Promoting the menstrual health of adolescent girls in China

Investigating the effect of peer-led educational intervention on behaviors related to pubertal health and its determinants in high school girls of Genaveh, Iran: Application of social cognitive theory

Background Empowering adolescents in the field of puberty health is one of the important goals of public health programs. The present study was carried out with the aim of determining the effect of peer-led training on puberty-related behavior and its determinants using social cognitive theory.

METHODS

A total of 245 teenage girls were randomly divided into two groups: the intervention group and the comparison group. The questionnaire measuring puberty-related behavior and its determinants was self-administered and completed before and 2 months after training in the two groups. One session for parents, four sessions for peer educators, and four sessions for participants were conducted for 1 month.

RESULTS

In the intervention group, unlike the comparison group, the mean scores of knowledge, outcome expectations, self-efficacy, self-control, social support, and behavior increased significantly after training (p <0.05). Based on regression analysis, outcome expectations and social support were the main determinants of puberty-related behavior (adjusted R2 = 0.464).

CONCLUSION

The findings of this study support the effectiveness of the peer-led educational intervention based on social cognitive theory in the improvement of puberty-related behavior and its determinants, which can be used in the design of puberty-related health promotion programs. Further research to assess the longer-term outcomes and to examine other theories of behavior change are suggested.

Systematic review of the effectiveness of menstrual health interventions in low- and middle-income countries in the East Asia and Pacific region

Background

In the context of rapidly expanding policy and practice, this systematic review collates and appraises evidence for the effectiveness of menstrual health interventions in the East Asia and Pacific region.

Methods

Structured searches were undertaken in 7 databases and Google Scholar. Grey literature was identified through searching and survey of stakeholders. Quantitative evaluations were eligible. We audited the interventions and outcomes assessed in current evidence, undertook risk of bias assessment, and narrative synthesis of findings. The review protocol was registered prior to searching (PROSPERO: 343613).

Findings

Eighteen studies were eligible; categorised according to the requirements for menstrual health they addressed. Information and education intervention studies (n = 11) found school-based programs improved menstrual knowledge test scores but did not evaluate impacts on broader outcomes. Evaluations of interventions providing materials, facilities, and services for menstruation (n = 4) focused on product acceptability. Studies exhibited a serious risk of bias without adequate controls, limitations in intervention allocation, adherence, and participant retention. Six studies of interventions to improve care for menstrual discomforts found decreased self-reported pain but had serious bias without placebo controls. Two interventions targeted the supportive social environment for menstruation.

Interpretation

There is insufficient evidence for the effectiveness of menstrual health interventions in the East Asia and Pacific region. Future research must improve reporting, provide clear intervention theory of change, and improve measurement of core concepts. Evaluations of interventions that align with policy and practice are needed, facilitated by partnerships between researchers, government, and practitioners.

Funding

UNICEF. Reckitt Global Hygiene Institute. NHMRC.

Mixed Method Evaluation of My Vital Cycles®: A Holistic School-Based Ovulatory Menstrual Health Literacy Program

There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program's impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

The relationship between physical activity and premenstrual syndrome in senior high school students: a prospective study

Reproductive-aged women experience somatic and affective symptoms of premenstrual syndrome (PMS) which affect their daily life and work, but there are limited tracking data on senior high school-age female students. To investigate the characteristics and incidence of PMS, and to detect the relationship between physical exercise participation and PMS in female students of senior high school. A prospective study was conducted among senior high school female students aged 14-16 years. The participant was asked to finish two questionnaires. One questionnaire collected information about demographic data and PMS symptoms which were recorded on a daily calendar named Daily Record of Severity of Problems (DRSP) per day. Another questionnaire was physical exercises participation questionnaire, collecting times of physical education (PE) class participation, exercise times, exercise type participation in morning exercise and recess exercise, times of morning exercise, times of recess exercise per week, recess exercise time, and autonomous exercise participation of students. The data were prospectively recorded for three consecutive months. Odds ratio (OR) with 95% confidence intervals (CI) was performed for results of the multivariate logistic regression analysis model. A total of 233 participants completed the prospective study, 78 (33.5%) participants experienced PMS. The incidence of the participants with mild PMS was 20.2% while moderate PMS was 11.6% and severe PMS was 1.7%. The most common somatic symptom was fatigue while the most common affective symptom was cannot concentrate. Participants with PE classes less than 2 times per week were 4.43 times (OR 4.43, 95% CI 1.18-16.6, p < 0.05) more possible to experience PMS than those with 2 times PE classes per week. PMS is a frequent phenomenon in senior high school female students. Female students with 2 times PE classes per week show a lower incidence of PMS. This study encouraged senior high school-age females to take more physical exercises per week and could be helpful to create a no-pharmacology coping strategy.

