Menstruation across time: Menarche, menstrual attitudes, experiences, and behaviors

Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness

BACKGROUND

Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being.

OBJECTIVES

This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness.

STUDY DESIGN

A cross-sectional online survey.

METHOD

A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates.

RESULTS

Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image.

CONCLUSION

Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

Perimenopausal women's voices: How does their period at the end of reproductive life affect wellbeing?

OBJECTIVE

To explore perimenopausal women's feelings towards their periods, the impact on their wellbeing and how we can support them.

STUDY DESIGN

Participants were recruited for focus groups through social media advertisements. In 6 online focus groups, 31 perimenopausal women aged 40-55 living in the UK were asked 5 questions relating to periods and perimenopause, support and education.

MAIN OUTCOME MEASURES

Content analysis.

RESULTS

When asked How do you feel about having a period? The participants often related back to the stress of menarche and said their period negatively impacted their wellbeing their whole lives. During perimenopause, their periods had become unpredictable, heavy, and a debilitating disruption to their lives. The women desired support at work through policy, and from family and friends. They believed that educating girls and boys during school was the best place to start, but that education through work and community groups was also needed. They felt healthcare professionals should have mandatory training regarding women's health issues and menopause.

CONCLUSION

The study highlights the impact of menstrual experiences on the wellbeing of perimenopausal women, emphasising the need for improved menstrual education from an early age. Comprehensive menstrual education in schools involving both genders to enable informed decision-making and improved training for healthcare professionals are recommended. Support networks for perimenopausal women will promote better quality of life for women as they go through their perimenopause journey.

Assessment of prevalence, knowledge and health-related practices of dysmenorrhea among Malaysian women in Kuala Lumpur: a cross-sectional survey

BACKGROUND

Menstruation is a natural phenomenon considered an important indicator of women's health, reflecting their endocrine function. Women in low middle income countries face substantial menstrual hygiene management challenges. Data on the knowledge of dysmenorrhea and health-related practices among Malaysian women are scarce. The present study aimed to investigate the prevalence of dysmenorrhea among Malaysian women in Kuala Lumpur and its association with socio-demographic factors, knowledge level, and general practices.

METHOD

A cross-sectional study was carried out among Malaysian women in Kuala Lumpur. A total of 362 unmarried women, nulliparous and aged between 18 and 25 years old, were included in this study. Participants were conveniently recruited through online platforms as well as face to face using a self-administered questionnaire with five sections consisting of demographics, menstrual characteristics, Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score for diagnosing and assessing the severity of dysmenorrhea as well as an evaluation of respondents' general knowledge and practices towards dysmenorrhea. The collected data were analysed using the SPSS tool, a descriptive statistic was used to report demographic characteristics. Inferential statistics was used to report the differentiation, association, and correlations of the variables.

RESULTS

The prevalence of primary dysmenorrhea was 73.2%. It was found that the majority of the respondents had poor knowledge (60%) and poor practices (61.88%) of dysmenorrhea. The most common preventive practices among the respondents were using dietary supplements, and herbs, taking a rest and exercising. The findings also indicated that dysmenorrhea among the respondents was significantly associated with family history of dysmenorrhea (p = 0.002), monthly income (p = 0.001), and knowledge level (p = 0.001).

CONCLUSION

Dysmenorrhea has a high prevalence among women in Malaysia in Kula Lumpur driven by low knowledge and lack of evidence-based practices among these women. Thus, it is critical for Government and healthcare authorities to promote education related to women health among Malaysian women.

Knowledge and practices related to menstruation among tribal adolescent girls

BACKGROUND

Despite the fact that every girl has to deal with menstrual hygiene, there is a lack of awareness about the process of menstruation and proper menstrual hygiene among adolescent girls, especially from tribal backgrounds.

AIM

The aim of the study was to assess the knowledge and practices related to menstruation among tribal (Munda) adolescent girls.

MATERIALS AND METHODS

This was a community-based cross-sectional study. The sample for the study consisted of 150 girls belonging to Munda tribe in the age group of 13-18 years, recruited by purposive sampling from various schools of Khunti district of Jharkhand state. Interview guide was predeveloped, validated, and used to study the knowledge and practices related to menstruation among adolescent girls. The data were collected by a personal interview of the study subjects.

RESULTS

The mean age of menarche of the study subjects was 14.1 years. It was evident that only 48.67% of the participants were aware about menstruation before menarche and the most important source of the information about menstruation for them was their friends (53.33%) followed by mothers.

CONCLUSIONS

Knowledge about menstruation is poor among tribal adolescent girls and practices included various myths and misconceptions.

A systematic review of the menstrual experiences of university students and the impacts on their education: A global perspective

Background

Higher education attainment is linked to improved health and employment outcomes but the impact of university students’ experiences of menstruation on their education is less clear. The objective of this review was to synthesise qualitative and quantitative research on university students’ menstrual experiences and educational impacts.

