Reply

To the Editor: We would like to thank Dr. Naseem Qureshi for his comments and would like to respond to some of the issues raised by him. The first issue pertains to the diagnosis of premenstrual syndrome (PMS) among mothers of the study subjects. In our study we requested that the college women to make enquiries from their mothers as to whether they suffered from PMS as diagnosed by a physician or as per the criteria suggested by us. In a population-based study, it was not possible to be more precise about the maternal diagnosis of PMS. We agree with Dr. Qureshi that “these college women might have learnt PMS symptoms from their mother.” It might be noted that there are shared biological, psychological and environmental factors that influence the mother-daughter relationship such as expectations and self-perceptions^1,2 and this may explain the observations made for mother/daughter dyads. This point was mentioned by us in the article. Data on a family history of depression and mental illness in our study was also a self-report by the study-population. Information is sometimes collected by this method in public health research and one does make allowances in judgment for this inherent limitation.

The second issue relates to the timing of the premenstrual symptoms. In the definition adopted by us we mentioned that the symptoms remit two days prior to or “at the commencement of menses”. According to the American College of Obstetrics and Gynecology, PMS symptoms occur in the luteal phase and disappear “as a woman’s period starts.”³ Lurie and Borenstein in their study have defined PMS and specifically mention that the symptoms “disappear a few hours after onset of menstruation.”⁴ Others too had adopted the same definition as ours.⁵ Definitions, however are revised from time to time and there may be slight variations in the definition by different authorities.

The third issue which interests Dr. Qureshi is the choice of the 13 PMS symptoms selected by us. After reviewing several research papers on this subject, we selected the symptoms most frequently reported for this condition. Moreover there was the “other” category for women to report any symptom not mentioned by us. The symptoms included the following: headache, breast swelling/pain, general oedema, acne, binge eating, craving for sweet/salty foods, constipation, tiredness, irritability, mood swings, anxiety, insomnia and depression. I agree with Dr. Qureshi that space constraint in journals prevents authors from attaching the questionnaire with their article. We will send the questionnaire to interested people upon request.