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

Women's Attitudes Towards Menstruation and Their Associations With Well-Being: A Latent Profile Analysis

Over the lifetime, women develop attitudes toward menstruation, which can affect their physical and psychological well-being. Up to now, literature has poorly investigated the relationship between attitudes toward menstruation, specific variables potentially associated with these attitudes - such as women's age, sources of information, level of education, use of hormonal contraceptives - and some indicators of well-being, such as body appreciation, self-esteem, and emotional regulation. This study aims to fill this gap. The main objective is to identify attitude toward menstruation profiles able to describe the heterogeneity of the sample and relate them to the variables and indicators of well-being mentioned above. A Latent Profile Analysis was performed on a sample of 452 women, aged 18 to 53, who filled out an online survey. Specifically, three different menstrual attitude patterns profiles were identified, namely predictable annoying event, predictable natural event and unpredictable and deniable event. The main findings show that age and having acquired knowledge from scientific sources contribute to the development of positive attitudes, which in turn are associated with higher levels of self-esteem and body appreciation. On the other hand, using hormonal contraceptives and relying on the Internet as a source of information about menstruation are linked to negative attitudes, which in turn are associated with reduced self-esteem and body appreciation, and greater emotional dysregulation.

Degendering Menstruation: A Scoping Review Exploring the Experiences of Transgender and Non-Binary People

Menstruation is a biological process experienced by up to 800 million people on any given day. Historically, menstruation has been studied from the female perspective. However, it should be considered that not all who menstruate are women. Therefore, the purpose of this research was to determine the status of evidence on transgender and non-binary individuals' experiences with menstruation. Arksey and O'Malley's (2005) framework for conducting a scoping study was used to guide this review. The authors used five steps of the six-step process to identify the research problem and search strategy, select studies based on defined inclusion and exclusion criteria, extract key information from five selected studies, and chart, summarize, and report the results as themes. The analysis resulted in the identification of four themes: (1) gender dysphoria and the influence on identity; (2) menstrual management and transformation as a turning point; (3) managing menstruation in precarious spaces; and (4) moving toward an open dialogue. Findings suggest a need for awareness of diverse and inclusive menstrual experiences. Inclusive advertising and menstrual products are needed to support transgender and non-binary people and reduce gender dysphoria. Policy initiatives should support the reconceptualization of infrastructure so that bathrooms are safe and comfortable places. Future opportunities for research exploring menstrual management within transgender and non-binary populations with emphasis on global research with diverse cultures and social structures is necessary to address gaps in the existing literature.

Effects of estetrol/drospirenone on self-reported physical and emotional premenstrual and menstrual symptoms: Data from the phase 3 clinical trial in the United States and Canada

OBJECTIVE

To describe the effects of estetrol 15mg/drospirenone 3 mg on physical and emotional premenstrual and menstrual symptoms in a North American population.

STUDY DESIGN

We used Menstrual Distress Questionnaire (MDQ) data from an open-label phase 3 trial conducted in the United States and Canada that enrolled participants 16-50 years to use estetrol/drospirenone for up to 13 cycles. Four most bothersome MDQ domains were evaluated: the physical domains of Pain and Water Retention and the emotional domains of Negative Affect and Impaired concentration. We assessed mean changes from baseline to end of treatment in premenstrual and menstrual scores in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain.

RESULTS

Of 1864 treated participants, 1308 (70.2%) completed both MDQs of which 676 (51.7%) were starters and 1179 (90.1%) were US participants. Starters reported significant improvements (p < 0.05) for menstrual Pain (-3.3), premenstrual (-1.5) and menstrual (-2.0) Water Retention and premenstrual Negative Affect (-1.2). Switchers reported no significant changes in any of the four domains. We observed a decrease in symptom intensity in >40% of participants within the domain Pain for Headache, Cramps, Backache, Fatigue, and General Aches and Pain; within the domain Water Retention for Weight Gain, Skin Blemish, Painful or Tender Breast, and Swelling; and within the domain Negative Affect for Anxiety, Mood Swings, and Irritability.

CONCLUSION

Estetrol/drospirenone starters experienced the most significant improvements in the MDQ domains Pain, Water Retention, and Negative Affect. Domain scores for switchers remained stable.

Menstrual cycle effects on cognitive performance: A meta-analysis

Does a woman's cognitive performance change throughout her menstrual cycle? Menstruation continues to be a taboo topic, subject to myths about how it affects women. Despite the considerable number of empirical studies, there have been few quantitative summaries of what is known. To address this gap, we conducted a meta-analysis of cognitive performance across the menstrual cycle, including the domains of attention, creativity, executive functioning, intelligence, motor function, spatial ability, and verbal ability. We included studies that measured women's performance at specific points in the cycle for tasks that have objectively correct responses. Our analysis examined performance differences across phases using Hedges' g as the effect size metric. Across 102 articles, N =  3,943 participants, and 730 comparisons, we observe no systematic robust evidence for significant cycle shifts in performance across cognitive performance. Although two results appeared significant with respect to differences in spatial ability, they arise from a large number of statistical tests and are not supported in studies that use robust methods to determine cycle phase. Through the use of Egger's test, and examination of funnel plots, we did not observe evidence of publication bias or small-study effects. We examined speed and accuracy measures separately within each domain, and no robust differences across phases appeared for either speed or accuracy. We conclude that the body of research in this meta-analysis does not support myths that women's cognitive abilities change across the menstrual cycle. Future research should use larger sample sizes and consistent definitions of the menstrual cycle, using hormonal indicators to confirm cycle phase.

