Edited by: Pentti Nieminen, University of Oulu, Finland
Reviewed by: Hannu Vähänikkilä, University of Oulu, Finland; Andrija Babić, University of Split, Croatia
This article was submitted to Healthcare Professions Education, a section of the journal Frontiers in Medicine
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing.
The impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms.
A database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included “menstrual disturbances” and “medical students,” “prevalence” OR “symptoms” of “Premenstrual syndrome” OR “Premenstrual dysphoric disorder” OR “Dysmenorrhea” in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS).
Initially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms.
The current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.
Menstruation has a significant impact on a woman's physical, mental and social wellbeing. Menstrual health is defined as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity, in relation to the menstrual cycle” (
Pre-menstrual dysphoric disorder (PMDD) is a severe form of PMS that occurs in 3–8% females resulting in serious psychological symptoms (
Many forms of treatment and self-care are available to control the symptoms of most women, but 3 in 4 women suffer from some form of PMDD (
Studies suggests that female medical students around the world are also disadvantaged due to abnormal menstrual cycles. PMS, PMDD, and dysmenorrhea are leading causes of academic and personal wellbeing impairment in a medical school (
The absence from classes and other social activities during abnormal menstruation creates anticipatory anxiety and up to 20% medical students loathe menstruation due to severe pain (
Although a few systematic reviews addressed the prevalence of menstrual disturbances among the female population (
Over time, medical education has reformed itself to accommodate students' needs by including students with learning disabilities (
a) Probe the prevalence of PMS, PMDD and dysmenorrhea using meta-analysis among medical students.
b) To assess the effect of this prevalence on class absenteeism and overall quality of life.
c) To provide an overview of pharmacological and other modes of interventions adopted by female medical students worldwide to reduce the clinical symptoms of menstrual disturbances.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed by the researchers (
Published studies
Two independent reviewers (SM and SN) screened the retrieved papers based on titles and abstracts. Criteria for examination of full text of the relevant paper after the initial database screening were as follows:
Articles reporting data on impact and prevalence of PMS, PMDD, and/or dysmenorrhea that could be extracted for statistical analysis were only included
Studies conducted in any geographical location but on medical/health sciences/nursing students
All the studies that include cross-sectional studies, or cohort based
Studies published from 2016 till September 2021 (last 5 years) and the female population studied adequately
The non-peer-reviewed editorials, letters, commentaries, incomplete data, reviews, conference posters, preprints, and thesis were excluded
Any confusion or doubts regarding the study selection were resolved by reaching a consensus.
PRISMA protocol of literature search process.
Two independent reviewers (SM and SaN) evaluated the quality of the methodologies used in selected studies by a modified version of Newcastle Ottawa Scale (NOS) (
Author SM extracted the relevant data, and the data was crosschecked by SaN and others. In a blank excel sheet, data on author and year of publication, geographical location, duration of the study, age range of the study participants, total number of populations, diagnosis and scale used as diagnosis criteria, and reported prevalence for each eligible study were extracted. The included study authors were contacted for clarification and assistance with incomplete study and non-response was considered as exclusion. Any disagreement amongst authors was resolved by consensus and discussion with PR.
Meta-analysis of quantitative data was performed to estimate the cumulative prevalence from individual studies. The summary estimates of prevalence were reported along with their 95% confidence intervals (CI) for PMS, PMDD, and dysmenorrhea. The pooled prevalence data was presented in a Forest plot. All the analyses were done using “Comprehensive meta-analysis” software version 3. Presence of publication bias was examined by the visual inspection of funnel plot. The “one-study-removed” procedure was used as a sensitivity analysis to determine whether the overall estimates of menstrual disorders in female medical students were influenced by outlier studies.