Methods

Eligible studies were identified through systematic searching across eight peer-reviewed databases, websites for menstrual health organisations, grey literature databases, and reference lists of included studies. Eligible studies must have reported on at least one of the antecedents or components of menstrual experience outlined in the integrated model of menstrual experience in relation to university students or reported on the impact of their menstrual experiences on their education. Study characteristics and findings were extracted, analysed and presented as a narrative synthesis. The quality of evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42020178470.

Results

Eighty-three studies were eligible for inclusion. Most studies (n = 74; 89%) were quantitative and the highest proportion of studies were conducted in lower-middle-income countries (n = 31; 37%). Self-reported dysmenorrhea, other physical and emotional menstrual-related symptoms, and menstrual stigma contributed to negative menstrual experiences among female students. Very few studies considered the menstrual experiences of non-binary and transgender menstruating students, and culturally diverse students. Dysmenorrhea contributed to university absenteeism, impaired participation and concentration, and declining academic performance. Inadequate sanitation facilities for menstrual management and challenges containing menstruation also negatively impacted education.

Conclusions

Female university students’ experiences of menstruation can negatively impact their education, highlighting the need for program and policy responses at university to improve students’ wellbeing and educational engagement. Further research on the menstrual experiences of gender diverse, migrant and international students is needed as there is insufficient evidence to date.

Healthy, safe and responsible: the modern female traveller

One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues.

Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks.

Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.

Women's Cognition and Attitude with Eco-Friendly Menstrual Products by Consumer Lifestyle

With rapid technology developments and the convenient and fast pace of life in recent years, many people are using disposable products, which cause environmental and ecological damages. A variety of eco-friendly menstrual products have been launched on the market, and "menstrual pads" now have a large market share in Taiwan's menstrual product industry. This study interviewed experts and collected questionnaires for qualitative and quantitative investigation and analysis. The results show that women have positive and open concepts regarding sustainability, as well as a good understanding of their body and are very interested in the performance and usage efficiency of products. The results also indicate that consumers purchase based on their lifestyles; most women collected enough product information before purchasing while overcoming the difficulties in dealing with the environment and learning to adapt them, and the majority of consumers attach importance to comfort, volume, and duration of blood absorption. The results suggest that the government and private enterprises should increase and improve sanitation education and sanitary facilities and guide the approach and serve as an important reference index for the promotion of eco-friendly menstrual products for environmental benefits.

Menstruation distress is strongly associated with hormone-immune-metabolic biomarkers

OBJECTIVE

To examine the associations between menstruation features and symptoms and hormone-immune-metabolic biomarkers.

METHODS

Forty-one women completed questionnaires assessing characteristic menstruation symptoms, duration of menstrual cycle and number of pads used/day and completed the Daily Record of Severity of Problems (DRSP) during the consecutive days of their menstrual cycle. Menses-related symptoms (MsRS) were computed from the sum of 10 pre- and post-menses symptoms and the menstruation blood and duration index (MBDI) was computed based on the daily number of pads and duration of menses. We assayed serum levels of various biomarkers at days 7, 14, 21, and 28 of the subjects' menstrual cycle.

RESULTS

MBDI was significantly associated with a) MsRS including low abdominal cramps, and gastro-intestinal (GI) and pain symptoms (positively); b) plasma levels of haptoglobin (Hp), CCL5, insulin growth factor (IGF)-1, and plasminogen activator inhibitor (PAI)1 (all positively); and c) estradiol and paraoxonase (PON)1 arylesterase activity (both inversely). MsRS were significantly predicted by CCL5 and IGF-1 (both positively) and progesterone (inversely). Low-abdominal cramps, and gastro-intestinal and pain symptoms were associated with lower progesterone levels. The MBDI+MsRS score was significantly predicted by the cumulative effects of (in descending order of importance): Hp, IGF-1, PON1 arylesterase, estradiol and PAI.

CONCLUSION

Menstruation-related features including estimated blood loss, duration of menses, cramps, pain, and gastro-intestinal symptoms are associated with hormone-immune-metabolic biomarkers, which mechanistically may explain those features. Future research should construct a cross-validated algorithm using MBDI+MsRS features in a larger study group to delineate a useful case-definition of menstruation-related distress.

Neuropsychological function is related to irritable bowel syndrome in women with premenstrual syndrome and dysmenorrhea

BACKGROUND

There is increasing evidence demonstrating the co-occurrence of primary dysmenorrhea (PD), premenstrual syndrome (PMS), and irritable bowel syndrome (IBS) in women. This study aimed to investigate whether women who have symptoms of IBS in addition to PD and PMS also report more severe or frequent menstruation-associated symptoms and psychological complications compared to women with PD and PMS alone.

METHODS

The study group included 182 female University students aged 18-25 years. IBS was diagnosed using the Rome III criteria. The severity of PMS and PD was determined using a 10-point visual analog scale and PSST (Premenstrual Syndrome Screening Tool), respectively. Neuropsychological functions including cognitive function, depression score, anxiety score, stress, insomnia, daytime sleepiness, quality of life and personality were assessed using standard questionnaires.

