Volume 8, Issue 1 (Jan-Mar 2019)                   JCHR 2019, 8(1): 3-10 | Back to browse issues page

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Karimain kakolaki Z, MazloomyMahmoodabad S S, Heidari F, Khadibi M, Gerayllo S, Yoshany N. Comparison Quality of Life in the Three Groups: Women with Premenstrual Syndrome, Premenstrual Dysphoric Disorder and General Population in Yazd . JCHR. 2019; 8 (1) :3-10
URL: http://jhr.ssu.ac.ir/article-1-478-en.html
1- Department of Health, Faculty of Medical Sciences, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
2- Social Determinants of Health Research Center, Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Department of Critical Care Nursing, School of Nursing, Gerash University of Medical Science, Gerash, Iran
4- Department of Nursing, Faculty of Medical Sciences, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
5- Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , sakinehgerayllo@ssu.ac.ir
6- Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Premenstrual syndrome (PMS) is a set of symptoms including emotional, physical and behavioral changes that develop before the menstrual period (1). A mild form of the symptoms is named as PMS by the American College of Obstetricians and Gynecologists (ACOG) while Premenstrual Dysphoric Disorder (PMDD) is the severe presentation of that (2). According to the ACOG report, 85% of the women of reproductive age experience at least one symptom of PMS and PMDD prevalence is 3–8% (2). In a study in Iran, the prevalence of PMS and PMDD is 44% and 16% respectively (3).
The most common symptoms of PMS and PMDD are the following: swelling and tenderness of breast, headache, bloating, sleep disturbances, appetite changes, poor concentration, decreased interest, social withdrawal, irritability, mood swings, anxiety/tension, depression, and feeling out of control (4, 5). Premenstrual symptoms can lead to numerous problems in women such as impairment of physical performance and psychological health and serious dysfunction in social or occupational aspects (6, 7). PMS is not a serious threat, but it can influence women's quality of life and mental health and reproductive (8). PMS makes women more sensitive than men to depression, especially women are more susceptible during premenstrual, postpartum and the climacteric (9).
The quality of life is often described as an individual's perception of their position in life within the culture and value system. For evaluation of the functional impact of a disease, health-related quality of life is used. It assesses QOL in the following eight domains: physical activities, social activities, role activities, emotional role functioning, bodily pain, general mental health, vitality and general health perceptions (1). Through improvements in QOL, the complications associated with this disorder can be reduced or make it more tolerable (4).
Several studies indicated a relationship between PMS and QOL. Maleki’s study on Iranian women illustrated that premenstrual symptoms have a significant impact on health-related quality of life, especially on mental and emotional domains (3). Also, Hautamaki et al. reported that premenstrual symptoms in fertile age could impair the quality of life (10). In a study performed on female students with PMS, a relation between stress and the pre-menstrual syndrome with the quality of life was seen (11). A recent study conducted on Korean women revealed the impact of PMS on daily life activities and also stated that there is a significant association between the severity of PMS and the proportion of women with impaired daily life activities (12). This disorder is particularly common in the younger age groups and, therefore represents a significant public health problem in young girls (13). The findings of other studies emphasize that often the problem of women with premenstrual syndrome and marital dissatisfaction is in emotional dimension (14).
To the author best knowledge, previous studies on premenstrual symptoms and their impact only focused on non-Iranian populations, while there are only a few studies in the literature that on limited samples have evaluated the impact of premenstrual symptoms on women’s quality of life who live in Iran. It seems that reducing the symptoms of premenstrual syndrome can improve the quality of life (12). It is necessary to investigate the impact of premenstrual symptoms among larger samples with different age groups and to use a disease-specific tool along with a generic measure to assess health-related quality of life. The purpose of this study was to assess the quality of life in a sample of Iranian women in Yazd with premenstrual disorders (PMS and PMDD) and the general population.
This cross-sectional study was conducted with the participation of 246 women referring to Yazd health centers. Sampling was conducted from August 2016 to March 2017. These individuals were selected from women referring to health care centers in suburbs of Yazd (Azadsahr and Emamshahr health care centers); in categorizing health care centers, five centers were placed in suburban areas. Sampling was done randomly based on the family number registered in the electronic health case. Based on the lottery number of the household file, individuals were invited to participate in the study. Inclusion criteria for participation included people in the 15-49 age range, being married and willing to participate. Qualified individuals completed the questionnaires after declaring their consent. According to the same study (8), taking into account the level of confidence 0.95, p=%80 and d=0.5 sample was estimated for246 people. In this study, data collection tools were Quality of Life questionnaire SF36, screening questionnaires PMS (Premenstrual Syndrome Screening Tool) and the Demographic data. 
