INTRODUCTION:

Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses. PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. PMS is a very common condition. Its symptoms affect more than 90 percent of menstruating women. It must impair some aspect of her life².

The cause of PMS is unknown. However, many researchers believe that it’s related to a change in both sex hormone and serotonin levels at the beginning of the menstrual cycle. Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also modulate activity in parts of brain associated with premenstrual symptoms. Serotonin levels affect mood. Serotonin is a chemical in brain and gut that affects mood, emotions, and thoughts².

The symptoms of PMS are usually mild or moderate. Nearly 80 percent of women report one or more symptom that does not substantially affect daily functioning, according to the journal American Family Physician. Twenty to 32 percent of women report moderate to severe symptoms that affect some aspect of life. Three to 8 percent report PMDD. The severity of symptoms can vary by individual and by month.²

Treatments and lifestyle adjustments can help to reduce or manage the signs and symptoms of premenstrual syndrome. For many women, lifestyle changes like modification of diet, regular exercise, relaxation etc can help relieve PMS symptoms. But depending on the severity of symptoms, doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include: Antidepressants, Nonsteroidal anti-inflammatory drugs (NSAIDs), Diuretics, Hormonal contraceptives³

Complementary remedies used to soothe the symptoms of premenstrual syndrome are Vitamin supplements, Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking. Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chaste berry (Vitex agnus), evening primrose oil and St. John's wort³.

NEED FOR THE STUDY:

Menstrual abnormalities are common in adolescent and can lead to stressful conditions. All over the world around 75% of girls are experiencing problems associated with menstruation. The major abnormalities are dysmenorrhea, premenstrual syndrome (PMS), and menstrual irregularities. These disorders may lead to problems in daily activities such as academic excellence, achievements in sports, and loss of self-confidence. The lifestyle pattern of any individual leads to their prone of disease. Female reproductive cycle directly or indirectly influence with diet, physical work, and mental stress⁴.

New research has confirmed other findings that ginger root (Zingiber officinale) can relieve premenstrual pain and associated symptoms, without some of the side effects associated with NSAIDs.⁵

Traditionally in India, variety of folk medicines has been used to treat day today minor disorders such as dysmenorrhea, indigestion nausea. Today ginger remains a component of more than 50% of the traditional herbal remedies and has been used to treat nausea, indigestion, fever and infection. Of the 115 different chemical components found in ginger root, the therapeutic benefits come from gingerols, the oily resin from the root that acts as a potent antioxidant and anti-inflammatory agent. Chewing on a piece of ginger candy can curb pain caused from inflammation, GI distresses, nausea, loss of appetite, motion sickness and other forms of pain. Also, ginger has been used for the treatment of dysmenorrhea as a spasmodic, anti–inflammatory and circulatory stimulant (Ostrazenski 2002, Yassin 2012). A study was conducted in western Iran to assess the effectiveness of ginger in providing relief to patients of primary dysmenorrhea. The study result showed thatpain in ginger intervention group 29 (82.85%) was significantly greater than that of placebo group 16 (47.05%). Hence it conclude that Ginger is effective in minimizing the Pain severity in Primary dysmenorrhea.⁶

A new research study published in the International Scholarly Research Notices Obstetrics Gynaecology found a link between ginger tablets and reduction in the severity of premenstrual syndrome (PMS).

Women aged 18-35 years were randomly allocated to two groups. One group received two 250mg ginger capsules daily from seven days before menstruation to three days after menstruation for three cycles. The second group was given two 250mg sugar capsules daily similar to the first group. Each group recorded the severity of PMS by reporting their mood, any physical symptoms (headaches, backache, weight gain etc.) and behavioural characteristics (fatigue, increased or decreased appetite etc.) Researchers found that there was a significant difference in PMS including severity of mood, physical and behavioural symptoms between the two groups. Women who received the ginger tablet reported reduced severity in all areas (mood, physical and behavioural symptoms).⁷

Jean Hailes endocrinologist Dr Sonia Davison says this study is novel in that it examined the effects of ginger capsules on PMS symptoms. “Whilst the results appear promising, this is a small study and further research needs to be carried out to confirm these findings,” says Dr Davison. “PMS symptoms are troubling for many women and ginger may be a future treatment strategy for women who have bothersome PMS symptoms.”⁷

PROBLEM STATEMENT:

“A study to determine the effectiveness of ginger candy on pre menstrual syndrome among college girls in selected colleges, Satna”

OBJECTIVES:

1. To assess the level of premenstrual syndrome among experimental and control group of college girls in selected colleges.

