RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT

FOR
DISSERTATION

Mrs. G. MANJULA DEVI

1-YEAR M. Sc NURSING
PSYCHIATRIC NURSING
YEAR 2008-2009

INDIAN COLLEGE OF NURSING BELLARY

#50, VIJAYANAGAR COLONY, CANTONMENT,
BELLARY- 583104.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
PERFORM FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1

NAME OF THE CANDIDATE AND

Mrs. G. MANJULA DEVI, 1-YEAR M. Sc

ADDRESS

NURSING
INDIAN COLLEGE OF NURSING BELLARY
#50, VIJAYANAGAR COLONY,
CANTONMENT,
BELLARY- 583104.

NAME OF THE INSTITUTE

INDIAN COLLEGE OF NURSING BELLARY

COURSE OF THE STUDY AND

1-YEAR M. Sc NURSING, PSYCHIATRIC

SUBJECT

NURSING

DATE OF ADMISSION TO THE

18/06/08

COURSE
5

TITLE OF THE STUDY

A STUDY TO ASSESS THE KNOWLEDGE

OF PREMENSTRUAL SYNDROME AMONG
WOMEN OF CHILD BEARING AGE IN
SELECTED AREA AT BELLARY

6.

BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION
Woman is the companion of man gifted with equal mental capacity. Women
constitute half of the population of the world. They had a number of different roles in
society. Women strengths include good listening and communication skills, flexibility
to compromise, extensive experience in practical problem solving and caring for
people. The presence of women seems to be potent ingredient in fostering and
maintaining local population. Elevating the health status of women is essential to
improving the health of the entire community.
Premenstrual Syndrome (PMS) or premenstrual tension is collection of physical,
psychological and emotional symptoms related to a womens menstrual cycle. While
most women of child-bearing age (about 80%) have some premenstrual symptoms.
[APOTEKI; PMS 2007 ] women with PMS have symptoms of sufficient severity
to interfere with some aspects of life.
PMS was originally seen as an imagined disease when women first started
reporting the symptoms; they were often told it was all in their head. Interest in
PMS began to increase often it was used as a criminal defense.
In Britain the term premenstrual syndrome was coined in 1931, when
researchers first suggested that the condition was due to hormonal imbalance
related to the menstrual cycle. Recent studies revealed that the PMS occur during
the child bearing years.
3

PMS has been linked to serious psychological problems in a small group of

women. In Great Britain, women have been acquitted of various crimes on the
ground that the PMS from which they were suffering at the time of their action
caused a temporary psychiatric disturbance. The American Psychiatric Association
(APA) in 1994 recognized the possible psychiatric implications of PMS when it
classified the related Premenstrual Dysphoric Disorder (PMDD).
According

to

the

World

Health

Organization,

International

Statistical

Classification of Disease and Related problems, 10th revision (ICD-10).Geneva:

WHO: 1992. Premenstrual syndrome is often classified under the generic term
Premenstrual syndrome which is listed in the International Statistical Classification of
diseases and Related Health Problems, 10th revision (ICD-10).
According to the Diagnostic and Statistical Manual of Mental Disorders, 4 th
edition of the American Psychiatric Association (1994). Washington, DC has
defined the criteria for PMDD. To full fill the diagnostic criteria a patient needs to
present five or more distressing symptoms during the luteal phase and at least one
of these symptoms have to be mood symptoms. The cardinal symptoms are:

Irritability

Depressed mood

Affect lability

PMS might be a socially constructed disorder and PMS is a collection of

symptoms more than 200 different symptoms have been identified but three most
prominent symptoms are irritability, tension and dysphoria [Rodin et al 1992].
Originally described in 1931 by an American neurologist, according to him
behavioral and emotional changes may include anxiety, depression, irritability, panic
attack, lack of co-ordination decreased work or social performance and its
psychoneuroendcrine disorder, which is more functional impairment.
PMS is a common problem in women of child bearing age of the estimated 40
million suffers, more than 5 millions requires medical treatment for marked mood
and behavioral changes.
Health personal can help to create awareness among women on comprehensive
measures to reduce the PMS in their child bearing age. This is in turn helps to
prevent the negative impact on the quality of life of women.

