J Gandhara Med Dent Sci

ORIGINAL ARTICLE

April - June 2026

ACADEMIC STRAIN UNDER HORMONAL STRESS: PREMENSTRUAL SYNDROME AND

PREMENSTRUAL DYSPHORIC DISORDER AMONG FEMALE MEDICAL STUDENTS -

PREVALENCE AND ACADEMIC IMPACT

Sadia Shoukat

, Azra Ahmed

, Sakeena Ahmed

, Nusrat Jameel

Nazia Azam Yousfani

How to cite this article

Shoukat S, Ahmed A, Ahmed S,

Jameel N, Yousfani NA. Academic

Strain under Hormonal Stress:

Premenstrual Syndrome and

Premenstrual Dysphoric Disorder

among Female Medical Students -

Prevalence and Academic Impact J

Gandhara Med Dent Sci. 2026; 13(2):

18-23.

Date Submission: 13-10-2025

Date Revised: 04-03-2026

Date Acceptance: 06-03-2026

Associate Professor and Consultant,

Department of Gynecology and

Obstetrics, Suleman Roshan Medical

College , Tando Adam

Assistant Professor and Consultant,

Department of Gynecology and

Obstetrics, Suleman Roshan Medical

College, Tando Adam

Senior Registrar and Consultant,

Department of Gynecology and

Obstetrics , Suleman Roshan Medical

College, Tando Adam

Associate Professor, Department of

Public Health, Suleman Roshan

Medical College, Tando Adam

Correspondence

Sadia Shoukat, Assistant Professor

and Consultant, Department of

Gynecology and Obstetrics, Suleman

Roshan Medical College, Tando Adam

+92- 334-2041601

nadiashoukat2010@hotmail.com

ABSTRACT

OBJECTIVES

The study aims to determine the prevalence of premenstrual syndrome (PMS)

and premenstrual dysphoric disorder (PMDD) among female medical

students and evaluate the impact these conditions have on the students’

academic performance.

METHODOLOGY

This cross-sectional study was conducted over two months at Suleman

Roshan Medical College, using a census to include all female medical

students with regular cycles and no major health conditions. Data were

collected via a structured questionnaire based on ICD-10 and DSM-5 criteria

to diagnose PMS and PMDD, and to assess academic impact. Participation

was voluntary, anonymous, and required informed consent. Data were

analyzed using SPSS version 23, employing both descriptive and inferential

statistics. A p-value of less than 0.05 was considered statistically signicant.

RESULTS

Study found high prevalence of premenstrual disorders among the 182

participants, with 90.1% meeting the criteria for PMS and 26.4% for PMDD.

The most common moderate-to-severe symptoms were fatigue 61.0%,

irritability 52.2%, and depressed mood 50.5%. Symptoms were strongly

associated with academic impairment, with over 70% of students reporting

negative eects on exam performance and concentration. A direct dose-

response relationship was observed, with increased symptom severity

associated with greater academic performance diculties.

CONCLUSION

This study concludes that premenstrual syndrome and premenstrual

dysphoric disorder are highly prevalent among female medical students and

are signicantly associated with substantial academic impairment.

KEYWORDS: Premenstrual Syndrome, Premenstrual Dysphoric Disorder,

Academic Performance, Students, Medical

INTRODUCTION

Premenstrual syndrome (PMS) is a cyclical medical

condition marked by recurring physical and

psychological symptoms that appear during the luteal

phase of the menstrual cycle and subside shortly after

menstruation begins. Diagnosis requires three main

criteria: consistent symptom recurrence across most

menstrual cycles, signicant disruption of daily

activities, and ruling out other medical or psychiatric

conditions.

The International Classication of Diseases

ICD-10 species that PMS requires at least one

characteristic symptom, such as psychological

discomfort, bloating, breast tenderness, peripheral

edema, musculoskeletal pain, concentration issues,

sleep disturbances, or appetite changes that resolve with

the onset of menstruation.

