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The effects of progressive muscle relaxation exercises on premenstrual syndrome symptoms and violence tendencies in women: a randomized controlled trial

BMC Women's Health volume 25, Article number: 176 (2025) Cite this article

Abstract

Background

Although violence is reported in women with premenstrual syndrome (PMS), preventive interventions are among the essential responsibilities of nurses. This study aimed to determine the effect of progressive muscle relaxation exercises (PMRE) given to women with PMS on PMS symptoms and violent tendencies.

Methods

The study was conducted experimentally with a pre-test/post-test control group between January and August 2024 in a province located in the southeastern Anatolia region of our country. The study included 106 participants, 53 experimental and 53 control, who had PMS. Participants were provided with a PMRE application for eight weeks. Data were collected through the ‘Personal Information Form, PMS Scale and Violence Tendency Scale (VTS).’ Data were analysed using descriptive statistics, chi-square, independent samples t-test and one-way multivariate analysis of variance.

Results

Participants in the intervention group had significantly lower mean scores on the post-test PMS scale and the VTS than participants in the control group (p < 0.05). The difference between the PMS scale's pre-test and post-test mean scores was statistically significantly lower in the experimental group (P < 0.001). The difference between the groups was statistically significant in terms of the combined dependent variables, including the pre-test and post-test change in the mean scores of the PMS scale and the VTS (F(2,103) = 158.77, P < 0.001; V = 0.245; ηp2 = 0.755). This difference explained 75.5% of the variance in the dependent variable.

Conclusion

PMRE administration has a high level of efficacy in reducing PMS and violence tendencies.

Trial registration

ClinicalTrials ID: NCT06208670 Dated:22.12.2023.

Peer Review reports

Introduction

Premenstrual syndrome (PMS) is a common condition in women of reproductive age [1]. PMS is a multifactorial syndrome caused by the interaction of biological factors such as hormonal fluctuations and genetic predisposition, as well as psychosocial stress, unhealthy lifestyle and environmental factors. Current research shows that chronic stress, sedentary lifestyle, nutritional deficiencies and harmful habits can significantly increase both the frequency and severity of PMS symptoms [2,3,4]. In a systematic study evaluating data from 17 countries, the prevalence of PMS was 47.8% [1]. As a result of meta-analysis studies in which PMS, which is an important women's health problem in Turkey, was analysed, it was determined that the prevalence was 52.2%, and women experienced moderate PMS [5, 6]. PMS is characterised by recurrent, cyclical, physical and behavioral symptoms during the luteal phase of the normal menstrual cycle (the time between ovulation and the onset of menstruation). The International Society for Premenstrual Disorders outlines the criteria for PMS. More than 150 different psychological, physical and behavioral symptoms have been reported that may be associated with PMS. Symptoms must not be present at other times during the cycle, cause significant impairment, not represent an exacerbation of another disorder, and be present for at least one symptom-free week [7].

In many studies, compared to women without PMS, women with PMS are two or three times more likely to have a major depressive disorder, anxiety disorder, substance use disorder, suicide plans and attempts, and criminal offenses [8,9,10,11,12,13,14,15]. In addition, studies have reported that as PMS severity increases in women, the tendency to violence, domestic fights and child abuse increases [16,17,18]. In Evcili and Güçlü's study [18], which examined the effect of violent tendency, which may be a potential factor in terms of such psychiatric comorbidities in women with PMS, it was found that the tendency to aggression increased as the severity of PMS increased. According to the “Frustration-Aggression” theory, it is noteworthy that when sensitive subjects encounter stressors that prevent the fulfillment of their various needs, they may be reactively prone to violence, which is notable in terms of revealing the discussions on PMS and violent tendencies [18, 19]. In support of this, Taylor and Dalton [20], in their book section “Premenstrual Syndrome: A New Criminal Defense?” Taylor and Dalton [20] stated that PMS and criminal responsibility might cause a crime involving various behavioral changes, such as violence and aggression, that can be mitigated/eliminated. Because violence and aggression are becoming increasingly widespread all over the world, it is interesting that a person who feels cognitively impaired is more prone to violence [18].

