Dysmenorrhoea Among Adolescent Girls - Characteristics And Symptoms Experienced During Menstruation

Introduction :

Adolescence is a transition period from childhood to adulthood and is characterized by a spurt in physical, endocrinal, emotional, and mental growth. As the direct reproducers of future generations, the health of adolescent girls influences not only their own health, but also the health of the future population. Almost a quarter of India's population comprises of girls below 20 years.¹

One of the major physiological changes that take place in adolescent girls is the onset of menarche, which is often associated with problems of irregular menstruation, excessive bleeding, and dysmenorrhoea. Of these, dysmenorrhoea, recurrent, cramping lower abdominal pain during menstruation is one of the common problems experienced by many adolescent girls. The prevalence of dysmenorrhoea among adolescent females ranges from 60 to 83 percent. Many adolescents reported limitations on daily activities, such as missing school, sporting events, and other social activities, because of dysmenorrhoea. However, only 15 percent of females seek medical advice for menstrual pain, signifying the importance of screening all adolescent females for dysmenorrhoea.²

The society for menstrual cycle research reports a survey conducted in Eastern Turkey with 1951 girls from 26 high schools on the effects of dysmenorrhoea on the school performance and relationship with family and friends. Unsurprisingly, more than half of the girls surveyed reported that dysmenorrhoea does affect their ability to perform well at school, with 50% of the girls reporting “lack of focus on the content of the courses” and 26.9% reporting “not being able to answer the questions in exams despite having the knowledge”. Majority 77.3% reported “having problems with their families” when they are experiencing menstrual pain. ³

A descriptive cross-sectional study was conducted in the schools in Sidon city, Lebanon among 389 schoolgirls on their menstrual experiences. It shows that 97% used negative words like “disgusting” (30.5%), “painful” (9.1%), “bad” (8.8%), “I hate it” (5%), “It's hard” (3.9%), “depressing” (3.8%), “like a disease” (3.4%), “tiring” (3.4%), “I wish I never had it” (0.9%), “ridiculous” (0.9%), “like a virus”, “embarrassing” (0.6%) and others (0.3%).The findings indicates that the dysmenorrhoea is higher among the girls having negative menstrual experiences .This shows that even though menstruation is a blessing most of the girls are not able to perceive it and consider it as a curse throughout their life due to the pain associated with it.⁴

Another study was conducted to find the incidence of dysmenorrhoea among 1648 adolescent girls in selected districts of Karnataka. In that the incidence of dysmenorrhoea was found to be 87%, of these 46.69% had severe pain during menstruation. Among those 63% of girls experienced dysmenorrhoea before the onset of bleeding and 37% experienced after the onset of bleeding^3.

Statement of the problem

A descriptive study to assess dysmenorrhoea, Characteristics and associated symptoms among adolescent girls in selected residential schools of Udupi district, Karnataka.

Aims and objectives

1. identify dysmenorrhoea and associated symptoms among adolescent girls in selected residential schools of Udupi district.

2. assess the charachteristics of dysmenorrhoea among adolescent girls in selected residential schools of Udupi district.

3. find out the association between dysmenorrhoea and selected variables.

Materials and methods :

A descriptive survey was used for the study. The settings for the study were residential schools in Udupi district. Only adolescent girls between 12 to 17 years, studying in residential schools were included in the study. Simple random sampling was used to select the four residential schools in Udupi district by using lottery method.The schools selected were Sharada residential school, Udupi, Sri Bhuvanendra residential school, Karkala, Little rock residential school, Brahmavar and Jawahar Navodaya Vidyalaya, Hebri.All the adolescent girls who met the sampling criteria were included in the study.The total sample size was 233.The data was collected from 5^th January to 10^th March 2013.

