Prevalence of menstrual problems among the adolescent school girls in Private high schools of Mysuru district, Karnataka

Introduction

India is one of the most populous countries in the world. Adolescents (10-19) constitute about one-fifth of India’s population. As per the 2011 census, in absolute numbers, there are 253 million adolescents in India.¹

Transition from girlhood to womanhood has been recognized as a special period in adolescence girls. This transitional period from childhood to adulthood is characterized by rapid physical, mental, and sexual development. Menstruation is a normal physiological process that begins during adolescence period and it is associated with various symptoms with their onset, before, during or after menstruation.² In India majority of adolescent girls are suffering from at least one reproductive health morbidities which may affect the normal life of adolescents and young adult women. Some of the most common menstrual problems in adolescents are dysmenorrhoea, premenstrual syndrome, abnormal uterine bleeding, amenorrhoea and polycystic ovarian syndrome. ³ Age of menarche and common menstrual problems influenced by various factors such as heredity, environmental conditions, body stature, socioeconomic status, nutritional and health status, family size, level of education, and psychological well-being which are diagnosable and mostly treatable even at peripheral level in early stage, but this part of women’s health is often ignored by primary health care in India.⁴

In public health agenda, menstrual problems are considered as minor problems in developing countries but they may be life threatening complications associated with them. Early identification of menstrual problems and followed by prompt treatment may help in reduction in the suffering as well as improve scholastic performance and the quality of life among adolescents.

In this background, the present study was undertaken to estimate the prevalence menstrual problems among adolescent girls studying in JSS high schools of Mysuru.

Materials and Methods

After obtaining approval by institutional ethics committee, the present cross-sectional study was conducted in JSS High Schools at Urban areas of Mysuru for the period of one year. The sample size was calculated by considering the reported prevalence of 84.8% with absolute allowable error of 10% and 5% Alfa level to be 320.5 thus adolescent girls in the age group of 13 to 16 years assenting and their parents consenting to participate in the study were included. Line listing of the JSS high schools in the Mysore city was done. Using lottery method 4 schools were randomly selected for carrying out the study. Population proportionate to Size sampling (PPS) technique was applied based on the strength of the students in each school and in each class to calculate and recruit study participants. From the list of attendance in the selected class based on the required number of samples, systematic random sampling was carried out to select the study subjects.

Prior consent is obtained from the school authorities and students participating in the study. Data was collected by self-administered pretested, semi structured questionnaire with details on socio-demographic characteristics and menstrual problems experienced by the study subjects in last six months. Operational definitions for the history of menstrual problems were developed through thorough review of literature and content validated from the faculty members in the Department of Obstetrics and Gynaecology.

Statistical analysis

Data was compiled and analysed using SPSS version 24. Quantitative variables were expressed in frequency, percentages, mean and standard deviation. Chi square test is used for testing the association between the menstrual problems and mental health status. The associations were interpreted statistically significant at p<0.05.

Results

Socio-demographic characteristics

Among 320 study subjects included in the study, majority 117 (36.6%) were 15 years old and the mean age was 14.76 ± 0.846 years. 145(45%) of them were studying in the 8th standard, 118(36.9%) were in 9th standard. 251 (78.4%) of fathers and 247 (77.2%) of mothers of study subjects were literates. Business was the commonest occupation among fathers 135 (42.1%). 295 (92%) were below poverty line and 267 (83.4%) were belonging to Nuclear families. (Table-1) 

Menstrual problems

Out of 320 study patricians, 93% study participants had one or other menstrual problems as shown. Dysmenorrhoea was most prevalent menstrual problem followed by menorrhagia. 55% study participants were suffering from the dysmenorrhoea, 43% study participants had menorrhagia, 14 % study Participants had irregular cycles, and 5 % study participants had amenorrhea. 52.4% study participants had Premenstrual syndrome. (Figure 1)

Factor influencing the menstrual problems:

In present study, there was no association between age, socio-economic status, and type of family with menstrual problems (Table-3)

