The Relationship Between Premenstrual Syndrome and Food Patterns in University Student Girls

Forough Darabi; Niloufar Rasaie; Sima Jafarirad

doi:10.5812/jjhr.26656

The Relationship Between Premenstrual Syndrome and Food Patterns in University Student Girls

Forough Darabi ¹ , Niloufar Rasaie ¹ and Sima Jafarirad ^{1
, 2
, *}

Authors Information

¹ Faculty of Paramedicine, Department of Nutrition, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran

² Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran

Article information

Jentashapir Journal of Health Research: December 01, 2014, 5 (6); e26656
Published Online: December 20, 2014
Article Type: Research Article
Received: June 21, 2014
Revised: August 15, 2014
Accepted: November 15, 2014
DOI: 10.5812/jjhr.26656

To Cite: Darabi F, Rasaie N, Jafarirad S. The Relationship Between Premenstrual Syndrome and Food Patterns in University Student Girls, Jentashapir J Health Res. 2014 ; 5(6):e26656. doi: 10.5812/jjhr.26656.

Abstract

Materials and Methods: Eighty-six university student girls from Ahvaz Jundishapur University of Medical Sciences participated in the survey and PMS was diagnosed using the diagnostic criteria of the American College of Obstetricians and Gynecologists. They completed a daily symptom-rating questionnaire for PMS symptoms. The score of categorical symptoms (mood-emotional and gastrointestinal disorders, pain, fatigue-focus, and other disorders) were determined separately. Student food pattern was determined according to the Iranian food pyramid. The correlation between symptom scores and food group servings was determined by the Pearson correlation coefficient.

Results: The score for each categorical symptom showed significant differences between healthy and students who suffered from PMS (P < 0.001). A significant negative relationship was observed between milk consumption and pain score (P = 0.038, r = -0.224), and between total dairy consumption and pain score (P = 0.019, r = -0.253). Total disorder scores showed a significant negative relationship with total dairy product (P = 0.024, r = -0.243).

Copyright © 2014, Ahvaz Jundishapur University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Menstruation in girls and women is accompanied by some symptoms and problems that are multidimensional that have diverse effects on physiological body systems (1). Premenstrual syndrome (PMS) is a group of physiologic and somatic symptoms related to the menstrual cycle (2). These symptoms occur during the luteal phase of the menstrual cycle when the plasma progesterone concentration is high (3) and resolved at the end of menstruation (2). The exact etiology of PMS remains unknown but there is some evidence that hormonal and neuroendocrine factors as possible causes of PMS symptoms (2).

According to epidemiological studies, the prevalence rate of PMS is high in Asia and low in Europe. France has the lowest prevalence of PMS among European countries and Iran has the highest prevalence among Asian countries (4).

The PMS treatments are divided into herbal (5), psychotropic (6, 7), hormonal, and surgical methods. Most women who suffer from severe PMS need psychotropic or hormonal treatments to control the symptoms (8). Some studies have shown that the fruit extract of vitex agnus castus is the only remedy to control irritability and mood disorders (9). Other studies that have used calcium, vitamin B6, and vitamin E also showed positive effects by controlling PMS symptoms (10-12). In a clinical trial study using high carbohydrate beverages in women suffering from PMS, anger and confusion symptoms were decreased after 90 - 180 minutes consumption (13). Additionally, a high starch diet and carbohydrate supplements showed a significant reduction of PMS symptoms (14, 15). In Zahedan (Iran), adolescent girls who suffer from PMS had low intakes of dairy products, fruits, and vegetables when compared with healthy girls (16).

An appropriate dietary pattern is necessary for a healthy lifestyle that could have positive effects on many aspects of life such as menstrual cycles in women. A study on dietary intakes could help nutritionist determine food patterns and their effect on some problems such as PMS symptoms in women. The Iranian food pyramid is an appropriate dietary pattern that was designed for Iranian adults (17) and by following the food pyramid guidance helps to improve overall health (18). No studies were found about the relationship between dietary patterns (according to food pyramid) and PMS emotional and physiological symptoms in Iranian women. An appropriate diet effects different aspects of life (19) such as a high prevalence of PMS in Iran, the effects of PMS on daily performance, economic and financial aspects of life. This study was designed to investigate the effects of food patterns on PMS symptoms female students at the Ahvaz Jundishapur University of Medical Sciences.

