndrome Scale (PMSS). There
are two types of analysis used one is Descriptive Statistics and the other is Inferential Statistics. One-way ANOVA and Karl Pearson’s
Correlation
Coefficient techniques are used. Results show that the age category of 16-17 has more PMS problems, Intermediate students have more
PMS problems and urban respondents have more PMS problems because of the awareness and acknowledgement of the problem by
showing concern towards the female by their family members. There is a significant relationship among factors of PMS.
Key Words: Follicular Stimulation Hormone, Menstrual Phase, Pre-menstrual syndrome, pre-menstrual Dysphoric Disorder

INTRODUCTION
Pre-menstrual syndrome is a psychosomatic problem that than necessary to dislodge its lining. Treatment options
is manifested in females during the late luteal phase of the include pain-relieving medication and the oral
menstrual cycle. The characteristics of Pre-menstrual contraceptive pill. Heavy Menstrual Bleeding-(previously
syndrome are experienced in almost all women in the known as menorrhagia) – if left untreated, this can cause
reproductive phase. The menstrual cycle is a complex anemia. Treatment options include oral contraceptives and
phenomenon that occurs in reproductive females which is a hormonal intrauterine device (IUD) to regulate the flow.
controlled by glands and hormones that these hormones Amenorrhea– or absence of menstrual periods. This is
produce. The main four phases of the menstrual cycle are considered abnormal, except during pre-puberty,
namely 1. Menstruation 2. The follicular phase 3. pregnancy, lactation, and post-menopause. Possible causes
Ovulation 4. Luteal phase. Menstruation is the process of include low or high body weight and excessive exercise.
eliminating menstrual fluid which contains blood and The physical and psychological symptoms of
mucous from the uterus through the vagina. The length of Premenstrual Syndrome are: Physical Symptoms include
this period is usually between three days and one week. Headache, Bloating, Uterine cramps, Disturbed sleep
The follicular phase starts from day one of menstruation. schedule, Hunger pangs, Abdominal pain, Joint pain,
Follicular Stimulating Hormone (FSH) from the pituitary Acne, Breast tenderness, Changes in appetite, back pain,
gland is released to produce follicles that later become an Weight gain. The Behavioral symptoms include
egg that facilitates pregnancy. the third stage ovulation is irritability, Tension, Depressed mood, Mood swings,
the process of releasing an egg from the ovary. Ovulation Tearfulness, Anxiety, Anger, Fatigue, and Restlessness.
is a crucial process that occurs mid-cycle or two weeks The severity of symptoms leads to Pre-Menstrual
before menstruation begins. “Fertile window”, the Dysphoric Disorder (PMDD). PMDD is listed in the
probability of getting pregnant can be known by keeping DSM-IV as a "depressive disorder not otherwise
track of ovulation during the menstrual cycle. The luteal specified." The symptoms of PMDD are remarkably
phase is of utmost importance where the levels of similar to those of Major Depressive Disorder (MDD).
progesterone along with small amounts of estrogen PMDD symptoms include Markedly depressed mood. A
increase to facilitate pregnancy. if sperm cells are not symptom of MDD is depressed mood most of the day,
fused with the egg, the corpus luteum withers and dies nearly every day. Decreased interest in usual activities.
which results in a drop in progesterone hormone. This is One criterion for MDD is markedly diminished interest or
the final stage and critical period during the menstrual pleasure in all activities. Lethargy, fatigability, or lack of
cycle. PMS– hormonal events before a period can trigger energy. Similarly, patients with MDD have fatigue or loss
a range of side effects in women at risk, including fluid of energy. Hypersomnia or insomnia are also symptoms of
retention, headaches, fatigue, and irritability. Treatment MDD. The difference between PMDD and MDD is that
options include exercise and dietary changes. Dys- PMDD symptoms are cyclical, subsiding with the onset of
menorrhoea– or painful periods. It is thought that the menses, points out Endicott. The DSM-IV also notes that
uterus is prompted by certain hormones to squeeze harder some mood disorders, somatoform disorders, personality
disorders, and general medical conditions, such as thyroid change during every period. The hormonal fluctuation
and other endocrine disorders, migraine, anemia, or disappears with pregnancy and also during menopause.
