Assess the Premenstrual Physiological Symptoms , Academic Performance among Female Medical Student in Hafr Al Batin , University

Premenstrual time is a critical time in the life of females. The symptoms that occur in women during this time, which can adversely affect their social interaction, educational performance and emotional well-being. The study aimed to assess of premenstrual symptoms and academic performance among female medical student. Sampling: stratified sampling technique used to select 120 participants. The tools contain four sections to assess basic data, menstrual history, premenstrual physical symptoms and academic performance during premenstrual time. Results: Majority of the adolescent girls experienced associated somatic symptoms during premenstrual period like pains in abdomen and back, headache and breast tenderness. Regarding academic performance, the participant was reported changes during by premenstrual phases in several ways specially learning motivation and abilities and behavioral performance in class.


Introduction
Premenstrual syndrome (PMS) is characterized by the presence of both physical and behavioral symptoms during the second half of the menstrual cycle and interfere with different life aspects in the woman's life [1]. Women with PMS experience a wide variety of cyclic and recurrent physical, emotional, behavioral, and cognitive symptoms that begin in the luteal phase (second half) of the menstrual cycle and resolve shortly after the onset of menses (the follicular phase). However, the main compliance includes behavioral symptoms; such as depression, irritability, and anxiety; and physical complains; such as breast pain, bloating and swelling, and headache. The symptoms are started and the recurrent during the end of the luteal phase of the menstrual cycle with a symptom-free period shortly after menses has begun, typically when the menstrual flow has ended [2][3]. The American College of Obstetricians and Gynecologists (ACOG) defined PMS as a clinical condition characterized by the cyclic presence of physical and emotional symptoms unrelated to any organic disease that appear during the 5 days before menses in each of the three prior menstrual cycles and disappear within 4 days of the onset of menses, without recurrence until at least cycle day1 [4].
Diminished academic performance is one of the main complaints attributed to menstrual-cycle problems. The menstrual period has a notable role on the academic performance of students Women with heavy and painful menstrual periods have more problems affecting their academic and social lives. Diminished academic performance is one of the main complaints attributed to menstrual-cycle problems In support of HI, the vast majority of significant correlations and associated standardized regression coefficients were negative, pointing to the generally adverse effects of menstrual-cycle moods and symptoms on academic performance [5,6]. Many adolescent girls experience various premenstrual physical, emotional or behavioral changes, which at times reach such levels of severity that may have substantial social impact upon herself, her associates, her work and academic performance. So, the study was done to assess the premenstrual Part 3: Premenstrual Symptoms Screening Tool (PSST) [9] . The subjects were asked to complete a standardized health questionnaire, described below, and underwent a brief face-to-face interview was rated according to a 4-point Likert scale (0 = absent, 1 = mild, 2 = moderate, and 3 = severe). A positive screen for PMS was rated as moderate to severe, the presence of at least one of the first four symptoms rated as moderate or severe, and at least one item of the second table rated as moderate or severe.
Part 4: Academic performance scale: Academic stress and Academic demand scale -It consisted statement 20 statement (range 0 to 80). To account for time spent studying, each day participants recorded hours and minutes spent as well the distress caused by studying on a scale of 0-4 (0=no distress and 10-extreme or the most distress).

Aim of the Study
1. Assess the pre-menstrual physiological symptoms.
2. Determine the academic achievement during pre-menstrual time.

Methods
Permission: an official letter from the Faculty of Nursing was directed to the director of the responsible authorities of the study settings for earning his consent before collecting the data after explicating the study aim.
Tools Validity and Reliability: Tool it was developed by the researchers after reviewing relevant and recent literature. Content validity was assured by a jury of 5 experts in the field of obstetric and pediatric nursing.
Pilot Study: A pilot study was conducted on 10% of the students (who were excluded from the study sample) to test the clarity, applicability of the study tools, identification of a suitable place for interviewing women, and to detect any possible obstacles that might face the researchers.