Dysmenorrhea and the clinical encounter: testing a conceptual model of physician-patient interactions among emerging adults

ABSTRACT

Dysmenorrhea affects as much as 85% of female youth in Canada and the United States and can negatively impact academic performance, overall health, and mental well-being. The physician-patient relationship can play an important role in supporting patients with pain conditions, such as dysmenorrhea. Through effective communication, trust, and validation, physician-patient interactions can empower pain patients, potentially improving pain outcomes. To date, no studies have quantitatively examined the impact of physician-patient interactions on youth's experiences of dysmenorrhea. Therefore, our aim was to explore the relationships among perceived physician communication, pain invalidation, trust in the physician, treatment adherence, menstrual sensitivity, and dysmenorrhea symptom severity among emerging adults (EA) and test a conceptual model of potential interactions using partial least squares structural equation modeling (PLS-SEM). The online survey was administered to Canadian and American EA aged 18 to 21 (Mage = 19.4, SD = 1.1) years with dysmenorrhea. Two models were tested using PLS-SEM: model A only included participants who had received a treatment plan from their physician (n = 279) and model B included the full data set (N = 362). In both models, the perception of more effective physician communication and reduced pain invalidation were related to lower dysmenorrhea symptom severity through menstrual sensitivity. In model A, better physician communication and lower pain invalidation were also associated with higher reported treatment adherence by trust in the physician; however, neither treatment adherence nor trust in the physician were associated with dysmenorrhea symptom severity. Future research should include additional elements within the clinical encounter and further refine the model.

Using an Interpretive Phenomenological Approach to Understand the Menstrual Experience of Young Adults

Background/Objectives: an estimated 1.8 billion people worldwide menstruate, and many face difficulties managing. Young adults often encounter stigma, exclusion, and a lack of resources to manage menstruation comfortably. A review of studies on college students revealed that menstrual symptoms and stigma lead to absenteeism, poorer performance at work and school, and decreased quality of life. This study examines the multifaceted perceptions of a diverse group of young adults aged 18-25 to gain a deeper understanding of the menstrual experience, including cultural stigma, to advocate for personalized care and policy change. Methods: we used snowball sampling and employed a qualitative research methodology integrating a Qualtrics survey (n = 620) and focus groups (n = 50). We used an interpretive phenomenological approach to thematically code participants' lived experiences by assigning codes to text segments and grouping them by broader themes using the Nvivo 14.23.3 software to understand the underlying meaning and significance of the data. Results: a diverse group of young adults completed the study. Key themes include difficulties attending work/school/social activities related to the physical and mental health challenges associated with menstruation, a cultural stigma, and a lack of access to healthcare and care products during menstruation. Quality of life could be improved with decreased stigma and improved self-care strategies. Limitations include the small sample size and the qualitative study design. Conclusions: this study highlights the need for a holistic approach to supporting menstruation. Recommendations include increasing access to menstrual healthcare, an understanding of cultural differences, and consideration of policy accommodations such as paid time off by workplaces and educational institutions related to menstruation.

Association between primary dysmenorrhoea on quality of life, mental health and academic performance among medical students in Indonesia: a cross-sectional study

OBJECTIVES

To investigate the association between primary dysmenorrhoea and quality of life, mental health and academic performance among medical students in Indonesia.

DESIGN

A cross-sectional study using an online survey was conducted among Indonesian medical students. Primary dysmenorrhoea occurrence and severity, as well as their associations with quality of life, mental health and academic performance, were assessed using validated questionnaires. The associations of dysmenorrhoea occurrence and severity were analysed alongside other potential independent variables, including age, region, stage of study and parental income. Statistical analyses included χ2 tests, t-tests and multiple regression models to adjust for confounders (p<0.05).

SETTING AND PARTICIPANTS

Indonesia (June-July 2021: n=630 medical students).

OUTCOMES

The primary outcomes were quality of life, mental health and academic performance, assessed as dependent variables. Quality of life was measured using the Quality of Life Scale, mental health was assessed through depression and stress scores from the Depression Anxiety Stress Scales-42; and academic performance was evaluated through concentration and activity disruption, absenteeism and cum laude grade point average (GPA). The independent variables were primary dysmenorrhoea occurrence and severity, categorised as mild or moderate-to-severe using the Verbal Multidimensional Scoring System.