In the nursing literature, PMS is of great interest in addressing a significant public health problem among women of reproductive age. In addition to standard care, many categories of interventions (non-pharmacologic strategies, surgical treatment, antidepressant or hormonal methods) have been defined within the scope of PMS [7, 17]. Within the scope of non-pharmacological interventions, the role of complementary therapies and techniques, which are increasingly used today, cannot be ignored in reducing PMS symptoms [21]. Among these, Progressive Muscle Relaxation Exercises (PMRE), first developed by the American Dr. Jacobson, is a relaxation technique significantly reducing PMS symptoms. PMRE aims to relax the muscles of the body by incorporating breathing techniques. PMRE increases endorphins, the body's natural analgesic and happiness hormone, thus reducing stress, pain and anxiety [22].

Although the positive effects of PMRE on PMS are well known in the literature, some critical knowledge gaps have been identified regarding the combined evaluation of the effect of PMRE on PMS symptoms and propensity to violence, which is our topic. Therefore, the priority is to evaluate the effectiveness of randomised controlled trials of PMRE on PMS symptoms and propensity to violence. Accordingly, this study aimed to evaluate the effect of PMRE intervention on PMS symptoms and the tendency to violence. The study's central hypothesis (H1) is that PMRE affects PMS and the tendency to violence. The sub-hypotheses are that PMRE reduces PMS levels (H2) and PMRE reduces the tendency to violence (H3).

Materials and methods

Study design

This randomised controlled trial adopted a prospective pre- and post-test intervention design. This study was planned and reported according to CONSORT guidelines (Fig. 1) [23]. This study was registered in the NIH US National Library of Medicine Clinical Research Registry, NCT06208670, on 22.12.2023. Ethics committee approval was obtained from the Siirt University Non-Interventional Clinical Research Ethics Committee (Board Decision No: 5998) on 08.12.2023. Institutional approval was obtained from Siirt Training and Research Hospital (Registration no: E-71987595) on 21.12.2023. Written and verbal informed consent was obtained from the participants. Researcher ST received a PMRE Training Certificate before starting the study. The training content consists of theoretical and practical information. The researcher obtained permission from the Turkish Psychological Association to use the PMRE for the PMRE application conducted by the researcher ST (Date: 03.11.2023, No:2023/0246).

Fig. 1
figure 1

Consort diagram of the study

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Participants

This study was conducted in a Training and Research Hospital in Siirt province, located in the southeastern Anatolia region of Turkey, between January and August 2024. The study's target population was women who scored 110 and above on the PMS Scale (PMSS). G*Power software (version 3.1.9.3) was used to calculate the sample size required for the study [24]. Based on the pretest and posttest PMSS mean scores of Çitil and Canbay Çitil's study [25], the sample size was determined as a minimum of 90 participants (n = 45 for each group) with an estimated medium-large effect size of 0.60, two-sided hypothesis, α = 0.05, 0.80 power, and 1:1 distribution ratio. Considering possible attrition, a total of 106 participants were included in the study, 53 in each group.

Inclusion criteria were: being between 18–53 years of age, being single, being at least literate, having a regular menstrual cycle (between 21–35 days), not having a psychiatric diagnosis or gynecologic disease (abnormal uterine bleeding, fibroids, ovarian cysts, etc.), not having undergone PMRE before, and not having any health problems that may prevent PMRE. Exclusion criteria were having irregular menstrual cycles, using oral contraceptives because they affect PMS, not attending the sessions, using any method to reduce PMS symptoms, voluntarily withdrawing from the study at any stage after inclusion, or developing any health problem.

Randomisation

The determination of the participants in the study consisted of two stages. The first stage identified participants who met the inclusion criteria with a PMS Scale (PMSS) score of 110 and above. The researcher informed the individuals who applied to the hospital for any reason on two days of the week (Tuesday- Thursday) between January and March 2024 about the purpose of the study and obtained their consent. Participants who met the inclusion criteria completed the introductory information form, PMSS, and Violence Tendency Scale (VTS) in a room where they felt comfortable in the hospital and delivered them to the researcher SG (300 participants were reached at this stage). The SG asked the participants to use pseudonyms or other signs when filling in the forms so that they could be contacted later and took the participants' contact information. A total of 150 participants with a mean PMSS measurement score of 110 and above were selected for randomisation. Before randomisation, the participants were sorted by the SG according to the order of inclusion in the study. At this stage, none of the participants knew each other, did not interact with each other, and did not know at baseline that they would receive a possible intervention to reduce PMS symptoms.

