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Keywords:

  • Jordan;
  • premenstrual dysphoric disorder;
  • premenstrual syndrome;
  • women's mental health

Abstract

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References

Accessible summary

  • The prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) among Jordanian women were 80.2% and 10.2% respectively; which is higher than most published literature.
  • The most severe symptoms of PMS and PMDD were abdominal cramp, lower back pain and breast pain.
  • Taking analgesics was the most frequently used method to alleviate the symptoms of PMS and PMDD.
  • High stress levels affected the symptoms of PMS and PMDD negatively; therefore, controlling stress level will reduce the severity of symptoms.

Abstract

The objectives of this study were to detect the prevalence, severity and factors associated with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) among Jordanian women, and to identify the most common self-treatment strategies used by women to alleviate the symptoms associated with PMS and/or PMDD. Data were collected from 254 women studying or working at one of the largest Jordanian governmental university using Shortened Premenstrual Assessment Form (SPAF), Perceived Stress Scale (PSS) and Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Text Revision (DSM-IV-TR) research criteria for diagnosis of PMDD. The findings indicated that the prevalence of PMS and PMDD were 80.2%, 10.2% respectively. Abdominal cramp, lower back pain and breast pain were reported to be the most severe symptoms associated with PMS and PMDD. Significant correlations were found between severity of premenstrual symptoms and perceived stress level, age, body mass index, marital status, perception of health in general and absent from work. The most frequently reported self-treatment strategies used by women to alleviate PMS and PMDD symptoms were: taking analgesics, increasing hot fluids intake, wearing heavy and warm clothes, and lying down on the abdomen. Understanding the prevalence, severity and self-treatment strategies for women experiencing PMS and PMDD symptoms help in improving women's quality of life and decrease their suffering from these symptoms.


Introduction and background

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References

Premenstrual syndrome (PMS) is a complex physical and emotional symptoms that occurs repeatedly in a cyclic fashion preceding menstruation (7–14 days before the onset of menstruation) and then disappear after the menstrual period [Dickerson et al. 2003, American College of Obstetrics and Gynecology (ACOG) 2005]. Overall, 75–85% of menstruating women reported having one or more premenstrual symptoms. Premenstrual emotional symptoms are conceptualized in feminist research as intra-psychic phenomena because changes in emotions are due to the combination of environmental and psychological factors. PMS is not always considered as pathological unless the women start suffering from feelings of out of control in their behaviours, which may affect their relationships with others especially with the intimate partner (Mooney-Somers et al. 2008).

In 1983 in the USA, the National Institute of Mental Health conference dedicated for this phenomenon and planned the first diagnostic criteria requiring a prospective and daily assessment of these symptoms. Later in 1987, the American Psychiatric Association (APA), in the Diagnostic and Statistical Manual of Mental Disorders 3rd Edition-Revision (DSM III-R), introduced the diagnosis of Late Luteal Phase Dysphoric Disorder that became in 1994 in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) the premenstrual dysphoric disorder (PMDD), with the same diagnostic criteria (APA 2000, Limosin & Ades 2001). Because of psychological and emotional problems such as anxiety, mood symptoms and social impairment that appeared and involved in PMS and PMDD; psychiatrists and mental health nurses are more concerned about this syndrome and become one of their major domains (Campbell et al. 1997).

PMDD, therefore, is a well-defined clinical entity characterized by severe recurrent depressive and anxiety symptoms of premenstrual onset that remit a few days after the onset of menses (APA 2000). Symptoms of PMDD were considered if they were severe enough to interfere with social activities (Baca-Garcia et al. 2004). In both PMS and PMDD, symptoms diminished rapidly within the onset of menses (Bloch et al. 1997, Johnson 1998, Daugherty 1999, Carr 2001, Grady-Weliky 2003, Halbreich et al. 2006). The exact cause of PMS and PMDD are not clearly understood but have been attributed to hormonal changes, neurotransmitters, prostaglandins, diet, drugs and women's lifestyle (Deuster et al. 1999, Neal et al. 2000, Connolly 2001).