The tools developed by the researcher were validated by seven experts. . Data were collected in January 2013, after obtaining permission from concerned school authorities and participant's informed consent. Tool 1: Baseline proforma, Tool 2: Dysmenorrhoea questionnaire, Tool 3:Numerical Pain Scale. The baseline proforma consisted of the background information of the samples. Dysmenorrhoea questionnaire was constructed to know in detail regarding the history, characteristics and symptoms associated with dysmenorrhoea. It consist of four sections. Section 1 –Menstrual history, section 2 –Dysmenorrhoea associated symptom checklist, section 3 – Dysmenorrhoea characteristics and section 4 –Effects of Dysmenorrhoea. The intensity of pain was measured by using a numerical pain scale. It's a line with equidistant marks from 0 to 10.The minimum score was 0 and maximum score was 10.The scores were arbitrarily classified as mild dysmenorrhoea (1-3), moderate dysmenorrhoea (4-7) and severe dysmenorrhoea (8-10).

Content validity was established by the percentage of agreement of experts The test-retest method was employed to find out the reliability, where ‘r’ was found to be 0.98.

Results :

4) Association between dysmenorrhoea and selected variables

Study showed an association between family history and dysmenorrhoea (Z=16.673, p-value=0.001) and there is no association between age in years, onset of menarche, duration of menstrual flow, dietary pattern and family history of dysmenorrhoea.

Table 1

Frequency and percentage distribution of baseline variables. N= 233

Sl.no	Sample characteristics	Frequency	Percentage (%)
1)	Age in years 12-14	159	68.2
	15-17	74	31.8
2)	Year of study 7th	45	19.3
	8th	51	21.9
	9th	68	29.2
	10th	69	29.6
3)	Type of family Nuclear Family	151	64.8
	Joint family	79	33.9			N=233
4)	Extended Family	3	1.3	Presence of dysmenorrhoea	Frequency	Percentage (%)
	Family history of dysmenorrhoea			Yes	146	62.7
	yes	117	50.2	No	87	37.3
5)	no	116	49.8	Total	233	100.0
	Dietary pattern vegetarian	66	28.3
	mixed diet	167	71.7
6)	Any known medical problems
	Anemia	12	5.2
	Headache	17	7.3
	other problems	12	5.2
	No	192	82.4

Table 2

Frequency and percentage of dysmenorrhoea N=233

Presence of dysmenorrhoea	Frequency	Percentage (%)
Yes	146	62.7
No	87	37.3
Total	233	100.0

Table 3

Frequency and percentage distribution of the dysmenorrhoea associated symptoms N=146

Physical symptoms	Frequency	Percentage (%)	Ranking of the symptoms
Tiredness	110	75.3	1
Headache	42	28.7	11
Giddiness	33	22.6	15
Sleeplessness	47	32.19	10
Increased sleep	41	28.08	12
feeling fullness in lower abdomen	71	48.6	7
back pain	106	72.6	2
tenderness of breasts	24	16.4	17
knee pain	50	34.2	9
swelling of legs	23	15.7	18
facial puffiness	33	22.6	15
Gastrointestinal symptoms
Loss of appetite	39	26.7	13
Increased appetite	22	15	19
Nausea	16	10.9	20
Vomiting	16	10.9	20
Eliminational symptoms
constipation	29	19.8	16
Diarrhea	10	6.8	21
Increased frequency of urination	50	34.2	9
Profuse sweating	38	26	14
Psychological symptoms
Depression	57	39	8
Mood swings	78	53.4	5
Irritability	97	66.4	3
Inability to concentrate	82	56.1	4
Nervousness	77	52.7	6

Table 4

Frequency and percentage distribution based on menstrual history.