RESULTS

Of the 182 young females, 31 (17.0%) had IBS. Average days of bleeding during the menstrual cycle and mean pain severity on the PSST scale were significantly greater in the group with IBS compared to the non-IBS group (p < 0.01). The non-IBS individuals scored more favorably than the women with IBS with respect to severity of depression, insomnia, daytime sleepiness (p < 0.05). The PSST scores were significantly correlated with scores for depression (r = 0.29; p < 0.001), anxiety (r = 0.28; p < 0.001), stress (r = 0.32; p < 0.001), insomnia (r = 0.34; p < 0.001) and daytime sleepiness (r = 0.31; p < 0.001); while, they were negatively correlated with cognitive abilities (r = - 0.20; p = 0.006) and quality of life (r = - 0.42; p < 0.001). Linear regression analysis showed that the PSST scores were possibly significant factors in determining the scores for depression, anxiety, stress, quality of life, insomnia and daytime sleepiness (p < 0.05).

CONCLUSION

IBS is related to psychological comorbidities, in particular depression, sleep problems and menstrual-associated disorders. IBS may exacerbate the features of PMS which should be taken into account in the management of PMS.

Training female adolescent students with intellectual disabilities about genital hygiene skills using peer training

PURPOSE

The study aimed to evaluate the effects of peer training of female adolescent students diagnosed with intellectual disabilities and started menses, about genital hygiene and menstrual care skills on a baby doll.

METHODS

This study was planned as a non-control group research design including pre-test, post-test and follow-up stages. It was conducted in special educational institutions. The population consisted of 68 female students between 10-18 years old. Calculation of sample size was not performed, and 65 students were included in the study. The data were collected using Socio-Demographic Form, Genital Cleansing Skill Form (GCSF), Pad Replacement Skill Analysis Form (PRSAF), and Teacher/Parent Opinion and Feedback Form. The statistical analysis of the study data was performed using Mc-Nemar test, Mann-Whitney U test, Kruskal-Wallis test and Friedman test followed by Dunn-Bonferroni post-hoc test.

RESULTS

In all follow-up periods, GCSF and PRSAF scores compared by Mann-Whitney U and Kruskal-Wallis tests did not change based upon demographic characteristics (p > 0.05). Friedman test showed that GCSF and PRSAF scores showed significant differences between the follow-up periods (p < 0.001). According to Dunn-Bonferroni post-hoc test, there was no statistically significant difference between 2nd and 3rd follow-up scores with respect to both GCSF and PRSAF (p > 0.05). However, 2nd and 3rd follow-up scores were found to be significantly higher than 1st follow-up score (p < 0.05).

CONCLUSION

The study demonstrated that menstrual care skills of female adolescent students with intellectual disabilities improved after training and peer training was found to be effective. Peer training can be useful when used as continuing training to help individuals achieving a higher criterion of mastery.

Experiences with Menses and Menstrual Suppression of Young Women with a History of Cancer

Background: Adolescent and young adult (AYA) women undergoing multiagent chemotherapy are at risk for heavy menstrual bleeding (HMB). There is a paucity of data on the experiences with menses of AYA women with cancer, their risk for HMB, and how they perceive menstrual suppression. Objective: This study aimed to (1) describe the attitudes and experiences of AYA women with a history of cancer regarding their menses and menstrual suppression and to (2) investigate facilitators and barriers to improve this aspect of oncologic care. Design/Methods: AYA women with a history of cancer completed individual semistructured interviews regarding their experiences, attitudes, and preferences around menstrual health. Two independent reviewers conducted a thematic analysis of transcribed interviews to elicit major themes. Results: We interviewed 20 young women with a history of cancer (mean age 19.9 years) who were treated with chemotherapy within the past 5 years. Themes included the following: (1) negative feelings and worry about menstrual bleeding; (2) positive attitudes toward menstrual suppression; (3) misconceptions about menstrual health; and (4) desire for tailored discussions about menstrual suppression. Conclusions: AYA women with a cancer history elucidate clear opinions regarding menstruation during chemotherapy, and many hold misconceptions regarding menses and menstrual suppression. Enhanced patient-provider communication and patient educational resources around menstrual health and menstrual suppression are needed to improve comprehensive oncologic care during chemotherapy.

"My mama told me it would happen": menarche and menstruation experiences across generations

The purpose of this study was to understand women's menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older (Mean = 49.13 ± 14.76 years; Range = 19-78 years) living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.

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.

Blood, joy and tears: menarche narratives of undergraduate females in a selected in Nigeria Private University

The aim of the study is to add to the body of knowledge on less researched aspects of female adolescent health in Nigeria. It specifically explored the menarche or first period narratives of 136 young women, focusing on the contents of the discussion that ensued with whom they told when they first got their period using qualitative methodology. It also explores sources of premenstrual information and how the menstrual period is managed. The sample consisted of 136 undergraduate females in Redeemer's University, Ede, Nigeria. Almost all of the respondents (95%) received information about menstruation from mothers, female relatives and school lessons prior to menarche. The majority of the respondents first told either their mother or a female relative when they first got their period and viewed menarche as a crisis. Two salient themes emerged from the contents of the narratives; celebration and advice. The advice theme was further explored and three advice patterns were identified: being a woman, hygiene and changed dynamics in relationships with males. Data from the present study suggests that only certain aspects of the menstruation discourse have evolved. All respondents reported using sanitary towels during their menstrual period with the majority experiencing cramps regularly and (61%) using pharmalogical agents for remedy. It is envisaged that findings from the study will be useful in future health intervention programmes and research on female adolescent health in Nigeria and elsewhere.

Experience of Menarche Among Jordanian Adolescent Girls: An Interpretive Phenomenological Analysis

STUDY OBJECTIVE

Menarche is a significant physical and emotional experience for adolescent girls, especially in certain cultures, where it is viewed as a rite of passage, affecting the meaning of lived experiences. The purpose of the study was to explore the menarche experience among Jordanian adolescent girls when they reach menarche.

DESIGN

Interpretive phenomenological analysis.

SETTING

Az-Zarqa City, Jordan.

PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES

A homogenous sample of 7 Jordanian girls, ages 12-14 years, who had their first menstruation within the past 6 months. Participants were asked to narrate their experiences through journal writing; their reports to be used for interpretive phenomenological analyses by 2 independent researchers, to ensure the findings' trustworthiness.

RESULTS

Three major themes emerged as: (1) menstruation as a forbidden topic; (2) keeping the "topic" to oneself; and (3) no more secrets. Each theme was characterized according to distinct sets of emotions and knowledge-seeking patterns because Jordanian culture and Islamic teachings had greatly influenced the girls' experience of menarche. Menarche was considered a social taboo; not to be openly discussed. At the first signs of menarche, participants were shocked, scared, confused, and anxious. They had limited information and support from their family or school system. Therefore, they relied on self-perceptions about menarche, and viewed the experience of menstruation with profound negative emotions. Participants hesitated to share their experiences with their mothers and close friends. They felt alone and experienced their emotional turmoil in isolation and without support.

CONCLUSION

Jordanian adolescent girls need formal health education to understand and manage the reproductive changes that occur in their bodies.

More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture

Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial.

Managing Menstruation

Although research has examined women’s thoughts toward menstruation, the role passive and active coping strategies play in the acceptance of menses and getting-on with daily activities remains relatively unexplored. In total, 217 undergraduate females having normal regular monthly menstrual periods completed inventories assessing severity of menstrual symptoms, cognitive and emotional representation of health state, general and specific coping strategies, and acceptance. It was found that women having a more emotionally focused representation of menstruation (passive coping style) had a heightened belief that menstruation is debilitating and bothersome and, regardless of symptom severity, scored lower in acceptance of menstruation. Conversely, women using more active strategies to cope with menstrual symptoms were observed to be more generally resourceful and to conjunctively use more palliative coping strategies. More importantly, for women experiencing high levels of menstrual discomfort, use of active coping was associated with better acceptance and getting-on with everyday activities.

Menarche and Menstruation in Rural Adolescent Girls in Maharashtra, India

Background:

Menarche and menstrual experiences play a critical role in adolescent girls’ life. These not only significantly influence their sexual and reproductive health but also possess much social and educational impact. This study qualitatively explores the perceptions, practices and experiences related to menarche and menstruation among rural Indian adolescent girls which has been less studied in the past literature.

Methods:

A convenience sampling method was used to select 32 adolescent girls (eight girls who did not reach menarche and 24 girls who attained menarche) from rural Maharashtra in India. Information about the perceptions, practices and experiences of menarche and menstruation among the participants was obtained through focus group discussions and was analyzed using thematic analysis.

Findings:

Most of the participants, especially girls without menarche lacked adequate knowledge about menstruation and its processes. All communications regarding menstruation were between friends, whereas mothers were found to be playing a limited role. Some of the girls were using sanitary pads, while most girls still use old cloths. Financial concerns and difficulty in obtaining sanitary pads were major obstructions for their use. Lack of awareness and appropriate care for menstrual morbidities were reported among these girls, which put impact on their educational attainment.

Conclusions:

Suitable strategy needs to be developed for providing correct knowledge about menstruation among adolescent girls, such as inclusion of adolescent friendly services in school curriculum and training of mothers and teachers to provide friendly counselling to the girls. Further, menstrual pad vending machines could be installed in schools and colleges, for easy access of sanitary pads at subsidized rate. Special care and support during menstruation can prevent several adverse events from occurring in adolescent girls’ lives.

Menstrual knowledge and practices of female adolescents in Vhembe district, Limpopo Province, South Africa

BACKGROUND

Although sexual issues are openly discussed in the media, sexuality and reproductive functions are treated as taboo. Menstruation is a normal physiologic process, but carries various meanings within cultures and is rarely discussed amongst families and communities.

PURPOSE

This study sought to assess the knowledge and practices of secondary school girls towards menstruation in the Thulamela municipality of Limpopo Province, South Africa.

METHODS

A quantitative descriptive study design was used and respondents were selected by means of convenience sampling from a population of secondary school girls. The sample consisted of 273 secondary school girls doing Grades 10-12. A self-administered questionnaire was used to collect data, which was analysed by computing frequencies and percentages using the Statistical Package for Social Sciences (SPSS version 12).

FINDINGS

The findings revealed that respondents experienced menarche at 13 years and that menstruation is a monthly bleeding (80%) that happens to every female; it is a sign of adulthood (91%). 15% reported that it is the removal of dirt from the stomach and abdomen, 67% indicated the source of menstruation being the uterus, 65% the vagina and 13% from the abdomen. 73% reported having fear and anxiety at the first experience of bleeding and that they could not maintain adequate hygienic practices due to a lack of privacy and sanitary towels.

CONCLUSION

Interventions are needed to increase girls' opportunities to discuss menstruation and access information from adults including mothers, parents and guardians. School-based sexuality education should be comprehensive, begin early and be regularly repeated.

THE ASSOCIATION BETWEEN MENSTRUAL CYCLE CHARACTERISTICS AND PERCEIVED BODY IMAGE: A CROSS-SECTIONAL SURVEY OF POLISH FEMALE ADOLESCENTS

The increasing prevalence of negative body perceptions among adolescent girls and the tendency towards wishing to be thinner have become a cultural norm in Western culture. Adolescent girls are particularly vulnerable to developing a negative body image due to physical and sexual changes occurring during puberty. This study aimed to evaluate the association between different measures of body image perceptions and different phases of the menstrual cycle after controlling for weight status and other potential confounders in Polish adolescent girls aged 12-18 years. Three-hundred and thirty participants of a cross-sectional survey conducted in 2009, normally cycling and with no eating disorders, completed a background questionnaire and the Stunkard Figure Rating Scale, and their anthropometric measurements were collected. The dependent outcome variables were measures of body image (actual body image, ideal body image and ideal-self discrepancy) and dichotomous body image perception (satisfied versus dissatisfied) adjusted for other predictor factors: socio-demographic variables, menstrual history and cycle phases, and weight status. One-way ANOVA indicated that weight status, age at menarche and menstrual cycle phase were associated with actual body image and rate of ideal-self discrepancy. Ideal body image was associated with weight status and menstrual cycle phase. General logistic regression models were constructed to evaluate associations of body dissatisfaction and all potential predictor variables. The final selected model of the multiple logistic regression analysis using the backward elimination procedure revealed that adjusted for other factors, negative body image was significantly associated with different phases of the menstrual cycle (p trend=0.033) and increasing body weight status (p trend=0.0007). The likelihood of body dissatisfaction was greatest during the premenstrual phase of the menstrual cycle (OR=2.38; 95% CI 1.06, 5.32) and among girls in obesity class I (OR=8.04; 95% CI 2.37, 27.26). The study confirmed the association between body image dissatisfaction in adolescent girls and different phases of the menstrual cycle after controlling for weight status. The issue of negative body self-image is not only of cognitive, but also of practical value as understanding better the factors contributing to the formation of a negative body image may be instrumental in developing preventive health programmes targeted at young people.

The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh

OBJECTIVES

To assess the impact of a school-based menstrual education programme on: (1) menstrual knowledge, beliefs and practices, (2) menstrual disorders experienced, and (3) restrictions on menstruating adolescents.

DESIGN

Intervention study.

SETTING

Araihazar area, Bangladesh.

PARTICIPANTS

416 adolescent female students aged 11-16 years, in grade 6-8, and living with their parents.

INTERVENTIONS

A school-based health education study conducted from April 2012 to April 2013.

PRIMARY AND SECONDARY OUTCOME MEASURES

We randomly selected 3 of 26 high schools in the study area. We delivered 6 months of educational intervention by trained (by an obstetrician and gynaecologist) research assistants (RAs) on menstrual hygiene among school girls. RAs read the questionnaire and participants answered. The changes in knowledge, beliefs and practices regarding menstruation, menstrual disorders experienced, and the restrictions and behaviours practiced by menstruating adolescents were compared between the baseline and the follow-up assessments.

RESULTS

After health education, participants reported a significant improvement (p<0.001) in 'high knowledge and beliefs' scores compared to baseline (51% vs 82.4%). Significant improvement was also observed in overall good menstrual practices (28.8% vs 88.9%), including improvements in using sanitary pads (22.4% change after the intervention), frequency of changing pads/cloths per day (68.8%), drying the used absorbent (77.6%), methods of disposing of the used absorbent (25.5%), and cleaning of genitalia (19.2%). During the follow-up, the participants reported significant improvements in the regularity of their menstrual cycle (94.5% vs 99.5%) and fewer complications during menstruation (78.6% vs 59.6%).

CONCLUSIONS

The programme produced significant changes in the knowledge, beliefs and practices of menstrual hygiene, complications from lack of hygiene, and the behaviour and restrictions of the menstruating adolescents. These results demonstrate the feasibility of implementing a health education programme for adolescents on menstrual hygiene in secondary schools serving rural Bangladesh.

Age at menarche, reactions to menarche and attitudes towards menstruation among Mexican adolescent girls

OBJECTIVE

To investigate the relationships between menarcheal timing and both menarcheal experience and attitudes toward menstruation in Mexican girls.