various infections can be exacerbated during the The second reason is due to the chemical imbalances in
premenstrual phase. the brain. Pre-menstrual syndrome influences the
action of progesterone on neurotransmitters like GABA,
ETIOLOGY: opioids, serotonin, and catecholamines. Neurotransmitters
are chemical messengers in our brain that regulate bodily
The etiology of Pre-menstrual syndrome is uncertain yet
functions in turn decrease serotonin levels as a mood
several factors determine its severity. These include:
regulator and increased progesterone levels are one of the
Hypothalamic-pituitary ovary axis: The hypothalamus in notable reasons for the cause of Pre-Menstrual Syndrome.
our brain plays a key role in the secretion of (GnRH)
Similar to Pre-Menstrual Syndrome, there are clinical
Gonadotrophic Releasing Hormone which in turn
conditions that are psychiatric like Substance Abuse
activates and secretes Follicular Stimulating Hormone
Disorder, Anorexia, Bulimia, Depression, Anxiety, Panic,
(FSH) and Luteinizing Hormone (LH) from gonadotroph
Anemia, and gynecological conditions like endometriosis,
cell in the anterior pituitary gland.
and hypothyroidism. Hence, we must ensure that the
Luteinizing Hormone (LH) helps in the production of physical and psychiatric condition are aligned with the
estradiol by ovaries. The role of estradiol is for the symptoms of Pre-Menstrual Syndrome, which occurs only
development of the breast and accelerates growth and during the luteal phase of the menstrual cycle and which
skeletal maturation. Follicular Stimulating Hormone shows a negative impact on the person’s daily activities.
(FSH) on the other hand activates ovarian follicles and This is known as the effect on a person’s psychological
fluctuation in the Hypothalamic Pituitary Ovary Axis well-being. Psychological well-being is when you’re
results in the development of Pre-Menstrual Syndrome. mentally healthy and feel positive overall about your life.
Due to the increased concentration of estradiol, which As more awareness and education are brought into the
sensitizes the pituitary GnRH, a burst of Follicular public conversation about mental health and taking care of
Stimulating Hormone (FSH) and Luteinizing Hormone is yourself, it’s important to understand the role
seen clearly which is a positive- feedback mechanism. psychological well-being plays in your overall health.
This mechanism causes menstruation to be cyclical in People who prioritize their psychological well-being have
females. Gonadotropin, which is released by (GnRH) been shown to have decreased physical health risks, rate
secretion is inhibited by prolactin and progesterone along their happiness higher, and tend to have more meaningful
with estradiol. This effort is seen in the luteal phase of the relationships in life.
menstrual cycle. Since mood and behavioral symptoms
Psychological well-being carries a lot of weight because it
are key features of PMS, underlying mechanisms must
impacts your overall life happiness and contentment.
involve the brain. Indeed, sex steroids easily pass the
Achieving that level of well-being means you are content
blood-brain barrier, and sex steroid receptors are abundant
with your life and have a positive outlook on both yourself
in many brain regions that regulate emotions and
and your overall situation. In addition, psychological well-
behavior, including the amygdala and the hypothalamus.
being has been tied to better physical health. A positive
The brain neurotransmitter serotonin is implicated in the
mindset has been linked to a decrease in cardiovascular
regulation of mood and behavior, partly because of
disorders or complications. This is likely due to a desire to
observations made in preclinical studies, and partly
take care of yourself if you have higher levels of
because of the antidepressant and anxiety-reducing effects
psychological wellness. Another benefit of psychological
exerted by serotonin-facilitating drugs in human beings.
well-being is a better social life. If you are content with
This notion has also gained support from genetic studies
your life and feel good about yourself, you’re more likely
and brain imaging experiments.
to engage in social activities with others and seek people
Brain Serotonergic synapses: out for companionship.

