|Year : 2019 | Volume
| Issue : 13 | Page : 30-34
Dysmenorrhea and menstrual patterns among adolescent school girls in Kano
Ayyuba Rabiu, Idris Sulaiman Abubakar, Ibrahim Garba
Department of Obstetrics and Gynecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||19-Feb-2019|
Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Bayero University Kano, P.M.B. 3011, Kano
Source of Support: None, Conflict of Interest: None
Background: Dysmenorrhea is a periodic cramping lower abdominal pain which occurs at menstruation. It could be primary when there is no organic basis and secondary when its due to underlying pelvic pathology. The primary dysmenorrhea frequently begins during adolescence. Abnormal menstrual patterns can also be encountered among adolescent. Objective: The objective of the study is to determine the rate of dysmenorrhea and menstrual patterns among adolescent school girls. Methods: It was a descriptive cross-sectional survey that was carried out among female adolescent girls in three secondary schools at Kano. Approval for the study was obtained from Kano State Ministry of Health. Consent/assent was obtained from all the participants/guardians. Information on dysmenorrhea and menstrual patterns was recorded on a pretested structured questionnaire. The data obtained were analyzed using SPSS Version 19, Statistics (SPSS Inc., IL, Chicago, USA). P < 0.05 was considered statistically significant. Results: The mean menstrual cycle ± standard deviation was 27.5 ± 8.76 days. Up to 52 (25%) of the adolescent girls have a 28-day menstrual cycle. The average duration of menstrual flow was 4.9 ± 1.51. The amount of blood flow was normal in 177 (81.6%), scanty/light in 21 (9.7%), and heavy in 19 (8.7%) of the adolescent school girls. The menstrual cycle was regular in 194 (89%) adolescent girls. The prevalence of dysmenorrhea and metrorrhagia was 42.5% and 12.5%, respectively. Conclusion: The prevalence of dysmenorrheal (42.5%) was high in the study. About one-quarter of the adolescent girls had a cycle length of 28 days. The average duration of flow was 4.9 ± 5.1 days with a normal amount of blood flow and regular menses in more than 80% of the adolescent school girls. There was a statistically significant association between heavy menstruation and dysmenorrhea (P < 0.005).
Keywords: Adolescent school girls, dysmenorrhea, Kano, menstrual pattern, Nigeria
|How to cite this article:|
Rabiu A, Abubakar IS, Garba I. Dysmenorrhea and menstrual patterns among adolescent school girls in Kano. N Niger J Clin Res 2019;8:30-4
| Introduction|| |
Dysmenorrhea is defined as a cyclical cramping lower abdominal or pelvic pain which occurs before, during menstruation, or both. It is considered as an important health problem of adolescent school girls that has an impact on their daily activities and quality of life. It can be divided into two broad categories as primary and secondary.
Primary dysmenorrhea is defined as painful menses occurring among females in the absence of pelvic pathology, frequently beginning during adolescence. It is observed only in ovulatory cycles, frequently emerging within 6–12 months after menarche with no organic basis. On the other hand, secondary dysmenorrhea is a menstrual pain associated with underlying pathology with its onset usually years after menarche.
Dysmenorrhea is often accompanied by other symptoms, such as nausea, vomiting, sweating, headaches, diarrhea, and tremulousness, all occurring just before or during the menses.
Primary dysmenorrhea is extremely common, especially among adolescents.
It has been confirmed that production of uterine prostaglandins, which cause uterine contractions and ischemia, is responsible for dysmenorrhea. Women with more severe period pain are found to have higher levels of prostaglandins in menstrual fluid.
Its prevalence varies greatly across different ethnic groups. It was reported as 69.8% in Maiduguri, 62% in Oyo State. The research has shown that as many as 90% of female adolescents and at least 50% of menstruating women globally report suffering from dysmenorrhea.