DESIGN

Cross-sectional survey.

SETTINGS

Sample of adolescents attending 10 different public schools.

PARTICIPANTS

Mexican postmenarcheal adolescents, aged 11-16 years.

INTERVENTION

Participants answered 1 questionnaire about menarcheal experience and another about attitudes towards menstruation.

RESULTS

Early maturers (menarche before 11 years) were more likely than average (menarche at 11 or 12 years) or late maturers (menarche at 13 or more years) to state they had not known what they should do at the moment they got their first period (P < .01), that they had not felt prepared to start menstruating (P < .05), and that they thought they must keep secret the fact of already having had their first period (P < .05). Concerning their emotional reactions to menarche, early maturers were the most likely to have felt scared (P < .05), worried (P < .05) and sad (P < .05) and were the least likely to have felt calm (P < .05). They were also the most likely to show current secretive attitudes towards menstruation (P < .01). Finally, late maturers showed more positive attitudes toward menstruation than their peers (P < .01).

CONCLUSIONS

These results could be useful for developing resources to help early maturing girls manage menstruation. Since these girls have limited or in some cases no time for preparation, they need special support.

Life Style Factors Associated with Premenstrual Syndrome among El-Minia University Students, Egypt

Aim. To determine the score and frequency of premenstrual syndrome (PMS) among female college students and to detect the possible risk factors of PMS. A trial of life style modification regarding prevention and control of PMS symptoms was carried out using counseling. Materials and Methods. A cross-sectional study was conducted on 253 El-Minia University unmarried female students. A self-administered questionnaire inquiring about symptoms of PMS in the previous three months and risk factors possibly related to it was used. PMS score was calculated. Multiple regression analysis was performed to determine which of several biopsychosocial and dietary factors influenced PMS. Life style modification counseling was done to prevent and control PMS. Results. The study revealed that 80.2% of the participants experienced various degrees of PMS symptoms which were significantly associated with a family history of PMS, physical inactivity, habitual excess consumption of coffee, BMI, frequent consumption of fast food, and smoking, but these factors explained only 52% of the variability in the logistic regression model. Conclusion. We recommend the introduction of a reproductive health component into school and college health education programs and encourage female adolescents and young adults to adopt a healthy behavior.

Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi

We introduce the concept of "menstrual poverty" to categorize the multiple deprivations relating to menstruation in resource-poor settings across the Global South, and we examine how this affects the psychological well-being of adolescent girls in an urban informal settlement in Kenya. We use qualitative data collected through 34 in-depth interviews and 18 focus group discussions with girls, women, and key informants. Menstrual poverty involved practical and psychosocial challenges affecting girls at home and at school. Its emotional impacts included anxiety, embarrassment, fear of stigma, and low mood. Further research is needed on how menstrual poverty affects girls' psychological and educational outcomes.

Attitudes toward menstruation in females with schizophrenia or schizoaffective disorders in Taiwan

OBJECTIVE

The aims of this cross-sectional, case-controlled, observational study were to examine attitudes toward menstruation in female patients with schizophrenia or schizoaffective disorder and in a control group, and to explore the associations between attitudes toward menstruation and psychopathology, menstrual regularity during antipsychotic treatment, and menstrual distress symptoms.

METHODS

Fifty-eight patients treated with anti-psychotic medications for at least the previous 6 months were placed in irregular (irregular menstrual cycle) (n = 31) and regular (regular menstrual cycle) (n = 27) groups. Sixty-two, age-matched, healthy female participants with regular menstrual cycles were enrolled as a control group. Psychopathology was assessed by psychiatrists using the Positive and Negative Syndrome Scale (PANSS). The Menstrual Attitude Questionnaire (MAQ) was used to assess attitudes toward menstruation, and symptom checklists based on the Moos Menstruation Distress Questionnaire (MMDQ) were used to assess menstrual distress symptoms.

RESULTS

Patients with psychotic disorders (both irregular and regular groups) had more negative attitudes toward menstruation than the control group. In the Schizophrenia group, there was no association between the severity of psychotic symptoms and their influence on attitudes toward menstruation. Moreover, regular menstrual cycles during antipsychotic treatment and fewer menstrual distress symptoms were the two main predictors for more positive attitudes toward menstruation in the patient group.

CONCLUSION

This is one of the first studies to explore the relationship between psychotic symptoms and attitudes toward menstruation. The findings provide more support for the assumption that attitudes toward menstruation are derived from a woman's perception of her bodily experience rather than a psychiatric disorder.

Mexican adolescents' experience of menarche and attitudes toward menstruation: role of communication between mothers and daughters

OBJECTIVES

First, to explore the kind of information that Mexican mothers give their daughters about menstruation before their menarche, and to study the impact of this communication on how prepared the daughters felt when they experienced their menarche. Second, to investigate the influence of the menarcheal experience on attitudes toward menstruation.

DESIGN

Cross-sectional survey.

SETTINGS

Sample of adolescents attending 3 different public schools.

