Document Type : Original Article


1 Department of Gynecology and Obstetrics, College of Medicine, Al-Iraqia University, Baghdad, Iraq

2 Department of Gynecology and Obstetrics, Baghdad Teaching Hospital, Baghdad, Iraq


Premenstrual tension is a common public health problem that significantly affects the personal well-being, academics, and of adolescents’ life quality. Consequently, the purpose of the study is to ascertain the prevalence of premenstrual tensions and evaluate its academic and social impact on Iraqi female medical students. From February 2022 to May 2022, a cross-sectional study was carried out at several institutions in Baghdad/Iraq, including (the College of Medicine, Pharmacy, and Dentistry). An online self-questionnaire was used to gather information on the premenstrual tension symptoms, menstrual pain, and academic performance of 2080 Iraqi female medical students. Most respondents (73.6%) experienced various premenstrual symptoms with varying degrees of severity; the most frequent symptoms were depressed mood, anger, irritability, flatulence, acne, and breast tenderness.  Approximately (49.0%) of the participants experienced menstrual pain, (78.1%) reported regular menstruation, and (40%) reported learning difficulties. The predominant impact on academic performance was lack of concentration (39.5%) and difficulty in work (34.0%). Among the participants, the majority of the students (59.4%) reported self-medicating with painkillers such as NSAIDs. Furthermore, the study shows that premenstrual symptoms were significantly linked with reduced academic performance and interpersonal relationships among Iraqi medical students (P<0.001). The current study found that premenstrual tension symptoms are associated with poor educational performance and poor interpersonal relationships among Iraqi female medical students. To close the gender gap in our society for a better future, more study is required to analyze and assess the cause of premenstrual tension symptoms and therapeutic interventions.

Graphical Abstract

The effect of premenstrual tension on academic performance and social interactions among Iraqi medical students


Main Subjects

Selected author of this article by journal

Dr. Ekhlas Ali Hussein
Al Iraqia University

Google Scholar

Open Access

This article is licensed under a CC BY License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit:


Publisher’s Note

CMBR journal remains neutral with regard to jurisdictional claims in published maps and institutional afflictions.


Letters to Editor

Given that CMBR Journal's policy in accepting articles will be strict and will do its best to ensure that in addition to having the highest quality published articles, the published articles should have the least similarity (maximum 15%). Also, all the figures and tables in the article must be original and the copyright permission of images must be prepared by authors. However, some articles may have flaws and have passed the journal filter, which dear authors may find fault with. Therefore, the editor of the journal asks the authors, if they see an error in the published articles of the journal, to email the article information along with the documents to the journal office.

CMBR Journal welcomes letters to the editor ([email protected], [email protected]) for the post-publication discussions and corrections which allows debate post publication on its site, through the Letters to Editor. Critical letters can be sent to the journal editor as soon as the article is online. Following points are to be considering before sending the letters (comments) to the editor.

[1] Letters that include statements of statistics, facts, research, or theories should include appropriate references, although more than three are discouraged.

[2] Letters that are personal attacks on an author rather than thoughtful criticism of the author’s ideas will not be considered for publication.

[3] There is no limit to the number of words in a letter.

[4] Letter writers should include a statement at the beginning of the letter stating that it is being submitted either for publication or not.

[5] Anonymous letters will not be considered.

[6] Letter writers must include Name, Email Address, Affiliation, mobile phone number, and Comments.

[7] Letters will be answered as soon as possible.

