The Relationship between Severity of Premenstrual Syndrome and Psychiatric Symptoms

Article excerpt

Objective: Premenstrual syndrome is a common disorder experienced by up to 50% of women during reproductive age. The prevalence of severe form of PMS (PMDD) is 3 % to 8%. Psychiatric disorders in PMS patients have resulted in significant morbidity and in some cases caused resistance to the treatment process

Material and Method: 390 participants (264 with PMS/PMDD, and 126 healthy students of University of Guilan) who completed the demographic questionnaire, daily symptom rating (DSR) and the checklist 90-revised (SCL-90-R) took part in this study. This study was conducted using a cross sectional method.

Results: According to repeated measure variance, the mean scores of psychiatric symptoms (Depression, Anxiety, Aggression, Interpersonal sensitivity) in the PMS group were significantly higher than the healthy group (p< 0/05), and increase in severity of PMS from mild to severe was accompanied by increase in mean score of these subscales. There was a significant difference in mean score of depression, anxiety, aggression and interpersonal sensitivity between the 3rd and the 13th day of the cycle. Significant effect of the DSR grouping (PMS and Healthy group) and time interaction emerged in interpersonal sensitivity and aggression, significant effect on the DSR grouping (Mild, Moderate, Severer) and time interaction demonstrated in interpersonal sensitivity.

Conclusion: Patients with prospective confirmed PMDD seemed to suffer from psychiatric symptoms. Therefore, recognizing co-morbid psychiatric symptoms in patients with PMDD is of prime importance. All healthcare providers should be sensitive to mental status of women with PMS.

Keywords: Premenstrual syndrome, Psychiatric symptoms, Severity of illness

Iran J Psychiatry 2012; 7:36-40

Premenstrual syndrome (PMS) is characterized by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4 days of the onset of menses and be severe enough to interfere with normal and daily function. The severe form of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the significant function impairment. (1, 2, 3). The most common symptoms are tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (4). The physiopathology of PMS has yet to be fully clarified. various biological theories have been proposed as the cause of this syndrome and may include the effect of progesterone on neurotransmitters such as serotonin, opiods, catecholamine and GABA, increased prolactin level or increased sensitivity to the effect of prolactin, insulin resistance, sensitivity to endogenous hormones, abnormal hypothalamic- pituitary-adrenal axis function, nutritional deficiencies (Calcium, Mg, B6) ( 5,6,7). About 30% to 50% of menstruating women experience mild to moderate form of PMS, and 4% to 14% experience severe PMS (5). PMS leads to capacity loss of the individual, and to such psychological problems as anxiety, depression, committing suicide; and therefore results in decrease in quality of life. In fact, PMS influences not only women but also their family and the society (8, 9). Lifetime history of anxiety or mood disorders has been reported in over half of women presenting with PMS. The incidence of depression among patients with PMS is greater than healthy women (10, 11). Several reports indicate that irritability, impulsivity, anger, anxiety, tension and nervousness are much more prevalent in premenstrual period and may be no less prevalent than depressive symptoms. Comorbidity of PMS/PMDD with anxiety disorder, phobia, obsessive-compulsive and panic disorders was demonstrated (11, 12). In this study, we decided to assess psychiatric symptoms in PMS group compared to those without PMS.

Materials and Method

In this study, respondents completed four different measurements including: sociodemographic questionnaire, DSM-IV PMDD/PMS criteria questionnaire, the daily symptom rating (DSR) ,and the symptom Checklist-90-Revised (SCL-90-R). …