Abstract
Background
Premenstrual syndrome (PMS) and its more severe form premenstrual dysphoric disorder (PMDD) are highly prevalent conditions, but there seems to be ethnic and cultural variances in their distribution.
Aims
To explore the prevalence of PMS/PMDD and their typical clinical features in a Bulgarian population.
Materials and methods
This investigation was designed and executed as a cross-sectional descriptive study. Three hundred and five conveniently recruited females with no psychiatric history filled in a self-evaluation questionnaire based on DSM-IV tapping on different symptoms of PMS. The prevalence of the conditions was calculated.
Results
32.1% (N = 98) of the tested females (mean age 31.04 ± 6.31) suffered from PMS and 3.3% (N = 10) were diagnosed with PMDD. The leading symptoms in the sample were irritability, fatigue and changes in appetite, depressed mood, mood swings, and anxiety, and abdominal bloating, breast tension and tenderness. Most of the symptoms were moderately severe. Mild and moderate cases of PMS were near equally distributed and more frequent than severe ones.
Conclusion
PMS is a common condition which is usually mildly expressed, but severe cases are not an exception. The clinical picture is dominated by almost equally distributed psychological and somatic symptoms.
Keywords: Premenstrual syndrome, Premenstrual dysphoric disorder, Prevalence, Clinical picture
Background
Premenstrual syndrome (PMS) is broadly defined as a cluster of emotional, physical, and behavioural symptoms that arise around the end of the luteal phase and dissipate with the beginning of menstruation or briefly thereafter [1]. According to different investigations on the prevalence of PMS, its frequency varies considerably depending on the methodology and assessment instruments used [1–9].
Altogether results show, that up to 90% of women of reproductive age experience several premenstrual symptoms varying from mild to severe; around 20–40% of them experience PMS, and 2–8% suffer from premenstrual dysphoric disorder (PMDD) [10]. At the same time, it seems that the prevalence of the syndrome varies among cultures and ethnic groups [11, 12], although such a difference is not always to be found as shown in a study of females of European, East Asian, and South Asian origin [13]. Country-specific studies on the prevalence are necessary for proper and more accurate evaluation of the prevalence of the syndrome [14].
Having in mind the above-mentioned considerations, together with the lack of structured investigations on the topic in the Bulgarian population, we decided to examine the prevalence of PMS/PMDD and its characteristics.
Materials and methods
Study sample
The current investigation was designed as a cross-sectional descriptive study. The study sample consisted of 350 females of Bulgarian origin between 18 and 50 years of age with regular menstrual cycles with a length between 21 and 35 days who were recruited in outpatient settings. Forty-five of them dropped out because of inaccurate completion of the questionnaire or unwillingness to report an existing psychiatric condition. The final group consisted of 305 females. The participants were recruited randomly by visiting different companies, administrative offices, universities. Those women who agreed to participate and certified this by signing an informed consent form were interviewed about their body weight and gynaecological condition, including recent or present pregnancy, regularity and duration of menstrual cycle, use of contraceptives or other hormonal preparations. Co-morbid mental disorders were excluded by Mini International Neuropsychiatric Interview (M.I.N.I.6.0.).
Criteria for exclusion were lactation within 3 months prior to study, pregnancy, oral contraceptives use, co-morbid mental disorder, and use of psychopharmacological medicines for any reason.
PMS/PMDD were diagnosed by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) [15] and the American College of Obstetrics and Gynaecology (ACOG) [16]. We used a questionnaire based on the PSST (Premenstrual Screening Tool, Additional file 1) which is a self-evaluation instrument for a retrospective assessment of symptoms persisting for 2 weeks before menstruation in the preceding 12 months [17]. It assesses premenstrual symptoms, such as mood, anxiety, sleep, appetite, and somatic symptoms—breast tenderness, headaches, joint/muscle pain, abdominal bloating, weight gain, palpitations, hot and cold flashes. For the purpose of precise description of the clinical picture, we assessed this latter symptom group separately. The participants evaluate each symptom and the level of functional impairment (if present) on a 4-point Likert scale as “not at all”, “mild”, “moderate”, and “severe”. The following diagnostic criteria were used: mild/moderate PMS: 1. At least one of 1, 2, 3 4 is mild/moderate; 2. In addition at least four of 1–19 are mild/moderate; 3.20 is mild/moderate; PMDD: 1. At least one of 1, 2, 3, 4 is severe; 2. In addition at least four of 1–19 are severe; 3.20 is severe.