The second stage, the assignment of the participants to the experimental and control groups, was done by the researcher, SG, through the online “randomizer.org” website using a simple random allocation method to avoid selection bias. The researcher, SG, created two lists of 53 participants (2 sets of 53 unique numbers per set with a range of 2 sets: 1 to 106). Then, SG sealed the lists in an opaque envelope. Without knowing the lists in both envelopes, researcher ST considered the first envelope the experimental group and the second the control group. The researcher then contacted the participants through the pseudonyms and signs used on the SG forms and contact information and informed them about the study. However, the women in the PMRE group did not know that they were in the experimental group, and the women in the control group did not know that they were in the control group. Demographic variables affecting PMS were similarly distributed in both groups after randomisation, and there was no significant difference between the groups (P > 0.05).

Data collection instruments

Introductory Information Form, PMSS, and VTS were used to collect data in the study.

Introductory Information Form: The researchers' form, created in light of the literature [7, 10, 26, 27], consisted of 11 questions. The questions questioned socio-demographic characteristics such as age, marital status, educational status, income status, body mass index (BMI), age at menarche, menstrual frequency, perception of menstruation, and the impact on life.

Premenstrual Syndrome Scale (PMSS)

The scale developed by Gençdoğan in 2006 consists of 44 items, a 5-point Likert type and nine sub-dimensions [28]. The “None” option was given 1 point, and the ‘continuous’ option was given 5 points. The lowest and highest total scores that participants can get from each sub-dimension are 7-35 for “depressive feelings,” 7-35 for “anxiety,” 6-30 for “fatigue,” 5-25 for “irritability,” 7-35 for “depressive thoughts,” 3-15 for “pain,” 3-15 for “change in appetite,” 3-15 for “change in sleep habits,” and 3-15 for “bloating.” The lowest score that can be obtained from the whole scale is 44, and the highest score is 220. It is evaluated that as the scale score increases, the severity of PMS symptoms also increases. In addition, the presence of PMS was evaluated if 50% of the maximum score that could be obtained from the total scale and sub-dimensions was exceeded. Cronbach’s alpha coefficients for the scale's sub-dimensions were between 0.75 and 0.91, and Cronbach's alpha coefficient for the total score was 0.75 [28]. In this study, the alpha coefficient for the scale's sub-dimensions was between 0.71 and 0.83, and the alpha coefficient for the total score was 0.86.

Violence Tendency Scale (VTS)

The scale was developed by Göka, Bayat, and Türkçapar (1995) to determine aggression and violence tendencies and was redesigned in the research on "Violence in the Family and the Social Sphere" conducted by the Turkish Prime Ministry Family Research Institute without changing its basic structure and content validity was ensured [29]. The scale includes 20 questions graded between 1 and 4. On the scale, 1-20 points (very low tendency to violence), 21-40 points (low tendency to violence), 41-60 points (high tendency to violence), and 61-80 points (very high tendency to violence). The Cronbach’s alpha reliability coefficient of the scale was reported as 0.88 by Özgür et al. [30]. The Cronbach's alpha reliability coefficient in this study was 0.83.

Data collection

Data were collected between April and August 2024 by the researcher’s SG. In our study, the pilot study was conducted with 10 women to determine the comprehensibility and applicability of the data collection tools before the intervention, and it was decided that the data collection forms were comprehensible. Pilot study data were not included in the experimental and control groups. Pre-test data were collected during the identification of the research sample group, and post-test data were collected eight weeks after the start of the PMRE intervention in the experimental group. Data collection included the Introductory Information Form, the PMSS, and the VTS. Both the intervention and control groups were administered the Introductory Information Form, PMSS and VTS as a pre-test and the PMSS and VTS as a post-test.

Intervention

Experimental group

For the PMRE sessions, participants in the experimental group were divided into six groups (only group six had eight participants), with an average of nine participants in each group. PMRE exercises were applied in line with the application protocol described by Mushtaq and Ajaz [22] based on scientific principles. The participants determined a typical day and time for PMRE. In the literature, the number of PMRE exercises varies as two sessions in 12 weeks or three sessions in eight weeks for 24 sessions [25, 31]. In this study, a total of 24 sessions of PMRE, three sessions per week (each session averaged 20 min) for eight weeks under the guidance of ST, a researcher with a PMRE certificate. Participants were instructed to wear comfortable clothes for the sessions and not eat at least one hour before. On the day of the intervention, a reminder message was sent to participants two hours before each week's start time. In the first session, participants were referred to the PMRE intervention but were not given the expectation that the intervention would affect their PMS symptoms (single-masked). One of the weekly sessions was conducted with the researcher, ST, in a hospital hall suitable for a quiet and calm environment. Participants were ensured to be in a comfortable position during the intervention. The other two sessions were conducted at home. Sessions were performed at the same frequency until the study was completed. No side effects of PMRE were observed in the study participants. At the end of eight weeks, the participants in the experimental group were re-evaluated with the PMSS and the VTS.

