Premenstrual Syndrome (PMS) refers to a group of physical, emotional, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and significantly impact daily functioning. Premenstrual symptoms can sometimes mimic cardiac symptoms, making it essential to understand the differences. Symptoms like chest discomfort, palpitations and shortness of breath may sometimes leads to cardiac consultations which in turn increases the anxiety.1

While the severity of symptoms varies among individuals, studies suggest  that up to seventy five percentage of menstruating women experience some form of premenstrual discomfort, and approximately 3–8% suffer from the more severe form known as Premenstrual Dysphoric Disorder (PMDD)2,3. The burden of PMS is particularly significant among female medical students, who often endure high levels of academic stress, irregular routines, and limited emotional support systems4.

Coping mechanisms plays a key role in management of PMS and there is a need to understand how women cope with PMS. Effective coping strategies help in modulating the symptom severity of PMS and also enhance the quality of life5. The Brief COPE inventory is a validated tool for assessing various coping styles, ranging from adaptive mechanisms such as planning and acceptance to maladaptive responses like denial or self-blame6.

This study aims to explore the prevalence and severity of PMS among female medical students using the Premenstrual Symptoms Screening Tool (PSST) and to examine the coping mechanisms they employ. Insights from this study can contribute to early identification, support, and intervention strategies tailored to the specific needs of this vulnerable population. 7

Earlier studies on PMS concentrated on prevalence among female medical students but very limited literature is available on coping mechanisms for PMS on which the current study focuses.

AIMS & OBJECTIVES

To study the severity of PMS among female medical students

To study the relation between socio-demographic variables and severity of PMS among female medical students.

To study the association between severity and its association with coping strategies among female medical students

This is a descriptive cross-sectional study to assess the severity of premenstrual symptoms and the coping strategies used by female medical students. The study was conducted among four hundred undergraduate medical students, aged eighteen years and above from a medical college in South India who consented to participate.

 Tools :

After prior ethical clearance all the individuals were applied with self-designed and semi-structured online questionnaire consisting of socio-demographic details, the Premenstrual Symptoms Screening Tool (PSST), and the Brief COPE inventory. The PSST, a nineteen item scale developed by Steiner et al 7 was applied to classify participants into No PMS, PMS, or PMDD based on clinical criteria. The Brief COPE scale, a 28 item self-report tool developed by Carver 6 assessed the frequency of use of various coping strategies, both adaptive and maladaptive. Data was entered into Microsoft Excel and statistical analysis was done using SPSS version 25. Descriptive statistics such as frequencies, percentages, means, and standard deviations were calculated. Chi-square tests were used to examine associations between PMS categories and socio-demographic factors. One-way ANOVA was applied to compare coping strategy scores across PMS severity groups. A p-value < 0.05 was considered statistically significant.

Students who are not willing to participate in the study and individuals with known psychiatric illness other than PMS or PMDD were excluded from the study

Table1: Socio-demographic variables of the patients

The mean age of the participants was 20.04 years with a standard deviation of 1.71 years. A vast majority (74.5%) was hostellers, and only 0.75% were married. 5.51% were from low SES, 70% identified as middle class, and 24.56% reported upper socioeconomic backgrounds.

Only 5.01% of participants had a prior diagnosis of PMS or PMDD, and 39.35% reported dysmenorrhea. Irregular menstrual cycles were observed in 18.55% of the participants.

Regarding health behaviors, 34.09% reported caffeine intake, but only 0.5% reported smoking or alcohol use while 6.03% reported poor sleep hygiene. A large majority (83.96%) were physically active, either regularly or occasionally.

Table 2: Distribution Based on Premenstrual Symptoms Screening Tool

(PSST) Diagnosis

The descriptive analysis of the PSST scores based on clinical criteria revealed a diverse distribution of premenstrual symptoms among participants. 23.75% reported few symptoms not meeting diagnostic criteria for PMS or PMDD. However, clinically significant group (26.5%) of individuals qualified for a diagnosis of moderate PMS, while a (10.25%) met the criteria for severe PMS.  Out of 400 participants, 305 had clinically significant symptoms leading to 76.25% prevalence of PMS.

