Prevalence and Lifestyle Correlates of Premenstrual Syndrome and Its Severity Among Female University Students in Yemen: A Cross-Sectional Study of Dietary Habits and Qat Use

TL;DR

This study finds that nearly half of female university students in Yemen experience moderate-to-severe premenstrual syndrome, with lifestyle factors like fast-food consumption and Qat chewing linked to higher symptom severity.

Contribution

The study identifies Qat chewing and fast-food intake as novel correlates of PMS severity in a conflict-affected, resource-limited population.

Findings

41.1% of participants experienced moderate-to-severe PMS, with psychological symptoms being most common.

Overweight/obese status, rural residence, high fast-food consumption, and Qat chewing were independently associated with higher PMS severity.

A synergistic effect was found between overweight/obese status and fast-food intake on PMS severity.

Abstract

Background

Premenstrual syndrome (PMS) is a significant public health challenge that adversely affects the quality of life and academic performance of young women. While lifestyle factors are implicated in its etiology, evidence from populations experiencing protracted conflict and resource limitations is critically lacking. This study investigates the exploratory prevalence, symptom patterns, and modifiable lifestyle correlates of PMS severity among female university students in Yemen.

Materials and methods

In this cross-sectional study, 175 female students aged 15 to 25 from a university in Ibb, Yemen, were recruited between March and September 2024 via convenience sampling. Participants completed a validated Arabic-language questionnaire assessing demographic characteristics, lifestyle behaviors (including the culturally specific use of Qat), and the severity of 22 PMS symptoms using the Arabic Premenstrual Syndrome Scale. Moderate-to-severe PMS was classified using adapted diagnostic criteria from the Arabic Premenstrual Symptoms Screening Tool. The primary outcome was the total PMS severity score. Data were analyzed using bivariate tests and hierarchical multiple linear regression to identify associated factors while adjusting for demographic confounders (age and college level). The sample size provided sufficient power for regression analysis but was underpowered for high-precision prevalence estimation.

Results

The exploratory prevalence of moderate-to-severe PMS was 41.1% (n = 72). Psychological symptoms represented the most burdensome domain, with depressed mood (84.6%), anxiety (81.7%), and irritability (78.9%) being the most prevalent. In multivariable analysis, four modifiable factors were independently associated with higher PMS severity: overweight/obese status (β = 4.85, p = 0.008), rural residence (β = 3.78, p = 0.013), high fast-food consumption (β = 5.10, p = 0.004), and Qat chewing (β = 2.95, p = 0.015). Exploratory analysis revealed a significant interaction between overweight/obese status and fast-food intake (p = 0.018), indicating a synergistic association with symptom severity. The full model explained 40.1% of the variance in PMS severity.

Conclusions

This study reveals a high burden of PMS symptoms strongly linked to modifiable lifestyle and anthropometric factors among students in a conflict zone. The identification of Qat chewing and fast-food intake as key correlates underscores the importance of context-specific health behaviors. Although causal inference is limited by the cross-sectional design, these findings highlight a critical opportunity for nonpharmacological public health promotion, such as nutritional counseling and weight management programs, to potentially mitigate morbidity and improve the well-being of young women in humanitarian settings.