Discussion

Socio-demographic characteristics

The present study, adolescent girls between ages of 13 to 16 year were included. Majority participants were in the age group of 14 year (35%) and 15year (36.6%) mean age is 14.17years with standard deviation of 0.846 years. It is comparable with studies conducted by NazeemaBeevi P et al.⁵ and also mean age of study participant is 14.75 year by Ram Ravi et al.6 In present study 86.2% mothers were house makers, similarly report was to be found by S R Quraishi et al.³

Prevalence of menstrual problems

In present study shows that 93% were had one or more menstrual problems. These results are similar to the observations made by P Nazeema Beevi et al5 and R Ravi et al, 6 where they have observed that, 84.4% and 97.7% of the subjects were having one or the other menstrual problems. This higher prevalence of menstrual problems clearly indicates that the menstrual problems are major public health concerns which need to be addressed at the earliest.

55% subjects in the present study were found to have dysmenorrhoea, which is slightly more than that observed by P Nazeema Beevi et al5 to be 33% and that of R Ravi et al6 to be 72.6% and similar to the observations made by V Farthing et al7to be 52.02%. This variation in the burden of dysmenorrhoea may be due to the subjectivity attached to the symptoms and the extent to which study participants give importance to this symptom. However, all the above mentioned studies categorically mention that dysmenorrhoea to be a commonest menstrual problem among adolescent girls.

In the present study 43% had subjects had history suggestive of Menorrhagia this is similar to the observations made by of R Ravi et al⁷ , where they found the prevalence of menorrhagia to be 45%. Menorrhagia compared to other menstrual problems is of more serious concern as it will make an adolescent girl more prone for anaemia and related complications.

14.4% of the subjects in the present study had Irregular menstrual cycles. This was quite similar to the study conducted by Waghachavare VB et al,⁸ where it was observed to be 14.5% and lesser than the observations made by R Ravi et al to be 31%.⁶

In the present study, 52.2% subjects had the history suggestive of Premenstrual syndrome. This was quite higher compared with the observations made by Waghachavare VB et al⁸ to be 17.2% and Buddhabunyakan N to be 29.8% and 18.4% by Raval CM at al.^{9, 10} The higher prevalence of premenstrual syndrome in the present study could be the subjective nature of these symptoms and the expressivity of the study participants. 5% of the subjects had history of primary amenorrhea in the present study. This was lesser compared to the observations made by Waghachavare VB et al, ⁸ who reported the prevalence to be 17.7%.

In present study it was observed that 16% subjects had visited the hospital/doctors for their menstrual problems. This was slightly lower than the observations of Waghachavare VB et al⁸ where 36.13 % adolescents have visited doctor for menstrual problems. A study conducted by Symphorosa SC et al.¹¹ also reveals that the health seeking behaviour among adolescent girls to be poor. Common reasons for not visiting hospital for menstrual problems in the present study was the lack of awareness about visiting the health facility for these problems and the feel that these problems are common during adolescence. Other factors include, shy nature of girls, poor support from family and health care being expensive.

Factors affecting menstrual problems

In present study reveal that there was no association between age, and socio-economic status, Types of family with menstrual problems. Reported by S R Quraishi et all that there was no association between types of family with menstrual problems.³ the similar observations were also made by Mi Yu et al in their study among Adolescent Korean Girls, where there was no statistically significant association between menstrual problems with age, socioeconomic status of the family, age at menarche and smoking. ¹²

Socio-demographic characteristics like age, type of family and socioeconomic status in the present study have not played the major role in determining the menstrual problems among adolescents.

Conclusion

In the present study, prevalence of menstrual problems was found to be high among adolescent girls. There was no significant association between socio demographic variables with menstrual problems. Heath seeking behaviour among adolescents was found to be poor. Thus, girls should be Encouraged to seek health care for the treatment of menstrual problems and there is a need to undertake regular screening activities for the adolescent girls on both menstrual and mental health problems in order to detect them early and provide essential support.