Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

Premenstrual Syndrome, Anxiety, and Depression Among Menstruating Rural Adolescent Girls: A Community-Based Cross-Sectional Study

Introduction Menstrual periods in young females can add a new challenge to the already difficult adolescent transition period. Menstrual health concerns can have extreme physical and psychosocial impacts on adolescent girls. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are extremely common yet underestimated. Depression in adolescents is a mental and emotional disorder. The objective of the study was to find out the prevalence of PMS, PMDD, anxiety, and depression among rural menstruating adolescent girls and the factors associated with it. Methods This was a community-based cross-sectional study carried out among 20 rural schools for the period of one year. Sample size was calculated based on previous research. Adolescent females who had menstruated for one year were included and those with primary amenorrhea and previously diagnosed mental health abnormalities were excluded. Becks' Depression Inventory, Hamilton Anxiety Scale, and Premenstrual Symptoms Screening Tool (PSST-A) were used. Data were collected by interview technique and entered in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States), and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Results Out of 430 rural adolescent girls, 180 (41.9%) were 15 years, 277 (64.4%) belonged to nuclear families, 236 (54.9%) exercised less than 30 minutes, 144 (33.5%) had menarche at the age of 13 years, 288 (67%) had regular cycles, 266 (61.9%) had moderate flow during the menstrual cycle, 302 (70.2%) had a flow duration of less than seven days, and 243 (56.5%) had dysmenorrhea. Thirty-eight (8.8%) girls had PMDD and 75 (17.4%) had PMS. Age, family status, severity of menstrual flow, duration of cycle, and presence of dysmenorrhea, depression, and anxiety had a statistically significant association with PMDD. The class/grade in which studying, cycle regularity, flow during the menstrual cycle, duration of the cycle, dysmenorrhea, anxiety, and depression status had a statistically significant association with PMS. Conclusions The menstrual cycle's impact on the mental health of rural adolescent girls should not be ignored and schools can be instrumental in improving their quality of life. Regular counselling and mental health supervision by school teachers and peer groups can be beneficial.

Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study

Adolescent girls face social, psychological, and physical problems managing menstruation in schools in low-resource settings. This study aimed to evaluate the social and physical menstrual health environment of secondary schools in Wakiso and Kalungu districts, Uganda, in preparation for a subsequent menstrual health intervention trial to improve education, health and wellbeing. We conducted a qualitative rapid assessment in 75 secondary schools in Uganda. This involved conducting in-depth interviews with 150 head/senior teachers and 274 students, 26 Focus Group Discussions with students, and 13 transect walks to observe school Water, Sanitation and Hygiene (WASH) facilities between May and October 2021. Due to COVID-19 related school closures, face-to-face research activities were halted and in-depth interviews were conducted over phone and replaced focus group discussions. We employed a thematic framework analysis approach using the social-ecological model (which focuses on the complex interplay between individual, interpersonal, institutional, and societal factors) to generate themes and key concepts. Participants described the social and physical menstrual health environment of secondary schools at the individual level (knowledge gaps on menstruation before menarche, negative norms and beliefs about menstrual health); interpersonal level (limited psycho-social support, myths and misconceptions about the disposal of sanitary materials and pain relief, menstrual hygiene management (MHM) support from school nurses, peers and senior teachers); institutional level (non-implementation of Government circulars on MHM, lack of school-level guidelines policies and programs on MHM and poor WASH facilities, i.e. lack of soap, safe water and unclean toilets); and societal level (MHM programmes provided by civil society groups, health workers, and students' school associations). The findings showed individual, societal and institutional burdens related to menstrual experiences. Multi-level evidence-based interventions aimed at improving the social and physical environment for menstrual health among school-going girls are needed.

Menstruation behaviour influencer model: a grounded theory of menstrual experiences of shame, embarrassment, stigma and absenteeism among pubescent girls in semi-urban and rural secondary schools in Enugu State, Nigeria

Introduction

severally, studies had identified menstrual-associated shame, embarrassment, stigma, and absenteeism among pubescents in school with resultant challenges on their bio psycho-social functioning. However, what is not clear is the contribution of the home and school to the experiences. The objectives of the study were to explore the experiences with menstruation and menstrual hygiene management; explore the experiences with menstrual-associated shame, embarrassment, stigma, and absenteeism among participants; explore the bio-psycho-social issues associated with the experiences; understand the meaning of the experiences and propose a mid-range theory that explains the influences on pubescents´ menstrual behaviours.

Methods

constructivist grounded theory design was used to explore the experiences of 20 purposively recruited pubescents from rural and semi-urban secondary schools. In-depth Interviews, focused group discussions, key informant interviews, and observations were employed to collect data until data saturation. Open and focused coding was conducted to identify emerging themes and sub-themes. These themes were returned to participants and literature for verification.

Results

four (4) categories and eleven (11) sub-categories emerged from the data and formed four (4) themes that influence pubescents´ menstrual behaviour. They include: 1) individuals´ bio-physiological status, knowledge of menstrual health and menstrual characteristics; 2) regimenting school through strict rule enforcement, punishment/motivation, forced participation, and compliance; 3) scheduling academic activities/examination, sporting and other extra curricula activities; and 4) providing menstrual support by individual and institutional efforts to pubescents. Based on the relationship with other themes, the menstrual behaviour influencer model was proposed.

Conclusion

menstrual influencers require the interaction between menstrual support and menstrual enablers by institutions for positive menstrual behavior. Failure to achieve this balance will lead to menstrual-associated shame, embarrassment, stigma, absenteeism, and school drop-out.

Prevalence and effects of menstrual disorders on quality of life of female undergraduate students in Makerere University College of health sciences, a cross sectional survey

BACKGROUND

Menstrual problems affect as high as 90% of adolescent females and are the main reason for gynecology visits. Dysmenorrhea was the most frequent menstrual disorder for which adolescents and their parents were referred to a physician. Many undergraduate students are adolescents who undergo several hormonal changes that affect menstrual patterns. This study aimed to determine the prevalence of menstrual disorders and to determine the effect of menstrual disorders on quality of life (QOL) of female undergraduate students at Makerere University college of health sciences.

METHODS

A cross sectional study design using a self-administered questionnaire. WHO (World Health Organization) QOL-BREF (QOL-Best Available Reference document) questionnaire was used to assess QOL of participants. Collected data was double entered into EPIDATA, and transferred to STATA for analysis. Data was presented using tables, and analyzed using percentages, frequencies, medians, interquartile range, means and standard deviations, t-test and ANOVA were used to establish statistical significance. P < 0.05 was considered statistically significant.

RESULTS

Of the participants, 275 were included in the data analysis. The median age of the participants was 21 years with range of 18-39 years and interquartile range of 20-24 years. All the participants had attained menarche. Of the participants, 97.8% (95%CI: 95.2-99.0) (269/275) reported some form of menstrual disorder. Premenstrual symptoms were the commonest disorder (93.8% (95%CI: 90.2-96.1), N = 258) followed by dysmenorrhea (63.6% (95% CI: 57.7-69.1), N = 175), irregular menstruation (20.7% (95%CI: 16.3-25.9), N = 57), frequent menstruation (7.3% 95% CI:4.7-11.0, N = 20) and infrequent menstruation (3.3% (95% CI:1.7-6.2), N = 9). Dysmenorrhea and premenstrual symptoms significantly reduced the QOL scores of participants.

CONCLUSION

Menstrual disorders were highly prevalent with negative effects on QOL and class attendance. Efforts should be made to screen and possibly treat menstrual disorders among university students as well as to conduct further studies to elucidate more on the effects of menstrual disorders on quality of life.