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ISSN: 2380-5439
Journal of Health Education Research & Development
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A Random Survey of Menstrual Problems in Allithurai and Lalgudi Areas of Tiruchirapalli District

Kavitha T*
Vellalar College for Women, Thindal, Erode, Tamil Nadu-638012, India
Corresponding Author : Kavitha T
Assistant Professor of Zoology
Vellalar College for Women, Thindal
Erode, Tamil Nadu-638012, India
Tel: + 0424 224 4101
Email: [email protected]
Received: May 13, 2015 Accepted: August 21, 2015 Published: August 24, 2015
Citation: Kavitha T (2015) A Random Survey of Menstrual Problems in Allithurai and Lalgudi Areas of Tiruchirapalli District. J Health Edu Res Dev 3:134. doi:10.4172/2380-5439.1000134
Copyright: © 2015 Kavitha T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

A survey was carried out to study the common menstrual problems faced by women during their menstural period. 210 individuals of Allithurai and Lalgudi areas of Tiruchirappalli district were interviewed personally with a standard questionnaire. The statistical analysis was performed using SPPS software. The level of significance was analyzed using chi-square test where the results emphasized that 31.4% had their first menses at the age of 14, maximum number of respondents (68.6%) experiences pain and 68% showed medium bleeding. Most of them experienced psychological problems which affects their routine life. The most prevalent psychological symptom is anger (35.7%). Of the individuals surveyed most of them (92.9%) had a regular menstrual cycle with less abnormality. Marriage has a significant effect on bleeding, bleeding in between two successive periods, days of menses, pain, fatigue, increased appetite, fainting, indigestion and forgetfulness. Area also had a significant effect on many of the symptoms surveyed. The women residing in Allithurai area had shown significantly higher irregular periods.

Keywords
Menstrual problem; Tiruchirappalli; Psychological symptoms; Irregular periods; Fainting; abnormality; Standard questionnaire
Introduction
Menstrual problems are the major gynaecological problems which occur frequently in majority of women. Menstrual problems affect the physiology, psychology and well-being of a woman. By knowing what type of symptoms and when to expect symptoms, help women to schedule her activities. The problems may be due to heredity or hormonal imbalance.
The menstrual cycle is the monthly physiological change that occurs in woman who attained menarche. Normal menstrual cycle is maintained by both endocrine and reproductive system. The menstrual cycle can be divided into several phases namely menstrual phase, follicular phase, ovulation and luteal phase.
Menstruation is the physiologic shedding of endometrium. It is also called menstrual bleeding or menses, periods or catamenia. Follicular phase, also called proliferative phase during which the ovarian follicles are stimulated to mature. The matured follicle is called Graafian follicle, which undergoes changes to form ovum. Ovulation is a process in which the ovum is released from the ovary. Luteal phase is also called secretary phase, during which the corpus luteum is formed. It secrets several hormones.
Menstrual problems
The menstrual problems are not always problems but bodily reactions to various changes inside. Most of the women have some symptoms or a combination of a few or all of them, which may be either physical or emotional. The most common external symptoms of menstrual period are acne. It can be on the face or on any other part of the body and can be bothersome for a week before the periods. They feel disinterested and tired 3 days before (PMS) and during the periods. Insomnia or change in appetite is also a part of menstrual cycle.
Some women experiences back ache, headache or abdominal pain during their menstrual cycle. Joint pain or muscle pain also occurs to some women. Pain around the breasts, swelling, soreness or heaviness also occurs during menstruation. Abdominal cramps are the worst among the menstrual pains that really bother all activities. These are caused by the involuntary contraction of the uterine muscles. Women tend to have mood swing, anxiety, depression or aggression along with physical stress during those days.
According to the abnormality of the menstrual cycle, they are classified as
Menorrhagia – It is a heavy and prolonged periods, i.e. the bleeding which continues above 8 days.
Metrorrhagia – Irregular timing of the menstrual periods usually more frequent.
Menometrorrhagia – Irregular, frequent periods with heavy bleeding.
Oligomenorrhea – Less than 8 periods a year, or the cycle coming less frequent than every 35 days.
Dysmenorrhea – Painful periods i.e. periods with severe abdominal pain, nausea, diarrhea or heavy blood loss may co – exists.
Amenorrhea – Absence of periods.
Euromenorrhea – Menstrual cycle that has no abnormalities of flow, timing or pain.
By reviewing the literature on these aspects, it was found that in last two decades many surveys were carried out on the prevalence of menstrual problems in various parts of the world [1-6].
Demier et al. performed a study on dysfunctional uterine bleeding and other menstrual problems of secondary school students in Adana, Turkey. Age at menarche and menstrual problems were studied. Dysmenorrhea was experienced by 38.7% of the girls and 41% uses pain killers during menstruation, half of them used the drugs on consultation with their family members, while other half had taken self-medications. Most of the students discussed their menstrual problems with their mothers [7].
