Prevalence of Menstrual Problems among Adolescent School Girls in Rural Tamil Nadu

Longitudinal associations of menstrual characteristics with mental health problems among Chinese girls

Cross-sectional studies indicate that menstrual problems are related to poorer mental health; however, longitudinal studies are limited. This longitudinal study aimed to determine whether baseline menstrual characteristics were risk factors for incident and persistent mental health problems. The study was conducted among Chinese adolescent girls. Menstrual characteristics including menarche, menstrual cycle and menstrual pain were assessed at baseline, whereas mental health problems including PTSD, depression, anxiety, ADHD, insomnia, psychotic-like experiences, non-suicidal self-injury, suicide ideation, suicide plan, and suicide attempt were assessed at baseline (n = 1039) and at the 1-year follow-up (n = 946) by self-administered, structured questionnaires. Multiple logistic regressions were performed to examine whether menstrual characteristics were associated with incident (e.g., PTSD at follow-up but not baseline) and persistent (e.g., PTSD at both time points) mental health problems. The results demonstrated that early menarche was related to persistence of psychotic-like experiences; irregular menstruation was associated with higher rates of incident anxiety and insomnia, and persistent depression, anxiety, ADHD, insomnia, non-suicidal self-injury, suicide ideation, and suicide plan; menstrual pain was associated with elevated rates of incident PTSD and depression, and persistent depression, insomnia, psychotic-like experiences, non-suicidal self-injury, suicidal ideation, suicide plan, and suicide attempt. In conclusion, irregular menstruation and menstrual pain specifically contributed to the development of emotional problems and insomnia, and were associated with maintenance of the most mental health problems in early adolescence. The long-term effects of menstrual problems on mental health need further study.

Understanding Adolescent Gynecological Issues: A Cross-Sectional Study at a Tertiary Care Center

BACKGROUND AND OBJECTIVES

Adolescence is a crucial phase in a woman's life, as it signifies the beginning of her reproductive journey. During this time, there are notable variations in sexual development and a sense of caution that can present challenges for healthcare providers. The rationale for studying adolescent gynecological problems lies in the need to understand and address the unique reproductive health challenges faced by young girls. By investigating these issues, researchers and healthcare professionals can develop effective strategies for prevention, early detection, and treatment of gynecological conditions in adolescents. This knowledge is crucial for promoting the overall well-being and reproductive health of young girls, ensuring they receive appropriate care and support during this critical stage of development. This study focuses on identifying the most common gynecological issues in teenagers, exploring the root causes, examining the available treatment options, and understanding how they are managed at a tertiary care facility.  Methods: This cross-sectional observational study took place at a tertiary care center and focused on gynecological issues in adolescent females who sought care at the gynecology department from January 2016 to December 2022. The study participants were categorized into three groups: early adolescence (10-13 years), middle adolescence (14-16 years), and late adolescence (17-19 years) for analysis. Ethical approval was obtained for this hospital-based research, which involved examining, investigating, and treating the study participants.

RESULTS

Out of the 49,700 new female patients, 2000 (4.02%) fell within the specified age range. The average age of the participants was 16.87±2.16, and the majority of them sought help for menstrual issues (63.45%), followed by abdominal discomfort (15.6%) and vaginal discharge (7.2%). Menstrual disorders were the most common concern, with dysmenorrhea and puberty menorrhagia being prevalent issues. Abdominal pain was caused by various factors, such as urinary tract infections, ovarian tumors, pelvic inflammatory disease, endometriosis, and endometrial tuberculosis. The majority of cases were treated conservatively, with only a small percentage requiring surgical intervention.

CONCLUSION

The significance of early detection and intervention in addressing gynecological issues among adolescents is highlighted in the findings of this research, underscoring the necessity for specialized healthcare services that cater to the specific needs of this demographic. Adolescent gynecology plays a crucial role in safeguarding the reproductive health and overall well-being of young women, emphasizing the importance of seeking assistance proactively.

Menstrual symptoms and subjective well-being among postmenarchal adolescents

BACKGROUND

Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated.

OBJECTIVE

This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents.

STUDY DESIGN

A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses.

RESULTS

Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, -17.3; 95% confidence interval, -22.4 to -12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls with severe symptoms (mean difference for: dysmenorrhea, -20.72; heavy bleeding, -15.75; irregular periods, -13.81; mood disturbance, -24.97; other general symptoms, -20.29), but significant differences were observed even for moderate or mild symptoms. The composite menstrual health index was significantly associated with World Health Organization Five Well-Being index scores in regression analysis, independently of age, age at menarche, body mass index, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status.

CONCLUSION

Despite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.

Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study

BACKGROUND

Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes.

METHODS

Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes.

FINDINGS

4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β -3·34, 95% CI -7·04 to 0·37).

INTERPRETATION

Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem.

FUNDING

Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.

