Premenstrual syndrome and premenstrual dysphoric disorders among Jordanian women

Barriers to Diagnosis and Treatment for Premenstrual Dysphoric Disorder (PMDD): A Scoping Review

Premenstrual dysphoric disorder (PMDD) is a significant public health challenge. While research has increased over the past decade, barriers to PMDD diagnosis and treatment persist. This paper explores the global barriers to diagnosis and treatment for PMDD. A scoping review of the literature was performed using the PubMed, PsycINFO, and CINAHL Plus databases to compile existing data on barriers to PMDD diagnosis and treatment. Eligibility criteria for articles included original research published within the last 10 years, written in English, and focused on PMDD with explicit assessment of at least one barrier to diagnosis and/or treatment. Findings were organized into four domains: individual, medical, cultural, and structural barriers. At the individual level, barriers include internalized norms and stigma that deter help-seeking; medical trauma and mistrust; feelings of fear, shame, self-blame, and confusion; and diminished autonomy and increased side effects from prescribed PMDD treatments. Medical barriers include limited provider knowledge, nonadherence to diagnostic and treatment guidelines, and negative patient-provider interactions. Cultural barriers include reproductive and mental health stigma; gender and cultural norms; and cultural preferences for alternative medicine that reduce access to pharmacological treatment. At the structural level, barriers include fragmented healthcare and limited access to health services. These findings highlight the many diagnostic and treatment barriers for individuals living with PMDD, underscoring the need for future research and intersectional approaches to improve health outcomes for this population.

Understanding premenstrual syndrome: experiences and influences among monastir university students

Menstrual health is increasingly recognized as a critical health issue by the World Health Organization, encompassing physical, psychological, and social dimensions. Approximately 1.8 billion women globally experience menstruation, with severe hormonal fluctuations leading to premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder (PMDD), which significantly affects quality of life. This study investigates PMS symptoms among university students in Monastir (Tunisia) through a descriptive cross-sectional design involving 150 participants. Data was collected via a semi-structured questionnaire, assessing sociodemographic information and PMS symptoms using the validated A-PMS diagnostic tool. Results indicated that 100 % of participants experienced PMS, with 69.3 % reporting moderate to severe physical symptoms such as fatigue and pain, while 65.3 % noted significant psychological symptoms including anxiety and mood swings. Over half of the students reported mild impacts of PMS on relationships and academic performance, with 48 % experiencing absenteeism due to symptoms. Despite the prevalence of symptoms, the majority did not seek medical help. The findings highlight the critical need for educational institutions and healthcare professionals to address PMS and implement support strategies, thereby enhancing the well-being and academic success of young women. This research underscores the importance of raising awareness and developing effective interventions for menstrual health in this population.

Premenstrual Dysphoric Disorder: A Cross-Sectional Study on Prevalence and Awareness Among Medical Students

BACKGROUND

 Premenstrual dysphoric disorder (PMDD), a severe form of PMS, has been recognized recently as a mental disorder. PMDD can present with disabling physical, mental, and psychological symptoms affecting women's daily functions. Due to its overlapping nature with other disorders, the prevalence of PMDD remains unknown. This study aimed to evaluate the awareness of PMDD among medical students and to assess the prevalence of PMDD among female students.

METHODS

 This cross-sectional study included 377 medical students from King Saud bin Abdulaziz University for Health Sciences, Jeddah. PMDD awareness was assessed using a self-developed questionnaire, and prevalence among women was evaluated with the PSST. Data were analyzed using the John's Macintosh Project software, version 10.0 (JMP Statistical Discovery, LLC, Cary, NC), with chi-square, Mann-Whitney, and Kruskal's tests, considering p < 0.05 as statistically significant.

RESULTS

 Out of 377 students, there was a significant difference in recognizing PMDD as a mental disorder between 106 female students (66%) and 51 male students (27.3%). Significantly higher PMDD awareness was observed among students in the clinical years and those with medical or mental conditions. Around 40% of the students had a positive attitude toward PMDD, believing it may require medical management. Among the 150 female medical students who met the inclusion criteria for PSST assessment to screen for PMDD, 8.7% tested positive, and this was correlated with the severity of dysmenorrhea. Anxiety/tension was the most common symptom in the PMDD group, with significant impairment in social activities and home responsibilities.

CONCLUSION

 The study demonstrated a noticeable level of awareness toward PMDD among medical students, especially among women and those in the clinical years. The association between PMDD symptoms and the severity of dysmenorrhea highlights the relationship between hormonal fluctuations and PMDD manifestations. Early detection and intervention are required to improve the quality of life for women with PMDD. Further research is recommended to assess the awareness of practitioners and the general population about the diagnosis of PMDD and to explore PMDD pathophysiology.

