Age at menarche, reactions to menarche and attitudes towards menstruation among Mexican adolescent girls

Comparison of body image and peer relations among girls with normal, early, and late menarche

BACKGROUND

The onset of menstruation is a turning point in women's sexual maturity that, unlike other stages of growth, occurs abruptly and is a critical stage in girls' lives. The present study investigated body image and peer relations among girls with early, late, and normal menarche.

MATERIALS AND METHODS

This casual-comparative descriptive study included female students aged 9-17 in Isfahan. The participants were selected using multistage cluster random sampling. Out of 5,984 students, 56, 37, and 43 were selected for the normal, early, and late menarche groups. The Body Image Concern Inventory and Index of Peer Relations were the two tools used in this study. Moreover, the data were analyzed using a covariance statistical test.

RESULTS

Girls with early menarche had better peer relations than those with late menarche (P = 0.01). In addition, there was a significant difference between adolescents with normal and late menarche in terms of body image (P = 0.01). Girls who experienced late menarche were more concerned about their body image and appearance; however, girls with early menarche experienced more impaired performance (P = 0.05).

CONCLUSION

The first menstrual cycle, or menarche, affects psychological variables such as body image and peer relations. The later the menarche, the fewer problems in regard to body image and peer relations.

Assessment of knowledge, attitudes, and practices regarding menstruation and menstrual hygiene among early-reproductive aged women in Bangladesh: a cross-sectional survey

Background

Poor menstrual hygiene practices during menstruation increases the risk of reproductive tract infections, absenteeism, and negative impact on school performance. Despite being a global problem, there is a lack of knowledge and misconceptions about menstrual hygiene among women of all ages, especially in developing countries like Bangladesh. The study aims to assess the knowledge, attitudes, and practices toward menstrual hygiene among early reproductive-aged women in Bangladesh to help policymakers and planners take effective initiatives.

Methodology

A cross-sectional survey was conducted between July and December 2022 in Dhaka, Rajshahi, Chittagong, Sylhet, and Barisal regions of Bangladesh. A convenience sampling technique was utilized to recruit a total of 1,214 participants (100% female; mean age: 22.87 ± 2.64 years). A semi-structured questionnaire including informed consent, socio-demographic information, as well as questions regarding knowledge (6-item), attitudes (7-item), and practices (6-item) toward menstruation and menstrual hygiene practices, was used to conduct the survey. All analyses were performed using the STATA (Version 15.0) and Statistical Package for the Social Sciences (SPSS version 25.0).

Result

The mean scores of the knowledge, attitudes, and practices were 4.9 ± 1.51 (out of 6), 12.58 ± 1.58 (out of 14), and 8.80 ± 1.87 (out of 12), respectively. The higher scores of knowledge, attitudes, and practices were significantly associated with several socio-demographic and menstruation-related factors (education, family type, type of menstruation, duration of menstruation, etc.).

Conclusion

This study identified several key factors associated with improved knowledge, attitudes, and practices related to menstrual hygiene, including higher education levels, student status, younger age, non-alcohol consumption, and regular menstrual cycles. To enhance menstrual hygiene practices among women, it is crucial to implement targeted interventions that address knowledge disparities and tackle social and environmental influences.

Menstrual hygiene access and practices in Latin America: scoping review

OBJECTIVE

to synthesize available evidence related to menstrual hygiene access and practices in Latin America and the Caribbean.

METHOD

literature scoping review with research protocol registered in the Open Science Framework, carried out in the bibliographic databases: PubMed, Scopus, Web of Science and Portal Regional da Biblioteca Virtual em Saúde. Data were analyzed using simple descriptive statistics and thematic analysis.

RESULTS

15 publications were included, the majority of which addressed adolescents in Brazil: 12 articles, two technical reports and a course conclusion monograph. As recurring themes in the publications, the following stand out: Access to dignified conditions for managing menstrual hygiene; Need for access to information on menstrual hygiene management; and Practices for managing menstrual hygiene.

