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©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

Original Article 

Menstruation; A Cause Of Recurrent Emotional Stress In Young Females 

Afshan Tabassum1, Sadaf Ahmed1&2 & Shamoon Noushad2 

1-Department of Physiology University of Karachi 

2- Advance Educational Institute & Research Centre 

Corresponding Author: afshantabassum124@yahoo.com 

Abstract 

The event in the early & late proliferative period of the menstrual cycle can be experienced as physical, psychological, 

physiological & emotional indicators, sometimes it is well observed as premenstrual syndrome (PMS) among 

reproductive aged women, specifically characterized by emotional & physical symptoms that consistently occur 

during the leutal phase of the menstrual cycle. The purpose of our study was to determine the frequency and severity 

of occurrence of these characterizing symptoms as well as to compare these with PMS in young girls. We also 

investigated about the impact of these conditions on the quality of life. Women aged 17-35 years with pre-menstrual 

pain were recruited in the study. PMS related data was collected on record of severity of pain while emotional stress 

score were calculated by using Sadaf Stress Scale (SSS). According to our results 48% of these women reported sharp 

pain with 39% having pain in abdomen back and thigh region. According to SSS 26% lies in moderate emotional 

stress, 30% in mild and 11% in severe emotional stress. Those women having severe intensity of pain reported 80% 

moodiness, 60% irritability and 40% abnormal laughter. The present results showed consistent and strong relationship 

between PMS symptoms and level of interference in all domain of women’s quality of life. We can conclude that PMS 

is the most common problem in women that distresses their educational performance and emotional well-being. There 

should be modified strategies for the detection and management of PMS on women for better quality of life.  

Keywords 

Sadaf Stress Scale, Premenstrual Syndrome, Emotional Stress, Pain 

  

Introduction 

Menstruation a reproductive cycle solely conducted & 

regulated by hormonal abrupt releases & fluctuations 

under the control of HPO-axis involving the glands 

and reproductive organs (Wilson, 1996; Norman, et 

al., 1997 and Messinis, 2006). During this 28days 

menstrual cycle body go through many physiological 

events (Grayce, 2014) results to develop several pre & 

peri-menstrual symptoms. The set of physiological, 

psychological & behavioral symptoms starts to appear 

just before the onset of menstruation & subside till the 

3-4day of bleeding, termed as premenstrual syndrome 

‘PMS’ (Govind, et al., 2007). PMS highly prevalent 

gynecological condition & according to a familiar 

study in Pakistan, reported high prevalence of PMS 

with varying intensities (Hashim, et al 2014) not only 

this, but numerous other researches conclusions also 

supports that PMS is highly prevalent as every female 

experiences at least 1-2 symptoms though the severity 

varies. Pandey, et al., 2013 concluded PMS with 100% 

of prevalence and according to many other studies the 

prevalence rate lies up to 95%in females vary with 

symptomatic severity (Khater, 2011) but only 2-5% 

suffers from severe symptoms. Recurrent long term 

encounter, a considerably significant factor to develop 

stress in young reproductive aged females suffering 

with PMS because any chronic trigger/stressor can 

develop stress response when exceeded its threshold 

(Chrousos, et al., 1992). Stress is a condition that 

develops when body faces circumstances (stressors) 

interrupting the chain of body’s homeostasis cascade, 

triggers the stress response mechanisms to cope up 

with the situation and bring the equilibrium back but 

in the mean while body must experience some 

characterizing symptoms of stress which intensity 

must be under the influence & potential of stressors. 

But the frequency & occurrence of stress symptoms 

are more likely to relate with the category of stress, the 

body dealing with at the time (Sadaf, 2014). Periodic 

menstrual cycle, with recurrent encounters of pre & 

peri-menstrual symptoms co-relate it with the chronic 

negative stress, as defined by (Sadaf, 2014) ‘when a 

long term stressor Is present around for a phase or 

prolong period of life results in chronic stress that 

could be dangerous in many ways first, because of 

people get used to it and ignore this stress harming 

their mental and physical health secondly persistence 

pressure can lead to even more retarded health 

conditions.’ The menstrual distressing PMS symptoms 

like pelvic pain & rest are potential stressors to 

develop emotional stress in menstruating females by 

establishing unpleasant & uncomfortable impacts 

reflect behavioral and emotional status develop 

characterizing symptoms of emotional stress in 

females during pre & peri-menstrual phase. The 

purpose of our study was to determine the frequency 

& severity of occurrence of menstrual characteristics 

symptom as well as to compare these with PMS in 

young girls. And also investigate its impact on their 

quality of life.   