Ethical Considerations
Permission to conduct the study was obtained. Each one was informed about the purpose and benefits of the study in the first part before starting the questionnaire, where every one can't be starting the questionnaire without consent to participate in data collection in the current study. The student were assured that all data was used for research purpose only and each one was informed of the rights to refuse participation in the study or withdraw at any time before completing the questionnaire with no consequences.

Statistical Analysis
Computerized data entry and Statistical analysis were fulfilled using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive and analytical statistics were used such as number, percentage, mean and standard deviation. According to (Table 2) more than one-half (52.5%) of the student's attained menarche before age of 13 years. 72.5% of them had regular rhythm. More than more than one half (57.5% & 52.5%) of them had reported bleeding for less than 5 day and change per day less than 3 soaked pad, respectively. more than three quartier (76.7%) of the participant had background knowledge about menstruation . the sours of this information usually received either from mother (43.33%) or their finders (30.83%). While only 4.17% of them had reported the medical staff, doctor or nurse is source for information.

Menstrual history
NO. %    ( Table 5) show that learning motivation regarding learning characteristics, 54.2% of the study participants were never to Seek the "Hows" and "Whys" rather than taking them for granted. And 39.2% of them had Logics Able to understand diagrams by intuition. Regarding creativity the study participant never to demonstrate a keen sense of humor and like to think in different angles. Regarding role as leadership abilities the student never to Like to participate in-group activities or have ability to understand other people's feelings and needs (46.7% & 31.7%).

Discussion
As the menstrual period is known to affect the student's academic performance. Premenstrual moods and symptoms may well play a discernible role in the academic performance of some adolescent female students Because the academic stress viewed as a chronic stress due to the nature of academic demands; was associated with negative health outcomes of depression and physical illness. It is therefore, conceived that academic stress experienced by female college students may be implicated as negatively affecting the premenstrual symptom experience [10]. This study investigate the premenstrual symptoms, mood change and academic performance among nursing students.

