A STUDY ON THE PREVALENCE OF PREMENSTRUAL SYNDROME AND ITS RELATIONSHIP WITH ANTHROPOMETRIC INDICES

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1 TJPRC: International Journal of Pharmacology and Physiology (TJPRC: IJPP) Vol. 1, Issue 1, Jun 2015, TJPRC Pvt. Ltd. A STUDY ON THE PREVALENCE OF PREMENSTRUAL SYNDROME AND ITS RELATIONSHIP WITH ANTHROPOMETRIC INDICES KAVITHA. P 1 & SHANMUGHAVADIVU. R 2 1 Research Scholar, Department of Physiology, Coimbatore Medical College, Coimbatore, Tamil Nadu, India 2 Additional Professor, Department of Physiology, Coimbatore Medical College, Coimbatore, Tamil Nadu, India ABSTRACT Background Premenstrual syndrome[pms] is a common serious problem characterized by a set of physical, cognitive, affective and behavioral symptoms that occur cyclically during luteal phase of menstrual cycle and resolve quickly within few days of onset of menstruation. Cause for PMS remains undetermined, however combination of cyclical ovarian activity together with the effect of oestradiol and progesterone on the neurotransmitters serotonin and GABA appear to be key factor. Obesity is one of the risk factor for PMS Aim and Objective To determine the prevalence of Waist hip ratio, Waist height ratio. PMS, and its relationship with anthropometric indices like Body Mass Index, Materials and Methods A Cross sectional study was conducted on first year students of a college after obtaining oral consent.study period was February to April female students having regular menstrual cycle were included. Irregular menstrual cycle, diabetes, heart disease, psychiatric disease, any drug intake were excluded. Data was collected using selfadministered structured questionnaire along with weight, height, waist circumference, hip circumference.bmi was calculated by using Quetelet s index. Results The present study shows prevalence of PMS was about 74.4%. Statistical analysis was done using Fischer Exact test. There was no significant relation between PMS and BMI,PMS and WHR,PMS and WHTR. Conclusion In this study it was found that there is no significant relationship between PMS and obesity. Reason for the PMS in these cases may be the levels of oestradiol and progesterone in the luteal phase which affect the neurotransmitters serotonin and GABA. This high prevalence of PMS requires attention. Reproductive health education should be introduced into school and college health education curriculum which will help the young students in getting information, education and support regarding reproductive health. KEYWORDS: Premenstrual Syndrome, Anthropometric Indices, BMI, Waist Hip Ratio, Waist Height Ratio

2 28 Kavitha. P & Shanmughavadivu. R INTRODUCTION Premenstrual syndrome[pms] is a common serious problem characterized by a set of physical, cognitive, affective and behavioral symptoms that occur cyclically during luteal phase of menstrual cycle and resolve quickly within few days of onset of menstruation(dr.swati,2014,anandha Lakshmi S. Priy M,2011). It occurs 7-14 days prior to onset of menstruation (Howkins, 2005). WHO prevalence of Premenstrual syndrome 47.8%, Epidemological surveys have estimated that about 75% of reproductive age group experience some symptoms attributed to premenstrual phase of menstrual cycle. Prevalence of Premenstrual syndrome in reproductive age group is about 30-40%. Premenstrual syndrome affects the interpersonal relationship, social interaction, work performance, emotional well-being and overall health related quality of life (Dr. Swati, 2014). Nowadays development of obesity in adolescent has increased from 5% to 18.1% (Dr.Swati, 2014). It is mainly due to fast food intake and unhealthy food pattern. Obesity was measured by anthropometric indices like Body Mass Index(BMI), Waist hip ratio(whr), Waist height ratio(whtr). Adolescents with high Body Mass Index(BMI) are susceptible to metabolic, functional, clinical and social problems. Waist height ratio(whtr) is an important indicator because it does not depends on age, sex and ethinicity(rafia Bano). Aim and Objective To determine the prevalence of PMS, and its relationship with anthropometric indices like Body Mass Index, Waist hip ratio, Waist height ratio. MATERIALS AND METHODS This cross sectional study was conducted between February to April 2015 in first year MBBS students. Data was collected using self-administered structured questionnaire for 95 female students after obtaining informed oral consent. The questionnaire included personal, socio-demographic profile, dietary history, birth history, medical history, menstrual history, premenstrual symptoms, Detailed menstrual history was taken which include age of menarche, duration of menstrual cycle, menstrual flow, details of premenstrual symptoms include occurrence of pain, nervous tension, mood swings, irritability, anxiety, depression, forgetfulness, confusion, dizziness, insomnia, weight gain, abdominal bloating, fatigue & weakness, nausea & vomiting, breast tenderness, headache & backache, food craving and palpitation(dr.swati,2014).90 female students having regular menstrual cycle were included. Irregular menstrual cycle, diabetes, heart disease, psychiatric disease, any drug intake were excluded..bmi was calculated according to WHO Classification. According to current American Psychiatric Association (DSM-IV) Diagnostic criteria for Premenstrual syndrome requires atleast 5/11 specific symptoms including one major mood symptom (Dr. Meir Steiner, 2000, Khairani Omaet al.2009,.michael P Wakeman2003).Weight was measured by standard weighing machine, Height was measured by stadiometer, Waist circumference was measured inbetween lower rib and iliac crest. Hip circumference was measured at the greatest protuberance of buttock. Waist hip ratio(whr) and Waist height ratio(whtr) were calculated Table 1: WHO Classification of Body Mass index BMI (Kgs/m 2 ) Classification < 18.5 Under Weight Normal Weight