Our search through the databases finally identified 26 articles on prevalence of menstrual disturbances including PMS, PMDD, dysmenorrhea that were included in the systematic review from 2016 till 2021. The article exclusion criteria included the following reasons:
Not relevant to the objective
Not in line with the inclusion criteria
The studies were not conducted on medical students
The full text pdf was not available
Not original research
No availability of statistical results
All the included studies were of cross-sectional design across the world at varied number and time frames. Although most of the studies were on medical students however, a few reported prevalence from non-medical students too with a reasonable statical comparison of prevalence. The total number of female medical student from the included studies was 4,874. Although most of the studies exclusively reported the prevalence of either PMS or PMDD or dysmenorrhea however, a few studies do indicate prevalence of two menstrual disturbances in a single population. Therefore, the prevalence data were calculated accordingly. A detailed synthesis of included studies is provided in
Qualitative synthesis of the 26 included studies.
Alkhamis et al. ( |
Saudi Arabia | Cross sectional | Not indicated | Female medical student, 20–23 | PMS, PMDD/self-administered questionnaire | 258 | 29 (11.2%) | 32 (12.5%) | Not indicated adequately |
Kushwaha et al. ( |
Nepal | Cross sectional | October 2019 to December 2019 | Female medical student, 17–25 | Primary dysmenorrhea/verbal multidimensional scoring system (VMSS) | 75 | Not indicated adequately | Mild primary dysmenorrhea is prevalent in 42 (49.4%) MBBS students and moderate to severe primary dysmenorrhea is prevalent in 33 (56.9%) MBBS students | |
Al-Shahrani ( |
Saudi Arabia | Cross sectional | Not indicated | Female medical student, 18–25 | PMS/The Premenstrual Syndrome Scale (PSS) | 388 | 252 (64.9%) | Not indicated adequately | 152 (39.2%) |
Hashim et al. ( |
Saudi Arabia | Cross sectional | September 2017 and May 2018 | Female medical student, 19–22.4 | Primary dysmenorrhea/SF-36 | 336 | Not indicated adequately | Not indicated adequately | 269 (80.1%) |
Shah and Christian ( |
India | Cross sectional | Not indicated | Female medical student, 18–24 | PMS and PMDD/Premenstrual Symptoms Screening Tool | 166 | 31 (18.9%) had moderate to severe PMS | 10 (6.09%) | Not indicated adequately |
Kanti et al. ( |
India | Cross sectional | July to August 2019 | Female medical student, 21–23 | PMS and Dysmenorrhea/Menstrual symptom questionnaire and menstrual bleeding questionnaire | 150 | 86 (56%) | Not indicated adequately | 86 (56%) |
Minichil et al. ( |
Ethiopia | Cross sectional | May to June, 2019 | Female medical student, 18–26 | PMDD/DSM-5 | 386 | Not indicated adequately | 134 (34.7%) | Not indicated adequately |
Bilir et al. ( |
Turkey | Cross sectional | December 2017 and January 2018 | Female medical student, 18–27 | PMS and Dysmenorrhea | 50 | Not indicated adequately | Not indicated adequately | 12 (26%) |
Özder and Salduz ( |
Turkey | Cross sectional | May 2017 to June 2017 | Female medical student, 17–26 | Dysmenorrhea/structured questionnaires to state socio-demographic and medical characteristics, and their dysmenorrheal status and habits, and Visual analog scale to assess the severity of dysmenorrhea | 413 | Not indicated adequately | Not indicated adequately | 329 (79.7%) |
Verma et al. ( |
India | Cross sectional | Within 1 weeks' time | Female medical student, 17–28 | PMS and Dysmenorrhea | 183 | 156 (85.24%) | Not indicated adequately | 111 (60.66%) |
Majeed-Saidan et al. ( |
Pakistan | Cross sectional | December 2017 to May 2018 | Female medical student, 12–51 | PMS/ACOG PMS diagnostic criteria | 280 of them were medical students | Moderate PMS: 166(59.4%). Severe PMS 22 (8%). But no differentiation for medical students. | Not indicated adequately | Not indicated adequately |
Nama et al. ( |