Women around the world usually used various self-treatment strategies or behaviours to control or relief the symptoms of PMS and PMDD based on their cultural beliefs and practices that influenced by socializing factors such as country, rural vs. urban, religion, educational level and work environment (McMaster et al. 1997). In developing countries, the educated and professional women reported more about psychological and affective symptoms of PMS than less educated women as they exposed more to media and other cultures (McMaster et al. 1997). The less educated women reported least about psychological symptoms as they are not aware about these symptoms and its relation to premenstrual period; however, most of them reported only the physical symptoms (McMaster et al. 1997). Therefore, healthcare professionals and mental health nurse in Jordan must take into consideration the awareness level of women, cultural practices and the perception of Jordanian women related PMS and PMDD psychological symptoms to bridge the gap between evidence-based health programme and the health needs of Jordanian women.

The prevalence and severity of PMS and PMDD

There are many factors that affect the prevalence and severity of both PMS and PMDD. Among these factors are: levels of perceived stress, age, level of education, socioeconomic status, marital status, body mass index (BMI), menstrual history, nutritional status and physical activity (Deuster et al. 1999). There are no statistical data about the prevalence of PMS or PMDD in Jordan. However, the literature conducted in the worldwide indicated that the prevalence of PMS ranged between 75% and 85% and the prevalence of PMDD ranged between 3% and 10% of the menstruating women (Rivera-Tovar & Frank 1990, Barnhart et al. 1995, Campbell et al. 1997, Johnson 1998, Soares et al. 2001, Eliot 2002, Tabassum et al. 2005).

Research studies showed that the prevalence of PMS and PMDD were higher among younger women, women with less than high school education, women with lower income level, women with higher BMI, women whose age at menarche was 12 years or younger, women whom menses last more than 6 days, women who are physically inactive, women who are smokers, and women who reported more perceived stress level (Cohen et al. 2002, Freeman 2003, Halbreich et al. 2003). Also, literature did not show significant differences between the prevalence of PMS or PMDD and whether the women had been pregnant or not, whether the women is considered as a regular coffee drinker or not, and whether the women taking birth control pills or not (Ellen et al. 1995, Deuster et al. 1999, Richards et al. 2006, Thu et al. 2006).

The role of stress and major life events has received considerable attention in terms of association with somatic health. With respect to PMS, women who reported significant life stressors were more likely to report premenstrual symptoms. Several studies have examined the association between stress and severity of PMS. Groups who reported low, moderate and severe stress levels had prevalence rates for PMS of 1.9%, 6.7% and 13.7% respectively (Deuster et al. 1999). Jandrof et al. (1986) supported the positive relationship between daily stress and severity of premenstrual symptoms. Beck et al. (1990) studied, prospectively during three consecutive menstrual cycles, the association between occurrence of psychological stress and severity of premenstrual symptoms among 25 women who have severe PMS. Results showed that psychological stress accounted for 6% of the severity of premenstrual symptoms.

Severe premenstrual symptoms frequently interfere with a woman's ability to function across multiple settings including home, school and work. Those symptoms adversely affect women during their reproductive years. Women complaining of PMS or PMDD have high rates of work absenteeism, lower productivity (Heinemann et al. 2010) and reduced quality of life because of physical and psychological burden and adverse effect on relationships (Halbreich et al. 2003). Premenstrual impairment may also affect women and influencing their marital relationships and housekeeping (Mooney-Somers et al. 2008).