RESULTS

Primary dysmenorrhoea was significantly associated with reduced quality of life, mental health challenges and academic disruptions. Students with dysmenorrhoea had significantly lower Quality of Life scores (-1.82, 95% CI: -2.63 to -1.02; p<0.001), with moderate-to-severe pain linked to an even more significant reduction (-2.09, 95% CI: -2.54 to -1.63; p<0.001). Dysmenorrhoea occurrence was significantly associated with depression (OR 2.16, 95% CI: 1.23 to 3.81; p=0.007), while severity was associated with both depression (OR 2.07, 95% CI: 1.47 to 2.92; p<0.001) and stress (OR 1.82, 95% CI: 1.26 to 2.62; p<0.001). Dysmenorrhoea occurrence and severity significantly disrupted concentration (OR 12.92, 95% CI: 6.14 to 27.22; p<0.001 and OR 7.24, 95% CI: 4.68 to 11.19; p<0.001, respectively), activities (OR 34.95, 95% CI: 4.77 to 256.16; p<0.001 and OR 6.92, 95% CI: 4.63 to 10.36; p<0.001) and absenteeism (OR 12.10, 95% CI: 1.65 to 88.83; p=0.014 and OR 5.65, 95% CI: 3.32 to 9.63; p<0.001). Cum laude GPA was not significantly associated.

CONCLUSIONS

Primary dysmenorrhoea is significantly associated with the quality of life, mental health and academic performance of medical students in Indonesia. Addressing its implications can enhance student well-being and academic outcomes.

The association between dietary diversity and patterns in Chinese university students with abnormal uterine bleeding: a cross-sectional study

BACKGROUND

Abnormal uterine bleeding (AUB) is a common gynecological issue during reproductive years. Researches on how dietary diversity and patterns influence AUB in Chinese university students are limited, with some studies not clearly defining irregular menstruation. This research investigated the incidence of AUB according to the International Federation of Gynecology and Obstetrics criteria and sought to identify preventative factors via online questionnaires.

METHODS

Food intake was assessed via factor analysis. This study analyzed the relationships among the dietary diversity score (DDS), dietary patterns, and AUB via univariate and multivariate binary logistic regression models and generalized additive models.

RESULTS

The sample consisted of 698 students, with 434 (62.2%) having experienced AUB. Among them, 87 (20.05%) reported abnormal frequency, 250 (57.60%) reported irregular menstrual cycle, 41 (9.45%) reported prolonged duration, and 268 (61.75%) reported abnormal flow volume. A 1-unit increase in the DDS was linked to a 22% lower risk of AUB (odds ratio 0.78, 95% CI: 0.67, 0.90). A high DDS (≥ 6) was consistently associated with a lower risk of AUB across all the models. Using a two-piecewise linear regression model and recursive algorithm, a nonlinear, reverse L-shaped relationship was identified between the "low fat plant-based" dietary pattern factor score (FAC4) and AUB, with an inflection point of 1.45. Before this point, FAC4 had a protective effect on AUB (odds ratio 0.42, 95% CI: 0.21, 0.84).

CONCLUSIONS

Our study underscores the importance of a varied diet as a preventive measure for AUB, utilizing a DDS to quantify the relationship between dietary diversity and AUB. According to our findings, higher dietary diversity and moderate adherence to a "low fat plant-based" dietary pattern may be significant protective factors against AUB in university students.

Relationship between menstrual cycle and cognitive function in women with primary dysmenorrhea

Background/aim

To evaluate the relationship between the change in pain intensity over days of the menstrual cycle and cognitive function in females with primary dysmenorrhea.

Materials and methods

One hundred thirty-four females with primary dysmenorrhea who were admitted to our hospital from January 2021 to November 2023 were assessed. Of these participants, 46 individuals who subjectively stated that their cognitive function was affected, for whom neurology consultation was requested, and for whom patient data were available, were included in the study.

Results

A significant decrease was seen in phonemic and semantic fluency on day 3 of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease was observed in the forward and backward digit span (DGS) scores on day 3 of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease was seen in the forward and backward DGS scores on the most painful day of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease in the logical memory subtest Wechsler Memory Scale revised scores on the most painful day of menstruation (p < 0.001).

Conclusion

Consistent with the literature, strong evidence was found showing a negative correlation between dysmenorrhea and cognitive function. Future prospective, larger sample-size studies comparing cognitive function in females with and without dysmenorrhea at various stages of the menstrual cycle are needed.

The effect of listening to music and drawing on coping with dysmenorrhea complaints in nursing students: randomized controlled trial

AIM

To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students.

METHODS

The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions.

RESULTS

Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group.

CONCLUSIONS

Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women's health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea.

CLINICAL TRIALS REGISTRATION NUMBER

https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023.

Examining impact of menstrual cup distribution programming on attitudes about menstruation

This study seeks to use a data science approach to explore the social impact of the CampusCup program on the attitudes about menstruation by analyzing differences between students who participate in CampusCup and those who do. The study found a statistically significant difference in attitudes about menstruation among individuals who participated in the CampusCup program and those who do not use menstrual cups. This study also found that in addition to menstrual cup usage, functionality appreciation, knowledge about menstrual health, and perceived university support for menstruators are all significant factors in the prediction of attitudes about menstruation.

Exercise and endometriosis-is there a promising future? A narrative review

BACKGROUND

Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control.

AIM(S)

Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms.

OBJECTIVE(S)

Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control.

RATIONALE

Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise.

