Linking Premenstrual Syndrome With Salivary Alpha-Amylase Levels and Stress Levels: A Cross-Sectional Study
,
Abstract
Objective: This study aims to analyze the correlation between salivary alpha-amylase (sAA) and stress in adolescents with premenstrual syndrome (PMS), and to assess the predictive ability of sAA levels and stress for PMS.
Materials and methods: Sixty-two adolescents with and without PMS (31 each) were grouped based on their PMS status, measured using the Shortened Premenstrual Assessment Form (SPAF). Stress was measured using the Kessler Psychological Distress Scale (K10). The levels of sAA were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data were analyzed using the Pearson correlation test, Receiver Operating Characteristic (ROC) curve analysis, and multiple linear regression analysis.
Results: Stress and PMS expressed a significant positive correlation (p=0.001; r=0.66). sAA levels and PMS showed a significant positive correlation (p<0.05; r=0.42). The level of sAA in adolescents with PMS was 23.28±12.02 ng/mL, almost twice higher than in adolescents without PMS (12.10±7.5 ng/mL). The cut-off value of sAA level on PMS was ≥15.02 ng/mL with a sensitivity and specificity of 67.7%. The level of sAA and stress were significantly able to predict PMS (p<0.001). The correlation value of SAA levels and stress with PMS is positive (r=0.705), suggesting they can predict PMS by
49.7% (R2=0.497).
Conclusion: There is a positive relationship between sAA levels and stress in adolescents with PMS. SAA levels and stress were able to predict PMS in adolescents with an accuracy of 49.7%.
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5. Victor FF, Souza AI, Barreiros CDT, Barros JLN, Silva FACD, Ferreira ALCG. Quality of Life among University Students with Premenstrual Syndrome. Rev Bras Ginecol Obstet. 2019;41(5):312-317.
6. Buddhabunyakan N, Kaewrudee S, Chongsomchai C,
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7. Czajkowska M, Hanzel I, Słomska A, Skrzypulec-Plinta V. Diagnostic Criteria and Management in Premenstrual Syndrome. Gynecology and Obstetrics medical project. 4 (42) 2016: 049-053
8. Robinson LLL, Ismail KMK. Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes. Int J Womens Health. 2015; 7:811-818.
9. Shamnani G, Gupta V, Jiwane R, Singh ProfS, Tiwari S, Bhartiy S. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among medical students and its impact on their academic and social performance. Natl J Physiol Pharm Pharmacol. 2018;8(8):1205.
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11. Liu Q, Wang Y, van Heck CH, Qiao W. Stress reactivity and emotion in premenstrual syndrome. Neuropsychiatr Dis Treat. 2017; 13:1597-1602.
12. Meng Y, Chang L, Hou L, Zhou R. Menstrual attitude and social cognitive stress influence autonomic nervous system in women with premenstrual syndrome. Stress. 2022;25(1):87-96.
13. Nandakumar H, Kuppusamy M, Sekhar L, Ramaswamy P. Prevalence of premenstrual syndrome among students – Stress a potential risk factor. Clin Epidemiol Glob Health. 2023; 23:101368.
14. Gollenberg AL, Hediger ML, Mumford SL, Whitcomb BW, Hovey KM, Wactawski-Wende J, et al. Perceived stress and severity of perimenstrual symptoms: the BioCycle Study. J Womens Health (Larchmt). 2010;19(5):959-67.
15. Aguilar-Raab C, Stoffel M, Hernández C, Rahn S, Moessner M, Steinhilber B, et al. Effects of a mindfulness-based intervention on mindfulness, stress, salivary alpha-amylase and cortisol in everyday life. Psychophysiology. 2021;58(12).
16. Hensten A, Jacobsen N. Salivary Alpha Amylase as a Stress Biomarker. OSP J Dent Sci. 2019;1: JDS-1-103.
17. Bañuelos MS, Musleh A, Olson LE. Measuring Salivary Alpha-Amylase in the Undergraduate Neuroscience Laboratory. J Undergrad Neurosci Educ. 2017;16(1): A23-A27.
18. Tammayan M, Jantaratnotai N, Pachimsawat P. Differential responses of salivary cortisol, amylase, and chromogranin A to academic stress. PLoS One. 2021;16(8).
19. Jafari A, Pouramir M, Shirzad A, et al. Evaluation of Salivary Alpha Amylase as a Biomarker for Dental Anxiety. Iran J Psychiatry Behav Sci. 2018;12(1).