A more severe form,

Premenstrual Dysphoric Disorder (PMDD), aects a

smaller group of individuals. According to DSM-5

criteria, diagnosing PMDD requires at least ve

symptoms, including at least one emotional symptom,

i.e., mood swings, irritability, depression, or anxiety,

along with possible physical symptoms.

Both

conditions negatively impact quality of life, but

PMDD’s emotional symptoms generally cause greater

psychosocial disruption.

Globally, 50 to 80% of

women of reproductive age experience premenstrual

symptoms, with 30 to 40% reporting moderate to severe

PMS needing treatment, and 3 to 8% meeting the

criteria for PMDD.

The eects of PMS/PMDD are

especially signicant in academic environments.

Studies from Brazil show PMS prevalence of 46.9%

among university students, with 11.1% meeting PMDD

criteria.

Similarly, data from a Pakistani medical

university indicates higher rates, 51.7% for PMS and

https://doi.org/10.37762/jgmds.13-2.803

J Gandhara Med Dent Sci

April - June 2026

5.8% for PMDD.

These conditions notably interfere

with learning, with 76.3% of aected students reporting

decreased academic performance, 79.2% struggling

with group discussions, and over 66% facing challenges

during evaluations.

This relationship is bidirectional:

neuroendocrine research demonstrates that cyclical

fluctuations in estrogen directly inuence cognition and

emotional regulation, while academic stressors, such as

demanding coursework and nancial pressures, may

worsen symptoms.

9,10,11

This creates a vicious cycle

where poor academic performance increases stress,

which further intensies premenstrual symptoms.

12,13

Although international data on PMS prevalence exist

and a few Pakistani studies have reported basic

prevalence rates among female medical students,

research examining its academic impact on medical

students in Pakistan is limited.

14,15,7,16,8,17

To our

knowledge, no such study has been conducted within

our institution. This study aims to ll this important gap

by examining the prevalence of PMS according to ICD-

10 criteria and PMDD based on DSM-5 criteria among

female medical students, while also evaluating its

academic eects to highlight the need for targeted

interventions, such as counseling services, cognitive

behavioral therapy, and institutional academic support

for students aected.

2,4

METHODOLOGY

A cross-sectional, questionnaire-based observational

study was conducted over two months at Suleman

Roshan Medical College. A complete enumeration

(census) sampling method was employed; all eligible

female medical students were invited to participate

voluntarily with informed consent, as the total

population was under 400, thereby enhancing statistical

power and eliminating sampling bias. Inclusion criteria

required participants to be female medical students of

the college with regular menstrual cycles over the

preceding 6 months and no known medical or

psychological disorders; individuals who did not meet

these criteria or who refused to participate were

excluded. Data were collected using a structured

questionnaire, developed by the research team, which

consisted of sections on socio-demographics,

gynecological history, and assessment of premenstrual

syndrome against ICD-10 diagnostic criteria, evaluation

of premenstrual dysphoric disorder against DSM-5

criteria, including the requisite ve symptoms and

functional impairment, and the academic impact of

these conditions. Symptom severity was classied as

none, mild, moderate, or severe using Sternfeld’s

criteria, and participants were specically instructed to

report symptoms that exhibited a cyclical pattern,

appearing in the luteal phase and resolving after

menstrual onset. The nal section included an open-

ended question that solicited students’ views on the

institutional support needed. The study received prior

approval from the Institutional Review Board, and

ethical standards were maintained through strict data

anonymization and voluntary informed consent. The

collected data were analyzed using IBM SPSS

Statistics. Descriptive statistics, including frequencies

and percentages, were used to summarize participants'

sociodemographic, gynecological, and clinical

characteristics. The prevalence of PMS and PMDD was

calculated as simple proportions. To evaluate the

association between PMS severity and academic

impairment, a one-way analysis of variance (ANOVA)

and Logistic regression were performed. The tests were

selected to compare the mean academic impact scores

across the ordinal categories of PMS severity (none,

mild, moderate, severe). A p-value of < 0.05 was

considered signicant.