Sl.no	Sample characteristics	Frequency	Percentage (%)
1)	Age of menarche
<12	54	23.2
12-13	146	62.7
14-15	31	13.3
<15	2	0.9
2)	Duration of menstrual cycle
	15-20	33	14.2
	21-28	125	53.6
	29-35	50	21.5
	>35	25	10.7
3)	Number of days of menstruation
	<3	10	146
	3-4	67	87
	5-6	135	4.3
	>6	21	28.8
4)	Presence of abdominal pain
	yes	57.9	62.7
	no	9.0	37.3
5)	Number of soaked pads changed per day
	<2	31	13.3
	2-3	147	63.1
	4-5	53	22.7
	>5	2	0.9

Table 5

Frequency and percentage distribution of adolescent girls based on dysmenorrhoea characteristics N=146

Sl.no	Sample characteristics	Frequency	Percentage (%)
1)	Experience of pain due to menstruation first menstruation onwards	68	46.6
	within an year after first menstruation	34	23.3
	after one year	30	20.5
	after two or more years	14	9.6
2)	Day of menstruation with severe pain One day before the onset of menstruation	31	21.3
	On the first day	66	45.2
	On the second day	50	34.24
	Any other days	13	8.90
3)	Total duration of pain in hours <1	39	26.7
	1-4	71	48.6
	5-8	28	19.2
	>8	8	5.5
4)	Body parts having pain lower abdomen only	46	31.5
	lower abdomen and back only	53	36.3
	lower abdomen, back and legs	43	29.5
	other body parts	4	2.7
5)	Measures taken to get relief from abdominal pain:
	medicines	15	10.2
	hot applications	18	12.32
	massage	15	10.2
	bedrest	108	73.97
	any other	5	3.42
	no measures	4	2.73

Table 6

Frequency and percentage distribution of the effects of menstrual pain N=146

Sl.no	Sample characteristics	Frequency	Percentage(%)
1)	Effect on daily activities
	yes	65	44.5
	no	81	55.5
2)	Effect on studies school absenteeism	5	3.4
	feeling weak and tired	53	36.3
	lack of concentration	32	21.91
	Not interested to study	21	14.38
	No	48	32.9
3)	Effect on sleep yes	57	39
	no	89	61
4)	Rest during the time of dysmenorrhoea <6hrs	77	52.7
	6-18hrs	24	16.4
	18-24hrs	5	3.4
	>24hrs	2	1.4
	No	38	26
5)	Action taken for dysmenorrhoea during school hours
	inform class teacher and seek help	8	5.4
	inform friends and get help	30	20.5
	manage the situation by self	74	50.7
	ask permission from teacher and going to hostel	42	28.8
	other measures	2	1.8
6)	Skipping meals during dysmenorrhoea breakfast	17	11.6
	lunch	35	23.9
	dinner	21	14.3
	any other	5	3.4
	No	84	57.5

Table 7

Association between dysmenorrhoea categories and selected variables.  n=146

Variables	Dysmenorrhea categories			Chi-square	p-value	Significance
	mild	moderate	severe
1. Age in years
12-14	16	53	25	4.283	0.232*	Not significant
15-17	12	24	16
2. Onsetof menarche
<12	8	17	15
12-13	18	48	19	10.377	0.259**	Not significant
14-15	2	11	7
>15	0	1	0
3. Duration of menstrual flow
<3	1	3	1	11.277	0.224**	Not significant
3-4	12	18	9
5-6	13	46	25
>6	2	10	6
4. Dietary pattern
vegetarian	4	22	13	3.266	0.352*	Not significant
mixed diet	25	56	27
7. Family history of dysmenorrhea
yes	16	40	30	16.673	0.001*	Significant
no	12	37	11
8. Sleep
yes	10	32	15	0.439	0.803*	Not significant
No	18	45	26

*Pearson chi-square test was used

**Fissure exact test was used for categories with less than 5 samples.

Close

Fig 1

Pie diagram showing percentage of adolescent girls with dysmenorrhoea.

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Discussion :

Conclusion :

Dysmenorrhoea is a very common problem among adolescent girls and they experience a number of physical, gastrointestinal, eliminational and psychological symptoms associated with it . Adolescent girls, almost silently suffer the pain by dysmenorrhoea and the symptoms associated with it. It is found to be a leading cause of low academic performance. The finding of this study indicates the need for appropriate intervention through lifestyle changes.