Effects of Yoga on Balance, Cognition, Posture, and Body Awareness in Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is characterized by a combination of cognitive, somatic, behavioral, and emotional disorders that occur during the late luteal phase of the menstrual cycle, resolve rapidly after menstruation, and can be severe enough to disrupt daily activities. When reviewing the literature, studies examining the effects of yoga-based exercises on premenstrual syndrome appear to be quite limited. Our aim is to raise awareness among professionals working in this field in our country, contributing to the reduction of symptoms and improvement of the quality of life of individuals with premenstrual syndrome.

Menstruation is a process characterized by symptoms accompanied by emotional, physical, and behavioral changes that occur regularly every month from menarche to menopause, covering an average of 30-35 years of a woman's life. Although menstruation, which constitutes a large period of a woman's life, is a natural physiological cycle, the symptoms that accompany the cycle are among the most common women's health problems.Premenstrual Syndrome (PMS) is defined as 'a condition characterized by distressing physical, behavioral, and psychological symptoms that begin 7-10 days before the menstrual cycle and disappear or significantly decrease with the cessation of menstruation, without being attributed to any underlying psychiatric disorder. Depression, angry outbursts, irritability, anxiety, lack of concentration, and decreased sleep quality are among the most common emotional symptoms of PMS, while physical symptoms include breast tenderness, swelling, fatigue, headache, edema in the extremities, and a feeling of pain or aching. In addition to these frequently seen symptoms in the literature, more than 200 symptoms are defined for PMS. Hormonal fluctuations in women with premenstrual symptoms trigger changes in ligament elasticity, negatively affecting postural balance, coordination and proprioception, and leading to a higher risk of injury. This health issue, which affects many women worldwide, is known to disrupt women's social relationships, increase their tendency to make mistakes or have accidents, reduce work and school performance, and lead to higher rates of sleep problems, substance abuse, criminal behavior, and impaired cognitive functions responsible for memory and emotional control. The etiology of PMS is multifactorial and uncertain, and therefore, there is no definitive treatment method. Although different treatment options are preferred, the aim of the treatment is to relieve the symptoms. Studies have demonstrated that PMS symptoms are more severe in inactive women and that women with severe PMS symptoms are more likely to be inactive. Yoga is one of the oldest methods of personal development, which integrates the body, mind, and spirit, facilitating self-awareness. Yoga increases bodily awareness and cognition as it includes many mind-body exercises such as balancing, stretching, strengthening, physical harmony, breathing and meditation techniques. Studies show that yoga has positive psychological and mental effects on individuals and improves their quality of life. Despite many PMS symptoms negatively impacting a woman's participation in work and social life, there is limited research in the existing literature on specific symptoms. Therefore, this study aims to determine the effectiveness of yoga-based exercises on symptoms in individuals with premenstrual syndrome.

Eligibility Criteria:
Inclusion Criteria:

* Presence of premenstrual symptoms (scoring 132 or above on the Premenstrual Syndrome Scale (PMSS)),
* Aged 18 and above,
* Able to read and write,
* Willing to participate voluntarily in the study and have signed the informed consent form,
* No problems with cooperation and communication,
* Normal menstrual cycle length (21-35 days) in the past 3 months,
* Not having taken any medications or mineral supplements during the last three menstrual cycles.

Exclusion Criteria:

* Amenorrhea
* Being in the menopausal period
* Pregnancy
* Having given birth
* A diagnosis of cancer
* Having previously practiced yoga
* Having exercise intolerance
* Having received hormone replacement therapy
* Having been enrolled in a physiotherapy program in the past 3 months
* Regular exercise within the past 3 months
* Having musculoskeletal, neurological, serious cardiopulmonary, chronic systemic, psychiatric, balance and coordination, or vestibular system disorders that may prevent participation in exercise