A cross sectional study on menstrual pattern among adolescent school girls in urban slums of Bengaluru.

Introduction

Menstruation is a conspicuous sign of sexual maturation in early life of reproductive health among adolescent girls.¹ Menarche refers to first menstrual cycle or first menstrual bleeding in a girl’s life, which typically occurs between 10-16 year.^2,3 The duration of normal menstrual flow is 2-7 days but majority experience menstrual flow that last for 3-5 days. Menstrual cycle length varies between 21- 45 days in adolescent, where in after 3rd year of menarche, cycles are 21-35 days long as typical adults.³ Menstrual cycle pattern varies among individuals at different times of her life.⁴ To identify what constitutes normal and abnormal menstrual patterns of menstrual cycles especiallyamong adolescent girls is very important. Menstrual cycle variations that actually fall within the normal range or may be attributable to significant underlying medical issues with the potential for long term health consequences.³ Menstrual symptoms like lower abdominal pain, pain in the lower back, irregular bleeding are common before establishment of normal menstrual pattern.^3,5 Hence the present study was taken up to assess the menstrual pattern among the adolescent girlsin urban slums.

Materials and Method

This Cross sectional study was conducted among adolescent school girls aged 14-16 years studying in High schools (includes class 8th, 9th & 10th) of urban field practice area of BMCRI during July to August 2018. After explaining the study purpose, a pre tested, semi- structured questionnaire was self administered to the participants. Informed assent was obtained from the participants. School teachers were informed regarding the study and they in turn had taken consent of the parents of the participantsand confidentiality was assured in regard to their participation. Questionnaire included sections like socio-demographic profile, menstrual characteristics and menstrual symptoms.^6–8 The questionnaire was in English language, before administering it all the items were explainedand clarified their doubts beforehand. All the High schools were Private English medium schools.

Inclusion criteria: All the adolescent girls who had attained menarche were included in the study after taking assent from them.

Exclusion criteria: Adolescent girlswho were not present on the day of visit to the school were excluded.

Sample size: Sample size calculation was calculated according to study conducted by Shabnam et al6 , 2018, and a sample size of 150 was obtained.

Multi stage random sampling with Probability Proportional to Size sampling technique was used. Of 5 High schools, 3 schools were selected randomly by chit picking andfrom each school all the high school girls were included in the study who were present on the day of data collection which constitutes 33, 46 and 71 participants respectively.

Data analysis: Data was coded and entered in MS Excel and analyzed usingstatistical software SPSS version 20.0. Results were expressed in terms of percentages, tables and graphs.

Results

This Cross-sectional study was conducted among adolescent school girls studying in High schools (includes class 8th, 9th&10th) of urban field practice area of BMCRI. The total number of participants in this study constituted 150.

Table 2 shows age distribution of the participants, majority were Hindu by religion (72.7%) and from nuclear families (72.0%). Majority of the mothers of the participants were home makers(65.3%) and had completed middle schooling(30.7%).

Table 3 shows, menstrual pattern among adolescent girls, like duration of blood flow during their menstrual cycle, cycle length, material used during their cycles and number of times they changed the material during their cycles.

Figure 1 represents menstrual symptoms which are commonly experienced among adolescent girls during their cycles. Lower abdominal pain is the most common symptom which was reported in 109(72.7%) participants, followed by pain in lower back and generalized weakness [93(62.0%) which was reported by 95(63.3%) and 93(62.0%) participants. Other menstrual symptoms reported among the participants were irregular menses, excessive bleeding and nausea, headache & vertigo which was seen in 47(31.3%), 41(27.3%) and 22(14.4%).

Discussion

The present study was conducted to explore the menstrual pattern among the adolescent girls studying in high school.

Menstruation being an important phase of women’s life, associated with physiological,psychological and pathological changes. Menstruation is influenced by many factors such as nutrition, environment, socio-economic conditions.⁹

Menarche typically occurs between 10 to 16 years, with mean age of menarche is between 12 to 13 years.^5,9,10 In this study, the mean age of the menarche in adolescent girls was found to be 12.31+1.16 years, which falls within normal age of menarche and also similar to the study conducted by Tarannum et al(2018) and Chan et al(2009) which was 12.52±1.41 years and 12.3+1.1 years respectively.^8,11 But, few studies also quote that there is a decrease in age of menarche in recent decades due to factors related to nutrition, physical activity, physical built and others.^9,12

A few menstrual symptoms are physiological such as lower abdominal pain, low back ache, fullness of the breasts or gastralgia, headache, vomiting, tiredness, dizziness, experienced just prior or during menstruation which usually subsides as the menstrual cycle completes.These menstrual symptoms can be sometimes incapacitating to carry out their daily activities and also affects quality of life, such as, menstruation including painful (dysmenorrhea), and heavy or excessive menstrual bleeding.^10,13 If these conditions are severe, it might affect reproductive health in long term, hence need to be evaluated.

In this study, dysmenorrhea reported was 72.7%, which almost similar to the finding of study done by Omidvar S et al, (2016) which was found to 70.2%.¹³ Dysmenorrhea was the most common menstrual symptom experienced by adolescent females.¹⁴

In this study, other than dysmenorrhea, symptoms experienced by adolescent girls were pain in the lower back, generalized weakness and nausea, headache & vertigo which was found to be 63.3%, 62.0% and 14.4% respectively. In comparison to a study conducted by Kabir et al (2014), thefindings reported were, pain in the lower back in 52%, generalized weakness in 6%, and nausea, headache & vertigo in 32%.¹¹

In present study, irregular menses was reported in 31.3% , but in study done by Kabir et al (2014) the prevalence reported was 6%.¹⁵ Initial few years of menarche, irregular cycles can be common. These irregular cycles should be keenly investigated, which might be an early sign implying Polycystic ovary syndrome (PCOS), Thyroid dysfunction , Cushing syndrome and so on.⁵

In present study, excessive bleeding was reported in 27.3%, which corresponds to the findings of study done by Omidvar S et al (2014) where excessive bleeding reported was 30.1%.¹⁶ Excessive or heavy menstrual bleeding is one of the most common cause of Iron Deficiency Anemia in women especially in reproductive and child bearing age group.¹⁷

The present study attempted to throw light upon the menstrual pattern and its symptoms which the adolescent girls endure during their menstrual cycles. This information recommends the need for treatment and management in menstruation with adolescent girls as main target, which will be carried throughout rest of their life.

Conclusion & Recommendation

In this study, the mean age of the participants was 15.03+ 0.83 years and the mean age of menarche was 12.31+1.16 years. Among 150 adolescent girls,110(73.3%) had a cycle duration of blood flow 4 – 5 days, cycle length in 78(52.0%) girls was 29 – 35 days, and 145(96.7%) of them used menstrual pads. Dysmenorrhea was the most commonly reported symptom in 109(72.7%) girls, followed by low backache and generalized weakness in 95(63.3%) and 93(62.0%) respectively. Excessive bleeding was reported in 41(27.3%), which is much higher when compared to other studies.

Comprehensive health education and awareness activities regarding normal pattern of menstruation and its symptoms and menstrual problems targeted on adolescent girls, mothers and school teachers could help themto acquire knowledge regarding the menstrual issues, which in turn can help the adolescents to manage menstruation and promote positive health care seeking behavior among them. Anxiety and stress are common issues experienced during adolescent phase, which can be address by health education, awareness and counselling.

Limitations of the study

Since this study was conducted in the urban area field practice of Bangalore Medical College and Research institute,so this can be cannot be generalized to rural Bengaluru.

Source of funding: None.

Conflict of interest: None.