Characteristics of the menstrual cycle in 13-year-old Flemish girls and the impact of menstrual symptoms on social life

Is it time to agree upon a standardised approach to the assessment of contributing factors and impacts of adolescent pelvic pain?

BACKGROUND

A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments - or their use - to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools.

METHODS

Literature searches were performed in MEDLINE, PsycInfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience.

RESULTS

We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep.

CONCLUSIONS

Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients.

Heavy menstrual bleeding and dysmenorrhea in adolescents: A systematic review of self-management strategies, quality of life, and unmet needs

BACKGROUND

Heavy menstrual bleeding (HMB) and dysmenorrhea (DM) are common gynecological problems.

OBJECTIVE

To systematically review the needs, quality of life (QOL), and effectiveness of self-management strategies among young women (12-25 years) with DM or HMB.

SEARCH STRATEGY

Relevant terms were searched through PubMed, EBSCO, Google Scholar, ProQuest, and Ovid between 2010 and 2022.

SELECTION CRITERIA

Qualitative and quantitative studies published in peer-reviewed journals, females aged 12-25, exploring DM or HMB, reporting supportive care needs, quality of life, self-treatment strategies, and/or treatment-seeking behavior.

DATA COLLECTION AND ANALYSIS

Abstracts were reviewed for eligibility by two researchers. Included studies were extracted and assessed for quality independently by two authors, with discrepancies resolved through consensus or the involvement of a third researcher. Data extracted included study details, menstrual history, symptoms, self-care strategies, and quality of life. The Joanna Briggs Institute checklists were used for quality assessment.

MAIN RESULTS

The search returned 285 190 studies, of which 55 were eligible for inclusion. Prevalence rates of HMB and DM were in the ranges 4%-63% and 42%-94%, respectively. Over 80% of young women with DM and HMB experienced physical and psychological problems, including pelvic pain, sleep issues, mood disturbance, diarrhea, and nausea. Academic performance and daily activities were severely affected. Most (>62%) named their mothers as their primary source of information, and friends as the secondary source (10%-65%). Few studies explored needs, but they could be inferred and fell under school-related and social needs. QOL was poorer in those who had DM than those who did not. Pain was the most common issue that drove young women to find treatment. More than 70% used medication to reduce pain. More than half chose home remedies (e.g., heat therapy, massages, herbal tea, hot drinks). No studies provided information about the efficacy and dosage of medication and herbal remedies.

CONCLUSIONS

HMB and DM have a large impact on daily living, with large areas of unmet need. Limited access to information impairs the management of symptoms and consequent QOL.

Adolescent dysmenorrhoea in general practice: tensions and uncertainties

This Perspectives article reflects on findings from our systematic review about adolescent dysmenorrhoea Q, drawing on sociology of diagnosis theory. We consider tensions and uncertainties between presentation with symptoms of dysmenorrhoea and processes of symptom categorisation and diagnosis in adolescents, tracing these through research and clinical guidance, considering possible implications for clinical practice. We argue that challenges in distinguishing between primary and secondary dysmenorrhoea in research translate into challenges in differentiation in clinical practice. We argue that framing this distinction as clear cut and straightforward belies the well-documented challenges in diagnosis of endometriosis, and that not recognising uncertainty and complexity inherent in this task may benefit neither clinicians nor patients.

Menstrual Cycle Characteristics of U. S. Adolescents According to Gynecologic Age and Age at Menarche

STUDY OBJECTIVE

To characterize typical menstrual cycle characteristics in adolescents and determine how these differ with age at menarche or years since menarche (gynecologic age).

METHODS

We surveyed 13 to 18-year-old U.S. users of the Clue app (N = 6,486) and linked their responses to app-recorded cycle data (N=38,916 cycles). We analyzed cycle characteristics including cycle length, cycle variability, period length, experience of heavy flow, and dysmenorrhea in relation to gynecologic age and menarcheal age using mixed effects models.

