Measure the Symptoms Related to Pre-Menstrual Syndrome Among Married and Unmarried Females During their Reproductive Life Span

Objective The study was aimed to estimate premenstrual syndrome and its consequent symptoms in married and unmarried females during menstrual phase, pre-ovulatory phase and post-ovulatory phase. Methodology A cross sectional survey based study has been conducted in young females of 25-35 age groups. Participants were divided into two groups. Group A were with PMS and group B were healthy subjects. The evaluation of manifestations in all three phases was gathered by using PRISM calendar. The data was collected and stored and analyzed by applying Chi-square test by using SPSS v.22.0. Result The result revealed that the severity was different among unmarried (55%) and married (50%) in all three phases of Menstrual cycle. Unmarried female shows their symptoms 54.5% in menstrual phase, 27.3%in post ovulatory phase and 18.2% in preovulatory phase, while married females express 50%, 30%, and 20.0% respectively in all the three phases. The significant (p<0.05) result were recorded in menstrual phase by showing back pain, anxiety, breast pain, headache, depression, nausea, abdominal cramps, irritability and swelling in both married and unmarried women. While Diarrhea and vomiting found on-significant (p>0.05). Constipation was additional significant factor present in married females. Discussion The present study among unmarried females and married females revealed that premenstrual syndrome (PMS) differs in each of three groups. Women of reproductive age either married or unmarried showing significant symptoms of PMS, however different phases have different percentage among these two groups. Conclusion According to our results, we concluded that in unmarried and married females, PMS were found frequently during menstrual phase and remaining two phases has no prevailing clinical manifestation.


Introduction
Premenstrual syndrome (PMS) has been variously defined and known as a psychoneuron-endocrinal disorder of unknown etiology that consists of a myriad of physical and psychological symptoms that occur in the one to two weeks before menstruation and subside a few days after menstruation 1 . Premenstrual syndrome (PMS) is a documented clinical problem since the earliest Greek Hippocrates blamed the agitated blood for shivering, lassitude and heaviness of the head. They explained how the disturbed blood found its way to the uterus where it escaped the body causing the relief of symptoms, the process of menstruation 2 . The cause of PMS is unknown but the underlying mechanism is believed to involve changes in hormone levels Symptoms often vary between women and resolve around the start of bleeding Common symptoms include acne, tenderness of breasts, bloating, feeling tired, irritability, stress, anxiety, increased emotional sensitivity and mood swing this symptom are present for around six days and vary in severity; from mild to severe. About 80% women report some symptoms prior to menstruation 3  Severe symptoms may be suffered by about 2-5% reproductive females that undergo medical treatment 5 .In reproductive females, the ovarian cycle consist of three phases, follicular phase, ovulation phase, and luteal phase whereas the uterine cycle consist of menstruation phase, proliferative phase, and secretary phase. Endocrine system controls both of the cycles, using contraceptives by married women disturb hormonal system which interferes normal reproductive cycles that causes interruptions in daily life activities 6 .The study was aimed to estimate premenstrual syndrome and its consequent symptoms in married and unmarried females during menstrual phase, pre-ovulatory phase and post-ovulatory phase.

Methodology
A cross-sectional survey based study was designed and conducted to compare symptoms of Pre-menstrual syndrome in married and unmarried women in all three phases of menstrual cycle. The ethical clearance was obtained from the Institutional Review Board, university approval and patient consent was signed. Data collection was carried out during January 2016 to May 2016.Total 80 individuals of both groups were taken randomly of the age 25-35 years. Subjects understudy having PMS were kept in group A while the healthy subjects having no PMS were kept in group B. In both of the groups the number of subjects remains same; 40 participants respectively. Subjects under age 25 and those who were on medicine were excluded from the study.
Data were collected using a specially designed PRISM calendar through which clinical manifestations during the whole cycle were recorded. As well as their sociodemographic details, past medical history, dietary habits and exercise habits were questioned. PRISM calendar were provided to each female and instructed them to fill it throughout the cycle for the following three months. Data were computerized into SPSS 16.0 software. Chi-square test was used to compare study parameters and PMS related problems between those two groups.

Result
All the subjects under the study were between the ages of 25-35 years with the mean of 30 years. The data of participants was consisting of some parameters which were qualitative. The parameters include; back pain, abdominal cramps, anxiety, swelling, irritability, depression, headache, nausea, vomiting, constipation, diarrhea, and breast pain. Results were analyzed by Chi-square test, study revealed that the severity of premenstrual syndrome among married and unmarried females were different. About 55% unmarried females suffering from PMS  P-value<0.05 is considered as significant by using Pearson's Chi-square test of independence.

Discussion
The present study among unmarried females and married females revealed that premenstrual syndrome (PMS) differs in each of three groups. About 55% unmarried females showed PMS during their reproductive life span; whereas, 50% married females exhibited PMS. Different studies revealed that, in pre-ovulatory phase symptoms were significantly higher in unmarried females as compared to married females 7 .During menstrual phase, the recording were similar as compared to preovulatory phase, but constipation remained significantly higher among married females as compared to unmarried females. The results of post-ovulatory phase, presented that PMS were found to be significantly increased in married females as compared to unmarried females 8 . Chi-square results revealed that PMS including back pain, anxiety, breast pain, headache, depression, nausea, abdominal cramps, irritability and swelling were found to be significant (p<0.05) among both married and unmarried females. But the frequency remained different among all the phases, in comparison of married and unmarried females, which disturb their daily physical activity levels. However, diarrhea and vomiting were found to be insignificant among both groups (p>0.05). Diet, physical exercise, use of contraceptives, depression may exacerbate PMS in both married and unmarried females 9 . It is cleared from our study that women of reproductive age either married or unmarried showing significant symptoms of PMS, however different phases have different percentage among these two groups.

Conclusion
It was concluded that in unmarried and married females, PMS were found frequently