FREQUENCY OF PREMENSTRUAL SYNDROME IN WORKING WOMEN VS HOUSEWIVES IN PESHAWAR

Transcription

1 ORIGINAL ARTICLE FREQUENCY OF PREMENSTRUAL SYNDROME IN WORKING WOMEN VS HOUSEWIVES IN PESHAWAR Musarrat Jabeen, Fouzia Gul Department of Obstetrics and Gynecology, DHQ Women and Children Hospital, KUST Institute of Medical Sciences, Kohat (Pakistan) ABSTRACT Objective: To find out the frequency of premenstrual syndrome (PMS) in working women Vs housewives/women working in their own houses in Peshawar. Material and Methods: This prospective study was carried out at Postgraduate Medical Institute, Peshawar in the year -, on 2 women ( working women and house wives/women working in their own houses) meeting the criteria. Their daily prospective symptoms were recorded on a menstrual chart administered to them for three consecutive months. One housewife withdrew by the third month from the study because she got pregnant. Diagnostic and Statistical manual criteria () was used for the diagnosis of PMS. Results: In this study, % (/) of working women and 2.2% (2/) of housewives had PMS. In working women the predominant symptoms were tension and irritability (.2%) followed by fatigue (.%) and depression (.2%) while in house wives fatigue was at the top i.e. 7%, followed by depression (2%) and anxiety (%). More severe symptoms occurred in.% of working women and in 2 of house wives. About.% (n=7/) of working women and % (n=/2) housewives/women working in their own houses were unmarried. Around.% of working women and of house wives had dysmenorrhea. Analgesics and antidepressants were the most commonly used drugs. Conclusion: The frequency and severity of PMS is more common in working women as compared to housewives, probably due to more stressful life. Key words: Premenstrual Syndrome, Working Women, Housewives. INTRODUCTION has been classified in the Diagnostic and Statistical Manual (D.S.M.) of Mental Disorders Premenstrual syndrome (PMS) is defined th as the recurrence of psychological and physical ( ed) as "depressive disorder not otherwise symptoms in the luteal phase, which remit in the specified," emphasizing emotional and cognitive- follicular phase of the menstrual cycle. Somatic behavioral symptoms. For the symptoms to be symptoms of premenstrual syndrome include considered to represent the premenstrual syndrome, bloating, fluid retention, weight gain, mastalgia, it is necessary that some impediment be reported abdominal discomfort, pain, lack of energy, with regard to routine activities at work, at school headache, and exacerbations of chronic illnesses or in social activities. It is estimated that up to. such as asthma, allergies, epilepsy, or migraine. million women in the United Kingdom experience Commonly reported affective changes are such severe symptoms that their quality of life and dysphoria, irritability, anxiety, tension, aggression, interpersonal relationships are greatly affected. depression, feelings of being unable to cope, and a Over % of these women will seek medical 2, sense of loss of control. PMS is a common cyclic 7 treatment. As the non-specific symptoms of PMS disorder of young and middle-aged women. Up to may overlap with psychiatric, endocrine, medical percent of menstruating women report having or gynecologic disorders, therefore it is necessary one or more premenstrual symptoms, and 2 to to differentiate PMS from other major mood and % report disabling, incapacitating symptoms. The physical disorders. Etiology of PMS is not clearly severe form of premenstrual syndrome is called as known and is probably multifactorial and premenstrual dysphoric disorder (PMDD). PMDD speculative, attributing to hormonal changes, 2

2 FREQUENCY OF PREMENSTRUAL SYMPTOMS (PMS) IN WORKING WOMEN & HOUSEWIVES were entered in the study in a random order without stratification of date. Inclusion criteria; 7 Apparently healthy woman with history of no major 7 medical or surgical illness, with regular menstrual With PMS 7 cycles, both married or unmarried and ranging in age Without PMS from - years. Total 2 Exclusion criteria: 2 Women were excluded from the study if they were pregnant, lactating, desired a new pregnancy, or Working women Housewives were taking contraceptive pills or injections, if they Fig had irregular menstrual cycles or if their cycles were neurotransmitters ( Serotonin, dopamine, the beyond 2- days in length. endorphin and cofactor for their production --- Women were also excluded if they met diagnostic pyridoxine), prostaglandins, diet, drugs, and,, criteria for a major psychiatric illness other that late lifestyle. This may be the reason that there were luteal phase dysphoric disorder or were taking as many as 27 different treatments for PMS psychoactive medications. available. Research is going on to study the causes and various management options of PMS. Patients were not accepted for the study if they were unwilling to take adequate alternative precautions to PMS