Methodology 

A cross-sectional study design with sample size 

(N=100). The participants were selected from different 

fields like students, house wives & working women. 

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Afshan Tabassum 17 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

All selected subjects were healthy reproductive age 

females between 17-35 years of age & not diagnosed 

with any medical disease condition to make sure that 

all the reported symptoms were not due to any 

pathological condition but physiological menstrual 

distress. Both married & unmarried females were 

included in the study whereas, pregnant and 

menopausal women were excluded. Firstly a pre-

questionnaire comprised of 20 questions was filled by 

every participants in which we asked basic 

information related to their menstrual cycle like age of 

menarche, cyclic regularity, blood flow, daily physical 

activity/exercise & other related questions. The pre-

questionnaire was designed to focus on data collection 

related to PMS & symptoms, their rate of prevalence 

& its relating link with stress occurrence. An important 

criteria was set in order to get the most accurate 

answers, we asked the subjects to fill the questionnaire 

within first 3days of their menstrual cycle so that the 

participants can able to answer exactly   according to 

that condition they were experiencing at that time. In 

the 2nd step for emotional stress evaluation we asked 

the subjects to fill the SADAF STRESS SCALE 

(SSS). In which 15 emotional stress associated 

symptoms are included. Participant rated the 

symptoms according to their experienced severity & 

frequency of occurrence. The data was analyzed by 

using SPSS method. SADAF STRESS SCALE (SSS): 

SSS is a tool for stress evaluation. It’s a questionnaire 

type scale measures the various types of stresses in 

ages 14 and above. There are different associated 

symptoms provided in the scales for different 7 types 

of stress. For stress evaluation and intensity 

determination calculation & scoring are also provided. 

According to the scores the stress level were 

categorized as normal, mild, moderate and severe.  By 

calculating the data according to formula & following 

the provided scoring in the SSS manual we can 

evaluate & score the level or intensity of symptoms 

from normal, mild, moderate & severe level of stress. 

Results & Discussion 

Our present study results positively establish a 

connection between chronic negative stressor (PMS) 

& emotional stress. Pelvic pain, one of the 

characterizing menstrual distress symptom is highly 

reported by females as shows in fig 1 the pain intensity 

during PMS reported by participating females. 

  
Fig 1: Pain intensity during PMS  

Fig 2: Mood changes during period  

The pain prevalence as presented by our study result is 

100% because every female reported with a certain 

type & intensity of pain. Sharp was most highly 

reported type of pain by 48% of females. PGs as hyper 

contractility & inflammatory cascade inducer consider 

to be the key factor behind the menstrual pain, 

cramps/bloating, MM, sleep disturbance and other 

GIT symptoms (Mannix, 2008; Baker, et al., and 

Bernstein, et al., 2014).  With periodic PMS 

encounters the mood instability also monitored as 

females experience different sets of mood wavering 

during their cycle. Aggressiveness, the most reported 

mood change by 37% females whereas other mood 

were also reported by participant’s considerable scale, 

as shows in fig. 2.The exact etiology of PMS is not 

known yet but due to its periodic appearance just after 

the leutal phase and probable aggravation with onset 

of menstrual flow relates PMS with the hormonal 

events involve the ovarian changes & corpus leutum 

formation consider an initiator to bring on the cyclic 

mood changes and symptomatic appearances that 

supported by, an ovulatory asymptomatic phase 

followed by ovulatory symptomatic phase (Govind, et 

al., 2007).Chronic negative stressor (PMS) with its 

repetitive encountering waves can potentially leads the 

body to swim into emotional stress because our study 

results shows that all the pain perceiving females 

endorse the emotional stress symptoms of SSS with 

high frequencies & varying intensities (Fig: 3). 