20. Weiss LR, Venezia AC, Smith JC. A single bout of hard RPE-based cycling exercise increases salivary alpha-amylase. Physiol Behav. 2019; 208:112555.
21. Allen SS, McBride CM, Pirie PL. The shortened premenstrual assessment form. J Reprod Med. 1991;36 11:769-772.
22. Tammayan M, Jantaratnotai N, Pachimsawat P. Differential responses of salivary cortisol, amylase, and chromogranin A to academic stress. PLoS One. 2021;16(8).
23. Lustyk MKB, Beam CR, Miller AC, Olson KC. Relationships among Perceived Stress, Premenstrual Symptomatology and Spiritual Well-Being in Women. J Psychol Theol. 2006;34(4):311-317.
24. Cheng SH, Shih CC, Yang YK, Chen KT, Chang YH, Yang YC. Factors associated with premenstrual syndrome - a survey of new female university students. Kaohsiung J Med Sci. 2013;29(2):100-5.
25. Hamaideh SH, Al-Ashram SA, Al-Modallal H. Premenstrual syndrome and premenstrual dysphoric disorder among Jordanian women. J Psychiatr Ment Health Nurs. 2014;21(1):60-68.
26. Khodayarifard M, Ghobari-Bonab B, Shokoohi-Yekta M. Stress and Coping Styles in University Students. Psychol Res. 2009;11(3):27.
27. Dilafruz Abduhamidovna K. Premenstrual syndrome in the modern science. IBMSCR. 2022;2(12):16-22.
28. Armand A, Talaee A. Investigating the Efficacy of Cognitive-Behavioral Stress-Management Training on Decreasing the Psychological Problems and Symptoms of Premenstrual Syndrome of Afflicted Women. IJOGI. 2012;15(21).
29. Gibbs RS, Danforth DN. Danforth’s Obstetrics and Gynecology. Lippincott Williams & Wilkins; 2008. Accessed June 23, 2024. https://cir.nii.ac.jp/crid/1130000796937651584.bib?lang=en
30. Pratiwi R, Sjattar H. Hubungan Stres dan Aktivitas Fisik dengan Derajat Premenstrual Syndrome Pada Remaja Putri Di Kelurahan Mangasa Kota Makassar. JIKP. 2021;10(2):206-214.
31. Purnawati J, Sinrang AW, Jusuf EC, Limoa E, Ahmad
M, Usman AN. Nutrition, mental status and level of
8-hydroxy-2-deoxyguanosine (OHDG) urine as predictors of premenstrual syndrome (PMS) in adolescent girls. Int J Curr Res Rev. 2020;12(23):7-13.
32. del Mar Fernández M, Regueira-Méndez C, Takkouche B. Psychological factors and premenstrual syndrome: A Spanish case-control study. PLoS One. 2019;14(3).
33. Nater UM, Rohleder N. Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: Current state of research. Psychoneuroendocrinology. 2009;34(4):486-496.
34. Ali N, Nater UM. Salivary Alpha-Amylase as a Biomarker of Stress in Behavioral Medicine. Int J Behav Med. 2020;27(3):337-342.
35. Hoferichter F, Lohilahti J, Hufenbach M, Grabe HJ, Hageman G, Raufelder D. Support from parents, teachers, and peers and the moderation of subjective and objective stress of secondary school student. Sci Rep. 2024;14(1).
36. Alsalman OA, Tucker D, Vanneste S. Salivary Stress-Related Responses in Tinnitus: A Preliminary Study in Young Male Subjects with Tinnitus. Front Neurosci. 2016; 10:338.
37. Cozma S, Dima-Cozma LC, Ghiciuc CM, Pasquali V, Saponaro A, Patacchioli FR. Salivary cortisol and
α-amylase: subclinical indicators of stress as cardiometabolic risk. Braz J Med Biol Res. 2017;
50(2): e5577.
38. Espin L, Villada C, Hidalgo V, Salvador A. Effects of sex and menstrual cycle phase on cardiac response and alpha- amylase levels in psychosocial stress. Biol Psychol. 2019; 140:141-148.
39. Washio H. Assessment of Well-Being Across Menstrual Phases in Female Students. Womens Health Rep (New Rochelle). 2023;4(1):531-535.