2. Objectives

3. Materials and Methods

The Students Research Ethical Committee approved this cross-sectional study. The survey was performed on 100 students residing in dormitories at Ahvaz Jundishapur University of Medical Sciences in winter 2014 and an informed consent form was signed by all participants. Inclusion criteria were as follows: above 18 years of age, regular menstruation, and no genital diseases; and exclusion criteria were as follows: emotional or physical stress in past three months (such as a relative’s death or surgery), physical illness, any drug consumption (such as anti-depression, hormonal drugs, multivitamins, and mineral supplements), a history of mental disease, or using a special treatment for PMS. The diagnostic criteria of the American College of Obstetricians and Gynecologists were used to study the frequency and severity of PMS symptoms (20). Accordingly, a diagnosis of PMS may be made if symptoms include at least one of the somatic and affective symptoms. A questionnaire was used to evaluate five categorical models: mood and emotional symptoms; pain; fatigue and focus symptoms; gastrointestinal symptoms; and three other disorders acne, polyuria, and increased weight. Then each categorical model was scored separately. The score ranges (for each symptom model) were as follows: zero (never), 1 (mild), 2 (moderate), 3 (relatively severe), and 4 (severe). Additionally, the total score (all five categorical models) was determined for each participant. Three questions about age at menarche (the first menstruation), menstrual cycle period, and bleeding cycle days were asked from each student. In this survey, food patterns were evaluated by the food pyramid (designed by USDA food guide pyramid (18) and in accordance with the Iranian pyramid). The picture of the food pyramid was shown to female student and one serving of a different food groups was explained to them. Then they were asked to report their daily intake from each food group for the past three months. The food groups were as follows: milk and dairy products (yogurt, ice cream, and doogh); bread and grain products (rice and pasta); meat and beans; fruits; vegetables; and oils. At the end of the study, 86 participants filled all of the questionnaires completely, 14 students were eliminated from the study for incomplete questionnaires and poor corporation.

Data were analyzed by SPSS (ver 16). The quantitative variables were shown as mean ± standard deviation (SD). The Pearson correlation coefficient was used and a linear relationship was determined and shown by scatter plots to evaluate the relationship between the two variables. P values below 0.05 were considered significant.

4. Results

Fifty-six (65.1%) students who suffer from PMS and 30 (34.9%) healthy female students included 86 total participants for this study. The mean age ± SD of healthy students and those who suffer from PMS was 19.8 ± 1.4 and 19.5 ± 1.1, respectively. There were no significant differences between the PMS and the healthy groups for age. Table 1 shows the mean ± SD of score for each categorical model of symptoms (mood and emotional symptoms; pain; fatigue and focus; gastrointestinal symptoms; other disorders; and total symptoms). There were significant differences between students suffering from PMS and healthy students.

The mean (±SD) for age at menarche, menstrual cycle period, and bleeding cycle days was 13.3 ± 1.3 (years), 27.5 ± 3.5 (days), and 6.4 ± 1.5 (days), respectively. Figure 1 indicates age at menarche and menstrual cycle period relationship with scores of mood-emotional symptoms, pain, and gastrointestinal symptoms. The Pearson correlation test showed a significant negative relationship between mood-emotional symptoms and age at menarche (P = 0.034, r = -0.229; Figure 1A), which means the greater the age of first menstruation the less the mood-emotional score will be. A significant negative relationship between pain score and age at menarche showed a lower age for first menstruation which lead to more pain (P = 0.006, r = -0.297; Figure 1B). The Pearson correlation test showed negative relationship between menstruation cycle period and pain (P = 0.019, r = -0.252; Figure 1C). The statistical relationship between gastrointestinal disorders and age at menarche displayed a negative relationship (P = 0.013, r = -0.267; Figure 1D). The correlation test between total disorders and age at menarche showed negative relationship again (P = 0.007, r = -0.288; Figure 1E), which revealed more age of first menstruation that led to less total disorders.