Pre-menstrual syndrome is widely known for its hormonal This benefit is also two-fold, as having close relationships
fluctuations in the menstrual cycle. Due to low levels of has been found
serotonin, the neurotransmitter and estrogen that fluctuate
to improve mental health and contribute to better
during the luteal phase are responsible for the changes in
psychological well-being. Also, Pre-Menstrual Syndrome
mood in women. The decreased estrogen causes the
is seen in women who live in a stressful condition whose
hypothalamus to release norepinephrine which in turn
family is detected with a history of depression or seen in a
decreases acetylcholine, dopamine, and serotonin leading
person who experienced Postpartum Depression (PPD).
to insomnia, fatigue, headache, mood swings, and
depression which are common for both Pre- Menstrual
Syndrome and Pre-Menstrual Dysphoric Disorder. Signs
and symptoms of Pre-Menstrual Syndrome change in
every individual depending upon their cyclic hormonal
 The sample consisted of 250 female teenagers as subjects.
The samples were collected using the purposive sampling
method on selective females between the ages of 16 and
19 divided into two categories. The study was carried out
OBJECTIVES
in public and private colleges in the Visakhapatnam
1. To find out the severity of Pre-menstrual district.
symptoms in teenage girls
PROCEDURE:
2. To find out the significant difference in
The samples consisted of 250 teenage girls who were
demographical variables concerning factors
categorized into 16-17 years and 18-19 years. The samples
associated with Pre-menstrual Syndrome
were collected using the purposive sampling method. The
3. To find out the relationship between the factors study was conducted in the urban areas of Visakhapatnam
related to Pre-menstrual syndrome district. Information about the study was gathered on the
symptoms related to Pre-menstrual syndrome on the
SAMPLE: subjects on a specially designed semi-structured socio-
demographic and clinical data sheet. The subjects were

menstrual Syndrome Scale (PMSS) to assess the severity from 1 (not present or no change from usual) to 5
of Pre-menstrual syndrome. (extreme change, perhaps noticeable even to casual
acquaintances) Based on the percentage of scores the
STATISTICAL ANALYSIS: levels of premenstrual symptoms graded into four
categories. They are “No symptoms”, “Mild”, “Moderate”
The main objective of the study was to conduct the
“severe” and very severe symptoms. Mild Symptoms -
prevalence and severity of Pre-menstrual syndrome in
only slightly apparent
teenage girls and find out the severity and symptoms
associated with Pre-menstrual Syndrome in the selected determining the emotional intelligence by giving a score
samples. There are two types of statistical analysis used of 5 for always, 4 for most often, 3 for occasionally, 2 for
which are: rarely, and 1 for never and reverse in case of negatively
worded statements. In this way, the expected score may
1. Karl Pearson’s Correlation Coefficient Technique range from 60-300 with a high score showing severe
Premenstrual Syndrome and a low score showing mild
Premenstrual Syndrome determining emotional
2. One Way (ANOVA) Analysis of Variance.
intelligence by giving a score of 5 for always, 4 for most
SCORING: often, 3 for occasionally, 2 for rarely and 1 for never and
reverse in case of negatively worded statements. In this
The pre-menstrual Syndrome Scale consists of nine way, the expected score may range from 60-300 with a
subscales and 44 items and ranks from 1-5, as 1 = “never,”
high score showing severe Pre-menstrual Syndrome and a
2 = “rarely,” 3 = “sometimes,” 4 = “very often,” and 5 =
low score showing mild Pre-menstrual Syndrome.