The reliability and validity of the Chinese version of premenstrual dysphoric disorder questionnaire for DSM-5

OBJECTIVE

Premenstrual dysphoric disorder (PMDD) seriously affects women's work and life, and early screening and diagnosis of PMDD can improve the quality of life of potential PMDD patients. The Premenstrual Dysphoric Disorder Questionnaire for DSM-5 (CTDP-DSM-5) is a validated screening tool for PMDD based on the DSM-5. This study intends to conduct reliability testing and validity evaluation of the scale after translation and revision in Chinese women.

METHODS

669 Chinese female college students were evaluated by a set of questionnaires including the Chinese version of CTDP-DSM-5 (CTDP-C), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Premenstrual Symptoms Screening Tool (PSST).

RESULTS

CTDP-C is a bi-dimensional screening instrument with 25 items. The factor structure of the CTDP-C fits well to the factor model of the original Spanish version (CFI = 0.957; TLI = 0.953; RMSEA = 0.036; χ2 = 5983.585, df = 300, p < 0.0001). The McDonald's omega reliability index obtained in this study was good (0.8) for both dimensions. In terms of convergent validity, the CTDP-C is significantly positively correlated with PSST (r = 0.533, p < 0.01). Furthermore, the instrument correlates positively with depression and anxiety. Finally, the CTDP-C scores can sensitively differentiate depressed from non-depressed patients (Cohen's d = 0.72). Similarly, sensitively differentiated anxious from non-anxious patients (Cohen's d = 0.80).

CONCLUSIONS

CTDP-C has good validity and reliability and it is an effective screening tool to identify Chinese patients with PMDD among college students, providing a basis for early detection, early diagnosis and early treatment of PMDD.

Psychological stress dysfunction in women with premenstrual syndrome

Premenstrual syndrome (PMS) encompasses a range of emotional, physiological, and behavioral symptoms that occur during the luteal phase of the menstrual cycle (MC) and resolve with the onset of menstruation. These symptoms, which can include fatigue, physical pain, anxiety, irritability, and depression, significantly affect women's daily lives and overall well-being. In severe cases, PMS can progress to premenstrual dysphoric disorder (PMDD), profoundly impairing quality of life. Despite its prevalence, the neural mechanisms underlying PMS-particularly those related to stress-are not fully understood.This review aims to explore the complex interactions between PMS and stress, with a focus on the hormonal pathways involved. We propose that abnormal stress coping styles and stress reactivity patterns, collectively referred to as stress dysfunction, are crucial factors influencing women's vulnerability to PMS. We examine the relationship between PMS and stress from four perspectives: (1) PMS shares neuroendocrine metabolic circuits based on hormonal fluctuations with stress reactivity systems; (2) there is comorbidity between PMS and stress-related disorders; (3) PMS itself may act as a stressor, potentially creating a negative feedback loop that exacerbates symptoms; and (4) biofeedback training used for stress disorders may be effective in treating PMS. By providing a detailed analysis of stress-related hormonal changes and their effects on PMS, this review offers new insights into the physiological processes underlying PMS. Understanding these interactions may inform the development of targeted interventions and improve the quality of life for women affected by PMS.

Premenstrual syndrome among medical versus non-medical workers and its association with work-related quality of life

BACKGROUND

Premenstrual syndrome (PMS) is a commonly underestimated disorder that negatively impacts a woman's life. Medical workers, who live a more stressful life, may report an increased rate of PMS. Studies on the relationship between PMS and work-related quality of life for medical professionals are scarce, particularly in the Arab world. This study aimed to compare the frequency of PMS among medical versus non-medical workers at Zagazig University and to assess the association between PMS and their work-related quality of life.

METHODS

A comparative cross-sectional study was conducted. The sample population consisted of 48 medical and 48 non-medical female workers aged 18-45 years from Zagazig University. The two groups filled out a questionnaire with 3 parts: sociodemographic and occupational data, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality of Life Scale (WRQL).

RESULTS

Severe PMS was reported in 45.8% of medical workers versus 20.8% of non-medical workers with a statistically significant difference between both groups (p = 0.009). Binary logistic regression showed that being a medical worker, clinical specialty, ≥ 8 years of work, ≥ 24 working hours per week, and having a non-set hourly schedule were predictors for severe PMS. PMS was found to be a statistically significant predictor of poor WRQL (p < 0.001). There was a highly significant negative correlation between the PMS score and the WRQL score (r =  - 0.302, p < 0.001).

CONCLUSION

Among medical workers, PMS is more common and more severe, and WRQL is worse and negatively correlated with PMS. We suggest further studies with larger samples to prove this association and planning for public health programs to screen for and manage PMS among medical workers in our community.