  1. Abo S, Smith D, Stadt M, Layton A (2022) Modelling female physiology from head to toe: Impact of sex hormones, menstrual cycle, and pregnancy. Journal of Theoretical Biology 540: 111074. doi:
  2. 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. International Journal of Women's Health: 777-785. doi:
  3. Abbas K, Usman G, Ahmed M, Qazi R, Asghar A, Shah AM, Rizvi A, Abid K, Haq KU, Tahir A (2020) Physical and psychological symptoms associated with premenstrual syndrome and their impact on the daily routine of women in a low socioeconomic status locality. Cureus 12 (10). doi:
  4. Chumpalova P, Iakimova R, Stoimenova-Popova M, Aptalidis D, Pandova M, Stoyanova M, Fountoulakis KN (2020) Prevalence and clinical picture of premenstrual syndrome in females from Bulgaria. Annals of general psychiatry 19 (1): 1-7. doi:
  5. 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. BioPsychoSocial medicine 13: 1-9. doi:
  6. Maity S, Wray J, Coffin T, Nath R, Nauhria S, Sah R, Waechter R, Ramdass P, Nauhria S (2022) Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis. Frontiers in Medicine 9: PMC8886240. doi:
  7. Lin S-Y, Yang Y-C, Lin C-C, Chang CY-Y, Hsu W-H, Wang I-K, Lin C-D, Hsu C-Y, Kao C-H (2021) Increased Incidence of Dysmenorrhea in Women Exposed to Higher Concentrations of NO, NO2, NOx, CO, and PM2. 5: A Nationwide Population-Based Study. Frontiers in Public Health 9: 682341. doi:
  8. Ologele I, Oyiza PD, Tijani OM (2021) Perceived Risk Factors of Dysmenorrhea among Female Undergraduates in University of Ilorin, Ilorin, Nigeria. Tanzania Journal of Science 47 (1): 10-18. doi:
  9. Karout S, Soubra L, Rahme D, Karout L, Khojah HM, Itani R (2021) Prevalence, risk factors, and management practices of primary dysmenorrhea among young females. BMC women's health 21: 1-14. doi:
  10. 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. International Journal of Environmental Research and Public Health 20 (1): 569. doi:
  11. Bruinvels G, Blagrove RC, Goldsmith E, Shaw L, Martin D, Piasecki J (2022) How lifestyle changes during the COVID-19 global pandemic affected the pattern and symptoms of the menstrual cycle. International Journal of Environmental Research and Public Health 19 (20): 13622. doi:
  12. Rad M, Sabzevary MT, Dehnavi ZM (2018) Factors associated with premenstrual syndrome in female high school students. Journal of education and health promotion 7: 64. doi:
  13. Zhang Y, Zhang H, Ma X, Di Q (2020) Mental health problems during the COVID-19 pandemics and the mitigation effects of exercise: a longitudinal study of college students in China. International journal of environmental research and public health 17 (10): 3722. doi:
  14. Ozimek N, Velez K, Anvari H, Butler L, Goldman KN, Woitowich NC (2022) Impact of stress on menstrual cyclicity during the coronavirus disease 2019 pandemic: a survey study. Journal of women's health 31 (1): 84-90. doi:
  15. Buddhabunyakan N, Kaewrudee S, Chongsomchai C, Soontrapa S, Somboonporn W, Sothornwit J (2017) Premenstrual syndrome (PMS) among high school students. International journal of women's health 2017: 501-505. doi:
  16. Hussein E, Hassan I, Issa H, Mohammed D (2023) Premenstrual Symptoms and Cycle Regularity: A Cross-sectional Study among Iraqi University Students during the COVID-19 Pandemic. Journal of Medicinal and Chemical Sciences 2023: 228-235. doi:
  17. Zheng W (2020) Mental health and a novel coronavirus (2019-nCoV) in China. Journal of affective disorders 269: 201-202. doi:
  18. Phelan N, Behan L, Owens L (2021) The Impact of the COVID-19 Pandemic on Women’s Reproductive Health. Front Endocrinol 12: 642755. doi:
  19. Terzi R, Terzi H, Kale A (2015) Evaluating the relation of premenstrual syndrome and primary dysmenorrhea in women diagnosed with fibromyalgia. Revista brasileira de reumatologia 55: 334-339. doi:
  20. Albsoul‐Younes A, Alefishat E, Farha RA, Tashman L, Hijjih E, AlKhatib R (2018) Premenstrual syndrome and premenstrual dysphoric disorders among Jordanian women. Perspectives in psychiatric care 54 (3): 348-353. doi:
  21. Farrokh-Eslamlou H, Oshnouei S, Heshmatian B, Akbari E (2015) Sexual & reproductive healthcare. Sex Reprod Healthc [Internet] 6 (1): 23-27. doi:
  22. Eryilmaz G, Ozdemir F, Pasinlioglu T (2010) Dysmenorrhea prevalence among adolescents in eastern Turkey: its effects on school performance and relationships with family and friends. Journal of pediatric and adolescent gynecology 23 (5): 267-272. doi:
  23. Tadese M, Kassa A, Muluneh AA, Altaye G (2021) Prevalence of dysmenorrhoea, associated risk factors and its relationship with academic performance among graduating female university students in Ethiopia: a cross-sectional study. BMJ open 11 (3): e043814. doi:
  24. Parra-Fernández ML, Onieva-Zafra MD, Abreu-Sánchez A, Ramos-Pichardo JD, Iglesias-López MT, Fernández-Martínez E (2020) Management of primary dysmenorrhea among university students in the South of Spain and family influence. International journal of environmental research and public health 17 (15): 5570. doi:
  25. De Sanctis V, Soliman AT, Daar S, Di Maio S, Elalaily R, Fiscina B, Kattamis C (2020) Prevalence, attitude and practice of self-medication among adolescents and the paradigm of dysmenorrhea self-care management in different countries. Acta Bio Medica: Atenei Parmensis 91 (1): 182. doi:
  26. Takeda T, Kai S, Yoshimi K (2021) Association between premenstrual symptoms and posttraumatic stress symptoms by COVID-19: A cross-sectional study with Japanese high school students. The Tohoku Journal of Experimental Medicine 255 (1): 71-77. doi:
  27. Demir O, Sal H, Comba C (2021) Triangle of COVID, anxiety and menstrual cycle. Journal of Obstetrics and Gynaecology 41 (8): 1257-1261. doi:
  28. Hussein E, Hassan I, Issa H, Al-Majeed A (2022) Dysmenorrhea among Female University Students during the COVID-19 Pandemic. Journal of Medicinal and Chemical Sciences 2022: 787-792. doi: