Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and Associated Factors of Premenstrual Syndrome in Chinese Adolescent Girls

  • Research
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Epidemiological data on premenstrual syndrome (PMS) in Chinese adolescents are limited. This study reported the prevalence and associated factors of PMS in a large sample of Chinese adolescents. A total of 5099 adolescent girls who had menarche participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort study in Shandong, China. A self-administered questionnaire was used to ask about PMS, age at menarche, menstrual cycle interval, menstrual flow length, menstrual regularity, period pain, body weight and height, trait anger, stressful life events, and demographics. The mean age of the sample was 15.19 years (SD = 1.32). The overall prevalence of PMS was 24.6%. The prevalence rates of PMS-anxiety, PMS-water retention, PMS-craving, and PMS-depression were 18.9%, 4.0%, 7.9%, and 11.5%, respectively. The most common symptoms were premenstrual irritability (54%) and fatigue (52.5%). Stepwise logistic regression showed that high levels of life stress (OR 2.26), high levels of trait anger (OR 4.65), alcohol consumption (OR 1.28), menstrual cycle interval ≤ 24 days (OR 1.45), and mild (OR 1.50), moderate (OR 2.57) or severe period pain (OR 4.84) were all significantly associated with increased likelihood of PMS. In conclusion, approximately 1 in 4 Chinese adolescent girls suffered from PMS. Multiple psychosocial and menstrual factors were associated with PMS. Further research is needed to understand developmental changes of PMS and its long-term impacts on psychosocial wellbeing in Chinese adolescent girls.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of Data and Material

Data available upon reasonable request.

References

  1. ACOG (2014) Guidelines for women’s health care: a resource manual, 4th edn. American College of Obstetricians and Gynaecologists, Washington, DC

    Google Scholar 

  2. Gudipally PR, Sharma GK (2022) Premenstrual syndrome. StatPearls, Treasure Island, FL

    Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington, VA

    Book  Google Scholar 

  4. Dennerstein L, Lehert P, Heinemann K (2012) Epidemiology of premenstrual symptoms and disorders. Menopause Int 18(2):48–51. https://doi.org/10.1258/mi.2012.012013

    Article  PubMed  Google Scholar 

  5. Quintana-Zinn FA, Whitcomb BW, Ronnenberg AG, Bigelow C, Houghton SC, Bertone-Johnson ER (2017) Premenstrual symptom patterns and behavioral risk factors in young women: a cross-sectional study. J Womens Health (Larchmont) 26(10):1099–1105. https://doi.org/10.1089/jwh.2016.5921

    Article  Google Scholar 

  6. Gao M, Gao D, Sun H, Cheng X, An L, Qiao M (2021) Trends in research related to premenstrual syndrome and premenstrual dysphoric disorder from 1945 to 2018: a bibliometric analysis. Front Public Health 9:596128. https://doi.org/10.3389/fpubh.2021.596128

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hantsoo L, Rangaswamy S, Voegtline K, Salimgaraev R, Zhaunova L, Payne JL (2022) Premenstrual symptoms across the lifespan in an international sample: data from a mobile application. Arch Womens Ment Health 25(5):903–910. https://doi.org/10.1007/s00737-022-01261-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, Kaikhavandi S (2014) Epidemiology of premenstrual syndrome (PMS)—a systematic review and meta-analysis study. J Clin Diagn Res 8(2):106–109. https://doi.org/10.7860/JCDR/2014/8024.4021

    Article  PubMed Central  Google Scholar 

  9. Braverman PK (2007) Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol 20(1):3–12. https://doi.org/10.1016/j.jpag.2006.10.007

    Article  PubMed  Google Scholar 

  10. Chau JP, Chang AM, Chang AM (1998) Relationship between premenstrual tension syndrome and anxiety in Chinese adolescents. J Adolesc Health 22(3):247–249. https://doi.org/10.1016/S1054-139X(97)00206-1

    Article  PubMed  Google Scholar 

  11. Hong JP, Park S, Wang HR, Chang SM, Sohn JH, Jeon HJ, Lee HW, Cho SJ, Kim BS, Bae JN, Cho MJ (2012) Prevalence, correlates, comorbidities, and suicidal tendencies of premenstrual dysphoric disorder in a nationwide sample of Korean women. Soc Psychiatry Psychiatr Epidemiol 47(12):1937–1945. https://doi.org/10.1007/s00127-012-0509-6