Table3: Association of PMS severity with lifestyle factors

The table displays the distribution of mild, moderate

, and severe PMS cases across various socio-demographic and lifestyle categories. Chi-square tests were performed to examine the association between each variable and PMS severity. No statistically significant associations (p < 0.05) were observed

Table 4: Mean Coping Strategy Scores (Brief COPE)

The mean scores for each coping domain were calculated, revealing a preference for adaptive coping mechanisms such as acceptance, planning, and active coping. Strategies like emotional support and positive reframing were also commonly used. In contrast, maladaptive strategies like denial, behavioral disengagement, and substance use scored comparatively lower, indicating that most participants relied on constructive methods to manage their distress.

Table 4. Association between PMS severity and coping mechanisms

A one-way Analysis of Variance (ANOVA) was conducted to examine differences in coping strategies across the three PMS severity groups—mild, moderate, and severe—as measured by the 14 subscales of the Brief COPE inventory. The results indicated statistically significant differences (p < 0.05) in all coping domains. Notably, strategies like emotional support, active coping, and self-distraction increased with PMS severity, indicating a shift toward more emotion-focused and problem-focused coping in severe cases. Conversely, maladaptive strategies such as substance use remained low across all groups

The current study was done on coping mechanisms for PMS among female medical under graduates  at a tertiary care hospital in south India. The current study advances the previous studies in studying the prevalence of PMS along with coping mechanisms among the study population. In the present study, premenstrual symptoms were reported by all participants, though only 76.25% met the diagnostic criteria for PMS/PMDD according to the Premenstrual Symptoms Screening Tool (PSST) which falls in line with current prevalence rate of 75% to 95%8. This is consistent with prevalence rates observed in similar studies, such as Bhuvaneswari et al. (2019), who reported a PMS prevalence of 61.5% among Indian medical students9. The high symptom prevalence across the sample suggests that while most women experience some degree of menstrual-related symptoms, only a subset face substantial functional impairment.

Analysis using the Brief COPE scale revealed significant variations in coping mechanisms based on PMS severity. Women with severe PMS reported significantly higher use of emotion-focused and problem-focused strategies such as emotional support, active coping, and acceptance. These findings are in line with Anzar et al., who found that women with more intense PMS symptoms were more likely to use emotion-regulation strategies to mitigate emotional distress 10. The adaptive use of such strategies may reflect increased psychological effort to manage more intense symptoms.

Interestingly, maladaptive coping strategies such as substance use and behavioral disengagement were less frequently reported and did not significantly differ across PMS severity levels. This may be attributed to increased mental health awareness and cultural disapproval of such behaviors, particularly in younger female populations in India 11.

Despite the theoretical relevance of socio-demographic and lifestyle variables in influencing PMS, our Chi-square analysis did not reveal statistically significant associations between PMS severity and factors such as residence, caffeine intake, physical activity, or prior PMS diagnosis. Physical activity approached significance (p = 0.0732), suggesting a potential trend. Some previous studies have identified physical activity and caffeine intake as modifiable factors in PMS symptomatology but results have been inconsistent across populations12,13

Overall, this study supports the notion that coping mechanisms—particularly adaptive ones—may play a critical role in the experience and severity of PMS symptoms. The absence of strong associations with lifestyle variables underscores the need to focus more on psychological and behavioral dimensions. These findings emphasize the potential benefits of incorporating stress management, counseling, and resilience-building programs in college health services to support young women dealing with PMS.

Study done among undergraduate medical students with large sample size, Application of validity tools with high sensitivity and specificity with Comprehensive analysis of both psychosocial and lifestyle correlates are the major strengths in this study.

Designing the study in cross sectional method is one of the limitations in the study as it may leads to causal inference. As the data was self-reported, recall bias may occur and as the study population was recruited from a single institute, results cannot be generalised.

The present study highlights a high burden of premenstrual symptoms among young women, with significant associations between PMS severity and socio-demographic and lifestyle factors. Coping strategies also varied significantly across PMS levels, indicating a shift toward adaptive and maladaptive mechanisms as symptom severity increased. These findings emphasize the need for early screening and psycho educational interventions targeting stress management and lifestyle modification.

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