Symptoms of PMS and PMDD

Women with PMS and PMDD share the same symptoms. What differentiates PMDD is a group of symptoms that is severe enough to cause impairment in women's function (APA 2000). Research studies have reported up to 200 premenstrual symptoms (Handerason 2000). However, the premenstrual symptoms reported in the literature fall into three domains: emotional, physical and behavioural domains. The most common emotional symptoms of PMS include depression, irritability, anxiety, tension, crying, oversensitivity, feeling out of control and mood swings. Physical symptoms include abdominal cramps, fatigue, abdominal bloating, breast tenderness and pain, acne, swelling, aches and weight gain. Behavioural symptoms include food cravings, appetite changes, poor concentration, sleep disturbances, social withdrawal, forgetfulness and decreased in activity level (Deuster et al. 1999, Freeman 2003).

The occurrence of premenstrual symptoms varies in severity according to several factors. For example, Thu et al. (2006) found that almost 60% of menstruating women complained of breast pain and discomfort, around 50% complained of lower abdominal cramp and discomfort, headache, and increasing stress before period, around 40% expressed sadness, depression, confusion, weight gain, irritability and conflict with friends. Less than 30% reported high rate of anxiety, withdrawal feeling, ineffective coping and distorted body image.

There are 11 symptoms of PMDD identified by APA and described in DSM-IV-Text Revision (DSM-IV-TR). These symptoms are briefly identified as: irritability, depression, sadness, feeling overwhelmed, stress, oedema, abdominal bloating, overweight, muscle pain, insomnia or hyperinsomnia and breast tenderness (APA 2000). Women with PMDD experience marked disruption in their relationships, work or social activities at levels similar to those with major depressive disorder (Freeman 2003).

Treatment strategies used to relieve symptoms of PMS and PMDD

Women suffering from PMS and PMDD usually used a variety of self-treatment strategies or habits to decrease or alleviate the severity of these symptoms. A wide variety of strategies and habits used by women to decrease the symptoms of PMS and PMDD have been mentioned in the literature. Many medicinal and non-medicinal treatments have been used including psychological treatments, diet modification, vitamin supplements, lifestyle changes and alternative healing modalities (Thys-Jacobs et al. 1999).

For women with mild and severe symptoms, mental health nurses can use the evidence-based practices to enhance and relief PMS and PMDD symptoms. Mental health nurses must be aware that most of the women considered PMS as a source of stress and this can be managed using different treatment strategies. Performing regular exercise, decreasing smoking, eliminating alcohol consumption, using alternative healing modalities (herbal therapies, acupuncture and aromatherapy) are efficient also in treating the symptoms of PMS. Moreover, supportive counselling, education and general self-care measures such as exercises and healthful diet (limit salt, sweet foods and caffeine) are useful in alleviating the symptoms (Handerason 2000, Macdougall et al. 2006, Indusekhar et al. 2007). For women seeking treatment for moderate to severe PMS with strong preferences for non-pharmacological interventions, mental health nurses may also consider psychological interventions such as behavioural therapy, relaxation therapy and cognitive behavioural therapy that could be effective to alleviate the symptoms of PMS and PMDD (Macdougall et al. 2006, Indusekhar et al. 2007).

Medicinal treatment may be another helpful alternative for severe symptoms when previous methods are not effective, using variety of drugs such as Selective Serotonin Reuptake Inhibitors (SSRIs), oral contraceptives, non-steroidal anti-inflammatory agents, mineral and vitamin supplements, and diuretics (Daugherty 1999, Neal et al. 2000, Carr 2001, Connolly 2001, Wyatt et al. 2001, Macdougall et al. 2006, Indusekhar et al. 2007). Taking calcium supplement during premenstrual period found to relieve severity of symptoms because calcium level is usually lower in premenstrual period (Daugherty 1999). Manganese also plays a role in alleviating PMS symptoms. The lower dietary manganese intake was associated with more severe symptoms during the premenstrual phase of cycle (Penland & Johnson 1993, Bendich 2000).