PMRE implementation protocol

The PMRE application steps were performed according to the protocol [22]. In the PMRE application, every muscle in the woman's body was gradually contracted and relaxed. This practice covered the entire area from head to toe. The exercise was performed by tensing and relaxing 16 muscle groups while taking deep breaths. The major muscle groups were followed in a specific order during the PMRE: hands, arms, eyebrows, eyes, neck, anterior neck, shoulders, back, chest, abdomen, buttocks, anterior thighs, posterior thighs, calves and feet. The exercise began after the participants were taught how to practice deep breathing. After three deep breaths, stretching and relaxation exercises were performed alternately from the facial muscles to the leg muscles, i.e., from the upper body to the lower limbs. Participants were instructed to inhale while tensing and to exhale while relaxing the muscles. During the exercise, participants were asked to focus on relaxation when the muscles were tensed and then relaxed. PMRE was performed in the same standardised way for each woman (Fig. 2).

Fig. 2
figure 2

Progressive muscle relaxation exercises protocol [22]

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Control group

The control group received no intervention after administering the pre-test. They were told to continue their routine coping habits for PMS for eight weeks in parallel with the experimental group without any intervention. Participants in the control group were also followed up regularly to ensure continuity in the study. At the end of the eight weeks, participants in the control group were re-evaluated with the PMSS and the VTS. After all the details of the research process were completed, the participants in the control group were informed about the PMRE. They offered the same PMRE program provided to the experimental group. However, no request was made for the program.

Outcomes

The primary outcomes included mean scores of total PMSS and its sub-dimensions and mean scores of total VTS. These outcomes were assessed at two time points: baseline and eight weeks after enrollment.

Statistical methods

SPSS 26.0 (IBM SPSS Statistics Version 26, 2019, SPSS Inc., Chicago, Illinois, USA) package program was used for statistical data analysis. The descriptive characteristics of the participants were evaluated by descriptive statistical methods (number, percentage, mean, and standard deviation). Kolmogorov–Smirnov and Shapiro–Wilk tests were used to determine the normal distribution of quantitative variables. Independent samples t-test and chi-square test were used to compare the experimental and control groups. The intergroup and inter-measurement comparisons of the mean scores of the PMSS and VTS and their sub-dimensions were performed with the t-test in independent groups. The effect size value (d) for t-tests in independent groups was evaluated as 0.2, 0.5 and 0.8 as small, medium and large effects, respectively [32]. One-way multivariate analysis of variance (MANOVA) was performed to determine the impact of PMRE on the pre- and post-test changes in total PMSS and total VTS. MANOVA assumption control showed that the data were normally distributed, with no outliers with the box plot and Mahalanobis distance (P > 0.001), and an approximately linear relationship between the dependent variables for all categories of the independent variable with the scatter plot. In addition, there was no significant multicollinearity (no strong correlation) between the dependent variables (r = 0.726, P < 0.001). Since Box's M test did not meet the homogeneity of covariance matrices (P < 0.001), Pillai's trace value was selected as the most robust criterion. The results were evaluated at the 95% confidence interval level, and the significance level was P < 0.05.

Results

The findings regarding the descriptive characteristics of the participants are given in Table 1. The mean age of the participants was 25.04 ± 4.73 years; 40.6% had undergraduate or higher education, 66.0% had middle income, 54.7% were students, and 45.3% spoke a language other than Turkish (27.4% Kurdish, 17.9% Arabic). The mean BMI of the participants was 23.38 ± 2.71 kg/m2, the mean age at menarche was 12.57 ± 0.97 years, the mean frequency of menstruation was 30.11 ± 1.82 days, and the mean duration of menstruation was 5.82 ± 0.89 days. 20.8% of the participants had a family history of PMS. 33.3% had a negative perception of menstruation, and 39.6% of the participants' daily lives were always negatively affected by menstruation. There was no significant difference between the groups in terms of control variables (P > 0.05), indicating that the intervention and control groups were homogeneous (Table 1).

Table 1 Comparison of the distribution of demographic variables by groups
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The comparison of the participants' total PMSS and its sub-dimensions and total VTS scores according to the groups and measurement times is presented in Table 2. When analyzed according to the groups, the pre test total PMSS and all its sub-dimensions and total VTS mean scores of the participants in the intervention group did not differ significantly compared to the participants in the control group (P > 0.05). It was determined that the mean post test PMSS and all its sub-dimensions and total VTS scores of the participants in the intervention group were significantly lower than the participants in the control group (P < 0.05). When analyzed according to the measurement time, the difference between the pre test and post test mean scores of total PMSS and all its sub-dimensions was statistically significantly lower in the experimental group (P < 0.001). In contrast, no statistically significant difference was found in the control group (P > 0.05). Accordingly, it was determined that the effect of PMRE application on decreasing PMSS and violence tendency was at a high level (Table 2).

Table 2 Pre test and post test intragroup and intergroup comparison of total PMSSa and total VTSb of the participants bu groups
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In comparing the total PMSS and total VTS pre test and post test change of the participants according to the groups, the mean scale scores decreased statistically significantly more in the experimental group participants (P < 0.001) (Fig. 3). When the changes in total PMSS and total VTS were evaluated as a composite variable before and after the test by MANOVA analysis, the difference between the groups in terms of the composite dependent variables showed a statistically significant difference (F(2,103) = 158.77, P < 0.001; V = 0.245; ηp2 = 0.755). The partial eta squared result shows that the independent variable explains 75.5% of the variance in the combined dependent variable. Participants in the experimental group showed a higher decrease in the change in the mean total PMSS and VTS scores compared to the control group, indicating that PMRE successfully reduced PMSS and violent tendencies.

Fig. 3
figure 3

Changes in total PMSS and total VTS by groups

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Discussion

This study focuses on the effect of PMRE on PMS symptoms and propensity to violence. PMS symptoms are one of the potential triggers that may lead to an increased tendency to violence.

The central hypothesis of our study (H1) is that PMRE has effects on PMS and tendency to violence. The sub-hypotheses are that PMRE reduces PMS levels (H2) and that PMRE reduces violent tendencies (H3). It was determined that the mean post test PMSS and all sub-dimensions’ scores of the participants in the intervention group were significantly lower than the participants in the control group. When analysed according to the measurement time, the difference between the pre test and post test mean scores of the total PMSS and all its sub-dimensions was statistically significantly lower in the experimental group. In contrast, no statistically significant difference was found in the control group.

Accordingly, it was determined that the effect of PMRE administration on reducing PMS was at a high level. This result confirmed the hypothesis “Hypothesis 2: PMRE reduces PMS levels”. Although PMRE is a helpful adjuvant treatment for PMS, limited research supports its use. PMRE reduces sympathetic nervous system activation in women with PMS, producing a relaxation effect and reducing the emotional symptoms of PMS [33]. According to Abic et al. [34] PMRE reduced PMS symptoms. Similarly, Citil and Citil Canbay [25] found that PMRE significantly reduced PMS symptoms. Demiralp Ovgun and Tuzun [35] conducted a PMRE that significantly reduced depression and anxiety levels in women with PMS. Other researchers have determined that exercise positively affects physical and psychological symptoms of PMS [36,37,38]. The study's findings are in line with the literature.

In previous studies, researchers reported that violence tendency, domestic fights, and child abuse increase as PMS severity increases in women diagnosed with PMS [16, 18]. In this study, we determined that the mean post test total PMSS scores of the participants in the intervention group were significantly lower than those in the control group. It was determined that the effect of PMRE intervention on reducing the tendency to violence was at a high level. This result confirmed the hypothesis “Hypothesis 3: PMRE reduces the levels of violent tendency”. PMRE is a technique in which the individual gradually creates a sense of calmness by actively contracting and relaxing specific muscle groups [12, 31]. As far as we know, there are no studies on the effect of PMRE on the tendency to violence in women with PMS; we reviewed the literature on different populations. Lee and DiGiuseppe [39] determined that PMRE produced the highest effect sizes in treating dysfunctional anger. İçel and Başoğul [40] found that the relaxation training and music therapy program applied to chronic psychiatric patients reduced the level of trait anger. In line with these findings, it would not be wrong to say that PMRE may trigger its success in reducing the tendency to violence more effectively than standard practices that focus only on optimising body functions.

