Psychosocial correlates of emotional responses to menarche among Chinese adolescent girls

Role of Pubertal Timing and Perceived Parental Attachment in Internalizing Problem Behaviours Among Adolescents

Adolescents need supportive social institutions to help them deal effectively with the demands of pubertal changes accompanied by new social roles, reducing their susceptibility to problem behaviors. Considering this, it will be investigated how internalizing problem behaviors in teenagers is affected by the interaction between pubertal timing and perceived parental attachment. For this, cross-sectional data from 772 adolescents with ages ranging from 11 to 15 years old was used. Regression analyses showed early maturing adolescents with insecure perceived parental attachments had higher levels of depression and anxiety than their early, on-time, and late maturing counterparts with secure perceived parental attachments. This finding supports the contextual amplification model, as the detrimental consequences of early maturation are impacted by difficult parent-adolescent relationships.

Age at menarche and its association with blood pressure in adult women of developing countries: a systematic review and meta-analysis

CONTEXT

Evidence about the effect of age at menarche (AAM) on blood pressure (BP) has largely been drawn from studies in developed countries. Studies in developing countries are expanding recently but have not been summarised.

OBJECTIVE

To systematically explore the association between AAM and BP and the potential modifiers in developing countries.

METHODS

We searched PubMed, Embase, and Web of Science for publications until March 2022. A random-effects model was used to calculate the pooled relative risk (RR) with 95% confidence interval (CI).

RESULTS

Twenty studies were eligible. In studies with participants' mean age at BP assessment <55 years, women in the oldest group as compared with the middle or the youngest group of AAM had a higher risk of hypertension in those studies without adjustment for confounders (RR 1.79, 95% CI 1.41-2.28, I²=97.0%), those with adjustment for confounders excluding adiposity (1.25,1.04-1.51, I²=84.8%), and those with adjustment for confounders including adiposity (1.38,1.03-1.86, I²=91.8%). In studies with participants' mean age at BP assessment ≥55 years, no significant differences were found for studies without adjustment for confounders (RR 1.07, 95% CI 0.78-1.47, I²=90.3%), studies with adjustment for confounders excluding adiposity (0.85, 0.78-0.92, I²=12.3%), or studies with adjustment for confounders including adiposity (0.95, 0.80-1.11, I²=45.5%). A similar association was observed between AAM and baseline systolic BP and diabolic BP.

CONCLUSION

Late menarche was associated with a higher risk of BP and this association was modified by age and adiposity in developing countries.

Systematic review of menstrual health and hygiene in Nepal employing a social ecological model

Menstrual health and hygiene are a major public health and social issues in Nepal. Due to inadequate infrastructure to provide education, healthcare, and communication as well as religious teachings, women and girls are excluded from participation in many activities of daily living and community activities during menstruation. Evidence based research addressing menstrual health and hygiene in Nepal is scares. The objective of this paper is to review the current state of knowledge on menstrual health and hygiene in Nepal through a socio-ecological perspective. This systematic review identifies knowledge gaps and targets for future research and interventions. Studies from Nepal that examined factors contributing to menstrual health and hygiene were identified through searches across six databases (Medline, CINAHL, Web of Science, PsychInfo, Nepal Journals Online and Kathmandu University Medical Journal) in January 2019. The SEM is a public health framework that describes how health is impacted at multiple levels including the individual, interpersonal, community, organizational and policy levels. Key themes were identified, and factors contributing to menstrual health and hygiene were categorized as per the level of socio-ecological model (SEM). After a comprehensive literature review, twenty peer-reviewed publications, published between 2003 and January 2019 were included in this review. Eighteen studies were descriptive and two were interventional. The main outcomes reported were reproductive health concerns and menstrual hygiene practices. Nine studies focused on knowledge, attitude, and practices regarding menstruation, seven studies highlighted reproductive health issues, three studies focused on prevalence of culturally restrictive practices, and one on school absenteeism and intimate partner violence. Lack of awareness regarding menstrual health and hygiene, inadequate WASH facilities, no sex education and culturally restrictive practices makes menstruation a challenge for Nepali women. These challenges have negative implications on women and girls’ reproductive as well as mental health and school attendance among adolescent girls. There are gaps in the evidence for high quality interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address needs identified at all levels of the SEM.

