Development and Validation of a Menstruation-Related Activity Restriction Questionnaire among Adolescent Girls in Urban Resettlement Colonies of Delhi

Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials

Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.

Study of Menstrual Hygiene Practices Among Adolescent Girls in a Tribal Area of Central India

Introduction Menstruation is an essential phenomenon in an adolescent girl's life. In India, females who are menstruating are considered impure and teenage girls are not allowed to undertake home chores or engage in religious or cultural events during their period. Up-to-date knowledge about menstruation, beginning in early adolescence, would improve safe practices and relieve the distress of millions of women. Material and methods A cross-sectional study was conducted among adolescent girls (10-19 years) residing in a tribal area of Nagpur District from January to March 2022. Three tribal residential schools (Ashram Shala) were selected from a total of six in Hingana Taluka of Nagpur District, using simple random sampling to fulfill the required sample size of 272. Demographic details, age at menarche, awareness of menstruation, sources of information about menstruation, menstrual hygiene practices, and restrictions observed during menstruation were assessed. Results The average age at menarche was 13.04+0.96 years (range 11-16 years). Only 45.17% of girls were aware of the menarche and menstrual cycle before its onset. The duration of the menstrual cycle ranged from 21-35 days in most of the girls (90.69%), and it was regular in 85.86% of girls. Duration of bleeding was two to six days for the majority of the girls (87.93%). Around 73.79% of girls were using sanitary pads, while 26.21% of girls were using clothes. The most important restrictions imposed on the girls during menstruation were not being allowed to attend religious functions (97.93%), followed by not being allowed to attend classes (65.86%). The use of sanitary pads was significantly more in late adolescent girls than in early adolescent girls (ꭓ²=14.97, p=0.0001), girls who have literate mothers than girls with illiterate mothers (ꭓ²=5.17, p=0.02), and girls belonging to higher socioeconomic classes (class I, II, III) than lower ones (class IV, V) (ꭓ²=44.23, p<0.0001). Conclusion The tribal adolescent girls still don't exercise proper hygiene throughout their periods. During menstruation, the majority of girls are still subjected to various restrictions.

Revalidation and adaptation of the Menstrual Practice Needs Scale (MPNS) in a cross-sectional survey to measure the menstrual experiences of adult women working in Mukono District, Uganda

OBJECTIVES

The Menstrual Practice Needs Scale (MPNS) is a comprehensive measure of menstrual self-care experience including access to sufficient, comfortable materials to catch or absorb bleeding, supportive spaces for managing menstruation and for disposal and laundering of used materials. It addresses a critical measurement gap to improve quantitative menstrual health research and programme evaluation. The scale was validated in a population of adolescent schoolgirls. This study appraises its performance among adult women.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

Seven cognitive interviews provided insights into the interpretability of scale items. A survey of 525 working women who had menstruated in the past 6 months (435 working in markets, 45 in schools and 45 working in healthcare facilities) in Mukono District, Uganda was used to test the dimensionality, reliability and validity of the measure.

RESULTS

The 36 scale items were well understood by the study population. Dimensionality was tested for the 28 items relevant to women disposing of menstrual materials and 32 items relevant to those washing and reusing materials. The original subscale structure fit with the data, however, fell short of recommended thresholds for those disposing of materials (root mean squared error of approximation, RMSEA=0.069; Comparative Fit Index, CFI=0.840; Trucker-Lewis Index, TLI=0.824). An alternative subscale structure was an acceptable fit for those disposing (RMSEA=0.051; CFI=0.911; TLI=0.897) and reusing materials (RMSEA=0.053; CFI=0.915; TLI=0.904). MPNS total and subscale scores demonstrated acceptable internal consistency. Higher scores reflected more positive menstrual experiences and were associated with well-being (total score r=0.24, p<0.001), not missing work due to the last menstrual period (total score OR=2.47 95% CI 1.42 to 4.30) and confidence to manage menstruation.

CONCLUSIONS

The MPNS offers a valid and reliable way to assess menstrual health needs. The revised factor structure can be used for samples of adult workers. Findings also highlight challenges in assessing the variety of experiences relevant to managing menstrual bleeding.