6.2 NEED FOR THE STUDY

Premenstrual syndrome (PMS), any of various symptoms experienced by women
of child bearing age in the days immediately preceding menstruation. It is most
common in women in their twenties and thirties. Some 70%-90% of menstruating is
having PMS on a cyclical basis.
PMS is estimated to affect up to 75% of women during their child bearing years.
It occurs more often in women:

Between their late 20s and early 40s

Who have at least one child

With a family history of a major depression

With a history of postpartum depression or an affective mood disorder

As many as 50%-60% of women with sever PMS have an underlying psychiatric

disorder. The frequency of premenstrual syndrome is according to ICD-10 criteria,
approximately 42% of women experience mild PMS and 31.7% experience
moderate PMS [Samia Tabassum 2005]. Epidemiological surveys have estimated
that as many as 75% of reproductive age women experience some symptoms
attributed to the premenstrual phase of menstrual cycle [Johnson SR 1987]. It has
been estimated from retrospective community surveys [Ramachandran S, Love EJ-

1992] that nearly 90% of women have experienced at least one premenstrual
syndrome as defined by ICD-10 criteria defined by WHO.
The number of women who experience PMS dependence entirely on stringency
of the definition of PMS while 80% of menstruating women have experienced at
least one symptom that could be attributed to PMS estimate [Dean BB, Borenstein
2006] of prevalence range from as low as 3% to as high as 30%.
A small group of reproductive age women (3% to 8%) reported much more
severe premenstrual symptoms of irritability, tension, dysphoria and lability mood,
which seriously interfere with their life style and relationship [Rivera-Tovar AD 1990].
Andersch B and Wende state without relief from these symptoms a womans
functioning in the home, social situations and at work can be substantially impaired
every month often over a span of many years.
Improper diagnosis has also led to over down estimates of the frequency of PMS.
For many years womens magazines failed to differentiate between the people of
same and there by created the impression that 75% to 80% of women suffer from
PMS. When strict diagnostic criteria are used [Limosin F and Aders 1994] 75% to
85% of women report one to three symptoms during their lives. While between 10%
and 15% of women are present with isolated or minor complaints such as breast
tenderness or mild mood changes. Only 2% to 5% suffer from symptoms serious
enough to qualify for a diagnosis of PMS ie symptoms that cause disruption of their
work activities.

Zhao G et al 1997 stated that experience of PMS a lower incidence of 35% and
30.4% respectively in china. Approximately 53% of the young college girls
experience PMS. In France the women of child bearing age experience 75% and
88% prevalence of PMS. The reason could be a stressful life of the developing
world.
Research has been done on PMS and PMDD in many countries but very few
studies have been reported on the experience of Indian women.
The investigator during field experience in their service observed that
psychological moods of some women are much varying at the time pre
menstruation. Due to this observation the investigator felt to conduct study to assess
the knowledge of premenstrual syndrome among women of child bearing age.

6.3 STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE OF PRE MENSTRUAL SYNDROME
AMONG WOMEN OF CHILD BEARING AGE IN SELECTED AREA OF
BELLARY
6.4 OBJECTIVES
1. To assess the knowledge of women of child bearing age on PMS
2. To develop and implement an instructional module on PMS
3. To determine the relationship between the knowledge of women of child
bearing age with selected demographic variables
6.5 OPERATIONAL DEFINITIONS
ASSESS: - To determine or evaluate the knowledge of women of child bearing
age on premenstrual syndrome.
KNOWLEDGE: - The information obtained from women of child bearing age on
PMS.
PREMENSTRUAL SYNDROME: - PMS, any of various symptoms experienced
by women of child bearing age in the days immediately preceding menstruation.
WOMEN OF CHILD BEARING AGE: - Female human, gives birth to children
during the age of 15 to 45 years

6.6 ASSUMPTIONS
1. Women of child bearing age may suffer from PMS
2. Knowledge may differ according to the background of the subjects
6.7 HYPOTHESIS
Demographic variables do not significantly influence the knowledge of women of
child bearing age