India | Cross sectional | June 1, 2020 to July 31, 2020 | Female medical student, 19–25 | PMS and Dysmenorrhea/pre tested, structured, self-administered questionnaire | 100 | 83 (83%) | Not indicated adequately | 86 (86%) |
Zalat et al. ( |
Saudi Arabia | Cross sectional | Academic year [2017–2018] | Female medical student, 21–23 | PMS/Premenstrual Evaluating Questionnaire (PEQ) based on the criteria of the American college of obstetrics & gynecology (ACOG) for the diagnosis of PMS | 98 | 54 (55.10 %) | Not indicated adequately | Not indicated adequately |
Yadav and Taneja ( |
India | Cross sectional | Not indicated | Female medical student, 17–22 | PMS and Dysmenorrhea/A self-descriptive cross-sectional study | 200 | 64 (32%) | Not indicated adequately | 140 (70%) |
Sharma et al. ( |
India | Cross sectional | Not indicated | Female medical student, 18–20 | PMS/A self-administered questionnaire | 209 | 121 (57.9%) | Not indicated adequately | Not indicated adequately |
Shamnani et al. ( |
India | Not indicated | Not indicated | Female medical student, 18–25 | PMS and PMDD/diagnosis criteria proposed by American College of Obstetrician and Gynecology | 240 | 156 (65%) | 29 (12%) | Not indicated adequately |
Rajkumari et al. ( |
India | Stratified random sample method | Not indicated | Female medical student, 18–22 | PMS/Inventory to Measure Psychosocial Stress (IMPS) and menstrual questionnaire | 81 | 65 (80%) | Not indicated adequately | Not indicated adequately |
Ghaderi et al. ( |
Iran | Cross sectional | April 2013 to July 2013 | Female medical student, 19–25 | Dysmenorrhea/visual analog scale (VAS) | 197 | Not indicated adequately | Not indicated adequately | 194 (98.4%) |
Acikgoz et al. ( |
Turkey | Cross sectional | March to June 2016 | Female medical student, 17–31 | PMS/Premenstrual syndrome scale (PMSS) | 100 | 52 (52%) | Not indicated adequately | Not indicated adequately |
Rumana Akbari et al. ( |
India | Cross sectional | For a period of six months in 2015 | Female medical student, 20–25 | PMS/PMS self-evaluation questionnaire | 270 | 84 (31.1%) | Not indicated adequately | Not indicated adequately |
Katwal et al. ( |
Nepal | Cross sectional descriptive study | 1st Dec. 2012 to 31st Jan. 2013 | Female medical student, 16–24 | Dysmenorrhea/questionnaire to complete | 184 | Not indicated adequately | Not indicated adequately | 123 (67%) |
Aryal et al. ( |
Nepal | Cross sectional | November to December 2015 | Female medical student, 17–25 | PMS and PMDD/American College of Obstetrics and Gynecology (ACOG) criteria. The diagnosis of PMDD was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-V). | 185 | 113 (61.1%) | 72 (38.9%) | Not indicated adequately |
Jaiprakash et al. ( |
Malyasia | Cross sectional descriptive study | March to May 2012 | Female medical student, 17–30 | PMS and Dysmenorrhea/questionnaire and verbal-multi-dimensional scoring system | 215 | 153 (91.6%) | Not indicated adequately | 167 (78%) |
Goweda et al. ( |
Saudi Arabia | Cross sectional | During the academic year 2013/2014 | Female medical student, Age not indicated | PMDD/Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition | 183 | Not indicated adequately | 67 (36.6%) | Not indicated adequately |
Raval et al. ( |
India | Cross sectional | January to August, 2012 | Female medical student, 17.3–20.5 | PMS and PMDD/DSM-IV-TR criteria and SCID-PMDD | 71 | 5 (7%) | 1 (1.5%) | Not indicated adequately |
Maryam et al. ( |
Indonesia | Cross sectional | September 2015 | Female medical student, 19–22 | Dysmenorrhea/DASS 42 | 136 | Not indicated adequately | Not indicated adequately | 74 (54.4%) |
Total number of students | 4,874 |
The final included articles were predominantly of cross-sectional design. Therefore, a modified NOS was used as explained in the methods section. To evaluate each study, a (*) was assigned to the any of the criteria of the NOS. Only one study (
Quality assessment of studies using modified Newcastle Ottawa Scale.
