ABSTRACT

Objective

The aim of this study was to investigate the frequency of premenstrual syndrome (PMS) in women between the ages of 18-45 working University of Health Sciences Turkey, Adana City Training and Research Hospital, and to examine its effect on quality of life.

Material and Methods

This research was conducted on 400 women working in, University of Health Sciences Turkey, Adana City Training and Research Hospital, between 15.12.2022 and 15.06.2023. The sociodemographic data form premenstrual syndrome scale (PMSS) and quality of life scale short from-36 prepared by us were applied to the participants by asking our survey questions, which were sent face-to-face or online.

Results

Of the women, 48.3% had PMS. When we looked at the relationship of age with PMS symptoms, PMS symptoms were most common in the 26-29 age range, while the incidence of symptoms decreased over 41 years of age. When the effect of the education level of the participants on PMS was examined; it was observed that the incidence of PMS symptoms increased as the education level increased. When the relationship between menstruation and PMS was evaluated, the PMSS total score was found to be higher for those whose menstruation is not regular, the score for those with regular menstruation was lower.

Conclusion

As a result of our research, an association was found between factors such as age, education level, and regular menstrual frequency and the incidence of PMS in women. It was determined that all these changes affect the quality of life of women negatively. The effect of PMS on quality of life reveals the importance of providing support to women in coping with these symptoms.

INTRODUCTION

The menstrual cycle occurs when the ovaries of the reproductive system regularly work every month (1). Emotional, behavioral, and somatic changes occur in the luteal phase (the second half of the menstrual cycle) and disappear with the onset of menstruation and are defined as premenstrual syndrome (PMS) (2, 3). The most common somatic symptoms during this period are changes in appetite, breast sensitivity, fatigue, water retention in the body, weight gain, emotional fluctuations, outbreaks of anger, increased anxiety, decay, and sadness (4, 5). PMS primarily affects the health of women; however, it generally affects women, their families, and the society in which they live. PMS symptoms negatively affect women’s family relationships, working life, and social life, disrupting their daily quality of life (6, 7). Women with PMS experience reduced quality of life due to anxiety, depression, reduced productivity at work, and increased accident rates (5-7). Knowledge of the impact of PMS on quality of life highlights the importance of supporting women in dealing with premenopausal syndrome. As a result of our study, we aimed to investigate the frequency of PMS in women working in our hospital and its impact on quality of life.

MATERIALS AND METHODS

From 15.12.2022 to 15.6.2023, 400 women aged 18 to 45 working University of Health Sciences Turkey, Adana City Training and Research Hospital were included in this cross-sectional study. Informed consent was obtained from all participants. Volunteers filled out our questionnaires either face-to-face or online in a working environment. The participants were given the sociodemographic data form and the premenstrual syndrome scale (PMSS) and the the short form (SF-36).

Premenstrual Syndrome Scale

The scale, which was validated in Turkish by Gençdoğan (8), was designed to measure the severity of premenstrual symptoms. The scale, which is widely used in Turkey, contains 44 statements that indicate a person’s “state within just one week”. The five likert-type PMS consists of nine subdimension (depressive sensation, anxiety, fatigue, nervousness, depressive thoughts, pain, changes in appetite, sleep changes and swelling). The lowest score was 44, and the highest was 220. The lower-dimensional scores are obtained by aggregating substances in these dimensions, and the total PMSS score is the sum of the lower-dimensional scores. High PMSS scores indicate more severe premenstrual symptoms. A total of 132 points are assessed as absent PMS, whereas 132 points and above are considered as having PMS. A score exceeding 50% of the maximum limit of total and subscale scores determines absence or presence of PMS (8).

Short Form-36 Quality of Life Scale

SF-36, one of the most commonly used generic scales for measuring quality of life, was developed by rand corporation in 1992 and conducted by Koçyiğit et al. (9) to evaluate the validity and reliability of the SF-36. The scale covers 36 elements, and these provide measurements of eight dimensions: physical, social, role constraints of physical functions, emotional problems, mental health, energy/vitality, pain, and general perception of health. The lower scale rate health from 0 to 100, with 0 indicating bad health and 100 indicating good health. The positive-rated scale improves health-related quality of life as the score of each health area increases.