 
 Fig 3: Frequency of emotional stress symptoms 

according to SSS reported by females 

32%

48%

17%

3%

MILD SHARP SHOOTING BURNING

88%
81%

48%

72%

87%

67%

49%

65%

38%
42%

58%
66%

47%

84%

61%

21%
14%

37%

11%
4%

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Afshan Tabassum 18 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

Hormonal fluctuations exclusively progesterone and 

estrogen consider core factor in PMS symptoms 

generation. Progesterone is a primary precursor in the 

biosynthesis of the adrenal corticosteroids impaired 

corticosteroid production results in a decrease in the 

ability to handle stress, e.g., surgery, trauma or 

emotional stress. If estrogen not maintained by 

progesterone peak it results in; irritable mood, bad 

temper, chronic fatigue and headache. Decreased 

estrogen also associated with negative mood swings 

‘crying spells, anxiety, and depression’(Sellman, 

1996) but there are many theories regarding to the 

etiology behind cyclic mood changes and physical 

symptoms related to PMS and an established 

statements still needed more explorations (Stearns,  

2001 and Govind, et al., 2007). 

  
Fig.4: Frequency of emotional stress symptoms 

reported by females perceiving sharp pain 

 
Fig 5: Severity level of emotional stress  

PMS can cause severe physical and emotional 

disability when it gets severe or intense (Stearns,  2001 

and Govind, et al., 2007) and if accompanied with 

dysmenorrhea(pelvic pain) can produce significantly 

intense emotional and physical stress symptoms 

ultimately leads the body towards more exertion 

producing profound physical and emotional stresses 

which also demonstrated  by results of our study that 

those females reported with dysmenorrheal and PMS 

symptoms, also evaluated with severe , moderate, and  

with mild emotional stress and along with this they 

also perceives emotional stress symptoms 

comparatively more frequent, evaluated with varying 

severity categorized on the basis of symptoms and 

their intensities the participants experienced ( as shows 

in Fig: 4). Overall 67% females were evaluated with 

different stress severity level, which is a very 

considerable proportion that every female bearing a 

load of emotional stress of unlike burden. Along with 

this the rest of 33% female were also reported different 

PMS & emotional stress symptoms with slighter 

intensity so they placed in normal level of stress, as 

presented in fig: 5.  

 
Fig. 6: Limiting social activities. 

The figure showed that 45% reported that they limits 

their social activities during menstruation, 25% 

females reported that they always limit their social 

activities while 30% females reported that they don’t 

limit/skip their social activities. This chronic stress 

also impacts the quality of life and capability to cope 

with routine activities as in our study significant 

number of participants reported that they always or 

sometimes skip their social/educational or 

interpersonal activities reflects the intruding effect of 

menstrual distress on quality of life.    

Conclusion & Recommendation 

Our research results demonstrate a very high 

prevalence rate of PMS in young adult females 

because a large proportion of participants reported 

characterizing symptoms of physical & emotional 

menstrual distress (PMS) & endorsed the theory that 

every women at least perceive 1-2 symptoms of PMS. 

We also evaluate 67% females with different severity 

level of emotional stress & the rest of population were 

also reported emotional stress symptoms but with 

slighter intensity & frequency. Hence it’s a supportive 

study to suggest that these gynecological conditions 

profoundly stressed up the body physically and 

emotionally and continuous symptomatic alterations 

lead to hindrances in daily life. So we conclude that 

with recurrent pattern of menstrual distresses i.e.; PMS 

leading to physiological & psychological stress can 

moodiness

26%

agitation, inability 

to relax…

sence of 

lonliness and 

isolation…

anxiety

7%

feeling 

insecure

7%

forgetfullness

7%

relationships 

conflicts

7%

abnormal 

laughter

13%

irritability 

(bad temper)

20%

normal
33%

mild
30%

moderate 
26%

severe
11%

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Afshan Tabassum 19 

 

©Advance Educational Institute & Research Centre                                                 Annals of Psychophysiology 

www.aeirc-edu.com                                                                                                       Volume 2, December 2015 

 

ISSN 2412-3188 
 

profoundly establish emotional stress symptoms in 

young adult females. We recommend that menstrual 

symptoms must get concerns to make timely detection 

possible if symptoms getting more intense or frequent 

because it’s vital to adopt healthier management 

strategies & balance quality of life.  

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