The mean ± SD for serving intakes of different food groups were as follows: grain group: rice 4.8 ± 2.3, pasta 2 ± 2.05, bread 2.3 ± 1.5; dairy group: milk 0.5 ± 0.7, yogurt 0.6 ± 0.4, doogh 0.7 ± 0.3, ice cream 0.5 ± 0.8, cheese 0.6 ± 0.5; meat and beans group: meat 2.5 ± 0.9, beans 0.6 ± 0.5, egg 0.4 ± 0.5; fruit group: 1.1 ± 0.8, vegetable group: 0.6 ± 0.6; and oil group: 6.5 ± 3.4. Figure 2 displays the relationship between food intakes (according to the Iranian food pyramid) with the score of categorical models of symptoms. The negative relationship between milk servings intake and pain (P = 0.038, r = -0.224; Figure 2A) revealed that the more milk consumed led to less pain. A negative relationship was observed between total dairy products consumption and pain (P = 0.019, r = -0.253; Figure 2B). The score of other disorders revealed negative relationship with milk (P = 0.018, r= -0.254; Figure 2C), ice cream (P = 0.032, r = -0.231; Figure 2D), and total dairy products intake (P = 0.009, r = -0.281; Figure 2E). These results indicate that if intakes of milk, ice cream, or total dairy products were increased, then the other disorders (like acne or increased weight) were decreased. Total disorders displayed a negative relationship with total dairy products intake (P = 0.024, r = -0.243). Other food groups did not show any relationship with the categorical models of symptoms.

Table 1. The Scores of Categorical Models of Symptoms in Healthy and Students Suffering from PMS ^{a, b}

Categorical Models of Symptoms	Scores		P Value ^c
Categorical Models of Symptoms	Healthy	PMS	P Value ^c
Mood-emotional	2.8 ± 2.7	6.8 ± 3.7	< 0.001
Pain	2.9 ± 1.9	8.0 ± 4.0	< 0.001
Fatigue and focus	2.7 ± 2.3	6.0 ± 3.2	< 0.001
Gastrointestinal	0.6 ± 0.9	1.6 ± 1.5	< 0.001
Other disorders	1.4 ± 1.5	3.2 ± 2.2	< 0.001
Total disorders	10.4 ± 5.9	25.6 ± 10.7	< 0.001

^a Abbreviations: PMS, premenstrual syndrome.

^b data are presented as mean ± SD.

^c Independent t-test significance level < 0.05.

Figure 1. The Correlation between Some Premenstrual Syndrome Symptoms with age at First Menarche and Menstruation Cycle Period

A) The negative relationship between age at menarche and mood-emotional symptoms score, P = 0.034, r = -0.229. B) The negative relationship between age at menarche and pain score, P = 0.006, r = -0.297. C) The negative relationship between menstrual cycle (days) and pain score, P = 0.019, r = -0.252. D) The negative relationship between age at menarche and gastrointestinal symptoms score, P = 0.013, r = -0.267. E) The negative relationship between age at menarche and total symptoms score, P = 0.007, r = -0.288.

Figure 2. The Correlation between Some Premenstrual Syndrome Symptoms with Milk and Dairy Products

A) The negative relationship between milk consumption and pain score, P = 0.038, r = -0.224. B) The negative relationship between total dairy consumption and pain score, P = 0.019, r = -0.253. C) The negative relationship between total dairy consumption and other disorders score, P = 0.009, r = -0.281. D) The negative relationship between milk consumption and other disorders score, P = 0.018, r = -0.254. E) The negative relationship between ice cream consumption and other disorders score, P = 0.032, r = -0.231. F) The negative relationship between total dairy consumption and total symptoms score, P = 0.024, r = -0.243.

5. Discussion

This survey shows a negative relationship among age at menarche and mood-emotional symptoms, pain, gastrointestinal, and total disorders. The participants in this study were older than 18, they remembered their age at menarche and reported it. In Taiwan, Liu et al. reported the age range at menarche 11 - 12 years old (79.1% of participants) (21). Our finding was closer to the mean age at menarche of Brazilian girls (13.65 ± 1.4) (22). Although the age at menarche for the university students in our research was higher than for females in Taiwan, the negative relationship between mood and emotional disorders and age at menarche needs further consideration. Accordingly, some studies revealed that an earlier menarche was associated with increased levels of depression (23-25). The important point is that emotional support (26, 27) for female first menstrual experiences (28). Many factors can affect age at menarche such as birth length and weight, social status, family income, and nutrition (29). Therefore, these factors will help females to experience menarche at the appropriate age and then reduce PMS disorders.

In this study, a negative relationship between pain and menstruation cycle period was observed. Severe pain is associated with increased levels of C-reactive protein (CRP) (30). Puder et al. have shown that 100% increases in high sensitive-CRP levels led to a 48% increases in total PMS symptom scores (31). Although we did not determine CRP levels in these female students, there might be the higher levels of CRP followed by more pain, which leads to fewer days in the menstrual cycle period.