    Article  PubMed  Google Scholar 

  12. Hickey M, Balen A (2003) Menstrual disorders in adolescence: investigation and management. Hum Reprod Update 9(5):493–504

    Article  PubMed  Google Scholar 

  13. Adams Hillard PJ (2008) Menstruation in adolescents: what’s normal, what’s not. Ann N Y Acad Sci 1135:29–35. https://doi.org/10.1196/annals.1429.022

    Article  PubMed  Google Scholar 

  14. Dutta A, Sharma A (2021) Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: a systematic review and meta-analysis. Health Promot Perspect 11(2):161–170. https://doi.org/10.34172/hpp.2021.20

    Article  PubMed  PubMed Central  Google Scholar 

  15. Azhary JMK, Leng LK, Razali N, Sulaiman S, Wahab AVA, Adlan ASA, Hassan J (2022) The prevalence of menstrual disorders and premenstrual syndrome among adolescent girls living in North Borneo, Malaysia: a questionnaire-based study. BMC Womens Health 22(1):341. https://doi.org/10.1186/s12905-022-01929-1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Drosdzol A, Nowosielski K, Skrzypulec V, Plinta R (2011) Premenstrual disorders in Polish adolescent girls: prevalence and risk factors. J Obstet Gynaecol Res 37(9):1216–1221. https://doi.org/10.1111/j.1447-0756.2010.01505.x

    Article  PubMed  Google Scholar 

  17. Halbreich U, Borenstein J, Pearlstein T, Kahn LS (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 28(Suppl 3):1–23. https://doi.org/10.1016/s0306-4530(03)00098-2

    Article  PubMed  Google Scholar 

  18. Itriyeva K (2022) Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Probl Pediatr Adolesc Health Care 52(5):101187. https://doi.org/10.1016/j.cppeds.2022.101187

    Article  PubMed  Google Scholar 

  19. Steiner M, Peer M, Palova E, Freeman EW, Macdougall M, Soares CN (2011) The Premenstrual Symptoms Screening Tool revised for adolescents (PSST-A): prevalence of severe PMS and premenstrual dysphoric disorder in adolescents. Arch Womens Ment Health 14(1):77–81. https://doi.org/10.1007/s00737-010-0202-2

    Article  PubMed  Google Scholar 

  20. Tschudin S, Bertea PC, Zemp E (2010) Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample. Arch Womens Ment Health 13(6):485–494. https://doi.org/10.1007/s00737-010-0165-3

    Article  PubMed  Google Scholar 

  21. Vichnin M, Freeman EW, Lin H, Hillman J, Bui S (2006) Premenstrual syndrome (PMS) in adolescents: severity and impairment. J Pediatr Adolesc Gynecol 19(6):397–402. https://doi.org/10.1016/j.jpag.2006.06.015

    Article  PubMed  Google Scholar 

  22. Smith H, Thomas SP (1996) Anger and locus of control in young women with and without premenstrual syndrome. Issues Ment Health Nurs 17(4):289–305. https://doi.org/10.3109/01612849609009402

    Article  PubMed  Google Scholar 

  23. Saglam HY, Basar F (2019) The relationship between premenstrual syndrome and anger. Pak J Med Sci 35(2):515–520. https://doi.org/10.12669/pjms.35.2.232

    Article  PubMed  PubMed Central  Google Scholar 

  24. Alshdaifat E, Absy N, Sindiani A, AlOsta N, Hijazi H, Amarin Z, Alnazly E (2022) Premenstrual syndrome and its association with perceived stress: the experience of medical students in Jordan. Int J Womens Health 14:777–785. https://doi.org/10.2147/IJWH.S361964

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lu D, Aleknaviciute J, Kamperman AM, Tamimi RM, Ludvigsson JF, Valdimarsdottir UA, Bertone-Johnson ER (2022) Association between childhood body size and premenstrual disorders in young adulthood. JAMA Netw Open 5(3):e221256. https://doi.org/10.1001/jamanetworkopen.2022.1256

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mitsuhashi R, Sawai A, Kiyohara K, Shiraki H, Nakata Y (2022) Factors associated with the prevalence and severity of menstrual-related symptoms: a systematic review and meta-analysis. Int J Environ Res Public Health 20(1):569. https://doi.org/10.3390/ijerph20010569