Mental health nurses must be aware when they counsel women about the medicinal and non-medicinal treatments for PMS and PMDD. While counselling, mental health nurses must take into account the personal history of the women and their psychosocial factors, their social and cultural beliefs, their cultural practices and perception of using medications to treat PMS and PMDD. Also, mental health nurses must increase women's awareness that the medications not only demonstrate efficacy in reducing the physical symptoms of PMS and PMDD but also improving psychological, social and occupational functioning, and increasing the emphasis on using medications under supervision of medical team (Indusekhar et al. 2007).

Aims of the study

No one study had investigated the prevalence of PMS and PMDD among Jordanian women; therefore this study was conducted to detect the prevalence, severity, and factors associated with PMS and PMDD among Jordanian women, and to identify the most common self-treatment strategies used by women to alleviate the symptoms associated with PMS and/or PMDD. More specifically this study aimed to answer the following research questions:

  1. What are the prevalences of PMS and PMDD among Jordanian women?
  2. What is the degree of severity of premenstrual symptoms among Jordanian women?
  3. What are the relationships among severity of premenstrual symptoms and perceived stress level, and some demographic and maternal variables among Jordanian women?
  4. What are the most common self-treatment strategies or behaviours that used by Jordanian women to alleviate symptoms of PMS and/or PMDD?

Methods

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References

Research design and setting

Descriptive correlational cross-sectional design was used to answer the research questions. Data were collected from female students and employees at the Hashemite University (HU) in Jordan. HU is one of the largest public universities that is located in Al-Zarka, the second largest city in Jordan. The number of the HU is approximately 25 thousands including students and employees coming from different areas of Jordan.

Sampling and data collection

The sample inclusion criteria were all female students and employees at the HU aged between 18 and 45 years. The exclusion criteria include those women who have gynaecological illnesses or problems within the last year, and those who have severe and acute physical and psychological illnesses such as anaemia, malignancy, chronic infection, depression, schizophrenia, bipolar, borderline personality disorder, addictions and other mental illnesses.

Researchers explained the purpose of the study and how to respond to questions to the participants, and then told them to return the completed questionnaire in the mail box of the researcher in the campus. All questionnaires were distributed to female students during their scheduled classes employing stratified random sampling using the academic year (level) as a stratified variable. Regarding female employees, the questionnaires were distributed by the researchers to all female employees at HU by hands. Two-hundred and fifty-four participants (159 students and 95 employees with response rate of 73%) returned the questionnaire. Confidentiality of information and anonymity of the participants were assured. Participants were told completing and returning the questionnaire is considered as their consent to participate in the study. Also, they asked not to include any names or identification numbers on the questionnaires. The researchers only had an access to participants' responses and they kept the questionnaires in a locked drawer after entering the data. The study was approved by the university ethics committee.

Instruments

The questionnaire used to collect the data consisted of six parts:

