A Comparative Study of Premenstrual Syndrome among Married and Unmarried Women

Premenstrual syndrome is characterized by a wide range of psychological, physical, and physiological symptoms. The study's goal was to evaluate and contrast premenstrual symptoms in married and unmarried women. The sample size was 300 women, including 150 unmarried and 150 married women selected by age group at SreeBalaji Medical College and Hospital's Obstetrics and Gynecology Out Patient Department. Data was collected from unmarried and married women using a premenstrual symptoms checklist. At the 0.05 level of significance, the value was confirmed to be statistically significant. There was a considerable difference in premenstrual symptoms between unmarried and married women, it can be deduced.


INTRODUCTION
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (WHO, 1992) defines premenstrual syndrome (PMS) as the occurrence of one painful premenstrual symptom among numerous symptoms [1]. While PMS negatively affects one's quality of life and social functioning, the presence of merely PMS symptoms is rarely seen as upsetting or debilitating; thus, the presence of PMS symptoms differs from a categorical diagnosis of PMS [2]. Premenstrual symptoms are mild to moderate in intensity, are Original Research Article not particularly debilitating, and do not necessarily occur on a regular basis, whereas premenstrual syndrome is more severe, involves a specific subset of symptoms, occurs on a regular basis, and has a significant impact on a woman's life.
Every woman's menstrual period is a natural occurrence that occurs throughout her reproductive years. During their menstrual period, the majority of women suffer some level of pain and discomfort. Many girls today experience medical problems related to menstruation, such as dysmenorrhea, weight gain, headaches, backaches, breast soreness, mood swings, and depression [3,4].
According to the research, a large number of women suffer with PMS to varying degrees, and premenstrual difficulties can interfere with a woman's ability to perform at home, at work, or in her interactions with others. There are only a few studies among Indian women of all ages that we are aware of. It's critical to look into the prevalence, severity, and most common symptoms of PMS in different populations in order to improve the quality of life, health, and well-being of reproductive-age women and the current study adds to that knowledge.

MATERIALS AND METHODOLOGY
This study was conducted in 300 women (150 married and 150 unmarried) of reproductive age group attending the Obstetrics and Gynaecology Out Patient Department, SreeBalaji Medical College and Hospital, Chrompet, Chennai-44 in collaboration with the Department of psychiatry, SreeBalaji Medical and Hospital, Chrompet, Chennai-44.

Study Design
Cross-Sectional Comparative Study. All women with or without symptoms of premenstrual syndrome were included in the study.In these women,the following detailed history was obtained. The results thus achieved have been statistically analyzed and presented.

RESULTS
This tabulation gives the age category of the cases. In total here were 5 cases in the married group and 24 cases in the unmarried group under the age 20. There were 49 cases in the married group and81 cases in the unmarried group between the age group 21 -25. There were 53 cases in the married group and 42 cases in the unmarried group between the age 26 -30. There were 43 cases in the married group and3 cases in the unmarried group abovetheage30to35 (Table 1).
This tabulation gives the Body Mass Index (BMI) classification of the cases. In total there were 5 cases in the married group and 8cases in the unmarried group in BMI under 18 (Underweight). There were 55 cases in the married group and 52 cases i.n the unmarried group in the BMI classification 18.5 -24.99 (Normal weight). There were 71 cases in the married group and 74cases in the unmarried group in the BMI classification 25 -29.99 (Over weight). There were 19 cases in the married group and 16 cases in the unmarried group in the BMI classification above 30 (Obese) ( Table 2).
This tabulation gives the occupational classification of the cases. In total there were 57 cases in both the groups as working. There were 62 cases who were housewives in the married group and 11 cases in the unmarried group were idle at home. There were 31cases in the married group and 82 cases in the unmarried group were students (Table 3).  This tabulation gives the classification of the socio economic status of the cases. In total there were 3 cases in the married group and10 cases in the unmarried group in the upper class. There were 56 cases in the married group and 11 cases in the unmarried group in the upper middle class. There were 79 cases in the married group and 51cases in the unmarried group in the lower middle class. There were 7 cases in the married group and 59 cases in the unmarried group in the lower upper class. There were 5 cases in the married group and 19 cases in the unmarried group in the lower class (Table 4).
This table shows that Irritability is more severe in unmarried women compared to married women and the p value is 0.017(<0.05) hence statistically significant (Table 5).
This table shows that Tension is more severe in the unmarried group of women compared to the married group and the p value is 0.000(<0.05) hence statistically significant (Table 6).
This table shows that unmarried women have more severe forms of disturbances in their eating habits compared to married women. The p value is0.000(<0.05)hence statistically significant (Table 7).
This table shows that in married group, women in the age group of26-30 years have severe PMS while in the unmarried group, women in the age group of 21-25 years suffer severe PMS. However age as such does not show any significant association with the occurrence of PMS since p value is>0.05(0.654) ( Table 8).
This table shows that women in over weight criteria ,both in married and unmarried group have severe PMS of about 36% and 54%respectivelyandthepvalueis <0.05(0.0216) , hence BMI has significant association with the occurrence of PMS (Table 9).