Regarding Premenstrual Symptoms
The current study revealed that, the Majority (87.5%) of the adolescent girls experienced associated symptoms during premenstrual symptoms. namely; pains either abdominal or back pain, breast tenderness, and headache (51.42-40 % & 49.52%) respectively. This result was similar to the study of Nattapong, et al. Who found that PMS is a common menstrual disorder among high school students and the three most common somatic symptoms were breast tenderness, headache and abdominal pain. In most cases, these symptoms were rated as mild to moderate in severity [10].
Regarding severity of premenstrual symptoms, the current study revealed that (39.2% & 50.8%), of the study participant described the symptoms as severe to moderate, respectively. The severity of PMS symptoms was rated by the participants on the basis of their impacts on their daily lives, ranging from mild to moderate to severe. Mild symptoms were defined as not limiting daily activity. Symptoms were considered moderate if there were marked limitations with regard to daily activity, and severe if the participants were unable to carry out the activities without discomfort [11].
44.2% of participant ask helping and counseling her friends and 28.5% of them reported absent from college or leave early to home due to this symptoms. This is in contrast to the results of which found the majority of participants consulted their mothers than their friends regarding symptoms of PMS. Prolonged stress exposure could lead to persistent malfunctions of the neuroendocrine system and trigger PMS. On the other hands, the current study go on line with who found that a positive significant relationship between abdominal menstrual pain and association within peers and colleagues. It was also obvious that females who suffer this health problem do seek help usually from friends well as seek help through peers [12,13].
Regarding the measurement to relieve the premenstrual symptoms, 37.5% of the participants use hot application to relieve premenstrual pain and discomfort. This result go on line with study of who found that the majority of the student use hot application to relive premenstrual pain on abdomen and back. Application of heat in the form of hot water bag considered the easily and available methods than counter analgesics [14].
The current study revealed that 76.7 % of the students have knowledge about menstruation and premenstrual symptoms. The sours of information usually through they mother (56.52%) and old sister (40.21%). These findings comply with the finding of the study of where 48% of the student have good knowledge about menstruation and premenstrual symptoms and received this knowledge from mother. This proved the highlight about the multiple social roles of women are determining their health status and leading to different health-related consequences. Thus, to plan the effective preventive intervention, providing valid and reliable evidence in this field is necessary because of the variability of the available studies results. Although recently reported reviews have provided useful results on other aspects of women health problem, there is no review of various studies result in Iran on the prevalence of PMS. In addition, few participants (3.1%) in this study had consulted their physicians for PMS, which was similar to findings from a previous study by Hamadan, in which PMS was evaluated in Indian adolescents (4%). As we found in the study, only a small proportion of participants consulted their friends (33.9%) or parents (22.8%) regarding PMS [15,16].
Around one third of the study participant (30%, 33.3%) had reported symptoms had severe interfere with the colleagues and family and social life activities the study go on line with the results of [2] who had shown that 20.2% of the females experienced the interference of symptoms with their relationship with colleagues [17]. 50% of the participant them had reported symptoms had severe interfere with the lecture or work and effect negatively on academic performance. This results was agree with The results of who reported that 70% of female had experience of absence from lecture or work, stated that symptoms affected the academic achievements [18].
According to the academic performance during premenstrual time, generally speaking, the current study revealed that regardless of aetiology though, the possible interference with academic. School performance at the menstrual and premenstrual phases of the monthly cycle remains potentially problematic. In current study the academic performance measure mainly aspect namely: learning and motivation, learning characteristics, behavioral Performance in class, creativity to learning and leader ship. These results go on line with study of who found that Academic performance was affected by premenstrual phases in several ways mainly study time, concentration, participation in-group activities, examination performance and class attendance [19].
Particularly, regarding learning and motivation during ability, this study revealed that , the student un able to focus on a topic Volume 03; Issue 12 for a long period of time, have no ability to learn autonomously and independently, enable to sustained interest this study go on line with. This results agree with the results of the study examined the effect of menstrual symptoms on academic performance of the students. Were said the student not having interest to go to the college during premenstrual period, and reported about lack of concentration during study hours. In addition, these symptoms were affecting the remembrance of the students also; difficulty in remembering the studied contents [20,21].
Regarding learning characteristics, the current study revealed that, the participant not able to seek the "Hows", and "Whys" rather than taking them for granted and have no ability to understand diagrams or exam logically. This results go on line with Even the menstrual symptoms were affecting the student's performance of examination. Here greater part of study participants were not having interest to write their examination during menstruation and were reported that they were not able to prepare for the examination and were having lack of concentration during examination [22].
Regarding , behavioral Performance in Class The menstrual symptoms were interfering with student's assignments and extracurricular activities Study or participate in activities in accordance with instructions Show courage to ask questions Able to concentrate on his/her study Able to cooperate with classmates and able to express his/her emotions effectively. This result go on line with the present study clearly stated the majority of students were having more difficulty to cope up with the classroom performance during menstruation. Although this study also stated that, the students were having more difficulty to complete their assignments and even during examination with the menstrual symptoms. It was supported by a study conducted among medical students of Nigerian university [23]. In sufficient sample, size was limitation of this study.

Conclusion
The present study has conclude that premenstrual syndrome was most problem facing girls in college, associated with academic performance changes. Especially due to the continues academic demand distress for assignments, papers, projects/presentations and time studying.

Recommendations
• Strategies should be developed for early detection and management of PMS in young women.
• Students should receive professional support in order to overcome the problems associated with PMS. And use coping methods.
• Even simple recommendations about healthy diet, excesses, reduce stress may help young girls to reduce symptoms.
• A study can be conducted with large samples to generalize the findings.
• A comparative study can be done between medical and other college.
• A comparative study can be done between educated and housewife.