“always”/ extreme changes. The lowest score is 44, and
220 is the highest. If the score (> 132) it will be Table 1: Frequency Distribution of Respondents of various
considered positive PMS, and as the score gets higher then categories
it indicates greater severity of symptoms during PMS. The
The premenstrual Syndrome Scale consists of 44 items
Variables Category Frequency Percentage
and has nine sub-dimensions: depressive sensation,
anxiety, fatigue, nervousness, depressive thoughts, pain, Age 16-17 98 40.83
appetite changes, sleep pattern changes, and bloating. The 18-19 142 59.17
minimum score on the scale is 44 and the highest score is College Intermediate 83 34.58
220. High scores indicate that PMS symptoms are intense.
Graduation 157 65.42
In evaluating the findings from the scale, PMS is
considered “present” if the total score exceeds 50% of the Annual <2 L 184 76.67
maximum score. For each of the symptoms of Pre- Income 2-5 L 22 9.17
menstrual syndrome, circle the number that most closely >5 L 34 14.17
describes the intensity of your premenstrual symptoms Residence Urban 168 70
during your last cycle. These are symptoms that would
occur during the premenstrual phase of your cycle. This Rural 72 30
phase begins about seven days before menstrual bleeding Type of Public 128 53.33
(or seven days before your period) and ends about the College Sector
time bleeding starts. Rate each item on this list on a scale Private 112 46.67
 Sector Null Hypothesis: There is no significant relationship
between Physiological, Psychological, and Behavioural
factors concerning Pre-menstrual syndrome.

From the above table, 40.83% of respondents are in the Table 2: Karl Pearson Correlation Coefficient between
category of 16-17 years age group and 59.17% of Physiological, Psychological, and Behavioural factors
respondents are in the category of 18-19 years age group. with respect to Pre-Menstrual Syndrome.
In this data collection, the respondents of the age group
between 18 and 19 are slightly more in number because Physiological Psychological Behavioral
this category of females are mostly aware of the
symptoms they experience during the menstrual cycle and Physiological 1.0 0.69** 0.78**
are willing to fill out the questionnaire as compared to
females of the age category between 16 and 17. From the Psychological 0.69** 1.0 0.6**
above table, 34.58% of respondents are pursuing
intermediate, and 65.42% of respondents are pursuing Behavioural 0.78** 0.6** 1.0
their graduation. In this data collection, most of the
respondents are from graduation because few respondents The Correlation Coefficient between Physiological and
of 17 years of age have already completed their high Psychological factors is
school education and enrolled in respective courses to
0.69 which indicates (0.69² = 0.47) 47 percent positive
pursue their graduation studies. From the above table,76%
relationship between psychological and physiological
of respondents have from annual income of below 2 lakhs
factors. This states that there are only a few psychological
per annum, 9% of respondents have from annual income
factors that correlate with physiological factors of
between 2 and 5 lakhs per annum, and 14% of respondents
Premenstrual syndrome. Headache, abdominal cramping,
have from annual income above 5 lakhs per annum. Most
nausea, and joint pains are the specific reasons for the
of the respondents have annual incomes below 2 lakhs per
onset of mood swings which are psychological factors
annum and hence there are almost equal numbers of
associated with physical symptoms. The Correlation
respondents who study in public and private institutions.
Coefficient between physiological and behavioral factors
The respondent family’s annual income which is below 2
is 0.78 which indicates (0.78² = 0.60) a 60 percent positive
lakh per annum mostly studied in a government sector as
relation between physiological and behavioral factors.
compared to other respondents who studied in the private
This states that there are only a few physiological factors
sector whose family’s annual income is in between 2 and
that correlate with behavioral factors of Pre-menstrual
5 and also above 5 lakhs per annum.
syndrome. Headache, body pains, nausea, and abdominal
From the above table, 70% of respondents live in urban cramping are some of the common physiological factors
areas and 30% of respondents live in rural areas. Most of of pre-menstrual syndrome which causes irritability,
the respondents are from urban areas since the survey is restlessness, tiresome, and anger in females which are
taken in urban centers, i.e., in Visakhapatnam. A few behavioral factors associated with physiological factors.
