Investigation of Self-Esteemin High School Students with Premenstrual Syndrome


1 M.Sc. of Nursing, Department of Nursing, School of Nursing andMidwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing andMidwifery, Shiraz University of Medical Sciences, Shiraz, Iran

3 PHD, Department of Theology, Faculty of Humanities Science College, Yasouj University, Yasouj, Iran

4 Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran


Abstract Background: Premenstrual syndrome (PMS) is one of themost common disorders of reproductive age, and it is reported that 90% - 85% of the people are suffering fromthis disorder. Among themultiple symptoms of mental premenstrual syndrome, dysphoria, irritability, tension, anxiety and physical symptoms of bloating and breast pain are more common symptoms that can interfere with personal, family and community relationships. Objectives: This study aimed to evaluate the frequency of the symptoms of PMS (physical, psychological and social) and the level of self-esteemin girls with PMS in 2013. Methods: A cross-sectional study was performed on 200 girl high-school students of Shiraz city who had PMS. The study tools in- cluded demographic questionnaire, premenstrual symptoms, screening tool (PSST), (completed in two consecutive months) and Cooper Smith questionnaire. Data was analyzed by applying SPSS (version 16) and descriptive statistics. Results: Themean age of the study population was 16.341.06. About 50.5 percent were within 14-16 years old. 11.433.89, 12.87 4.49, and 39.28  16.2 were the mean scores of physical, mental and total symptoms in girls with PMS, respectively. Moderate and high levels of self-esteemwere reported 53% and 47% respectively among the patients with PMS. Conclusions: The results showed that high self-esteem is decreased in patients with premenstrual syndrome. Due to the mood disorders, the subjects may avoid their perfection tendency and intensify their negative self-concept leading to low self-esteem. Different treatments, particularly psychological remedies, are required for those suffering fromPMS.