3 A Study on the Prevalence of Premenstrual Syndrome 29 and its Relationship with Anthropometric Indices Results Over Weight >30 Obesity Figure 1 shows that prevalence of PMS in this study among first year students 74.4% Figure 1: Distribution of Premenstrual Syndrome Table 2 shows that 72.7% of underweight students had premenstrual syndrome, 74.6% of normal weight students had premenstrual syndrome, 75% of overweight students had premenstrual syndrome. It shows that there was an increased prevalence of premenstrual syndrome in all BMI groups. But there was no statistical association between premenstrual syndrome and Body Mass Index. Table 3 shows that 74.6% of students with a WHR of <0.8 had premenstrual syndrome, 70% of students with a WHR of had premenstrual syndrome, % of students with a WHR of >0.9 had premenstrual syndrome. It shows that there was an increased prevalence of premenstrual syndrome in all WHR groups. But there was no statistical association between premenstrual syndrome and WHR Table 4 shows that 73.2% of students with a WHtR of < 0.5 had premenstrual syndrome. 87.5% of students with a WHtR 0.5 had premenstrual syndrome. But there was no statistical association between premenstrual syndrome and WHtR Table 2: Relationship Between Body Mass Index and Premenstrual Syndrome BMI BMI versus PMS PMS Absent Present Under weight Count % within BMI 27.3% 72.7% 100.0% Normal Count % within BMI 25.4% 74.6% 100.0% Over weight Count % within BMI 25.0% 75.0% 100.0% Count % within BMI 25.6% 74.4% 100.0% Fischer Exact Test , p-value

4 30 Kavitha. P & Shanmughavadivu. R Table 3: Relationship Between Waist Hip Ratio and Premenstrual Syndrome WHR WHR versus PMS PMS Absent Present <0.8 Count % within WHR 25.4% 74.6% 100.0% Count % within WHR 25.0% 70.6% 100.0% >=0.9 Count % within WHR 33.33% 66.67% 100.0% Count % within WHR 25.6% 74.4% 100.0% Fischer Exact Test 0.186,p-value > 0.05 Table 4: Relations Hip between Waist Height Ratio and Premenstrual Syndrome WHtR WHTR * PMS PMS Absent Present <0.5 Count % within WHtR 26.8% 73.2% 100.0% >=0.5 Count % within WHtR 12.5% 87.5% 100.0% Count % within WHtR 25.6% 74.4% 100.0% Fisher s exact test , p-value DISCUSSIONS The following Reasons may be attributed for the high prevalence of PMS Oestradiol and progesterone level in the luteal phase which affect the neurotransmitters serotonin and GABA. Increased carbohydrate intolerance in the luteal phase Pyridoxine deficiency-this vitamin play a role in oestrogen synthesis, dopamine & serotonin production Increased production of Vasopressin, Aldosterone, Prolactin & systemic prostaglandins adversely affecting renal function and contributing to fluid retention and bloating Fluctuation in the opiate peptide concentration affecting endorphin levels It is not clear whether PMS is an abnormal response to normal hormonal fluctuations or whether hormonal imbalances could lead to premenstrual syndrome.(elizabeth R. 2010, Howkins,2005). CONCLUSIONS Statistical analysis was done using Fischer Exact test. There was no significant relation between premenstrual syndrome(pms) and BMI,PMS and WHR,PMS and WHtR (Rafia Bano). But there was a high prevalence of premenstrual syndrome74.44% (Chang AM, 1995, Nour Mohammad Bakhshani.April2009). Reproductive health education should be introduced into school and college health education curriculum which will help the young students in getting information, education and support regarding their reproductive health. Mood changes due to hormonal fluctuation should be explained