Alkhamis et al. ( |
* | – | – | * | * | *** |
Kushwaha et al. ( |
* | * | – | * | * | **** |
Al-Shahrani ( |
* | – | – | * | * | *** |
Hashim et al. ( |
* | * | * | * | * | ***** |
Shah and Christian ( |
* | * | – | * | – | **** |
Kanti et al. ( |
* | – | – | * | * | *** |
Minichil et al. ( |
* | * | – | * | * | **** |
Bilir et al. ( |
* | * | * | * | * | ***** |
Özder and Salduz ( |
* | – | – | * | * | *** |
Verma et al. ( |
* | – | – | * | * | *** |
Majeed-Saidan et al. ( |
– | * | – | * | – | ** |
Nama et al. ( |
* | – | – | * | * | *** |
Zalat et al. ( |
* | – | – | * | * | *** |
Yadav and Taneja ( |
* | – | – | * | * | *** |
Sharma et al. ( |
* | * | – | * | * | **** |
Shamnani et al. ( |
* | – | – | * | * | *** |
Rajkumari et al. ( |
* | * | – | * | * | **** |
Ghaderi et al. ( |
* | * | – | * | * | **** |
Acikgoz et al. ( |
* | – | – | * | * | *** |
Rumana Akbari et al. ( |
* | – | – | * | * | *** |
Katwal et al. ( |
* | – | – | * | * | *** |
Aryal et al. ( |
* | – | – | * | * | *** |
Jaiprakash et al. ( |
* | – | – | * | * | *** |
Goweda et al. ( |
* | * | – | * | * | **** |
Raval et al. ( |
* | * | – | * | * | **** |
Maryam et al. ( |
* | – | – | * | * | *** |
SM and RN individually assessed the impact of menstrual disturbances and the lifestyle factor associations.
The high prevalence of menstrual disturbances impacted the academic and social life. Students were missing classes and some reported lower grades compared to others. In addition, many reported impairments of various aspects of the quality of life such as meeting friends and co-workers, relationships with their family and partners, etc. What alarming is the intervention by the medical students to reduce the symptoms of menstrual disturbances. Most of the students reported to self-medicate by using painkillers such as NSAID's and other hot drinks. A very few consulted doctors for treatment. Some medical students preferred not to share the menstrual discomfort and perceived it as taboo. The details of academic and health impact of the respective studies and frequent measures adopted by the students are listed in
Academic and social impact of menstrual abnormalities and the adopted intervention by the medical students to reduce complications.
E. G. Alkhamis et al. ( |
• One third of students was leaving early during the class |
• Coffee (71.3%) and painkillers (57.4%) as the most common type of treatment. |
Kushwaha et al. ( |
• Impairment of social and personal life | • Over two-thirds used home remedies alone or in combination with analgesic drugs. |
Al-Shahrani ( |
• Menstruation significantly affected the related quality of life subscales concerning the homework interface |
• Among the students who responded yes to PMS, only 4.1% use of drugs for menstrual regulation and 60% did not use any drug |
Hashim et al. ( |
• More than half reported increase in their absenteeism. |
• Periodical awareness programs should be introduced to minimize the consequences |
Shah and Christian ( |
• The school/work efficiency or productivity impaired |
• Less than one-fourth were using heating pads for their cramps. Herbal tea was used for its soothing effects and preventing menstrual cramps for some. |
Kanti et al. ( |
• 18% remained absent from class for 1 or 2 days due to pain. | • Only 7.1% were using medication. |
Minichil et al. ( |
• 35.5% perceived menstrual pain has an impact on their academic performance. |
• Some self-medication with paracetamol and ibuprofen. Tea and coffee were consumed by 37 and 51%, respectively. |
Bilir et al. ( |
18.2% reported school absenteeism due to PMS | • 92.6% used analgesic very commonly. Only 10% were on oral contraceptive pills. |
Özder and Salduz ( |