RESULTS

With increasing gynecologic age, we observed dose-dependent associations of lower odds of cycle irregularity (defined as cycles that were highly variable, short, or long) and higher odds of reporting ≥1 day of heavy flow. Individuals <1 year post-menarche had lower odds of heavy flow (Odds Ratio (OR) = 0.3; 95% confidence interval (CI): 0.1, 0.6), and increased odds of having a highly variable cycle (OR = 2.6; 95% CI: 1.3, 5.2) or short cycles (OR = 5.0; 95% CI: 2.3, 11.0) compared to those who were 6+ years post-menarche. We also found associations with early and late age at menarche. Compared to menarcheal age of 14+ years, menarcheal age ≤10 years was associated with shorter cycle length (β = -1.63 days; 95% CI: -2.51, -0.75), increased odds of dysmenorrhea (OR = 3.2; 95% CI: 2.3, 4.6), and decreased odds of high cycle variability (OR = 0.8; 95% CI: 0.6, 1.0).

CONCLUSION

Cycle characteristics in adolescence are associated with menarcheal age and gynecologic age. Notably, highly variable cycles are common, especially among those with younger gynecologic age or older menarcheal age.

Efficacy and Pain Tolerance of Alexandrite Laser Hair Removal at Different Stages of the Menstrual Cycle

BACKGROUND

Several different parameters play a role in the transition of hair follicles to the anagen phase, with the role of androgens, progesterone, and estrogen hormones and receptors being significant.

OBJECTIVES

The effectiveness of laser hair removal (LHR) and pain tolerance during procedure were investigated during 3 different phases of the menstrual cycle.

METHODS

Forty-eight axillae were randomly divided into 3 groups: menstruation, ovulation, and luteal. Three laser sessions were performed on each axilla at a 1-month interval. Blood hormone levels were measured in the patients. An alexandrite laser was applied during LHR sessions. Before each LHR session and 1 month after the third session, hair follicles in 4-cm2 areas in the center of the axillae were counted. Patients self-assessed the pain they felt during the laser application in each session with a visual pain scale.

RESULTS

The average values for hair counting in the groups were as follows (M, menstruation; O, ovulation; L, luteinization): M0 = 47.6, M1 = 27.4, M2 = 16.1, M3 = 9.9; O0 = 41.8, O1 = 21.1, O2 = 13.8, O3 = 8.6; and L0 = 49.4, L1 = 27.1, L2 = 15.1, L3 = 9.8. The average values on the visual analog scale scores in the groups were: M1 = 3.94, M2 = 3.06, M3 = 1.94; O1 = 3.50, O2 = 3.06, O3 = 1.69; and L1 = 3.63, L2 = 2.50, L3 = 1.56. Statistical analysis was conducted with Tukey post hoc analysis after analysis of variance.

CONCLUSIONS

The results of LHR are not affected by changes in hormone levels during the menstrual cycle in females. Although not statistically significant, it has been observed that pain tolerance during laser application is lower during the menstruation cycle.

LEVEL OF EVIDENCE: 3

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.

Dysmenorrhea among 12-year-old teenagers from different socioeconomic backgrounds

BACKGROUND

The age of menarche has been gradually declining since the end of the 20th century. Few studies have been carried out about dysmenorrhea in Europe and they mainly included girls over the age of 15 years.

METHODS

We conducted an observational study among sixth-grade schoolgirls (usually 11-12 years) during the 2020 academic year in 72 randomly selected public schools in a French region (approval number #20.94).

RESULTS

Among 1712 girls interviewed, 257 (23 %) had reached menarche. Overall, 83 % of these teenagers had dysmenorrhea. Symptoms were reported to occur since the first periods in 59 % of the girls. School absenteeism was positively correlated with severe abdominal pain (p = 0.001). Median age at menarche was 11 years (10.7-11.5). Periods lasted less than 3 days, 3-8 days, and more than 8 days in, respectively, 18 %, 70 %, and 7 % of the girls. Symptoms were significantly more frequent and more severe in the urban group than the rural group (p = 0.005). Symptoms were abdominal pain (70 %), fatigue (48 %), difficulty in concentrating (26 %), headache (25 %), digestive disorders (16 %), and breast discomfort (11 %). Of the girls with dysmenorrhea, 61 % took painkillers; 10 % were uncomfortable despite taking painkillers. Sport exemption was more frequent in the urban group (p = 0.003) and among girls with severe abdominal pain (p = 0.001).