  1. Talaei A, Fayyazi Bordbar MR, Nasiraei A, Pahlavani M, Dadgar S. Epi- demiology of premenstrual syndrome (PMS) in students of Mashhad University of Medical Sciences [In Persian]. Iranian J Obstet Gynecol In- fertil. 2009;12(2):15–22.
  2. Zare H, Taraj S. The effect of premenstrual syndromes on the function  of short-term, long-term and provident  memory  of  afflicted  women [In Persian]. Iranian J Obstet Gynecol Infertil. 2009;12(3):1–8.
  3. Douglas     Premenstrual    syndrome.    Evidence-based    treatment in family practice. Can Fam Physician. 2002;48:1789–97. [PubMed: 12489244].
  4. Freeman EW, Halberstadt SM, Rickels K, Legler JM, Lin H, Sammel MD. Core symptoms that discriminate premenstrual syndrome. J Womens Health (Larchmt). 2011;20(1):29–35. doi:1089/jwh.2010.2161. [PubMed:21128818].
  5. Olive DL, Palter SF. Reproductive physiology. In: Berek JS , editor. No- vaks gynecology. 14th ed. Philadelphia: Lippincott Williams  Wilkins; p. 161–84.
  6. Lee JC, Yu BK, Byeon JH, Lee KH, Min JH, Park SH. A study on the menstruation of Korean adolescent girls in Seoul. Korean J Pediatr. 2011;54(5):201–6. doi:3345/kjp.2011.54.5.201. [PubMed:21829411].
  7. O’Brien PM. Helping women with premenstrual syndrome. BMJ.1993;307(6917):1471–5. doi:10.1136/bmj.307.6917.1471. [PubMed:8281092].
  1. Delara M, Borzuei H, Montazeri A. Premenstrual disorders: preva- lence and  associated  factors  in  a  sample  of Iranian    Iran Red Crescent Med J. 2013;15(8):695–700. doi:10.5812/ircmj.2084. [PubMed:24578837].
  2. Lustyk MK, Widman  L,  Paschane  A,  Ecker    Stress, quality  of  life and physical activity in women with varying degrees of pre- menstrual symptomatology. Women Health. 2004;39(3):35–44. doi: 10.1300/J013v39n03_03. [PubMed:15256354].
  3. Geary Foodandmoodhandbook: find relief at lastfromdepression, anx- iety, PMS, cravings and mood swings. London: Thomsons; 2001. p. 1–6.
  4. Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, Wurtman R. The effect of a carbohydrate-rich beverage on mood, appetite, and cogni- tive function in women with premenstrual syndrome. Obstet Gynecol. 1995;86(4 Pt 1):520–8. doi:1016/S0029-7844(95)80009-3. [PubMed:7675373].
  1. Carson Mental health nursing: the nurse-patient journey. 2nd ed. Philadelphia: Saunders; 2000. p. 1–6.
  2. Aklichi M, Mahri Sabzevar of self-esteem in high school students in the academic year 89-88 [In Persian]. Sunrise Health. 2011;10(1):28–37.
  3. 14.Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2011;84(8):918–24. [PubMed: 22010771].
  4. Gammon J, Morgan-Samuel H. A study to ascertain the effect of struc- tured student tutorial support on student stress, self-esteem and cop- Nurse Educ Pract. 2005;5(3):161–71. doi:10.1016/j.nepr.2004.09.003. [PubMed:19038195].
  5. Babaei M, Fadakar Soghe R, Sheikhol-Eslami F, Kazemnejad Leili Sur- vey self esteem and its relevant factors among high school students [In Persian]. Holist Nurs Midwifery. 2015;25(3):1–8.
  6. Kaplan H, Sadock B. Kaplan and Sadock’s synopsis of psychiatry be- havioral science clinical psychiatry. 10th ed. Philadelphia: Lippincott Williams Wilkins; 2007. 12
  7. Yelsma P, Yelsma      Self-esteem    and    social    respect    within the high school. J Soc Psychol. 1998;138(4):431–41. doi: 10.1080/00224549809600398. [PubMed:9664861].
  8. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life  impairment  in depressive and anxiety disorders. Am J Psychiatry. 2005;162(6):1171–   doi:10.1176/appi.ajp.162.6.1171. [PubMed:15930066].
  9. Akbarzadeh M, Dehghani M, Moshfeghy Z, Emamghoreishi M, Tavakoli P, Zare Effect of Melissa officinalis Capsule on the Intensity of Premenstrual Syndrome Symptoms in High School Girl Students. Nurs Midwifery Stud. 2015;4(2). e27001. doi:10.17795/nmsjournal27001. [PubMed:26339667].
  10. Borenstein JE, Dean BB, Endicott J, Wong J, Brown C, Dickerson V, et Health and economic impact of the premenstrual syndrome. J Reprod Med. 2003;48(7):515–24. [PubMed:12953326].
  11. Asadi M, Salehi M, Sadooghi M, Afkham Ebrahimi A. Self-esteem and attitude toward body appearance before and after cosmetic rhino- plasty [In Persian]. Iran J Psychiatry Clin Psychol. 2013;19(1):28–33.
  12. Correa AJ, Sykes JM, Ries WR. Considerations before Otolaryngol Clin North Am. 1999;32(1):7–14. doi:10.1016/S0030- 6665(05)70112-2. [PubMed:10196435].
  13. Herz L, Gullone E. The Relationship between Self-Esteem and Parent- ing Style: A cross-cultural comparison of Australian and Vietnamese Australian adolescents. J Cross Cult Psychol. 2016;30(6):742–61. doi: 1177/0022022199030006005.
  14. Ponsoda V, Abad FJ, Francis LJ, Hills PR. Gender differences in the coopersmith self-esteem inventory:  The  incidence  of  differential item functioning. J Individ Dif. 2008;29(4):217–22. doi:1027/1614- 0001.29.4.217.
  15. Shahedifar N, Sharifian M, Setarehforozan A, Biglarian A. Exposure to physical violence between their parents and their relationship with self-esteem. Iran Red Crescent Med J. 2014;16(1).
  16. Rapkin AJ, Winer SA. Premenstrual syndrome and premenstrual dys- phoric disorder: quality of life and burden of illness. Expert Rev Pharmacoecon Outcomes Res. 2009;9(2):157–70. doi:1586/erp.09.14. [PubMed:19402804].
  17. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Arch Womens Ment Health. 2003;6(3):203–9. doi:1007/s00737-003-0018-4. [PubMed:12920618].
  18. Nisar N, Zehra N, Haider G, Munir AA, Sohoo NA. Frequency, inten- sity and impact of premenstrual syndrome in medical students. J Coll Physicians Surg Pak. 2008;18(8):481–4. [PubMed:18798584].
  19. Yang M, Wallenstein G, Hagan M, Guo A, Chang J, Kornstein
  20. Burden of premenstrual dysphoric disorder on health-related quality of life. J Womens Health (Larchmt). 2008;17(1):113–21. doi: 10.1089/jwh.2007.0417. [PubMed:18240988].
  21. Alexander M, Fawcelt JN, Punciman PJ. Nursing practice: hospital and home: the adult. Edinburgh: Churchil Livingston; 2000. p. 232–6.
  22. Kumari S, Sachdeva A. Patterns and Predictors of Premenstrual Symptoms among Females Working in a Psychiatry Hospital. Scien- tifica (Cairo). 2016;2016:6943852. doi:1155/2016/6943852. [PubMed: 27293977].
  23. Tabassum S, Afridi B, Aman Z, Tabassum W, Durrani R. Premenstrual syndrome: frequency and severity in young college girls. J Pak Med Assoc. 2005;55(12):546–9. [PubMed:16438276].