    Article  PubMed  PubMed Central  Google Scholar 

  27. Qiao M, Zhang H, Liu H, Luo S, Wang T, Zhang J, Ji L (2012) Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample in China. Eur J Obstet Gynecol Reprod Biol 162(1):83–86. https://doi.org/10.1016/j.ejogrb.2012.01.017

    Article  PubMed  Google Scholar 

  28. Gao X (2023) Academic stress and academic burnout in adolescents: a moderated mediating model. Front Psychol 14:1133706. https://doi.org/10.3389/fpsyg.2023.1133706

    Article  PubMed  PubMed Central  Google Scholar 

  29. Song Y, Agardh A, Ma J, Li L, Lei Y, Stafford RS, Prochaska JJ (2019) National trends in stunting, thinness and overweight among Chinese school-aged children, 1985–2014. Int J Obes (London) 43(2):402–411. https://doi.org/10.1038/s41366-018-0129-7

    Article  Google Scholar 

  30. Dong H, Li H (2022) Promoting sexuality education for children and adolescents on a large scale: program design, organizational cooperation network and administrative mobilization. Children (Basel) 9(10):1474. https://doi.org/10.3390/children9101474

    Article  PubMed  Google Scholar 

  31. Liu XC, Chen H, Liu ZZ, Wang JY, Jia CX (2019) Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents. Epidemiol Psychiatr Sci 28(3):280–289. https://doi.org/10.1017/S2045796017000488

    Article  PubMed  Google Scholar 

  32. Zhang L, Yang Y, Liu ZZ, Jia CX, Liu X (2018) Sleep disturbance mediates the association between intrafamily conflict and mental health problems in Chinese adolescents. Sleep Med 46:74–80. https://doi.org/10.1016/j.sleep.2018.02.012

    Article  PubMed  Google Scholar 

  33. Liu X, Liu ZZ, Liu BP, Jia CX (2022) Nightmare frequency and psychopathological problems in a large sample of Chinese adolescents. Soc Psychiatry Psychiatr Epidemiol 57(4):805–816. https://doi.org/10.1007/s00127-022-02224-y

    Article  PubMed  Google Scholar 

  34. Liu ZZ, Chen H, Bo QG, Chen RH, Li FW, Lv L, Jia CX, Liu X (2018) Psychological and behavioral characteristics of suicide attempts and non-suicidal self-injury in Chinese adolescents. J Affect Disord 226:287–293. https://doi.org/10.1016/j.jad.2017.10.010

    Article  PubMed  Google Scholar 

  35. Abraham GE (1983) Nutritional factors in the etiology of the premenstrual tension syndromes. J Reprod Med 28(7):446–464

    PubMed  Google Scholar 

  36. Spielberger CD (1980) Preliminary manual for the State-Trait Anger Scale (STAS). Consulting Psychologists Press, Palo Alto, CA

    Google Scholar 

  37. Lubke GH, Ouwens KG, de Moor MH, Trull TJ, Boomsma DI (2015) Population heterogeneity of trait anger and differential associations of trait anger facets with borderline personality features, neuroticism, depression, attention deficit hyperactivity disorder (ADHD), and alcohol problems. Psychiatry Res 230(2):553–560. https://doi.org/10.1016/j.psychres.2015.10.003

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chida Y, Steptoe A (2009) The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J Am Coll Cardiol 53(11):936–946. https://doi.org/10.1016/j.jacc.2008.11.044

    Article  PubMed  Google Scholar 

  39. Liu X, Liu LQ, Yang J, Cai FX, Wang AZ, Sun LM, Zhao GF, Ma DD (1997) Reliability and validity of the Adolescents Self-Rating Life Events Checklist. Chin J Clin Psychol 5(1):34–36

    Google Scholar 

  40. Liu BP, Wang XT, Liu ZZ, Wang ZY, Liu X, Jia CX (2019) Stressful life events, insomnia and suicidality in a large sample of Chinese adolescents. J Affect Disord 249:404–409. https://doi.org/10.1016/j.jad.2019.02.047