Menstrual health and hygiene are major public health and social issues in Nepal, due to a lack of health and education infrastructure, gender-based disparities and restrictive cultural and social norms. This study reviewed the current state of research on menstrual health and hygiene in Nepal. The socio-ecological model (SEM)—a public health framework that examines individual, interpersonal, community, organizational, and policy impacts on health—was employed to describe impacts on menstrual health and hygiene. After a comprehensive literature review, 20 papers were included in this analysis, of which 18 were descriptive and two were interventional. The primary menstrual health and hygiene outcomes reported were reproductive health concerns and menstrual hygiene practices. Key themes identified were knowledge, attitude, and practices regarding menstruation, reproductive health issues, prevalence of culturally restrictive practices, school absenteeism and intimate partner violence. The study results indicated lower menstrual health and hygiene challenges arose from lack of education around menstruation, lack of proper water, sanitation, and hygiene (WASH) facilities, poor sex education, and culturally restrictive practices. These challenges negatively impact women and girls’ reproductive health as well as mental health and school attendance. There is need for high quality, effective interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address improvements in menstrual health and hygiene at all levels of the socio-ecological model.

Patterns of premenstrual syndrome and depression symptoms in Chinese female university students: Results of a latent profile analysis

BACKGROUND

Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach.

METHODS

The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity.

RESULTS

The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude.

LIMITATIONS

Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results.

CONCLUSION

These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.

The Onset of Menstruation and Social Networking Site Use in Adolescent Girls: The Mediating Role of Body Mass Index

Evidence suggests that girls spend much time on social networking sites (SNS), often more than boys do. It has been proposed that this may have to do with sex-based differences in the need and approaches for socialization. We posit that adolescent girls are also unique in that they are developing physiologically and start menstruating. Based on prior research, we hypothesize that the onset of menstruation can drive physiological changes (increased body mass index (BMI)), which together with common behavioral-psychological (social and emotional) responses to menstruation can contribute to an increase in SNS use. We therefore aim to test whether BMI partially mediates the relationship between menstruation and SNS use in adolescent girls. Results based on a large nationally representative sample in the United Kingdom suggest that the age of menarche was negatively associated with daily hours of SNS use, and that BMI elevation partially mediated this association. These results extend the negative effects of the early onset of menstruation and imply that BMI control strategies may help to reduce the use of SNS in girls who experience menarche at an earlier age.

Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data

ABSTRACT

Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother-daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18-33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.

Menstrual Cup Use Intention and the Moderating Effects of Sexual Orientation and Gender Characteristic Among Female University Students in Taiwan: A Theory-Driven Exploration

Menstruation plays an important role in women's lives as it accompanies about half of their living years. However, little is known about women's intention to use menstrual cups, a relatively new menstrual product in Taiwan. Therefore, this study aimed to systematically explore the factors associated with menstrual cup use (MCU) intention among female university students in Taiwan, using the Theory of Planned Behavior (TPB). Data from 1245 female university students in Taiwan were collected using an anonymous online survey based on the TPB from December 2016 through January 2017. Multivariate logistic regression found the following TPB factors associated with high MCU intention: positive attitudes about positive (adjusted odds ratio [AOR] = 4.35, 95% confidence interval [CI] 2.87-6.60) and negative (AOR = 2.32, 95% CI 1.54-3.49) outcomes of MCU, supportive subjective norms (AOR = 1.88, 95% CI 1.33-2.65), and high perceived control over MCU under constraining conditions (AOR = 3.40, 95% CI 2.24-5.16). Sexual orientation and gender characteristic were also found to have moderating effects. For example, bisexual college girls with masculine characteristic who perceived high control over MCU under constraining conditions had elevated MCU intention (AOR = 2.45, 95% CI 1.04-5.76). Therefore, to improve women's menstrual health, future health education could focus more on introducing the different features of various menstrual products, including menstrual cups, and help users make informed decisions about which menstrual products could best suit their needs.

Unpreparedness, impurity and paradoxical feeling: menstruation narratives of Iranian women

BACKGROUND

Menstruation is universally experienced by all healthy females from menarche to menopause, although the cognitive and emotional dimension of this experience may differ across time and place.

OBJECTIVE

This qualitative study was conducted to explore the menstruation experiences of Iranian women.

METHODS

Eight Iranian university students, aged between 21 and 25 years, who were resident in Tehran, were interviewed and data were analyzed using an interpretive phenomenological analysis approach.