CONCLUSION

adolescents report difficulties in accessing toilets, water and absorbent materials, and lack of information about menstrual health, including in schools, leading to school absenteeism. Thus, gaps in the Latin American scientific literature reveal inequalities and diversity in menstrual experiences intersected by categories such as gender, social class and ethnicity.

HIGHLIGHTS

(1) Lack of access to hygiene products, toilets and water for personal hygiene. (2) Invisibility of the problem of period poverty in Latin America. (3) Lack of physical structure in schools aggravates and leads to school absenteeism. (4) Menstrual health literacy was insufficient for the demands of adolescents. (5) Primary studies on menstrual hygiene in Latin America are scarce.

Systematic review of educational interventions to improve the menstrual health of young adolescent girls

OBJECTIVES

To systematically review interventions that include an element of menstrual education delivered to young adolescent girls.

DESIGN

This was a systematic review and meta-analysis. Selected articles were quality assessed using the Mixed Methods Appraisal Tool quality appraisal checklist. A meta-analysis was conducted on a subset of articles, and the effect size of the intervention was calculated using Cohen's d. A logic model was constructed to frame the effect of menstrual education interventions on menstrual health.

SETTING

Papers reporting on interventions in high-income and low-income and middle-income countries were sought.

INFORMATION SOURCES

Seven electronic databases were searched for English-language entries that were published between January 2014 and May 2020.

PARTICIPANTS

The interventions were aimed at younger adolescent girls aged 10-14 years old.

INTERVENTIONS

The interventions were designed to improve the menstrual health of the recipients, by addressing one or more elements of menstrual knowledge, attitude or practices (KAP).

ELIGIBILITY CRITERIA

Interventions that had not been evaluated were excluded.

PRIMARY AND SECONDARY OUTCOMES

The most common type of output was a difference in knowledge or skill score ascertained from a pre and post test. Some studies measured additional outcomes, such as attitude or confidence.

RESULTS

Twenty-four eligible studies were identified. The number of participants varied from 1 to 2564. All studies reported improvements in menstrual KAP. The meta-analysis indicates that larger effect sizes were attained by those that encouraged discussion than those that distributed pamphlets.

CONCLUSIONS

Education interventions are effective in increasing the menstrual knowledge of young adolescent girls and skills training improves competency to manage menstruation more hygienically and comfortably. Interactive interventions are more motivating than didactic or written. Sharing concerns gives girls confidence and helps them to gain agency on the path to menstrual health.

TRIAL REGISTRATION NUMBER

For this review, a protocol was not prepared or registered.

Effect of a health education program on puberty knowledge among visually impaired female adolescent students

Background: One of the most important aspects of life is reproductive health, which receives less attention in public policy considerations because of its sociopolitical sensitivities. The aim of this study was to evaluate the effect of a designed health education program on knowledge about puberty health among visually impaired female adolescent students during 2011 and 2015.

Methods: This quasi-experimental study was conducted on 100 visually impaired female students aged 10 to 19 years. Data collection tool was a researcher-made questionnaire. Participants were recruited using convenience sampling method from Narjes educational center in Tehran. The educational needs assessments survey was used to learn about important issues and problems faced by this group to design effective educational programs. The effectiveness of the designed program was assessed by comparing the students' knowledge at the baseline and at 1-month follow-up. Data were analyzed in SPSS V.21 by using parametric descriptive statistics. The significant level was set as p<0.05

Results: The results showed that the puberty knowledge of participants was increased in all educational domains after intervention compared to the baseline (p<0.05). The knowledge about the onset of puberty changes showed the highest increase (from 2.02 at baseline to 7.51 at follow-up) and the knowledge about personal hygiene had the least change after the intervention (from 6.67 to 8.23). The majority of students did not have any information resources regarding puberty health, and about one quarter of them reported their mother as the main resource of puberty information.

