A CROSS-SECTIONAL STUDY CONDUCTED FOR THE ASSESSMENT OF PREMENSTRUAL SYMPTOMS AMONG THE ADOLESCENT SCHOOL GIRLS OF MEHSANA CITY

Objectives: The ojective is to study menstrual patterns. To study the prevalence of pre-menstrual symptoms among high school girls. Methods: It is a cross-sectional, observational, and prospective study. A total of 384 adolescent girls were randomly enrolled in the study as per inclusion and exclusion criteria. Girls were belonging to higher secondary standards. Confidentiality was assured, and written informed consent was obtained. A data collection form was formed to conduct the survey. Ethical approval was obtained. The data were analyzed in MS Excel 2019. A descriptive analysis was done. Results: A total of 384 high school girls with an age of 15.65±1.16 years were enrolled in the study. The calculated mean body mass index (BMI) was 18.82±2.93. 40.4% had an underweight BMI. The majority of the adolescent girls had regular menstrual cycles, and a few had irregular menstrual cycles every month. More than half (60.41%) did not know about premenstrual syndrome. Physical premenstrual symptoms were a downward dragging sensation (58.78%), lower back pain (55.53%), acne flare-ups (44.63%), diffuse headaches (37.72%), and painful periods (33.88%). Psychological symptoms in hierarchy are anger or irritability (52.16%), less interest in usual activities (44.03%), pelvic cramping (45%), cravings for sweets (42.88%), and mood swings (41.53%). Conclusion: The prevalence of premenstrual symptoms was higher for physical and psychological symptoms. Physical symptoms can affect routine activities, and psychological symptoms affect girls’ behavior and mental status.


INTRODUCTION
Premenstrual syndrome (PMS) is characterized by a wide variety of emotional and physical symptoms and behavioral changes, occurring before the menstruation phase of the menstrual cycle and subsiding after the beginning of the menstrual period.It is classified as a physical disease in the 10 th revision list of International Classification of Disease [1].The major abnormalities are dysmenorrhea, PMS, and menstrual irregularities.These conditions may lead to problems in routine activities such as academic and sports performance, and sometimes, it lead to a loss of self-confidence.Female reproductive cycles are directly or indirectly influenced by diet, physical work, and mental stress [2].

Study design and duration
It is a cross-sectional, observational, and prospective study conducted between May 2022 and December 2022.

Sample size and study population
Sample size was calculated with a 95% confidence interval for P that was expected to be about 50% (0.5) with a margin of error (d) no more than 0.05, n= (1.96^2) (0.50) (1-0.50)/(0.5^2),n=384.A total of 384 adolescent girls were randomly enrolled in the study as per inclusion and exclusion criteria.Girls were belonging to higher secondary standards.Confidentiality was assured, and written informed consent was obtained.

Instrument preparation and data collection
A data collection form was made to conduct the survey.It contains demographics, three questions regarding menstrual patterns, and four questions regarding pre-menstrual symptoms.The instrument also contains a list of premenstrual symptoms that can be plausible to happen during, before, and after the menstrual cycle.It was translated into a vernacular language.Data collection was done from May 2022 to December 2022 as per randomly enrolled schoolgirls.Data were collected after a detailed explanation of the instrument with a personal interview.

Ethical consideration
Ethical approval was obtained before data collection by submitting all relevant documents for the study to the local Independent Ethics Committee located in Mehsana City.This study was conducted in accordance with good clinical practice guidelines.

Data analysis
The collected data were analyzed in MS Excel 2019 and SPSS version 20.Descriptive analysis was done, and results were represented in terms of percentages and frequencies, as shown in tables and graphs.Pearson's correlation coefficient was run to determine the correlation between body mass index (BMI) and PMS.