2. To determine the effectiveness of ginger candy on premenstrual syndrome among experimental group of college girls.

3. To compare the level of premenstrual syndrome among the experimental and control group of college girls.

4. To find the association between the pretest scores of premenstrual syndrome among experimental and control group of college girls with their selected demographic variables.

HYPOTHESIS:

H₁There is a significant difference in the level of premenstrual symptoms among experimental group before and after administration of ginger candy

H₂The mean difference in post test scores of pre menstrual syndrome level will be significantly different among experimental and control group.

H₃There is a significant association between the level of premenstrual syndrome and selected demographic variables among college girls in experimental and control group.

METHODOLOGY:

Research approach:

Quantitative approach

Research design:

True experimental pre test post test control group design

Setting:

Manoj Jain Memorial College, Satna

Sample and sampling technique:

40 students (20 experimental and 20 Control) were selected by using random sampling technique

Criteria for sample selection:

Samples were selected based on the following inclusion and exclusion criteria.

Inclusion criteria:

Students those who are,

· Having regular menstrual cycle.

· Those who are willing to participate in this study.

Exclusion criteria:

Students who are,

· Having any chronic gynecological disorder

· Having any gastro intestinal disorders

Variables:

Independent variable:

ginger candy

Dependent variable:

level of pre menstrual syndrome

Description of Tool:

Part I: demographic variables

Part II: modified pre menstrual symptom scoring tool

Reliability of tool:

The reliability of the tool was identified by split half method by using spearman’s rank correlation formula. The ‘r’ value was 0.9. Hence the tool was reliable.

Data collection:

Data collection was carried out from 14/02/2019 – 20/06/2019. Pretest was conducted by using modified premenstrual syndrome scoring scale for both experimental and control group. Ginger candy was administered for experimental group one week before menstruation and on the first day of menstruation for each time (morning, afternoon and evening). Ginger candy was withheld for the control group. Post test was conducted for the both group after two consecutive menstruation by using the same scale

Analysis and interpretation of data:

The collected data were analyzed in terms of both descriptive and inferential statistics.

RESULTS:

Table.1: Section 1: Analysis of sample characteristics

Sl. no	Demographic characteristics	Experiment		Control
1.	Age (in years)	N	%	N	%
	16-18	5	25	6	30
	19-21	3	15	4	20
	22-24	12	60	10	50
2.	Age of menarche in years
	9-11 years	0	0	2	10.0
	12-14 years	9	45	12	60
	Above 14 years	11	55	6	30
3.	Dietary pattern
	Vegetarian	4	20	12	60.0
	Non vegetarian	16	80	8	40.0
4.	length of menstrual cycle
	<25 days	3	15	2	10
	25-27 days	6	30	5	25
	28-30 days	5	25	10	50
	>30 days	6	30	3	15
5.	duration of menstrual flow
	<3 days	1	5	2	10
	3-4 days	11	55	13	65
	5-6 days	6	30	2	10
	>6 days	2	10	3	15
6.	family history of PMS
	Yes	7	35	9	45
	No	13	65	11	55
7.	Body mass index
	Under weight (<18)	0	0	0	0
	Normal (18-24.9)	16	80	18	90
	Overweight (25-29.9)	4	20	1	5
	Obese (30 and above)	0	0	1	5
8.	Daily water intake
	< 1500ml	4	20	5	25
	1500ml-2000ml	16	80	13	65
	2000ml-2500ml	0	0	1	5
	> 2500ml	0	0	1	5