Conclusion: Providing educational programs during puberty has a crucial role in young girls’ knowledge increase. Providing a continuous health educational program that is tailored to the needs of this group of students using suitable strategies is recommended.

Case reports: Electroacupuncture decreases the climacteric symptoms by calcitonin gene-related peptide modulation

OBJECTIVE

The purpose of the current study was to evaluate the modulation of Calcitonin gene-related peptide (CGRP) associated to the efficacy of Electroacupuncture (EA) in the reduction of climacteric symptoms.

METHODS

Nine women between 51 and 59 years old with climacteric syndrome in menopause or perimenopause were included. Patients with hormone replacement therapy, psychiatric treatment with antidepressants, or acupuncture treatment in the last 3 months were excluded. A 4 Hz EA treatment was performed at acupoints Shenshu (BL-23), Pishu (BL-20), Guanyuan (REN-4), Taixi (KID-3), Fuliu (KID-7), Sanyinjiao (SP-6) and Neiguan (P-6) points. Women were treated two times a week for five consecutive weeks for a total treatment of 10 sessions. The menopause rating scale (MRS) was used to evaluate symptoms reduction and CGRP gene expression was measured before and after 10 EA session.

RESULTS

The results shown that climacteric symptoms diminish significantly after EA therapy. CGRP gene expression was down-regulated, evidencing a decrease of 5-fold after EA therapy respect to the initial condition.

CONCLUSION

EA treatment was associated with improvement in patients with climacteric syndrome and may be related to modulation of CGRP levels.

Menstruation practice among school and out-of-school adolescent girls, Lao PDR

BACKGROUND

The transition from childhood to adolescence is a critical transitional period for girls, and as they experience these changes, having knowledge of, and being able to practice, good menstruation hygiene management is crucial. The objective of this study was to understand in and out of school adolescents' menstrual hygiene management practice, sources of information and attitudes towards menstruation.

METHODS

A cross sectional, descriptive study was conducted between November 2018 and May 2019. The sampling included adolescent girls aged 11-19 years in higher secondary schools in Khammouane and Champassak provinces and out-of-school adolescent girls. Out of the total number of 433 participants enrolled in the study, only 343 girls had reached menarche and were included in the study. Factors associated with menstruation hygiene management practice were examined with bivariate and multivariate analyses.

RESULTS

Out of 343 subjects who had reached menarche, 44% reported good menstrual hygiene management practice. Over half of the participants, however, were unable to access the tools of good menstruation hygiene management practice, including having somewhere to dispose of used sanitary pads in private. Being older (16-19 years) (AOR:2.4; 95%CI 1.4 to 3.9), and having primary education (AOR 0.4; 95%CI 0.2 to 0.9) were associated with good practice as was fathers' level of education (AOR 2.1; 95%CI 1.0 to 4.1) and mother-girl discussion about menstruation (AOR 2.2; 95%CI 1.0 to 5.0). No significant differences were found between in- and out-of-school adolescents.

CONCLUSIONS

In this study, not all participants were able to practice optimal menstruation hygiene management. This is important as good menstrual hygiene management is associated with better health and being able to participate fully in education and work. Further education is needed, but it is also important to ensure that all adolescent girls have access to the necessary tools for effective menstruation hygiene management.

Unmet Needs and Experiences of Adolescent Girls with Heavy Menstrual Bleeding and Dysmenorrhea: A Qualitative Study

STUDY OBJECTIVE

To identify and examine the key areas of need and explore the experiences of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.

DESIGN AND SETTING

Qualitative interview study using semi-structured interviews. Gynaecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia.

PARTICIPANTS

Adolescent girls (12-18 years; mean age, 14.8 ± 1.5 years) presenting with heavy menstrual bleeding and/or dysmenorrhea at the clinic (N = 30).

INTERVENTIONS AND MAIN OUTCOME MEASURES

In-depth semi-structured interviews were conducted between May and August 2018. Interview data were thematically analyzed using a grounded theory approach. Themes covered experiences and unmet needs of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.