SEARCH STRATEGY

A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed.

INCLUSION CRITERIA

Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000.

EXCLUSION CRITERIA

Non-English publications, non-human studies.

RESULTS

Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted.

DISCUSSION

Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area.

CONCLUSION

For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.

Factors predicting menstrual irregularity among university students in Ho Chi Minh City, Vietnam: A cross-sectional study

Background

University students often face menstrual irregularities, particularly among healthcare students, due to rigorous study environments, such as night duties resembling professional staff responsibilities.

Objective

This study aimed to examine the prevalence of and factors predicting menstrual irregularities among female students in Ho Chi Minh City, Vietnam.

Methods

A cross-sectional study was conducted from April to July 2023 at the University of Medicine and Pharmacy at Ho Chi Minh City (UMP). Data were collected using self-administered questionnaires comprising sections on personal background, menstrual cycles, sleep duration, and academic stress. Descriptive statistics and multiple logistic regression were employed for data analysis.

Results

Approximately 48.3% of participants experienced menstrual irregularities. Overweight or obese students were more likely to experience irregularities compared to those of normal weight (AOR = 7.56, 95% CI = 1.34, 80.8). Nursing majors (including nursing, midwifery, and anesthesia resuscitation nursing) showed a higher likelihood of irregularities compared to other majors (AOR = 2.5, 95% CI = 1.35, 4.13).

Conclusion

This study highlights a significant prevalence of menstrual irregularities among female students. Interventions in nursing education should focus on promoting healthy lifestyles and regular physical activity to manage weight and mitigate menstrual irregularities.

Effects of E4/DRSP on self-reported physical and emotional premenstrual and menstrual symptoms: data from the phase 3 clinical trial in Europe and Russia

PURPOSE

To describe the effects of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg on physical and emotional premenstrual and menstrual symptoms.

MATERIALS AND METHODS

We used Menstrual Distress Questionnaire (MDQ) data from a phase-3 trial (NCT02817828) in Europe and Russia with participants (18 - 50 years) using E4/DRSP for up to 13 cycles. We assessed mean changes in MDQ-t-scores from baseline to end of treatment in premenstrual (4 days before most recent flow) and menstrual (most recent flow) scores for 4 MDQ domains in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain.

RESULTS

Of 1,553 treated participants, 1,398(90.0%), including 531(38%) starters, completed both MDQs. Starters reported improvements for premenstrual Pain (-1.4), Water Retention (-3.3) and Negative Affect (-2.5); and for menstrual Pain (-3.5), Water Retention (-3.4), and Negative Affect (-2.7) (all p < 0.01). For switchers, no changes were significant except an increase in premenstrual (+1.0, p = 0.02) and menstrual (+1.5, p = 0.003) Water Retention. We observed a change in symptom intensity in >40% of participants for Cramps, Backache and Fatigue (domain Pain), Painful or Tender Breast and Swelling (domain Water Retention) and Mood Swings and Irritability (domain Negative Affect).

CONCLUSION

E4/DRSP starters experienced significant improvements in the domains Pain, Water Retention and Negative Affect particularly benefiting those with more severe baseline symptoms. Switchers showed minimal changes.

Presenteeism and associated factors among women with menstrual symptoms

PURPOSE

Menstrual characteristics can affect a woman's productivity at work and college, but studies in a general population of adult women are scarce. In addition, it is important to know which menstrual symptoms are most associated with presenteeism in women to promote specific health actions. The present study aimed to assess menstrual symptoms associated with presenteeism in adult women.

METHODS

Online cross-sectional study in which menstrual characteristics, including menstrual flow, age of menarche, menstrual pain and cycle duration were assessed by a self-report questionnaire. The menstrual pain intensity was assessed by Numerical Rating Scale, and the presenteeism, by the Stanford Presenteeism Scale-6 (SPS-6). Women were divided in two groups, with and without presenteeism, based on the SPS-6 cutoff point. Data were analyzed by binary logistic regression and presented as odds ratios (OR).

RESULTS

Among the 430 women who participated in the study, 44.2% were classified as with presenteeism. Women with severe menstrual flow were more likely to have presenteeism (OR = 2.12) compared with women with mild and moderate menstrual flow. The higher menstrual pain intensity the higher the chances of a woman presenting with presenteeism (OR = 1.29).

CONCLUSIONS

These menstrual characteristics (intensity of menstrual flow and menstrual pain) seem to affect women's productivity at work and/or college, and should be assessed in research and clinical practice. Thus, public policies on women's health can be carried out based on these results.

Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components.

The impact of COVID-19 on menstrual cycle's alterations, in relation to depression and sleep disturbances: a prospective observational study in a population of medical students

BACKGROUND

The sars-Cov-2 pandemic has determined psychological stress, particularly in the young population of medical students. We studied the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students.

METHODS

293 female students at the Faculty of Medicine and Psychology of the Sapienza University of Rome (23.08 years old ± 3.8) were enrolled. In March 2021, one year after quarantine, a personal data sheet on menstrual cycle, examining the quality of the menstrual cycle during the pandemic, compared to the previous period. Concomitantly, the Beck Depression Inventory and the Impact of Event Scale have been administered. A Pearson chi-square test was assessed to evaluate the difference between the characteristics of the menstrual cycle and the scores obtained with the questionnaires.