Table 2: Pre And Post PMS level of Both Experimental And Control Group

Group		N	Range	Mean	Std. Deviation
Experiment	Pre PMS level	20	26-82	56.4	16.8
Experiment	Post PMS level	20	18-62	41.7	14.1
Control	Pre PMS level	20	27-84	51.4	12.6
Control	Post PMS level	20	27-82	51.7	13.8

Table 3: Comparison of Pre Test and Post Test Scores in Experimental group to assess the effectiveness of ginger candy

	Pre test		Post test		t value	DF	P value Inference
	Mean	SD	Mean	SD
Experiment	56.4	16.8	41.7	14.1	13.6	19	P<0.01*

*is significant;

Table 4: Comparison of Experiment and Control Scores

	Experiment		Control		t value	DF	P value Inference
	Mean	SD	Mean	SD	t value	DF	P value Inference
Pre test	56.4	16.8	51.4	12.6	1.06	38	P>0.05^NS
Post test	41.7	14.1	51.7	13.8	2.27	38	P<0.01*

*is significant; ^NSis not significant

Table 3: Section III: association between the level of PMS with selected demographic variables (both groups)

S. No	Characteristics	Chi-square value	Df	Result	P-value
1	Age in years	2.01	2	NS	0.36, ie , p>0.05
2	Age of menarche	21.2	2	Sig	0.0002, ie , p<0.05
3	Dietary pattern	4.81	1	Sig	0.02, ie , p<0.05
4	Length of menstrual cycle	4.7	3	NS	0.19, ie , p>0.05
5	Duration of menstrual flow	17.6	3	Sig	0.0005, ie , p<0.05
6	Family history of PMS	5.42	1	Sig	0.019, ie , p<0.05
7	Body mass index	2.81	3	NS	0.42 , ie, p>0.05
8.	Daily water intake	11.6	3	Sig	0.009, ie, p<0.05

v NS – Not significant at 5% level (i.e., P > 0.05)

v Sig – Significant at 5% level (i.e., P < 0.05)

In paired t-test table, it shows that the post test mean PMS score in the experimental group is 41.7 and pretest mean score is 56.4. The calculated ‘t’ value of experimental group is 13.6, this showed that there was a significant difference between pre test and post test scores.

In unpaired t-test table, it shows that the pre test mean PMS score in the experimental and control group were 56.4 and 51.4 respectively, the calculated ‘t’ value of pre test score is 1.06. This showed that there was no significant difference between experimental and control scores before administering ginger candy. In post test, it shows that the mean PMS score in the experimental group was 41.7 and in control group it was 51.7. The calculated ‘t’ value of post test was 2.27. This showed that there was a significant difference between experimental and control scores after the administration of ginger candy.

From the table age of menarche, dietary pattern, duration of menstrual flow, family history of PMS, and daily water intake are significant. The remaining characters are not significant.

DISCUSSION:

1. The first objective of the study was to assess the level of premenstrual symptom among experimental and control group of college girls in selected colleges

The pre-test findings of the study revealed that the overall mean PMS score in the pre-test among experimental group was 56.4 and control group was 51.4

These findings are consistent with the findings of Sharma P et al, conducted a study to study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. Girls in the age group 13-19 years who had had menarche for at least one year at the time of study. 198 adolescent girls have been studied. Data was collected by personal interviews on a pre-tested, semi-structured questionnaire. The questions covered menstrual problems, regularity of menses in last three cycles of menstruation and the effect of these problems on the daily routine. Analysis was done using SPSS version 12. Percentages were calculated for drawing inferences. More than a third (35.9%) of the study subjects were in the age group 13-15 years followed by 17-19 years, 15-17 years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work. Mothers and friends were the most common source of information on the issue⁸.

2. To determine the effectiveness of ginger candy on premenstrual syndrome among experimental group of college girls

The investigator has assessed the effectiveness of ginger candy. After administering ginger candy the samples has showed the PMS score in post-test with mean score of 41.7. Hence the overall improvement in the PMS score is 14.7. The findings of study depicted a real evidence of significance between pre-test and post-test PMS scores. The difference was statistically proved by using paired “t” test and calculated t value is 13.6 and it is significant at p< 0.05. So there is a significant difference between the pre and post-test PMS score of college girls, hence the hypothesis is accepted.