RESULTS
A total of 384 high school girls aged 15.65±1.16years were enrolled in the study.For the BMI category, each girl's height and weight were measured during data collection.The average height was 153.11±8.12cm and the average weight was 44.01±6.90kg.The calculated mean BMI was 18.82±2.93.Table 1 represents the percentage and frequency of the respondents according to their BMI categories.
Table 5 contains information regarding vaginal discharge.Are girls experiencing any vaginal discharge.39.3% (151) of respondents answered positively, and 32.8% (105) suggested that sometimes they were experiencing vaginal discharge.Among them all, only 20% (80) felt a specific odor from vaginal discharge.They have answered that different conditions are correlated with different colors, as follows:

DISCUSSION
In the present study, the age of the respondents was observed at 15.66±1.16years, which was in line with the study conducted at Ratnagiri, Maharashtra [3].The BMI category was calculated after observing the height and weight of the high school girls.Most of the girls were belonging to normal weight as compared to few had overweight category.Nearly 40.4% of the high school girls were in the underweight category.One study performed by Bhuvaneswari et al. in Turkey suggested that low body mass index is the reason for the risk of PMS among young girls [4].

Parmar and Deshpande
Out of all, nearly 28.82% of the high school girls experienced an irregular menstrual cycle for each consecutive month.Similar findings are suggested by author Priyanka Negi from the study she performed at Garhwal, U.P. [5] Almost 64% of the respondents suggested a 29 to 34 days interval between two consecutive menstrual cycle; these findings were in line with the study performed in Bhavnagar, Gujarat.[6] Among all high school girls, only 1.56% were experiencing menorrhagia, which reveals bleeding days more than 7 days.One more study performed by Shruti et al. explained that 15.2% had menorrhagia, which was quite high as compared to the present study findings [7].
Other high school girls had normal blood flow during their menstrual cycle.
About 60.41% of the girls did not know the term PMS or what it was, but the majority of them were suffered from premenstrual symptoms during their menstrual cycle.Out of all of them, most were experiencing premenstrual symptoms for 1-3 days, which were initiated before and during the menstrual cycle.This study's findings reveal physical and psychological premenstrual symptoms that can easily affect routine day-to-day activities.Almost 58.78% of the high school girls suggested a downward dragging sensation, followed by lower back pain (55.53%), pelvic cramping (45%), and acne flare-ups (44.63%).Half of the high school girls were experiencing anger without any reason or irritability following less interest in usual activities (44.03%), sweet item cravings (42.88%), and mood swings (41.53%).Similar findings were also concluded by different authors performed at different locations .[1][2][3][4][5][8][9][10][11] 65% of the high school girls had vaginal discharge, and among them, few felt a specific odor from vaginal fluid.Vaginal discharge could be a reason for the different infections, which can be diagnosed with the help of a specific odor, color, and its consistency.
Different studies concluded that low body mass index, food habits, junk food, early menarche, disturbed sleep patterns, consumption of caffeine and alcohol, etc. are responsible factors for the risk of premenstrual symptoms among younger girls [2,4,5,8,[12][13][14].However, this study suggested there might be a correlation between BMI and premenstrual symptoms.This study also helps to reveal the prevalence of PMS in terms of physical and psychological symptoms that affect the day-to-day activities of females.

CONCLUSION
The prevalence of premenstrual symptoms was higher for physical and psychological symptoms.Physical symptoms can affect routine activities, and psychological symptoms affect girls' behavior and mental status.BMI can be a risk factor for certain physical and emotional premenstrual symptoms.

DECLARATION OF INTEREST STATEMENT:
There is no conflict of interest.

Table 3 : Description of PMS Pattens
PMS: Premenstrual syndromeTable6represents data on the correlation established between BMI and premenstrual symptoms.p<0.05 will be considered as significant.Out of all different physical and psychological PMS, the following PMS has found a significant correlation with BMI: abdominal bloating (0.058), pelvic cramping (0.004), depressed mood (0.037), anger without any reason (0.034), savory craving (0.030), and less interest in usual activities (0.030).