Strengths and limitations

This study has several limitations. These limitations are that the study was conducted in a single center with a small sample, included only single participants, and had a single-masked design. There may be bias in the subjective results of self-assessed parameters such as depressive feelings, anxiety and pain, which are multidimensional and complex emotions based on participants’ personal feelings and judgments. External factors, such as previous life experiences or other psychosocial factors, can influence these parameters. Therefore, as the data are based on subjective data, there may be ascertainment bias in the study. However, we can reduce the importance of these factors with adequate randomization. Participants in the experimental group may have increased interest in PMRE regardless of PMRE administration. In addition, the control group did not receive any intervention, and women were monitored only using data collection forms during the intervention. Therefore, the effect of the PMRE intervention may have been more effective in the comparison between groups because the control group did not receive any intervention rather than the effectiveness of the intervention, which may have caused performance bias. Participants in the experimental group may have needed help providing the conditions to implement the PMRE intervention at home. Furthermore, the longitudinal effects of the PMRE intervention were not analyzed. Whether the intervention has lasting outcomes could be tested in future follow-up studies at specific time intervals to test the generalizability of the findings. These limitations emphasize the need for caution when interpreting the findings of this study.

Despite several limitations, one of the strengths of this study is that it follows a randomized controlled design and points to the intermediate effect of the PMRE intervention in reducing PMS symptoms and violent tendencies. Participants needed to learn which group they were in. The PMRE intervention was conducted under the guidance of researcher ST, an expert in the relevant field, and researcher SG carried out the data collection and analysis process. Pre test and post test measurements were used to increase the strength of the study. In addition, the application of valid scales is among the strengths of this study.

Conclusion

PMS is a common health problem, and women spend half of their lives with premenstrual period problems and experience decreased self-esteem, social isolation, decreased academic achievement, increased accident tendency and loss of labor force. Management of PMS can improve quality of life. In this study, regular administration of PMRE was found to have a reducing effect on PMS symptoms and a tendency to violence. We think that proving and using easy, inexpensive and effective interventions to improve PMS, a critical health problem for women, may be necessary in PMS management. Therefore, using practices such as PMRE that women can apply individually may be necessary in controlling PMS and reducing the tendency to violence. This study may be a guide for health professionals, social workers and policymakers working on the prevention of violence to take a multidisciplinary approach to PMS risk management as it addresses PMS and violence tendencies together. In addition, the small number of studies on the subject is evidence for new studies to be conducted.

Data availability

Data is provided within the manuscript or supplementary information files.

Abbreviations

BMI:

Body Mass Index

MANOVA:

Multivariate Analysis of Variance

PMRE:

Progressive Muscle Relaxation Exercises

PMS :

Premenstrual Syndrome

PMSS:

Premenstrual Syndrome Scale

VTS:

Violence Tendency Scale

References

  1. Direkvand-Moghadam A, Sayehmiri K, Delpisheh A, Kaikhavandi S. Epidemiology of premenstrual syndrome, a systematic review and meta-analysis study. J Clin Diagnostic Res. 2014;8(2):106–9.

    Google Scholar 

  2. Geta TG, Woldeamanuel GG, Dassa TT. Prevalence and associated factors of premenstrual syndrome among women of the reproductive age group in Ethiopia: systematic review and meta-analysis. PLoS One. 2020;15(11):e0241702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Andualem F, Melkam M, Takelle GM, Nakie G, Tinsae T, Fentahun S, et al. Prevalence of premenstrual syndrome and its associated factors in Africa: a systematic review and meta-analysis. Front Psych. 2024;15:1338304.

    Article  Google Scholar 

  4. Yang H, Ma Y, Wang Y, Fu C, Liu W, Li W. Association between physical activity and risk of premenstrual syndrome among female college students: a systematic review and meta-analysis. BMC Womens Health. 2024;24(1):307.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Erbil N, Yücesoy H. Premenstrual syndrome prevalence in Turkey: a systematic review and meta-analysis. Psychol Health Med. 2021;8:1–11.

    Google Scholar 

  6. Çitil ET, Çitil CF. Premenstrual syndrome severity in Turkey: a meta-analysis study. Psychol Health Med. 2023;28(7):1783–94.