5 A Study on the Prevalence of Premenstrual Syndrome 31 and its Relationship with Anthropometric Indices in health programmes because most of the suicidal tendency is common in luteal phase of menstrual cycle. Incorporation of exercise programs into the female secondary school and university programs should be encouraged (Mona Abd El-Rahim Elnagar et al,january, 2015,Apollo james et al, July-August 2014). REFERENCES 1. Elizabeth R. Bertone-Johnson,Susan E.Hankinson.Adiposity and Development of Premenstrual Syndrome,Journal of women s Health, (2010), Vol.19,Number 11, , Rafia Bano,Khairiyah Ahmad AI Mulyhan.Study on the Prevalence of Premenstrual syndrome and its relationship with Age at menarche,anthropometric Measure and Anemia,IJIRSE,ISSN(Online) Dr.Swati,Dr.Manisha Jindal,Cross -Sectional Study of Abnormal Body Mass Index As A Risk Factor for Premenstrual Syndrome In Adolescent Girls of NCR,NJIRM,(2014); Vol. 5(4), eissn: pissn: Anandha Lakshmi S. Priy M, Saraswathi I. Prevalence of Premenstrual Syndrome and Dysmenorrhoea among Female Medical Students and its Association with College Absenteeism, Int J Biol Med Res(2011): 2(4): Dr.Meir SteinerPremenstrual Syndrome and Premenstrual dysphoric disorder: guidelines for management J Psychiatry Neurosci,(2000);25(5): Mona Abd El-Rahim Elnagar,Howida Abu Ellife Mohamed Awed. Self Care Measures Regarding Premenstrual Syndrome among Female Nursing Students, International Journal of Nursing Didactics, (January, 2015): 5 (1), 7. Howkins and Bourne, Shaw s text book of Gynaecology,Elsiver,13 th Edition,(2005) Chang AM, Holroyd E, Chau JP. Premenstrual syndrome in employed Chinese women in Hong Kong. Health Care Women Int,(1995).; 16: Nour Mohammad Bakhshani,Prevalence and severity of premenstrual symptoms among Iranian female university students. J Pak Med Assoc.(April2009); Vol. 59, No Khairani Omar,Sitis. Mohsin, Muthu Palaniappen, Leelavathi,Idayu Badilla Idris,Rahmah M. Amin,Sham Sudin Khadijah Premenstrual Symptoms And Remedies Practiced By Malaysian Women Attending A Rural Primary Care Clinic. Afr J Prm Health Care Fam Med.(2009).1(1), Art. #18, 5 pages. DOI: /phcfm.v1i Apollo James Neethu Ros Tom, Greeshma Hanna Varghese, Swetha Lakshmi, T.R. Ashok Kumar,T.Sivakumar. Pre Menstrual Syndrome: Different Approaches of Management, Int. J. Pharm. Sci. Rev. Res., (July-Augest 2014). 27(1); Article No. 66, Pages: Michael P Wakeman. an open-label pilot study to assess the effectiveness of krill oil with added vitamins and phytonutrients in the relief of symptoms of PMS; Nutrition and Dietary Supplements 2013:5

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