RESULTS

A statistically significant association between menstrual alterations and stress during pandemic had been found. The onset of depressive symptoms and sleep disturbances was observed in 57.1% and in 58.1% of young women with cycle's alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, premenstrual syndrome had a significant correlation with both depression and sleep disturbances. The pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea.

CONCLUSIONS

The pandemic affected the menstrual cycle as well as the depressive symptoms and sleep. Practical implications of the study lead to the development of strategies for psychological intervention during the pandemic experience, in order to help medical trainees, with specific attention to women's needs. Future studies should analyze the impact of other types of social stress events, on sleep, depression and the menstrual cycle beside the pandemic.

Menarche and reproductive health in Spanish Roma women from a reproductive justice perspective: a qualitative study

OBJECTIVES

This study aimed to explore the perceptions of Roma women about their experience of menarche and reproductive health considering the principles of reproductive justice.

DESIGN

Qualitative study based on semi-structured interviews with Roma women ages 18 through 67 in different neighborhoods in the southeast of Spain. Using a thematic analysis, we analyzed experiences related to menarche and menstruation and their significance for reproductive health, the preparation for the phase of menarche and intergenerational support.

RESULTS

The Roma women interviewed shared their approach to the experiences of menarche and menstruation as children in their family environments with a focus on access to information provided by other women in the family and community for reproductive health management. In their discourses we observed that the onset of menstruation supposes a rupture in the public and private spaces of girls and women.

CONCLUSIONS

The results of this study suggest that women and girls do not gain access to information that contributes to their reproductive wellbeing through their experience of menarche. Access to resources and skills to manage biological changes in adolescents could contribute to reducing the impact of cultural myths, false ideas and taboos that prevent advocacy and empowerment on issues of reproductive justice.

Examining menstrual health experiences in Philadelphia, PA: A qualitative investigation

BACKGROUND

While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators.

OBJECTIVES

The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia.

DESIGN

This project was a qualitative research study.

METHODS

We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach.

RESULTS

Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies.

CONCLUSION

Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.

A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus

BACKGROUND

In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited.

OBJECTIVES

The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities.

DESIGN

An online cross-sectional study from February to May 2023.

METHODS

Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus.

RESULTS

Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation.

CONCLUSION

Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.

Help-seeking behaviour in dysmenorrhoea: A cross-sectional exploration using the Behavioural Model of Health Services Use

BACKGROUND

Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea.

OBJECTIVES

The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care.

DESIGN

A cross-sectional observational design was used.

METHODS

Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain.

RESULTS

The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour.

CONCLUSION

Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.

Determinants of academic achievement among higher education student found in low resource setting, A systematic review

BACKGROUND

Academic success is a measure of students' ability to attain their educational objectives, often assessed through regular evaluations or examinations. To establish effective policies and programs that align with academic accomplishments, conducting comprehensive data analysis is pivotal. Hence, this systematic review aimed to synthesize the factors impeding the academic achievements of Ethiopian students in higher education.

METHODS

A comprehensive review was conducted on studies involving Ethiopian university students from 2013 to 2022. The review encompassed 24 papers that were gathered from different databases like PubMed, Google Scholar, African Journals Online, Scopus, and Web of Science.

RESULTS

The findings of this research revealed that inadequate classroom environments, experiencing dysmenorrhea, and engaging in excessive social media usage were all linked to a decline in academic performance. Conversely, adopting healthy sleep habits, achieving high scores in entrance exams, and avoiding recent substance abuse were all factors positively influencing academic success. In addition, there was a positive correlation between academic excellence and being a health science college student and age range of 20 to 24 years old.

CONCLUSION

To enhance academic performance, it is crucial to address the negative factors identified, such as inadequate classroom environments, dysmenorrhea, and excessive social media usage, while promoting positive factors like healthy sleep habits, high scores in exams, and avoiding substance abuse. Additionally, being a health science college student and belonging to the age range of 20 to 24 were found to be associated with academic excellence.

Menstrual Abnormalities in Female International Students in Japan: Changes during Pre-Arrival, Difficult, and Current Periods

The number of Japan's international students has rapidly increased in the last decade. This study examines the relationship between menstrual abnormalities in cycle and symptoms, stress level, and lifestyle of female international students in Japan across three time periods, namely pre-arrival, difficult, and current time periods. A cross-sectional design was employed, and data were collected through a self-administered questionnaire, including the menstrual distress questionnaire (MDQ), between December 2022 and February 2023. The questionnaire was distributed to 56 female international students from two universities in Japan, and a total of 29 valid responses were collected. We found varying menstrual cycle abnormalities and severity of menstrual symptoms across three time periods, with the difficult period after arrival in Japan displaying the highest symptom severity. Higher stress levels were significantly associated with more severe menstrual symptoms. Lifestyle habits such as alcohol consumption were also linked to menstrual symptoms. The current study emphasizes the importance of providing menstrual education, support, and resources to address international students' unique challenges in managing their menstrual health while studying abroad. By promoting awareness, education, and access to healthcare services, universities may contribute to international students' well-being and academic success.

