INTRODUCTION AND NEED FOR THE STUDY:

Premenstrual syndrome (PMS) includes array of symptoms that emerges during the reproductive cycles of the women between 15-49 years of age. Premenstrual dysphoric disorder (PMDD) is the diagnostic criteria for PMS which was given by a multidisciplinary group of experts.¹ Meta-analysis which included 17 studies reported that the PMS lowest prevalence is in France (12%) and highest in Iran (98%).²

It was identified that workplace productivity is reduced due to menstrual symptoms as 45.2% American women take days off.³

Self-report survey conducted among female employee divided them into managers and non-managers. Irritability, Mood swings, feeling depressed, bloating, weight gain, headaches and anger were reported as most commonly occurring symptoms. These symptoms were hindering the work performance 57% of the subjects, 40 % have reported feeling less motivated during the onset of symptoms. However age and the category of the workers had no effect on the severity of the symptoms and job performance.⁴

Among 150 working females in a tertiary care hospital somatic symptoms were commonly reported followed by psychological and biological symptoms. PMS were more common and statistically significant among higher educational status and nursing profession and nuclear family workers.⁵

An online UK based anonymous survey among 125 working women identified that 90% of them reported some PMS, 40% reported it to be moderate or severe intensity. Presence of severe intensity of symptoms was significantly associated with poor presenteeism, higher absenteeism, intention to reduce working. Moderate intensity of symptoms were associated with poor sense of wellbeing, poor sleep quality, higher intake of alcohol, anxiety and depression. This study recommended that employers and line managers to provide tailored support and resources for those who need it.⁶

Military service women do face female-specific challenges. In a study among 108 female officers revealed that there exists the desire for menstrual suppression during the rigorous training period. Majority (71%) disagreed that training makes periods worse/magnified PMS, however 50% agreed that stopping periods while on training is a good idea.⁷

PMS and work related quality of life (WRQoL) among Turkish nurses. The mean age was 29.5% (±7.1) years and prevalence of PMS was 38.1%. WRQoL was low among nurses with PMS when compared to nurses with no PMS (p=0.179).⁸

A large scale study among 18,645 nurses, 8216 were diagnosed with PMS and remaining without PMS. Mean age 33.50 (SD±5.89). There existed a high prevalence of dysmenorrhea (79.2%) among participants with PMS. Poor sleep quality due to fluctuation in the hormone levels and emotional instability were present in the women during the menstrual cycles. Nursing quality was affected by fatigue, drowsiness and irritability on the subsequent day when the nurse had poor sleep quality.⁹

Multicentre cross sectional study at China conducted among 289 Emergency Department nurses revealed that PMS incidence was 67.47%. Commonly occurring symptoms were tiredness (76.90%), anger (76.90%), restlessness (75.40%), snoring (69.20%). Younger age group nurses were more significantly affected than the older age group. Presence of PMS was directly associated with the work stress score and anxiety score and not associated with education level.¹⁰

MATERIALS AND METHODS:

Research Design – Non experimental and descriptive in nature. Nursing officers in the age group of 20 to 49 years working in various wards and departments were selected. Sample size 30 - non-probability convenient sampling method adopted. Data collection technique used was paper and pencil, semi structured questionnaire method. Development of tool - A review of the research literature, experts’ opinion, and the investigator’s own experience helped in the development of the instrument. Description of tool - had 4 parts. Part I consisted of items on demographic characteristics like age, religion, marital status history of illness, age of menarche, presence of dysmenorrhea and length of menses. Part II - consisted of 24 yes or no questions on psychological, behavioural and physical symptoms as per DSM IV criteria and 2 open ended questions on the duration of these symptoms and any other peculiar symptoms. Part III consisted of 6 items; the items were rated by the respondents on a three -point scale, from increased, decreased to no effects. Part IV of the tool consisted 8 yes or no items on various coping measures that are followed by women with PMS. Two open ended questions on any other specific coping method followed and the other on beneficiary effects of the method used. Content validity was obtained by giving the tool to experts in the field of Obstetrics and Gynecology, Clinical Psychologist, Statistician and Senior Nursing Officers. Pilot Study - After obtaining formal administrative permission, a pilot study was conducted in a similar setting. The tool was administered to five nursing officers for pretesting, in order to check the clarity of the items, its feasibility and practicability. The subjects chosen were similar in characteristics to those of the subjects under study. Based on their responses, some minor changes were made in the items. It was found that it took 15 – 20 mins to complete the questionnaire and the items were clear and unambiguous. Procedure for Data Collection - Formal permission was obtained from the hospital authority to conduct the study and data was collected after explaining the purpose and nature of the study personally by the researcher from the subjects by prior appointments. The subjects were assured of anonymity. Questionnaire was administered to 30 nursing officers, 30 of them responded.

