Introduction
Adolescence is considered one of the most critical stages of human life, characterized by significant physical, psychological, and social changes [1]. For adolescent girls, one of the most important challenges during puberty is the onset of menstruation, which is often accompanied by the onset of premenstrual syndrome (PMS) [2]. PMS, a cyclical phenomenon that occurs during the luteal phase of the menstrual cycle, includes significant physical, psychological, and emotional changes that greatly impact quality of life, social relationships, and daily functioning [5]. The symptoms of this syndrome vary from person to person, but they commonly include irritability, anxiety, depression, fatigue, changes in sleep and appetite patterns, and physical pain such as headaches, bloating, and muscle pain [8, 9]. This phenomenon is not only a physiological issue but also a complex social and cultural issue in various societies [12]. In many societies, menstruation and related issues, including PMS, are still considered taboo [14]. These taboos and negative cultural attitudes can significantly impact the mental health of adolescent girls, leading to increased stress and anxiety and decreased self-esteem. Especially when these symptoms are interpreted as signs of weakness or incapacity, adolescents tend to avoid expressing their issues and refrain from seeking the necessary help [15]. Various studies have shown that cultural and social attitudes can significantly influence adolescent girls experience and management of PMS [18, 19]. In societies where menstruation is considered an immoral or impure subject, adolescent girls are often forced to conceal and suppress their symptoms, leading to increased feelings of guilt, anxiety, and depression. In this context, the present study aimed to explore the experiences of Iranian adolescent girls with PMS and the cultural and social impacts associated with it, focusing on understanding how these factors shape their perception and management of PMS symptoms.

Methods
This qualitative study used a phenomenological approach to explore the lived experiences of adolescent girls regarding PMS, focusing on how cultural beliefs and social attitudes influence their perceptions and management of PMS symptoms. A total of 18 adolescent girls from middle and high schools in Saghez City, Iran, who had experienced PMS at least once, participated in semi-structured interviews. Data were analyzed using Colaizzi’s method, a widely used approach for phenomenological analyses. The validity of the findings was ensured through triangulation of researchers and peer review of the coding process.

Results
Data analysis revealed three main themes. The first theme, “cultural taboos and silence,” refers to the cultural taboos surrounding menstruation and PMS that prevent open discussions and contribute to feelings of isolation among adolescent girls. Participants reported experiencing societal pressure to conceal their PMS symptoms due to fear of judgment or perceived shame. The second theme, “negative consequences of cultural beliefs about PMS,” addresses the negative impact of cultural beliefs, which often regard menstruation as a sign of weakness or impurity. Such beliefs lead to increased feelings of guilt, self-blame, and psychological distress. Many girls reported avoiding discussing their symptoms to avoid being perceived as weak or incapable. The third theme, “cultural and social strategies for managing PMS symptoms,” discusses the coping strategies that adolescent girls use, including individual strategies such as self-care routines and social strategies, such as seeking support from peers and family. Additionally, positive media portrayals and educational interventions were identified as helpful tools for providing coping strategies and reducing the cultural taboos surrounding PMS.

Conclusion
This study highlights the significant role of cultural beliefs and social attitudes in shaping adolescent girls’ experiences with PMS. Negative cultural beliefs, which are often associated with shame and self-blame, contribute to increased stress, isolation, and challenges in effectively managing symptoms. To tackle these issues, it is essential to promote education and raise awareness about PMS, while also working to break down the cultural taboos surrounding it. Open discussions, media campaigns, and supportive social networks can help reduce stigma and foster a more inclusive and supportive environment for adolescent girls. This study calls for further research into the cultural dimensions of PMS in different contexts and for evaluating the effectiveness of interventions aimed at reducing stigma and improving PMS management.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of University of Mohaghegh Ardabili, Ardabil, Iran (Code: IR.UMA.REC.1403.059)

Funding
This article was extracted from the PhD thesis of Hannah Asadi in the Counseling Department, Faculty of Psychology and Educational Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.