Short Form Health Survey (SF-36)
The Short Form Health Survey (SF-36) is an instrument used in assessing the health-related quality of life of patients and the general public(15). This multi-item scale assesses eight domains: a) physical functioning (questions 3, 4, 5, 6, 7, 8, 9, 10, 11, 12), b) role limitation due to physical problems (questions 13, 14, 15, 16), c) bodily pain(questions 21, 22), d) general health (questions 1, 33, 34, 35, 36), e) vitality (energy and fatigue) ( questions23, 27, 29, 31), f) social functioning (questions 20, 32), g) role limitation due to emotional problems (questions 17, 18, 19), and h) mental health (questions 24, 25, 26, 28, 30). The scores range from 0 to 100 and a higher score indicates the better health-related quality of life, zero representing the worst HRQOL and 100 representing the best possible score. Based on this, 36 questions of the questionnaire were organized in the form of 8 structures, and each question had a score between 0 (lowest score) and 100 (highest score). Therefore, according to the response of individuals to the questions' options, a score is assigned to the individual and the individual's score in any structure is obtained from summing up individual scores for the questions of each structure. Zero to 100 for each aspect is intended and is not cut-off point. Translation and validation of Iranian version of the SF-36 were done by Montazeri and colleagues(16). In assessing the internal consistency (to test reliability), the Cronbach’s α coefficient for all eight Quality of Life and Marital Satisfaction in Medical Staff in Iran SF-36 scales ranged from 0.77 to 0.90 except the vitality scale (a0.65) (17).
Premenstrual Syndrome Screening Tool
The PSST was used for screening women with PMS. This 19-items questionnaire consists of two parts. One consists of 14 questions designed to acquire the information toward the mood, physical and behavioral symptoms and the second contains five questions designed to assess the effects of PMS symptoms on people’s lives. The PSST is constructed by Canada’s McMaster University and standardized for Iranian population by Siahbazi et al (18). Women who meet three following conditions, are diagnosed as moderate or severe PMS: (i) for items 1 to 4, at least one should be moderate or severe, (ii) for items 1 to 14, at least four should be moderate or severe and (iii) for the last five items, at least 1 should be moderate. To meet the criteria for PMDD, women must experience these three conditions: (i) for items 1 to 4, at least one should be severe, (ii) for items 1 to 14, at least four should be moderate or severe and (iii) for the last five items, at least 1 should be severe.
Statistical analysis
Obtained data were coded and analyzed descriptively and inferentially using SPSS 18. Descriptive statistics were used to summarize and organize the data for frequency and percentage of samples in three groups. Kruskal-Walis Test was used for comparison groups on SF-36 subscales, and Mann-Whitney Test was used for pairwise comparison. The level of significance was set, a priori, at 0.05.
Ethical approval
The Institutional Review Board at Shahid Sadoughi University of Medical Sciences approved the study (code: IR.SSU.SPH.REC.1395.79). In order to allow research subjects to make an informed participation decision, they were fully informed of the importance, purposes, and methods of the research. The participants were reassured about their identity, and that other personal information would remain confidential, then the informed consent form was signed by them voluntarily.
A profile of the subjects
This study was conducted with 246 women who referred to Yazd health centers. The mean age of women was 30.92 ± 6.18 years.
Table 1 shows the distribution of demographic variables in women with PMS, PMDD, and the general population.
Table 1. Demographics frequency of samples in the three groups (n=246)
Variable General Population
N (%)
N (%)
N (%)
Age 17-25 22(17.7) 24(23.5) 4(20.0)
26-34 59(47.6) 57(55.9) 7(35.0)
35-42 43(34.7) 21(20.6) 9(45.0)
Marital Duration 1-5 39(31.5) 38(37.3) 4(20.0)
5.5-15 54(43.5) 51(50.0) 9(45.0)
≥15 31(25.0) 13(12.7) 7(35.0)
Number Of Offspring ≤2 102(82.3) 90(88.2) 16(80.0)
>2 22(17.7) 12(11.8) 4(20.0)
Women’s level of education Sub Diploma
17(13.7) 10(9.8) 4(20.0)
46(37.1) 28(27.5) 10(50.0)
Bachelor’s Degree 61(49.2) 64(62.7) 6(30.0)
Women’s employ Homemaker 90(72.6) 64(62.7) 14(70.0)
Employment 34(27.4) 38(37.3) 6(30.0)
Husband’s level of education Sub Diploma 27(21.8) 17(16.7) 8(40.0)
Diploma 47(37.9) 35(34.3) 6(30.0)
Bachelor’s Degree 50(40.3) 50(49.0) 6(30.0)
Husband’s employ Employee 49(39.5) 46(45.1) 6(30.0)
Self-Employment 72(58.1) 55(53.9) 11(55.0)
Unemployed 3(2.4) 1(1.0) 3(15.0)
Economic Status Weak 3(2.4) 0(0) 2(10.0)
Moderate 83(66.9) 78(76.5) 14(70.0)
Good 37(29.8) 22(21.6) 4(20.0)
Excellent 1(0.8) 2(2.0) 0(0)
Frequency and in the three groups
Samples were organized in three groups (PMS, PMDD, and General Population), half of the samples had no symptoms of premenstrual syndrome. Frequency and percentage of samples was 124 (50.4%) in the