Knowledge, attitude, experience and management on premenstrual syndrome among secondary level adolescence girl students of Kirtipur Municipality, Kathmandu, Nepal

INTRODUCTION

Adolescence in girls has been recognized as a special period between the ages of 10 to 19 years which signifies the transition from girlhood to womanhood. During puberty, hormonal, psychological, cognitive and physical changes occur simultaneously and interactively making physiological development a challenge adolescents have to face, with emotional, social and behavioural dimensions.¹ Menstruation is an important process of female reproductive cycle, but menstrual dysfunction in adolescent girls may affect the normal life of adolescence girls. Most of the adolescents’ girls were affected by premenstrual syndrome symptoms like dysmenorrheal, menorrhagia, metrorrhagia.² It is a menstrual disorder which is very common among teenagers and young women. This focuses more on somatic symptoms such as fatigue, abdominal bloating, breast tenderness, headache, and swelling in the extremities as well as affective symptoms include irritability, angry outbursts, irritability, depression, confusion, anxiety and social withdrawal.³

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome with specific focus on affective symptomatology. There are a few associated risk factors like exercise habits, smoking, use of alcohol, altered trans-capillary fluid balance, a diet rich in beef or caffeine containing beverages and stress. It is common for women in reproductive age group to feel discomfort a few days prior to the onset of menstruation.⁴ Adolescents with low self-esteem were found to expect failure, be generally nervous, show less effort towards being successful, ignore important things in life and feel worthless and untalented when they failed. It is known that some stimuli triggered by daily events also trigger premenstrual syndrome in women with sensitive personalities.⁵ In fact at least 75 percent of women with regular menstrual cycles report unpleasant physical or psychological symptoms. For the majority of women, these symptoms are mild and tolerable Premenstrual syndrome refers to symptoms such as acne, fatigue, bloating, anger, and moodiness. premenstrual syndrome affects between 14 percent and 89 percent of adolescents.⁶ Abdominal bloating and breast tenderness found as customary signs and 70 percent pubescent girls face these troubles before and during menstruation.⁷

Females with premenstrual dysphoric disorder complaint of breast tenderness, severe lower abdomen pain, bloating, joint and muscle pain, weight gain, sleep disturbances, irritability, anger, tension, low concentration, mood instability, and marked depression. The presence of these symptoms adversely affects their academic, social, and personal performance.⁸ In addition, American psychiatric association has also established criteria for diagnosis of premenstrual dysphoric disorder according to which a woman is diagnosed to have premenstrual dysphoric disorder when her life is significantly affected by moderate to severe symptoms of premenstrual syndrome.⁹ PMS symptoms have negative impact on academic and social performances of the students. The investigator felt that giving knowledge about PMS will help in coping with the negative impacts of PMS among the adolescent girls. Students are the promising group to country’s development. Therefore, the investigator felt a strong need to take up this study to assess the knowledge on PMS among adolescent girls.¹⁰

METHODS

A descriptive cross-sectional study was conducted among 322 adolescence girl students of higher secondary school of Kritipur Municipality. Data were collected from March 2022 to April 2022. The sample size was 322 adolescent girls. It was calculated using the formula z²pq/d² where the prevalence of 39 %, 95% confidence interval, and 5% margin of error were taken. Structured questionnaire was used to identify the knowledge, experience and management regarding premenstrual syndrome and Likert scale to access attitude on premenstrual syndrome. Self-Administered Questionnaire was used as a technique of data collection. Sampling technique was simple random sampling. Ethical approval was received from IRC and approval for data collection from respective municipality.

The data were entered and analyzed using IBM SPSS Statistics version 25.0. Based on the distribution and variance, appropriate statistical tests were used for analysis. Descriptive analysis was used to describe background characteristics. Chi-square test was used to test the difference between the categorical variables, and p<0.05 was considered as statistically significant

RESULTS

Most of the respondents belong to the age group 17-19 with the mean age of 17 years. Majority of the respondent (51.9%) were in grade X1 and minority (48.1%) were in grade XII. Most of the (99.7%) of respondent were unmarried. Out of the total respondent, 80.7% were Hindu followed by Buddhists (13.4%) and Christian (5%). Majority of the respondents were Brahmin/Chhetri (54.66%) followed by Janajati (41.93%) More than two-third of the respondents had nuclear family (Table 1).

Majority of the respondents (63.7%) heard about the premenstrual syndrome. 64.9% of respondents heard about premenstrual syndrome from friends followed by from social media (48.8%), family /relatives (37.1%), health professionals (19%) and books (16.6%). Likewise, majority of the respondents (95.1%) knew the meaning of Premenstrual syndrome (Table 2).