RESULTS

Premenstrual Dysphoric

Disorder

P-value

No (n=134) Yes (n=48)

Age (years)

16 – 20 24 (17.9%) 10 (20.8%) 0.65

>20 110 (82.1%) 38 (79.2%)

Marital

Status

Single 127 (94.8%) 46 (95.8%) 0.900

Married 07 (5.2%) 02 (4.2%)

Academic

Year

1st year 28 (20.9%) 07 (14.6%) 0.707

year 15 (11.2%) 03 (6.2%)

year 29 (21.6%) 10 (20.8%)

year 25 (18.7%) 16 (33.3%)

year 37 (27.6%) 12 (25.0%)

Age at

menarche

(year)

<13 35 (26.1%) 20 (41.7%) 0.061

13 – 16 93 (69.4%) 23 (47.9%)

>16 06 (4.5%) 05 (10.4%)

Menstrual

Cycle Length

<21 days 15 (11.2%) 09 (18.8%) 0.078

21-35 days

110 (82.1%) 35 (72.9%)

>35 days 09 (6.7%) 04 (8.3%)

Bleeding

Duration

1-3 days 46 (34.3%) 13 (27.1%) 0.013*

4-5 days 75 (56.0%) 28 (58.3%)

≥6 days 13 (9.7%) 07 (14.6%)

Menstrual

Flow

Intensity

Too Light 21 (15.7%) 05 (10.4%) 0.332

Moderate 106 (79.1%) 38 (79.2%)

Heavy 07 (5.2%) 05 (10.4%)

Menstrual

Pain

Severity

None 10 (7.5%) 03 (6.2%)

0.001

Mild 46 (34.3%) 07 (14.6%)

Moderate 44 (32.8%) 22 (45.8%)

Severe 29 (21.6%) 12 (25.0%)

Very Severe

05 (3.7%) 04 (8.3%)

Family

History of

PMS/PMDD

Yes 96 (71.6%) 40 (83.3%) 0.128

No 37 (27.6%) 08 (16.7%)

Actions

Taken for

Symptoms

None 38 (28.4%) 12 (25.0%)

0.001

Take Pain

Relief Medi

cation

37 (27.6%) 20 (41.7%)

Heat pad 43 (32.1%) 13 (27.1%)

Massage 09 (6.7%) 02 (4.2%)

Take Consu

ltation

07 (5.2%) 01 (2.1%)

Table 1 (a): Association between Sociodemographic/Menstrual

Characteristics and Premenstrual Dysphoric Disorder (PMDD) of

the participating medical students (N=182)

Academic Strain Under Hormonal Stress: Premenstrual Syndrome

J Gandhara Med Dent Sci

April - June 2026

Table 1(b): Association between Sociodemographic/Menstrual

Characteristics and Premenstrual Syndrome (PMS) of the

Participating Medical Students (N=182)

Premenstrual Syndrome P-value

No (n=18) Yes

(n=164)

Age (years)

16 – 20 02 (11.1%) 32 (19.5%) 0.385

>20 16 (88.9%) 132

(80.5%)

Marital

Status

Single 17 (94.4%) 156

(95.1%)

0.900

Married 01 (5.6%) 08 (4.9%)

Academic

Year

1st year 03 (16.7%) 32 (19.5%) 0.707

year 02 (11.1%) 16 (9.8%)

year 02 (11.1%) 37 (22.6%)

year 04 (22.2%) 37 (22.6%)

year 07 (38.9%) 42 (25.6%)

Age at

menarche

(year)

<13 02 (11.1%) 53 (32.3%) 0.061

13 – 16 16 (88.9% 100

(61.0%)

>16 0 (0.0%) 11 (6.7%)

Menstrual

Cycle

Length

<21 days 0 (0.0%) 24

(100.0%)

0.078

21-35

days

18 (12.4%) 127

(87.6%)

>35 days 0 (0.0%) 13

(100.0%)