10

6.8 REVIEW OF LITERATURE

Review of literature is a key step in research process. Review of literature
refers to an extensive, exhaustive and systematic examination of publications
relevant to the research project.
INTRODUCTION
Premenstrual syndrome (PMS) is characterized by cyclical physical and mood
disturbances during the luteal phase. Most women (75%-90%) of fertile age
experience cyclical changes during the menstrual cycle, but only 6-10% seek
medical help for their symptoms
This chapter is considered with the literature related to selected aspects of
knowledge on PMS among women of child bearing age. The results of studies
conducted in relation to present study that is knowledge of Premenstrual
syndrome.
A menstrual distress questionnaire completed by all the women during the
premenstrual and post menstrual phases of one menstrual cycle. By the author
[R.H.moos , 1968] studied the premenstrual symptoms of 89 healthy Mexican
women living in rural areas and whose education ranged from no schooling to
middle school attendance, and 182 women living in urban areas whose
education ranged from elementary school to professional studies. Women who
reported mild symptoms of PMS was 87% on somatic scale and 86% on
11

psychological scale. Urban women reported more severe psychological

symptoms than rural women. Thus it appears that the womens level of education
affected premenstrual symptoms more than their rural or urban background did.
A study examined the hypothesis that significant component of PMS is
psychological deregulation and enhanced reactivity to internal and external
stimuli. Earlier studies by Mathew, et al [1979] on control of PMS have shown
that PMS symptoms could be ameliorated with peripheral temperature training
and relaxation.
A comparative study evaluated by Konandreas San Francisco state university
[1990] have shown that association between PMS and increased emotional
arousal and automatic reactivity, self-regulation strategies that include relaxation,
breathing, quieting response and biofeedback may reduce the discomfort linked
with PMS.
A pilot study conducted by [Rapkin 2003 et al] on American women about skin
temperature control for premenstrual tension syndrome. Study evaluated that
PMS symptoms could be ameliorated with peripheral temperature and relaxation.
Moline, GK, 2004 conducted a study the effect of bio-feedback and relaxation on
premenstrual syndrome. The study revealed that self regulation strategies that
include relaxation, breathing, if women could learn to listen to, and respond to,
emotionally activating internal and external triggers by relaxing and breathing
diaphragmatically, the discomfort of PMS may be reduced

12

study

determined

review

of

treatment

of

PMS

and

PMDD.

Psychoneuroendocrinology, a treatment includes selective serotonin re-uptake

inhibitors, anti anxiety medications concerns about the harmful side effects of
long term medications use, the study evaluated to control ones own health,
drives the interest to develop behavioral intervention to reduce discomfort
associated with PMS
A study investigated by Zendell,SM (2004) on evaluating and managing PMS on
Medscape women. The symptom clusters occur only in the two weeks prior to
menstruation and typically taper off several days after the onset menstruation.
A study to investigate the biofeedback training and self regulation skills can
reduce the severity of PMS symptoms, by Mary Bier (2004). The sample were
nine participants, average age 26 with an average 14 years history of PMS
volunteered for the study. This pilot study suggests that women with PMS should
use self-regulation strategies to reduce discomfort as the first intervention before
using medications.
An observational study was conducted at the Khyber medical college, Peshawar
by convenient sampling on 384 young girls. The frequency of premenstrual
syndrome was 53% according to ICD-10 criteria, among which 42% was mild,
18.2% moderate and 31.7% severe. Conclusion that premenstrual syndrome is a
common problem in young girls.
Santosh, K Chaturved, National Institute of Mental Health and Neuroscience,
Bangalore conducted a study on Suicidal ideas during premenstrual phase
13

(2000). The study was determined the frequency of suicidal ideas and death wish
among 296 women from urban, rural, industrial and college populations in which
suicidal ideas and death with during PMS were reported by 30(10%) subjects
more among college student and industrial working women and less among
housewives.
Ramacharan S of Fick GH Jclin epidemiol (1992) conducted a research study on
the epidemiology of premenstrual symptoms in a population based sample of
2650 urban women. The study concluded that PMS is a common problem in the
reproductive age group and severe forms are more in urban women.
Kathrina Dalton MD, a family practitioner in England evaluated the effectiveness
of a program of aqueous progesterone suppositories on her own symptoms when
they were relieved, she repeated the study with 50 patients, they also
experienced improvement.
Friden. C, Linden HirschBerg, the university college of physical education and
sports, Sweden. The thesis on the influence of premenstrual symptoms on
postural balance and kinesthesia during menstrual cycle (2003) conclusion of
this study progesterone metabolites and the serolonergic system, involved in the
pathophysiology of PMS and PMDD. And postural control is altered in the mid
luteal phase in women with premenstrual symptoms.
A study conducted by the national institute of mental health. Research compares
the intensity of symptoms from cycle days 5 to 10 to the 6-day interval before the