40. Rapkin AJ, Akopians AL. Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause Int. 2012;18(2):52-59.
2. Park YJ, Shin H, Jeon S, Cho I, Kim YJ. Menstrual Cycle Patterns and the Prevalence of Premenstrual Syndrome and Polycystic Ovary Syndrome in Korean Young Adult Women. Healthcare (Basel). 2021;9(1):56.
3. Itriyeva K. Premenstrual syndrome and premenstrual dysphoric disorder in adolescents. Curr Probl Pediatr Adolesc Health Care. 2022;52(5):101187.
4. Siahbazi S, Montazeri A, Taghizadeh Z, Masoomie R. The Consequences of Premenstrual Syndrome on the Quality of Life from the Perspective of Affected Women:A Qualitative Study. JRMDS. 2018;6(2):
284-92.
5. Victor FF, Souza AI, Barreiros CDT, Barros JLN, Silva FACD, Ferreira ALCG. Quality of Life among University Students with Premenstrual Syndrome. Rev Bras Ginecol Obstet. 2019;41(5):312-317.
6. Buddhabunyakan N, Kaewrudee S, Chongsomchai C,
Soontrapa S, Somboonporn W, Sothornwit J. Premenstrual syndrome (PMS) among high school students. Int J Womens Health. 2017; 9:501-505.
7. Czajkowska M, Hanzel I, Słomska A, Skrzypulec-Plinta V. Diagnostic Criteria and Management in Premenstrual Syndrome. Gynecology and Obstetrics medical project. 4 (42) 2016: 049-053
8. Robinson LLL, Ismail KMK. Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes. Int J Womens Health. 2015; 7:811-818.
9. Shamnani G, Gupta V, Jiwane R, Singh ProfS, Tiwari S, Bhartiy S. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among medical students and its impact on their academic and social performance. Natl J Physiol Pharm Pharmacol. 2018;8(8):1205.
10. Alshdaifat E, Absy N, Sindiani A, AlOsta N, Hijazi H, Amarin Z, et al. Premenstrual Syndrome and Its Association with Perceived Stress: The Experience of Medical Students in Jordan. Int J Womens Health. 2022; 14:777-785.
11. Liu Q, Wang Y, van Heck CH, Qiao W. Stress reactivity and emotion in premenstrual syndrome. Neuropsychiatr Dis Treat. 2017; 13:1597-1602.
12. Meng Y, Chang L, Hou L, Zhou R. Menstrual attitude and social cognitive stress influence autonomic nervous system in women with premenstrual syndrome. Stress. 2022;25(1):87-96.
13. Nandakumar H, Kuppusamy M, Sekhar L, Ramaswamy P. Prevalence of premenstrual syndrome among students – Stress a potential risk factor. Clin Epidemiol Glob Health. 2023; 23:101368.
14. Gollenberg AL, Hediger ML, Mumford SL, Whitcomb BW, Hovey KM, Wactawski-Wende J, et al. Perceived stress and severity of perimenstrual symptoms: the BioCycle Study. J Womens Health (Larchmt). 2010;19(5):959-67.
15. Aguilar-Raab C, Stoffel M, Hernández C, Rahn S, Moessner M, Steinhilber B, et al. Effects of a mindfulness-based intervention on mindfulness, stress, salivary alpha-amylase and cortisol in everyday life. Psychophysiology. 2021;58(12).
16. Hensten A, Jacobsen N. Salivary Alpha Amylase as a Stress Biomarker. OSP J Dent Sci. 2019;1: JDS-1-103.
17. Bañuelos MS, Musleh A, Olson LE. Measuring Salivary Alpha-Amylase in the Undergraduate Neuroscience Laboratory. J Undergrad Neurosci Educ. 2017;16(1): A23-A27.
18. Tammayan M, Jantaratnotai N, Pachimsawat P. Differential responses of salivary cortisol, amylase, and chromogranin A to academic stress. PLoS One. 2021;16(8).
19. Jafari A, Pouramir M, Shirzad A, et al. Evaluation of Salivary Alpha Amylase as a Biomarker for Dental Anxiety. Iran J Psychiatry Behav Sci. 2018;12(1).
20. Weiss LR, Venezia AC, Smith JC. A single bout of hard RPE-based cycling exercise increases salivary alpha-amylase. Physiol Behav. 2019; 208:112555.
21. Allen SS, McBride CM, Pirie PL. The shortened premenstrual assessment form. J Reprod Med. 1991;36 11:769-772.
22. Tammayan M, Jantaratnotai N, Pachimsawat P. Differential responses of salivary cortisol, amylase, and chromogranin A to academic stress. PLoS One. 2021;16(8).