Warner et al. made a cross sectional survey of symptoms, reasons for referral and management of menstrual problems. Most of the individuals visited the clinics mainly due to menstrual loss. Some have undergone hysterectomy due to heavy bleeding [8].
Sharma and Gupta [9] performed a survey on menstrual pattern and abnormalities in high school girls of Dharan. Majority had spasmodic dysmenorrhea, among which only 20% experiences disturbances in their daily activities. The majority of students are ignorant about abnormal menstruation.
Demerath et al. studied recent decline in age at menarche. They found that the decline in age at menarche is due to increased Body Mass Index (BMI) during childhood or adolescence [10].
In 2006 Lee et al. did a cross-sectional analysis of menstruation among adolescent school girls in Malaysia, in which 75% of individual’s experiences premenstrual syndrome and 69% showed dysmenorrhea [11].
Cakir et al. [12] surveyed menstrual pattern and common menstrual disorders among university students in Turkey. Their survey concluded that the prevalence of dysmenorrhea and menstrual irregularity was considerably high. Most adolescents have inappropriate and insufficient information about menstrual problems.
A study was carried out on “What aspect of periods are most bothersome for women reporting heavy menstrual bleeding?” by Santer et al. [13]. Their survey showed a result that, pain is the most bothersome aspect of menstrual cycle followed by heaviness, mood changes, tiredness, etc.
Wiksten et al. studied on menstrual disorders and associated factors among adolescent girls visiting youth clinic [14]. Menstrual disturbances are often due to immaturity of the hypothalamic-pituitary-gonadal axis. The girls with secondary amenorrhea showed more frequent hypothalamic inhibition of the gonadal axis and the occurrence of polycystic ovary syndrome was common in the oligomenorrheic girls.
Anastaskis et al. performed a similar type of survey on menstrual problems in university students at London, through e-mail questionnaire. Their results show that those with heavy and painful periods and individuals even with light periods had an impact on their academic and social life [15].
Chan et al. studied the menstrual problems and health seeking behavior in Hong Kong Chinese school girls [16]. Their study acknowledges that, there is high prevalence of menstrual symptoms and dysmenorrhea as the gynaecological age increases. They also stated that these problems disrupt the daily activities of the girls, and these girls have a very poor knowledge about menstruation. The management of menstrual problems was studied by Fraquher, RCOG, Prentic and Grant et al. [17-20].
Factors affecting menstruation is studied by Parazzini et al. Sundell et al. Montero et al. and Hornsby et al. [21-24]. As reviewed from the literature the menstrual problems among women are most prevalent which is least considered. Survey regarding menstrual problems in India especially in South India is scanty. Many ladies are embarrassed and view periods as being intensely private events that are not up for discussion. Some are reticent because they are apprehensive about the medical tests they may have to undergo. There are many myths, cultural beliefs, ignorance and embarrassment shrouded in a fog. To disperse this fog a survey has been conducted in and around Allithurai of Tiruchirappalli city and Lalgudi area of Tiruchirappalli district.
Material and Methods
A survey was carried out to study various menstrual problems experienced by the girls and women with the age group between 12–35 years. A questionnaire was designed and the women with the age up to 35 were interviewed personally and their details are collected.
Place of survey
Personal report of 210 women was collected from Allithurai and Lalgudi areas of Tiruchirappalli.
Questionnaire
Name:
Age:
Marital status:
Age of menarche:
Menstrual period: Regular/ Irregular
If irregular: Twice in a month/ Once in 3 months/
Once in 6 months/ Once in 9 months/
Once in a year/Never have bleeding after 1st period
Days between two: More than 28 days/ 28 days/
successive periods Less than 28 days
Period of menses: 1 day/ 1-3 days/ 5 days/ 7 days
Bleeding: Light/ Medium/ Heavy
Bleeding /spotting
between the periods: Yes/No
Pain during menstrual periods: Yes/ No/ Sometimes
Stomach pain: Intense/ Less intense/ Sometimes
Pain in the hip: Intense/ Less intense/ Sometimes
Pain in arms: Intense/ Less intense/ Sometimes
Pain in legs: Intense/ Less intense/ Sometimes
Pain in joints: Intense/ Less intense/ Sometimes
Chest pain: Intense/ Less intense/ Sometimes
Days of severe pain: 1st day/ 2nd day/ First 3 days/
All the days
Physiological symptoms
Head ache: Intense/ Less intense/ Sometimes
Fatigue: Intense/ Less intense/ Sometimes
Nausea or vomiting: Intense/ Less intense/ Sometimes
Dizziness: Intense/ Less intense/ Sometimes
Constipation/loose bowels/diarrhea: Intense/ Less intense/ Sometimes
Increased appetite: Intense/ Less intense/ Sometimes
Fainting: Intense/ Less intense/ Sometimes
Indigestion: Intense/ Less intense/ Sometimes
Psychological symptoms
Anxiety: Yes/ No/ Sometimes
Confused: Yes/ No/ Sometimes
Depression: Yes/ No/ Sometimes
Forgetfulness: Yes/ No/ Sometimes
Irritability: Yes/ No/ Sometimes
Difficulty in concentrating: Yes/ No/ Sometimes
Mood swing: Yes/ No/ Sometimes
Anger: Yes/ No/ Sometimes
Have symptoms as before marriage: Yes/No
Treatment
Taking treatment: Yes/ No
Type of treatment: Drugs/ Hormones/ Others
Taken tablets to post – pone periods: Yes/ No/ Sometimes
Any other major disease: Yes/ No
Mention the disease: ______________________
Statistical analysis
The data collected from the individuals are fed on the SPSS (Statistical Package for Social Studies) for further analysis. The following
CHI – Square Test
The study is analyzed for the level of significance with respect to various factors using Chi–square test. The test emphasizes that if the difference is lesser then the significance level is greater that is the factor have a significant relation with other factors that was analyzed. The difference is analyzed at different probability levels according to the level of confidence.