RESULTS

A total of 12 themes were identified, and covered the impact of symptoms, experiences, and/or unmet needs of these adolescents. Key themes highlighting experiences and unmet needs related to (1) coordination of healthcare, (2) day-to-day coping, (3) school, and (4) information surrounding menstrual issues. From these themes, 7 unmet needs emerged and were organized under 3 key areas of need: (1) treatment, management, and care, (2) improvements in the school environment, and (3) menstrual health as a gendered issue.

CONCLUSION

Menstrual concerns can have a profound physical and psychosocial impact on adolescents. Effective school-based menstrual education programs may be key in reducing stigma, fear, and shame surrounding menstruation, in teaching positive management strategies and in encouraging adolescents to seek help for their menstrual concerns.

Confidence to manage menstruation at home and at school: findings from a cross-sectional survey of schoolgirls in rural Bangladesh

This study investigated girls' confidence to undertake menstrual management tasks at home and in school environments using cross-sectional data from a survey of 1,359 schoolgirls in Bangladesh. At home, 57% of girls reported they were 'very confident' undertaking tasks to manage their menstrual bleeding, while this figure was only 7% at school. We assessed personal, interpersonal and environmental contributors for each context. The use of sanitary pads was positively associated with confidence to manage menstruation at home, while other menstrual hygiene practices were unrelated. In multivariable models, features of sanitation facilities such as cleanliness and the presence of a bin were associated with increased confidence at home. At school, supportive policies, such providing permission to use the toilet when needed, were associated with greater confidence. Talking to a friend about menstruation was positively associated with confidence at school, while at home having discussed menstruation with parents predicted lower confidence. Findings provide quantitative support for the role of multiple independent predictors in girls' confidence to manage menstruation highlighted by qualitative studies. There is unlikely to be a single 'silver bullet' to improving menstrual experience.

Improving Female Adolescents' Knowledge, Emotional Response, and Attitude toward Menarche following Implementation of Menarcheal Preparation Reproductive Health Education

Menarche and menstruation are considered taboos and disconcerting by communities, including female adolescents. The Menarcheal Preparation Reproductive Health Education program was designed to prepare female adolescents for menarche. The aim of this study was to identify the influence of reproductive health education on female adolescents’ preparation, knowledge, emotional response, and attitude toward menarche. The research design was a quasi-experimental, pre–post test with control group design. We selected 174 female adolescents by a stratified random sampling technique. The respondents were divided into two groups: control and intervention. The intervention group was provided Menarcheal Preparations Reproductive Health Education program in the form of a booklet, whereas the control group experienced no intervention. Data analyses involved the use of a chi-square test, McNemar test, and logistic regression. The results showed that there were significant differences in terms of knowledge (p = .001), emotional responses (p = .001), and attitude (p = .001) between the groups, as well as before and after intervention in the intervention group. Logistic regression revealed that reproductive education was the most influencing factor among female adolescents’ knowledge (OR = 45.1; 95% CI: 13.8–148.1), emotional responses (OR = 12.7; 95% CI: 5.6–28.5), and attitude (OR = 12.4; 95% CI: 5.8–26.6) toward menarche. Therefore, this study supports a recommendation of using Reproductive Health Education Related to Menarcheal Preparation in schools and community settings to prepare female adolescents for menarche.

Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: a scoping review

Objectives

This study presents a scoping review of evidence relating to knowledge and experiences of puberty and menstruation among females aged 10–14 years in low- and middle-income countries.

Methods

Forty-four items from 12 countries were identified from a systematic scoping review and screening of 8083 items. Included studies were quality assessed.

