Menstrual-related attitudes and symptoms among multi-racial Asian adolescent females

Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review

OBJECTIVE

The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population.

METHODS

Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training.

RESULTS

The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours.

CONCLUSION

The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.

Examining Menstrual Health and Hygiene Educational Initiatives for American Middle and High School Menstruating Students: A Scoping Review

According to the American Medical Women's Association, period poverty refers to "inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management." A component of period poverty in the US can be attributed to the neglect of menstrual education and lack of menstrual health and hygiene tools in schools. This scoping review aims to examine the educational methods employed to improve menstrual knowledge in middle and high school menstruating students in both school and clinical settings. It also highlights gaps and barriers in equitable access to menstrual hygiene products. The five-stage framework by Arksey and O'Malley (2005) and the updated Joanna Briggs Institute (JBI) guide were used to guide the review. Six studies were retained for analysis. Two-thirds of menstruating students reported using at least one of the school's resources to obtain period products, and one-third of the participants reported missing school due to a lack of period products. Nearly half of the students needed period products at least once in the past school year but lacked the financial resources to purchase such products. Menstruating students reported embarrassment and a need for secrecy when accessing school bathrooms since the social and physical environments of school bathrooms heightened their discomfort while menstruating. Although a majority of adolescent students had basic knowledge of menstrual periods prior to menarche, the depth of their understanding of menstruation was limited. Findings from this review can inform the future development of evidence-based educational interventions to improve the overall menstruation experience for US menstruating adolescents.

Menstrual cycle characteristics, perceived impact on performance, and barriers to communication: Perspectives of high-performance adolescent athletes in Singapore

The purpose of this study was to examine the menstrual cycle (MC) characteristics, explore the impact on performance, and identify barriers to and facilitators of MC-related communication among high-performance female adolescent athletes in Singapore. Ninety athletes (15.4 ± 1.8 years) from multiple sports completed an online questionnaire. Eighty-four athletes were postmenarcheal (menarcheal age 11.9 ± 1.3 years), including two who were using an oral contraceptive pill (OCP). Secondary amenorrhea, current or history of, was self-reported in 16% of athletes. Sixty-two percent and 67% of non-OCP athletes perceived that the MC affected their ability to train and compete, respectively. Athletes preferred speaking to a parent (85%) and a female figure (67%) about MC-related concerns. Through thematic analysis, three barriers to communication were constructed: (1) pervasive menstrual stigma, (2) constraints of the training environment, and (3) the low value placed on MC-related conversations. Two facilitators of communication were constructed: (1) respect athletes' individual experiences as menstruating girls and (2) foster a safe space for MC-related conversations. Findings demonstrated that menstrual irregularities are common in adolescent athletes and screening for MC disorders, particularly primary amenorrhea should be undertaken in this population, with clear support pathways for management including symptom mitigation. To support athletes in raising MC-related concerns when needed, structured communication pathways that consider individual preferences and involve a (female) point of contact should be established within the training environment. Improving menstrual health literacy among adolescent athletes before any misinformation or negative perceptions are firmly established may contribute to longevity in their athletic careers.

COVID-Related Distress Is Associated with Increased Menstrual Pain and Symptoms in Adult Women

The COVID-19 pandemic resulted in heightened stress for many individuals, with women reporting more stress than men. Although a large body of evidence has demonstrated that stress, in general, can impact the menstrual cycle, it is not yet clear if COVID-specific stress would impact women's menstrual health. The current study explored the relationship between COVID-related stress and distress and menstrual variables (menstrual pain, number and severity of menstrual symptoms, and menstrual pain interference) in a sample of reproductive-age adult women. Seven-hundred fifteen women completed the initial survey and were re-contacted to complete the same survey three months later. Of those recontacted, 223 completed the follow-up survey. Results indicated that COVID-related stress and distress was associated with higher levels of menstrual pain, more frequent and more severe menstrual symptoms, and greater menstrual pain interference, even after accounting for age, hormonal use, bodily pain, and pain catastrophizing. Our findings suggest that women experience unique vulnerabilities that directly impact their health and functioning, and both research and clinical care should address these symptoms through careful assessment and treatment of menstrual pain and symptoms, particularly during and after periods of high stress and distress.