The study was approved by the University of Health Sciences Turkey, Adana City Training and Research Hospital Ethics Board (decision number: 2285, date: 01.12.2022).

Statistical Analysis

Parametric test techniques were used in this study because the scores showed a normal distribution. The t-test and analysis of variance (ANOVA) were used to analyze whether the scale scores differed from demographic characteristics. The t-test was used in the analysis of two-group demographic variables, whereas the ANOVA test was used in the analysis of group variables k (k>2). Statistical significance value p<0.05 was accepted.

RESULTS

15.8% of the women who participated in our study were between the ages of 18-25 years, 36.5% between 26-29 years, 30.4% between 30-35 years, 10.3% between 36-40 years, and 7.0% who were 41 years of age or older. According to education level, 13.5% of women were high school or high school graduates, and 63.7% were university graduates. Additionally, 22.8 had a master’s or doctoral degree (Table 1).

There was a significant difference in the presence of PMS according to age groups (p=0.009). In terms of education level, the highest prevalence of PMS was found in the group of those with a master’s or doctoral degree (60.4%), whereas the lowest rate was observed in those with secondary school or high school graduates (37.0%) (p=0.014) between educational degrees. A total of 56.4% of non-child participants had PMS, whereas only 36.7% of those with a child had it. This finding suggests that having children can affect the prevalence of PMS. 59.5% of women with irregular periods experience PMS, whereas 45.5% of those with regular periods have PMS, and PMS was more frequently seen in women with irregular periods (p=0.026). The prevalence of PMS (56.5%) among participants who experienced pain during menstrual periods and received medical treatment for the condition was significantly higher (p=0.002). Contrary to these data, chronic disease, smoking and alcohol use, regular exercise, menstrual age, and dysmenorrhea were not associated with PMS (Table 2). The average scores were highest for those between the ages of 26-29 with fatigue, depressive thoughts, changes in appetite, pain, swelling, and premenstrual syndrome scores, while the lowest scores were for those aged 41 and over (p=0.0009).

A regression analysis was conducted to study the effect of depressive thoughts, appetite changes, sleep changes, and bloating variables on qualityof life SF-36, and the established model was found to be meaningful (p=0.003; p=0.022; p=0.004; p=0.023). When the scores were studied, the negative influence of depressive thoughts (beta=-0.254) was found to be significant in the positive direction of appetite change (beta=0.132), sleep change in the negative direction (beta=-0.198), and obesity in the positive direction (beta=0.129). The effects of fatigue, depression, anxiety, nervousness, and pain on quality of life were not significant (p>0.05) (Table 3).

Physical power, emotional power, energy/vitality, mental health, social functioning, pain, general health, and quality of life total SF-36 scores varied depending on the presence of PMS (p=0.021; p<0.001; p<0.001; p<0.001; p<0.001; p<0.001; p<0.001; p<0.001). The average scores for physical role strength, emotional role power, energy/vitality, mental health, social functioning, pain, general health, and quality of life SF-36 were highest for non-PMS patients and lowest for those with PMS (Table 4).