  36.Tatari F, Shaker J, Hosseini M, Rezaii M, Amirian M, Amirian F. Fre- quencyof premenstrualdysphoricdisorder,       premenstrualsyndrome and some related factor in student of girl’s high schools of Kerman- shah [In Persian]. J Res Behav  Sci. 2007;5(1):13–9.

36.Arslan      Anger,    self-esteem,    and    perceived    social     sup- port in adolescence. Soc Behav Pers. 2009;37(4):555–64. doi: 10.2224/sbp.2009.37.4.555.

37. Chang YT, Chen YC. Study of menstrual  attitudes  and  distress  among postmenarcheal female students  in  Hualien    J  Nurs Res. 2009;17(1):20–9. doi:10.1097/JNR.0b013e3181999d25. [PubMed: 19352226].

38. Chen HM, Chen CH. Related  factors  and  consequences  of men-  strual distress in adolescent girls  with    Kaohsiung  J Med Sci. 2005;21(3):121–7. doi:10.1016/S1607-551X(09)70288-8. [PubMed: 15875437].

39. Lu ZJ. The relationship between menstrual attitudes and menstrual symptoms among Taiwanese J Adv Nurs. 2001;33(5):621–8. doi: 10.1046/j.1365-2648.2001.01705.x. [PubMed:11298198].


40. Sepehrirad M, Toozandehjani Effectiveness of cognitive-behavioral group therapy training and nutritional strategies based on tradi- tional medicine on premenstrual syndrome [In Persian]. Iran J Obstet Gynecol Infertil.

41. Hassiotis A, Serfaty M, Azam K, Strydom A, Martin S, Parkes C, et Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised con- trolled trial. Trials. 2011;12:95. doi:10.1186/1745-6215-12-95. [PubMed: 21492437].

42. Blake F. Cognitive therapy for Premenstrual Syndrome. Cogn Behav Pract. 1995;2(1):167–85. doi:1016/s1077-7229(05)80009-4.

43. Fritz MA, Speroff L. Clinical gynecology endocrinology and infertility. Philadelphia: Lippincott Williams Wilkins; 2011. p. 531–46.

44. Kashani L, Saedi  N,  Akhondzadeh    Femicomfort  in  the  treat- ment of premenstrual syndromes: a double-blind, randomized and placebo controlled trial. Iran J Psychiatry. 2010;5(2):47–50. [PubMed: 22952490].