INTRODUCTION:

A Women in her life time under goes various changes in their body. The major change that happens is the attainment of puberty and commencement of menstruation during the adolescent period.¹

Menstruation is one of the important change that begins during adolescence and may be associated with various physical, behavioral, psychological symptoms, occurring before or during the menstrual flow.²Disturbance of menstruation is one of the common presenting symptoms of adolescents in a gynecological outpatient department. In a study done at Maharashtra by Balachander et al, 54.25% of 400 adolescent had menstrual disorders. They can be classified as amenorrhea, irregular periods, menorrhagia, dysmenorrhea and Premenstrual Syndrome (PMS).³Premenstrual syndrome is defined as cyclic appearance of one or more of many symptoms in the luteal phase of each menstrual cycle, severe enough to disturb lifestyle or work, with an entirely symptom-free period for the rest of the cycle.³

NEED AND SIGNIFICANCE OF THE STUDY:

Prevalence of premenstrual syndrome is on hike which need proper diagnosis and management to maintain the quality of life of women. According to the Journal of clinical and diagnostic research the global prevalence of premenstrual syndrome is high. Prevalence of premenstrual syndrome was 47.8%. The lowest and highest prevalence were reported in France 12% and Iran 98% respectively. According to ICD-10, 91.4% participants (n=447) had, at least, one premenstrual symptom of any given severity (mild to severe) in at least more than or equal to half of the menstrual cycles during last 12 months duration. Only forty-two participants (8.6%) reported no symptoms.⁴

Premenstrual syndrome symptoms usually become problematic in the adolescent years and decline in the climacteric. Symptoms are most severe in the late 20s to mid-30s, but women are most likely to seek treatment after the age of 30 years. An adolescent experience and undergoes remarkable dynamic anatomical, physiological and psychological changes during this phase. The result is that during this disability and hormonal depression, young women are drawn into a whirl wind of depression. Hence this vulnerable phase of life requires special attention by health care providers who can help to create awareness among young females on comprehensive measures to reduce PMS in their child bearing age. This is in turn helps to prevent the negative impact on the quality of life of young women and thus improve their efficacy, productivity, functional ability and coping skills. Creating awareness to the age group of 18-20 years will aid them to identify premenstrual syndrome early and thus manage it properly, which in turn reduces the rate of absenteeism and improve academic performance. Therefore, the investigator felt a strong need to take up this study to assess the prevalence of premenstrual syndrome and knowledge regarding premenstrual syndrome and its management among girls.

PROBLEM STATEMENT:

A study to assess the prevalence of premenstrual syndrome and knowledge regarding premenstrual syndrome and its management among girls in a selected College, Kottayam.

OBJECTIVES:

· Assess the prevalence of premenstrual syndrome among girls.

· Identify the severity of premenstrual syndrome among girls.

· Assess the knowledge regarding premenstrual syndrome and its management among girls.

· Find the association between prevalence of premenstrual syndrome and selected socio-demographic, menstrual details and Body Mass Index (BMI) among girls.

· Determine the association between knowledge regarding premenstrual syndrome and its management and selected socio-demographic variables among girls.

OPERATIONAL DEFINITIONS:

Prevalence of Premenstrual Syndrome:

In this study prevalence of premenstrual syndrome refers to number of girls experiencing pre-menstrual syndrome which was measured by a rating scale based on American College of Obstetricians and Gynecologists (ACOG) criterion which consists of any one of the Affective symptoms and Somatic symptoms. These symptoms should occur in the three prior menstrual cycles during the five days before the onset of menses and the symptom must resolve within four days of onset of menses and not recur until after day 12 of the cycle.

KNOWLEDGE:

In this study knowledge refers to the information or awareness regarding pre-menstrual syndrome which include definition, etiology, risk factors, clinical feature, diagnosis and its management which was measured by a structured knowledge questionnaire.

Premenstrual Syndrome:

In this study premenstrual syndrome refers to any physical, behavioural and psychological symptoms that occur within the one or two weeks before the menstrual period. Physical symptoms include weight gain, abdominal bloating, tender and lumpy breasts, swollen ankles, headaches, back aches, skin changes, acne, upset stomach, insomnia, tiredness, joint aches and dizziness. Behavioural symptoms include food cravings and over eating. Psychological symptoms include irritability and mood swings, loss of confidence, feeling angry, feeling upset and emotional, depressed mood, tearfulness, anxiety, tiredness, poor concentration and restlessness. The severity of Premenstrual syndrome was assessed using Premenstrual Syndrome Scale (PMSS).

Management of Premenstrual Syndrome:

In this study management of premenstrual syndrome refers to pharmacological, non-pharmacological and surgical management of premenstrual syndrome. Pharmacological management includes hormone therapy, anti-depressants, complementary therapy, supplements and GnRH analogues. Non-pharmacological management includes changing lifestyle, exercise, plenty of water and stress management. Surgical management include hysterectomy.