• 34% students skipped a class | • 44% felt the need for analgesics. Only 14% sought medical advice. |
Verma et al. ( |
• 12 reported absenteeism from the college. | • More than 50% needed some form of medication |
Majeed-Saidan et al. ( |
• The overall wellbeing is impaired. | • More than 50% used over-the-counter medications 76.8% used alternative therapy |
Nama et al. ( |
• Decreased academic performance, difficulty in concentrating, forgetfulness, adjustment difficulties, loneliness | • Authors recommend inclusive and more flexible medical education curriculum design |
Zalat et al. ( |
• 35% reported forgetfulness and 40% reported confusion |
• More than 80% did not have history of taking medical advice for PMS |
Yadav and Taneja ( |
• 29% missed social activities and 12% missed college | • 55% needed drugs to treat menstrual disorders and 82.5% had misconceptions and taboos related to menstruation. |
Sharma et al. ( |
• Reduced productivity and inability of participate in social activities for majority |
• Authors discuss the association between caffeine intake and a higher PMS |
Shamnani et al. ( |
• 12% were absent in educational activities and 32% avoided joining social activities | • 45% of symptomatic participants consulted to their mothers, 28% to their friends, 21% to others. |
Rajkumari et al. ( |
• Higher stress score | • Stress is a positive predictor for all menstrual disorders |
Acikgoz et al. ( |
• Depression, fatigue, anxiety | • Depression risk should be evaluated in students with PMS |
Ghaderi et al. ( |
• 76% had negative impact on daily activities and 35% were absent from class | • More than half used ibuprofen, diclofenac. Many preferred herbal tea, chamomile, ginger, hot pack, etc. |
Rumana Akbari et al. ( |
• Not indicated adequately | • The prevalence of PMS is directly proportional to age and academic year of study. PMS was found to be more among students residing in hostels. |
Katwal et al. ( |
29% missed classes | • Positive relationship between psychological stress and dysmenorrhea. |
Goweda et al. ( |
Difficulty in concentrating | • Improving early detection of PMDD and proper management can improve general wellbeing and ensure a better health |
Jaiprakash et al. ( |
• 32% had social life impairment and 22% were absent from college | • Most of them did not take any medications. |
Aryal et al. ( |
Overall wellbeing is decreased | • Dysmenorrhea symptoms should be effectively screened by healthcare providers |
Raval et al. ( |
• Majority had reduced school/work efficiency or productivity |
• Various screening and assessment tools are available such as PSST for PMS and SCID-PMDD |
Maryam et al. ( |
• Productivity decreased | • Stress management to prevent more severe dysmenorrhea, and increase the productivity |
The lifestyle factors associated with menstrual disturbances found in our study are shown in
Major lifestyle factors associated with menstrual abnormalities.
Among the total female medical students of the included studies (
The forest plot of PMS prevalence. The diamond represents the overall results and 95% confidence interval of the random effect of the meta-analysis. Model: Random, overall effect size: 0.513, 95%CI: [0.396–0.629] (
The funnel plot of pooled prevalence of PMS is asymmetry and suggest that overall effect of the analysis is biased. In this case the intercept (B0) is 1.06576, 95% confidence interval (−7.59403, 9.72556), with
A total of 7 studies with a total of 1,487 female medical students were included in the meta-analysis for the prevalence of PMDD. Prevalence reported by individual studies ranged between 1 and 38%. The pooled estimate of PMDD was 17% (95% CI: 0.102–0.289).