leads to substantial impairment in prevent pregnancy occurring during the study. n o r m a l d a i l y a c t i v i t i e s a n d o c c u p a t i o n a l productivity and significantly increased work A proforma along with a menstrual chart absenteeism. As working women are under was prepared in which all the detail of history, immense physical and psychological pressures, general biodata of the patient and premenstrual there is a possibility that various effects of PMS symptoms were carefully recorded. may be more common in working women as Their daily prospective symptoms were compared to housewives. This study was recorded on a menstrual chart which was given to c o n d u c t e d t o f i n d o u t t h e f r e q u e n c y o f them for three consecutive months. By the end of premenstrual tension syndrome in working women third month, all the proformas, which had been Vs housewives/women working in their own distributed among the women, were collected and houses in Peshawar. statistical analysis was made. The patients kept MATERIAL AND METHODS daily record of their symptoms on the menstrual chart. Apart from the pre-study visit, women were This prospective study was carried out in advised to visit the O.P.D. twice during each the Department of Obstetrics and Gynaecology A menstrual cycle, thus a total of seven visits were Unit of Post Graduate Medical Institute, Peshawar made by the patients. No biochemical test was (NWFP) in the year -. performed on the patients. D.S.M criteria (Diagnostic and Statistical manual of mental Total of 2 educated women were th disorders. ed from American Psychiatric included in this study, from women working in Association () was used for the diagnosis of o f f i c e s w h i l e w o m e n, w e r e h o u s e PMS in this study. The number of patients with wives/women working in their own houses. PMS and severity of their symptoms, from both Women who agreed were counseled for the study the groups were compared, assessed and statistical in OPD, Gynae wards and in their houses. Patients data was prepared. STATUS OF EDUCATION IN WOMEN WITH PREMENSTRUAL SYNDROME (PMS) Matric F.A / F.Sc Level of Education B.A / MBBS or equivalent M.A. / Post Graduate Working Women with PMS (n=) 2 Table.%.%.2%.% House Wives with PMS (n=2) 2 2%

3 ASSOCIATED DYSMENORRHEA IN THE PATIENTS WITH PREMENSTRUAL SYNDROME Dysmenorrhea Working Women House Wives No Dysmenorrhea Mild Dysmenorrhea Moderate Dysmenorrhea Severe Dysmenorrhea (n=) Table 2 RESULTS Out of married working women, ( 2. % ) w o m e n h a d s a t i s f a c t o r y m a r i t a l This study was conducted on 2 women, relationship and (2%) had unsatisfactory marital from working class while women were relationship while (.2%) woman was widow house wives/ women working in their own houses. One patient withdrew by the third month from the and (.2%) woman was divorced. Similarly, out study because she got pregnant. She was a of 2 married house wives/ housewives/women housewife and was practicing barrier method for working in their own houses, (7.%) women contraception for the last 2½ yrs. Thus the data had satisfactory marital relationship and was made between working women and (.%) had unsatisfactory marital relationship house wives/ women working in their own houses. while (.7%) woman was widow. So amongst the married women, 2.% of working women and Out of total working women % 7.% of the house wives were living satisfactory (/) were diagnosed as cases of PMS while lives. In unsatisfactory women, those women were only 2.2% (2/) housewives had premenstrual included whose husbands had other wives or syndrome (Figure ). The ratio between these two multiple partners. The percentage of divorced groups of patients is approximately 2:. women was.2% in working class, which is quite In this study, 2.% (n=/) of working high while no divorced patient was found in the women and 2% (n=7/2) of house wives were in house wives, but we could not know exactly the age group of - 2 Years,.2% (n=2/) whether they got divorced during their working of working women and (/2) of housewives period or they started jobs after getting divorced. were from 2 - years of age while 2. No significant difference was noted (/) of working women and 2% (7/2) of amongst the patients regarding their level of house wives were in the age group - years. education (table ). In this study women below Out of working women, (.%) matriculation were not included so that they could were married and 7 (.%) were unmarried. Out fill the menstrual chart properly which were given of 2 housewives/women working in their own to them for months. Around.% of working houses, 2 () were married and (%) were women and of house wives had dysmenorrhea unmarried. Hence PMS was more common in as well, although the dysmenorrhea was of mild u n m a r r i e d w o r k i n g w o m e n a n d m a r r i e d severity in majority of cases (Table 2). Mean housewives/women working in their own houses. length of the cycles of working women was 2 HISTORY OF CONTRACEPTION IN PATIENTS WITH PREMENSTRUAL SYNDROME Types of Contraception No Contraception Safe Method Withdrawal Barrier I.U.C.D. Permanent.%..%.2% Working Women (n=) 7 7 Table 2.7%.7%.2%.2%.% 7.7% (n=2) (n=2) 2 House Wives % % % 2% % 2% 2% %