GIRLS:

In this study girls refers to female, within the age group of 18-20 years who have attained menarche.

HYPOTHESES:

All the hypotheses are tested at 0.05 level of significance

H₁: There is significant association between prevalence of premenstrual syndrome and selected socio-demographic, menstrual details and BMI.

H₂: There is significant association between knowledge regarding premenstrual syndrome and its management and selected socio-demographic variables.

REVIEW OF LITERATURE:

A cross sectional descriptive survey was conducted in Thailand on premenstrual syndrome among female university students. A total of 266 female students between the age of 16 and 35 were selected through simple random sampling. Data was collected with the help of a self-administered questionnaire based on American College of Obstetricians and Gynecologists (ACOG) guidelines. The results indicate premenstrual syndrome is very common among female at Assumption University. According to the data, more than 98% of the respondents indicated one or more premenstrual syndrome symptoms. However, only 28% reported feeling of premenstrual syndrome symptoms before every period. The study concluded that changes in lifestyle factors is an important approach for dealing with problematic PMS symptoms.⁵

A descriptive analytic study was conducted to assess knowledge and health behaviours about premenstrual syndrome in nursing secondary schools at Al-Diwaniya governorate. A non-probability, purposive sample of 282 adolescent students with premenstrual syndrome selected from four nursing secondary schools. Data was collected using a questionnaire based on ACOG guidelines. The result revealed that more study sample (44.6%) had insufficient knowledge toward premenstrual syndrome and 63.3% of girls had normal BMI. The assessment of knowledge is not affected by demographic characteristics and menstrual cycle characteristics, which mean the studied questionnaire can be amend for all individuals of the studied population. The study concluded that there is inadequate level of knowledge regarding PMS among students due to less exposure to information sources.⁶

A pre-experimental one group pre-test post-test study was conducted in Ludhiana to assess the effectiveness of planned teaching programme on knowledge regarding life style changes in prevention of premenstrual syndrome among adolescent girls, a total of 50 adolescent girls were selected by purposive random sampling technique. Data was collected with the help of a structured knowledge questionnaire on premenstrual syndrome. The study concluded that the analysis of the pre-test knowledge shows that in the pre-test scores, majority (22%) of the adolescent girls had average knowledge, 78% of them had poor knowledge whereas in the post-test, majority (60%) of the adolescent girls had average knowledge, 38% of them had good knowledge and the least (2%) of them had poor knowledge regarding lifestyle changes in prevention of premenstrual syndrome. There was no significant association of knowledge scores with the demographic variables like age, age at first menstruation, religion and family income and significant association of knowledge scores with the demographic variables like educational qualification and previous knowledge regarding life style changes in prevention of premenstrual syndrome. The study concluded that educating adolescent girls will help them to become more aware about their own health and also helps for early detection and treatment.⁷

MATERIALS AND METHODS:

Research design:

Descriptive survey design.

Setting of the study:

The study was conducted in St. Mary’s college Manarcadu, Kottayam.

Conceptual framework:

Betty Newman’s theory.

Research approach:

Quantitative non experimental approach

Population:

Population in the present study are girls who have attained menarche of age group 18-20 years.

Sample size:

The study sample consist of 100 girls studying in St. Mary’s College, Manarcadu and who met the inclusion criteria.

Inclusion criteria:

· Girls between the age group of 18-20years and studying in selected Arts College, Kottayam.

· Girls who have attained menarche.

· Girls who could read, write and understand English.

Exclusion criteria:

· Girls who were not willing to participate in the study.

· Girls who are absent during the period of data collection.

· Girls who were married.

Tools/ instruments:

In this study the data collection instruments used are:

· Tool 1: Profile of baseline variables

Section a: Socio-demographic variables

Section b: Menstrual details

Section c: Biophysical profile

· Tool 2: Rating scale to assess the prevalence of premenstrual syndrome.

· Tool 3: Structured knowledge questionnaire on premenstrual syndrome and its management.

Tool 1: Profile of baseline variables:

Section a: Socio-demographic variables:

Demographic variables were collected by self-reported technique using a structured questionnaire. It include age, religion, place of living, education. Type of family, monthly income, food habits and use of junk foods.

Section b: Menstrual details:

Menstrual details were collected by self-reported technique using a structured questionnaire. It includes age at menarche, duration of menstrual flow and pattern of menstrual flow, family history of premenstrual syndrome and previous knowledge regarding premenstrual syndrome.

Section c: Biophysical profile:

Biophysical assessment were performed by the investigator herself. Biophysical variables include assessment of height, weight and calculation of BMI.