The investigation was approved by Ethics Committee Medical Center “Sveti Naum”. All participants signed an informed consent before initiating the study procedures.
Statistical analyses
The data were analysed with the Statistical Package for Social Sciences version 13 (SPSS 13), whereby descriptive statistics and frequency analyses were followed by t-test. The p-level below 0.05 was considered as the criterion for statistical significance.
Results
Ninety-eight females (32.1%) (mean age 31.04 ± 6.31) met the criteria for PMS and 207 (67.9%) (mean age 30.22 ± 5.37) did not. The two groups did not differ significantly by age (t (303) = 1.174, p = 0.241).
According to our data, psychological and somatic symptoms were almost equally represented in the PMS group. The most prevalent symptoms within the psychological type were irritability, fatigue and changes in appetite, depressed mood, mood swings, and anxiety, whereas among the most common somatic ones were abdominal bloating, breast tenderness, headache, and weight gain (Table 1).
Table 1.
Prevalence of PMS symptoms in females with (N = 98) and without (N = 207) PMS
| Symptoms | PMS | No PMS | Symptoms | PMS | No PMS |
|---|---|---|---|---|---|
| Psychological | n (%) | n (%) | Somatic | n (%) | n (%) |
| Depressed mood | 77 (78.6) | 54 (26.1) | Abdominal bloating | 83 (84.7) | 154 (74.4) |
| Irritability | 86 (87.8) | 103 (49.8) | Weight gain | 48 (49.0) | 73 (35.3) |
| Mood swings | 75 (76.5) | 53 (25.6) | Breast tension | 80 (81.6) | 168 (81.2) |
| Anxiety | 69 (70.4) | 19 (9.2) | Joint pain | 29 (29.6) | 34 (16.4) |
| Hopelessness | 35 (35.7) | 7 (3.4) | Muscle pain | 28 (28.6) | 29 (14.0) |
| Apathy | 30 (30.6) | 10 (4.8) | Headaches | 53 (54.1) | 85 (41.1) |
| Poor concentration | 59 (60.2) | 61 (29.5) | Palpitations | 14 (14.3) | 17 (8.2) |
| Fatigue | 78 (79.6) | 90 (43.5) | Hot and cold flashes | 43 (43.9) | 30 (14.5) |
| Changes in appetite | 78 (79.6) | 121 (58.5) | |||
| Sweets craving | 68 (69.4) | 99 (47.8) | |||
| Sleep changes | 42 (42.9) | 19 (9.2) |
PMS premenstrual syndrome; N sample size; n number of subjects experiencing the symptom
The better part of the symptoms were moderately severe (Tables 2, 3)
Table 2.