    Article  PubMed  Google Scholar 

  7. Nevatte T, O’Brien PMS, Bäckström T, Brown C, Dennerstein L, Endicott J, et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279–91.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Borenstein JE, Dean BB, Endicott J, Wong J, Brown C, Dickerson VYK. Health and economic impact of the premenstrual syndrome. J Reprod Med. 2003;48(7):515–24.

    PubMed  Google Scholar 

  9. Yonkers KA, O’Brien PS, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200–10.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tadakawa M, Takeda T, Monma Y, Koga S, Yaegashi N. The prevalence and risk factors of school absenteeism due to premenstrual disorders in Japanese high school students—a school-based cross-sectional study. Biopsychosoc Med. 2016;10(1):13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Buddhabunyakan N, Kaewrudee S, Chongsomchai C, Soontrapa S, Somboonporn W, Sothornwit J. Premenstrual syndrome (PMS) among high school students. Int J Womens Health. 2017;9:501–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Karimi Z, Dehkordi MA, Alipour A, Mohtashami T. Treatment of premenstrual syndrome: appraising the effectiveness of cognitive behavioral therapy in addition to calcium supplement plus vitamin D. PsyCh J. 2018;7(1):41–50.

    Article  PubMed  Google Scholar 

  13. Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019;220(6):569.e1-569.e7.

    Article  PubMed  Google Scholar 

  14. Owens SA, Eisenlohr-Moul T. Suicide risk and the menstrual cycle: a review of candidate rdoc mechanisms. Curr Psychiatry Rep. 2018;20(11):106.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open. 2019;9(6):e026186.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol. 2004;104(4):845–59.

    Article  PubMed  Google Scholar 

  17. Halbreich U, Backstrom T, Eriksson E, O’Brien S, Calil H, Ceskova E, et al. Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol. 2007;23(3):123–30.

    Article  PubMed  Google Scholar 

  18. Evcili F, Guclu G. An analysis of the relationship between premenstrual syndrome and aggression tendencies among Turkish adolescent girls. Adolesc Psychiatry. 2022;12(2):144–56.

    Article  Google Scholar 

  19. Kruglanski AW, Ellenberg M, Szumowska E, Molinario E, Speckhard A, Leander NP, et al. Frustration–aggression hypothesis reconsidered: the role of significance quest. Aggress Behav. 2023;49(5):445–68.

    Article  PubMed  Google Scholar 

  20. Taylor L, Dalton K. Premenstrual syndrome: a new criminal defense? In: Gorr MJ, Harwood S, editors. Controversies in criminal law. 1st ed. New York: Routledge; 2019. p. 163–79.

    Chapter  Google Scholar 

  21. Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. Obstet Gynaecol. 2015;17(2):99–104.

    Article  Google Scholar 

  22. Mushtaq B, Ajaz AK. Jacobson muscle relaxation technique (Jpmr) (20 Min). JOJ Nurse Heal Care. 2018;8(1):555726.

    Google Scholar 

  23. Sunay D, Şengezer T, Oral M, Aktürk Z, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. Euras J Fam Med. 2013;2(1):1–10.

    Google Scholar 

  24. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences FRANZ. Behav Res Methods. 2007;39(2):175–91.

    Article  PubMed  Google Scholar 

  25. Çitil ET, Çitil CF. Effect of progressive muscle relaxation exercises on symptoms of premenstrual syndrome: a single-blind randomized controlled trial. Arch Psychiatr Nurs. 2024;51:228–34.

    Article  PubMed  Google Scholar 

  26. Farahmand M, Ramezani Tehrani F, Khalili D, Amin G, Negarandeh R. Factors associated with the severity of premenstrual syndrome among Iranian college students. J Obstet Gynaecol Res. 2017;43(11):1726–31.

    Article  PubMed  Google Scholar 

  27. Öztürk S, Karaca A. The role of midwife and nurse in relation to premenstrual symptoms and healthy lifestyle behaviors. BAUN Health Sci J. 2019;8(2):105–10.

    Google Scholar 

  28. Gençdoğan B. A new scale for premenstrual syndrome. Turk Psikiyatri Dergisi. 2006;8(2):81–7.

    Google Scholar 

  29. Göka E, Bayat B, Türkçapar M. Violence in the family and social sphere. Ankara: Prime Ministry Printing House; 1995.

  30. Özgür G, Yörükoğlu G, Baysan AL. High school student’s perception of violence, level of tendency to violence and effective factors. J Psy Nurs. 2011;2(2):53–60.