Results
A total of 210 members were interviewed randomly in and around the areas of allithurai, Lalgudi and other places. Among the respondents about 33.8% of women belong to the age group of 21–25, and in the age group of 16–20 & 26–30 the percentage of respondents are 22.4 and 21 respectively. When marital status was taken in account the number of married and unmarried respondents are more or less equal with the percentage of 51% & 49% respectively.
The age of menarche of these women was studied of which 31.4% had their first menses at the age of 14, 12.8% of women obtained menarche at 16th year and above. The prevalence of irregular menstrual period was too low i.e. 7.1% of which about 3.3% women experiences menstrual periods twice in a month and 2.9% have their menses once in 3 months (Table 1).
About 51.4% of women have the menstrual cycle of more than 28 days. 28 days cycle was found in 2.5% of cases whereas only 19% of women experiences less than 28 days of menstrual cycle. And the period of menses is nearly normal in majority of the respondents with the period length of 5 days. Only 7.6% have bleeding more than 5 days (Table 1).
The bleeding range is also medium in majority of the respondents (68%) and only 1.9% women experiences bleeding or spotting in between the periods (Table 1).
Prevalence of pain was studied among the women of which majority (68.6%) of them experiences pain during their menstrual periods. Stomach pain and hip pain was found to be more common followed by pain in arms and legs. Chest pain is found in very meager amount of cases. And the days of severe pain seems to be the 1st day of the menses, which was reported by 55.7% of cases (Table 2a).
Some of the other physiological symptoms such as head ache, fatigue, vomiting, dizziness etc are also studied of which fatigue (35.8%) is more prevalent compared to other symptoms (Table 2b and Figure 1).
Among the psychological symptoms, 18.6% experiences anxiety, 13.3% have a confused condition during their menses. Depression was seen in 21.9% of cases, 9.5% reported to have forgetfulness, 21% experiences irritability, followed by difficulty in concentrating (18.1%) and mood swing (11%). Of which the most prevalent symptoms is anger which is reported in 35.7% of individuals (Table 3).
Age of women have a significant relationship (P<0.05) with period of menses, bleeding, pain during the period, hip pain, pain in legs and depression. Whereas age has no significant effect on other menstrual problems like irregular periods, stomach pain, pain in arms & joints, chest pain head ache, fatigue, dizziness, constipation, fainting, indigestion, confusion, irritability, mood swing and anger (Table 4 and Figure 2).
Prevalence of bleeding, bleeding between periods, period of menses, stomach pain, pain in arms, head ache, fatigue, increased appetite, fainting, indigestion and forgetfulness increased significantly with the marriage (P<0.05). Irregular periods, stomach pain, hip pain, joint and chest pain, vomiting, constipation or loose bowel, anxiety, confusion, depression, irritability and mood swing have not increased significantly with marriage (Table 5).
Women living in Allithurai area have shown significantly higher irregular periods, stomach pain, pain in arms, legs and joints. Head ache, nausea and vomiting, constipation, increased appetite, indigestion, confusion and depression. Whereas other symptoms are not significant. In the Allithurai area there is a large Modern rice mill affecting the quality of women living in that area (Table 6).
Discussion
Menstrual disorders were found to be more common among majority of women. Especially the disorders are prevalent among young girls which were mainly due to the immaturity of the hypothalamic–pituitary gonadal axis. Eating disorders was another reason for the prevalence of amenorrhea [14].