Bleeding

Duration

1-3 days 02 (11.1%) 57 (34.8%) 0.013*

4-5 days 16 (88.9%) 87 (53.0%)

≥6 days 0 (0.0%) 20 (12.2%)

Menstrual

Flow

Intensity

Too Light 04 (22.2%) 22 (13.4%) 0.332

Moderate 14 (77.8%) 130

(79.3%)

Heavy 0 (0.0%) 12 (7.3%)

Menstrual

Pain

Severity

None 03 (16.7%) 10 (6.1%)

0.001

Mild 13 (72.2%) 40 (24.4%)

Moderate 2 (11.1%) 64 (39.0%)

Severe 0 (0.0%) 41 (25.0%)

Very

Severe

0 (0.0%) 9 (5.5%)

Family

History of

PMS/PMDD

Yes 17 (94.4%) 119 (72.6%)

0.128

No 01 (5.6%) 44 (26.8%)

Actions

Taken for

Symptoms

None 15 (83.3%) 35 (21.3%)

0.001

Take Pain

Relief Med

ications

01 (5.6%) 56 (34.1%)

Heat pad 2 (11.1%) 54 (32.9%)

Massage 0 (0.0%) 11 (6.7%)

Take Cons

sultation

0 (0.0%) 8 (4.9%)

Table 2: Frequency and Severity of Premenstrual Symptoms

among Medical Students (N=182).

Symptoms None n

(%)

Mild n

(%)

Moderat

e n (%)

Severe

n (%)

Psycho

logical

Sympt

oms

Severity

Irritability

/mood

swings

(17.0%)

(30.8%)

(29.1%)

(23.1%)

Anxiety/te

nsion

(23.6%)

(29.1%)

(30.2%)

(17%)

Depressed

mood

(23.1%)

(26.4%)

(30.2%)

(20.3%)

Poor Concen

tration

(29.7%)

(25.3%)

(34.1%)

(11.0%)

Fatigue/Le

thargy

(15.9%)

(23.1%)

(38.5%)

(22.5%)

Sleep

disturbances

(27.5%)

(31.9%)

(26.9%)

(13.7%)

Physical

Sympt

oms

Severity

Breast

tenderness

(51.1%)

(32.4%)

(14.8%)

(1.6%)

Bloating/w

eight gain

(45.6%)

(29.1%)

(21.4%)

(3.8%)

Headaches

(38.5%)

(30.8%)

(22.5%)

(8.2%)

Muscle/joi

nt pain

(24.7%)

(29.1%)

(32.4%)

(13.7%)

Appetite

changes

(26.4%)

(34.1%)

(33.0%)

(6.6%)

Swelling

(hands/feet

117

(64.3%)

(23.6%)

(9.3%)

(2.7%)

Figure 1: Proportion of medical students diagnosed with

Premenstrual Syndrome (PMS) based on ICD-10 criteria. Among

the 182 participants, the prevalence was 90.1% (n=164).

Academic Strain Under Hormonal Stress: Premenstrual Syndrome

J Gandhara Med Dent Sci

April - June 2026

Table 3: Prevalence and Severity of Academic Impairment

during Premenstrual Phase among Female Medical Students

(N=182)

Academic

Domain

Not at

all n

(%)

Slightl

y n

(%)

Moder

ately n

(%)

Severel

y n

(%)

Percentage

of students

experiencing

any

impairment

Class

concentrat

ion

(29.7%)

(42.9%)

(23.1%)

(3.8%)

70.3 %

Assignment

completion

(37.4%)

(33.5%)

(22.5%)

(6.6%)

62.6 %

Lecture

attendance

(36.8%)

(30.2%)

(25.3%)

(7.7%)

63.2 %

Study

group

participation

(35.7%)

(34.6%)

(26.4%)

(3.3%)

64.3 %

Academic

motivation

(33.5%)

(31.3%)

(33%)

(2.2%)

66.5 %

Group

work

(33%)

(33.5%)

(29.1%)

(3.8%)

67 %

Exam

performance

(28%)

(29.1%)

(38.5%)

(4.4%)

72 %

Figure 2: Association Between Premenstrual Syndrome Severity

and Academic Impairment Among Medical Students (N=182).