Authors contributions
Conceptualization, study design, data collection, analysis, and interpretation: Hana Asadi, Hossein Qamari and Zahra Akhavi; Initial draft preparation: Hana Asadi; Supervision, critical revision, administrative, material support: Hossein Qamari, Zahra Akhavi.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors express their sincere gratitude to all the administrators, supervisors, advisors, and students who participated in the research.



 

1. Ruiz WDG, Yabut HJ. Autonomy and identity: The role of two developmental tasks on adolescent's wellbeing. Frontiers in Psychology. 2024; 15:1309690. [DOI:10.3389/fpsyg.2024.1309690] [PMID] 
2. Vollmar AK, Mahalingaiah S, Jukic AM. The menstrual cycle as a vital sign: A comprehensive review. F&S Reviews. 2024; 6(1):100081. [DOI:10.1016/j.xfnr.2024.100081] [PMID]
3. Alfiah S. Analysis of age, nutrition status with premenstrual syndrome, and health education on the knowledge of adolescents at tri guna bhakti junior high school, Surabaya. Malahayati Nursing Journal. 2022; 4(6):1577-88. [DOI:10.33024/mnj.v4i6.6371]
4. Soliman FES, Essa HAEG, Elbialy A. The effect of premenstrual syndrome among adolescent nursing female students on their quality of life. Tanta Scientific Nursing Journal. 2022; 24(1):252-73. [DOI:10.21608/tsnj.2022.221605]
5. Dutta A, Sharma A. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis. Health Promot Perspect. 2021; 11(2):161-70. [DOI:10.34172/hpp.2021.20] [PMID] 
6. Amjadian M, Anbari M, Amini R, Khalilipour Darestani M, Dehghankar L, Panahi R. Studying the factors associated with Premenstrual syndrome prevention among pre-university students in Tehran. Journal of Preventive Medicine and Hygiene. 2022; 63(1):E6-E11. [DOI:0.15167/2421-4248/jpmh2022.63.1.2027] [PMID] 
7. Babapour F, Elyasi F, Shahhosseini Z, Hosseini Tabaghdehi M. The prevalence of moderate-severe premenstrual syndrome and premenstrual dysphoric disorder and the related factors in high school students: A cross‐sectional study. Neuropsychopharmacology Reports. 2023; 43(2):249-54. [DOI:10.1002/npr2.12338] [PMID] 
8. Gnanasambanthan S, Datta S. Premenstrual syndrome. Obstetrics, Gynaecology & Reproductive Medicine. 2019; 29(10):281-5. [DOI:10.1016/j.ogrm.2019.06.003]
9. Ashwathi PG, Alex DM. Personality facets, psychological distress and coping in indian females with premenstrual symptoms. International Journal of Indian Psychȯlogy. 2024; 12(3):3170-85. [DOI:10.25215/1203.308]
10. Gupta M, Dua D, Kaur H, Grover S. Prevalence of premenstrual dysphoric disorder among school-going adolescent girls. Industrial Psychiatry Journal. 2019; 28(2):198-202. [DOI:10.4103/ipj.ipj_79_19 .] [PMID] 
11. Hantsoo L, Epperson CN. Premenstrual dysphoric disorder: Epidemiology and treatment. Current Psychiatry Reports. 2015; 17(11):87. [DOI:10.1007/s11920-015-0628-3] [PMID] 
12. Azarbahram E, Maghsoodi S. [A study of the lived experience of gifted female students in Kerman from their menstruation (Persian)]. Journal of Social Work Research. 2020; 6(22):159-98.[DOI:10.22054/rjsw.2021.58269.464]
13. Dinh Trieu Ngo V, Bui LP, Hoang LB, Tran MTT, Nguyen HVQ, et al. Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study. Plos One. 2023; 18(1):e0278702. [DOI:10.1371/journal.pone.0278702] [PMID] 
14. Gaybor J. Every day (on line) body politics of menstruation. Feminist Media Studies. 2020; 22(4):898-913. [DOI:10.1080/14680777.2020.1847157]