In current study, no relationship was observed between bread and grain intake and PMS symptom scores. Mahmoudi et al. compared a high carbohydrate diet, carbohydrate supplements, and protein supplements to reduce symptoms of PMS and found that all interventions had the same reduction effect on the symptoms (14). In another study, participants consumed six high carbohydrate small meals per day for three months and the mood and physical symptoms of PMS decreased at the end of the third month (15). Recommended intakes of bread and grain products according to the Iranian food pyramid are 6 - 11 exchanges per day. The reason for any significant relationship between bread and grain product intake and PMS disorders is that the mean ± SD intake of this food group (9 ± 3.5 exchanges per day) was optimal. Hence, carbohydrate intake was optimal as well.

The interesting results of this survey were the negative relationship between dairy products and pain, other disorders (acne, increased weight, and polyuria) and total symptoms. Akhlaghi et al. used calcium tablets as a supplement for females suffering from PMS. Their results showed significant decreases in some somatic symptoms such as acne, increased weight, headache, joint pain, backache, and some mood-emotional disorders like irritability, depression, appetite changes, fatigue, and sleep disorders (10). Another study that used vitamin E and calcium supplements together showed a decrease of symptoms at the end of the intervention phase (12). Bakhshani indicated that dietary intake in adolescent girls was determined by the food frequency questionnaire. In these girls, dairy product intake led to decreased levels of PMS symptoms (16). Milk and dairy products are good sources of calcium, which explains our results for greater consumption of dairy products leading to a greater intake of calcium and, therefore, fewer symptoms of PMS.

In conclusion, it should be considered that menstruation is a complex problem. Factors affecting menstruation and cycle period are personal and environmental factors along with lifestyle (29). Dietary intake as an environmental factor needs more attention in girls, women during menstruation and optimal intake of foods specially milk, and dairy products (according to an appropriate food pattern like a food pyramid) could be effective against PMS symptoms.