Severity of psychological symptoms in females with PMS (N = 98)
| Severity | n (%) | Severity | n (%) | ||
|---|---|---|---|---|---|
| Depressed mood | Mild | 37 (48.0) | Poor concentration | Mild | 28 (47.5) |
| Moderate | 27 (35.1) | Moderate | 21 (35.6) | ||
| Severe | 13 (16.9) | Severe | 10 (16.9) | ||
| N | 77 (100) | N | 59 (100) | ||
| Irritability | Mild | 28 (32.6) | Fatigue | Mild | 26 (33.3) |
| Moderate | 32 (37.2) | moderate | 30 (38.5) | ||
| Severe | 26 (30.2) | Severe | 22 (28.2) | ||
| N | 86 (100) | N | 78 (100) | ||
| Mood swings | Mild | 20 (26.7) | Changes in appetite | Mild | 10 (12.8) |
| Moderate | 35 (46.6) | moderate | 41 (52.6) | ||
| Severe | 20 (26.7) | Severe | 27 (34.6) | ||
| N | 75 (100) | N | 78 (100) | ||
| Anxiety | Mild | 33 (47.8) | Sweets craving | Mild | 11 (16.2) |
| Moderate | 26 (37.7) | moderate | 35 (51.5) | ||
| Severe | 10 (14.5) | Severe | 22 (32.3) | ||
| N | 69 (100) | N | 68 (100) | ||
| Hopelessness | Mild | 12 (34.3) | Sleep changes | Mild | 13 (31.0) |
| Moderate | 13 (37.1) | moderate | 19 (45.2) | ||
| Severe | 10 (28.6) | Severe | 10 (23.8) | ||
| N | 35 (100) | N | 42 (100) | ||
| Apathy | Mild | 17 (56.7) | |||
| Moderate | 9 (30.0) | ||||
| Severe | 4 (13.3) | ||||
| N | 30 (100) |
PMS premenstrual syndrome, n number of subjects experiencing the corresponding symptom severity, N number of subjects experiencing the symptom
Table 3.
Severity of somatic symptoms in females with PMS (N = 98)
| Severity | n (%) | Severity | n (%) | ||
|---|---|---|---|---|---|
| Abdominal bloating | Mild | 17 (20.5) | Muscle pain | Mild | 14 (50.0) |
| Moderate | 42 (50.6) | Moderate | 14 (50.0) | ||
| Severe | 24 (28.9) | Severe | 0 (0.0) | ||
| N | 83 (100) | N | 28 (100) | ||
| Weight gain | Mild | 26 (54.2) | Headaches | Mild | 17 (32.1) |
| Moderate | 19 (39.6) | Moderate | 22 (41.5) | ||
| Severe | 3 (6.2) | Severe | 14 (26.4) | ||
| N | 48 (100) | N | 53 (100) | ||
| Breast tension | Mild | 17 (21.25) | Palpitations | Mild | 6 (42.9) |
| Moderate | 38 (47.5) | Moderate | 5 (35.7) | ||
| Severe | 25 (31.25) | Severe | 3 (21.4) | ||
| N | 80 (100) | N | 14 (100) | ||
| Joint pain | Mild | 9 (31.0) | Hot and cold flashes | Mild | 23 (53.5) |
| Moderate | 13 (44.8) | Moderate | 16 (37.2) | ||
| Severe | 7 (24.1) | Severe | 4 (9.3) | ||
| N | 29 (100) | N | 43 (100) |
N number of subjects experiencing the symptom; n number of subjects experiencing the corresponding symptom severity
Of the tested subjects 15.4% (N = 47) suffered from mild PMS and 13.4% (N = 41) from moderately severe. Severe syndrome corresponding to PMDD was registered in 3.3% (N = 10) of the participants (Fig. 1).
Fig. 1.
Severity of PMS (N = 98)
67.9% of our sample or 207 women did not suffer PMS. 6.3% of them (13 women) did not experience any premenstrual symptoms. The remaining 93.7% (194 women) suffered sub-threshold symptoms usually denoted as “normal” premenstrual symptoms. Most commonly reported were irritability (49.7%), increased appetite (58.5%), fatigue (43.5%), breast tension (81.1%), abdominal bloating (74.4%), increased weight (35.3%) (Tables 4, 5).
Table 4.
