Severity Of Premenstrual Syndrome Research Articles

Frequency and severity of premenstrual syndrome in women diagnosed with brucellosis

Frequency and severity of premenstrual syndrome in women diagnosed with brucellosis

The influence of premenstrual syndrome on the quality of life of women engaged in intellectual work

Currently, the role of intellectual work in the overall structure of professional activity has increased. Women suffering from premenstrual syndrome, as part of their professional activities, often engage in mental labor, which is reflected in increased fatigue, decreased performance. In order to assess the impact of premenstrual syndrome on the quality of life of women engaged in mental work, 237 women were surveyed about the course of premenstrual syndrome and quality of life according to the SF-36 questionnaire. As a result of the study, a significant decrease in indicators of physical functioning, pain intensity, vital activity, and social functioning was revealed. The total jinzi quality index in the group of mental work is the lowest of all considered. The severity of premenstrual syndrome is also the highest in comparison with the group of physical labor

Changes in menstrual symptoms and work productivity after checklist-based education for premenstrual syndrome: an 8-month follow-up of a single-arm study in Japan.

Premenstrual syndrome (PMS) is prevalent among women of reproductive age, but most do not seek medical advice. We hypothesized that building PMS awareness could promote medical help-seeking for PMS and thus reduce menstrual symptoms and improve work productivity. In January 2020, women aged between 25 and 44years, having paid work, and not currently consulting with an obstetrics and gynecology doctor (n = 3090) responded to the Menstrual Distress Questionnaire (MDQ), the Premenstrual Symptoms screening tool, and the World Health Organisation Health and Work Performance Questionnaire. In addition, they received checklist-based online education for PMS. Of 3090 participants, 2487 (80.5%) participated in a follow-up survey in September 2020. We conducted multiple logistic regression analyses and text analyses to explore factors that encouraged and discouraged medical help-seeking. We also evaluated changes in menstrual symptoms and work productivity, using generalized estimating equations with interactions between the severity of PMS, help-seeking, and time. During the follow-up period, 4.9% of the participants (121/2487) sought medical help. Those having high annual income (adjusted odds ratio [aOR] = 2.07, 95% confidence interval [CI]: 1.21-3.53) and moderate-to-severe PMS (aOR = 2.27, 95% CI: 1.49-3.46) were more likely to have sought medical help. Those who did not seek medical help despite their moderate-to-severe PMS reported normalization of their symptoms (36%), time constraints (33%), and other reasons for not seeking medical help. Participants with moderate-to-severe PMS who had sought medical help showed a significant improvement of - 8.44 points (95% CI: - 14.73 to - 2.15 points) in intermenstrual MDQ scores during the follow-up period. However, there were no significant improvements in premenstrual and menstrual MDQ scores or absolute presenteeism. Medical help-seeking alleviated intermenstrual symptoms in women with moderate-to-severe PMS, but only a small proportion of them sought medical help after PMS education. Further research should be conducted to benefit the majority of women who are reluctant to seek medical help, including the provision of self-care information. UMIN Clinical Trials Registry number: UMIN000038917.

Laparoscopic sleeve gastrectomy for premenstrual syndrome symptoms in patients with obesity.

Premenstrual syndrome (PMS) is a pathological condition characterized by a series of abnormal physical, psychological, and behavioral symptoms. We evaluated the effectiveness of laparoscopic sleeve gastrectomy (LSG) in the treatment of patients with obesity and PMS. In this case-control study, 131 patients with obesity (BMI ≥ 27.5kg/cm2) diagnosed with moderate-to-severe PMS from March 2018 to March 2022 were prospectively selected to undergo LSG or not at their own discretion. Participants self-reported their PMS severity using the Premenstrual Syndrome Screening Tool. Among them, 68 patients chose LSG surgery, and 63 control group patients were followed up without surgery. Data were recorded at baseline and at 3months post-treatment. We used a multivariate analysis to assess the improvement in PMS symptoms and associated factors. Of the 131 patients with obesity and PMS, the improvement rate of PMS in the LSG group was 57.35% (n = 39), while the improvement rate of PMS in the control group was 25.40% (n = 16). Furthermore, our study revealed that surgery is an independent factor affecting the improvement of patients with PMS. Additionally, there was a correlation between alcohol use, T2DM and obesity-related metabolic diseases, and BMI with PMS. The changes in BMI, testosterone, and estradiol(E2) levels may also contribute to the improvement of patients with obesity and PMS. LSG can improve the management of obesity in patients with PMS to some extent. Changes in BMI, testosterone, and E2 may be indicative of improvement in patients with obesity and PMS.