23. Lustyk MKB, Beam CR, Miller AC, Olson KC. Relationships among Perceived Stress, Premenstrual Symptomatology and Spiritual Well-Being in Women. J Psychol Theol. 2006;34(4):311-317.
24. Cheng SH, Shih CC, Yang YK, Chen KT, Chang YH, Yang YC. Factors associated with premenstrual syndrome - a survey of new female university students. Kaohsiung J Med Sci. 2013;29(2):100-5.
25. Hamaideh SH, Al-Ashram SA, Al-Modallal H. Premenstrual syndrome and premenstrual dysphoric disorder among Jordanian women. J Psychiatr Ment Health Nurs. 2014;21(1):60-68.
26. Khodayarifard M, Ghobari-Bonab B, Shokoohi-Yekta M. Stress and Coping Styles in University Students. Psychol Res. 2009;11(3):27.
27. Dilafruz Abduhamidovna K. Premenstrual syndrome in the modern science. IBMSCR. 2022;2(12):16-22.
28. Armand A, Talaee A. Investigating the Efficacy of Cognitive-Behavioral Stress-Management Training on Decreasing the Psychological Problems and Symptoms of Premenstrual Syndrome of Afflicted Women. IJOGI. 2012;15(21).
29. Gibbs RS, Danforth DN. Danforth’s Obstetrics and Gynecology. Lippincott Williams & Wilkins; 2008. Accessed June 23, 2024. https://cir.nii.ac.jp/crid/1130000796937651584.bib?lang=en
30. Pratiwi R, Sjattar H. Hubungan Stres dan Aktivitas Fisik dengan Derajat Premenstrual Syndrome Pada Remaja Putri Di Kelurahan Mangasa Kota Makassar. JIKP. 2021;10(2):206-214.
31. Purnawati J, Sinrang AW, Jusuf EC, Limoa E, Ahmad
M, Usman AN. Nutrition, mental status and level of
8-hydroxy-2-deoxyguanosine (OHDG) urine as predictors of premenstrual syndrome (PMS) in adolescent girls. Int J Curr Res Rev. 2020;12(23):7-13.
32. del Mar Fernández M, Regueira-Méndez C, Takkouche B. Psychological factors and premenstrual syndrome: A Spanish case-control study. PLoS One. 2019;14(3).
33. Nater UM, Rohleder N. Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: Current state of research. Psychoneuroendocrinology. 2009;34(4):486-496.
34. Ali N, Nater UM. Salivary Alpha-Amylase as a Biomarker of Stress in Behavioral Medicine. Int J Behav Med. 2020;27(3):337-342.
35. Hoferichter F, Lohilahti J, Hufenbach M, Grabe HJ, Hageman G, Raufelder D. Support from parents, teachers, and peers and the moderation of subjective and objective stress of secondary school student. Sci Rep. 2024;14(1).
36. Alsalman OA, Tucker D, Vanneste S. Salivary Stress-Related Responses in Tinnitus: A Preliminary Study in Young Male Subjects with Tinnitus. Front Neurosci. 2016; 10:338.
37. Cozma S, Dima-Cozma LC, Ghiciuc CM, Pasquali V, Saponaro A, Patacchioli FR. Salivary cortisol and
α-amylase: subclinical indicators of stress as cardiometabolic risk. Braz J Med Biol Res. 2017;
50(2): e5577.
38. Espin L, Villada C, Hidalgo V, Salvador A. Effects of sex and menstrual cycle phase on cardiac response and alpha- amylase levels in psychosocial stress. Biol Psychol. 2019; 140:141-148.
39. Washio H. Assessment of Well-Being Across Menstrual Phases in Female Students. Womens Health Rep (New Rochelle). 2023;4(1):531-535.
40. Rapkin AJ, Akopians AL. Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause Int. 2012;18(2):52-59.
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| Issue | Vol 19, No 3 (September 2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v19i3.20058 | |
| Keywords | ||
| Salivary Alpha-Amylase Premenstrual Syndrome Stress | ||
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How to Cite
1.
Hamzah G, Arsyad A, Jusuf E. Linking Premenstrual Syndrome With Salivary Alpha-Amylase Levels and Stress Levels: A Cross-Sectional Study. J Family Reprod Health. 2025;19(3):208-215.