15. Shaju JP, Sinha J, Joseph S. Exploring collective experiences: Menstruation-related Memes and Menstrual Narratives in Social Media as an Avant-garde Form of Life Writing. Rupkatha Journal on Interdisciplinary Studies in Humanities. 2023; 15(4):1-24. [Link]
16. Yang J, Joe SH, Lee MS, Kim SH, Jung IK. Survey of premenstrual symptom severity and impairment in Korean adolescents: Premenstrual dysphoric disorder, subthreshold premenstrual dysphoric disorder and premenstrual syndrome. Asia-Pacific psychiatry. 2014; 6(2):135-44. [DOI:10.1111/appy.12024] [PMID]
17. Johnston-Robledo I, Chrisler JC. The menstrual mark: Menstruation as social stigma. In: Bobel C, Winkler IT, Fahs B, Ann Hasson K, Arveda Kissling E, Ann Roberts T, editors. The palgrave handbook of critical menstruation studies. New York: Springer; 2020. [DOI:10.1007/978-981-15-0614-7_17]
18. AbdelQadir YH, Assar A, Abdelghafar YA, Kamal MA, Zaazouee MS, Elsayed SM, et al. Prevalence and patterns of premenstrual disorders and possible association with sexual harassment: A cross-sectional study of young Arab women. BMC Womens Health. 2022; 22(1):536. [DOI:10.1186/s12905-022-02130-0] [PMID] 
19. Alkhatib A, Zhou Q, Bajinka O, Pakwan Suwal R, Wiley J, Li X. Prevalence of menstrual symptoms change and influencing factors among international female students studying in china during acculturation period. BMC Women’s Health. 2022; 22(1):311. [DOI:10.1186/s12905-022-01897-6] [PMID] 
20. Kansiime C, Hytti L, Nelson KA, Torondel B, Francis SC, Tanton C, et al. Menstrual health interventions, schooling, and mental health problems among Ugandan students (MENISCUS): Study protocol for a school-based cluster-randomised trial. Trials. 2022; 23(1):759. [DOI:10.21203/rs.3.rs-1691233/v1]
21. Jaber RM, Alghzawi AO, Salameh HH. Premenstrual syndrome: Consultation sources and the impact on women’s quality of life. African Health Sciences. 2022; 22(1):80-7. [DOI:10.4314/ahs.v22i1.10] [PMID] 
22. Kibralew G, Demilew D, Koye S, Yitayih S, Kelebie M, Melkam M, et al. Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia. Frontiers in Psychiatry. 2024; 15:1362118. [DOI:10.3389/fpsyt.2024.1362118] [PMID] 
23. Brown DL. Living with premenstrual dysphoric disorder and premenstrual syndrome: A qualitative exploration [doctoral dissertation]. Manchester: University of Manchester. [Link]
24. Ivankova NV. Volume 12: Qualitative, multimethod, and mixed methods research. In: Tierney RJ, Rizvi F, Ercikan K, editors. International encyclopedia of education; Amsterda: ScienceDirect; 2023. [DOI:10.1016/b978-0-12-818630-5.14108-9]
25. Wall LL. Period poverty in public schools: A neglected issue in adolescent health. The Journal of Adolescent Health. 2020; 67(3):315-6. [DOI:10.1016/j.jadohealth.2020.06.027] [PMID]
26. Tohit NF, Haque M. Forbidden conversations: A comprehensive exploration of taboos in sexual and reproductive health. Cureus. 2024 Aug 12;16(8):e66723. [DOI:10.7759/cureus.66723]
27. Tomlinson MK. Moody and monstrous menstruators: The Semiotics of the menstrual meme on social media. Social Semiotics. 2021; 31(3):421-39. [DOI:10.1080/10350330.2021.1930858]
28. Kpodo L, Aberese-Ako M, Axame WK, Adjuik M, Gyapong M. Socio-cultural factors associated with knowledge, attitudes and menstrual hygiene practices among junior high school adolescent girls in the kpando district of Ghana: A mixed method study. Plos One. 2022; 17(10):e0275583. [DOI:10.1371/journal.pone.0275583] [PMID] 
29. Zare Z, Dashtiane S, Zare S. [Changing attitudes toward menstrual taboos from primitive societies to the age of media (a systematic review) (Persian)]. Family and Sexual Health. 2021; 2(1):39. [DOI:10.52547/fash.2.1.39]
