The disorders related to menstruation are the most common psycho-gynecologic disorders (1). Premenstrual syndrome (PMS) often causes some similar difficulties among females (2). PMS is commonly seen among women of reproductive age and can be aggravated by emotional and physical symptoms (3). (PMS) has a wide variety of signs and symptoms tend to recur in a predictable pattern including fatigue, pain, mood swings, food cravings, tender breasts, irritability and depression (1),(2). The physical and emotional changes individuals experience with premenstrual syndrome may vary from just slightly noticeable to intense (3). It's estimated that almost 3 of every 4 menstruating women, have undergone some form of premenstrual syndrome (4). 20 to 32 percent of women report moderate to severe symptoms that affect some aspects of life, moreover 3 to 8 percent of them report Premenstrual dysphoric disorder (PMDD). The severity of symptoms can vary by individual and by month (5). PMS symptoms start 5 to 11 days before menstruation and normally go away while menstruation begins (4). For most women, the physical pain and psychological distress are severe enough to affect their daily lives (5).
Researches have demonstrated that pain is most common complaint among menstruating women;it has some different difficulties for them, for example, many women often self-prescribe in order to relief pain caused by PMS (6). Generally, PMS increase perceived pain among women; it dramatically augments the risk of pain medication abuse (5),(7). PMS correlates with a significant increase among women in general population that makes them undergo direct medical costs and a large increase in indirect costs (8). It has been observed that pain intensity can be affected by psychosocial variables such as pain catastrophizing, beliefs on pain, coping skills, perceived social support, and learning about pain from important others (9),(6).
In this way, it has been reported that psychological distress is another most important symptom women suffer from before and during menstruation (10),(11). After the complaints about pain, psychological distress is the most common symptom that makes women consult with a mental health practitioner (12),(9). Years ago, it had been assumed that psychological distress is just only caused by physiological alterations while investigations have shown that premenstrual and menstruating psychological distress can be predicted by psycho-social factors and cultural instructions (8),(13),(14),(11),(1).
Therefore (PMS) has multifactorial etiology and it may be affected by hormonal, genetic, environmental, and psycho-socio-cultural factors (15),(8). Some common repetitive risk factors for premenstrual syndrome include a history of depression or mood disorders, such as postpartum depression or bipolar disorder, a family history of PMS, physical trauma, emotional trauma, domestic violence, substance abuse, a family history of depression, major depressive disorder, seasonal affective disorder, dysmenorrhea, generalized anxiety disorder, schizophrenia (5),(8),(9),(16).
Among psychological factors, suggestibility is the state where a subject is inclined (and willing to accept) the actions or suggestions of others (17),(18). Suggestibility can make individuals have selective attention and it may increase psychological distress (19). Suggestibility level has been defined as an index which can predict the intensity of psychogenic pain (20).
In this manner it has been observed that there was a negative significant relationship between the attitude towards menstruation, considering the menstruation a debilitating event and complaining about the severity and symptoms of PMS (6),(21). There had been a higher rate of complaining about severity and symptoms of PMS in individuals displaying negative attitudes towards menstruation, considering the menstruation as a debilitating event and failing to predict the changes concerning menstruation on themselves (22).
It should be mentioned that (PMS) can worsen menstruating women’s quality of life and social life (20),(5). (PMS) may adversely affect physical and social activities and interfere with interpersonal relationships and work productivity, and finally influence the quality of life (4). (PMS) is an important difficulty which decreases women’s self-confidence, impairs physical, social and mental health, causes the labor loss, negatively affects the daily life, social activities, family relationships, sleep quality, attendance on lessons and academic achievement and consequently decreases the quality of life. Thus, the detection of women with (PMS), determination of their frequent symptoms and the definition of relevant variables increasing these symptoms, can guide the interventions such as psychoeducation, developing positive attitudes, and increasing the coping mechanisms regarding the menstrual cycle and (PMS) to be planned in decreasing the (PMS)-induced problems.
With regard to importance of detecting effective psycho-social factors on intensity of premenstrual syndromes (perceived pain and psychological distress) this investigation has aimed to assess Predictability of pain intensity and psychological distress by suggestibility and attitude to menstruation among Iranian population of women.