RESULTS

Two main themes of the participant narratives were identified: "The menarche" and "women's perception of menstruation". Each of these elements comprised a number of sub-themes. The menarche experience was related to "inadequate preparation", "fear and horror" and "the mother". Women perceived menstruation as "shameful and secret", "sickness and impurity", "bothersome and painful", accompanied with "paradoxical feelings" and "irregularity and unpredictability".

DISCUSSION

The results of this study revealed that menarche experience for most of the women was a negative experience. Feelings of being fearful, shocked or worried could be influenced by inadequate preparation for menstruation. They reveived insufficient information from school or their friends and their mothers, specifically. Menstruation is shameful, kept secret and is usually hidden from men. Most of them experienced menstruation as a sickness and considered menstruating women as impure who must obey religious rules. Some of them had symptoms of premenstrual syndrome. For some women menstruation was both painful and pleasing and its irregularity and unpredictability made women anxious. The findings of this study highlight the effect of sociocultural factors on the menstruation experience.

Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries

Background

Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs.

Objectives

This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result?

Methods

Using a structured search strategy, articles that investigate young girls’ preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included.

Results

Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls’ knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls.

Conclusion

LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls’ education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

Promoting the menstrual health of adolescent girls in China

In China, nurses have limited presence in schools, thus, adolescent girls often lack accurate information about menstrual health, which may lead to incorrect and unhealthy menstrual-related behavior. This study investigated the effects of a culturally and developmentally tailored nursing intervention on the menstrual health of adolescent girls in China. Following institutional review board approval, adolescent girls aged 12-15 were recruited from two schools. A quasi-experimental, pretest-posttest design examined the effects of five interactive education sessions on menstrual health. The final sample included 116 adolescent girls. Significant improvement was observed in the intervention group regarding menstrual knowledge, confidence in performing menstrual healthcare behavior, and dysmenorrhea related self-care behavior. A nurse-managed education program improved adolescent girls' menstrual knowledge, promoted a more positive attitude, encouraged confidence, and improved pain relief practice. We recommend that professional nurses globally advocate for school nursing and routine menstrual health education for adolescent girls.

Self-Care Strategies among Chinese Adolescent Girls with Dysmenorrhea: A Qualitative Study

Little is known about how Chinese adolescent girls manage dysmenorrhea. This study aims to explore self-care strategies among Chinese adolescent girls with dysmenorrhea. The study uses a mixed methods design with two phases: a cross-sectional survey in phase I and semistructured interviews in phase II. This paper reports phase II. In line with the phase I findings, 28 adolescent girls with different characteristics (high or low levels of self-care behavior and pain intensity, who did or did not self-medicate, and who had or had not received menstrual education) were recruited for interviews. Content analysis was used for data analysis. Four categories emerged from the data: lifestyle changes, symptom management, communicating dysmenorrhea with others, and seeking medical advice. Girls selected their diets carefully and reduced physical activity during menstruation to avoid aggravating symptoms. Heat therapy commonly was employed for symptom management. A few girls self-medicated to obtain immediate relief from pain, but the majority expressed reservations about using medication because they worried about dependence and side effects. Some girls communicated dysmenorrhea with their family and friends, but the majority did not seek medical advice. The present study showed that girls employed various self-care strategies for dysmenorrhea, including some strategies stemming from traditional Chinese medicine. The findings revealed menstrual etiquette among Chinese adolescent girls with dysmenorrhea, and demonstrated that self-medication was not part of most girls' self-care. Understanding the self-care strategies of these girls is important, as it can help nurses develop a culturally-specific intervention to promote self-care among adolescent girls with dysmenorrhea.

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.

The Role of Mother in Informing Girls About Puberty: A Meta-Analysis Study

CONTEXT

Family, especially the mother, has the most important role in the education, transformation of information, and health behaviors of girls in order for them to have a healthy transition from the critical stage of puberty, but there are different views in this regard.

OBJECTIVES

Considering the various findings about the source of information about puberty, a meta-analysis study was conducted to investigate the extent of the mother's role in informing girls about puberty.

DATA SOURCES

This meta-analysis study was based on English articles published from 2000 to February 2015 in the Scopus, PubMed, and Science direct databases and on Persian articles in the SID, Magiran, and Iran Medex databases with determined key words and their MeSH equivalent.