4 SYMPTOMS IN PATIENTS WITH PREMENSTRUAL SYNDROME Working Women (n=) Symptoms Tension or Irritability Fatigue Depression Difficulty in Concentration Bloated feeling Anxiety Decreased efficiency Pain, Headache, Or Backache No. days and mean length of the cycles of house wives was 2 days. It can be seen that only women were using contraception among house wives while 7.% working women were on contraception (Table ). Patients who were using hormonal contraception were not included in the study because of the interference of hormones with ovulation. Hypertension was the most common (.2%, n=7/) associated illness in the family among working women group, followed by epilepsy (.%) and schizophrenia (.%). In house wives, hypertension (2%) and heart diseases (2%) were the commonest associated family illnesses, followed by cirrhosis () and Moderate with two dysphoric symptoms Severe with three dysphoric symptoms Extreme with more than three dysphoric symptoms Out of the 7 patients, majority was using analgesics to alleviate their aches and pains but a few patients from working class were found to be neurosis (). on danazol and diuretics also. Most of the patients from both the groups were using antidepressant Table shows that in working women the therapy also as 7% from working group and 2 predominant symptoms were tension and from house wives were taking anxiolytic and irritability (.2%) followed by fatigue (.%) and depression (.2%) while in house wives fatigue was the commonest symptom (7%), followed by depression (2%) and anxiety (%). But most of the patients had more than one symptom. Patients were divided on symptoms severity into groups as Mild with one dysphoric symptom %Age.2%.%.2% %.%. Table Fatigue Depression Anxiety Bloated feeling Symptoms were of mild severity in 2.7% of working women and in 2 % of housewives (Table ). More severe symptoms occurred in.% of working women with PMS and in 2 of house wives with PMS. Overall 2% of working women and.% of housewives had severe PMS. antidepressant (Table ). Majority of the patients were taking multiple drugs e.g. patients were taking analgesics as well as antidepressants at the same time. DISCUSSION House Wives (n=2) Symptoms Decreased Efficiency Pain, Headache, Backache Tension Difficulty in concentration No. %Age Premenstrual syndrome is characterized of various emotional and physical symptoms in young females. In our study % of working women and DISTRIBUTION OF PATIENTS ACCORDING TO SYMPTOMS SEVERITY Severity of Symptoms Working Women House Wives Mild Moderate Severe Extreme (n=) 7 2 Table 2.7% 2.2% 7.7%.% (n=2) 2 2% 2% 7% 2% % 2 2% 2% 2%

5 TREATMENT MODALITIES AMONGST THE PATIENTS FROM BOTH CLASSES Medication No - Treatment Analgesics Anxiolytics/antidepressants Diuretics Danazol Multivitamin + Calcium supplement Working Women (n=) Table 2.2% of housewives/women working in their Similarly symptoms of PMS have adverse effects own houses had premenstrual syndrome. These on work output as well, putting more pressure on figures are favouring other Pakistani studies the working women. Women with PMS have - reporting PMS in -% of women. However reported reduced work productivity and greater our study was a hospital based study and the,2 number of work days missed for health reasons. results are not representative of population. In our study, 2% of working women and Population based studies have shown different.% of housewives had severe PMS. If we prevalences of PMS in the world, ranging from analyze women with PMS only, more severe to %, according to the diagnostic criteria utilized, symptoms occurred in.% of working women and the place where the study was conducted. A with PMS and in 2 of house wives with PMS. number of valid and reliable diagnostic instruments Tabassum S et al had severe symptoms in.7% are available to document symptoms in PMS and of cases. Premenstrual dysphoric disorder, the PMDD, including the Calendar of Premenstrual 7 severe form of premenstrual syndrome affects to Experiences, the Premenstrual Syndrome Diary, 2 percent of women of reproductive age. It can be and the Daily Record of Severity of Problems. seen in our study that patients with severe degree We used the daily diary record of the symptoms of symptoms were from the working class. Perhaps for three consecutive months so that cycle-to-cycle this class can report their symptoms well than the variability can be examined. The diary of house wives who experience the same symptoms symptoms is helpful in proper diagnosis of PMS as but are unable to report them properly. Severity of many women may be found to have nonluteal PMS is also related with the general ill