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.

Menstrual Hygiene Management—Knowledge, Attitudes, and Practices Among Female College Students in Bhutan

Background: Girls and women face substantial menstrual hygiene management (MHM) challenges in low- and middle-income countries. These challenges are related to inadequate knowledge and insufficient water, sanitation, and hygiene (WASH) facilities. Currently, the literature on MHM among college-attending women in Bhutan is scarce. We aimed to explore the knowledge, attitudes, and practices (KAP) of female college students from all the 10 government colleges of Bhutan, documenting the conditions of available MHM facilities, from August to September 2018.

Methods: A cross-sectional KAP survey was conducted with a random sample of female students from all years and a random sample of MHM facilities at each college and hostel. A questionnaire was adapted from a similar study conducted with school students in Bhutan. Socio-demographics, overall KAP findings, and differences in KAP between first and final year students were analyzed; college and hostel toilets were self-reported and directly observed.

Results: In the survey, 1,010 participants completed the self-administered questionnaire. The comprehensive knowledge of menstruation was found to be low (35.5%) among participants. Half of the participants (50.3%) reported their mother as the source of information, and 35.1% of the participants agreed that women should not enter a shrine during menstruation. It was also reported that approximately 4% of median monthly pocket money was spent on the absorbents, and 96.9% of absorbents were wrapped before disposal. Half of the participants (55.1%) reported that their daily activities were affected due to menstruation, and 24.2% of the female students missed college due to dysmenorrhea. One-fifth of the participants (21.3%) reported unavailability of water in college, 80.1% of the participants reported absence of soap for hand washing, and 24.1% described no bins for disposal. The participants also reported that in 33.7% of hostel toilets, the door locks were missing. The direct observations also had similar findings.

Conclusions: Female students living in hostels during college years lose considerable resources during their formative years of learning, such as time, energy, and money, due to issues of menstruation management. Although the overall understanding of menstruation was low, the MHM practices of our participants scored highly, and the vast majority of them asked for a platform to discuss menstruation. Despite some agreement with menstrual taboos (e.g., visiting shrine), only 5.1% of the participants were uncomfortable conversing about MHM. Improved public health knowledge, psychosocial/medical support, and WASH infrastructure with freely available menstrual products could lead to more effective MHM practices among female college students.

Adolescent Menstrual Health Literacy in Low, Middle and High-Income Countries: A Narrative Review

Background: Poor menstrual health literacy impacts adolescents’ quality of life and health outcomes across the world. The aim of this systematic review was to identify concerns about menstrual health literacy in low/middle-income countries (LMICs) and high-income countries (HICs). Methods: Relevant social science and medical databases were searched for peer-reviewed papers published from January 2008 to January 2020, leading to the identification of 61 relevant studies. Results: A thematic analysis of the data revealed that LMICs report detrimental impacts on adolescents in relation to menstrual hygiene and cultural issues, while in HICs, issues related to pain management and long-term health outcomes were reported more frequently. Conclusions: In order to improve overall menstrual health literacy in LMICs and HICs, appropriate policies need to be developed, drawing on input from multiple stakeholders to ensure evidence-based and cost-effective practical interventions.

The Effects of a Dysmenorrhea Support Program on University Students Who Had Primary Dysmenorrhea: A Randomized Controlled Study

STUDY OBJECTIVE

This study aims to determine the results of a cognitive-behavioral approach in a dysmenorrhea support program that covers the symptoms, acquaintance, and attitudes toward menstruation of university students who had primary dysmenorrhea.

DESIGN AND SETTING

This randomized controlled, prospective, experimental study was carried out in a nursing school using a pretest-posttest design.

PARTICIPANTS

A total of 682 female nursing students and 584 volunteers from the 2017-2018 academic year participated in a study of the prevalence of primary dysmenorrhea (94.0%). Study subjects were first-year female nursing students who scored severe on a visual analog scale for primary dysmenorrhea. As a result of the analysis, 80 female nursing students were assigned to study and control groups. A total of 60 students, 29 in the study group and 31 in the control group, completed the study.

INTERVENTION

The study group participated in a 6-session cognitive-behavioral approach in a dysmenorrhea support program. No intervention was administered to the control group. The control group and the study group were followed by using data collection forms during three menstrual cycles.

OUTCOME MEASURES

The Participant Introductory Form (PIF), Dysmenorrhea Follow-up Form (DFF), Dysmenorrhea Information Form (DIF), Functional and Emotional Dysmenorrhea Scale (FEDS), Visual Analog Scale (VAS), and Menstrual Attitude Questionnaire (MAQ) were used to measure outcomes.

