ABSTRACT

Corresponding Author:
Dr. Hemalatha K,
Associate Professor,
Department of Obstetrics and Gynaecology,
Madras Medical College,
Chennai, Tamilnadu.
E-mail: drlathababu2017@gmail.com

ABSTRACT

BACKGROUND

Menstrual problems in adolescent girls are very common in this age group. Identification of abnormal menstrual problems is essential and correction is needed. In this study, we have attempted to study the frequency of menstrual problems and its impact on school and college attendance.

MATERIALS AND METHODS

In this study, 300 girls in the age group of 14 - 19 years who attained menarche were non-randomly selected for convenience. This study was carried out in a school and three colleges in Chengalpattu. Many criteria were applied and critically analysed.

RESULTS

Dysmenorrhoea was the commonest menstrual problem noticed, followed by irregular cycle pattern. There was a statistically significant association between school absenteeism and menstrual disorders.

CONCLUSION

Adolescent girls school health programme should include a provision for screening of adolescent girls for menstruation related problems, clearing misconception and offer them possible treatment options.

KEY WORDS

Adolescent Girl, Menstrual Problem, Dysmenorrhoea, Oligomenorrhoea.

BACKGROUND

According to WHO, the period of adolescence ranges from 10 to 19 years. The adolescent group comprises of one-fifth of the total population of the world. In India, about 21.4% of the population falls in this age group.

It is a phase of rapid physical growth and development along with physiological growth and behavioural maturity. This period needs special attention because an adolescent faces different problems during development, different circumstances in school and college.

Menarche, the first menstrual period of life is a milestone in female puberty that signifies the maturation of reproduction potential. Age of onset varies from 9 years to 18 years. In India, it is reported to be around 12 years.

The average age of menarche is around 13 years 6 months. The length of menstrual cycle is usually of 21 - 35 days from first day of menstrual period. The duration of bleeding is about 3 - 5 days and blood loom is between 30 - 80 mL. Cycle is often irregular in the beginning due to immature Hypothalamic Pituitary axis, but by the age of 17 - 18 years menstrual cycle becomes regular.

Age Distribution

• The study was conducted among girls of the age 14 to 19 years. 53% were in the age group of 18 - 19 years.
• 18% were in the age group of 16 - 17 years.
• 29% of them were in the age group of 14 - 15 years.
• Mean age of the participants was 16.97 years (1.87 SD).

Educational Status

The study subjects were school and UG students. Maximum number of participants were 1^st and 2^nd year undergraduate students (53%).

Socioeconomic Status

In our study, majority of the girls (65%) belonged to SE class 1 and 2.

BMI

In our study, 40% of the participants were underweight and 5.3% of them were obese. Though majority of girls belonged to higher status, there was increased prevalence of underweight among the study subjects.

Age at Menarche

The mean age at menarche in our study was 12.5 years (1.18 SD). The mean age at menarche reported by other studies in India were 12.85 years,⁽¹⁾ 12.5 yrs.,⁽²⁾ which correlates with our study.

Menstrual Pattern and Problem

• In our study, 77% of the girls had regular menstrual cycles and 23% had irregular menstrual cycles. Prevalence of irregular cycles reported by other studies was 31.8%,⁽³⁾ 24.17%⁽⁴⁾ and 23.1%.⁽⁵⁾
• 6% of the girls had hypomenorrhoea- menses less than 2 days.
• 83% of girls had bleeding for 3 - 7 days.
• 11% had menorrhagia - bleeding > 7 days which is similar to study conducted by Sharma et al⁽³⁾ with 4.8% having bleeding for less than 2 days and 14.9% with bleeding > 7 days.
• Dysmenorrhoea was the menstrual problem reported by 65% of the girls with other studies showing prevalence of 67.2 %⁽³⁾ and 68.7%.⁽⁶⁾

DISCUSSION

Other studies have shown the prevalence ranging from 27.9% to 74.3%. 51% of the girls had one or the other symptoms of premenstrual syndrome, which is similar to the prevalence in the study by Samia Tabassum et al (53%)⁽⁷⁾ and Christina John (45.8%).⁽⁸⁾ The commonest symptom reported by our subjects were Abdominal bloating (23%), Depression (14%), Anxiety (12%), Irritability (11%), Breast tenderness (9%), Fatigue (5%) and Headache (3%). Other studies have shown the prevalence of PMS 67.2% and 74.3%.⁽⁹⁾ Oligomenorrhoea was the commonest type of irregularity (16%) prevalent among the study subjects, which correlate with the study conducted by Mohite RV et al⁽¹⁰⁾ and Anupriya et al⁽⁵⁾ showing prevalence of 16.08% and 15.3%. Other studies have shown prevalence ranging from 1.2%⁽⁸⁾ to 19.3%.⁽¹¹⁾

Followed by polymenorrhoea (4%), which correlates with study conducted by Sasritha Agarwal et al with 3.6% of girls reporting polymenorrhoea and 3% of girls had secondary amenorrhoea which is similar to study by Karout et al⁽¹¹⁾ with prevalence of 5.1%; 30% of girls were absent to school or college due to menstrual problems like dysmenorrhoea and PMS despite 65% of girls having dysmenorrhoea only 8% had consulted physician for treatment.

There was statistically significant association between school absenteeism and menstrual disorder (P value <0.001%).

Among these, dysmenorrhoea and premenstrual symptoms had a significant effect on academic performance and was responsible for school absenteeism.

CONCLUSION

1. As the problems related to menstruation were quite frequent and often resulted in interruption of daily routine of adolescent girls, school health programmes should include a provision for screening menstrual problems and provide them relevant information and treatment options.
2. Proper education about menstruation and related problems is important for both adolescent girls and their mothers to prevent avoidance of health care.
3. In spite of high prevalence of menstrual problems among the adolescents, the percentage of girls seeking physician consultation is very low.
4. Pain is often neglected by women, who consider pain as normal part of menstrual cycle.
5. This may help in improving school attendance rates and academic performance of the girl students.