Progressive Muscle Relaxation Exercises on Premenstrual Syndrome

Premenstrual Syndrome (PMS) is defined as a set of physical, psychological, and behavioral symptoms that occur about five days before menstruation and disappear within a few days following its onset (Ryu \& Kim, 2015). In a systematic study evaluating data from 17 countries, the prevalence of PMS was 47.8% (Direkvand-Moghadam et al., 2014). In a systematic study conducted to investigate the prevalence of PMS in women of reproductive age in Turkey, the overall prevalence was determined as 52.2%. It was reported that PMS was seen in 59% of high school students, 50.3% of university students, and 66% of the general female population (Erbil \& Yücesoy, 2021). Although there are many different symptoms associated with PMS, common physical symptoms include abdominal bloating, weight gain, fatigue, breast tenderness, skin problems, dizziness, and headache or joint pain. Common psychological and behavioral symptoms include mood swings, anger, anxiety, aggression, sad or depressed mood, appetite changes, difficulty concentrating, and decreased interest in activities (Women's Health Concern 2012, Gunderson and Yates 2013; Yonkers \& Casper, 2022c). Symptoms related to PMS are reported to cause difficulty in attending school or work, a decline in academic achievement, economic losses, deterioration in interpersonal relationships, social isolation, risk of suicide attempt, substance abuse, and increased tendency to commit crimes or accidents (Borenstein et al., 2003; Yonkers et al., 2008; Tadakawa et al. 2016; Buddhabunyakan et al. 2017, Owens and Eisenlohr-Moul 2018, Abay and Kaplan 2019, Schoep et al. 2019a, 2019b). In addition, the tendency to violence, domestic fights, and child abuse have been reported in women diagnosed with PMS (Halberich, 2007). At the cognitive level, all of the positive thoughts that a person who is ready for violence attributes to violence can be defined as violent tendencies (Karaboğa, 2018). It is known that incidents of violence are increasing in our country, especially among young people (TBMM 2007). On the other hand, violence and aggression are essential problems that are becoming increasingly common all over the world (WHO2002, WHO 2014).

The treatment of PMS is usually carried out gradually, including non-pharmacological strategies, pharmacological strategies, including antidepressants or hormonal methods, and surgery (Walsh et al., 2015). PGE, first developed by the American Dr. Jacobson in the 1920s, involves each muscle group's contraction and relaxation, respectively (Liu et al., 2020). During PGE, the major muscle groups are followed in a specific order; this order is hands, arms, eyebrows, eyes, back of neck, front of neck, shoulders, back, chest, abdomen, buttocks, front of thigh, back of thigh, calf and feet (Bushra \& Ajaz, 2018; Dhyani et al., 2015; Liu et al., 2020; Perakam et al., 2019). Progressive relaxation exercise is a breathing and stretching method that provides relaxation of nerves and muscles from hand to foot, stimulating the parasympathetic nervous system and reducing sympathetic nervous system activities. In this way, blood pressure, heart and respiratory rate slow down, metabolic rate decreases, endorphin release, pain, and fatigue, and facilitate the transition to sleep (Özer \& Ergen, 2010; Kurt \& Kapucu, 2018).

PGE is among the non-pharmacological methods that nurses can offer caregivers (Yılmaz et al., 2019). It is necessary for health professionals, especially nurses, to evaluate all women of reproductive age in terms of PMS, to plan educational interventions that will increase their awareness of the issue and enable them to develop appropriate coping strategies, to support the planned educational interventions through written or visual materials, to provide effective and quality counseling services, and to aim to improve women's decreased quality of life (Abay \& Kaplan, 2019; Aksoy Derya et al. 2019, Akmalı et al 2020). Women may be advised to do relaxation exercises such as walking, running, swimming, and yoga regularly (at least 30 minutes a day) as they reduce stress by increasing endorphin levels and improve heart rate, lung capacity, and general health (Penedo \& Dahn 2005; ACOG 2015; Khajehei 2015).

The study aimed to determine the effect of progressive muscle relaxation exercises given to women with premenstrual syndrome on premenstrual syndrome symptoms and violent tendencies.