Results

A majority (40/44) of studies used school-based samples, and fifteen studies reported on interventions. Girls had inadequate knowledge about menstruation; menarche as a trigger for girls learning about menstruation was common. Adolescents struggled with menstrual hygiene. Negative emotions were associated with menarche and menstrual management. A minority of studies dealt explicitly with puberty. Most girls obtained information about menstruation and/or puberty from their mothers, although mothers were not necessarily girls’ preferred source for learning about these topics.

Conclusions

Young adolescent girls are under-prepared for puberty and menstruation. Predominantly school-based studies mean we know little about young out-of-school adolescents. The evidence base lags behind the rise in interest from practitioners as well as the development (and evaluation) of puberty and/or menstruation interventions.

Electronic supplementary material

The online version of this article (10.1007/s00038-019-01209-0) contains supplementary material, which is available to authorized users.

Qualitative Analysis of Sexually Experienced Female Adolescents: Attitudes about Vaginal Health

STUDY OBJECTIVE

To explore adolescent's perceptions of vaginal health, practices, and vaginally-placed products.

DESIGN

Semistructured interviews were audio-recorded and transcribed until theoretical saturation was achieved.

SETTING

Adolescent medicine clinics in New York City.

PARTICIPANTS

Female adolescents (N = 22) who were sexually experienced, predominately Hispanic (73%, n = 16) with a mean age of 17.7 years (range, 15-20 years).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Interviews were used to assess perspectives on vaginal health, specific vaginal hygiene practices, and attitudes about vaginally-placed products (contraceptive rings, intrauterine devices), and proposed multipurpose technologies administered as ring or gel). The interviews were transcribed and coded for relevant themes.

RESULTS

Overlapping themes included young women's view of their vagina as a space that needed to be healthy for sexual partners and future fertility. The vagina could not be presumed to be healthy and conversations about vaginal health were limited to include only specific individuals. All reported a variety of practices to maintain their vaginal health, including showering 1-5 times a day and using soaps specifically for the vagina. Attitudes about vaginally-placed products revealed concerns about the sensory experience of having a product in the vagina, safety concerns and interest in the product's objective (prevention of pregnancy or infection).

CONCLUSION

Adolescents have very specific views and practices about their vaginas. Clinicians should initiate conversations about vaginal health and hygiene with adolescents and focus on the normalcy of the vagina. Development of vaginally-placed products should focus on the sensory experience, safety, and purpose of the product.

Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia

Anemia affects approximately 25% of school-aged children (SAC-aged 5.00-14.99 years) globally. We determined in three countries the prevalence and determinants of anemia in SAC. Data on sociodemographics, inflammation and nutrition status were obtained from the 2006 Mexican National Nutrition Survey, the 2003-6 US National Health and Nutrition Examination Surveys, and the 2010 Encuesta Nacional de Nutrición Situación Colombia. In the US, vitamin A and iron deficiency (ID) were available only for girls aged 12.00-14.99 years to which our analysis was limited. Associations were evaluated by country using multivariable logistic regression adjusting for confounders and complex survey design. The prevalence of anemia and ID were: Mexico 12% (ID 18%), n = 3660; US 4% (ID 10%), n = 733; and Colombia 4% (ID 9%), n = 8573. The percentage of anemia associated with ID was 22.4% in Mexico, 38.9% in the US and 16.7% in Colombia. In Mexico, anemia was associated with ID (adjusted OR: 1.5, p = 0.02) and overweight (aOR 0.4, p = 0.007). In the US, anemia was associated with black race/ethnicity (aOR: 14.1, p < 0.0001) and ID (aOR: 8.0, p < 0.0001). In Colombia, anemia was associated with black race/ethnicity (aOR: 1.6, p = 0.005), lowest socio-economic status quintile (aOR: 1.8, p = 0.0005), ID (aOR: 2.7, p < 0.0001), and being stunted (aOR: 1.6, p = 0.02). While anemia was uniformly associated with iron deficiency in Mexico, Columbia, and the United States, other measured factors showed inconsistent associations with anemia. Additional data on anemia determinants in SAC are needed to guide interventions.