Premenstrual symptoms and remedies practiced by Malaysian women attending a rural primary care clinic

Background: Premenstrual symptoms affect about 40% of women of reproductive age. In an effort to alleviate premenstrual symptoms, affected women practice various remedial approaches. The aim of this study was to assess the prevalence and severity of premenstrual symptoms experienced by women, the associated factors and the remedial approaches practiced by them. Method: This was a cross-sectional study conducted at a rural primary care clinic situated in Hulu Langat, Malaysia. All women of reproductive age (18 to 44 years old) attending the clinic during the study period and who fi t the selection criteria were included. Premenstrual symptoms and severity were assessed using a self-report questionnaire, the Shortened Premenstrual Assessment Form (SPAF). It consists of 10 items that measure changes in mood, behaviour and physical symptoms. The respondents were also asked if they had used any remedy to relieve their symptoms. Results: A total of 158 women were included in the study. The majority of the respondents were Malay (70.3%), followed by Indian (16.5%) and Chinese (10.8%) women. About 75% of the women experienced at least one of the premenstrual symptoms. Approximately 7% of them reported experiencing severe symptoms in all three subscales of the SPAF. The frequently reported symptoms were body ache (75.3%), abdominal pain (75.3%), irritable feeling (63.9%) and breast discomfort (61.4%). The symptom score was higher among Malay women (p = 0.034), and those with a higher household income (p = 0.037) and higher educational level (p = 0.01). There was no signifi cant association between premenstrual symptoms and age, marital status, menstrual cycle and age of menarche. The common remedies used were vitamins (19%), a healthy diet (15.8%) and analgesics (13.3%). Approximately 60% of the women did not use any remedy to reduce their premenstrual symptoms. Conclusion: Premenstrual symptoms were common among women attending the clinic. The symptoms affect them signifi cantly both physically and emotionally. Thus, it is essential for primary care providers to take an active role in identifying, educating and managing premenstrual symptoms among women. intRoduction Premenstrual syndrome (PMS) is characterised by the recurrence of certain physical, psychological and behavioural symptoms, beginning the week before menses and disappearing within a few days after the onset of menses.1,2,3,4 The key diagnostic feature is that the symptoms must be absent in the time between the end of menstruation and ovulation. Premenstrual symptoms affect about 40% of women of reproductive age, with severe impairment occurring in approximately 5%, enough to impair their daily life and relationships.1,3,5,6,7 Most women of reproductive age have one or more emotional or physical symptoms, which are often mild, in the premenstrual phase of the menstrual cycle.3 The severe and predominantly psychological form of PMS is called premenstrual dysphoric disorder (PMDD).2,3,8,9 The diagnosis of PMDD on the basis of DSM-IV stipulates (1) the presence of at least fi ve luteal-phase symptoms, at least one of which must be a mood symptom (i.e., depressed mood, anxiety or tension, affected lability or persistent anger and irritability); (2) two cycles of daily charting to confi rm the timing of symptoms; and (3) evidence of functional impairment. Finally, the symptoms must not be the exacerbation of another psychiatric condition.10 However, many women with clinically signifi cant premenstrual symptoms do not meet full diagnostic criteria; they might not have a prominent mood symptoms as one of the fi ve different symptoms required as a minimum by DSM-IV. The American College of Obstetrics and Gynecology (ACOG) has attempted to rectify this situation by defi ning moderate to severe PMS; the criteria are the presence of at least one psychological or physical symptom that causes signifi cant impairment and that is confi rmed by means of prospective ratings.11 The exact aetiology of PMS is not known.2,6 It does not seem to be due to abnormal concentrations of sex steroids, but the symptoms are triggered by fl uctuations in such hormones; some patients probably are more sensitive to such fl uctuations. With respect to brain function, the transmitters serotonin and GABA have been implicated in the underlying mechanism. Treatments inhibiting ovulation, such as GnRH analogues, oestrogen and certain new oral contraceptives, effectively reduce the symptoms, as do treatment with selective serotonin reuptake inhibitors (SSRIs), which are regarded by some institutions as fi rst-line agents in severely affected patients.2,3,4,5,6,8,9,12 In an effort to alleviate premenstrual symptoms, affected women practiced various remedial approaches. Previous studies have examined many factors to elucidate the underlying ones contributing to this syndrome.2,3,8,12,13 These include lifestyle factors, affective state, marital status, dietary pattern, medication used, physical exercise, and socio-economic factors, and biological factors such as age and reproductive and menstrual history.. Women with premenstrual symptoms could improve their quality of life by understanding their body’s cyclic changes, planning their lives and seeking treatment when they anticipate experiencing premenstrual symptoms.14 The aim of this study was to determine the prevalence and severity of premenstrual symptoms experienced by women attending a primary care Vol. 1 No. 1 Page 1 of 5 Original Research Omar, Mohsin, Muthupalaniappen, Idris, Amin & Shamsudin PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e