Effect of Curcumin on Dysmenorrhea and Symptoms of Premenstrual Syndrome: A Systematic Review and Meta-Analysis.

Dysmenorrhea and premenstrual syndrome (PMS) are common periodic and frequent complications in women of reproductive age that can negatively affect health and quality of life. The present study examined the effects of curcumin on the severity of dysmenorrhea and PMS symptoms. A systematic review and meta-analysis of randomized controlled trials was conducted by searching databases such as the Cochrane Library, EMBASE, Scopus, PubMed, and Web of Science from inception to January 2023. Article screening was performed using Endnote ver. X8 (Clarivate). Review Manager (RevMan ver. 5.3; Cochrane) was used for the quality assessment and meta-analysis. A total of 147 studies were screened, of which five were finally selected for quantitative and qualitative analyses. The studies were conducted between 2015 and 2021, and a total of 379 participants with a mean age of 23.33±5.54 years had been recruited in these studies. The meta-analysis showed that curcumin consumption could significantly reduce the severity of dysmenorrhea (mean difference, -1.25; 95% confidence interval [CI], -1.52 to -0.98; three studies; I2=31%) and the overall score of PMS (standardized mean difference, -1.41; 95% CI, -1.81 to -1.02; two studies; I2=0%). The reduction in the severity of PMS and dysmenorrhea has been attributed to curcumin's anti-inflammatory and antidepressant activities. Although the findings suggest that curcumin may be an effective treatment for reducing the severity of PMS and dysmenorrhea, further research with a larger number of participants from various socioeconomic levels and a longer duration of treatment is needed to evaluate the effective dose of curcumin.

Prevalence and Severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among Physicians in Port Said City

Prevalence and Severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among Physicians in Port Said City

Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences.

The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history. The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD). Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder. A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017). Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

Differences in Prostaglandin f2α Level in Adolescent Girls Experienced and Not Experienced Premenstrual Syndrome: A Cross-Sectional Study

This study aims to determine the differences in Prostaglandin f2α concentration in female adolescents who experienced and did not experience Pre-Menstrual Syndrome (PMS). Cross-sectional study conducted at a single institution. The sample for this study was female adolescents at the Darul Arqam Islamic Boarding School in Makassar, consisting of 50 adolescents who experienced PMS and those who did not experience PMS in a ratio of 1:1. Prostaglandin f2α levels were measured using an ELISA kit. The sample used was 5 cc blood from the median cubital vein by laboratory staff 5 days before menstruation. Data were analyzed descriptively and statistically. The results showed that the average Prostaglandin f2α in the group that experienced PMS (379.07) was higher compared to the group that did not experience PMS (101.23) with a p-value &lt; 0.05, significantly. Furthermore, the group that experienced mild PMS had an average Prostaglandin f2α value of 283.32, while the group that experienced severe PMS had an average Prostaglandin f2α value of 454.31. The average Prostaglandin f2α level in the group who did not experience PMS, mild PMS, and severe PMS had a p-value &lt; 0.05. This study concludes that there is a significant difference in the Prostaglandin f2α Level in adolescents who experience PMS and those who do not experience it and there are differences based on the severity of PMS.

Women with more severe premenstrual syndrome have an enhanced anticipatory reward processing: a magnetoencephalography study.