The relationship between high physical activity and premenstrual syndrome in Japanese female college students

BACKGROUND

In recent years, moderate physical activity has attracted the attention of experts and women as a way to cope with premenstrual syndrome (PMS). Studies investigated the effects of exercise on PMS, but only a few reports focused on the relationship between physical activity, which included not only exercise but also routine bodily movements, and PMS. Therefore, the present study investigated the relationship between the amount of physical activity and PMS symptoms among sexually mature female students.

METHODS

A total of 381 female university students in Japan were surveyed using a paper or web-based questionnaire with the same content. The questionnaire consisted of basic information, PMS symptoms, and physical activity based on the International Physical Activity Questionnaire (IPAQ). Participants were divided into two groups (≥ 3000 The Metabolic Equivalent of Task (MET)-minutes/week and < 3000 MET-minutes/week) based on their total physical activity as calculated using the IPAQ guidelines. The two groups were then compared in terms of the severity of their PMS physical and psychological symptoms as calculated based on the American College of Obstetricians and Gynecologists' PMS diagnostic criteria. The Wilcoxon's rank-sum test was used for statistical analyses. We then divided the participants based on the presence or absence of each symptom and used the chi-square test to compare the intergroup differences in ratios. The statistical significance level was set at p < 0.05.

RESULTS

Those with total physical activity of ≥ 3000 MET-minutes/week had lower total PMS symptom scores (p < 0.01), physical symptom scores (p = 0.01), and psychological symptom scores (p = 0.01) compared with those with total physical activity of < 3000 MET-minutes/week.

CONCLUSION

These results suggest that young women with high physical activity (≥ 3000 MET-minutes/week) have milder symptoms of PMS.

The prevalence of menstrual disorders and premenstrual syndrome among adolescent girls living in North Borneo, Malaysia: a questionnaire-based study

Background

This study aimed to determine menstrual characteristics and related morbidities among adolescent girls living in Sabah, North Borneo, a less-developed state in Malaysia.

Methods

Data were obtained from a quantitative survey conducted in three government high schools located in Ranau, Sabah. The participants were adolescent girls who had attained menarche between the ages of 14 and 19.

Results

Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age at the time of the survey was 17 ± 1.4 years, and the mean menarche age was 12.2 ± 1.1 years. Our data demonstrated that 85.7% of the participants experienced dysmenorrhoea, of which at least 42.1% (mean pain score ± SD: 4.81 ± 0.76, 95% confidence interval (CI) 4.72, 4.90) experienced moderate dysmenorrhoea, and 11.2% (mean pain score ± SD: 7.86 ± 0.94, 95% CI 7.64, 8.08) experienced severe dysmenorrhoea. Over 70% of these girls complained of tiredness, headache, and appetite changes during menses.

Conclusions

The prevalence of menstrual disorders and related morbidities was high among the girls residing in Sabah. Reproductive health issues in rural and socioeconomically deprived areas remains poorly addressed. The main consequence of neglecting menstrual disorders and their related morbidities is impaired future sexual reproductive health in adults. Thus, addressing adolescent reproductive health issues is crucial, especially for girls living in areas where access to healthcare is difficult. The information gathered from this study can be used to strategize effective interventions to improve adolescents' reproductive health status in rural areas.

Adolescent Perceptions of Menstruation on Twitter: Opportunities for Advocacy and Education

PURPOSE

While some adolescents celebrate menstruation as a rite of passage, others seek discretion due to stigma. Many youth have used Twitter to combat stigma and raise awareness about other culturally taboo topics, but previous work has not explored youth conversations regarding menstruation. This study aims to assess whether Twitter can provide useful insights into how youth perceive menstruation.

METHODS

The team searched 162,316,839 tweets of 71,443 users of the age range 13-25 years in the Health Language Processing Twitter Youth Cohort for tweets that matched menstruation-related keywords: a pad, my pad, my period, her period, your period, tampon, diva cup, menstruate, that time of the month. Twelve codes emerged using a grounded theory approach and were sorted into three themes.

RESULTS

Analysis was conducted on 10,000 tweets. Three themes emerged, including menstrual health, menstrual stigma, and menstrual positivity. Tweets related to menstrual health included physical complications, sexual/reproductive health, health education, and LGBTQ health. Tweets that addressed menstrual stigma included inconvenience/limitations, shame/stereotypes, religion/alternate perceptions, access/affordability, and self-depreciation/harm. Tweets related to menstrual positivity included awareness/community, strength/resilience, and environment/sustainability.