PARTICIPANTS

405 Mexican postmenarcheal adolescents, aged 12-15 years.

INTERVENTION

Participants answered a questionnaire that had 3 parts: (a) General data, (b) topics related to menses that participants had discussed with their mothers prior to menarche, and (c) menarcheal experience. They also answered a questionnaire about menstrual attitudes.

RESULTS

Although most of the participants knew what they should do when they experienced their menarche, only 39% stated they had felt prepared to start menstruating. Regarding menstrual attitudes, adolescents scored highest on Negative Feelings and Secrecy rather than on Positive Feelings. Participants who had previously discussed the emotional aspects of menses with their mothers were more likely to claim they had felt prepared to start menstruating when they got their first period (OR = 3.45). The fact that adolescents felt prepared to start menstruating predicted positive attitudes toward menstruation (β = .19)

CONCLUSIONS

Discussing the emotional aspects of menses prior to menarche is crucial to being prepared for menarche, and to holding positive attitudes toward menstruation. Information on biological knowledge and practical aspects of menses needs to be supplemented with emotional issues.

Factors Influencing Attitude to Menstruation in Elementary School Girls according to the Presence of Menarche

PURPOSE

The purpose of this study was to examine factors related to attitudes to menstruation in elementary school girls according to menarche experience.

METHODS

Data were collected using a structured questionnaire from 208 girls in 5th or 6th grade (90 who were menarche and 118 who were not). The study was a cross-sectional study. Data were analyzed using SPSS/WIN 18.0 program for descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple regression.

RESULTS

There were significant differences in body image, menstrual knowledge and attitude between the two groups of students. Results from the multiple regression analysis revealed difference in related factors and in the magnitude of the relationship evaluated by standardized beta coefficients. Significant factors, listed by the magnitude of beta coefficients, among students in menarche were positive affect of menarche, self-oriented perfectionism-critical, negative affect of menarche. Significant factors among non-menarche students were menstrual knowledge and self-oriented perfectionism-critical.

CONCLUSION

There are differences between menarche and non-menarche girls in attitude to menstruation and related factors. Based on the results of the present study, systemic health education according to differences between the two groups should be developed to foster positive attitudes to menstruation.

Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

OBJECTIVE

The aim of this study was to evaluate baccalaureate nursing students' attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms.

METHODS

This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0.

FINDINGS

The average age of participants was 19.89 ± 1.43. The MAQ's five subscales' mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05).

CONCLUSIONS

The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.

A Turkish study on menarche and menstrual experiences and their effects on attitudes towards menopause

The purpose of this study was to investigate women's menarche and menstrual experiences and their effects on attitudes towards menopause. This research was planned as cross-sectional. A total of 300 women who had applied for a physical examination at the Maternity and Gynecology and Children's Hospital of Ordu province of Turkey were recruited for the study using the convenience sampling method. The study was conducted between 16 April and 28 May 2008. The research data were gathered using the Menopause Attitude Scale and a questionnaire. The average score for women on the Menopause Attitude Scale was 37.85 ± 10.34. Significant differences were found between attitudes of women towards menopause and the information they had received before menarche about menstruation (P = 0.024), the meaning of menstruation (P = 0.014), the interval time between menstrual periods (P = 0.017), problems experienced before menstruation (P = 0.035) and the desire of some women to continue menstruating and delay menopause (P = 0.005). Results of this study showed that more than half of the women had negative attitudes towards menopause. In order to help girls and women develop positive attitudes about menarche, menstruation and menopause, they need to have access to information during all phases of these important physical changes.

Mother-daughter communication about sexual maturation, abstinence and unintended pregnancy: experiences from an informal settlement in Nairobi, Kenya

Parental communication and support is associated with improved developmental, health and behavioral outcomes in adolescence. This study explores the quality of mother-daughter communication about sexual maturation, abstinence and unintended pregnancy in Korogocho, an informal settlement in Nairobi, Kenya. We use data from 14 focus group discussions (n = 124) and 25 interviews with girls aged 12-17, mothers of teenage girls, and key informant teachers. Many girls and women believed that mothers are the best source of information and support during puberty but only a minority described good experiences with communication in practice. Girls preferred communication to begin early and be repeated regularly. Mothers often combined themes of sexual maturation, abstinence and avoiding pregnancy in their messages. Communication was facilitated by mothers' availability, warmth and close parent-child relationships. Challenges included communication taboos, embarrassment, ambiguous message content, and parental lack of knowledge and uncertainty. Neighborhood poverty undermined some mothers' time and motivation for communicating.

Menstrual disorders in adolescent school girls in Enugu, Nigeria

STUDY OBJECTIVE

To determine the prevalence, pattern of menstrual disorders, treatment practices, and the effect of menstrual disorders on school attendance in adolescent school girls in Enugu, Nigeria.

DESIGN

Cross-sectional survey.

SETTING

Randomly selected secondary schools.

PARTICIPANTS

Postmenarcheal adolescent school girls aged 10-19 years.

METHODOLOGY

Pretested, semi-structured questionnaires were used to survey 500 consenting students. The main outcome measures were menstrual disorders. Data was analyzed using SPSS for windows version 15. Data was compared using chi-square test and P ≤ 0.05 was regarded as statistically significant.