STUDY SELECTION

Quantitative cross-sectional articles were extracted by two independent researchers and finally 46 articles were selected based on inclusion criteria. STROBE list were used for evaluation of studies.

DATA EXTRACTION

The percent of mothers as the current and preferred source of gaining information about the process of puberty, menarche, and menstruation from the perspective of adolescent girls was extracted from the articles. The results of studies were analyzed using meta-analysis (random effects model) and the studies' heterogeneity was analyzed using the I(2) calculation index. Variance between studies was analyzed using tau squared (Tau(2)) and review manager 5 software.

RESULTS

The results showed that, from the perspective of teenage girls in Iran and other countries, in 56% of cases, the mother was the current source of information about the process of puberty, menarche, and menstruation. The preferred source of information about the process of puberty, menarche, and menstruation was the mother in all studies at 60% (Iran 57%, and other countries 66%).

CONCLUSIONS

According to the findings of this study, it is essential that health professionals and officials of the ministry of health train mothers about the time, trends, and factors affecting the start of puberty using a multi-dimensional approach that involves religious organizations, community groups, and peer groups.

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.

A cross-sectional study of the beliefs and attitudes towards menstruation of Chinese undergraduate males and females in Hong Kong

AIMS AND OBJECTIVES

To explore the beliefs and attitudes towards menstruation of Chinese undergraduates in Hong Kong and to compare those of (1) male and female undergraduates with those of (2) undergraduates studying health-related vs. nonhealth-related programmes.

BACKGROUND

Menstruation is typically viewed as a forbidden topic or a troublesome experience. These negative beliefs and attitudes result from existing myths and taboos associated with cultural factors and health education levels.

DESIGN

A cross-sectional survey was conducted in all universities in Hong Kong. Undergraduates were invited through convenience sampling to complete a questionnaire assessing their attitudes and beliefs towards menstruation.

METHODS

A questionnaire on 'beliefs about and attitudes towards menstruation' was adopted. Questionnaires were self-administered by the respondents.

RESULTS

A total of 450 questionnaires were distributed, and a response rate of 96.6% was obtained; 416 completed questionnaires were collected and analysed. Many Chinese undergraduates agreed that menstruation is annoying, causes disability, involves prescription and proscription and is not pleasant. When comparing the beliefs and attitudes towards menstruation of Chinese male undergraduates with those of female undergraduates, females tended to disagree that menstruation should be maintained secret, but tended to agree that it was annoying. When comparing the beliefs and attitudes towards menstruation of Chinese undergraduates studying health-related programmes with those under nonhealth-related programmes, the latter group exhibited a higher level of belief in prescription and proscription for menstruation than the former group.

CONCLUSION

Chinese undergraduates in Hong Kong were influenced by the traditional Chinese culture and social environment, resulting in negative attitudes towards menstruation. This study recommends that sex education, especially reproductive health education, be extended to tertiary education.

RELEVANCE TO CLINICAL PRACTICE

This study provides relevant information on planning the content of sex education or reproductive health education for Chinese undergraduates.

Nongenetic determinants of age at menarche: a systematic review

BACKGROUND

The acceleration of pubertal development is an important medical and social problem, as it may result in increased morbidity and mortality in later life. This systematic review summarizes relevant data about nongenetic factors, which contribute to age at menarche (AAM), and suggests those which may be the most important.

METHODS

The available literature from 1980 till July 2013 was searched using PubMed and Google Scholar databases. Finally, 154 papers were selected for the analysis.

RESULTS

Environmental factors, which may affect AAM, vary in populations of different ethnicity. The prenatal, infancy, and early childhood periods are the most susceptible to these factors. Body weight, high animal protein intake, family stressors (e.g., single parenting), and physical activity seem to influence AAM in most populations.

CONCLUSIONS

The data about influence of nongenetic factors on AAM are still inconsistent. The factors affecting prenatal and early childhood growth seem to have a larger effect on further sexual maturation. Further studies are needed in order to validate the association between other environmental determinants and AAM in different ethnical groups.

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.

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.

Cultural practices relating to menarche and menstruation among adolescent girls in Taiwan--qualitative investigation

STUDY OBJECTIVE

The aim of this study was to qualitatively record the cultural attitudes and practices associated with menarche and menstruation in Taiwanese girls, particularly with respect to coping mechanisms.

