THE EFFECT OF GUİDED IMAGERY ON PREMENSTRUAL SYNDROME

Premenstrual Syndrome (PMS) is a condition characterized by physical, behavioral, and emotional symptoms that typically occur at the end of the luteal phase of a woman's menstrual cycle, 7-10 days before menstruation, and resolve at the onset of menstruation or shortly afterward. When diagnosing PMS, women are advised to keep a symptom diary for at least two menstrual cycles. The diary should document symptoms during the luteal phase and the symptom-free period until ovulation. Underlying physical or psychological conditions that could exacerbate symptoms should also be considered.

PMS can be diagnosed when symptoms occur for at least three consecutive menstrual cycles, beginning within five days before menstruation, ending within four days after menstruation starts, and interfering with normal daily activities. Evaluations should also consider medical, psychological, sociocultural, and lifestyle factors.

Symptoms of PMS include irritability, feelings of loss of control, anxiety, depression, insomnia or hypersomnia, difficulty concentrating, crying for no reason, fatigue, increased appetite, edema, weight gain, dizziness, headaches, joint and muscle pain, breast tenderness, changes in sexual activity, and avoidance of social interactions, among over 200 psychological, physical, and behavioral symptoms. Up to 90% of women of reproductive age report experiencing one or more of these symptoms in the days before menstruation, which can affect behavior, well-being, and social or work environments.

Although the exact cause of PMS is not fully understood, it is believed that endocrine factors-such as carbohydrate intolerance, fluid retention, progesterone deficiency, estrogen imbalance, endorphin deficiency, adrenal or thyroid dysfunction, hyperprolactinemia, and hypoglycemia-along with psychological factors like genetics and stress, contribute to its development.

Traditionally considered a concern for women of reproductive age, PMS is increasingly recognized as a common mental health issue, significantly impairing daily functioning. The COVID-19 pandemic has also been associated with an increase in some PMS symptoms. The wide range of PMS symptoms makes it challenging to determine its true prevalence, which varies widely across studies. Women often use both pharmacological and non-pharmacological strategies to manage physical and psychological symptoms during the premenstrual period. PMS can negatively affect self-confidence, social relationships, quality of life, and academic performance, making effective treatment increasingly important.

Treatment focuses on alleviating both physical and psychiatric symptoms, and may include dietary supplements and complementary-alternative therapies. Complementary approaches such as reflexology, pilates, acupressure, music, exercise, and guided imagery have shown promising results in reducing premenstrual symptoms. Mind-body approaches in complementary therapies are known to have psychological benefits. Among these, relaxation techniques are the most commonly used, aiming to neutralize stress-related physical changes, including muscle tension, high blood pressure, and hormonal fluctuations, while calming the mind.

Guided imagery is a mind-body communication technique that involves the flow of thoughts and how the brain encodes, stores, and recalls sensory information. It is based on the connection between mind and body, recognizing that the mind can influence physiological responses. Stress and anxiety directly affect the brain and immune system. Guided imagery can be practiced with an instructor or through pre-recorded audio or video, and individuals can also practice self-directed imagery, creating their own scenarios. It can be applied in groups or individually. This technique has been shown to reduce stress, improve mood, strengthen the immune system, reduce fatigue, enhance sleep quality, and minimize nausea and vomiting.

Studies among university students have shown that guided imagery effectively alleviates premenstrual symptoms. Additionally, hypnotherapy and virtual reality-based relaxation interventions have been found to reduce PMS symptoms. However, research on using guided imagery specifically for reducing premenstrual symptoms in university students is still limited.

Inclusion criteria

• Regular menstrual cycles (21-35 days over the last three cycles)
• Age 18 years or older
• No medical treatment for PMS
• Ability to communicate effectively in Turkish
• No psychiatric diagnosis or gynecological disorder (e.g., abnormal uterine bleeding, myoma, ovarian cysts)
• A score >89 on the Premenstrual Syndrome Scale (PMSS)
• No prior participation in guided imagery training

Exclusion criteria

• Failure to perform guided imagery at the correct time or in the prescribed manner
• Irregular menstruation during the last three months
• Use of contraceptives
• Use of analgesics during menstruation while participating in the study