Bars represent mean academic impact scores with 95%

confidence intervals. Academic impairment demonstrates a

significant progressive increase with PMS severity (p < 0.001).

Table 4: Association between PMDD Diagnosis and Academic

Impact Areas (Chi-Square Tests)

Academic Impact Area

Pearson Chi-

Square Value

P-Value and

statistical

significance

Class Concentration 15.81 0.001

Group Participation 17.21 0.001

Academic Motivation 9.32 0.025

Exam Performance 9.27 0.026

Group Work 13.92 0.003

Assignments Completion 15.20 0.002

Lecture Attendance 10.46 0.015

DISCUSSION

Our study reveals considerable menstrual health

challenges faced by female medical students, with

90.1% experiencing PMS (as shown in Figure 1) and

24.6 % meeting criteria for PMDD. Additionally,

dysmenorrhea aected 92.9% of participants, with

63.7% reporting moderate to very severe pain. This

high burden translates directly into academic

impairment. A particularly strong nding was the dose-

response relationship; as PMS severity increased, so did

the level of academic diculty, a correlation that was

both statistically strong and educationally meaningful.

The results of the current study align with those of

Siregar et al., who also showed a direct relationship

between increasing premenstrual symptom severity and

its negative eect on academic performance. A similar

relationship was shown in a study of Iraqi medical

students, which revealed that 40% experienced

increased learning challenges, primarily manifesting as

a lack of concentration (50.1%) and trouble working

(42.7%).

18,19

However, it contrasts with the work of

Alemu et al., who found no signicant link, suggesting

that the unique pressures of medical education may

amplify these eects, variations in diagnostic criteria,

and sociocultural factors inuencing symptom

reporting. A key consistency with other literature is the

dominance of psychological symptoms over purely

physical complaints, highlighting the profound impact

on mental focus and motivation.

20,21

The PMDD

prevalence in this study (26.4%) is higher than the

16.3% and 13.8% reported by Omar et al. and Alemu et

al., respectively, yet remains lower than the 34.7%

documented by Minichil et al.

20,22,23

Whereas, the

prevalence of dysmenorrhea 92.9% matches exactly

with a study conducted at an Egyptian university on

female medical students. Worldwide, dysmenorrhea

rates vary widely, 16.8% to 94%, according to a WHO

review, suggesting that cultural and methodological

factors inuence these numbers.

24,25,26

A critical

analysis of our ndings with other studies reveals a

distinction between the perception of premenstrual

symptoms and their underlying pathology. While

students who perceived their menstrual pain as

impacting their academic performance were more likely

to develop PMDD, suggesting a notable cognitive-

affective component, our bivariate analysis identied a

later age at menarche as the statistically signicant

associated factor for a PMDD diagnosis. This contrast

implies that while subjective appraisal may amplify

distress, the development of PMDD may be

intrinsically linked to specic biological determinants

of reproductive development. In comparison, a PMS

diagnosis was more directly associated with greater

menstrual pain severity.

10,23,27

LIMITATIONS

This study’s limitations include its cross-sectional

design, which precludes causal inference, and its single-

Academic Strain Under Hormonal Stress: Premenstrual Syndrome

J Gandhara Med Dent Sci

April - June 2026

institution sample, which may limit generalizability.

Reliance on self-reported data introduces the possibility

of recall bias. Furthermore, the ndings may be

inuenced by the specic cultural context and the use

of subjective academic impact measures rather than

objective performance indicators. Future longitudinal,

multi-institutional studies incorporating clinical

assessments and objective metrics are recommended to

address these constraints.