respondents are temporarily staying in hostels who have The Correlation Coefficient between psychological and
shifted from their native rural area for education, further behavioral factors is 0.6 which indicates (0.6² = 0.36) a 36
few respondents travel daily to their respective colleges percent positive relationship between physiological and
from their area. behavioral factors and the null hypothesis is accepted at a
1% significance level. This states that there are only a few
From the above table, 53% of respondents are from the psychological factors that correlate with behavioral factors
public sector and 46% are from the private sector. In this of Premenstrual syndrome. Psychological factors such as
data collection, most of the respondents are from the restlessness, mood swings, and irritability are some of the
public sector because graduates usually choose to join behavioral factors associated with Premenstrual
government colleges by writing an entrance exam for Syndrome.
which they are allotted seats based on the rank they score.
In the meantime, intermediate or high school students do Hypothesis II:
not have access to write an entrance exam though they can
join government colleges directly. Most of the respondents There is a significant difference between Age Groups
prefer to join private colleges because of the various concerning the factors associated with Pre-menstrual
courses offered by them that are based on the students’ syndrome.
interest, unlike government colleges which do not give Df Sumof Mean F Value Pr(>F)
coaching to crack further entrance exams on par with the Squares
academics. Square

Hypothesis 1:
Age 1 4735 4735 7.411 0.00696* Total 239 156771
*

Residual 238 152037 639

s Annual Mean Sd n
Total 239 156772 income
Below 2 L 95.47 24.71 190
Table 3: One Way ANOVA for significance difference
between age groups concerning the factors associated 2-5 LA 90.91 29.76 24
with Pre-menstrual syndrome. Above 5 L 97.38 28.53 26
Age Mean Sd n
Table 4: One Way ANOVA for significant difference
16-17 100.57 18.44 98 between annual income concerning the factors associated
with Pre-menstrual syndrome.
18-19 91.53 29.05 142
Hypothesis IV:

Table 5: One Way ANOVA for significant difference

There is a significant difference between the age groups
between Educational Qualification concerning the factors
concerning the factors associated with Pre-menstrual
associated with Pre-menstrual syndrome.
syndrome because the P value of the age difference
represents that there is a significant difference of less Df Sum of Mean F Value Pr(>F)
than 0.001 which denotes significance at a 1% level. F Squares Square
value is 7.41 which indicates that there is a significant Educational 1 3442 3442 5.343 0.0217*
difference between the 16-17 and 18-19 age groups. the Qualification
age category between 1617 years shows the symptoms of Residuals 238 153330 644
Pre-menstrual syndrome at a higher rate when compared
Total 239 156772
to the age category between 18-19 years. The reason here
is because, the category of females between 16 and 17
years are intermediate students who prepare for various Educational Mean Sd data n
entrance examinations like IIT, JEE, NEET, etc and due Qualification
to high pressure and stress, the females of this category Intermediate 100.43 18.10 83
experienced more symptoms associated with Pre-
menstrual Syndrome. Graduation 92.47 28.47 157
Hypothesis III: Null Hypothesis: There is a significant difference between
Null Hypothesis: There is no significant difference Educational Qualifications concerning the factors
between the Annual Income concerning the factors associated with Pre-menstrual syndrome. The F value is
associated with Pre-menstrual syndrome because the P 5.34, which is significant at 0.05 level. There is a
value is greater than 0.05 which accepts the null significant difference between Intermediate students and
hypothesis. The category of Annual income does not Graduate students concerning the factors associated with
have any significance related to the symptoms associated Premenstrual syndrome. The Education category
with Pre-menstrual syndrome. Most of the respondents Intermediate group shows the symptoms of Pre-menstrual
have annual incomes below 2 lakhs per annum and hence syndrome at a higher rate when compared to the
there are almost equal numbers of respondents who study Graduation. The reason here is intermediate students
in public and private institutions. The respondent prepare for the entrance examinations like IIT, JEE, and
family’s annual income which is below 2 lakh per annum NEET and they experience stress at a greater level for
mostly studied in the government sector as compared to their age when compared to graduates.