Severity of psychological symptoms in females without PMS (N = 207)
| Symptom | Severity | No PMS—n (%) | Symptom | Severity | No PMS—n (%) |
|---|---|---|---|---|---|
| Depressed mood | Mild | 36 (66.7) | Poor concentration | Mild | 36 (59.0) |
| Moderate | 14 (25.9) | Moderate | 19 (31.2) | ||
| Severe | 4 (7.4) | Severe | 6 (9.8) | ||
| N | 54 (100) | N | 61 (100) | ||
| Irritability | Mild | 42 (40.8) | Fatigue | Mild | 54 (60.0) |
| Moderate | 51 (49.5) | moderate | 23 (25.6) | ||
| Severe | 10 (9.7) | Severe | 13 (14.4) | ||
| N | 103 (100) | N | 90 (100) | ||
| Mood swings | Mild | 41 (77.4) | Changes in appetite | Mild | 54 (44.6) |
| Moderate | 12 (22.6) | moderate | 31 (25.6) | ||
| Severe | 0 (0.0) | Severe | 36 (29.8) | ||
| N | 53 (100) | N | 121 (100) | ||
| Anxiety | Mild | 15 (78.9) | Sweets craving | Mild | 39 (39.4) |
| Moderate | 4 (21.1) | moderate | 33 (33.3) | ||
| Severe | 0 (0.0) | Severe | 27 (27.3) | ||
| N | 19 (100) | N | 99 (100) | ||
| Hopelessness | Mild | 5 (71.4) | Sleep changes | Mild | 8 (42.1) |
| Moderate | 2 (28.6) | moderate | 11 (57.9) | ||
| Severe | 0 (0.0) | Severe | 0 (0.0) | ||
| N | 7 (100) | N | 19 (100) | ||
| Apathy | Mild | 10 (100) | |||
| Moderate | 0 (0.0) | ||||
| Severe | 0 (0.0) | ||||
| N | 10 (100) |
PMS: premenstrual syndrome; n: number of subjects experiencing the corresponding symptom severity; N: number of subjects experiencing the symptom
Table 5.
Severity of somatic symptoms in females without PMS (N = 207)
| Symptom | Severity | No PMS— n (%) | Symptom | Severity | No PMS— n (%) |
|---|---|---|---|---|---|
| Abdominal bloating | Mild | 82 (53.2) | Muscle pain | Mild | 15 (51.7) |
| Moderate | 40 (26.0) | Moderate | 12 (41.4) | ||
| Severe | 32 (20.8) | Severe | 2 (6.9) | ||
| N | 154 (100) | N | 29 (100) | ||
| Weight gain | Mild | 50 (68.5) | Headaches | Mild | 38 (44.7) |
| Moderate | 21 (28.8) | Moderate | 26 (30.6) | ||
| Severe | 2 (2.7) | Severe | 21 (24.7) | ||
| N | 73 (100) | N | 85 (100) | ||
| Breast tension | Mild | 70 (41.7) | Palpitations | Mild | 11 (64.7) |
| Moderate | 70 (41.7) | Moderate | 5 (29.4) | ||
| Severe | 28 (16.6) | Severe | 1 (5.9) | ||
| N | 168 (100) | N | 17 (100) | ||
| Joint pain | Mild | 14 (41.2) | Hot and cold flashes | Mild | 13 (43.3) |
| Moderate | 12 (35.3) | Moderate | 13 (43.3) | ||
| Severe | 8 (23.5) | Severe | 4 (13.4) | ||
| N | 34 (100) | N | 30 (100) |
N number of subjects experiencing the symptom, n number of subjects experiencing the corresponding symptom severity
Discussion
Our results replicate relatively well what is known from prior research in the field [5, 8, 9, 18]. Despite the use of different diagnostic instruments, the prevalence of PMS usually varies around 20–40% [10]. This is entirely comparable to our data, namely 32.1%. Our results on the prevalence of PMDD—3.3%, are also similar to previous reports in the literature—3–8% [8, 9, 12, 19, 20], although much higher rates have also been reported [6].
The estimates of the prevalence of PMS differ also among cultures and ethnic groups. A study among Japanese women reports low levels of both PMS and PMDD—5.3% and 1.2%, respectively. The authors assume that this is a consequence of the traditional Confucian ethics, which subdue individual welfare to the group wellbeing and as a result women have difficulties verbalizing their complaints [21]. On the contrary, two consecutive studies in the Pakistani population find higher prevalence of PMS—92.4% and 98.2%, respectively [11, 12]. The authors explain it partly with ethnic specificities. But this data is not confirmed by a Canadian team of investigators who targeted 4 ethnic groups—Caucasian, East Asian, South Asian, and a fourth group, including other ethnicities. They do not find any significant differences among groups which the authors relate to the unification of lifestyle and health-related attitudes in modern society [13]. Regarding the Balkans, the available data do not prove to be considerably different either from the data for Europe or from ours—the prevalence of PMS among Greek students is 25.7% [22] and in Turkey—16% [23].