    Article  PubMed  Google Scholar 

  41. Yang Y, Liu X, Liu ZZ, Tein JY, Jia CX (2022) Life stress, insomnia, and anxiety/depressive symptoms in adolescents: a three-wave longitudinal study. J Affect Disord 322:91–98. https://doi.org/10.1016/j.jad.2022.11.002

    Article  PubMed  Google Scholar 

  42. Liu XC, Liu LQ, Yang J, Chai FS, Wang AZ, Sun LM, Zhao GF, Ma DD (1997) Reliability and validity of the Adolescents Self-Rating Life Events Checklist. Chin J Clin Psychol 5(1):34–36

    Google Scholar 

  43. Liu X, Liu ZZ, Jia CX (2021) Repeat self-harm among Chinese adolescents: 1-year incidence and psychosocial predictors. Soc Psychiatry Psychiatr Epidemiol 56(11):1979–1992. https://doi.org/10.1007/s00127-021-02085-x

    Article  PubMed  Google Scholar 

  44. Liu X, Kurita H, Uchiyama M, Okawa M, Liu L, Ma D (2000) Life events, locus of control, and behavioral problems among Chinese adolescents. J Clin Psychol 56(12):1565–1577. https://doi.org/10.1002/1097-4679(200012)56:12%3c1565::AID-7%3e3.0.CO;2-U

    Article  PubMed  Google Scholar 

  45. Matsumoto T, Egawa M, Kimura T, Hayashi T (2019) A potential relation between premenstrual symptoms and subjective perception of health and stress among college students: a cross-sectional study. Biopsychosoc Med 13:26. https://doi.org/10.1186/s13030-019-0167-y

    Article  PubMed  PubMed Central  Google Scholar 

  46. Jeong D, Lee H, Kim J (2023) Effects of sleep pattern, duration, and quality on premenstrual syndrome and primary dysmenorrhea in Korean high school girls. BMC Womens Health 23(1):456. https://doi.org/10.1186/s12905-023-02600-z

    Article  PubMed  PubMed Central  Google Scholar 

  47. Singh P, Sharma C, Krishna S, Mishra V, Yadav G, Patwa P, Gothwal M, Jhirwal M (2022) Lifestyle and prevalence of menstrual disorders among undergraduate medical and nursing students: can we bring a change? J Obstet Gynaecol India 72(Suppl 1):326–333. https://doi.org/10.1007/s13224-021-01606-7

    Article  PubMed  PubMed Central  Google Scholar 

  48. Khalilzadeh P, Amirzadeh-Iranagh J, Khalkhali HR, Maheri M (2023) Evaluating the effect of educational intervention based on the health belief model on the lifestyle related to premenstrual syndrome and reduction of its symptoms among the first-grade high school girls. BMC Public Health 23(1):1001. https://doi.org/10.1186/s12889-023-15950-y

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Lijin County Center for Disease Control and Prevention, Zoucheng City Center for Disease Control and Prevention, and Yanggu County Center for Disease Control and Prevention, Shandong Province, China, and all participating class teachers for their assistance with data collection, and all students for their voluntarily participating in the study. The authors would also like to thank Julie Ingram, MS at Arizona State University for her assistance with proofreading.

Funding

This work was funded in part for data collection by National Natural Science Foundation of China (Grant number 81573233).

Author information

Authors and Affiliations

  1. Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Xianchen Liu

  2. Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan, China

    Xianchen Liu

  3. School of Psychology, Northeast Normal University, Changchun, China

    Zhen-Zhen Liu

  4. Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL, USA

    Yanyun Yang

  5. Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan, China

    Cun-Xian Jia

Authors
  1. Xianchen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhen-Zhen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanyun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cun-Xian Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

XL conceptualized the study, performed data analysis, and drafted the manuscript. Z-ZL participated in the study design, collected data, managed data, and reviewed and revised the manuscript. YY contributed to the study design and data analysis and reviewed and revised the manuscript. C-XJ contributed to the study design, supervised data collection and data management, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Xianchen Liu.

Ethics declarations

Conflict of Interest

All authors have no conflicts of interests/competing interests to declare.

Ethical Approval

The study was approved by the research ethics committee of Shandong University School of Public Health, China. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, X., Liu, ZZ., Yang, Y. et al. Prevalence and Associated Factors of Premenstrual Syndrome in Chinese Adolescent Girls. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01624-8

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10578-023-01624-8

Keywords

Search

Navigation