  1. The prevalence of PMS was measured according to the Diagnostic criteria adopted by the ACOG (2005). ACOG recommends using the PMS diagnostic criteria developed by the University of California at San Diego. The criteria includes the appearance of at least one of the following affective and somatic symptoms during the 5 days before menses in each of the three previous cycles, which began to disappear with the onset of the menses: depression, angry outburst, irritability, anxiety, confusion, social withdrawal, breast tenderness, abdominal bloating, headache and swelling of extremities. Women were asked to indicate if they experience any one of these symptoms during the last three previous cycles. Those who met the diagnostic criteria were considered as having PMS.
  2. The prevalence of PMDD was measured using the research criteria identified by APA in DSM-IV-TR (APA 2000). Research criteria identified by DSM-IV-TR is the most common criteria used to diagnose PMDD (Smith et al. 2003). The research criteria indicated that, in most menstrual cycles during the past year, the presence of at least five symptoms (one of which must be affective) out of 11 during the last week of the luteal phase, which began to remit within few days after the onset of the follicular phase and were absent in the week post menses. The researchers provided the participants with a list containing the 11 symptoms and asked them to indicate which symptom has been experienced most of the time during the last year, and then participants were asked to confirm these symptoms prospectively during three consecutive symptomatic cycles. Those who met the diagnostic criteria were considered as having PMDD.
  3. The severity of premenstrual symptoms was measured using the Shortened Premenstrual Assessment Form (SPAF) (Allen et al. 1991). The SPAF is composed of a 10-item retrospective measure designed to measure changes in mood, behaviour and physical condition during the premenstrual period within the last three premenstrual periods. Women were asked to rate the severity of change in symptoms on a scale of 1–6 (1 = no change at all to 6 = extreme change) during the premenstrual period. The SPAF allows assessment of three PMS factors (negative affective, water retention and pain) that occur in the 7 days prior to the onset of menses, compared with the non-premenstrual state. Items were summed to provide the SPAF score. The higher the total scores on SPAF, the more severe the premenstrual symptoms. The SPAF was found to be reliable (Cronbach's alpha 0.80) and valid (Allen et al. 1991, Thu et al. 2006). In this particular sample; Cronbach's alpha for SPAF was 0.88.
  4. The perceived stress level was measured using the Cohen Perceived Stress Scale (PSS) (Cohen et al. 1983). PSS consists of 14 questions relating to respondents' thoughts and feelings about stress during the last month. PSS measures the degree to which situations in one's life are appraised as stressful. Questions were designed to tap how unpredictable, uncontrollable and overloaded respondents find their lives. The questions are easy to understand and the response alternatives are simple. The questions are general in nature and free of content specific to any special group. Responses for each question ranged between 0 (Never) to 4 (Very often). The scores of (0–4 for each of the 14 questions summed to obtain a total stress score. The possible range was between 0 and 56. A score of 17 or lower indicate a low stress level. A score between 18 and 23 indicates a moderate stress level. A score of 24 or more indicates a high stress level (Cohen et al. 1983). The PSS showed adequate reliability and coefficient alphas were ranged from 0.84 to 0.86, the test–retest reliability was 0.88. Concurrent validity was conducted and was significantly correlated with life events score and depression (Cohen et al. 1983). In this particular sample; Cronbach's alpha for PSS was 0.82.
  5. Self-treatment strategies that used to relieve symptoms of PMS and PMDD were identified by providing the participants with a list of self-treatment strategies derived from various sources of literature and from panel of experts. Women were asked to indicate which self-treatment strategies (behaviours or habits) that they usually used to alleviate the symptoms of PMS and/or PMDD. Also, participants were asked to write down any self-treatment strategy that is not appearing in the provided list.
  6. Demographic and gynaecological characteristics were assessed using a demographic sheet that includes: participants' age, marital status, employment status, smoking status, regular coffee intake, daily sleeping hours, using of oral contraceptives for treatment of PMS or PMDD, absence from work due to PMS/PMDD, educational level, income level, weight and height, age at menarche, regularity, frequency, duration and intensity of menstrual cycle.

For the purpose of this study, all parts of the questionnaire were translated into the Arabic language by an expert in bilingual language. Another bilingual expert translated the Arabic version into English without accessing to the original version to standardize the conceptual meanings for Arabic and English-speaking respondents. A third bilingual faculty member compared the Arabic and the English versions, corrected any incongruence in the translation, and reviewed the denotations and connotations of each item to maintain the integrity of the instrument.

Statistical analysis

The Statistical Package for Social Sciences (spss version 12.0) was used to generate descriptive and inferential statistics at a significant level of <0.05. Positively stated items in the PSS were reversed before performing the analysis. Spearman and Pearson correlations were used to investigate the relationship among studied variables (Polit & Beck 2006).