Laboratory studies reveal that young women with premenstrual syndrome (PMS) often exhibit decreased reward processing during the late luteal phase. However, studies based on the self-reports find opposite results (e.g., higher craving for high-sweet-fat food). These differences may lie in the difference between the stimulus used and measuring the different aspects of the reward. The present study was designed to expand previous work by using a classic monetary reward paradigm, simultaneously examining the motivational (i.e., reward anticipation, "wanting") and emotional (i.e., reward outcome, "liking") components of reward processing in women with high premenstrual symptoms (High PMS). College female students in their early twenties with High PMS (n = 20) and low premenstrual symptoms (Low PMS, n = 20) completed a monetary incentive delay task during their late luteal phase when the premenstrual symptoms typically peak. Brain activities in the reward anticipation phase and outcome phase were recorded using the magnetoencephalographic (MEG) imaging technique. No group differences were found in various behavioral measurements. For the MEG results, in the anticipation phase, when High PMS participants were presented with cues that predicted the upcoming monetary gains, they showed higher event-related magnetic fields (ERFs) than when they were presented with neutral non-reward cues. This pattern was reversed in Low PMS participants, as they showed lower reward cue-elicited ERFs than non-reward cue-elicited ones (cluster mass = 2560, cluster size = 891, p = .03, corrected for multiple comparisons), mainly in the right medial orbitofrontal and lateral orbitofrontal cortex (cluster mass = 375, cluster size = 140, p = .03, corrected for multiple comparisons). More importantly, women with High PMS had an overall significantly higher level of ERFs than women with Low PMS (cluster mass = 8039, cluster size = 2937, p = .0009, corrected for multiple comparisons) in the bilateral precentral gyrus, right postcentral gyrus, and left superior temporal gyrus (right: cluster mass = 410, cluster size = 128, p = .03; left: cluster mass = 352, cluster size = 98, p = .05; corrected for multiple comparisons). In the outcome phase, women with High PMS showed significantly lower theta power than the Low PMS ones for the expected non-reward feedback in the bilateral temporal-parietal regions (cluster mass = 47620, cluster size = 18308, p = .01, corrected for multiple comparisons). These findings reveal that the severity of PMS might alter reward anticipation. Specifically, women with High PMS displayed increased brain activities to reward-predicting cues and increased action preparation after the cues appear.

Volatile organic compounds from human skin as biomarkers of menstruation phase and severity of premenstrual syndrome: An exploratory pilot study

Background and aimNumerous women of reproductive age experience physical or mental discomfort during their natural menstrual cycle due to paramenstrual symptoms, such as premenstrual syndrome (PMS). To date, there is no established biomarker for the diagnosis of PMS. This study investigated the relationship between skin gas composition and menstruation cycles, and evaluated the possibility of skin gas composition as a biomarker of paramenstrual symptoms. MethodsWe conducted an exploratory pilot study. Healthy Japanese women (aged 20–29 years) underwent blood and skin gas analyses on 1 day corresponding to menstruation, preovulatory, middle luteal, and late luteal phases. Skin gas was collected from the cubital fossa and armpit using a Passive Flux Sampler; samples were analyzed for 65 volatile organic compounds (VOCs) by gas chromatography-mass spectrometry (GC-MS). Non-parametric statistical analysis was performed to identify VOCs related to the menstrual cycle, levels of female hormones, and severity of PMS. ResultsFourteen women participated; of those, 12 completed the study. Regarding the relationship with the menstrual cycles, seven and four VOCs were significantly and marginally changed, respectively, at the cubital fossa during menstruation. Of those 11 compounds, 10 were also correlated with the levels of serum female hormones. At the armpit, five and three compounds were significantly and marginally changed, respectively, during menstruation. Of those eight compounds, five were also correlated with the levels of serum female hormones. In the study of PMS severity, analysis of the changes in VOCs suggested that ketones and fatty acids are increased during menstruation in the severe PMS group versus the mild PMS group. ConclusionsThe results of this study suggest that certain VOCs emitted in skin gas related to the menstrual cycle, levels of female hormones, and severity of PMS. These findings may advance the metabolic understanding and development of diagnostic biomarkers for menstruation-related symptoms.