PARTICIPANTS

Forty-eight adolescent girls participated.

INTERVENTION

Adolescent girls were individually interviewed to investigate the effects of their cultural practices, coping mechanisms, and physiological symptoms during menarche and menstruation.

MAIN OUTCOME MEASURE(S)

The qualitative investigation revealed mixed reactions to menstruation, such as eating chocolate, using sanitary napkins, and feeling irritable or embarrassed. Cluster construction suggested that adolescents were prepared for menarche but required emotional support; in addition, the new generation employed the Internet to learn how to cope.

RESULTS

A phenomenological approach showed that menarche and menstrual attitudes among Taiwanese adolescents were comprised in 4 dimensions: self-perception, information, and cultural practices with regard to menarche; physiological symptoms and psychological reactions during menstruation; coping mechanisms during menarche and menstruation; and methods for coping and cultural practices for menstruation. Cultural beliefs and the Internet have changed cross-cultural contacts.

CONCLUSIONS

Educators and health professionals should seek to understand this generation of girls, who perceive the world as more flexible and available and have more creativity and new eating behaviors and hobbies.

Attitudes toward menstruation, menstrual-related symptoms, and premenstrual syndrome among adolescent girls: a rural school-based survey

Folk culture surrounding menstrual-related matters has considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to examine these associations. With a higher score indicating a more positive attitude toward menstruation, the mean attitude score was 3.84 (SD ± 1.62) out of a maximum of six. No significant association was observed between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI 1.01-1.10) and menstrual phase (OR 1.04, 95% CI 1.01-1.07), were more likely to consult a physician for premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05-0.83). The findings imply the need for education to help adolescent girls manage menstrual symptoms and increase awareness of the benefit of treating them. Given that menstrual-related information was widely available from mothers, family, and social culture are potentially important in shaping good menstrual attitudes.

Premenstrual syndrome and dysmenorrhea: urban-rural and multiethnic differences in perception, impacts, and treatment seeking

BACKGROUND

Attitudes toward menarche and menstruation are largely influenced by sociological, cultural, and family environmental factors. Recognizing the influential effects that these factors might have on shaping adolescents' attitudes is crucial in designing a more effective means of transmitting health information.

AIMS

This study aimed to gather an in-depth understanding of perceptions, impacts, and treatment seeking on menstruation-related issues from an ethnically mixed group of rural and urban girls.

METHODOLOGY

In total, 27 focus group discussions (172 participants) were conducted between November 2008 and April 2009. Participants were adolescent girls aged 13-19 years, recruited from 7 public secondary schools in the Federal Territory of Kuala Lumpur and 4 public secondary schools from the rural districts of Kelantan, in Malaysia.

RESULTS

Many participants revealed that they were not given or had not received detailed information about the mechanism or physiology of menstruation prior to its onset. Thus, many described the onset of menarche as shocking, an event for which they were unprepared, and which has had a tremendous impact on their emotions. More positive acceptance of menarche was reported in the urban than with the rural groups. Despite the high prevalence of premenstrual syndrome and dysmenorrhea, participants across urban-rural and ethnic groups perceived the problems as completely normal, hence they relied on self-care methods and did not want to seek professional treatment. More rural girls compared to urban girls were embarrassed to talk to their mothers or consult their physicians regarding menstruation-related problems.

CONCLUSION

Menstruation-related education would have a positive impact in improving adolescent girls' knowledge and in nurturing a positive attitude toward menstruation-related matters at home, at school, and in the community.

Going through the rites of passage: timing and transition of menarche, childhood sexual abuse, and anxiety symptoms in girls

Menarche is a discrete, transitional event that holds considerable personal, social, biological, and developmental significance. The present longitudinal study examined both the transition and timing of menarche on the trajectory of anxiety in girls with histories of childhood maltreatment (N = 93; 63% European American, 14% multiracial, 10% Latino, 9% African American, and 4% Native American). We hypothesized that because menarche is a novel, unfamiliar experience, girls would show greater anxiety around the time of menarche. The anxiety-provoking nature of menarche may be accentuated among earlier-maturing girls and girls with histories of childhood sexual abuse. Results indicated that earlier-maturing girls were more anxious in the pre- and peri-menarche periods than their later-maturing peers; however, their anxiety declined after menarche. Childhood sexual abuse was associated with heightened anxiety throughout this transition. The developmental significance of the timing and transition of menarche in relation to childhood sexual abuse and anxiety is discussed.