As mentioned above, differences in the diagnostic instruments used also play a role in the estimates of the prevalence of PMS. For example, a Saudi Arabian team of researchers used a questionnaire based on the definition of the American College of Obstetrics and Gynecology and found PMS in 35.6% of the sample, from which 22.4% severe [24]. When DSM-IV is used, the prevalence of PMS varies from 1.2% in a Japanese community sample to 17.9% among Brazilian students [21, 25], 29% in Ukraine [5], and 37.3% in Myanmar [6]. We also use the DSM-IV definition and our results are comparable to those from Ukraine. This could probably be explained with cultural similarities.
Furthermore, our data prove similar to the results of three other studies that like us, used the PSST questionnaire—an Israeli team that reports 25.6% prevalence for PMS and 9.9% for PMDD [9], an Indian group that finds PMS in 18.4% of its sample and PMDD in 3.4%, resp. [20], and Iranian researchers that observe PMS in 30.7% and PMDD in 12.9% [8]. Comparable results were obtained in two other studies—one in Turkey—16% [23], and another one in Uzbekistan—28.1% [7], that used the Premenstrual Symptoms Form (PAF). These results are also close to ours—32.1%.
Our findings on the nearly equal distribution of both symptom types in the clinical picture of PMS are also in accord with the data from other researchers [8], although there are also reports with different results [26]. All of the following have been reported as core symptoms of the syndrome: anxiety, fatigue, depression and tension, headaches, skin disturbances, cramps, breast aches/tension, weight gain and abdominal/extremities bloating, anger, irritability, mood changes, changes in appetite and sleep pattern, specific foods craving, reduced interest in activities [19, 27]. Most commonly described as severely disabling are irritability and tension, and as causing most severe distress—headaches [28].
The results from our sample are all in all congruent to these findings with irritability being practically the most prevalent psychological symptom and the third most commonly severely expressed after changes in appetite and sweets craving, and headaches being the third in row of prevalence as well as severity among somatic symptoms. In addition, we identified breast tension and tenderness and abdominal bloating as core somatic symptoms.
Limitations
The presented study has certain limitations. The sample size is small and needs to be enlarged in order to obtain representative results. The data on the gynaecological condition of women and the characteristics of their menstrual cycle are only anamnestic. The patients were not prospectively followed up.
Conclusion
For the first time, our study estimates the prevalence rate and describes the typical clinical signs of PMS/PMDD among Bulgarian women. PMS is broadly distributed and occurs at a similar rate in Bulgaria as in other European countries. It is most commonly mildly expressed and severe cases are rare. The clinical picture consists of nearly evenly distributed psychological and somatic symptoms of which most common are irritability, changes in appetite, breast tension and tenderness, abdominal bloating.
Supplementary information
Additional file 1. Premenstrual Symptom Screening Tool.
Acknowledgements
Not applicable
Abbreviations
- ACOG
American College of Obstetrics and Gynaecology
- DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
- PAF
premenstrual symptoms form
- PMDD
premenstrual dysphoric disorder
- PMS
premenstrual syndrome
- PSST
premenstrual screening tool
- SPSS
statistical package for social sciences
Authors' contributions
RI contributed to the study conception, study design, execution of the research project, wrote the first draft; MS contributed to the organization of the research project, was involved in execution of the statistical analysis and reviewed the manuscript; DA contributed to the organization of the research project, evaluated critically the statistical analysis and reviewed the manuscript; MP contributed to the organization of the research project, evaluated critically the statistical analysis and reviewed the manuscript; PCh contributed to the organization of the research project, evaluated critically the statistical analysis and reviewed the manuscript; MS-P contributed to the organization of the research project, evaluated critically the statistical analysis and reviewed the manuscript; KF contributed to the conception of the research project, the design of the statistical analysis and reviewed and critiqued the manuscript. All authors read and approved the final manuscript.