These findings are consistent with the following findings of a new research study published in the International Scholarly Research Notices Obstetrics Gynaecology found a link between ginger tablets and reduction in the severity of premenstrual syndrome (PMS). Women aged 18-35 years were randomly allocated to two groups. One group received two 250mg ginger capsules daily from seven days before menstruation to three days after menstruation for three cycles. The second group was given two 250mg sugar capsules daily similar to the first group. Each group recorded the severity of PMS by reporting their mood, any physical symptoms (headaches, backache, weight gain etc.) and behavioural characteristics (fatigue, increased or decreased appetite etc.). Researchers found that there was a significant difference in PMS including severity of mood, physical and behavioural symptoms between the two groups. Women who received the ginger tablet reported reduced severity in all areas (mood, physical and behavioural symptoms).⁹

3. To compare the level of premenstrual syndrome among the experimental and control group of college girls

In unpaired t-test, it shows that the post test mean pms score in the experimental group is 41.7 and in control group mean score is 51.7. The calculated ‘t’ value of pre test score is 1.06 and post test is 2.27. This showed that there was a significant difference between experimental and control scores. Hence H2 is accepted.

These findings are consistent with the findings of Samira Khayat et al (2014). They carried out this study to evaluate effects of ginger on severity of symptoms of PMS. This study was a clinical trial, double-blinded work, and participants were randomly allocated to intervention (n = 35) and control (n = 35) groups. To determine persons suffering from PMS, participants completed daily record scale questionnaire for two consecutive cycles. After identification, each participant received two ginger capsules daily from seven days before menstruation to three days after menstruation for three cycles and they recorded severity of the symptoms by daily record scale questionnaire. Data before intervention were compared with date 1, 2, and 3 months after intervention. Before intervention, there were no significant differences between the mean scores of PMS symptoms in the two groups, but after 1, 2, and 3 months of treatment, there was a significant difference between the two groups (P < 0.0001). Based on the results of this study, maybe ginger is effective in the reduction of severity of mood and physical and behavioral symptoms of PMS and we suggest ginger as treatment for PMS¹.

REFERENCES:

1. Samira Khayat, Masoomeh Kheirkhah, Zahra Behboodi Moghadam, Hamed Fanaei, Amir Kasaeian, and Mani Javadimehr.Clinical Study: Effect of Treatment with Ginger on the Severity of Premenstrual Syndrome Symptoms. ISRN Obstetrics and Gynecology; Volume 2014; Hindawi Publishing Corporation. http://dx.doi.org/10.1155/2014/792708

2. Pre menstrual syndrome. available from: URL: http://www.healthline.com

3. Pre menstrual syndrome-symptoms and causes, Available from: URL:https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787

4. Priyanka negi etal. Menstrual abnormalities and their association with lifestyle pattern in adolescent girlsof Garhwal, journal of family medicine and primary care; 2018 Jul-Aug; 7(4): 804–808. available from: URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132013

5. Ginger to relieve menstrual cramps. Available from: URL:http: ://www.verywellhealth.com

6. Effectiveness of ginger tea on dysmenorrhea. Available from: URL:http:tnmgrmu.ac.in

7. Ginger matches NSAIDs in reducing pre menstrual pain. Available from: URL :https://www.realnatural.org/ginger-premenstrual-pain-mood/

8. Sharma P, Malhotra C, Taneja DK, Saha R. Problems related to menstruation amongst adolescent girls. Indian J Pediatr. 2008 Feb; 75(2): 125-9. Available from: URL: https://www.ncbi.nlm.nih.gov/pubmed/18334791

9. Ginger to reduce severity of premenstrual syndrome symptoms. Available from: URL:http://jeanhailes.org.au/news.

Received on 06.09.2019 Modified on 18.09.2019

Int. J. Nur. Edu. and Research. 2019; 7(4): 512-516.

DOI: 10.5958/2454-2660.2019.00113.3