Many psychological and behavioral risk factors have been associated with primary dysmenorrhea. Ylikorkala and Dawood reported that teenage age, smoking, nulliparity, high socioeconomic status, heavy menstrual flow, physical activity, depression, anxiety, and attempt to lose weight are all risk factors associated with dysmenorrhea. The family history of dysmenorrhea has also been reported to be associated with dysmenorrhea. Menstruation is the monthly flow of blood and cellular debris from the uterus that begins at puberty and ceases at menopause, once it is established, a mature female menstruates every lunar month at an average flow of 2–7 days.,, A normal cycle length ranges from 21 to 35 days, and the average amount of flow is 30 mL with a range of 13–80 mL.,
The normal menstrual cycle totally depends on the action and interaction of hormone released from hypothalamus–pituitary and ovaries and their effect on the endometrium. Abnormal menstrual patterns that can be encountered by adolescents include unusually infrequent menses (oligomenorrhea), heavy flow (menorrhagia), scanty menses (hypomenorrhea), unusually frequent (polymenorrhea), and unusually painful menstruation (dysmenorrhea).
Although several researches have been carried out on menstruation and menstrual patterns among female students in Nigeria,,,, this study was specifically targeted toward adolescent school girls with a view of describing the incidence of dysmenorrhea and menstrual patterns so as to provide policymakers with recommendations toward addressing the conditions by modifying health promotion and educational activities for the girl child in our environment.
| Methods|| |
It was a descriptive cross-sectional survey that was carried out among female adolescent girls in three secondary schools (GGSS Shekara, GGSS Dala, and St Louis SS, Kano) at Kano, North Western Nigeria. A list of all the female secondary schools within Kano metropolis was made, and three secondary schools were chosen at random using a random number generator. Consecutive adolescent girls were interviewed within the selected institutions. Approval for the study was obtained from Kano State Ministry of Health. Consent/assent was obtained from all the participants/guardians. Information on dysmenorrhea and menstrual patterns was obtained and recorded on a pre-tested structured questionnaire. The data obtained were analyzed using IBM Statistical Package for Social Science (SPSS) Version 19, Statistics (SPSS Inc., IL, Chicago, USA). P < 0.05 was considered statistically significant.
In this study, normal menstrual flow means flow that does not require changing the absorbent pads more than 2 times in the day and once at night; scanty/light menses means absorbent pad that is hardly soaked during the day or night; and heavy flows refer to menses that require changing the pads more than 3 times during the day and more than 2 overnight or with blood clots.
The menstrual cycle was regular all the time 96 (44.1%), regular in majority of the time 87 (39.7%), regular occasionally 11 (5.0%), and irregular (unpredictable) 24 (11.0%) among the adolescents F.
| Results|| |
The study was conducted from January 1 to December 31, 2016. The number of adolescent girls participated in the survey was 219.
The mean age ± standard deviation [SD] of the adolescent school girls was 16.1 ± 1.34 years. The median age was 16 years.
The mean menstrual cycle ± SD was 27.5 ± 8.76 days. The median menstrual cycle was 28 days. A larger proportion of the adolescent girls has 30 days 59 (28.4%) and 28 days 52 (25.0%) menstrual cycle. The average duration of menstrual flow was 4.9 ± 1.51.
The amount of blood flow was normal in 177 (81.6%), scanty/light in 21 (9.7%), and heavy in 19 (8.7%) of the adolescent school girls [Figure 1].
The menstrual cycle was regular all the time 96 (44.1%), regular in majority of the time 87 (39.7%), regular occasionally 11 (5.0%), and irregular (unpredictable) 24 (11.0%) among the adolescents [Figure 2].
Ninety-three (42.5%) of the adolescent girls experienced pains (dysmenorrhea) during menstruation while 66 (30.1%) had no dysmenorrhea [Table 1].
|Table 1: Dysmenorrhea and metrorrhagia experienced by the adolescent girls|
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Among those that had dysmenorrhea, 78 (43.5%) experienced it occasionally, 54 (30.2%) always and 47 (26.3%) most of the time. Only 27 (12.5%) experienced intermenstrual bleeding (metrorrhagia) [Table 1].