    Google Scholar 

  31. Dayapoğlu N, Tan M. Evaluation of the effect of progressive relaxation exercises on fatigue and sleep quality in patients with multiple sclerosis. J Altern Complement Med. 2012;18(10):983–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cohen J. The t test for means. In: Cohen J, editor. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2013. p. 20–6.

    Chapter  Google Scholar 

  33. Jasuja V, Purohit G, Mendpara S, Palan B. Evaluation of psychological symptoms in premenstrual syndrome using PMR technique. J Clin Diagn Res. 2014;8(4):BC01-03.

    PubMed  PubMed Central  Google Scholar 

  34. Abic A, Dag-Canatan S, Er-Korucu A, Aksoy-Can A. The effects of yoga and progressive muscle relaxation exercises on premenstrual syndrome: a randomized controlled trial. Women Health. 2024;64(3):261–73.

    Article  PubMed  Google Scholar 

  35. DemiralpOvgun C, Tuzun EH. The effect of progressive muscle relaxation technique and myofascial release technique on premenstrual symptoms, blood circulation, and quality of life in women with premenstrual syndrome: a single-blind randomized controlled study. Medicine. 2023;102(27):e34223.

    Article  Google Scholar 

  36. Çitil ET, Kaya N. Effect of pilates exercises on premenstrual syndrome symptoms: a quasi-experimental study. Complement Ther Med. 2021;1:57.

    Google Scholar 

  37. Kamalifard M, Yavari A, Asghari-Jafarabadi M, Ghaffarilaleh G, Kasb-Khah A. the effect of yoga on women’s premenstrual syndrome: a randomized controlled clinical trial. Int J Women’s Heal Reprod Sci. 2017;5(3):205–11.

    Article  Google Scholar 

  38. SimsekKucukkelepce D, Unver H, Nacar G, Tashan ST. The effects of acupressure and yoga for coping with premenstrual syndromes on premenstrual symptoms and quality of life. Complement Ther Clin Pract. 2021;42:101282.

    Article  Google Scholar 

  39. Lee AH, DiGiuseppe R. Anger and aggression treatments: a review of meta-analyses. Curr Opin Psychol. 2018;19:65–74.

    Article  PubMed  Google Scholar 

  40. İçel S, Başoğul C. Effects of progressive muscle relaxation training with music therapy on sleep and anger of patients at community mental health center. Complement Ther Clin Pract. 2021;43:101338.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all the women who shared their time and experience to participate in this study and Siirt University Scientific Research Projects Coordination Office for financial support.

Funding

This study was financially supported by Siirt University Scientific Research Projects Coordination Office with the project number 2024-SİÜSHMYO-013. The funders had no roles in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Siirt University, Vocational School of Health Services, Dialysis Program, Siirt, Türkiye

    Sabri Toğluk

  2. Siirt University, Faculty of Health Sciences, Siirt, Türkiye

    Sidar Gül

Authors
  1. Sabri Toğluk
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  2. Sidar Gül
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Contributions

Both the authors designed the study, searched literature, analyzed the data, prepared the manuscript, and approved the final version for submission.

Corresponding author

Correspondence to Sidar Gül.

Ethics declarations

Ethics approval and consent to participate

Ethics committee approval was obtained from Siirt University Non-Interventional Clinical Research Ethics Committee (Board Decision No:5998) on 08.12.2023. Institutional approval was obtained from Siirt Training and Research Hospital (Registration no: E-71987595) on 21.12.2023. Written and verbal informed consent was obtained from the participants. Researcher ST received a PMRE Training Certificate before starting the study. The training content consists of theoretical and practical information. The researcher obtained permission from the Turkish Psychological Association to use the PMRE for the PMRE application conducted by the researcher ST (Date: 03.11.2023 No: 2023/0246).

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Not applicable.

Competing interests

The authors declare no competing interests.

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Toğluk, S., Gül, S. The effects of progressive muscle relaxation exercises on premenstrual syndrome symptoms and violence tendencies in women: a randomized controlled trial. BMC Women's Health 25, 176 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-025-03712-4

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BMC Women's Health

ISSN: 1472-6874

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