Determination of the motherly reactions to adolescents' experience of menarche. II

OBJECTIVES

The study was conducted to identify mothers' reactions to adolescent girls' experience of menarche.

METHODS

This descriptive study was conducted in Obstetrics and Gynecology Clinic of the University Hospital in Eastern Anatolia in Erzurum, Turkey, between April and May 2009. The study comprised mothers of adolescent girls who had experienced menarche during the last 12 months. Two hundred and four mothers formed the sample for this study. However, 10 were removed from the study because their daughter did not inform them about their menarche experience and the mothers could not answer some questions. The study was thus conducted with 194 mothers. The data were collected via a questionnaire prepared by the researchers and the data were evaluated using percentages. Approval for the research was obtained from the hospital and the ethics committee before commencement. The researchers provided the women with information about the survey.

RESULTS

The average age of mothers was 41.37 ± 6.5. A total of 44.3% of mothers had achieved primary school educational level and 78.9% of mothers have lived in a nuclear family. Mothers' reactions to their daughters' experience of menarche largely consisted of providing them with information about what to do (72.2% of them gave information about bathing, 59.3% of them gave information about genital hygiene). Mother' positive attitudes were very low (18% of them kissed their daughters, 11.3% of them congratulated their daughters). There were 12.4% of mothers who were sad about their daughters' experience of menarche.

CONCLUSIONS

It was determined in this study that the extent to which mothers showed reactions of happiness to their daughters' experience of menarche is rather low, but the rate of mothers telling their daughters what to do in this period was quite high.

Determination of the motherly reactions to adolescents' experience of menarche

OBJECTIVES

The study was conducted to identify mothers' reaction to adolescent girls' experience of menarche.

METHODS

This retrospective and descriptive study was conducted in the Nursing School and Erzurum Health School of Atatürk University in Erzurum, Turkey, in October 2008. The study comprised 191 first-year students. The data were collected via a questionnaire prepared by the researchers. The data were evaluated using SPSS software, using percentage, arithmetical average, and standard deviation.

RESULTS

The average age of the students was 18.82 +/- 1.1 years. A total of 92.1% of students had a democratic family structure. It was also determined that the age of the mother when the student experienced menarche was generally 30-39 years (71.7%). For 48.2 % of the students, menarche occurred at 12-13 years of age; 52.9% of them found menarche a normal event and 69.1% of them first reported their experience of menarche to their mothers. Mothers' reactions to their daughters' experience of menarche largely consisted of giving information about what to do in this period.

CONCLUSIONS

It was determined in this study that the extent to which mothers showed reactions of happiness to their daughters' experience of menarche is rather low, but the rate of mothers telling their daughters what to do in this period was quite high.

Menstrual Attitude Questionnaire: confirmatory and exploratory factor analysis with Turkish samples

AIM

This study is a report of an investigation of the psychometric properties of the Turkish version of the Menstrual Attitude Questionnaire.

BACKGROUND

Cultural, social and family environments influence women's beliefs about and attitudes towards menstruation. Awareness of these beliefs and/or attitudes and their cultural origins is necessary to understand women and their reactions to menstruation when offering health care. Although the Menstrual Attitude Questionnaire has been used in several studies, the psychometric properties of the Turkish version have not been investigated.

METHODS

Confirmatory factor analyses were carried out with two different samples - high school (n = 650) and undergraduate university students (n = 569) - in Turkey in the spring semester of 2006. Exploratory factor analyses were then used to modify the factor structure.

RESULTS

Confirmatory factor analysis did not confirm the factor model reported in the United States of America. However, compared with British and Indian samples, Turkish attitudes showed better fit than both British and Indian samples with comparative fit index values of 0.776 and 0.797 for the high school and university samples respectively. Finally, exploratory factor analysis yielded a 28-item measure for the high school sample and 31-item measure for the university sample, with a 5-factor solution. Reliability estimates of both scales were satisfactory, being 0.73 for the high school and 0.79 for the university sample.

CONCLUSION

The modified 5-factor Menstrual Attitude Questionnaire could be a useful tool for assessing menstrual attitudes among Turkish high school and university students. The overall score permits comparison with results from earlier studies using the original instrument.