In terms of the relationship between the PMS subdimensions and the SF-36 scale, there was a negative, weak relationship between fatigue and physical role strength, emotional role force, vitality, mental health, social functionality, pain, general health, and overall quality of life SF-36 (r=-0.189, p<0.001; r=-0.276, p<0.001; r=-0.337, p<0.001; r=-0.305 p<0.001; r=-0.288, p<0.001; r=-0.257, p<0.001; r=-0.201, p<0.001; r=-0.283, p<0.001). There was a negative, weak correlation between depressive emotion and physical role strength, emotional role strength, social functioning, pain, general health, and overall quality of life SF-36 (r=-0.138, p=0.006; r=-0.252; p<0.001; r=-0.212, p<0.001; r=-0.240, p<0.001; r=-0.254, p<0.001) There was a negative, weak, strong relationship between depressive thoughts and emotional role strength, mental health, social functioning, pain, general health, and overall quality of life SF- 36 (r=-0.319, p<0.001; r=-0.445; p<0.001); r=-0.321, p<0.001; r=-0.334, p<0.001 r=-0.308, p<0.001; r=-0.375, p<0.001). There was a negative, weak-strong relationship between anxiety and mental health, social functionality, and quality of life overall SF-36 (r=-0.410, p<0.001; r=-0.369, p<0.001; r=0.336, p<0.001) There was a negative weak-strong relationship between nervousness and physical role strength, emotional role power, energy/ vitality, social functioning, pain, general health, and overall quality of life SF-36 (r=-0.157, p<0.001; r=-0.195, p<0.001; r=-0.203, p<0.001; r=-0.234, p<0.001; r=-0.151, p<0.03; r=-0.246, p<0.001) (Table 5).

A regression analysis was carried out to study the effect of the PMS variable on quality of life SF-36, and it was found to be significant that PMS had a negative effect (p<0.001) (Table 6).

DISCUSSION

This study aimed to determine the PMS and quality of life of hospitalized women. In the study, 57.5% of the 26-29 year-olds and 25% of those under 41 years of age and older suffer from PMS. Similarly, in the study conducted by Demir et al. (10), the majority of women were in the 24-28 age group (44.1%), while the group aged 39 years and over (4.3%) constituted the lowest proportion. According to the literature, PMS symptoms have been shown to decrease with age because women are more able to tolerate and develop ways to cope with PMS over time.

When the impact of the level of education of participants on the prevalence of PMS was studied, the highest rate was found in those with a master’s or doctoral degree (60.4%), whereas the lowest rate was found in those with secondary school or high school graduates (37.0%). In support of our study, Khella (11) showed that PMS symptoms are more common and more severe among highly educated women with possible stress associations with PMS than among women with lower educational levels.

In our study, 56.4% of non-child participants experienced PMS, whereas only 36.7% of those with children had PMS. Contrary to the relationship between fertility and PMS violence we found in this study, Önal (12) found that 73.2% of women with PMS have children. When evaluating the relationship between the age of first menstruation and the presence of PMS, the lower dimensions of the PMS included appetite changes that differed from those of the first menstrual age (p<0.05). According to the mean scores, appetite changes were higher in those aged 13-14 years at menarche and lower in those aged 15 years and older.

Duster, adera, and south-paul found that women aged 12 years or younger were 1.6 times more likely to develop PMS during menopause. (13). In support of this finding, a study by Öztürk (14) found that women diagnosed with PMS had a shorter time to first menstruation than those who did not have PMS.

In this study, the prevalence of PMS in women aged 18-45 years was 48.3%. The prevalence of PMS was 57.4% in a 2012 study of college students with short and close colleagues (15). While PMS symptoms pose a threat to a person’s health when assessed individually, it should not be forgotten that they also affect family, friends, and the working environment, thereby imposing socioeconomic burdens on society. PMS is a major health problem for women suffering from symptoms such as impotence, anxiety, depression, and suicide. PMS leads to physical and psychological changes in women. These changes have a negative impact on women’s family life, social relations, school life, and work. It has been found to affect women’s mental health, including loss of capacity, anxiety, depression, and suicide, and negatively affects their quality of life. Understanding the impact of PMS on quality of life highlights the importance of providing support for women in dealing with these symptoms.

Study Limitation

The study is cross-sectional in nature and does not report cause and effect. The fact that the study was conducted in a single center is one of the limitations of the study.

CONCLUSION

It is one of the tasks of general practitioners to tell women that these symptoms are seen by many, to tell them that this is a health problem that reduces their quality of life, and to guide them to manage these symptoms.

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Investigation of the Frequency of Premenstrual Syndrome and Its Effect on Quality of Life in Women Aged 18-45 Years Working in Adana City Training and Research Hospital