There was a statistically significant association between dysmenorrhea and heavy menstruation (χ2 = 4.396, P = 0.036) [Table 2].
|Table 2: Cross tabulation between the amount of menstrual blood and dysmenorrhea|
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| Discussion|| |
The mean menstrual cycle in this study was 27.5 ± 8.76 days. This is similar to the mean menstrual cycle length of 27.8 ± 3.14 days reported by Ajah et al. in southwestern Nigeria. The mean menstrual cycle length also falls within the range of menstrual cycle reported by Thomas et al. in Ile-Ife, Nigeria.
One quarter (25.0%) of the female adolescents presented with 28-day menstrual cycle length. This is slightly higher than the figure of 10%–15% of women with 28-day menstrual cycle length reported by Knudtson. The average duration of menstrual flow was 4.9 ± 5.1 days. This falls within the average duration of 5 ± 2 days reported by Knudtson. Umeora and Egwuatu reported a mean menstrual flow of 3.3 ± 0.9 days with a range of 1–8 days among Igbo women of south-eastern Nigeria. Our findings fall within the range reported.
In more than 2/3 of the adolescent girls 177 (81.6%), the amount of blood flow was normal. It was scanty/light in 21 (9.7%). Here, absorbent pad is hardly soaked during the day and another at night. The heavy menstrual period was observed among 19 (8.7%) adolescent school girls which necessitated changing the pads more than three times during the day and more than two times overnight or with blood clots. Amaza et al. in their reports on menstrual pattern showed that the blood flow per cycle was small (≤4 pads/day) 22 (13.0%), moderate (5–10 pads/day) 135 (79.9%), and heavy (2 pads at a time) 12 (7.1%) among female medical students in University of Maiduguri, Nigeria. Our findings were closely similar.
Our study also showed that the menstrual cycle was regular all the time 96 (44.1%), regular in majority of the time 87 (39.7%), regular occasionally 11 (5.0%), and irregular 24 (11.0%) among the adolescent girls. Amaza et al. showed that the regularity of the menstrual cycle was regular 148 (87.6%) and irregular 21 (12.4%) among medical students in Maiduguri. Dambhare et al. also reported regular cycles 273 (70.0%) among school adolescent girls in urban central India. Our study and their findings suggested that most of the adolescent girls have a regular menstrual cycle.
Dysmenorrhea was experienced among 93 (42.5%) of the adolescent school girls. This is similar to the findings of Dambhare et al. in rural central India 78 (45.61%), and less than the figure of 118 (69.8%) reported by Amaza et al. The age difference between the adolescent girls in our study and that of the female medical students from Maiduguri reported by Amaza et al. might be responsible for the slight difference. Among those with dysmenorrhea, 78 (43.5%) experienced it occasionally, 54 (30.2%) always, and 47 (26.3%) most of the time. A report from a Finnish study showed that 54% of girls aged 10–20 years complained of dysmenorrhea occasionally while 13% always experienced it.
Intermenstrual bleeding (metrorrhagia) was reported among 27 (12.5%) adolescent school girls. This was lower than the figure of 18.6% reported by Amu and Bamidele. in Osogbo, south-western Nigeria. A report from the World Health Organization, global epidemiological surveys have shown that self-reported 3 months prevalence of intermenstrual period was 5%–17%., Other studies have reported a prevalence of metrorrhagia ranging from 1% to 11%.,,,
In this study, we found statistically significant association between heavy menstruation and dysmenorrhea (P2 = 4.396, P = 0.036). Similar finding was also reported by other workers.,
| Conclusion|| |
The prevalence of dysmenorrhea and metrorrhagia among school adolescent girls was 42.5% and 12.5%, respectively. About one-quarter of the adolescent girls had a cycle length of 28 days. The average duration of flow was 4.9 ± 5.1 days with a normal amount of blood flow and regular menses in more than 80% of the adolescent school girls.
There was a statistically significant association between heavy menstruation and dysmenorrhea (P < 0.005).
Parent/teachers and guardian should be aware that the prevalence of dysmenorrhea is high among adolescent school girls and the severity of the pain is associated with heavy menses. Health promotion and education on dysmenorrhea and menstrual pattern should be introduced in girl secondary schools.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]