Funding
No funding or compensation was received for authoring this manuscript.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate
Ethics approval for this study was granted by the Ethics Committee Medical Center “Sveti Naum”. All participants signed an informed consent before initiating the study procedures.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Footnotes
Publisher's Note
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Contributor Information
Petranka Chumpalova, Email: chumpalova@abv.bg.
Rossitza Iakimova, Email: rosica.iakimova@abv.bg.
Maya Stoimenova-Popova, Email: dr.maya.stoimenova@gmail.com.
Daniil Aptalidis, Email: aptalidis@gmail.com.
Milena Pandova, Email: milena.pandova@gmail.com.
Maria Stoyanova, Email: mb_milenkova@yahoo.com.
Konstantinos N. Fountoulakis, Email: kostasfountoulakis@gmail.com
Supplementary information
Supplementary information accompanies this paper at 10.1186/s12991-019-0255-1.
References
- 1.Ismaili E, Walsh S, Michael P, O’Brien S, Backstroem T, Dennerstein L, et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016;19:953–958. doi: 10.1007/s00737-016-0631-7. [DOI] [PubMed] [Google Scholar]
- 2.Cohen LS, Soares CN, Otto MW, Sweeney BH, Liberman RF, Harlow BL. Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women: The Harvard Study of Moods and Cycles. J Affect Disord. 2002;70:125–132. doi: 10.1016/S0165-0327(01)00458-X. [DOI] [PubMed] [Google Scholar]
- 3.Wittchen HU, Becker E, Lieb R, Krause P. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med. 2002;32(1):119–132. doi: 10.1017/S0033291701004925. [DOI] [PubMed] [Google Scholar]
- 4.Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD) Psychoneuroendocrinology. 2003;28(Suppl 3):1–23. doi: 10.1016/s0306-4530(03)00098-2. [DOI] [PubMed] [Google Scholar]
- 5.Crow EM, Jeannot E. Premenstrual Syndrome: symptomatic and diagnosed prevalence, dualistic treatment approach—a cross-sectional study in Ukraine. Int J Prev Med. 2017;8:66. doi: 10.4103/ijpvm.IJPVM_18_16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Oo HH, Sein MT, Mar O, Aung A. Assessment of premenstrual syndrome among reproductive aged Myanmar women. Asian J Med Sci. 2016;7(4):39–43. doi: 10.3126/ajms.v7i4.13298. [DOI] [Google Scholar]
- 7.Khodjaeva N, Khaydarova F. Prevalence of premenstrual syndrome among women of child-bearing age with regular menstrual cycle. Med Health Sci J. 2013;14(3):144–149. doi: 10.15208/mhsj.2013.25. [DOI] [Google Scholar]
- 8.Hariri FZ, Moghaddam-Banaem L, Bazi SS, Malehi AS, Montazeri A. The Iranian version of the premenstrual symptoms screening tool (PSST): a validation study. Arch Womens Ment Health. 2013;16(6):531–537. doi: 10.1007/s00737-013-0375-6. [DOI] [PubMed] [Google Scholar]
- 9.Reuveni I, Dan R, Segman R, Evron R, Laufer S, Goelman G, et al. Emotional regulation difficulties and premenstrual symptoms among Israeli students. Arch Womens Ment Health. 2016;19:1063–1070. doi: 10.1007/s00737-016-0656-y. [DOI] [PubMed] [Google Scholar]
- 10.Matsumoto T, Sakura H, Hayashi T. Premenstrual syndrome: biopsychosocial aspects of premenstrual syndrome and premenstrual dysphoric disorder. Gynecol Endocrinol. 2013;29(1):67–73. doi: 10.3109/09513590.2012.705383. [DOI] [PubMed] [Google Scholar]
- 11.Hashim R, Ayyub A, Hameed S, Qamar K, Raza G. Premenstrual syndrome: messes with my academic performance. Pak Armed Forces Med J. 2014;64(2):199–203. [Google Scholar]
- 12.Ghani S, Parveen T. Frequency of dysmenorrhea and premenstrual syndrome, its impact on quality of life and management approach among medical university students. Pak J Surg. 2016;32(2):104–110. [Google Scholar]
- 13.Jarosz AC, Jamnik J, Jarosz AE. Hormonal contraceptive use and prevalence of premenstrual symptoms in a multiethnic Canadian population. BMC Womens Health. 2017;17:87. doi: 10.1186/s12905-017-0450-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, Kaikhavandi S. Epidemiology of premenstrual syndrome, a systematic review and meta-analysis study. J Clin Diagn Res. 2014;8(2):106–109. doi: 10.7860/JCDR/2014/8024.4021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). 2000. Washington, DC: Author.