DISCUSSION

This study provides insights into youth perceptions about menstruation. There was overwhelming emphasis placed on the negative expectations and shame around menstruation. A significant minority of tweets were directly or indirectly related to advocacy or education, which supports the potential use of Twitter as a platform to improve public health messaging, transform health outcomes, and promote equity among youth who menstruate.

Prevalence, attitude and practice of self-medication among adolescents and the paradigm of dysmenorrhea self-care management in different countries

Self-medication (SM) is an important worldwide public health issue affecting children and adolescents. The pattern of SM varies in different communities, affected by factors such as age, sex, income, expense, self-care orientation, educational level and medical knowledge. It is a fairly common practice: for minor health problems, it often provides cheap, rapid, and convenient solutions, outside of the health care system of many countries. Painkillers, antipyretics, cough medicines, cold preparations, dermatological products, nutritional supplements and antibiotics are the drugs most frequently used. Potential risks include incorrect self-diagnosis, improper dosage, inappropriate choice of therapy, masking of severe disease and drug interactions. Lack of awareness of warnings and precautions, storage conditions, the recommended shelf-life and adverse reactions increase the risk of side effects. Little is known about the SM of dysmenorrhea by adolescent girls. Attitudes towards treatment are influenced by cultural, ethnic, and religious factors. Some girls discuss dysmenorrhea with family and friends, and the majority may not seek medical advice. As dysmenorrhea is a common problem for adolescents, it is essential that these girls be aware of the normal and abnormal symptoms of menstruation. In the light of these findings, the roles of family, school, health professionals and health authorities are of utmost importance for the implementation of measures to approach this health problem in a more efficient way. (www.actabiomedica.it)

Menstrual attitude dimensions, Anxiety and Body Esteem in adolescent girls

One of the horrifying experiences that adolescent girls endure is menstruation. Understanding how some individual-related factors affect menstrual attitudes has substantial implications for coping with difficulties that come with it. We tested the direct and interactive effect of anxiety and body esteem dimensions (attribution, weight & appearance) on dimensions of menstrual attitudes (debilitating, bothersome, natural, prediction & denial) among adolescent girls in Ibadan, Nigeria. This is a cross- sectional survey of 276 secondary schools girls aged 12-19 years (M= 14.89, SD= 1.46). Multivariate Analysis of Variance results revealed adolescent girls with lower anxiety reported positive menstrual attitude by anticipating the onset of menstruation. Body esteem-appearance directly influenced both debilitating and bothersome dimensions of menstrual attitude; suggesting girls with higher body esteem for appearance positively accept menstrual experience as weakening and inconvenient. Interactively, anxiety and appearance dimension of body esteem influenced prediction dimension; likewise anxiety, weight and attribution dimensions of body esteem. It is concluded that body esteem and less anxiety are important for adolescent girls' positive menstrual attitudinal change. Thus, reduced apprehension and high self-respect for body appearance and weight are recommended for accepting menstruation as a normal bodily function occurrence during a woman's reproductive lifespan.

Prevalence and Predictors of Dysmenorrhea, Its Effect, and Coping Mechanisms among Adolescents in Shai Osudoku District, Ghana

Background

Dysmenorrhea has been the most common gynecological problem worldwide. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s and usually declining with age. It has also been reported that dysmenorrhea affects more than 80% of women in the reproductive age. The study objective was to examine the predictors of dysmenorrhea, its effect, and coping mechanisms among adolescents in Shai Osudoku District, Ghana.

Methods

We conducted a cross-sectional study in September and November 2017 in selected schools in Shai Osudoku District, Ghana. We employed self-administered questionnaire to obtain data from adolescents volunteered to participate in the study. We analyzed the data using the SPSS programme IBM version 20. We used the Pearson chi-square test and multiple logistic regression analysis to assess the association between exposure variables and the outcome variable. The odds ratio was reported to establish the risk of dysmenorrhea at a confidence interval of 95%, and statistical significance was assumed at p < 0.05.

Results

The prevalence of dysmenorrhea was 68.1% (95% CI, 65.0–72.0) with one-third recounting their pain as severe. The pain during menstruation negatively influences the daily physical activities (22.5%), school attendance (6.9%), concentration during classes' hours (27.9%), and academic performance (31.1%) of the respondents. Besides, adolescents who do not live with their parent experienced a 53.1% increase in odds of self-reporting dysmenorrhea (AOR, 1.53 (95% CI, 1.02–2.23)). Similarly, respondents who had irregular menstrual cycle experienced a 72.5% increase in odds of self-reporting dysmenorrhea (AOR, 1.73 (95% CI, 1.16–2.57)). Finally, a significant association between irregular menstrual cycle (p < 0.01), not lived with their parent (p < 0.04), and self-reported dysmenorrhea was found.