Findings

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References

Sample's demographic and gynaecological characteristics

The final sample consisted of 254 participants whose age ranged between 18 and 45 years (mean 23.5, SD = 6.1). The majority of the sample were single (n = 202, 79.5%). Out of the total sample, 95 (37.4%) participants were employees and 159 (61.8%) were students. Most participants (88.6%) were non-smokers, and only 94 (37%) were regular coffee drinkers. More than half of the participants (64.1%) indicated that they sleep on average 7–9 h per day (mean = 7.6, SD = 1.6). Of the total sample, only 38 (15.5%) had been pregnant at least one time. Only nine women (3.7%) used oral contraceptives to relieve the symptoms of PMS. Approximately 36 (14.3%) of the sample had a sick leave or absent from work or school because of severity of premenstrual symptoms. Most of the participants (71.1%) had a regular menstrual cycle. Table 1 summarizes the characteristics of the study sample relating to socio-demographic and other gynaecological data.

Table 1. Demographic and gynaecological characteristics of the sample (n = 254)
Variablen (%)
  1. a

    JD (Jordanian Dinar), which is equal $1.4

Educational level 
High school78 (30.7)
Diploma38 (15.0)
Baccalaureate118 (46.5)
Master/Doctorate20 (7.9)
Family monthly income by JDsa 
Less than 200 JDs15 (6.4)
200–499 JDs116 (49.6)
500–999 JDs80 (34.2)
1000 JDs and more23 (9.8)
Body mass index 
Less than 20 (underweight)65 (25.6)
20–24.9 (normal)144 (56.6)
25–29.9 (overweight)37 (14.6)
30 and more (obese)8 (3.2)
Age at menarche 
9–11 years13 (5.2)
12–13 years129 (51.2)
14 years and more110 (43.7)
Menstrual cycle 
Regular180 (71.1)
Irregular73 (28.9)
Frequency of the menstrual cycle 
Less than 20 days12 (4.8)
20–31 days204 (81.0)
More than 31 days36 (14.3)
Duration of the menstrual cycle 
Less than 6 days137 (54.6)
6 days and more114 (45.4)
Intensity of the menstrual cycle 
Light30 (11.9)
Medium187 (73.9)
Heavy36 (14.2)

Prevalence of PMS and PMDD

In the current sample of Jordanian women, the prevalence of PMS as measured by Diagnostic criteria of University of California at San Diego was 80.2%. The prevalence of PMDD as measured by research criteria of the DSM-IV-TR was 10.2%.

Severity the premenstrual symptoms

Severity of premenstrual symptoms was measured by SPAF on three symptom's factors: ‘negative affective’, ‘water retention’ and ‘pain’. The most severe premenstrual symptoms were those related to ‘pain’ factor (43.7% above the midpoint, mean = 3.37) (see Table 2). The most frequently reported pain complaints were: lower back pain (61.4%), abdominal cramp (52.4%) and breast pain (49.6%). The second most severe premenstrual symptoms were those related to ‘negative affective’ factor (39.4% above the midpoint, mean = 3.09). The most frequently reported negative affective complaints were: irritability (49.2%), feeling of overwhelmed (46.9%) and sadness and depression (45.3%). The least premenstrual symptoms reported by the participants were those related to water retention (32.4% above the midpoint, mean = 2.76) such as oedema and swelling (26.8%) and weight gain (33.9%).

Table 2. Means and standard deviations of the severity of premenstrual symptoms subscales (n = 254)
Subscales (factors)MeanSDNo. of items% above midpoint
Pain3.371.36343.7
Negative Affective3.091.27439.4
Water Retention2.761.33332.7

Correlations between premenstrual symptoms and study variables

Significant positive correlations were found between severity of premenstrual symptoms and perceived stress level, age, income level, BMI, marital status, perception of health in general and absent from work. More severe premenstrual symptoms were correlated with higher perception of stress level. Severity of premenstrual symptoms was found to be high in older women and those with higher BMI. Married women reported more severe symptoms (mean = 34.0, SD = 11.6) than those who are not (mean = 29.6, SD = 10.5). Participants, who indicated that their health in general was bad or poor, had more severe premenstrual symptoms. Women with severe premenstrual symptoms reported higher rates of absent from work than those who reported less severe symptoms (see Table 3).