DISCUSSION
Our study demonstrates the prevalence and severity Premenstrual syndrome among married and unmarried women. p-value less than 0.05 are statistically significant. In a total of 300 women (150married and 150 unmarried) this study shows that there is significant association between marital status and severity of PMS. Unmarried women experience severe forms of PMS (53%) compared to married women (46%).Also the p value is <0.05 hence statistically significant. This could be due to changing lifestyle patterns and more stress related burdens met by theun married women nowa days. Also among married women, working group are affected very much by severe PMS (65%)compared to house wives(33%)and students(l %) and in the unmarried women both working and students are affected equally, 50% and 50%respectively.There exists statistical significance (pvalue <0.05) inrelationship to occupationan dseverity of PMS. This could be duet otheinc reased stress, responsibilities and work load burden in the working society compared to less stress in housewives and students. Also it might be due to carrier building, working women get married later and in tum this may be the real cause of increasing frequency in workingwomen as it has been reported that mentally unstable and unsatisfied women are more prone to cyclical ovarian hormone changes. Perhaps working class can report their symptoms well than the housewives and students who experience the same symptoms but are unable to report the properly [5][6][7].

This finding is supported by Mona A Abd El
Hamid et al's study of PMS in 113 female employees, which found a statistically significant difference in physical symptoms (nausea and vomiting) between single and married participants, with a p value (0.050) for the single female participants [8]. Dinnerstein, 46, who conducted a study on the influence of premenstrual symptoms on everyday activities and discovered that married women reported, increased symptoms of premenstrual syndrome, disagreed with this conclusion. These findings contradict those of Ghanbari, who observed no statistically significant difference between his investigated sample group in terms of marital status and syndrome symptoms. Also disagreed with Bakhshani et al., who claimed that there was no significant difference in symptoms of premenstrual syndrome between married and unmarried women in his study group [9].  This study shows that there is no significant association between SES and PMS and the p value is >0.05. 50% of the unmarried women who experienced severe PMS were in the upper lower class, while the majority of the married women who had severe PMS (58%) belonged to lower middle class . This result is disagreed by the study conducted among adolescents in both rural and urban areas of West Bengal which states that Significant association was observed between significance (p value <0.05) in relationship of these symptoms to the unmarried group of women. Whereas impairment in efficiency/fatigue (26%) and Depression (26%) takes the top place in married women followed by lowered Motor-coordination/Physical activity (19%) and disturbances in Sexual drive (13%). The p value is <0.05 for all these symptoms, hence statistically significant. Majority of the women in both the groups experienced more than one symptom.

CONCLUSION
Irritability, Socioeconomic Status, Tension, Eating Habit, and Occupation were the most common symptoms among single and married women, respectively. Unmarried women reported a higher number of premenstrual symptoms. PMS is an essential health issue that has to be explored in depth because of the associated distress and stigma connected with the menstrual cycle.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.