Knowledge, attitude and practice of adolescent girls towards reproductive health: a cross-sectional study in Turkistan region, Kazakhstan

Background: Reproductive health of adolescent females is an important health concern. Aim: To determine the impact and the knowledge, attitude and practice of female adolescents toward reproductive health. Materials & methods: This is a survey based cross-sectional study conducted in Turkistan region. Results: A total of 1250 participants were included with a mean age of 17.3 ± 1.4 years, and >80% of the participants have completed high school. A total of 1191 girls had the onset of menarche at approximately 13.2 years old, and 85.7% reported menstrual disorder. Conclusion: There is poor knowledge and practice of reproductive health among participating adolescents. Alcohol consumption, high BMI, bad family relationships and lack of gynecological visits were found to negatively affect reproductive health.

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.

Association between early menarche and suicidal behaviors in Korean girl adolescents

Early menarche can be the socio-psychological problems. We studied the association between early menarche and suicidal risk behaviors among South Korean girl adolescents using national-wide data.Web-based self-report data from 2006 to 2015 the Korea Youth Risk Behavior Web-based Survey data were used in this study. Menarche status was divided into an "early menarche" group (at <12 years of age) versus "not early" menarche group (at ≥12 years of age).Participants with adolescent girls with early menarche group showed a higher prevalence of substance use, higher levels of stress, poorer self-rated health status, unhappier perceiveness, more frequent depressed mood, inter-sexual kissing or petting, inter-sexual intercourse, homosexual kissing or petting, being the victim or the assailant of sexual assaults, sexual transmitted diseases experience, pregnancy, and abortion experience than the not early menarche group. Adolescent girls with early menarche who had suicidal ideation (25.4% vs 22.2%, P < .001), suicidal plans (4.1% vs 2.6%, P < .001), and suicidal attempts (6.8% vs 5.2%, P < .001) were higher than that in the adolescent girls with not early menarche. A multivariate analysis after adjusting revealed that the odds ratios for suicidal ideation, plans, and attempts were 1.07 (95% confidence interval [CI]: 1.05-1.10), 1.35 (95% CI: 1.28-1.41), and 1.13 (95% CI: 1.09-1.18), respectively.Adolescent girl with early menarche was associated with suicidal behaviors.

A qualitative study of adolescent girls' experiences of menarche and menstruation in rural Tamil Nadu, India

Background: In low- and middle-income countries, women and girls experience menstrual hygiene management-related health and social challenges such as urinary tract infections, social stigma, and school and workplace absenteeism.

Purpose: In this study, we sought to explore how adolescent girls in rural Thirumalaikodi, Tamil Nadu, India experience menarche and menstruation, how their experiences connect to the sociocultural context, and what strategies they use to manage menstruation. This study also informed the adaptation and development of a school-based water, sanitation, and hygiene intervention.

Methods: We conducted ten semi-structured qualitative interviews with adolescent girls in ninth standard from June-July 2018. Data were analysed using a thematic network approach.

Results: Findings revealed that menarche inaugurates biological transitions of puberty and cultural codes that shape gender norms. Gender norms in turn generate, maintain, and reproduce stigmatizing attitudes, beliefs, and practices that influenced the development of coping mechanisms at home and at school. Resulting adaptations to the intervention consisted of two activities (school lesson and an extracurricular activity) that address knowledge gaps and myths.

Conclusions: This study demonstrates the importance of qualitative research in unpacking adolescent girls’ experiences with menarche and menstruation. Study findings also show how formative research can contribute to the adaptation and development of a contextually and culturally-relevant water, sanitation, and hygiene intervention.

Menstrual disorders and quality of life of women in an urban area of Puducherry: A community-based cross-sectional study

Background:

Menstrual disorders are common among women in reproductive age group and affect their normal functioning and social life. Due to cultural reasons, menstrual problems often get unreported. In India, the literature on the effect of menstrual disorders on the quality of life (QOL) of women is limited.

Objectives:

To estimate the prevalence of menorrhagia and dysmenorrhea among women in an urban field practice area and to compare their QOL with women without menstrual disorders.

Methods:

This is a community-based cross-sectional study among women who have attained menarche and not yet attained menopause in an urban field practice area of a tertiary care teaching institute in Puducherry. Households were selected by systematic random sampling, and a door-to-door survey was done using an Android-based mobile phone app Epi Info. A pretested questionnaire was used for collection of sociodemographic details. QOL was measured using World Health Organization BREF scale.

Results:

A total of 119 women were interviewed, and their mean (standard deviation) age was 33 (10) years. The majority was homemakers (63%), belonging to lower socioeconomic status (60%) and one-fifth had no formal education. The prevalence of dysmenorrhea was 45% [95% confidence interval (CI): 36.6%–54.4%] and that of menorrhagia was 17% (95% CI: 11.6%–25.3%). QOL in women with dysmenorrhea was poor compared with normal women in physical, psychological, social, and environmental domains (mean score 57.9 vs. 69.7, P < 0.001).

Conclusions:

Prevalence of dysmenorrhea and menorrhagia is comparatively high in this study area. QOL of women with these disorders was poor.