30. Mohammed S, Larsen-Reindorf RE. Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys. Plos One. 2020; 15(10):e0241106. [DOI:10.1371/journal.pone.0241106] [PMID] 
31. Guo J, Zhang Z, Song J, Jin L, Yu D, Liao S. Femvertising and postfeminist discourse: Advertising to break menstrual Taboos in China. Women’s Studies in Communication. 2022 3; 45(3):378-98. [DOI:10.1080/07491409.2022.2053624]
32. Maulingin-Gumbaketi E, Larkins S, Whittaker M, Rembeck G, Gunnarsson R, Redman-MacLaren M. Socio-cultural implications for women's menstrual health in the Pacific Island Countries and Territories (PICTs): A scoping review. Reproductive Health. 2022; 19(1):128. [DOI:10.1186/s12978-022-01398-7] [PMID] 
33. Taghinejad Esfahani M, Rana M, Movahed E, Helmieh A, Ahmadi A Yar. [Social encounters with menstruation: A feminist ethnography of the menstrual experience among female instagram users (Persian)]. Journal of Applied Sociology. 2024; 35(4):1-32. [Link]
34. Mousavi M. [The taboo of femininity (Persian)]. Tehran: Feyruzeh; 2018. [Link]
35. Piotrowski K, Bojanowska A, Nowicka A, Janasek B. Perfectionism and community-identity integration: The mediating role of shame, guilt and self-esteem. Current Psychology. 2023; 42(2):1308-16. [DOI:10.1007/s12144-021-01499-9]
36. Collardeau F, Dupuis HE, Woodin E. The role of culture and social threats in constructing shame: Moving beyond a western lens. Canadian Psychology/Psychologie Canadienne. 2023; 64(2):132. [DOI:10.1037/cap0000329]
37. Al Sabbah H, Al Mutawa N, Assaf EA. Prevalence and associations of premenstrual syndrome with dietary and lifestyle factors among female university students in Dubai: A cross-sectional study. Women’s Health. 2024; 20:17455057241260026.  [DOI:10.1177/17455057241260026]
38. Dong Y, Wang H, Zhu L, Li C, Fang Y. How parental involvement influences adolescents’ academic emotions from control-value theory. Journal of Child and Family Studies. 2020; 29:282-91. [DOI:10.1007/s10826-019-01586-3]
39. Bilir E, Yıldız Ş, Yakın K, Ata B. The impact of dysmenorrhea and premenstrual syndrome on academic performance of college students, and their willingness to seek help. Turkish Journal of Obstetrics and Gynecology. 2020; 17(3):196-201. [DOI:10.4274/tjod.galenos.2020.97266] [PMID] 
40. Berg L. What do the bloody spiritualists say? Exploring menstruation advocacy and feminist frictions in Sweden. European Journal of Women’s Studies. 2025; 32(1):20-35. [DOI:10.1177/13505068241312296] 
41. Sales de Castro GA. “PMS is not just a cliché”? A media framing analysis of PMS and PMDD in the New York times [master thesis]. Omaha: University of Nebraska; 2023. [Link]
42. Agnew S, Sandretto S. A case for critical literacy analysis of the advertising texts of menstruation: Responding to missed opportunities. Gender and Education. 2016; 28(4):510-26. [DOI:10.1080/09540253.2015.1114073]
43. Steele EH, McKinney C. Emerging adult psychological problems and parenting style: Moderation by parent-child relationship quality. Personality and individual differences. 2019; 146:201-8. [DOI:10.1016/j.paid.2018.04.048]
44. Sharma A, Thakur S. Psycho-social correlates of premenstrual syndrome: Predictive role of self-esteem and social support. Indian Journal of Positive Psychology. 2024; 15(3):343-6. [Link]
45. Akın Ö, Erbil N. Investigation of coping behaviors and premenstrual syndrome among university students. Current Psychology. 2023; 1-11. [DOI:10.1007/s12144-023-04419-1] [PMID]