Premenstrual Syndrome's Impact on Work-Related Quality of Life Among Jordanian Nurses

Introduction Premenstrual syndrome (PMS) is a regular clinical condition that affects most women during their reproductive years. Its related symptoms may be linked to a decrease in women's quality of life. Female nurses may be more susceptible to PMS due to the demanding nature of their job. The importance of nurses' jobs and how their quality of life will affect patients and themselves in parallel make female nurses a population that is worth investigating. Our objective is to estimate the level of PMS among Jordanian nurses and assess the potential impact of PMS on work-related quality of life among them. Methods A cross-sectional study was conducted on 210 nurses who completed a questionnaire regarding demographic data, menstrual characteristics, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality-of-Life Scale (WRQoL). The nurses were classified as having or not having PMS according to the PSST. Results The prevalence of PMS was 60.5%, the results showed a significantly lower mean WRQoL score for nurses with PMS (mean = 65.47, SD = 15.38) compared to nurses without PMS (mean = 70.54, SD = 14.47). The multivariable regression model revealed that the adjusted odds ratios for age, combined oral contraceptive pill (COCP) use, family history, severe dysmenorrhea, job and career satisfaction, and stress at work were 0.90 (95% CI = 0.84, 0.96), 5.18 (95% CI = 1.33, 20.17), 2.52 (95% CI = 1.23, 5.18), 11.78 (95% CI = 2.48, 56.02), 0.92 (95% CI = 0.85, 0.99), and 1.20 (95% CI = 1.01, 1.42), respectively. Conclusion PMS is quite prevalent among Jordanian nurses, with a negative impact on their work-related quality of life. Healthcare managers might implement special regulations for female nurses with PMS to improve their work-related quality of life. This research suggests that PMS is a substantial factor in the low work-related quality of life among Jordanian nurses.

Premenstrual syndrome severity in Turkey: a meta-analysis study

The aim of this research is to determine the severity of Premenstrual Syndrome (PMS) in Turkey through meta-analysis by examining articles that scan for PMS with Premenstrual Syndrome Scale (PMSS). In this study 25 primary studies, published between January 2012-June 2021 were examined. In these studies, attention was paid to use the same measurement tool to make a common estimation. The measurement tool used in the studies to diagnose PMS was the PMSS, which is frequently used in Turkey. Evaluations were made regarding the scores in the PMSS total and sub-domains. At the end of the meta-analysis of PMS, which is an important women's health problem in Turkey as well as throughout the world, it was identified that women living in Turkey experienced PMS at moderate severity. However, it was not overlooked that the scores in the sub-domains of PMSS were high. Moderate PMS negatively affects women's social and work lives. Knowing the PMS severity of women in a society may be important to understand and correctly evaluate women in the premenstrual period. It is thought that positive results will be received by raising awareness in women about this important health problem and conducting remedial studies.

Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

Dimensional (premenstrual symptoms screening tool) vs categorical (mini diagnostic interview, module U) for assessment of premenstrual disorders

BACKGROUND

Premenstrual syndrome (PMS) is the constellation of physical and psychological symptoms before menstruation. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS with more depressive and anxiety symptoms. The Mini international neuropsychiatric interview, module U (MINI-U), assesses the diagnostic criteria for probable PMDD. The Premenstrual Symptoms screening tool (PSST) measures the severity of these symptoms.

AIM

To compare the PSST ordinal scores with the corresponding dichotomous MINI-U answers.

METHODS

Arab women (n = 194) residing in Doha, Qatar, received the MINI-U and PSST. Receiver Operating Characteristics (ROC) analyses provided the cut-off scores on the PSST using MINI-U as a gold standard.

RESULTS

All PSST ratings were higher in participants with positive responses on MINI-U. In addition, ROC analyses showed that all areas under the curves were significant with the cutoff scores on PSST.

CONCLUSION

This study confirms that the severity measures from PSST can recognize patients with moderate/ severe PMS and PMDD who would benefit from immediate treatment.

Top 100 Cited Papers on Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Bibliometric Study

BACKGROUND

Premenstrual syndrome/premenstrual dysphoric disorder is a serious condition affecting women worldwide, causing clinically significant distress or interference. Therefore, solving these diseases has become the utmost concern worldwide, culminating in numerous studies. In this study, we performed bibliometric analysis on the 100 most cited papers with the aim of identifying research hot spots and trends in this field.

METHODS

We screened the Science Citation Index Expanded (SCIE) of Web of Science (WOS) to identify the top 100 cited studies on PMS/PMDD. Next, we analyzed relevant literature from various journals, countries/regions, institutions, authors, and keywords. Finally, we used VOSviewer and Citespace software to generate knowledge maps and identify hot spots and trends.