Table 1-Socio-Meno-Demographic Characteristics of Nursing officers N=30

Variables	Frequency
Age (years)
20 – 29	14 (46.66)
30 – 39	10 (33.33)
40 – 49	06 (20)
Mean and SD 30.8 ±7.72
Age at menarche (Years)
<15	28 (93.33)
>15	2 (6.66)
Mean and SD 13.83 ± 1.26
Religion
Hindu	23 (76.66)
Christian	7 (23.33)
Marital status
Married	14 (46.66)
Single	16 (53.33)
Dysmenorrhea
Present	10 (33.33)
Absent	20 (66.66)
Length of Menstrual cycle (Days)
20 – 24	1 (3.33)
25 – 29	14 (46.66)
30 – 35	12 (40)
>35	3 (10)
Mean and SD 29.13 ± 3.38
Duration of Symptoms (Months)
< 1 year	2 (6.66)
1 year	4 (13.33)
> 1 year	21 (70)
Nil	3 (10)
Mean and SD 18.43 ± 9.29

Inference:

The mean age of the nursing officers was 30.8 (SD ±7.72) Mean age of Menarche was 13.83 (SD ± 1.26). Dysmenorrhea was present in 33.33% and the mean length of Menstrual cycle was 29.13 (SD ± 3.38). One or more PMS symptoms were present in 70% for more than a year’s time. (Mean and SD 18.43 ± 9.29)

Table 2 – Presence of Premenstrual symptoms as per DSM IV Criteria N=30

S No	Symptoms	Present (Freq)	Absent (Freq)
1	Feel Depressed	13	17
2	Feel Hopeless	4	26
3	Remain anxious	4	26
4	Get tensed over issues	9	21
5	Cry even for small issues	3	27
6	Become sensitive when not attended	8	22
7	Get angry over small issues	10	20
8	Get irritated on others	12	18
9	Decreased interest in work activities	10	20
10	Decreased interest in social activities	14	16
11	Increased arguments with others	1	29
12	Difficulty in concentrating on the job involved	5	25
13	Become tired soon	17	13
14	Feeling of lack of energy	17	13
15	Over eating	-	30
16	Specific food craving	3	27
17	Insomnia	4	26
18	Hypersomnia	5	25
19	Feel emotionally out of control	4	26
20	Breast tenderness/swelling	17	13
21	Headache	4	26
22	Bloating	8	22
23	Weight gain	4	26
24	Joint pain/calf muscle pain	11	19
25	Any other	1	-
26	Duration of these symptoms
	Less than 1 year	2	-
	1 year	4
	More than 1 year	21
	Nil	3

Inference:

Figure 1- Presence of PMS as per DSM IV Criteria N=30

Inference:

PMS was present in 63% of the participants as per DSM IV criteria i.e., the symptoms were present in most menstrual cycles during the past year, five (or more) of the symptoms were present for most of the time during the last week of the luteal phase, began to remit within few days after the onset of the follicular phase, and were absent in the week post menses, with at least one of the symptom being either feeling depressed, feel hopeless, remain anxious and get tensed over issues.