CONCLUSIONS

The duration of the menstrual cycle was similar between the various socioeconomic groups, but symptoms and ways of coping were significantly different. Dysmenorrhea is definitely an issue that has to be raised with teenagers as soon as menarche occurs or even before that. Easy access to skilled health practitioners should be widespread.

Proposal for targeted, neo-evolutionary-oriented secondary prevention of early-onset endometriosis and adenomyosis. Part II: medical interventions

According to consistent epidemiological data, the slope of the incidence curve of endometriosis rises rapidly and sharply around the age of 25 years. The delay in diagnosis is generally reported to be between 5 and 8 years in adult women, but it appears to be over 10 years in adolescents. If this is true, the actual onset of endometriosis in many young women would be chronologically placed in the early postmenarchal years. Ovulation and menstruation are inflammatory events that, when occurring repeatedly for years, may theoretically favour the early development of endometriosis and adenomyosis. Moreover, repeated acute dysmenorrhoea episodes after menarche may not only be an indicator of ensuing endometriosis or adenomyosis, but may also promote the transition from acute to chronic pelvic pain through central sensitization mechanisms, as well as the onset of chronic overlapping pain conditions. Therefore, secondary prevention aimed at reducing suffering, limiting lesion progression, and preserving future reproductive potential should be focused on the age group that could benefit most from the intervention, i.e. severely symptomatic adolescents. Early-onset endometriosis and adenomyosis should be promptly suspected even when physical and ultrasound findings are negative, and long-term ovulatory suppression may be established until conception seeking. As nowadays this could mean using hormonal therapies for several years, drug safety evaluation is crucial. In adolescents without recognized major contraindications to oestrogens, the use of very low-dose combined oral contraceptives is associated with a marginal increase in the individual absolute risk of thromboembolic events. Oral contraceptives containing oestradiol instead of ethinyl oestradiol may further limit such risk. Oral, subcutaneous, and intramuscular progestogens do not increase the thromboembolic risk, but may interfere with attainment of peak bone mass in young women. Levonorgestrel-releasing intra-uterine devices may be a safe alternative for adolescents, as amenorrhoea is frequently induced without suppression of the ovarian activity. With regard to oncological risk, the net effect of long-term oestrogen-progestogen combinations use is a small reduction in overall cancer risk. Whether surgery should be considered the first-line approach in young women with chronic pelvic pain symptoms seems questionable. Especially when large endometriomas or infiltrating lesions are not detected at pelvic imaging, laparoscopy should be reserved to adolescents who refuse hormonal treatments or in whom first-line medications are not effective, not tolerated, or contraindicated. Diagnostic and therapeutic algorithms, including self-reported outcome measures, for young individuals with a clinical suspicion of early-onset endometriosis or adenomyosis are proposed.

Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects

The potential for repeated ovulation and menstruation is thought to have provided a Darwinian advantage during the Palaeolithic. Reproductive conditions remained relatively stable until the pre-industrial era, characterized by late menarche, very young age at first birth, multiple pregnancies, and prolonged periods of lactational amenorrhoea. For hundreds of thousands of years, menstruators experienced few ovulatory cycles, even though they were genetically adapted to ovulate and menstruate every month. In the post-industrial era, the age at menarche gradually declined, the age at first birth progressively increased, and breastfeeding became optional and often of short duration. This created a mismatch between genetic adaptation and socio-environmental evolution, so that what was initially a probable reproductive advantage subsequently contributed to increased susceptibility to diseases associated with lifetime oestrogen exposure, such as ovarian, endometrial and breast cancer and, hypothetically, also those associated with the number of ovulatory menstruations, such as endometriosis and adenomyosis. The incidence of endometriosis shows a steep and progressive increase around the age of 25 years, but given the consistently reported delay in diagnosis, the actual incidence curve should be shifted to the left, supporting the possibility that the disease has its roots in adolescence. This raises the question of whether, from an evolutionary point of view, anovulation and amenorrhoea should not still be considered the physiological state, especially in the postmenarchal period. However, an increase in the frequency of endometriosis in recent decades has not been demonstrated, although this deserves further epidemiological investigation. In addition, as endometriosis occurs in a minority of individuals exposed to retrograde menstruation, other important pathogenic factors should be scrutinised. Research should be resumed to explore in more detail the transtubal reflux of not only blood, but also endometrial cells, and whether they are systematically present in the peritoneal fluid after menstruation. If repetitive ovulatory menstruation during the early reproductive years is shown to increase the risk of endometriosis and adenomyosis development and progression in susceptible individuals, hormonal interventions could be used as secondary prevention in symptomatic adolescents.