RESULTS

In the case of primary dysmenorrhea, the use of nonpharmacological methods was higher in the study group than in the control group. In the third cycle, although the rate of analgesics use was 20.7% in the study group, it was 50% in the control group. Primary dysmenorrhea symptoms, pain levels, and analgesic use decreased. No change was observed in the attitude toward menstruation.

CONCLUSION

A cost-effective, reliable, cognitive-behavioral approach-based dysmenorrhea support program can be used to relieve symptoms, decrease the use of analgesics, and increase knowledge about primary dysmenorrhea.

Efficacy and safety of over-the-counter analgesics for primary dysmenorrhea: A network meta-analysis

BACKGROUND

Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea.

METHODS

The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities.

RESULTS

Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac.

CONCLUSION

Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.

Absenteeism during Menstruation among Nursing Students in Spain

Absenteeism can clearly have a negative impact on academic performance among university students. Certain experiences or symptoms such as menstrual pain are very common in women and can lead to absenteeism. The current study was aimed at examining the presence of menstrual experiences or symptoms and their impact upon absenteeism among healthy (illness-free) female university nursing students in Spain. A total of 299 students participated in this research, which was a descriptive cross-sectional, observational study. An ad hoc online questionnaire was used based on sociodemographic and gynecological data, together with the noted menstrual experiences; the most prevalent of which were bloating, which affected 87.3% of students; dysmenorrhea and irritability, which affected 76.3%; and fatigue, which affected 70.6%. Students with dysmenorrhea had a 6.95 higher (odds ratio (OR) 6.95; 95% confidence interval (CI) 3.39-14.25) odds of absenteeism; in those who reported dizziness, the odds of absenteeism was 4.82 times higher (OR 4.82; 1.76-13.23); in those who manifested nausea and vomiting, the percentage of absenteeism was 3.51 higher (OR 3.51; 95% CI 1.51-8.15); in those who presented sleep alterations, the odds were 2.95 higher (OR 2.95; 95% CI 1.39-6.25); and for those who felt depressed the odds were 2.18 times higher (OR 2.18; 95% CI 1.21-3.94) Absenteeism was found to be more likely in women with dysmenorrhea. However, in addition, higher odds of absenteeism were also found in women with nausea and vomiting, dizziness, sleep disorders, and those who feel depressed. These menstrual experiences can be considered a relevant problem among young women, leading to absenteeism, and a negative influence on academic performance. It is essential to raise awareness of the socioeconomic impact of absenteeism and establish new strategies for improving menstrual experiences.

Status and Factors of Menstrual Knowledge, Attitudes, Behaviors and Their Correlation with Psychological Stress in Adolescent Girls

BACKGROUND AND OBJECTIVE

Adolescent girls perceive menstruation as a negative experience, which can affect adolescents' physical and mental health. The aims of this study were to describe the menstrual knowledge, attitudes, and behaviors of adolescent girls in China and to examine their association with psychological stress. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A cross-sectional study was conducted among 1349 adolescent girls aged 11-14 years in Changsha, China. Participants anonymously completed questionnaires that assessed sociodemographic characteristics, menstrual knowledge and attitudes, dysmenorrhea self-care behaviors, and perceived stress. One-way analysis of variance and Pearson r correlation and multiple linear regression analyses were conducted to examine the differences and associations among variables.

RESULTS

The mean age of menarche was 11.70 (±0.82) years. A total of 1053/1349 (78.1%) of girls had a knowledge of menstruation before menarche and their mothers were the main source 931/1349 (69.0%) of their knowledge. More than half (53.4%) of adolescent girls experienced different degrees of dysmenorrhea. The mother's education, family monthly income, family type, and the girls' age, grade, menstrual status, age at menarche, sanitary napkin change frequency, menstrual restrictions, and dysmenorrhea influenced menstrual knowledge, attitudes, and practice. Psychological stress was affected by age, grade, age at menarche, sanitary napkin change frequency, menstrual restrictions, dysmenorrhea, and menstrual knowledge, attitudes, and practices.

CONCLUSION

Psychological stress management during menstruation should be a focus of health education programs for adolescent girls. During adolescence, health care providers should not only pay attention to the physical changes of adolescence girls, but also provide stress management skills to help them cope with menstrual-related concerns.

Educational interventions to improve menstrual health: approaches and challenges

BACKGROUND

Inappropriate menstrual care practices result in adverse health consequences among girls. Developing and implementing interventions that minimize these adverse consequences and facilitate development of healthy menstrual behavior are a priority for any nation.