Table 3. Correlations between severity of premenstrual symptoms and study variables (n = 254)
DemographicsCorrelation coefficientP-value
  1. *Significant correlation at <0.05 levels; **significant correlation at <0.01 levels.

Perceived stress level0.3530.000**
Age0.1300.038*
Occupation−0.0720.265
Educational level0.0400.523
Income level0.1300.048*
Body mass index0.1850.003**
Sleeping hours0.0230.717
Smoking−0.1010.107
Coffee intake−0.0890.161
Marital status0.2220.000**
Age at menarche−0.1190.060
Regularity of menstrual cycle0.0760.226
Frequency of menstrual cycle0.0050.941
Duration of menstrual cycle0.0690.277
Amount of menstrual cycle0.0420.504
Oral contraceptive usage−0.0320.617
Perception of health in general0.6050.000**
Absence from work0.1500.017*

Strategies used to relief symptoms of PMS and PMDD

Participants reported numerous self-treatment strategies to alleviate symptoms of PMS or/and PMDD. Those self-treatment strategies included taking analgesics (54.7%), increasing hot fluids intake (53.5%), wearing heavy and warm clothes (48.4%) and lying down on the abdomen (41.3%) (see Table 4). The least self-treatment strategies used were taking medications containing minerals (1.9%), antidepressants (1.9%), hormones (0.4%) and diuretics (0.4%).

Table 4. Frequencies and percentages of using self-treatment strategies to alleviate premenstrual syndrome and premenstrual dysphoric disorder symptoms (n = 254)
No.Self-treatment strategy (behaviour)n (%)
 1Taking analgesics139 (54.7)
 2Increasing hot fluids intake136 (53.5)
 3Wearing heavy and warm clothes123 (48.4)
 4Lying down on the abdomen105 (41.3)
 5Drinking cinnamon62 (24.4)
 6Decreasing cold fluids intake52 (20.4)
 7Taking warm shower41 (16.2)
 8Doing abdominal massage41 (16.2)
 9Decreasing coffee intake35 (13.8)
10Listening to music32 (12.6)
11Providing hot bags to the abdomen26 (10.3)
12Increasing sexual intercourse (n = 49 married)4 (8.2)
13Performing physical activities and sports20 (7.8)
14Performing deep breathing relaxation16 (6.3)
15Taking vitamins11 (4.3)
16Decreasing salty food intake11 (4.3)
17Taking antidepressants5 (1.9)
18Taking minerals5 (1.9)
19Taking diuretics1 (0.4)
20Taking hormones1 (0.4)

Discussion

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References

In the current study, the prevalence of PMS among a sample of Jordanian women was found to be 80.2%. This prevalence rate was congruent with the results of most studies. For example, Campbell et al. (1997), Johnson (1998) and Barnhart et al. (1995) found that the prevalence of PMS was 75%. Clenchner-Smith et al. (1998) found that the prevalence of PMS was slightly higher (88%) while Tabassum et al. (2005) found it to be slightly lower (53%).

Literature indicated that the prevalence of PMDD ranged between 3% and 10% (Eliot 2002). In the current study, the prevalence of PMDD was found to be 10.2%. This prevalence rate was congruent with the results of Rivera-Tovar & Frank (1990) and Soares et al. (2001) who found that the prevalence of PMDD was around 10% of the menstruating women. However, the prevalence of PMDD in the current study was slightly lower than the results of Tabassum et al. (2005), Angst et al. (2001), Spitzer et al. (2000) who found it to be 18.2%, 13% and 19% respectively.

In this study, the most severe PMS symptoms were: lower back pain (61.4%), abdominal cramp/pain (52.4%), breast pain/tenderness (49.6%), irritability (49.2%), feeling overwhelmed (46.9%) and sadness and depression (45.3%). It is obvious that severe symptoms of PMS were those related to pain (breast, abdomen, back) and negative affect (depression, irritability, sadness), and the least severe symptoms were those related to water retention (bloating, oedema and swelling). These results were congruent with the Thu et al. (2006) results. However, DeRonchi et al. (2005) found that 20% of menstruating women were affected by minor depressive symptoms.

