Self-Administered Questionnaire
“Prevalence, impacts and medical managements of premenstrual syndrome
among female students: cross-sectional study in college of health science,
Mekelle University, Mekelle, northern Ethiopia”
Code number _______________
1. Age ________ Height________ Weight_____________
2. Marital status: ☐Single ☐ In relationship ☐Married ☐Divorced ☐ Others (specify)___
3. Your current year in college? a) 1st year b) 2nd year c) 3rd year d) 4th year
e) 5th year
and above
4. Your department: a) Generic nursing b) Midwifery c) Psychiatry nursing
d) Public health /Health Officer
e) Pharmacy f) Medicine g) Dental surgery
5. Where do you live? a) In the dorm b) In private c) With family d) With husband
6. Do you have chronic diseases like depression, diabetes mellitus, cardiovascular diseases,
psychiatric disorders?
☐ Yes
☐ No
7. Have you used contraceptive in the past? ☐ Yes
☐ No (skip No.8 if no)
8. If yes to No.7, number of years used? a) 1 year b) 2-4 years c) 5-7 years d) > 8 years
9. Present contraception use: a) Pills
contraceptives
b) Loop
c) Depot
d) Implants
e) Injectable
f) not use contraceptives
10. Do you usually have a period/menstruation once a month at least in the past two months?
a) Yes
b) No
11. At what age you started menstruating? a) 10-12 b) 13-15 c) 16-18 d) 18-20
e) Other (specify) __________
12. What is the average length of your cycles? a) 21 b) 28 c) 30 d) others (specify) __
13. Numbers of days bleeding in one cycle of menstruation? a) 1-3 b) 3-5 c) 5-8 d) others
(specify) ___________
14. Do you usually experience premenstrual symptoms with your periods? a) Yes b) no
15. Have you ever-sought medical care for the pain you feel during the menstruation in the past?
a) Yes
b) no
16. If yes to No.16, what types of treatment or remedies have you used? (More than one answer
possible)
a) Pain killers like ibuprofen and aspirin
c) Herbal medications
b) Hot drink like milk and tea
d) Massage e) others (specify) _____________
17. What is your menstrual flow type? a) Mild b) Moderate c) Heavy
d) Extremely heavy
18. Do you face academic performance impairment due to menstrual pain?
a) Yes
b) No
19. If yes to question No.19, which one do you face from the following?
a) Frequent class missing
b) Exam missing
c) Low grade scoring
d) Withdrawing from your learning
20. Do you feel that you score less than boys due to the problems related with your menstrual
pain?
a) Yes
b) No
21. Please mark”√” under the symptoms, behaviors and conditions you experience
around your
menses (you can pass the symptoms you do not experience)
N.B

Mild PMS symptoms: Symptoms as minor as not interfering routine daily activities

Moderate PMS symptoms: Symptoms interfering routine daily activities

Severe PMS symptoms: Symptoms hindering participation in any activity
Symptoms and behavior or feelings
Degree of symptom or conditions appearing
Mild
A). Abdominal bloating
B). Painful breast (breast tenderness)
C). Generalized body pain
D). Headache
E). Back pain
F). Weight gain
G). Weight loss
H). Eating more than usual
Moderate
Severe
I). Shortness of breath
J). Abdominal cramps
K). Weakness
L). Vomiting
M). Difficulty concentrating
N). Sleep loss
O). Forgetfulness
P). Craving for sweet foods and alcohol
Q). Depressed mood
R). Loss of interest in doing things
S). Anger
Thank you for your time, willingness and effort!!!!!