Conclusion

This study establishes that dysmenorrhea is high among adolescents in Shai Osudoku District which negatively affects the daily activity of majority of them.

Knowledge, utilization and barriers to primary care services for sexual and reproductive health among adolescents in secondary schools in Selangor, Malaysia

Early sexual debut, partner violence, pregnancy and sexually transmitted infections contribute to negative health outcomes among adolescents. While the primary care clinics offer accessible sexual and reproductive health (SRH) services to adolescents, it is uncertain whether adolescents are aware of and utilize these services. This study aimed to examine Malaysian adolescents' knowledge, utilization and barriers to primary care services for SRH. A cross-sectional survey was conducted from August to November 2011 among adolescent from five randomly selected schools in Selangor, Malaysia. A self-administered questionnaire was used to assess their knowledge, attitudes, sexual behaviors and utilization of SRH services. A total of 680 adolescents participated in the study. One in ten of the adolescents were aware of the availability of SRH services, and only 6.9% of them had ever visited a primary care clinic for SRH. About 75% of them felt uncomfortable going to a primary care clinic for SRH services. Knowledge and utilization of primary care clinics for SRH among adolescents in Malaysia is poor.

Premenstrual Syndrome: Existence, Knowledge, and Attitude Among Female University Students in Karachi

Objective

The aim of this study was to investigate the existence, knowledge, and the attitude of female students towards premenstrual syndrome (PMS).

Methods

This cross-sectional study was conducted in three universities in Karachi, Pakistan. A total of 448 female students participated in the study. The clinical criterion of American College of Obstetricians and Gynecologists (ACOG) for PMS was used to assess the prevalence of PMS in the participants. The questionnaire was set in four parts, one each to assess the knowledge, the attitude, and practices regarding PMS and one to assess the gap between self-perceived PMS and actual PMS. Data were analyzed descriptively using the Statistical Package for the Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY).

Results

The majority (96.4%) of female students were aware of PMS, while only 19% females knew about premenstrual dysphoric disorder. The self-reported prevalence of PMS was 79.5% and the prevalence using the ACOG criteria was 23.9%. Common symptoms were irritability, angry outbursts, depression, breast tenderness, and gastrointestinal problems. More than half (60.4%) of the participants reported PMS disturbed their normal routine, while 81.5% reported stress exacerbated their symptoms. The majority (77.5%) of women believed PMS was a significant issue to be discussed but 49.4% did not take treatment for their PMS.

Conclusion

There is a significant impact of PMS in the lives of Pakistani women, and it is a common problem all over the globe. Despite the growing awareness, there remains a considerable deficiency of knowledge about the necessity to consult a doctor or seek treatment for their symptoms.

Development and psychometric validation of the Menstrual Health Instrument (MHI) for adolescents in Korea

The aims of the researchers were to develop and test initial psychometric properties of the Menstrual Health Instrument, a measure of menstrual health in adolescents that comprehensively evaluates menstrual health. Data were collected with a convenience sample of 230 Korean adolescent girls. As a result of exploratory factor analysis with the 29-item instrument, five factors were extracted: affective symptoms, somatic symptoms and school life, daily habits for menstrual health, menstrual cycle characteristics, and attitudes and perceptions on menstruation. The reliability and validity estimates indicate the Menstrual Health Instrument could be used for screening in school or community settings.

Experience of dysmenorrhea among a group of physical therapy students from Cairo University: an exploratory study

INTRODUCTION

Dysmenorrhea is a condition describing the painful cramps that women feel before or during the menstrual period. While dysmenorrhea is the most common gynecologic complaint affecting adolescent and young women and there has been significant progress in understanding its pathophysiology and managing the symptoms, many young women do not seek medical consultation and remain untreated.

AIM OF THE STUDY

The aim of the study was to explore the prevalence of dysmenorrhea, its physical impact, and associated coping behaviors among university students.

METHODS

A total of 269 female college students volunteered to participate in the study. Data regarding the students' experience with dysmenorrhea were collected via self-reported questionnaire developed based on relevant literature. Pain was scored on visual analog scale (VAS).