other respondents who studied in the private sector
whose family’s annual income is between 2 and 5 and Hypothesis V:
also above 5 lakhs per annum. Hence, we accept the null Hypothesis: There is a significant difference between
hypothesis of no significance concerning the factors Place of staying concerning the factors associated with
associated with Pre-menstrual syndrome. Premenstrual syndrome. There is a significant difference
Annual Df Sum o Mean F Value Pr(>F) between the rural and urban concerning the factors
Income
Squares f Square associated with Pre-menstrual syndrome because the P
Annual 2 578 289.2 0.439 0.645 value of the Place of staying difference represents that
income there is a significant difference of less than 0.01 level
Residuals 237 156193 659 which denotes significance at 1% level. The place of
staying of Urban areas show the symptoms of Pre-
menstrual syndrome at a higher rate when compared to The study has been carried out to assess the prevalence
Rural areas. The reason here is that the pattern of living and severity of Premenstrual Syndrome in teenage girls of
and lifestyle in urban areas is quite different which is the age category of 16-17 and 18-19 years. Having Pre-
completely contrasted in rural areas. Also, there is a huge menstrual Syndrome especially in females of reproductive
awareness of problems and remedies related to age during the late Luteal phase of the menstrual cycle is a
menstruation in urban areas while there is still a lack of painful process experienced by every female that affects
awareness on tracking the menstrual cycle, and the physiological, psychological, and behavioral processes
availability of psychological support to females in rural in daily life. In this study, the author took 250 samples of
areas and it has been an unsung problem in our society. teenage girls. The study was carried out in the urban area
Hence, we accept the hypothesis at a 1% level of of Visakhapatnam district. The samples were collected
significance difference between areal distribution using the Purposive Sampling method. Tools used for data
concerning the factors associated with Pre-menstrual collection were the Premenstrual Syndrome Scale
syndrome (PMSS). Pre-menstrual syndrome is one of the difficult
stages that every female experiences in the late luteal
Table 6: One Way ANOVA for significant difference phase of the menstrual cycle. In conclusion, it can be said
between Areal Distribution concerning the factors that during the late luteal phase of the menstrual cycle,
associated with Pre-menstrual syndrome. females of reproductive age experience Headache,
Df Sum o Mean F Value Pr(>F) Bloating, Uterine cramps, Disturbed sleep schedule,
Squares f Square Hunger pangs, Abdominal pain, etc physical symptoms
along with psychological symptoms along with behavioral
Place of 1 3741 3741 5.818 0.0166** symptoms like anxiety, restlessness, increased stress level,
staying etc,
Residuals 238 153031 643
Although not every symptom is seen in every individual,
Total 239 156772 some experience mild levels of severity, and some
experience moderate to severe levels. In the study
conducted between the categories, 16-17 and 18-19 years,
respondents of the age category between 16-17 years
Place of Mean Sd data n
reported that they have experienced high levels of
staying
symptoms associated with Pre-menstrual Syndrome.
Urban 97.80 25.33 168 Urban area participants have high PMS problems,
Rural 89.19 25.40 72 Intermediate students have high PMS problems.

LIMITATIONS OF STUDY
Hypothesis VI: Large populations having equal representation of all
categories of reproductive females should be included.
Table 7: One Way ANOVA for significant difference
between College Types concerning the factors associated Coping mechanisms, relaxing techniques, and awareness
with Pre-menstrual syndrome. of Pre-menstrual Syndrome should be suggested to reduce
the severity of the symptoms.
Df Sum o Mean F Value Pr(>F)
Squares f Square The study is limited to teenage girls studying college in
College 1 69 68.6 0.104 0.747 the Visakhapatnam district
Type
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