Title: Factors Associated with Premenstrual Symptoms: A Study among Graduate-Level
Students of the Institute of Science and Technology, Tribhuvan University
Version: 3 Date: 31 May 2025
Reviewer's report:
The aim of this study was to determine the prevalence of premenstrual syndrome (PMS) and
associated factors among female postgraduate students at Tribhuvan University, Nepal .
Method:
Cross-sectional design , total of 285 participants
Data collection: PMS assessment with PSST (Premenstrual Symptoms Screening Tool), stress
levels were measured with DASS-21
Statistical analysis: Multiple logistic regression
Inclusion criteria: 15–49 years of age, regular menstruation in the last two months
Exclusions: PCOD, pregnancy, some chronic diseases
Age at menarche (age of onset) # # PMS risk # (OR: 0.689)
Presence of dysmenorrhea # PMS risk # (OR: 2.032)
Use of period delaying medication # PMS risk is high # (OR: 11.015)
Stress level :
Mild stress (OR: 2.713)
Moderate stress (OR: 3.934)
Severe stress (OR: 19.267)
Although causality cannot be established, which is specific to cross-sectional studies, it is
suitable for relationship analysis.
Sample suitability ensured: 285 participants selected from the entire target population
PSST (Premenstrual Symptoms Screening Tool): Internationally valid tool for the diagnosis of
PMS
DASS-21: Valid/reliable scale to determine stress, anxiety and depression levels
Internal consistency values are high (PSST # = 0.961, DASS # = 0.848)
Clinical Significance:
PMS is a common problem that affects academic success, social interaction and quality of life.
Study reveals strong effects of dysmenorrhea and stress on PMS
The intense effect of menstrual delaying drugs (OR: 11.0) is remarkable; it is emphasized that
drugs used especially for religious/cultural reasons can cause hormonal imbalance.
Social Reflections:
87% of the participants did not use menstrual delaying medication; however, PMS increased
significantly in the minority who did.
The strong relationship between stress level and PMS reveals the need for psychosocial support
Most students seek alternative solutions; medical consultation rates are very low
Strengths:
A pioneering study collecting data at this level in the Nepalese context
Use of valid measurement tools (PSST, DASS-21)
Reaching the entire sample
Comprehensive statistical analysis and multivariate modeling
Limitations:
Cross-sectional design # cause-effect inference not possible
Data collected based on subjective statements without clinician support # information and
response errors may occur
Additional factors such as nutrition, physical activity, and sleep quality are not addressed in
depth.
Information such as the brand, dosage, and duration of use of period delaying drugs is missing.
Recommendations for Future Research:
Studies supported by clinical examination
PMS development and course should be monitored with a longitudinal design
The effects of menstrual medication use, nutrition, exercise and psychosocial support on PMS
should be investigated with control groups.
This study revealed that PMS is quite common (40%) among female postgraduate students
and is significantly associated with factors such as stress , dysmenorrhea , use of menstrual
delaying drugs , and early menarche . These findings suggest the development of awareness-
raising policies for women's health in educational settings, the dissemination of psychological
support programs, and the promotion of medical counseling.