Table 3- PMS Interference With work and Relationship N=30

S No	Activities	Increased	Decreased	No effects
S No	Activities	Frequency (%)	Frequency (%)	Frequency (%)
1	Your work performance	1 (3.33)	6 (20)	23 (76.6)
2	Your home responsibility	-	4 (13.33)	26 (86.60)
3	Your relationship with patients and relatives	Improved	Deteriorated	27 (90)
3	Your relationship with patients and relatives	-	3 (10)	27 (90)
4	Your relationship with your co-workers	-	3 (10)	27 (90)
5	Your relationship with your family members	-	1 (3.33)	29 (96.60)

Inference:

Work performance was decreased in 6 and home responsibility decreased in 4. Relationship with relative and co-workers were deteriorated in 3 participants only.

Table 4 - Coping Measures adopted by participants N=30

S No	Coping measures	Adopted (Freq)	Not adopted (Freq)
1	Rest	22	08
2	Exercise	08	22
3	Meditation	04	26
4	Yoga	01	29
5	Dietary Supplementation Tab Calcium Tab Vit B₆	03	27
6	Taking analgesics	08	22
7	Other drugs	-	30
8	Primerose	-	30
9	Anyother Hot water bag Listening music Reading books	03 02 01	25
10	Benefits Relief	18	-
	Increased work performance	02	-
	Free from worries	01	-

Inference:

Rest as a coping measure was adopted by 22 participants, exercise and taking analgesics were adopted by 8 participants. Eighteen participants expressed that their symptoms were relieved by adopting the coping measure.

DISCUSSION:

The mean age of the nursing officers was 30.8(SD ±7.72) Mean age of Menarche was 13.83(SD±1.26). Dysmenorrhea was present in 33.33% and the mean length of Menstrual cycle was 29.13(SD±3.38), in a similar study among Turkish nurses the mean age was 29.5%(±7.1) years⁸ in another large scale study Mean age 33.50(SD±5.89).⁹

One or more PMS symptoms were present in 70% for more than a year’s time. Mean duration of symptoms was 18.43(SD±9.29). Among the Turkish nurses prevalence of PMS was 38.1%.⁸PMS was present in 63% of the participants as per DSM IV criteria i.e., the symptoms were present in most menstrual cycles during the past year, five (or more) of the symptoms were present for most of the time during the last week of the luteal phase, began to remit within few days after the onset of the follicular phase, and were absent in the week post menses, with at least one of the symptom being either feeling depressed, feel hopeless, remain anxious and get tensed over issues. A large scale study among 18,645 nurses, 8216 were diagnosed with PMS and remaining without PMS.⁹Multicentre cross sectional study at China conducted among 289 Emergency Department nurses revealed that PMS incidence was 67.47%.¹⁰

Tiresome, lack of energy, Breast tenderness/swelling, decreased interest in social activities and feeling depressed were majorly found among the participants. Anger, irritation, decreased interest work activities and Joint pain/calf muscle pain were next in line. High prevalence of dysmenorrhea (79.2%) existed among the participants with PMS. Poor sleep quality due to fluctuation in the hormone levels and emotional instability was present in the women during the menstrual cycles. Nursing quality was affected by fatigue, drowsiness and irritability on the subsequent day when the nurse had poor sleep quality.⁹Commonly occurring symptoms among emergency department nurses at China were tiredness (76.90%), anger (76.90%), restlessness (75.40%), and snoring (69.20%). Younger age group nurses were more significantly affected than the older age group.¹⁰

Work performance was decreased in 6 and home responsibility decreased in 4. Relationship with relative and co-workers were deteriorated in 3 participants only. WRQoL was low among nurses with PMS when compared to nurses with no PMS (p=0.179).⁸ Presence of PMS was directly associated with the work stress score and anxiety score and not associated with education level.¹⁰

CONCLUSION:

PMS is found to be more severe in women in their twenties and thirties and it can hit women at any time before menopause, frequently changing in its intensity and severity overtime. Since it is a cyclical problem nurses or working women should be given shift wise duties to cope up with the symptoms. Educating women on various coping measures will help them cope with it effectively.

CONFLICT OF INTEREST:

The author has no conflict of interestregarding this investigation.

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Received on 21.12.2023 Modified on 14.02.2024

Asian J. Nursing Education and Research. 2024; 14(2):141-144.

DOI: 10.52711/2349-2996.2024.00028