Acknowledgements

Footnote

References

1. Halbreich U. The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology. 2003; 28 Suppl 3: 55-99[PubMed]
2. Indusekhar R, Usman SB, O'Brien S. Psychological aspects of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol. 2007; 21(2): 207-20[DOI][PubMed]
3. Hammarback S, Ekholm UB, Backstrom T. Spontaneous anovulation causing disappearance of cyclical symptoms in women with the premenstrual syndrome. Acta Endocrinol (Copenh). 1991; 125(2): 132-7[PubMed]
4. A DM, K S, A D, Sattar K. Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. J Clin Diagn Res. 2014; 8(2): 106-9[DOI][PubMed]
5. Makvandi S, Zargar Shoushtari S. [Midwifery students' attitudes towards herbal medicine and its application in obstetric]. Jentashapir J Health Res. 2012; : 81-6
6. Hamid N, Ataei Moghanloo V, Eidi baygi M. [Comparison efficacy of three methods of cognitive behavior therapy, pharmacotherapy and cognitive behavior therapy with exposure and response prevention in obsessive-compulsive disorder symptoms]. Jentashapir J Health Res. 2012; : 1-12
7. Aghaei E, Jamali Paghale S, Abedi A. [Meta-analysis of effectiveness of drug treatments on rate of depression symptoms in Iran in 2001-2010]. Jentashapir J Health Res. 2012; 3(3): 459-67
8. Baker LJ, O'Brien PM. Premenstrual syndrome (PMS): a peri-menopausal perspective. Maturitas. 2012; 72(2): 121-5[DOI][PubMed]
9. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013; 79(7): 562-75[DOI][PubMed]
10. Akhlaghi F, Hamedi A, Javadi Z, Hosseinipour F. [Calcium administration effect on premenstrual syndrome]. Razi J Med Sci. 2004; 10(37): 669-76
11. Dolatian M, Montazeri S, Valaei N, Ahmadi M. [The comparison of vitamin B6 and vitamin E effects on premenstrual syndrome symptoms]. J Zanjan Univ Med Sci Health Services. 2002; 9(37): 5-10
12. Pourmohsen M, Zoonemat-Kermani A, Taavoni S, Hosseini AF. [Effect of combined calcium and vitamin E consumption on premenstrual syndrome]. Iran J Nursing. 2010; 23(65): 8-14
13. Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstet Gynecol. 1995; 86(4 Pt 1): 520-8[PubMed]
14. Mahmoudi Z, Shhpourian F, Bastani F, Parsay S, Hosseini F. [The comparision of carbohydrate supplement and dietary carbohydrate addition on severity of premenstrual syndrome]. J Kermanshah Univ Med Sci. 2009; 1(40): 10-9
15. Abedian-Kasgari K, Shahhosseini Z, Dansh M. [Assessment of starch dietary regimen regarding pre-menstrual syndrome among high school students in Sari during 2007]. J Mazandaran Univ Med Sci. 2008; 18(65): 19-27
16. Bakhshani NM, Hasanzadeh Z. [Relationship of premenstrual syndrome and nutritional style]. Med J Mashhad Uni Med Sci. 2012; 55(3): 151-7
17. Safavi SM, Omidvar N, Djazayery A, Minaie M, Hooshiarrad A, Sheikoleslam R. Development of Food-Based Dietary Guidelines for Iran: A Preliminary Report. Ann Nutr Metab. 2007; 51(suppl 2): 32-5
18. Food guide pyramid.
19. Shakerinejad Q, Naghashpour M, Hajinajaf S, Jaruvandi F, Lurizadeh MR. [The relation between demographic indexes and nutrient-intake pattern among first grade female students of Ahvaz high schools, district 1]. Jentashapir J Health Res. 2011; 2(1): 35-43
20. ACOG . ACOG practice bulletin: premenstrual syndrome. Int J Gynecol Obstet . 2001; 73: 183-91
21. Liu HL, Chen KH, Peng NH. Cultural practices relating to menarche and menstruation among adolescent girls in Taiwan--qualitative investigation. J Pediatr Adolesc Gynecol. 2012; 25(1): 43-7[DOI][PubMed]
22. Pitangui AC, Gomes MR, Lima AS, Schwingel PA, Albuquerque AP, de Araujo RC. Menstruation disturbances: prevalence, characteristics, and effects on the activities of daily living among adolescent girls from Brazil. J Pediatr Adolesc Gynecol. 2013; 26(3): 148-52[DOI][PubMed]
23. Black SR, Klein DN. Early menarcheal age and risk for later depressive symptomatology: the role of childhood depressive symptoms. J Youth Adolesc. 2012; 41(9): 1142-50[DOI][PubMed]
24. Deng F, Tao FB, Wan YH, Hao JH, Su PY, Cao YX. Early menarche and psychopathological symptoms in young Chinese women. J Womens Health (Larchmt). 2011; 20(2): 207-13[DOI][PubMed]
25. Joinson C, Heron J, Lewis G, Croudace T, Araya R. Timing of menarche and depressive symptoms in adolescent girls from a UK cohort. Br J Psychiatry. 2011; 198(1): 17-23[DOI][PubMed]
26. Nadi Najafabadi F, Nazari Chegeni A, Bassaknejad S. Design and test a model of the relationship between negative life events and mental health with resiliency and social support mediation in female medical sciences students at jundishapour university of Ahvaz. Jentashapir J Health Res. 2014; 5(1): 483-94
27. Bassaknejad S, Hooman F, Purabolghasemi R, Hamidiyan Jahromi S. [The relationship between emotional intelligence and general health among midwifery students of Ahvaz Jundishapur University of Medical Sciences]. Jentashapir J Health Res. 2011; 1(1): 25-31
28. Marvan ML, Alcala-Herrera V. Age at menarche, reactions to menarche and attitudes towards menstruation among Mexican adolescent girls. J Pediatr Adolesc Gynecol. 2014; 27(2): 61-6[DOI][PubMed]
29. Dossus L, Kvaskoff M, Bijon A, Fervers B, Boutron-Ruault MC, Mesrine S, et al. Determinants of age at menarche and time to menstrual cycle regularity in the French E3N cohort. Ann Epidemiol. 2012; 22(10): 723-30[DOI][PubMed]
30. Sturmer T, Raum E, Buchner M, Gebhardt K, Schiltenwolf M, Richter W, et al. Pain and high sensitivity C reactive protein in patients with chronic low back pain and acute sciatic pain. Ann Rheum Dis. 2005; 64(6): 921-5[DOI][PubMed]
31. Puder JJ, Blum CA, Mueller B, De Geyter C, Dye L, Keller U. Menstrual cycle symptoms are associated with changes in low-grade inflammation. Eur J Clin Invest. 2006; 36(1): 58-64[DOI][PubMed]