The effect of cognitive behavioral therapy on symptoms of premenstrual syndrome and premenstrual dysphoric disorder

During puberty, menstruation is known as an essential phenomenon for most girls.  Menstrual cycle disorders are prevalent in teenage girls (1). Premenstrual syndrome is a common disorder that occurs during menstruation until menopause. It is characterized by physical, mental, and behavioral changes in the luteal phase of women's menstrual cycle. Premenstrual syndrome starts 6-12 days before menstruation and continues until two days after menstruation (3). If this syndrome causes disrupts a person's family, social, and work activities during her life, it is called premenstrual dysphoric disorder (4). Premenstrual dysphoric disorder affects approximately 5% of women of reproductive age. Its symptoms include emotional, psychological, behavioral, and physiological changes that occur at the end of the last luteal phase and improve within a week after a period (5). Premenstrual symptoms can cause transitory problems in women, such as impairment in physical function and mental health, as well as severe impairments in occupational functions and social aspects (6). The aim of treating premenstrual syndrome and premenstrual dysphoria is to reduce symptoms and improve the performance and quality of life of women suffering from these two disorders. Treatment is divided into drug and non-drug treatments, including diet, exercise, and behavioral therapy knowledge-based on cognition, emotion, and behavior. Therefore, negative and irrational thoughts can cause discomfort and problems in people (7, 9). Cognitive behavioral therapy emphasizes that thinking processes are as important as environmental influences. Therefore, negative and illogical thoughts can cause discomfort and problems in people. For this reason, this educational method aims to correct illogical ideas, ineffective beliefs, misinterpretations, and cognitive errors, provide a feeling of control over life, facilitate constructive self-talk, and strengthen coping skills. Since premenstrual syndrome and premenstrual dysphoric disorder can lead to long-term behavioral and psychiatric disorders such as mood swings, depression, and anxiety, and changes related to menstruation are considered an essential mediating factor in completed suicide (13, 14), this research aims to determine the effectiveness of cognitive behavioral therapy on the symptoms of premenstrual syndrome and premenstrual dysphoric disorder in women in the city of Hamedan.

The method used in the present research was a semi-experimental pre-test-post-test design with a control group and follow-up phase. The study's statistical population included all women aged 18 to 45 in Hamedan, Iran who were referred to obstetrics and gynecology clinics in 2022. The sampling method was purposeful and convenient. Questionnaires were distributed in three large gynecology and obstetrics centers in Hamedan City. Three hundred eighty-four people were selected using Morgan's Sampling Table. After dropping volunteers, 216 participants were selected to complete the Premenstrual Symptom Screening Tool (PSST) questionnaire. Finally, based on the inclusion and exclusion criteria, 40 people were randomly divided into four separate groups of ten people each for premenstrual syndrome (experimental group n=10 and control group n=10) and premenstrual dysphoric disorder (experimental group n=10 and control group n=10). The inclusion criteria included being between the ages of 18 and 45, having regular periods, not taking any special medication, and obtaining the required score based on the cut-off point of the screening questionnaire. Premenstrual symptoms with a score of 19-28 were classified as premenstrual syndrome, and a score higher than 28 was classified as premenstrual dysphoria. Participants who scored between 19 and 28 were placed in the premenstrual syndrome group, and those who scored higher than 28 were assigned to the premenstrual dysphoric disorder group. Exclusion criteria included not wanting to cooperate at any stage of the research and not participating in more than two sessions in the study. The data obtained from statistical methods of univariate covariance analysis were analyzed using SPSS version 24 software.

The results show that cognitive behavioral therapy is effective for women suffering from premenstrual syndrome and premenstrual dysphoric disorder between 18 and 45 years old in Hamedan city. This section consists of two parts. The first part shows a significant difference between the mean scores of the premenstrual syndrome post-test of the two experimental and control groups (F=8.33, P<0.01). Besides, a significant difference was found between the mean scores of premenstrual syndrome follow-up of the two experimental and control groups (F=28.05, P<0.0001), indicating the durability of the treatment. Therefore, the difference in mean values is significant, and indicatively, cognitive behavioral therapy reduced premenstrual syndrome symptoms. The second part indicates a significant difference between the mean scores of the premenstrual syndrome post-test of the two experimental and control groups (F=9.36, P<0.007). Moreover, a significant difference was observed between the premenstrual syndrome follow-up scores of the two experimental and control groups (F=21.97, P<0.0001), indicating the durability of the treatment. Hence, the difference in mean values is significant, and demonstratively, cognitive behavioral therapy reduced premenstrual dysphoric disorder symptoms.

The results indicate that cognitive behavioral therapy, using implemented strategies and techniques, is effective in reducing the symptoms of premenstrual syndrome and premenstrual dysphoric disorder in women. Therefore, this treatment method can be considered a low-risk and safe approach without any side effects. Additionally, considering the duration of the follow-up phase in the present study, it can be said that cognitive behavioral therapy has long-lasting and stable effects over time, making it a promising treatment for women who suffer from future anxiety.