- 16.ACOG . Clinical management guidelines for obstetricians–gynecologists: premenstrual syndrome. Washington: American College of Obstetricians and Gynecologists; 2000. [Google Scholar]
- 17.Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Arch Womens Ment Health. 2003;6(3):203–209. doi: 10.1007/s00737-003-0018-4. [DOI] [PubMed] [Google Scholar]
- 18.Tschudin S, Bertea PC, Zemp E. Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample. Arch Womens Ment Health. 2010;13:485–494. doi: 10.1007/s00737-010-0165-3. [DOI] [PubMed] [Google Scholar]
- 19.Joshi JV, Pandey SN, Galvankar P, Gogate JA. Prevalence of premenstrual symptoms: preliminary analysis and brief review of management strategies. J Midlife Health. 2010;1(1):30–34. doi: 10.4103/0976-7800.66995. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Raval CM, Panchal BN, Tiwari DS, Vala AU, Bhatt RB. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar. Gujarat. Indian J Psychiatry. 2016;58(2):164–170. doi: 10.4103/0019-5545.183796. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Takeda T, Tasaka K, Sakata M, Murata Y. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Japanese women. Arch Womens Ment Health. 2006;9(4):209–212. doi: 10.1007/s00737-006-0137-9. [DOI] [PubMed] [Google Scholar]
- 22.Karaoulanis SE, Mouzas OD, Rizoulis AA, Angelopoulos NV. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in greek nursery students. Eur Psychiatry. 2010;25(Suppl 1):1394. doi: 10.1016/S0924-9338(10)71380-8. [DOI] [Google Scholar]
- 23.Özcan H, Subaşı B. Psychopathology in premenstrual syndrome. J Mood Disorders. 2013;3(4):146–149. doi: 10.5455/jmood.20130514121254. [DOI] [Google Scholar]
- 24.Rasheed P, Al-Sowielem LS. Prevalence and predictors of premenstrual syndrome among college aged women in Saudi Arabia. Ann Saudi Med. 2003;23(6):381–387. doi: 10.5144/0256-4947.2003.381. [DOI] [PubMed] [Google Scholar]
- 25.Teng C-T, Guerra AH, Filho V, Artes R, Gorenstein C, Andrade LH, Wang YP. Premenstrual dysphoric symptoms amongst Brazilian college students: factor structure and methodological appraisal. Eur Arch Psychiatry Clin Neurosci. 2005;255(1):51–56. doi: 10.1007/s00406-004-0535-9. [DOI] [PubMed] [Google Scholar]
- 26.Kumari S, Sachdeva A. Patterns and predictors of premenstrual symptoms among females working in a psychiatry hospital. Hindawi. 2016;2016:6943852. doi: 10.1155/2016/6943852. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Freeman EW, Halberstadt SM, Rickels K. Core symptoms that discriminate premenstrual syndrome. J Womens Health. 2011;20(1):29–35. doi: 10.1089/jwh.2010.2161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Schmelzer K, Ditzen B, Weise C, Andersson G, Hiller O, Kleinstaeuber M. Clinical profiles of premenstrual experiences among women having premenstrual syndrome (PMS): affective changes predominate and relate to social and occupational functioning. Health Care Women Int. 2015;36:1104–1123. doi: 10.1080/07399332.2014.954701. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Additional file 1. Premenstrual Symptom Screening Tool.
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.