Is there a relationship between internalized misogyny and premenstrual syndrome and dysmenorrhea in young women? A descriptive-relational study.

This study utilized a descriptive and relational design to determine the relationship between young women's experiences of premenstrual syndrome (PMS) and dysmenorrhea with internalized misogyny. A total of 487 individuals were accessed. Data were collected through the "Personal Information Form" prepared by the researchers, the "Functional and Emotional Measure of Dysmenorrhea" the "Premenstrual Syndrome Scale," and the "Internalized Misogyny Scale." The internalized misogyny scale mean score had significant effects on the functional and emotional measure of dysmenorrhea mean score (p < 0.05). The internalized misogyny scale mean score was found to have a statistically significant effect on the premenstrual syndrome scale (p < 0.05). This study found that young women's internalized misogyny was highly correlated with PMS and dysmenorrhea, and increased internalized misogyny also increased the severity of PMS and dysmenorrhea in young women.

Effect of modified alternate day fasting diet on the severity of premenstrual syndrome and health-related quality of life in women with overweight or obesity: a trial study protocol

IntroductionPremenstrual syndrome (PMS) includes a range of physical, behavioural and psychological symptoms and decreases women’s health-related quality of life (HRQoL). It has been proposed that increased body mass index (BMI)...

Premenstrual sendromu olan adolesan kızlarda serebral lateralizasyon

Purpose: In this study, it was aimed to compare differences and similarities the cerebral lateralization of adolescent girls with Premenstrual Syndrome (PMS) with the control group. We also aimed to investigate whether there was a relationship between PMS severity and cerebral lateralization.&#x0D; Materials and Methods: A total of 79 female adolescents aged 14-18 years who met the study inclusion criteria completed the study. A second interview was held with all participants who filled out the Premenstrual Assessment Form (PAF) during the luteal periods of menstrual cycles (1-7 days before menstruation). All participants completed the Harris lateralization test.&#x0D; Results: The mean age was 192.85 ± 14.54 (range 167 - 216) months. The median PMS score was found to be 2.26 (1.00 - 5.10). While PMS was not detected in 35 (44.30%) participants, mild PMS was detected in 20 (25.32%) participants, moderate in 14 (17.72%), and severe in 10 (12.66%) participants. Sixty-seven (84.81%) participants had right hand dominance and three (3.80%) left hand dominance, nine (11.39%) participants had hand uncertainty. While the hand and eye dominance were on the same side in 41 (51.90%) participants, cross-lateralization (all right hand, left eye) was detected in 11 (13.92%) participants. Indeterminate lateralization (Harris lateralization score of 1 or 2) for the hand and eye was significantly higher in the PMS group.&#x0D; Conclusion: The findings raise the question of whether lateralization (hand-eye) is less common in individuals with PMS and whether there will be a common etiology for lateralization problem and PMS. Further studies are needed considering the factors that may contribute to this etiology and some of the limitations we have presented in our study.

Investigation of coping behaviors and premenstrual syndrome among university students.

This study aims to examine premenstrual syndrome (PMS) in university students and their coping behaviors. 452 female students were included in this descriptive and correlational study. The data were collected using a descriptive information form, the Premenstrual Syndrome Scale (PMSS), and the Premenstrual Change Coping Inventory (PMS-Cope). PMS symptoms were found in 80.5% of students. Seeking positive affect-inducing activities to cope with PMS was found to be a significant predictor of reducing the severity of PMS (β =-0.265, p < .001). In coping with PMS, it is necessary to consider the perceptions of taking medication, seeking social support, or seeking positive affect-inducing activities as a coping method to determine the social and cultural beliefs of university students and control PMS. PMS is a significant health problem and raising awareness of the issue alone may not be enough. It should also be noted that the severity of PMS can vary markedly between ethnic groups, and women's strategies for coping with symptoms and their effectiveness may differ between cultures. It is pivotal to develop strategies for university students to cope with PMS and provide personalized care.

Association between Dietary Habits and Severity of Symptoms in Premenstrual Syndrome.