14

onset of menses. The study reveals that symptom intensity must increase at
least 30% in the six days before menstruation.
C. Amenda in his paper on The emergency of premenstrual syndrome as a
social problem (1991).He stated PMS as a disease is born out of a patriarchal
society. The PMS symptoms are often in conflict with the way a woman should
behave, contending that anger, irritability, and increased sex drive on patterns of
behavior which go against social norms.

15

7.

MATERIALS AND METHODS

7.1 SOURCE OF DATA
Women of child bearing age
7.2 METHOD OF DATA COLLECTION
I.

Research design

Non-experimental descriptive design and descriptive study and will be used to

assess the knowledge of premenstrual syndrome among women of child
bearing age.
II.

Research variables
Study variables: - To assess the awareness of PMS
Extraneous variables: - It contains baseline characteristics such as age,
education occupation, type of family and marital status

III.

Setting
The study will be conducted in the selected area at Bellary

IV.

Population

All the women of child bearing age

V.

Sample
16

Women of child bearing age who fulfill inclusion criteria are considered as
sample and the sample size is 100.
VI.

Criteria for sample selection

Inclusion criteria
1. Women of child bearing age
2. Able to read Kannada and English
3. Available at the time of data collection
4. Who are responsive and interested
Exclusive criteria
1. Women above 45 years
2. Who are not willing to participate in the study
VII.

Sampling technique
Probability, simple random sampling technique

VIII.

Tool for data collection

The tool consists of the structured questionnaire of the following parts
Part-1: - Deals with demographic data
Part-2: - Deals with structure questionnaires to assess the knowledge of PMS

IX.

Method of data collection

17

After obtaining the permission from the municipal health officer, Bellary and
the tool shall be given to experts in the field of gynecology and psychiatric
medicine for content validity. After obtaining their agreeability the same tool
shall be used data collection
Duration of study-2 to 4 weeks
X.

Plan for data analysis

The data collected will be analyzed by using descriptive and inferential

statistics
Descriptive statistics: - Mean, percentage, frequency, distribution and
standard deviation will be used
Inferential statistics: - Coefficient- correlation and chi square will be used
XI.

Projected out come

After the study the researcher will assess the knowledge of PMS among
women of child bearing age

18

7.3 Does the study require any investigations or intervention to the

patients or other human beings or animals?
No, the study does not require any investigations conducted on patients,
human beings or animals.

7.4 Has ethical clearance been obtained from your institutions?

There is no ethical issue concerned with this study.

19

8.

LIST OF REFERENCES
1. PMS: Women Tell Women How to Control Premenstrual Syndrome by
Stephanie Degraff Bender (Author), Kathleen Kelleher (Author) "In
this book, we are going to focus on the emotional and psychological
aspects of premenstrual syndrome (PMS).
2. Howkins and Bourne (1994) Shaws text book of Gynaecology (12th
edition) P.P. 226.
3. Suicidal ideas during premenstrual phase Santosh K. Chaturvedi ,
Prabha S. Chandra, G. Gururaj, R. Dhanasekara Pandian and M. B.
Beena, Department of Psychiatry, Department of Epidemiology, National
Institute of Mental Health and Neurosciences, Bangalore 560 029, India
4. A paper on premenstrual syndrome at :
http://www.medindia.net/education/familymedicine/Premenstrualsyndrome-Presentation.htm
5. An ortical on Premenstrual Syndrome: Frequency and Severity in young
college girls by Samia Tabassum, Bilqis Afridi, Zahid Aman, Wajeeha
Tabassum, Rizwana Durrani from the Department of Obstetrics and
Gynaecology, Khyber Teaching Hospital, Department of Surgery, PGMI,
Lady Reading Hospital, Department of Psychology, University of
Peshawar, Khyber College of Dentistry, Peshawar