CONCLUSIONS

This study conrms a high prevalence of premenstrual

syndrome among female medical students, with

symptom severity demonstrating a direct, dose-response

relationship to academic impairment. The signicant

disruption to exam performance and concentration

necessitates institutional recognition of this issue. These

findings provide compelling evidence for implementing

supportive policies, such as academic accommodations

and wellness resources, to promote educational equity

and student well-being.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Green LJ, O'Brien PMS, Panay N, Craig M; Royal College of

Obstetricians and Gynaecologists. Management of premenstrual

syndrome. BJOG. 2017;124:e73–e105. doi:10.1111/1471-

0528.14260

2. World Health Organization. International statistical

classification of diseases and related health problems. 10th

revision (ICD-10). Geneva: World Health Organization; 1992.

3. Yonkers KA. Epidemiology and pathogenesis of premenstrual

syndrome and premenstrual dysphoric disorder. UpToDate.

2008. Available from: https://www.uptodate.com

4. American Psychiatric Association. Diagnostic and statistical

manual of mental disorders. 5th ed. Washington (DC):

American Psychiatric Association; 2013.

5. Ryu A, Kim TH. Premenstrual syndrome: A mini review.

Maturitas. 2015;82(4):436-440.

doi:10.1016/j.maturitas.2015.08.010 PMID:26358865

6. Rezende AP, Alvarenga FR, Ramos M, Franken DL, Costa JS,

Pattussi MP, et al. Prevalence of premenstrual syndrome and

associated factors among academics of a university in midwest

Brazil. Rev Bras Ginecol Obstet. 2022;44:133-141.

doi:10.1055/s-0041-1741456 PMID:35349323

7. Nisar N, Zehra N, Haider G, Munir AA, Sohoo NA. Frequency,

intensity and impact of premenstrual syndrome in medical

students. J Coll Physicians Surg Pak. 2008;18(8):481-484.

PMID:18760073

8. Hashim R, Ayyub A, Hameed S, Qamar K, Ali S, Raza G.

Premenstrual syndrome: Messes with my academic

performance. Pak Armed Forces Med J. 2014;64(2):199-203.

9. Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Choudhry ZS.

Anxiety and depression among medical students: A cross-

sectional study. J Pak Med Assoc. 2010;60(8):699-702.

PMID:20726214

10. Tolossa FW, Bekele ML. Prevalence, impacts and medical

managements of premenstrual syndrome among female

students: Cross-sectional study in College of Health Sciences,

Mekelle University, Ethiopia. BMC Womens Health.

2014;14:52. doi:10.1186/1472-6874-14-52 PMID:24629038

11. Parry BL, Nowakowski S, Martinez LF, Berga SL.

Premenstrual dysphoric disorder. In: Pfa DW, Arnold AP,

Etgen AM, Fahrbach SE, Rubin RT, editors. Hormones, Brain

and Behavior. 2nd ed. San Diego: Academic Press; 2009. p.

2945-2974. doi:10.1016/B978-008088783-8.00094-9

12. Hamdan-Mansour AM, Hamaideh SH, Arabiat DH, Azzeghaiby

SN. Psychosocial correlates of motivation for academic

accomplishment among university students. Procedia Soc Behav

Sci. 2014;159:32-36. doi:10.1016/j.sbspro.2014.12.323

13. Hamaideh SH, Al-Ashram SA, Al-Modallal H. Premenstrual

syndrome and premenstrual dysphoric disorder among

Jordanian women. J Psychiatr Ment Health Nurs.

2014;21(1):60-68. doi:10.1111/jpm.12047 PMID:23701449

14. Bakhshani NM, Mousavi MN, Khodabandeh G. Prevalence and

severity of premenstrual symptoms among Iranian female

university students. J Pak Med Assoc. 2009;59(4):205-208.

PMID:19402278

15. Ezadi Z, Ramozi M, Barati H, Hosseini M, Hakimi S,

Mohammady N, et al. Prevalence and associated factors of

premenstrual syndrome among female university students of

reproductive age group in Kabul, Afghanistan: A cross-sectional

study. Womens Health Rep (New Rochelle). 2025;6(1):403-

411. doi:10.1089/whr.2024.0106

16. Kalsoom U, Sultana A, Amjad T, Bairam S. Prevalence of

premenstrual syndrome and knowledge assessment regarding its

prevention among medical students of a private medical college

of Islamabad. Pak Armed Forces Med J. 2018;68(1):159-164.