RESULTS

Four hundred ninety-five students responded giving a response rate of 99%. The mean age of the girls was 14.9 ± 1.7 years. Most were Christians (99.2%) and their mean age of menarche was 12.7 ± 1.3 years. The prevalence of menstrual disorders was 69.4% and dysmenorrhea, premenstrual dysphoric disorder, and short menstrual cycles were the commonest disorder. Being older, later age of menarche, and being domiciled in the boarding house were significantly associated with menstrual disorders (P < 0.05). Dysmenorrhea was responsible for the greatest number of school abscences. The mean days of school absenteeism was 1.8 ± 1.2. In 80% of cases paracetamol, aspirin, or piroxican were the drugs used for symptom relief. Only 16.3% of respondents ever consulted a doctor for their menstrual disorders.

CONCLUSION

There was a high prevalence of menstrual disorders as well as a high rate of non-expert treatment of the disorders. This underscores the need for awareness creation. Parents and adolescents should consult trained practitioners when significant menstrual disorder occurs in order to rule out or treat associated or underlying medical conditions.

Relationships between menstrual and menopausal attitudes and associated demographic and health characteristics: the Hilo Women's Health Study

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as "natural," to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.

Menarche among Brazilian women: memories of experiences

OBJECTIVE

to present women's experiences of menarche and related memories.

DESIGN

qualitative study using focus groups for data collection.

SETTING

the city of Campinas, São Paulo state, Brazil.

PARTICIPANTS

64 women aged 21-51 years, experiencing menstrual periods, with former or current sexual activity and no perceived infertility.

METHODS

eight focus groups were carried out using a semi-structured guideline. Discussions were recorded with participants' consent, and transcribed and revised. Thematic content analysis was carried out using gender relations as the theoretical framework.

FINDINGS

menarche was experienced as a passage from childhood to womanhood, associated with belonging to a new group and acquiring a new status in the family. The experiences of menarche were not always welcomed or expected, but were recalled as associated with body changes and awareness of sexual issues. The mother's behaviour and attitudes towards menarche were clearly seen as generators of strong and everlasting impressions, either in a positive or negative way. Memories related to the experience of menarche extended through their life, interfering with their relation with their own body, including their reproductive health.

KEY CONCLUSIONS

the way in which menarche is experienced may exert an impact on women's reproductive health, sexuality and lifestyle behaviours.

IMPLICATIONS FOR PRACTICE

the acknowledgement of menarche experiences can be useful to guide health-care providers towards more effective education of girls on sexual and reproductive health issues and better attention to women's needs.

[Menstrual attitudes and maternal child rearing attitudes in middle school female students]

PURPOSE

This correlational study was performed to identify the impacts of maternal child rearing attitudes on the menstrual attitudes and the determinants of positive menstrual attitudes in female middle school students.

METHODS

With convenience sampling, 198 middle school female students were recruited living in one major city and its surrounding areas in Korea. Data was collected using a self administered questionnaire including menstrual attitudes and maternal child rearing attitudes from April 1 to July 15, 2008.

RESULTS

Among the Maternal child rearing attitudes, affectionate, achievement oriented and rational attitudes had positive correlations to a positive menstrual attitude, and an autonomous attitude had a negative correlation to a negative menstrual attitude. As determinants of positive menstrual attitudes, feeling of menarche, mother's response at first menstruation, and rational maternal child rearing attitudes were delineated and their explained variance for a positive menstrual attitude was 18.5%. There was no difference on menstrual attitudes by K clustering in terms of maternal child rearing attitudes.

CONCLUSION

These results support the critical role of the mother. Especially desirable maternal child rearing attitudes in relation to a positive menstrual attitude would be affectionate, achievement oriented and rational for early adolescent girls. In further studies, considerations are needed for menstruation related education and research for early adolescents and active involvement of the mother & daughter together.

Menstrual health care behavior and associated factors among female elementary students in the Hualien region

The purposes of this study were to measure menstrual knowledge, assess menstrual health care behavior and investigate the factors associated with menstrual health care behavior among fifth and sixth grade female students. The subjects were 417 female students from 12 elementary schools in the Hualien region of Taiwan. The stratified cluster random sampling method was adopted. The questionnaire used in the study consisted of three sections: personal information, a menstrual knowledge questionnaire, and a menstrual health care behavior questionnaire. The results of this study show that the majority of the respondents felt that menstruation had an influence on their emotions (74.8%), daily life (73.1%), schoolwork (61.6%), and social interaction (50.1%). The total correct response rate for the menstrual knowledge questionnaire was 45.1%. There was a significant difference between aboriginal and non-aboriginal female students in terms of the correct answer rate for the menstrual knowledge questionnaire. The mean score for menstrual health care behavior was 2.66 (SD = 0.82). Elementary level female students who had better menarche preparation scored higher on the menstrual knowledge questionnaire, and those whose first period had already occurred felt more confident in their ability to execute proper menstrual health care behavior. The results prompted the recommendation to families and elementary schools to encourage students to improve their menstrual health care behavior during menses.