health and symptom patterns. The three key elements of the poor work output. Lustyk MKB et al reported that diagnosis are symptoms consistent with PMS, women with high PMS had significantly more consistent occurrence of symptoms only during the stress and poorer quality of life than women with luteal phase of the menstrual cycle, and negative 2 low PMS. impact of symptoms on function and lifestyle. Premenstrual syndrome is a common In this study PMS was more common in disorder of women of reproductive age. In our women working in offices (%) as compared to study,.2% of working women and of housewives or women working at home only housewives were from 2 years of age. (2.2%). This observation is negating findings 2 Although there was no significant age difference in from Deuster PA et al who reported that there the two groups, these findings support the was no difference in symptoms of PMS between evidence that PMS symptoms typically beginning the women who worked outside of the home and between the ages of 2 and years. Freeman EW those who did not. However there is no doubt that 2 et al reported that the younger women reported women working in offices in our set up are under more symptoms while seeking medical treatment great social and cultural pressures which may for PMS. This may be due to the fact that the affect the health status of the working women. younger women are experiencing a time when Hourani LL found that a high level of job stress is 27 the most significant predictors of premenstrual PMS is discussed to a much greater extent. 2 symptoms. Generally stressful life context is In this study, no significant difference more influential in the experience of perimenstrual between the two groups was noted regarding age, symptoms than episodes of stressful experiences socioeconomic condition, level of education, 22 during a particular menstrual cycle phase. history of contraception, dysmenorrhea and marital.7%.% 7.7%.77%.% (n=2) 2 House Wives % 2 2%

6 relationship etc. However, PMS was more common Various hormonal and nonharmonal agents are in unmarried working women as.% of working being used in PMS and many more agents are women with PMS were unmarried and only % being evaluated for the future use in PMS. of housewives/women working in their own houses, with PMS were unmarried. It might be that CONCLUSION due to carrier building, working women get The frequency and severity of PMS is married later than the house wives and perhaps more common in working women as compared to this may be the real cause of increased frequency housewives. In this study, no significant difference in the working class because it has been reported between the two groups was noted regarding age, that mentally unstable and unsatisfied women are socioeconomic condition, level of education, more prone to the cyclical ovarian hormone 2 history of contraception, dysmenorrhea and marital changes. relationship. Symptoms of PMS are more common In working women the highest incidence from 2- years of age in both groups. However, was of tension or irritability (.2%) followed by PMS was more common in unmarried working fatigue (.%) and depression (.2%), while in women as compared to unmarried women confined house wives fatigue (7%) was at the top followed to houses. The common most symptoms of PMS in by depression (2%) and then anxiety (%). More working women were tension/irritability, fatigue than 2 symptoms have been associated with and depression and in house wives were fatigue, PMS, but irritability, tension, and dysphoria are the depression and anxiety. 2 most prominent and consistently described. In a local study, order of frequency of symptoms Limitation of study: This was a hospital based occurring in PMS was general body discomfort, study and the findings are not the true anxiety, backache, fatigue and depression. representation of the population. A large scale Cramps, backaches, fatigue, and tension are most population based study is required to identify the prevalent during the menstruum; weight gain, skin prevalence of PMS in working women and disorders, painful breasts, swelling, irritability, housewives. mood swings, and depression are more prevalent in the premenstruum. REFERENCES. Wyatt K, Dimmock P, Jones P, Obhrai M, Dysmenorrhea is a common menstrual O'Brien S. Efficacy of progesterone and d i s o r d e r i n w o r k i n g w o m e n a l t h o u g h progestogens in management of premenstrual dysmenorrhea is not considered a part of PMS. syndrome: Systematic review. Br Med J However in our study there was no significant 2;2:77. difference regarding dysmenorrhea between working women and housewives. Almost all the patients from both groups had dysmenorrhea also, and perhaps the most common misdiagnosis of PMS is that of dysmenorrhea but the actual reason for this confusion is the inadequate history of the patient, otherwise they are different entities. 