Age at menarche is another critical factor that brings forth several irregularities. From the studies it was found that the age at menarche has been lowered very much for the past 40 to 50 years. The decline in the age at menarche was mainly due increased BMI during childhood [10,25]. In the present study 31.4% of the women had their menarche at the age of 14 years (Table 1 and Figure 3) 21% at thirteen years and 23.3% had at fifteen years. The clinical report of AAP & CAHC showed that in different population of world the median age of menarche is 12–13 years [26]. For black females it is 12.06 years for Hispanics with 12.25 years and non-Hispanics with 12.55.
According to World Health Organization International and Multicenter study of 3073 girls, the median length of the first cycle after menarche was 34 days with 38% of cycle lengths exceeding 40 days. So the irregular menstrual cycle in young girls may not be taken in account, since they vary from 34 days to even more than 60 days followed by their first and second menses [27]. In the present survey, 51.4% have been showing a menstrual cycle of more than 28 days and 29.5% with 28 days cycle and less percentage have been showing a short cycle.
According to National Health Interview Survey (NHIS) both the premenstrual and menstrual effects produced emotional distress among 19% of the surveyed individuals.
In the present work 45.2% were reported to be having the period of menses for 1-3 days and 44.8% for 5 days, only 24 % have the period of 1 day & 7.6% have all the seven days. The duration between two successive periods is more than 28 days for 51.4% women. A survey carried out in Turkey by Cakir et al. also conveys a similar result with 27.7 ± 2.5 days duration between two successive periods and 5.8 ± 1.4 days of menstrual flow [12].
Survey in Trichirappalli district shows that 68.6% women experiences pain during their cycle, intense stomach pain (23.8%), intense hip pain (25.7%) and intense leg pain (23.3%). 80% of respondents have no head ache, 94.8% have no chest pain & 84.3% have no pain in joints. Pitts et al. have reported high rates of pelvic pain in Australian women. Among 4366 women 15% of them reported severe pain with dysmenorrheal, 7.3% women with dyspareunia & 20% of women with chronic pelvic pain [28].
In the present survey, 68% of the women reported to have a normal menstrual flow. About 13.3% & 18.7% of women have light and heavy flow respectively. A similar type of study was carried out by Yuen et al. in which they reported that 75% of girls had a menstrual flow (16). Heavy and very heavy menstrual flow was reported by 16.4% & 1.5% of the girls respectively, light (5.9%) and very light (0.8%) menstrual flow was also reported. 37.7% of girls reported other menstrual related symptoms. They include dizziness (30.2%), anxiety (29.7%), fatigue (29.2%) & nausea (6.2%). Similar trend was seen in the present study with the percentage as follows dizziness (5.6%), nausea (9.9%), fatigue (51.9%) and anxiety (21.5%).
Yang et al. in 2005 analyzed the endocrine and reproductive function of females exposed to PCBS/ PCDFS showed higher rate of menstrual cycle in the exposed girls. There was higher rate of irregular menstrual cycle in the exposed girls (P=0.061) than in unexposed girls as compared to controls [29].
Agrawal and Agrawal reported in their survey that dysmenorrhoea is a very common problem among adolescent girls & they experience a number of physical and emotional symptoms associated with increased intensity of pain [30]. In occurrence of dysmenorrhea the probability experiencing the symptoms also is increased. Adolescent girls slightly suffer the pain and discomfort associated. It also affects their academic performance.
Abnormal menstruation is seen significantly more common girls who practices dieting and those who did not perform physical exercise. Abnormal menstrual flow and irregular periods are more common among girls who have smoking habit [11].
The girls with the age group of 14 to 20 years tend to lose weight with menstrual irregularity and menstrual pain. This study reported that about 7% of adolescents have symptoms which were severe enough for them to be absent from school [11].
Dysfunctional uterine bleeding and dysmenorrhoea are controlled effectively by intake of oral contraceptives [31]. Levonorgestrel-containing intrauterine contraceptive which show a drastic decrease in menstrual blood loss [17].
As a result of dysmenorrhea and other discomfort during menstruation many take pain killers. Demier et al. in his survey stated that 41% uses pain killers and the remaining takes it without doctors advice [7]. In the present work the same was analysed which was found to be 14.8% of which most of them take it without doctors consultation.
A survey conducted in 767 students of which 71% had regular menstrual cycle. One in three had received some treatment either contraceptive pills or analgesia [15].
Kristiansdottir in 2000 evaluted the cost of menstrual cycle for young Swedish women age 14–20 years, the oral contracepstive users had a lighter menstrual flow and shorter periods (1 day less) then the girls with menstrual periods. The expenditure related to menstrual cycle are considerable for young Swedish women [32-35].
This work can be carried out, still in large population, factors like pollution or excessive work or diet can be studied. The role of exercise and yoga, role of stress, effect of hormone level in blood etc. can be studied.
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