17. Bukhari SS, Burki SA, Joiya RS, Ijaz F, Rahman F, Awan MA,

et al. Impact of examination stress on premenstrual syndrome

among female medical students. Ann King Edward Med Univ.

2023;29(Suppl 3):229-233. doi:10.21649/akemu.v29iSpl3.5576

18. Siregar MF. Stress levels and characteristics of medical faculty

students undergoing premenstrual syndrome and its association

with academic achievements. Stress. 2013;3(1).

19. Talib Hassan I, Saadi Issa H, Hussein EA, Ali Haddad R. The

effect of premenstrual tension on academic performance and

social interactions among Iraqi medical students. Cell Mol

Biomed Rep 2023;3(4):205-211. doi:10.55705/cmbr.2023.39010

1.1113

20. Alemu SM, Habtewold TD, Haile YG. Mental and reproductive

health correlates of academic performance among Debre Berhan

University female students, Ethiopia: The case of premenstrual

dysphoric disorder. Biomed Res Int. 2017;2017:9348159.

doi:10.1155/2017/9348159 PMID:28567457

21. Tenkir A, Fisseha N, Ayele B. Premenstrual syndrome:

Prevalence and eect on academic and social performances of

students in Jimma University, Ethiopia. Ethiop J Health Dev.

2003;17(3):181-188. doi:10.4314/ejhd.v17i3.9838

22. Omara EI, Salama RA, Tadross TM, Ahmed SK, Mohamed

MG, Dewan SM, et al. Impact of premenstrual tension

syndrome on academic performance among female university

students from the United Arab Emirates: A cross-sectional

study. Health Sci Rep. 2024;7(10):e70124.

doi:10.1002/hsr2.70124 PMID:39221471

23. Minichil W, Eskindir E, Demilew D, Mirkena Y. Magnitude of

premenstrual dysphoric disorder and its correlation with

academic performance among female medical and health

science students at University of Gondar, Ethiopia. BMJ Open.

2020;10(7):e034166. doi:10.1136/bmjopen-2019-034166

PMID:32665392

24. Shehata N, Arafa A, El Wahed HA, Fahim AS, Hussein GK.

Epidemiology of dysmenorrhea among university students in

Egypt. Int J Womens Health Wellness. 2018;4(1):073.

doi:10.23937/2474-1353/1510073

Academic Strain Under Hormonal Stress: Premenstrual Syndrome

J Gandhara Med Dent Sci

ORIGINAL ARTICLE

April - June 2026

LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).

COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.

It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.

25. Latthe P, Latthe M, Say L, Gülmezoglu AM, Khan KS. WHO

systematic review of prevalence of chronic pelvic pain: A

neglected reproductive health morbidity. BMC Public Health.

2006;6:177. doi:10.1186/1471-2458-6-177 PMID:16824213

26. Dahlawi H, Bukhari I, Alshammari F, Althaqib G, Alhawasawi

M, Bashiri R, et al. Eect of dysmenorrhea on academic

performance among students studying in Princess Nourah Bint

Abdulrahman University, Riyadh. Int J Med Dev Ctries.

2021;5(2):588-594. doi:10.24911/IJMDC.51-1608990432

27. Goweda RA, Alkot MM, Alturkistani FA, et al. Prevalence of

premenstrual dysphoric disorder among medical students of

Umm Al-Qura University, Makkah, Saudi Arabia. World Fam

Med J. 2016;99:1-7.

Sadia Shoukat - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Azra Ahmed - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Sakeena Ahmed - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Nusrat Jameel - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Nazia Azam Yousfani - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Critical Revision; Supervision;

Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Academic Strain Under Hormonal Stress: Premenstrual Syndrome