The forest plot of PMDD prevalence. The diamond represents the overall results and 95% confidence interval of the random effect of the meta-analysis. The prevalence of PMDD was reported in 6 studies including 1,487 participants. The estimated prevalence, pooled from all included studies for PMDD was found to be 17.7% (95% CI: 0.102–0.289) with a high level of heterogeneity (
A total of 13 studies with a total of 2,497 female medical students, were included in the meta-analysis for the prevalence of dysmenorrhea. Prevalence reported by individual studies ranged between 24 and 98%. The pooled estimate of dysmenorrhea was 72.7% (95% CI: 0.634–0.804) with a high level of heterogeneity (
The forest plot of dysmenorrhea prevalence. The diamond represents the overall results and 95% confidence interval of the random effect of the meta-analysis. The prevalence of dysmenorrhea was reported in 13 studies including 2,497 participants. The estimated prevalence, pooled from all included studies for dysmenorrhea was found to be 17.7% (95% CI: 0.102–0.289) with a high level of heterogeneity (
The funnel plot of pooled prevalence of dysmenorrhea is asymmetry and suggest that overall effect of the analysis is biased. In this case the intercept (B0) is 1.06576, 95% confidence interval (−7.59403, 9.72556), with
This study is a first-of-its-kind prevalence study in medical students where a systematic review and meta-analysis of included studies were provided clearly. We searched the databases comprehensively and extracted the relevant data on menstrual disturbances in female medical students worldwide.
Although all humans experience some hormonal surges at puberty, women are predominantly susceptible to physical and mental stress caused by endocrinal changes associated with the menstrual cycle. Throughout the active reproductive life of a female (from menarche→regular menstrual cycle→pregnancy→menopause), the body goes through hormonal fluctuations, leading to stress and mood alterations. A high level of stress and mood disturbances can further complicate the menstrual cycle. The hypothalamic-pituitary-gonadal/adrenal (HPG/HPA) axis provides essential feedback and regulatory influence to maintain physiological homeostasis. Therefore, abnormality of either HPG or HPA is a major contributing factor for menstrual disturbances (
Pre-menstrual symptoms include a spectrum of psychosomatic symptoms arising in the luteal phase of the menstrual cycle affecting the typical lifestyle of a female and getting resolved after the menstruation cycle begins. The American Congress of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA) both have a set of diagnostic criteria based on physical and psychological symptoms for diagnosing PMS and PMDD, respectively (
We searched the databases comprehensively and extracted the relevant data on menstrual disturbances in female medical students worldwide. Our study found common complaints of PMS, PMDD, and dysmenorrhea in female medical students. Some studies have also reported a combination of menstrual disturbances (
Although we searched comprehensively, we did not find a suitable study from the USA, Canada, UK, Australia, and other western countries. However, studies are available on the impact of therapeutic interventions for treatment of PMS and PMDD (
An exciting aspect of this review was to investigate root causes of the menstrual disturbances in medical students and the impact on academic and social life. Although we did not quantify the causal statistical data, our study highlights behavioral and lifestyle factors such as food and drink preferences, lack of exercise, smoking, caffeine intake, etc., may have a strong association with menstrual disturbances. It is also interesting to notice a trend of traditional interventions such as over-the-counter pain killers, drinking hot tea, etc., to reduce the symptoms of menstrual disturbances in medical students. This study supports evidence from previous observations by Kushwaha et al., who reported a lower incidence (19 vs. 48%) of moderate to severe dysmenorrhea in students who had been exercising regularly vs. students who did not. Most respondents adopted home remedies to manage painful menstruation without medical consultation. In addition, 61% respondents used analgesic drugs out of which 51% used Mefenamic acid as the most common self-medicated drug. The more concerning fact is that 78% had used drugs once a day, but 68% had insufficient knowledge about drug dosage (
In accordance with the present results, a previous study by Alkhamis et al., reported a 23.3% prevalence of PMS and PMDD. Fifty-six percent of medical student respondents in the study were not involved in any exercise, and 21% did not sleep for 6 h or more. Sixty-five percent reported consuming caffeine regularly, and 26% reported eating junk food more often than others. Although no precise statistical analysis was shown between lifestyle behaviors and the prevalence of PMS and PMDD, a national association is possible. It was also reported that female students left early from the class because of PMS. Consequentially, 29.1% of the female medical students indicated low-grade scoring, and 22.5% reported lower grades than males. Among students with PMS or PMDD, 71.3% used hot drinks such as coffee, 57.4% used traditional pain killers as a mode to reduce pain. Only 11.2% opted for medical treatment (
These results corroborate the ideas of Al-Shahrani et al., who reported that 50% students who experienced PMS did not exercise and 25% had a family history of menstrual problems. The quality of life was also significantly impaired in medical students because of menstruation disorder. More than 60% of the respondents did not use any medication or medical consultation to reduce the discomfort during the menstrual cycle (
Overall, this research paper shows direct and significant impact of menstrual disorders on the academic and personal quality of life of female medical students. Moreover, the academic disadvantage may lead to an unequal platform for success compared to other medical students. Therefore, this gap should be considered for a critical intervention by the medical universities, all stakeholders and government agencies.