A Review and Meta-Analysis of the Prevalence and Health Impact of Polycystic Ovary Syndrome Among Medical and Dental Students

Women currently comprise the majority of students graduating from medical school and face unique stressors not seen with their male counterparts. In particular, during their medical education, women with polycystic ovary syndrome (PCOS) experience symptoms of the disorder, which strongly impact both their academic and social lives. This in turn influences their academic and professional future. Although women as medical professionals, in general, are happy with their careers, awareness, and understanding on the part of medical educators will definitely be helpful to women medical students in their path to being successful medical professionals. The first objective of our current study is to find the prevalence of PCOS in medical and dental students. The second objective is to find the academic and health impacts of PCOS and what type of interventions are being adopted to relieve the symptoms. Using the keywords such as "PCOS," "medical students," and "dental students", the search engines PubMed, Embase, and Scopus were used to retrieve relevant articles published from 2020 to 2022. After removing the duplicates, 11 prospective cross-sectional studies were utilized for qualitative and quantitative analysis. The pooled prevalence of 2,206 female medical students diagnosed with PCOS was 24.7%. The students in the various studies were aware of their PCOS diagnosis and were taking therapeutic medications. The most common associated complications reported were BMI abnormalities, abnormal hair growth, and acne, along with other complications such as stress and poor academic and social life. The majority also had significant family histories of concurrent clinical conditions such as diabetes, hypertension, and other menstrual abnormalities. Considering the huge impact of PCOS, medical educators, policymakers, and all stakeholders should take proactive measures to accommodate students' needs and bridge the social gap. Special awareness of needed lifestyle changes should be a part of the medical education curriculum for an inclusive educational environment, as it will minimize the gender discrepancy in academic satisfaction and professional life.

The experiences of menstrual symptom changes among international students studying in China during the acculturation period: A phenomenology study

Objectives

Menstruation is a normal physiological phenomenon among female which could be influenced by the process of acculturation. Few studies have explored the experience of menstrual symptom changes among international female students studying in China. Therefore, this paper aims to summarize international female students' experiences of menstrual symptom changes when they were studying in China and interpret these changes through considering the influence of acculturation on their social and academic lives.

Methods

We used a descriptive phenomenology approach. Structured in-depth face-to-face interviews were conducted between May and November 2019 among ten international female students studying in one Province located in south central China. Participants were those who reported having experienced menstrual symptom changes during the acculturation period, which was defined as the first six months of living in China. All interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo 11.0 with the guidance of Colaizzi's seven-step method.

Results

The international female students' experiences of menstrual symptom changes were summarized and grouped into five main categories and 13 subcategories. The main categories include: 1) demonstration of menstrual symptom changes, 2) challenges of maintaining menstrual function in the new setting, 3) coping styles to take care of menstrual health, 4) consequences of the menstrual symptom changes, and 5) culture-based attitude toward menstruation.

Conclusions

International female students reported experiences of menstrual symptom changes, including somatic and psychological symptoms during the acculturation period. Culture barriers, academic stress, and sleep patterns are common factors influencing their menstrual symptom changes. More culturally-tailored interventions should be explored to improve the menstrual health of international female students in China.

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.

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study

OBJECTIVE

We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory.

DESIGN

Cross-sectional study in a large central university.

PARTICIPANTS

Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt).

MEASURES

An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered.

RESULTS

30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus.

CONCLUSIONS

The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.

Reusable period products: use and perceptions among young people in Victoria, Australia

BACKGROUND

Reusable menstrual products have expanded the choices available for menstrual care and can offer long-term cost and environmental benefits. Yet, in high-income settings, efforts to support period product access focus on disposable products. There is limited research to understand young people's product use and preferences in Australia.

METHODS

Quantitative and open-text qualitative data were collected through an annual cross-sectional survey of young people (aged 15-29) in Victoria, Australia. The convenience sample was recruited through targeted social media advertisements. Young people who reported menstruating in the past 6 months (n = 596) were asked questions about their menstrual product use, use of reusable materials, product priorities and preferences.

RESULTS

Among participants, 37% had used a reusable product during their last menstrual period (24% period underwear, 17% menstrual cup, 5% reusable pads), and a further 11% had tried using a reusable product in the past. Reusable product use was associated with older age (age 25-29 PR = 3.35 95%CI = 2.09-5.37), being born in Australia (PR = 1.74 95%CI = 1.05-2.87), and having greater discretionary income (PR = 1.53 95%CI = 1.01-2.32). Participants nominated comfort, protection from leakage and environmental sustainability as the most important features of menstrual products, followed by cost. Overall, 37% of participants reported not having enough information about reusable products. Having enough information was less common among younger participants (age 25-29 PR = 1.42 95%CI = 1.20-1.68) and high school students (PR = 0.68 95%CI = 0.52-0.88). Respondents highlighted the need for earlier and better information, challenges navigating the upfront cost and availability of reusables, positive experiences with reusables, and challenges for use, including cleaning reusables and changing them outside the home.