2. Smith R, Studd J. Premenstrual syndrome. Clin Rev Gynaecol ;-7. The commonest drugs used by both groups w e r e a n a l g e s i c s f o l l o w e d b y a n x i o l y t i c s /antidepressants. Treatment goals for PMS are to ameliorate or eliminate symptoms, reduce their impact on activities and interpersonal relationships and minimize adverse effects of treatment. N o n p h a r m a c o l o g i c m e a s u r e s a n d d i e t a r y supplements have been tried for relieving the symptoms of PMS. The American College of Obstetricians and Gynecologists (ACOG) recommends selective serotonin reuptake inhibitors (SSRIs) as initial drug therapy in women with severe PMS and PMDD. Anxiolytic agents such as alprazolam is not recommended because of addictive potential, tolerance, and significant side effects. Analgesic like Naproxen sodium and Mefanamic acid improves various physical symptoms and headache in women with PMS.. Chuong CJ, Coulam CB. Current views and the beta-endorphin hypothesis. In: Gies LH, Kase NG, Berkowith C, Eds. The premenstrual syndromes. New York: Churchill Livingstone, :7-.. Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual Syndrome. American Family Physician 2; 7: O ' B r i e n P M. H e l p i n g w o m e n w i t h premenstrual syndrome. Br Med J ;7: 7-.. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number, April 2. Premenstrual syndrome. Obstet Gynecol 2;:-. 7. Hylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med 7

7 ; : -2.. Kessel B. Premenstrual syndrome. Advances in. diagnosis and treatment. Obstet Gynecol Clin Chakmakjian ZH. A critical assessment of North Am 2;27: 2-. therapy for the premenstrual tension syndrome. J Reprod Med ; 2: Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with. Dean BB, Borenstein J E. A prospective premenstrual syndrome. Arch Fam Med assessment investigating the relationship ;(2):22-. between work productivity and impairment with premenstrual syndrome. J Occup 2. Hourani LL, Yuan H, Bray RM. Psychosocial Environment Med 2; :-. and lifestyle correlates of premenstrual symptoms among military women. J Womens. Akmal N, Akhtar N, Attique R, Raana G. Health (Larchmt). 2; (7):2-2. Prevalence of premenstrual syndrome in Pakistani women. J Pak Med Assoc. ; 22. Woods NF, Most A, Longenecker GD. Major ():-. life events, daily stressors, and perimenstrual symptoms. Nurs Res ; ():2-7.. Tabassum S, Afridi B, Aman Z, Tabassum W, D u r r a n i R. 2. Borenstein JE, Dean BB, Endicott J, Wong J, Premenstrual Syndrome: and Brown C, Dickerson V, Yonkers KA. Health severity in young college girls. J Pak Med and economic impact of the premenstrual Assoc 2;(2):-. syndrome. J Reprod Med 2;(7): Shershah S, Morrison J, Jafarey S. Prevalence 2. Grady-Weliky TA. Premenstrual Dysphoric of premenstrual syndrome in Pakistani women. Disorder. N Eng J Med 2;: -. J Pak Med Assoc ;:- 2. Lustyk MKB, Widman L, Paschane A, Ecker. Akmal N, Akhtar N, Attique R, Raana G. E. Stress, Quality of life and physical activity Prevalence of pre-menstrual syndrome in i n w o m e n w i t h v a r y i n g d e g r e e s o f young girls. Ann King Edward Med Coll 2; premenstrual symptomatology. Women & 2(2):27-. Health 2; ():.. Deuster PA, Adera T, South-Paul J. Biological, 2. Freeman EW, Rickels K, Schweizer E, Ting T. social, and behavioral factors associated with Relationships between age and symptom premenstrual syndrome. Arch Fam Med severity among women seeking medical ;(2):22-. treatment for premenstrual symptoms. Psychol Med ; 2(2):-.. Wittchen HU, Becker E, Lieb R, Krause P. Prevalence, incidence and stability of 27. Silva CM, Gigante DP, Carret ML, Fassa AG. premenstrual dysphoric disorder in the Population study of premenstrual syndrome. community. Psychol Med 22; 2():-2. [Article in Portuguese]. Rev Saude Publica 2; ():7-.. Mortola JF, Girton L, Beck L, Yen SSC. Diagnosis of premenstrual syndrome by a 2. Freeman E. Prevalence and Risk Factors of simple, prospective, and reliable instrument: Premenstrual Syndrome. Clin Adu Psychiatric The Calendar of Premenstrual Experiences. Disorder ; 7:-. Obstet Gynecol ;7: Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int 7. Thys-Jacobs, Alvir JMJ, Fratarcangelo P. Clin Psychopharmacol 2;(suppl ):S-7. Comparative analysis of three PMS assessment i n s t r u m e n t s : T h e i d e n t i f i c a t i o n o f. Woods NF, Most A, Dery GK. Prevalene of premenstrual syndrome with core symptoms. perimenstrual symptoms. Am J Public Health Psychopharmacol Bull ;: -. 2; 72():27-.. Endicott J, Nee J, Harrison W. Daily Record. Lori BG, Grace L; Susan RS, James HY. of Severity of Problems (DRSP): reliability Menstrual disorders and occupational, stress, and validity. Arch Womens Ment Health. 2; and racial factors among military personnel. J ():-. Occup Environ Med 2; 2:7-. Address for Correspondence: Dr Musarrat Jabeen Gynecologist & Asstt Prof Department of Obstetrics and Gynecology, DHQ Women and Children Hospital, KUST Institute of Medical Sciences, Kohat (Pakistan)