Menstrual and menarche experience among pubescent female students in Taiwan: implications for health education and promotion practice

AIMS AND OBJECTIVES

This study aimed to explore the menarche and menstruation experiences of young females aged 10-12 years in elementary education in Taiwan.

BACKGROUND

Menarche is a significant milestone in a woman's life and for female adolescents it is a sharply defined biological event that can be a traumatic and uncomfortable time. If used, school nurses can make a significant contribution in educating young people and help to ameliorate these problems. Understanding how young women feel about menstruation is a central element to sexual health education practice.

DESIGN

A qualitative research design was employed using focus groups.

METHODS

Data were collected from 20 female students, aged between 10-12 years. Focus groups were recorded, transcribed and subject to a thematic analysis.

RESULTS

Three themes emerged from the data analysis reflecting the menstrual experience of participants. These were: 'Changing bodies: the physical effects of menarche and menstruation', 'Emotional issues: the psychological impact of menarche and menstruation' and 'Social dimensions of the menarche and menstruation'.

CONCLUSION

Our findings show that young females can experience significant physical and emotional difficulties around menstruation - many of which stem from poor information and the reactions of their peer group to menstrual activity. The potential for school nurses to contribute to this education is significant and schools should explore the manner in which nurses can contribute to this area of health education.

RELEVANCE TO CLINICAL PRACTICE

Nurses involved in health education work with young people and ensure that menstruation education addresses the social and psychological impact of the menarche as well as the physical elements of menstruation. Boys should not be absent from this education and the impact of their attitudes towards menstruation upon their female peers should be addressed in health education work.

A qualitative investigation of women's experiences of the self and others in relation to their menstrual cycle

OBJECTIVES

This study aimed to compare and contrast detailed accounts of a community sample of women, with prospectively defined low or high premenstrual symptoms, highlighting differences/similarities.

METHODS

Semi-structured interviews were conducted with 16 women (9 with 'low' and 7 with 'high' symptom levels) and analysed using template analysis.

RESULTS

'Low symptom' women perceived themselves as generally laid back but demonstrated a need for organization and control in the family environment. They accepted less than perfect relationships, compared themselves favourably to others and perceived themselves as having strong support networks. There was a negative perception of the introduction to menarche but this was coupled with strong maternal support. 'High symptom' women showed patterns of perfectionism, an emphasis on self-sacrifice and unfavourable comparison of self with others. They reported feeling alone, overwhelmed by tasks and experienced relationships as characterized by unresolved tensions. Menarche was viewed as a positive experience but accompanied by low maternal support. Both groups viewed their symptoms as irrational and controllable outside the home, but vented on partner, close family and children. There was acknowledgement of difference from 'normal' ('low') with an emphasis on the all-encompassing nature of symptoms ('high').

CONCLUSIONS

Women with high and low menstrual cycle symptoms viewed aspects of themselves and their relationships with others in both similar and different ways. A major issue for high symptom women was that they struggled to tolerate imperfections, both in their own performance or in their relationships with others, potentially emphasizing the role of cognitive appraisals in interventions.

Age-period-cohort projections of breast cancer incidence in a rapidly transitioning Chinese population

Breast cancer incidence should be assessed separately in different populations, as it differs substantially between Chinese and Caucasian women, and more generally in developing versus developed populations. Estimation of future trends is important for public health planning. On the basis of the recent breast cancer incidence trends, we projected future disease rates in the rapidly transitioning Chinese population of Hong Kong. We used local data on breast cancer incidence and mid-year population figures for the years 1974-2003. We fitted Poisson age-period-cohort models with autoregressive priors on the age, period and cohort effects, and used projections of these effects to forecast future incidence to 2018. We found that age-standardized breast cancer incidence would continue to rise by approximately 1.1% per annum over the next 15 years, from 45.9 cases in 1999-2003 to 54.3 per 100,000 (95% credible interval: 50.9, 58.4) in 2014-2018. Recent secular incidence increases can be attributed to both ageing and intergenerational effects beginning with the postwar baby boomers, whereas there is no evidence for important changes by time period. There does not appear to be differential cohort-related risk for pre- vs. postmenopausal disease. Unlike most other cancers, breast cancer risk in local women would continue to increase in the short to medium term, at a similar rate of increase compared with historical trends. This could most likely be attributed to Hong Kong's socioeconomic developmental history and continuing adoption of westernized lifestyle changes.