Smartphone apps for menstrual pain and symptom management: A scoping review

The past decade marks a surge in the development of mobile apps used to digitally track and monitor aspects of personal health, including menstruation. Despite a plethora of menstruation-related apps, pain and symptom management content available in apps has not been systematically examined. The objective of this study was to evaluate app characteristics, overall quality (i.e., engagement, functionality, design aesthetics, and information), nature and quality of pain and symptom tracking features, and availability and quality of pain-related intervention content. A scoping review of apps targeting facets of the menstrual experience was conducted by searching the Apple App Store. After removal of duplicates and screening, 119 apps targeting menstrual experiences were retained. Pain and menstrual symptoms tracking were available in 64 % of apps. Checkboxes or dichotomous (present/absent) reporting was the most common method of tracking symptoms and was available in 75 % of apps. Only a small subset (n = 13) of apps allowed for charting/graphing of pain symptoms across cycles. Fourteen percent of apps included healthcare professionals or researchers in their development and one app reported use of end-users. Overall app quality measured through the Mobile App Rating Scale (MARS) was found to be acceptable; however, the apps ability to impact pain and symptom management (e.g., impact on knowledge, awareness, behaviour change, etc.) was rated as low. Only 10 % of apps (n = 12) had interventions designed to manage pain. The findings suggest that despite pain and symptom management content being present in apps, this content is largely not evidence-based in nature. More research is needed to understand how pain and symptom management content can be integrated into apps to improve user experiences.

The Association between Childhood Adversity and Risk of Dysmenorrhea, Pelvic Pain, and Dyspareunia in Adolescents and Young Adults: A Systematic Review

PURPOSE

Exposure to adverse childhood experiences (ACEs) has been associated with poor health outcomes, including chronic pain. However, little is known about the potential impact on the development of pelvic pain in adolescents and young adults. This systematic review was conducted to explore the association between ACEs and dysmenorrhea, pelvic pain, and dyspareunia in adolescents and young adults.

METHODS

Medline, Embase, and PsycNET were searched, using keywords related to childhood adversity, dysmenorrhea, pelvic pain, and dyspareunia.

RESULTS

Of the 566 articles identified, 19 studies were included. There was an association between the number and severity of ACEs and the risk of dysmenorrhea. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health. No association was found for immigration and bullying, and findings were inconsistent regarding female genital mutilation, parental separation, and parental death.

CONCLUSIONS

Future research should include longitudinal follow-up and use validated tools to assess childhood adversity. A greater understanding of the risk of ACEs among adolescents and young adults with dysmenorrhea, chronic pelvic pain, and dyspareunia could provide insight into the development of these conditions.

Patient-reported outcomes in autosomal inherited bleeding disorders: A systematic literature review

Aim

Currently, it is unknown which patient‐reported outcomes are important for patients with autosomal inherited bleeding disorders. Therefore, the purpose of this study is to systematically review the available literature assessing patient‐reported outcomes and their measurement methods in autosomal inherited bleeding disorders.

Methods

The Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trails and Google Scholar databases were searched from inception until 14 August 2020. Studies on patient‐reported outcomes in patients with von Willebrand disease, inherited platelet function disorders and coagulation factor deficiencies were included.

Results

Twenty‐one articles met the inclusion criteria. Three studies were assessed as having poor quality, and therefore a high risk of bias. Nineteen studies had fair quality rating. Different measurements methods were used, ranging from predefined to self‐developed questionnaires. The majority of included studies focused on von Willebrand disease. Patients with von Willebrand disease reported lower health‐related quality of life compared to the general population. Overall, this trend was especially visible in the following domains: vitality, physical and social functioning and pain. Women with inherited bleeding disorders scored lower on health‐related quality of life compared to men, especially women with heavy menstrual bleeding. Patients with joint bleeds or heavy menstrual bleeding reported an increased level of pain.