OBJECTIVES

This study aimed at collating, summarizing and reviewing evidence to assess the effectiveness of interventions to improve menstrual health and the challenges faced in doing the same.

METHODS

A systematic review of studies published in peer-reviewed journals and project reports was conducted. Intervention studies related to menstrual health management conducted from 2007 to 2018 were analyzed. A total of 27 interventions conducted among young girls in different countries were identified and study characteristics and outcomes were reviewed.

RESULTS

Different intervention studies used a variety of methods like lectures, discussions, demonstrations using multiple audio-visual aids and provision of resources like menstrual cups, sanitary pads and washing soap to spread awareness about menstrual hygiene. Most of the interventions reported a positive impact on the awareness and menstrual practices of girls. However, in a few studies no significant change was observed in the attitude regarding regular bathing, practices related to self-medication for dysmenorrhea and socio-cultural taboos.

CONCLUSION

This review of literature has offered insights into the scope and development of future interventions so that apart from increasing awareness and knowledge on menstrual health issues, sustained behavior change can be brought about among girls to improve their health.

Developing and trialling a school-based ovulatory-menstrual health literacy programme for adolescent girls: a quasi-experimental mixed-method protocol

INTRODUCTION

A review of international and Australian school-based resources suggests that teaching of the ovulatory-menstrual (OM) cycle is predominantly couched in biology. A whole-person framework that integrates spiritual, intellectual, social and emotional dimensions with the physical changes of the OM cycle is needed to facilitate adolescent OM health literacy. This paper describes the protocol for a study that aims to develop and trial an intervention for adolescent girls aged 13-16 years that enhances positive attitudes towards OM health coupled with developing skills to monitor and self-report OM health. These skills aim to foster acceptance of the OM cycle as a 'vital sign' and facilitate confident communication of common OM disturbances (namely, dysmenorrhoea, abnormal uterine bleeding and premenstrual syndrome), which are known to impact school and social activities.

METHODS AND ANALYSIS

Phase I will comprise a Delphi panel of women's health specialists, public health professionals and curriculum consultants and focus groups with adolescent girls, teachers and school healthcare professionals. This will inform the development of an intervention to facilitate OM health literacy. The Delphi panel will also inform the development of a valid and reliable questionnaire to evaluate OM health literacy. Phase II will trial the intervention with a convenience sample of at least 175 adolescent girls from one single-sex school. The mixed-method evaluation of the intervention will include a pre-intervention and post-intervention questionnaire. One-on-one interviews with teachers and school healthcare professionals will expand the understanding of the barriers, enablers and suitability of implementation of the intervention in a school-based setting. Finally, focus groups with purposively selected trial participants will further refine the intervention.

ETHICS AND DISSEMINATION

The study findings will be disseminated through local community seminars, conferences, peer-review articles and media channels where appropriate. The Curtin University of Human Research Ethics Committee has approved this study (approval HRE2018-0101). This project is registered with the 'Australian and New Zealand Clinical Trials Registry'.

TRIAL REGISTRATION NUMBER

ACTRN12619000031167; Pre-results.

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.

Effects of Menstrual Self-management Education Program on Knowledge and Behavior of Menstrual Self-management in High School Girls

PURPOSE

To examine the effect of menstrual self-management education program on knowledge and behavior of menstrual self-management in high school girls.

METHODS

With a randomized controlled trial, 100 high school girl students were randomly assigned into experimental group and control group. Menstruation self-management program was consisted of a total of four sessions of education program (1 hour of education per session). Control group only received the first class of education. Measurement tools were 20-item menstrual knowledge scale and 12-item women's genito-urinary hygiene scale. Pretest and post-test questionnaires were administered.

RESULTS

There were significant differences in menstrual knowledge as well as menstrual self-management behavior between the two groups. The experimental group showed significant improvement in both menstrual knowledge score (t=13.37, p < .001) and menstrual self-management behavior score (t=8.38, p < .001) than the control group.

CONCLUSION

Results of this study suggest that the monthly self-management education program is effective in increasing the knowledge of menstruation of female high school students and enhancing their performance. This program needs to be implemented as a part of high school's standard sex education. Further study is needed to analyze follow-up effects of the program on self-management behavior of students after at least one menstrual cycle.

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.

Menarche, menstrual problems and suicidal behavior in Chinese adolescents

BACKGROUND

Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents.

METHODS

An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality.

RESULTS

The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10-1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00-1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05-1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06-1.66).

LIMITATIONS

This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents.

CONCLUSIONS

Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in adolescents.