Jordanian women reported that they control or decrease symptoms of PMS and PMDD by taking analgesics, taking hot fluids, wearing warm clothes and lying down on the abdomen. These self-treatment strategies were used mostly because pain was the most severe symptom reported by women; and because of the easiness of medication use or availability of these strategies especially for women who spend long time outside homes such as employees and students. Very few women used SSRI, hormones, diuretics and minerals because these drugs used to overcome severe symptoms, as well as using these medications require medical prescriptions. This study suggested that women with severe symptoms used self-treatment strategies and over the counter analgesics, which may reflect significant unmet medical need for Jordanian women. So, improving clinical identification of these women by mental health nurses and increasing awareness of the women will have a lot of benefit and need extensive work from health professional in educating and treating women in Jordan.

Severity of premenstrual symptoms in the current study increased with age. The least severe symptoms of PMS were reported by students whose age ranged between 18 and 22 years and who were physically active. Employees reported higher severity of premenstrual symptoms than the students. This is may be due to employers' sedentary lifestyle, as lack of exercise contributes to the severity of premenstrual symptoms. Physical activity also relief swelling that occurs before menstruation by enhancing poor physiological brain performance by increasing the circulation to the brain and in effect overrides the limitations caused by symptoms. In addition, severe symptoms were found to be higher among participants who has longer duration of menstrual cycles and who are older.

The findings in the current study regarding BMI is congruent with a study conducted by Masho et al. (2005) who found that women with higher BMI have severe premenstrual symptoms as compared with those who have lower BMI. The role of stress has received considerable attention in association with somatic health. As a result of this association, participants with low level of stress reported the least severe premenstrual symptoms. This is congruent with results of Beck et al. (1990) and Deuster et al. (1999) who found that during stressful situations, cortisol is increased, which in turn worsen the premenstrual symptoms. With respect to the income level, the prevalence of PMS among women with low income level was higher than those who have higher income. This is congruent with study conducted by Deuster et al. (1999) and this is may be due to the belief that low income level is a major life stressful event, which in turn increases the severity of premenstrual symptoms (Johnson 1998, Daugherty 1999, Thys-Jacobs et al. 1999, Bendich 2000, Neal et al. 2000, Carr 2001, Eliot 2002).

Conclusions and implications

In conclusion, this study showed a high prevalence rate of PMS/PMDD among Jordanian women similar to the results reported in different countries. Pain was found to be the most severe and prevalent symptom and using analgesics was the most self-treatment strategy used by women. Increase Jordanian women awareness, increase effectiveness of treatment strategies and improve clinical identification of PMS/PMDD are needed from mental health nurses who are working with women seeking treatment for PMS and PMDD. Mental health nurses may also involve the partners in treatment plans by explaining to them how to help their female partners to deal with the physical and emotional symptoms of PMS and PMDD. However, involving Jordanian male partners in such psycho-maternal issues still considered a cultural barrier and needs work from the mental health nurses to increase the awareness of men about emotional changes caused by PMS and PMDD. Women suffering from PMS or PMDD may use self-treatment strategies such as reducing intake of salt, sugar, caffeine, dairy products and alcohol; eating frequent and smaller portions of foods high in complex carbohydrates; performing exercise regularly; and practising relaxation and stress management techniques.

Limitations

First, the sample of this study was drawn from only university students and employees who may limit the generalizability of the results to all Jordanian women. In the future, further studies using larger and more representatives sample are encouraged. Second, data of this study were obtained from participants through self-reported questionnaire, which may reflect bias in self-reporting (i.e. participants may have underestimated or overestimated their level of PMS and PMDD symptoms).

References

  1. Top of page
  2. Abstract
  3. Introduction and background
  4. Methods
  5. Findings
  6. Discussion
  7. References
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