Conclusion

Patients with autosomal inherited bleeding disorders report lower health related quality of life, especially those with joint bleeds or heavy menstrual bleeding. Numerous measurement methods are used in patients with autosomal inherited bleeding disorders, highlighting the need for studies using established, standardized measurement methods.

Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight

OBJECTIVE

To characterize the menstrual cycle (regularity and menstrual flow length), the prevalence of dysmenorrhea and self-monitoring of the cycle in students from Lisbon region, and explore the effect of chronological age, age at menarche and body mass index (BMI) on menstrual disorders.

METHODS

This is a cross-sectional study with 848 girls aged 12-18 years. A questionnaire about the sociodemographic context and characteristics of the menstrual cycle, and weight and height measures were assessed. BMI was classified according to International Obesity Taskforce criteria. A descriptive analysis of the variables was made, and Odds Ratios (ORs) and 95% confidence intervals (95%CIs) were determined.

RESULTS

Mean age at menarche was 12.4 years and mean BMI was 22.0kg/m2. Among adolescents, 59% have regular menstrual cycle, 83% have menstrual flow length of ≤6 days. 88% suffered from dysmenorrhea, among which 8,7% declare absenteeism from school and 49% took pain medication, and 65% self-monitor their menstrual cycle. Higher maternal education was associated with a higher self-monitoring of menstrual cycle among the sample (OR 1.60; 95%CI 1.15-2.17). Girls with menarche <12 years-of-age are more likely to have menstrual flow length of >6 days (OR 1.73; 95%CI 1.19-2.51) and dysmenorrhea (OR 1.87; 95%CI 1.11-3.16) than those with menarche ≥12 years-of-age. No significant association between BMI and menstrual cycle variables was observed.

CONCLUSIONS

The results suggest that menstrual disorders are frequent and may be associated with early menarche, but not with BMI. It is important to encourage self-monitoring of the menstrual cycle to detect menstrual disorders timely and promote health and well-being.

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.

The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis

Introduction: Dysmenorrhea (period pain) and associated symptoms are very common in young women <25 years. This time corresponds with a significant stage in adolescents and young women's academic lives at both school and in higher education. Dysmenorrhea may cause absenteeism from class or result in reduced classroom concentration and performance. Owing to cultural and economic differences, any impact may vary by country. This systematic review and meta-analysis examines the prevalence of dysmenorrhea in young women and explores any impact it has on their academic performance and other school-related activities. Materials and Methods: A search in Medline, PsychINFO, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was carried out in June 2018. Results: Thirty-eight studies including 21,573 young women were eligible and included in the meta-analysis. Twenty-three studies were from low-, lower middle-, or upper middle-income countries, and 15 studies were from high-income countries. The prevalence of dysmenorrhea was high 71.1% (N = 37, n = 20,813, 95% confidence interval [CI] 66.6-75.2) irrespective of the economic status of the country. Rates of dysmenorrhea were similar between students at school (N = 24, 72.5%, 95% CI 67.5-77.0) and at university (N = 7, 74.9%, 95% CI 62.9-84.0). Academic impact was significant, with 20.1% reporting absence from school or university due to dysmenorrhea (N = 19, n = 11,226, 95% CI 14.9-26.7) and 40.9% reporting classroom performance or concentration being negatively affected (N = 10, n = 5126, 95% CI 28.3-54.9). Conclusions: The prevalence of dysmenorrhea was high, irrespective of country, with dysmenorrhea having a significant negative impact on academic performance both at school and during higher education.

Menstrual Patterns in the First Gynecological Year: A Systematic Review

STUDY OBJECTIVE

Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane Library) were systematically searched from database inception to 2018. Eligible studies described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents in GY1. Two authors independently screened studies, extracted data, and assessed methodological quality.

RESULTS

Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days. Frequent menstrual bleeding was reported in up to 23% of participants, infrequent menstrual bleeding in up to one-third, and "irregular menstrual bleeding" in up to 43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol was 0 to 45% and increased throughout GY1. However, all used definitions that would be considered subovulatory in clinical practice.

CONCLUSION

Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults. A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation, irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice should be advocated and prompt medical management should be accessible.