Tool 2: Rating scale to assess prevalence of premenstrual syndrome:

Prevalence of premenstrual syndrome was collected by self-reported technique using rating scale. It includes 17 physical symptoms, two behavioural symptoms and 14 psychological symptoms. Prevalence of PMS is assessed based on American College of Obstetricians and Gynecologists (ACOG) criterion which consists of any one of the Affective symptoms (Psychological symptoms) and Somatic symptoms (Physical symptoms). These symptoms should occur in the three prior menstrual cycles during the five days before the onset of menses and the symptom must resolve within four days of onset of menses and not recur until after day 12 of the cycle.

For assessing the severity of PMS, each symptoms was rated on a four point scale (0, 1, 2 and 3) and the total score is 99.

The severity of PMS was categorized as follows:

Mild PMS - 1-33

Moderate PMS - 34-66

Severe PMS - 67-99

Tool 3: Structured knowledge questionnaire on premenstrual syndrome and its management:

The knowledge questionnaire was developed with the intention to assess the knowledge level of girls on premenstrual syndrome and its management. The total number of items in the questionnaire was 30. Each item had only one correct answer for which a score of one was allotted and score of zero was given for each wrong answer. The highest possible score was 30. The main aspects of knowledge are basics of PMS (Definition, prevalence, etiology and risk factors) clinical features, diagnosis and management.

Categorization of scores:

Level of knowledge Score

Good knowledge – 21-30

Average knowledge – 11-20

Poor knowledge – 1-10

RESULTS:

· The study finding revealed that out of 100 samples a majority 73% of the samples experience premenstrual syndrome based on the American College of Obstetrician and Gynaecologist (ACOG) diagnostic criteria.

· The study findings of the present study showed that more than half (69.86%) of the samples had moderate PMS.

· The study finding revealed that out of 100 samples about 88% had average knowledge, 9% had poor knowledge and 3% had good knowledge regarding premenstrual syndrome and its management.

· The study finding revealed that there is significant association between prevalence of premenstrual syndrome with age in years (χ²=6.48, P<0.05).

· The study finding revealed that there was a significant association between level of knowledge regarding premenstrual syndrome and its management with monthly family income (χ²=15.956, P<0.05).

CONCLUSION:

The findings of the present study showed that the prevalence of premenstrual syndrome was 73% among the girls based on the American College of Obstetrician and Gynaecologist (ACOG) diagnostic criteria. More than half (69.86%) of the samples have moderate PMS. About 88% of the samples had average knowledge, 9% had poor knowledge and 3% had good knowledge regarding premenstrual syndrome and its management. The girls had scored less in the management aspect of the knowledge. There was significant association between prevalence of premenstrual syndrome with age in years (χ²=6.48, P<0.05). It was also found that there was significant association between level of knowledge regarding premenstrual syndrome and its management with monthly family income (χ²=15.956, P<0.05).

LIMITATIONS:

· The study was done on small group of samples so generalization is limited.

· Convenience sampling was used in the sample selection. Hence, it reduces the possibilities of generalization of findings.

· The study was confined to students of one college only.

· Homogeneity was not completely maintained in terms of socio-demographic characteristics of the samples which limits the generalization of findings.

NURSING IMPLICATIONS:

The study findings have implications for nursing education, nursing practice, nursing administration and nursing research.

Nursing service:

· Nurses can assess the prevalence and severity of premenstrual syndrome in girls and thus maintain the quality of life of girls.

· This study can be used as an information illustration for nurses working in educational setup and gynecology department.

Nursing education:

· The result of the study can be used by a nurse educator as an informative illustration to nursing students while teaching a topic on premenstrual syndrome.

· Based on the present study student nurses can use this tool to identify the prevalence of premenstrual syndrome among girls in hospital and community setting.

· Results of the present study can be discussed in continuing nursing education sessions.

Nursing administration:

The nurse administrators can arrange and conduct workshops, conference, in-service education programs on premenstrual syndrome and can arrange community programs on identification of premenstrual syndrome and develop awareness regarding its management.

Nursing research:

The study can be utilized by subsequent researchers for their reference and for further study.

RECOMMENDATIONS:

· A descriptive study can be conducted to detect the risk factors contributing to premenstrual syndrome.

· A descriptive study can be conducted to detect the attitude towards PMS and practice of girls regarding management of premenstrual syndrome.

· A follow up study can be conducted to assess the effectiveness of information booklet on premenstrual syndrome and its management.

· Development of school health services needed for better detection and management of PMS in the adolescent population.

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Received on 27.05.2021 Modified on 24.02.2022

Asian J. Nursing Education and Research. 2022; 12(3):283-288.

DOI: 10.52711/2349-2996.2022.00060