20

6. A whikipedia meterial on PMS:

http://en.wikipedia.org/wiki/Premenstrual_syndrome

21

7. A paper on PMS symptoms:

http://www.healthline.com/adamcontent/premenstrualsyndrome?
utm_medium=kontera&utm_source=kontera&utm_ad=kontera&
utm_campaign=adam&utm_term=PMS
8. Wilhelm H, Cronje A, Studd J. Premenstrual syndrome. In: Studd J.
Progress in obstetrics and gynecology, vol 15. 1st ed. London: Churchill
Livingstone 2003, pp. 169-83.
9. Ramcharan S, Love EJ, Fick GH. The epidemiology of premenstrual
symptoms in a population based sample of 2650 urban women. J Clin
Epidemiol 1992;45:377-92.
10. Pearlstein T, Stone AB. Premenstrual Syndromes. Psychiatr Clin North Am
1998;21: 577-90. 4. World Health Organization. International Statistical
Classification of Disease and Related problems, 10th revision (ICD-10).
Geneva: WHO: 1992.
11. Johnson SR. The epidemiology and social impact of premenstrual
symptoms. Clin Obstet Gynaecol 1987;30:367-76.
12. Rivera-Tovar AD, Frank E. Late luteal phase dysphoric disorder in young
women. Am J Psychiatry 1990;147:1634-6.
13. Andersch B, Wendestam C, Hahn L, Ohman R. Premenstrual complaints.
Prevalence of premenstrual symptoms in a Swedish urban population. J
psychosom Obstet Gynaecol 1986;5:39-49.
14. Yonkers KA, Halbreich U, Freeman E, Brown C, Endicoot J, Frank E, et al.
Symptomatic improvement of premenstrual dysphoric disorder with
sertraline treatment: a randomized controlled trial. JAMA 1997;278:983-8.
15. American Psychiatric Association. Diagnostic and Statistical Manual
ofMental Disorders, 4th Edition. Washington: American Psychiatric
Association1994, pp. 715-8.
16. Sternfeld B, Swindle R, Chawla A , Long S, Kennedy S. Severity of
Premenstrual symptoms in a health maintenance organization
population.Obstet Gynaecol 2002;99:1014-24.
17. Shershah S, Morrison J, Jafarey S. Prevalence of premenstrual syndrome
in Pakistani women. J Pak Med Assoc 1991;41:101-3.
22

18. Serfaty D, Magneron AC. Premenstrual syndrome in France:

Epidemiologyand therapeutic effectiveness of 1000 mg of micronized
purified flavonoid fraction in 1473 gynecological patients. Fertilite
Contraception Sexualite 1997;25:85-90.
19. Zhao G, Wang L, Qu C. Prevalence of premenstrual syndrome in
reproductive women and its influential factors. Zhong hua Fu Chan ke Za
Zhi 1998;331:222-4.
20. Cleckner-Smith CS, Doughty AS, Grossman JA. Premenstrual symptoms.
Prevalence and severity in an adolescent sample. J Adolese Health
1998;22:403-8.
21. Wittchen HU, Becker E, Lieb R. Krause P. Prevalence, incidence and
stabilityof premenstrual dysphoric disorder in the community. Psychol Med
2002;32:119-32.
22. Banerjee N, Roy KK, Takkar D. Premenstrual dysphoric disorder- a study
from India. Int J Fertil 2000;45:342-4.

23

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

The research topic selected by the

student is quite appropriate and forward
it for acceptance.

11. NAME AND ADDRESS OF THE GUIDE

CHANNAMMA
PROFESSIONAL AND H.O.D.
DEPARTMENT OF PSYCHIATRIC
INDIAN COLLEGE OF NURSING,
BELLARY.

12. SIGNATURE OF THE GUIDE

13. CO-GUIDE IF ANY

14. SIGNATURE

15. HEAD OF THE DEPARTMENT

16. SIGNATURE

17. REMARKS OF THE PRINCIPAL

18. SIGNATURE

SUNITHA
LECTURER ,
DEPARTMENT OF PSYCHIATRIC,
INDIAN COLLEGE OF NURSING,
BELLARY.

I discussed with the research

committee, problem is good and
feasible.

24