Premenstrual syndrome (PMS) is a set of physical, psychological, and emotional symptoms that occur during the luteal phase of the menstrual cycle. The etiopathogenesis of this condition is not fully understood, and several studies suggest a possible role of environmental factors, such as diet. The aim of this work was to investigate the relationship between dietary habits and the occurrence and severity of PMS. Forty-seven women were enrolled in the study. Participants were asked to complete the Daily Record of Severity of Problems (DRSP) to diagnose PMS and to complete a three-day food record during the perimenstrual phase. Thirty women completed the study (16 with PMS and 14 controls). An analysis of the food diaries revealed no differences between the women with PMS and the control subjects in terms of total energy intake (1649 vs. 1570 kcal/day), diet composition, and the consumption of macro- or micronutrients, except for copper, whose consumption was higher in women with PMS than in the control subjects (1.27 ± 0.51 vs. 0.94 ± 0.49 mg/d, p < 0.05). The data presented here are very preliminary, and only a significant difference in copper intake was found when comparing women with PMS and controls. Larger studies are needed to better define how diet may contribute to the exacerbation of the psychological and somatic symptoms associated with PMS and whether PMS itself may influence macro- or micronutrient intake by changing dietary habits.

Предменструальный синдром как проявление десинхроноза в студенческой среде

Objective. To study the prevalence and severity of premenstrual syndrome (PMS) in female students from Khabarovsk higher education institutions and to evaluate the efficacy of using hormonal contraceptives to increase the psychological adaptation among students. Patients and methods. A voluntary online random survey including 565 female students from Khabarovsk higher education institutions was conducted between October and December 2021. The diagnosis was verified by using diary entries about the nature of existing complaints during 2–3 menstrual cycles with assessing the severity of symptoms on a three-point scale. Results. The results showed that the severity of PMS symptoms was distributed as follows: mild degree – 70.81%, moderate degree – 23.08%, severe degree – 6.11 ± 1.14%. The evaluation of the results of using drospirenone-containing contraceptive for 6 months demonstrated a statistically significant reduction in the frequency of PMS symptoms (p &lt; 0.001). Conclusion. PMS in female students from higher education institutions remains an important problem which has a negative impact both on general health and on the process of social adaptation in studies (54.98%) and behavior in the surrounding society (61.31%). The use of drospirenone-containing contraceptive for 6 months significantly reduced the emotional load by improving sleep, reducing irritability, aggressiveness, etc. (р &lt; 0,001). Key words: premenstrual syndrome, students, drospirenone-containing oral contraceptive

Premenstrual syndrome and its biopsychosocial symptoms among physiotherapy students in Eastern Delta: An exploratory study

Background. During the luteal phase of the menstrual cycle, a set of clinically significant physical and psychological symptoms known as premenstrual syndrome (PMS) emerge. This condition can be extremely distressing and hinder females’ ability to work. Purpose. To calculate the prevalence and severity of PMS and its biopsychosocial symptoms in female physiotherapy students in Eastern Delta and to investigate the relationship between various socio-demographic and reproductive factors. Methods. At Delta University for Science and Technology in Gamasa, Egypt, 396 female physiotherapy students participated in an exploratory cross-sectional survey with a mean age of 20.23±1.07 years and BMI with a mean of 28.86 ± 5.05 kg/m2. The premenstrual syndrome scale (PMSS) was adopted to assess the prevalence of PMS and related symptoms, and a self-administered questionnaire was used to gauge sociodemographic and reproductive data. Results: Three hundred ninety-six females of 438 females completed the study. In 85% of cases, PMS predominated research calculations. The PMS group displayed symptoms of fatigue, cramping in the abdomen, tension, mood fluctuations, and decreased productivity more overtly. According to a multiple linear regression analysis, living in a rural area, hitting menarche earlier, having a higher BMI, and having a family history were all significantly linked to PMS (p &lt; 0.05). Conclusion. Female students have a high prevalence of PMS and its biopsychosocial symptoms. Therefore, adoption of preventive reproductive health and counseling services should be implemented as a standard component of routine clinical treatment for university students.