Majority of respondents (94.1%) reported that mood swings was the sign and symptoms of premenstrual syndrome followed by irritability (79.5%), acnes (72.7%), headache (72.2%), food cravings (67.3%), change in sleep pattern (59%), aggression (57.6%), abdominal bloating (52.2%), joint pain (51.2%), breast tenderness (44.4%) and others (1.5%). Similarly, majority (89.4%) responded stress as a risk factor of PMS followed by dietary factor (49.5%) family history, (47%), overweight (46.5%), caffeine intake (25.8%), alcohol abuse (19.7%) and others (1%). Nearly two-third (64.3%) respondents reported sleep as a relieving factor for PMS followed by physical exercise (63.8), yoga/meditation (59.3%), home remedies (58.8%) and consult doctor (58.8%) and (53.3%) dietary factor (Table 3).

Majority of respondents (90.2%) had very poor level of knowledge and minority (9.8%) had fair/ below average level of knowledge (Table 4).

Majority (40.1%) agreed that PMS disturbs normal routine whereas 43.2% agreed that stress worsen PMS. Majority (34.2%) agreed that traditional medicine suitable to be used to treat PMS. Furthermore, 36.3% agreed that dietary changes help to relieve. Similarly, 35.7% agreed that medication relieve PMS disagreed and (6.2%) strongly disagreed. The entire respondent had extremely negative attitude towards PMS (Table 5-7).

Majority of the respondents (77%) experienced PMS. More than two-third of respondents (75.6%) shared about their PMS. Among them, the 71.4% preferred to share with mother followed by with the friends (58.2%) (Table 8).

Majority (81.9%) experienced mood swings followed by irritability (63.3%), headache (53.2%), acnes (48.8%), food cravings (46.8%). Similarly, majority (54%) experienced with moderate symptoms of the PMS followed by the mild symptoms (26.2%) of the PMS (Table 9).

Majority of respondents (73.1%) who experienced PMS had drink lots of water for management followed by used hot bags (70.7%), 27.3% seek medical care. Among those who had sought medical care, 50% visited to the pharmacy followed by visited hospital (42.4%) (Table 10).

Association between the social-demographic characteristics like education status of respondent’s mother, education status of respondent’s father with level of the knowledge regarding premenstrual syndrome (Table 11).

**Multiple responses

** Multiple responses

**Multiple responses

** Multiple responses

*Statistically significant p<0.05

DISCUSSION

This study found that 90.2% of the respondent had very poor knowledge on premenstrual syndrome and 9.2% of the respondent had fair /below average knowledge regarding premenstrual syndrome. All of the respondents had negative attitude towards premenstrual syndrome. In contrast to this study, a study conducted by Givshad et al in Iran found that only 3.6% of the respondent had good knowledge, (61.8%) had average knowledge and 34.5% of them had poor knowledge. The 9.1% respondents had negative attitude, 63.6% of them had ambivalent attitude and 27.3% had positive attitude towards premenstrual syndrome.¹¹

In this study, the most frequent affective symptoms were mood swings (81.9%) and irritability (63.3%) and somatic symptom in this study was acnes (48.8%). Although headache (53.2%), aggression (41.1%), change in sleep pattern (42.7%), food cravings (46.8%) like symptoms were also present in significant number of female students. Similar study conducted in Thailand showed that most common physical psychological symptoms were breast tenderness (74.4%) and angry bursts (97.7%).¹² Other study conducted was performed in West Bengal, India among adolescent girls of rural school reported that out of the affective symptoms irritability was highest (84.8%) followed by anger (70.5%) and anxiety (62.7%) and the most common somatic symptoms reported was breast tenderness.¹³ In the study done in some of the undergraduate medical students in Nepal was reported that the most common PMS symptoms seen were abdominal discomfort and fatigue with (94.84%) and (76.28%) and the emotional symptoms were mood swings (35.05%), anxiety (27.31%) and (31.95%) irritability.

In this study, it was observed that PMS influenced academic and social activities. With regard to the academic impacts of PMS, (73.9%) of the respondent had difficulty in study followed by lack of concentration (56.4%), (34.1%) absenteeism, (15.6%) low scores. This result agrees with study done in Jimma Southwest Ethiopia on the prevalence of PMS and its association with Academic and social performance of the college students , which reported that PMS influenced academic and social activities .With regard to the academic performance of PMS, (77.9%) of the respondents failed to concentrate on their classroom , (64.5%) failed to carry out their homework and (61.1%) were absent from class.¹⁴ Another study done in Saudi Arabia reported that performance impairment like poor concentration in class (48.3%), daily home chores (41.6%) and homework tasks (36%). It is predictable that these students suffering from PMS after graduating and getting a job, would be periodically absent at work and have reduced productivity.¹⁵

CONCLUSION

The study was conducted with the purpose to assess knowledge, attitude, experience and management on premenstrual syndrome among secondary level adolescent girl students of Kritipur municipality. PMS is a prevalent yet undertreated, disorder among girl students of secondary school which adversely affected their academic and social performance. This study found that majority of the respondents had very poor knowledge on premenstrual syndrome and all of the respondents had negative attitude towards premenstrual syndrome. The prevalence of PMS among the female students of higher secondary level was found to be high.

ACKNOWLEDGEMENTS

Author would like to thanks to all the participants of the study, Kritipur municipality, department of public health, Hope international college, and all peoples who directly and indirectly helped during the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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