RESULTS

The top 100 highly cited studies were published in 55 journals, between 1999 and 2017, across 24 countries/regions around the world. Most articles were published in Obstetrics and Gynecology, whereas Psych neuroendocrinology had the largest average number of citations per paper. The United States had the highest number of publications, followed by England, Canada, and Sweden. The top three institutions that published the highly cited literature were the University of Pennsylvania, Yale University, and National Institute of Mental Health (NIMH). Obstetrics, Gynecology, Psychiatry, and Reproductive Biology were the main research directions, whereas the top 10 Co-occurrence of Keywords included double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial. Results from cluster analysis indicated that more comprehensive epidemiology and steroid pathogenesis have gradually become the hot spots and trends.

CONCLUSION

These findings demonstrated that bibliometric analysis can intuitively and rapidly reveal the frontiers and hot spots of research in PMS/PMDD. Notably, epidemiology, steroid pathogenesis, GABAA receptor delta subunits, and double-blind placebo-controlled trials are potential areas of focus for future research.

Prevalence of premenstrual syndrome and its association with psychosocial and lifestyle variables: a cross-sectional study from Palestine

Background

Premenstrual Syndrome (PMS) is a very common problem with symptoms that can negatively affect normal daily life. This cross-sectional study aimed to investigate the prevalence of PMS symptoms and their relationship with psychosocial status and lifestyle of female students at An-Najah National University in Palestine. A sample of 398 female students was randomly selected to participate in the study. Arabic Premenstrual Scale (A-PMS) was used for PMS assessment. Psychosocial variables were determined using the DASS-21 Arabic version, and dietary habits were measured using a 24 item self-reported questionnaire. Data was analyzed by one-way ANOVA and Chi-square tests using SPSS software version 23.

Results

The 398 participants (100%) suffered from some kind of PMS symptoms; 398 (100%) had physical symptoms, 397 (99.7%) had psychological symptoms, and 339 (85.2%) had behavioral PMS symptoms. All PMS symptoms were significantly associated with student psychosocial status (p < 0.01). Preferring a certain type of food during menstruation was significantly related to psychological PMS symptoms (p < 0.001), and physical symptoms (p < 0.01). Following a diet was significantly related to physical symptoms (p < 0.05) and behavioral symptoms (p < 0.001). Moreover, drinking herbal tea was significantly related to physical symptoms (p < 0.001) and behavioral symptoms (p < 0.05).

Conclusion

The findings of the study revealed a relatively high prevalence of PMS syndrome with a significant relationship with dietary habits and psychosocial status.

Premenstrual disorders among young Turkish women: According to DSM-IV and DSM-V criteria using the premenstrual symptoms screening tool

PURPOSE

This study aimed to determine the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) according to the DSM-IV and DSM-V criteria using the premenstrual symptoms screening tool (PSST) in young Turkish women aged 15-24 years.

DESIGN AND METHODS

This descriptive study included 760 Turkish female students in Izmir.

FINDINGS

The prevalence of PMS was 61.1% and 26.1 and that of PMDD was 20.4% and 10.0%, based on the DSM-IV and DSM-V criteria using PSST, respectively. In the PMDD category, the most common symptoms were anger/irritability (97.4%). PMS/PMDD prevalence is common in young women, especially in adolescents, and PMDD prevalence was alarmingly high.

PRACTICE IMPLICATIONS

Health professionals take an active role in the diagnosis and management of PMS/PMDD.

Traditional Chinese medicine on treating premenstrual syndrome and premenstrual dysphoric disorder: A protocol for systematic review and meta-analysis

BACKGROUND

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are common disorders that manifest themselves in the late luteal phase, and significantly interfere with an individual's daily activities. Clinical evidence suggests that traditional Chinese medicine (TCM) may ease PMS/PMDD symptoms. Here, we review a protocol for exploring the effectiveness and safety of TCM in PMS/PMDD management.

METHODS

We will conduct a literature search for randomized controlled trials (RCT) for TCM use in PMS/PMDD on PubMed, web of science, EMBASE, the Cochrane central register of controlled trials (Cochrane Library), Chinese national knowledge infrastructure, Chinese VIP Information, Wanfang, as well as Chinese biomedical literature database. The search included all relevant reports for up to June 1, 2020. The search results were independently analyzed by 2 reviewers who extracted the data. RCT quality will be assessed using the risk-of-bias tool. The evidence will be inspected using the grading of recommendations assessment development and evaluation (GRADE). We will utilize Stata and Revman for systematic review and meta-analysis and analysis of direct and indirect evidence.

RESULTS

Based on current evidence, this study will elucidate the rationale for the utilization of TCM in PMS/PMDD treatment.

CONCLUSION

Conclusions from this study will inform about the effectiveness and safety of TCM in PMS/PMDD management.

TRIAL REGISTRATION NUMBER

CRD42020192822.

ETHICS AND DISSEMINATION

Since all data utilized in this systematic review and meta-analysis are published, ethical approval is not needed. Additionally, in the trial of the review process, all data will be evaluated anonymously.