CONCLUSIONS

Many young people are using reusable products, with environmental impacts an important motivator. Educators should incorporate better menstrual care information in puberty education and advocates should raise awareness of how bathroom facilities may support product choice.

Effect of Menstrual Distress on Interpersonal Relationships, School Absenteeism, Work Productivity, and Academic Performance

Women's health has always been one of the major research areas to identify health patterns to understand the challenges women face and to provide essential support. As time changes, various new challenges and issues emerge around menstrual distress. More research is still needed to identify efficient physiological and psychological support strategies. The current chapter provides a detailed insight into how menstrual pain affects a woman and girl's interpersonal relationships, school presence, peer relations, productivity at the workplace, and academic performance. Further, the chapter captures various literature evidence on the effect of cultural and religious factors affecting menstruation. The chapter also emphasizes providing strategies and mapping down existing policies that are in action to address the challenges women face due to menstrual distress.

Menstrual Hygiene Management Inequalities among School Girls in Badagry, Nigeria

OBJECTIVES

The study assessed menstrual hygiene management (MHM) inequalities among public and private in-school adolescents in Badagry, southwest Nigeria. Also assessed was the impact of available water, sanitation, and hygiene (WASH) facilities on MHM within the school premises.

METHODS

For this descriptive, cross-sectional study 420 students were selected via multi-stage sampling and data were obtained via a validated semi-structured questionnaire and observational checklist. Data were analysed at 95% confidence limit.

RESULTS

The students had a mean age of 15.3±1.6 years. All the private schools had functioning WASH facilities whereas only 50% of public schools did. The toilet to student ratios for the private and public schools were 1:155 and 1:296, respectively. Over two-thirds (67.1%) of the students reportedly use sanitary napkins for MHM, followed by tissue (17.1%), and clothes (15.5%). Additionally, the private school students were two times less likely to use alternatives to sanitary napkins and 9.8 times more likely to obtain sanitary materials at school if required (p<0.001). A significantly higher proportion of public-school menstruating in-school adolescents changed their sanitary towels in the bush (p=0.003) due to lack of privacy and took their used sanitary materials home (p<0.001) for management due to reduced access to sanitary bins.

CONCLUSION

Even though the situation in the public schools was worse, both public and private schools lack the enabling environment for MHM. School health promotion interventions, such as provision of subsidized/affordable menstrual pads and basic WASH facilities and campaigns to break the culture of silence are required for the wellbeing of girls. This article is protected by copyright. All rights reserved.

Menstrual irregularity and its associated factors among college students in Ethiopia, 2021

Background

Menstrual irregularity can occur at any age, but it is most common among women under the age of 23 years. Menstrual irregularity is a foremost gynecological problem and a cause of anxiety to students and those close to them. These students experience monthly absenteeism, premenstrual symptoms, and a lack of concentration due to menstrual problems, all of which interfere with their education. Therefore, this study aimed to assess the magnitude of menstrual irregularity and associated factors among college students in Debre Berhan Town, North Shewa, Amhara Regional State, Ethiopia, in 2021.

Methods

An institution-based cross-sectional study was conducted from June to July 2021 in Debre Berhan town. Data was collected using self-administered questionnaires in 420 eligible female college students by systematic random sampling technique. Weight and height were measured and Body Mass Index (BMI) was calculated after data collection. Each questionnaire was checked for completeness, cleaned, coded, entered into EPI-DATA, and then transported to SPSS software. Bi-variable and multivariable logistic regression analyses were employed to determine the association of each independent variable with the dependent variable. P ≤ 0.05 were used to declare association and select predictors.

Results

In the current study, 395 students participated with a response rate of 93.6%. Of all the total respondents, the magnitude of menstrual cycle irregularity was 33.4% (95% CI 28.6–38.2). Age < 20 years old [AOR = 3.88, 95% CI (1.25–12.18)], age of menarche ≤ 12 years [AOR = 4, 95% CI (1.18–13.9), sleeping hours ≤ 5 h [AOR= 2.26, 95% CI (1.04–4.93)], perceived stress [AOR = 2, 95% CI (1.53–3.23)] and being overweight [AOR = 2, 95% CI (1.13–3.23) were the variables significantly associated with the magnitude of menstrual irregularity.

Conclusion and recommendation

This study shows that more than one-third of the college students in Debre Berhan town have experienced menstrual irregularity. Being less than 20 years old, having a history of early menarche, being overweight, and perceived stress were a variable significantly associated with menstrual irregularity. To control menstrual irregularity, girls should control their weight and lead a healthy lifestyle, including getting adequate sleep which could be aided by training on time management.