RESULTS

Most respondents (84.01%) reported feeling pain in the abdomen and back (VAS score, 5.00). Mood swings (84.8%) and dizziness (48.2%) were, respectively, the most common affective and somatic symptoms related to menstruation. There was a significant difference in the amount of menstrual flow (p=0.004) and incidence of dysmenorrhea (p=0.03) according to menstrual regularity. Most students (91.2%) did not seek medical consultation for dysmenorrhea, and 62.4% used analgesics. However, no significant correlation (p=0.25) was found between analgesic intake and pain relief. While most students (90.7%) did not miss exams, 48.7% reported poor satisfaction with their academic performance because of dysmenorrhea.

CONCLUSION

Dysmenorrhea is highly prevalent among college students, with many physical impacts and associated activity limitations. Collaborative efforts from health care providers, program coordinators, and parents should focus on increasing awareness and improving management strategies to treat dysmenorrhea.

Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries

Background

Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs.

Objectives

This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result?

Methods

Using a structured search strategy, articles that investigate young girls’ preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included.

Results

Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls’ knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls.

Conclusion

LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls’ education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

[A structural equation modeling on premenstrual syndrome in adolescent girls]

PURPOSE

The aims of this study were to construct a hypothetical structural model which explains the premenstrual syndrome (PMS) in adolescent girls and to test the fitness with collected data.

METHODS

The participants were 1,087 adolescent girls from 3 high schools and 5 middle schools in B city. Data were collected from July 3 to October 15, 2012 using self-reported questionnaires and were analyzed using PASW 18.0 and AMOS 16.0 programs.

RESULTS

The overall fitness indices of hypothetical model were good (χ² =1555, p<.001), χ²/df=4.40, SRMR=.04, GFI=.91, RMSEA=.05, NFI=.90, TLI=.91, CFI=.92, AIC=1717). Out of 16 paths, 12 were statistically significant. Daily hassles had the greatest impact on PMS in the adolescent girls in this model. In addition, PMS in adolescent girls was directly affected by menarche age, Body Mass Index (BMI), amount of menstruation, test anxiety, social support, menstrual attitude and femininity but not by academic stress. This model explained 27% of the variance in PMS in adolescent girls.

CONCLUSION

The findings from this study suggest that nursing interventions to reduce PMS in adolescent girls should address their daily hassles, test anxiety, menstrual attitude and BMI. Also, social support from their parents, friends, and teachers needs to be increased.

A cross-sectional study of the beliefs and attitudes towards menstruation of Chinese undergraduate males and females in Hong Kong

AIMS AND OBJECTIVES

To explore the beliefs and attitudes towards menstruation of Chinese undergraduates in Hong Kong and to compare those of (1) male and female undergraduates with those of (2) undergraduates studying health-related vs. nonhealth-related programmes.

BACKGROUND

Menstruation is typically viewed as a forbidden topic or a troublesome experience. These negative beliefs and attitudes result from existing myths and taboos associated with cultural factors and health education levels.

DESIGN

A cross-sectional survey was conducted in all universities in Hong Kong. Undergraduates were invited through convenience sampling to complete a questionnaire assessing their attitudes and beliefs towards menstruation.

METHODS

A questionnaire on 'beliefs about and attitudes towards menstruation' was adopted. Questionnaires were self-administered by the respondents.

RESULTS

A total of 450 questionnaires were distributed, and a response rate of 96.6% was obtained; 416 completed questionnaires were collected and analysed. Many Chinese undergraduates agreed that menstruation is annoying, causes disability, involves prescription and proscription and is not pleasant. When comparing the beliefs and attitudes towards menstruation of Chinese male undergraduates with those of female undergraduates, females tended to disagree that menstruation should be maintained secret, but tended to agree that it was annoying. When comparing the beliefs and attitudes towards menstruation of Chinese undergraduates studying health-related programmes with those under nonhealth-related programmes, the latter group exhibited a higher level of belief in prescription and proscription for menstruation than the former group.

CONCLUSION

Chinese undergraduates in Hong Kong were influenced by the traditional Chinese culture and social environment, resulting in negative attitudes towards menstruation. This study recommends that sex education, especially reproductive health education, be extended to tertiary education.

RELEVANCE TO CLINICAL PRACTICE

This study provides relevant information on planning the content of sex education or reproductive health education for Chinese undergraduates.