Antenatal depressive symptoms are strongly predicted by the severity of pre-menstrual syndrome: results of partial least squares analysis

Background/Objective: Antenatal depression (AD) is the commonest morbidity during pregnancy. There is evidence that premenstrual syndrome (PMS) and AD share common immune-inflammatory and sex hormonal pathways. This study aims to evaluate the association between the severity of depressive PMS and AD in early and late pregnancy. Method: Participants were followed from early (<=16 weeks) to late pregnancy (>=20 weeks). The Premenstrual Symptoms Screening Tool (PSST) was used to assess PMS and AD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results: Up to 57.6% of the variance in the early EPDS score was explained by the regression on the first factor extracted from 10 depression and anxiety PSST items (dubbed the DepAnx PSST), insomnia PSST, relation dissatisfaction, and partner abuse. There were specific indirect effects of DepAnx PSST (p < 0.001), insomnia PSST (p = 0.041), relation dissatisfaction (p = 0.023) and partner abuse (p = 0.007) on the late EPDS which were mediated by the early EPDS score. Conclusion: The affective, but not psychosomatic, symptoms of PMS strongly predict AD symptoms suggesting that the pathophysiology of affective PMS symptoms overlap with those of AD.

Factors Associated with Premenstrual Syndrome: A Cross-Sectional Study of Female Adolescents (Morocco)

Background: Premenstrual syndrome (PMS) is a heterogeneous disorder which includes physical and affective symptoms that most females of reproductive age experience during the luteal phase of their menstrual cycle. Objective: This study aims to investigate the factors associated with PMS among adolescent schoolgirls and to assess the severity of PMS. Methods: A cross sectional study conducted among 102 adolescents representing Marrakesh city. A structured questionnaire was used. Data analysis was done with SPSS version 26. Results: The rate of mild to severe PMS were 52.9 %, 25.5 % and 21.6 % respectively. The most common physical symptoms were backache (52.9%) and breast tenderness (36.3%), while the most common affective symptoms were irritability (49 %), anxiety (46.1 %) and mood swelling (45.1 %). Significant differences were observed between PMS group and non-PMS group in level of education (p&lt; 0.05), sweets consumption (p&lt; 0.05) and family’s status (p&lt; 0.05). There was no significant association between PMS and BMI. Conclusion: Based on the findings, it seems that the occurrence of PMS is associated with sweet consumption frequency. This study showed also that the most common PMS symptoms were irritability and backache.

HUBUNGAN ASAM LEMAK OMEGA 3, IMT/U DAN TINGKAT STRES DENGAN TINGKAT PREMENSTRUAL SYNDROME (PMS) PADA REMAJA PUTRI TUNAGRAHITA DI KECAMATAN MARGAASIH

Premenstrual syndrome (PMS) is a combination of physical and emotional disorders that affect 20-80% of women of reproductive age that occur in the last 14 days of the menstrual cycle. Until now the cause of PMS is still unknown, many factors contributed to PMS severity, including nutritional intake and lifestyle. This study was aimed to analyze the relation between intake of omega 3 fatty acid, BMI / A, and stress levels in intellectual disability adolescent girls with the severity of premenstrual syndrome in margaasih district. This study was quantitative research by using a cross-sectional design. This study was used a total sampling technique with a sample of 34 respondents. Data were obtained from the filling out of the questionnaire and measurement of body weight and height using digital scales and microtoise. Bivariate analysis was performed by used a chi-square test. The univariate analysis showed the prevalence of premenstrual syndrome in intellectual disability adolescent girls in margaasih district with mild category was 55.9% and the moderate category was 44.1%. Chi-square test results showed a significant correlation between omega-3 fatty acid intake (p-value = 0.005), BMI / U (p-value = 0.007), and stress level (p-value = 0.045) with severity of premenstrual syndrome . The conclusion obtained in this study was that there was a significant correlation between intake of omega 3 fatty acids, BMI / U, and stress levels with the severity of premenstrual syndrome.