Menstrual cycles during COVID-19 lockdowns: A systematic review and meta-analysis

Coronavirus disease 2019 lockdowns produced psychological and lifestyle consequences for women of reproductive age and changes in their menstrual cycles. To our knowledge, this is the first systematic review to characterize changes in menstrual cycle length associated with lockdowns compared to non-lockdown periods. A search on 5 May 2022 retrieved articles published between 1 December 2019, and 1 May 2022, from Medline, Embase, and Web of Science. The included articles were peer-reviewed observational studies with full texts in English, that reported menstrual cycle lengths during lockdowns and non-lockdowns. Cross-sectional and cohort studies were appraised using the Appraisal tool for Cross-Sectional Studies and the Cochrane Risk of Bias Tool for Cohort Studies, respectively. Review Manager was used to generate a forest plot with odds ratios (OR) at the 95% confidence interval (CI), finding a significant association between lockdown and menstrual cycle length changes for 21,729 women of reproductive age (OR = 9.14, CI: 3.16-26.50) with a significant overall effect of the mean (Z = 4.08, p < 0.0001). High heterogeneity with significant dispersion of values was observed (I 2 = 99%, τ = 1.40, χ2 = 583.78, p < 0.0001). This review was limited by the availability of published articles that favored high-income countries. The results have implications for adequately preparing women and assisting them with menstrual concerns during lockdown periods.

Menstrual considerations for transgender male and gender diverse adolescents who were assigned female at birth

Menstruation is a female normative process. Physiologically, it indicates that the hypothalamic-pituitary-ovarian axis is functioning appropriately, and all the correct female end-organs are intact. Menarche also heralds a girl's arrival into womanhood, which culturally is often celebrated. It is a sign of the possibility of fertility, pregnancy and motherhood. However, menstruation for transgender males, and other gender diverse individuals assigned female at birth, may be anything but celebratory. For these adolescents, menstruation is an indication that one's body is not functioning appropriately and that one does not have the correct organs congruent to their gender identity. Menstruation or the anticipation of menarche for many transgender males is often met with worsening of dysphoria, anxiety, depression and suicidal ideation. Therefore, to meet the physiologic and psychologic needs of transgender males, one needs to be aware of issues that may be present in relation to menstruation and be knowledgeable on how to medically proceed with sensitivity and respect toward one's gender identity. Research on menstruation, both from a physical and psychologic perspective, has been historically based on women and cannot be simply extrapolated to be the same for transgender males. Although there is a paucity of literature on the subject, over the past decade there has begun to be a great interest in the care of transgender individuals. This article focuses on concerns related to menstruation among transgender adolescent males and gender diverse individuals assigned female at birth, including suppression of menses, fertility, contraception, and pregnancy.

Premenstrual Syndrome and Its Association with Perceived Stress: The Experience of Medical Students in Jordan

Objective

To assess the prevalence of premenstrual and menstrual symptoms and to investigate premenstrual severity’s association with perceived stress of premenstrual syndrome among medical students.

Methods

This is a cross-sectional study. Data were collected between March and April 2021, a self-administered online questionnaire (Supplementary Material) was distributed to a sample of female medical students in Jordan (n=594).

Results

The mean age was 21.6 ±2.2 years, and the mean body mass index (BMI) was 22.8 ±4.1 kg/m2. Most students were in their 5th and 6th university year, where 75.4% reported having dysmenorrhea, 45.8% used pharmacological agents for pain relief, while 54.2% used non-pharmacological means, and 58.1% occasionally skipped lectures. Most participants reported a constellation of physical and psychological symptoms. The mean for the premenstrual severity scale score was 29.3, and the mean for the perceived stress scale scores was 21.6. There was a statistically significant correlation between the premenstrual severity scale score and the perceived stress scale, between the premenstrual severity scale and absenteeism, between premenstrual severity scale and year of study, and between dysmenorrhea and the perceived stress scale, but not between the severity of symptoms and method of pain relief.

Conclusion

Premenstrual and menstrual symptoms have a negative impact on students that affects their academic participation. More support should be given from universities to address the menstruation-related struggles of female students.

Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis

Background

The stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing.

Objective

The impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms.

Methods

A database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included “menstrual disturbances” and “medical students,” “prevalence” OR “symptoms” of “Premenstrual syndrome” OR “Premenstrual dysphoric disorder” OR “Dysmenorrhea” in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS).

Results

Initially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms.

Conclusions

The current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.

Yoga and meditation, an essential tool to alleviate stress and enhance immunity to emerging infections: A perspective on the effect of COVID-19 pandemic on students

The COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has negatively impacted the global healthcare and economic systems worldwide. The COVID-19 pandemic has also created an emotional and psychological pandemic among people of all ages irrespective of economic status and physical wellbeing. As a consequence of prolonged lockdowns, one of the most severely affected age groups globally is the young adults' group, especially students. Uncertainties in the academic calendar, restricted outdoor activities, and unusual daily routines during lockdowns led to higher incidences of stress, anxiety, and depression among students worldwide. In this review, we summarise the available evidence on the effect of lockdowns on students and discuss possible positive impacts of yoga and meditation on various psychological, emotional, and immunological parameters, which can significantly influence the general wellbeing and academic performance of students. Perspectives shared in the review will also bring awareness on how yoga and meditation could boost students' performance and assist them in maintaining physical and mental wellbeing during stressful conditions such as future epidemics and pandemics with novel infections. This information could help create better educational curriculums and healthy routines for students.

Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey

Objectives:

There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university.

Methods:

An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant.

Results:

A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors.

Conclusion:

Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.