One of the early studies in 1971 by Kantero and Widholm on over 5,000 female adolescents reported a 43% irregular menstrual cycle rate with 20% having irregular menses 5 years after menarche (
Medical education has evolved in recent times not just to follow the government guidelines but also to fulfill the motto of education for all. Education trends have debunked the myth that only students of science background can apply and get into medical school. Many institutions have additional pre-medical programs tailored for non-medical students who wish to learn and practice medicine. In addition, a significant number of medical students in the USA require additional accommodations due to learning disabilities. Providing equal opportunities to all the sections of the students is advantageous for society and a fulfilling experience for a medical school. Currently, the USA has several practicing doctors who completed their medical studies with learning disabilities like ADHD (
The current study is the first systematic review and meta-analysis of three predominant menstruation disturbances among female medical students worldwide. Present study adds value to the existing body of literature on female reproductive and personal wellbeing. The review also provides an overview of the traditional lifestyle factors leading to menstruation disturbances among medical students. In addition, the review also sheds light on the impact of menstrual disturbances in the academic and personal life. The present systematic review and meta-analysis may have overlooked some studies that could have been included in our review despite comprehensive search strategy. The present study could not find enough relevant studies from USA, UK, and Australia. Since the gray literature of the thesis and another non-peer-reviewed article were excluded, a piece of valuable information may have been lost because of this. The subgroup analysis of PMS, PMDD, and dysmenorrhea, could have been more in-depth, but that would also be too much information for a busy reader. A significant limitation of our study is the presence of a considerable level of heterogeneity. This could be due to the diverse geographical population with different cultures and differences in methodologies of the study protocol. The heterogeneity of results and different outcomes posed a major problem and could be resolved in the future by introducing a core outcome set but we still have to work on that. Present study includes
The current systematic review and meta-analysis shows a high prevalence of PMS and dysmenorrhea among female medical students. However, the prevalence of PMDD is relatively low in the same population. Most reproductive age group female students have impairment of academic and social quality of life because of menstrual symptoms. Lifestyle, socio-demographic, genetic, and psychological factors may contribute to the menstrual disturbances. Since there are a smaller number of studies and sharp variation of estimates in worldwide research data, it would be interesting in future to compare the prevalence of menstrual disturbances and associated factors between the female medical students of USA, UK, and Australia to the rest of the world in a large-scale study to find out the personal, professional, and economic impact of menstrual disturbances. Since a significant population of the studies either miss classes or have impairment of the academic performance, all stakeholders should step up the formulation of guidelines to increase our medical student population's overall quality of life. Early intervention in the medical universities and formulation of strategies to improve pain, mood, depression, and associated symptoms of menstrual disturbances would increase educational opportunities and foster a better quality of life. Finally, further studies are needed to evaluate and assess the cause of the menstrual disturbances and therapeutic interventions to bridge the gender gap in our society for a better tomorrow.
The original contributions presented in the study are included in the article/
SM and SaN: conceptualizing, literature search and screening, methodology selection, data extraction, project administration, supervising and writing, and manuscript preparation. TC, JW, SaN, and RN: conceptualizing, data extraction and analysis, validation, writing, and reviewing and editing. RS: meta-analysis validation and data curation. RW and PR: conceptualizing, supervision, interpretation, and review and editing. RN, ShN, and SaN: final review and editing, data visualization, and project administration. All authors contributed to the article and approved the submitted version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
We would like to acknowledge the efforts of Suzanne Paparo, Faculty Librarian, St. George's University School of Medicine, Grenada in assisting with database access.
The Supplementary Material for this article can be found online at: