Menstrual Characteristics of Pubertal Girls: A Questionnaire-Based Study in Turkey

Association between adverse childhood experiences and menstruation-related symptoms among Japanese female workers: A cross-sectional study

BACKGROUNDS

Menstruation-related symptoms are a common and serious health problem even without a specific diagnosis such as premenstrual dysphoric mood disorder (PMDD) or dysmenorrhea. Various adverse childhood experiences (ACEs) might be associated with menstruation-related symptoms, not only traditional traumatic events such as abuse, but also expanded ACEs such as childhood poverty, school bullying, or natural disasters.

OBJECTIVE

This study examined the association between expanded ACEs (ACEs for Japanese) and menstruation-related symptoms among Japanese working women.

METHODS

Data came from an online survey conducted in October 2023 that included women aged 20-44 working full-time, who have never been pregnant and are not currently using contraception. Menstruation-related symptoms severity was evaluated using the Menstrual Distress Questionnaire (MDQ) and the Premenstrual Dysphoric Disorder (PMDD) scale. The MDQ score of the premenstrual and menstrual phases were classified into four categories as menstrual symptoms severity of each phase. Logistic regression assessed the association between ACEs and each outcome, adjusting for covariates.

RESULTS

The analysis included 2000 women. Premenstrual and menstrual symptoms severity increased with two or more ACEs. In the fully adjusted model, women with four or more ACEs significantly showed severe premenstrual symptoms (adjusted odds ratio [aOR] = 2.81, 95%CI:2.12-3.72), and severe menstrual symptoms (aOR = 3.03, 95%CI: 2.29-4.02). Four or more ACEs were associated with PMDD (aOR = 5.61, 95%CI: 2.65-11.89). Childhood poverty and school bullying were also associated with menstruation-related symptoms severity, and natural disasters with PMDD.

CONCLUSIONS

Expanded ACEs were associated with menstruation-related symptoms. The results suggested the importance of trauma-informed care in gynecology, obstetrics, and occupational health practice.

Longitudinal associations of menstrual characteristics with mental health problems among Chinese girls

Cross-sectional studies indicate that menstrual problems are related to poorer mental health; however, longitudinal studies are limited. This longitudinal study aimed to determine whether baseline menstrual characteristics were risk factors for incident and persistent mental health problems. The study was conducted among Chinese adolescent girls. Menstrual characteristics including menarche, menstrual cycle and menstrual pain were assessed at baseline, whereas mental health problems including PTSD, depression, anxiety, ADHD, insomnia, psychotic-like experiences, non-suicidal self-injury, suicide ideation, suicide plan, and suicide attempt were assessed at baseline (n = 1039) and at the 1-year follow-up (n = 946) by self-administered, structured questionnaires. Multiple logistic regressions were performed to examine whether menstrual characteristics were associated with incident (e.g., PTSD at follow-up but not baseline) and persistent (e.g., PTSD at both time points) mental health problems. The results demonstrated that early menarche was related to persistence of psychotic-like experiences; irregular menstruation was associated with higher rates of incident anxiety and insomnia, and persistent depression, anxiety, ADHD, insomnia, non-suicidal self-injury, suicide ideation, and suicide plan; menstrual pain was associated with elevated rates of incident PTSD and depression, and persistent depression, insomnia, psychotic-like experiences, non-suicidal self-injury, suicidal ideation, suicide plan, and suicide attempt. In conclusion, irregular menstruation and menstrual pain specifically contributed to the development of emotional problems and insomnia, and were associated with maintenance of the most mental health problems in early adolescence. The long-term effects of menstrual problems on mental health need further study.

Evaluation of Abnormal Uterine Bleeding in Adolescents: Single Center Experience

Objective

Abnormal uterine bleeding (AUB) is the most common gynecologic complaint in adolescent girls. The aim of this study was to identify the diagnostic and management differences between those with/without heavy menstrual bleeding.

Methods

Retrospective data was collected from adolescents aged 10-19 years, diagnosed with AUB. Adolescents with known bleeding disorders at admission were excluded. All girls were classified according to the degree of anemia; group 1 had heavy bleeding [hemoglobin (Hb) <10 g/dL] and group 2 had moderate or mild bleeding (Hb >10 g/dL). Admission and follow-up characteristics were compared between the two groups.

Results

The cohort consisted of 79 girls with a mean age of 14.3±1.8 years and mean age of menarche of 11.9±1.4 years, with 85% experiencing menstrual irregularity in the two years after menarche, rising to 95.3% in group 1 (p<0.01). Anovulation was evident in 80% of the cohort. Of these 79 girls, 13 (16.5%) had polycystic ovary syndrome and two (2.5%) had structural anomalies (uterus didelphys). Three girls (group 1, n=2) had previously undiagnosed clotting factor VII deficiency; no other clotting deficiencies were diagnosed. Nineteen of 34 (56%) with personal (n=2)/family history of thrombosis had MTHFR mutation. None had venous thromboembolism during follow-up of >6 months.

Conclusion

The majority of AUB (85%) occurred in the first two years after menarche. A small proportion (3.8%) had undiagnosed clotting factor deficiency. The frequency of MTHFR mutation was 50% in girls with history of thrombosis; however this did not increase the risk of bleeding/thrombosis and so routine evaluation does not appear to be justified.

A cross-sectional study on prevalence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India

INTRODUCTION

Menstrual cycle gets affected by various modifiable risk factors. To assess prevalence of various types of menstrual problems, lifestyle and mental health status, identification of variables as predictors for menstrual problems and level of polycystic ovary syndrome (PCOS) awareness among rural and urban population of Punjab, the present study has been carried out.

METHODS

The study was conducted from November 2019 to July 2020 in the Malwa region of Punjab, India, with 2673 participants (15-25 years). Epidemiological information was collected using predesigned questionnaire along with depression, anxiety and stress (DASS-21) score mental health assessment tool. MS-Excel (2019) and IBM SPSS 18.0 (SPSS Inc., Chicago, IL) was used for statistical analysis.

RESULTS

The overall prevalence of different menstrual problems was 60.61%, with dysmenorrhea (50.64%) being most common problem. Body mass index (BMI), menarche age, physical activity, and mental health status are significant (p < 0.05) predictors of menstrual problem both in rural and urban population. Overall, only 3.30% subjects were aware about PCOS.

CONCLUSION

Dysmenorrhea is the most common menstrual problem, both in rural and urban population. BMI, sedentary lifestyle, electronic gadgets usage, and mental health are associated with menstrual problems. Low awareness on PCOS indicates need to create awareness as the condition can be easily managed with early intervention.

Policies and interventions to remove gender-related barriers to girls' school participation and learning in low- and middle-income countries: A systematic review of the evidence

Background

Gender disparities in education continue to undermine girls' opportunities, despite enormous strides in recent years to improve primary enrolment and attainment for girls in low- and middle-income countries (LMICs). At the regional, country and subnational levels gender gaps remain, with girls in many settings less likely to complete primary school, less likely to complete secondary, and often less likely to be literate than boys. The academic and policy literatures on the topic of gender-related barriers to girls' education are both extensive. However, there remain gaps in knowledge regarding which interventions are most likely to work in contexts with different combinations of barriers.

Objectives

This systematic review identified and assessed the strength of the evidence of interventions and exposures addressing gender-related barriers to schooling for girls in LMICs.

Search Methods

The AEA RCT Registry, Africa Bibliography, African Education Research Database, African Journals Online, DEC USAID, Dissertation Abstracts, EconLit, ELDIS, Evidence Hub, Global Index Medicus, IDEAS-Repec, Intl Clinical Trials Registry, NBER, OpenGrey, Open Knowledge Repository, POPLINE, PsychINFO, PubMed, Research for Development Outputs, ScienceDirect, Sociological Abstracts, Web of Science, as well as relevant organization websites were searched electronically in March and April of 2019. Further searches were conducted through review of bibliographies as well as through inquiries to authors of included studies, relevant researchers and relevant organizations, and completed in March 2020.

Selection Criteria

We included randomized controlled trials as well as quasi-experimental studies that used quantitative models that attempted to control for endogeneity. Manuscripts could be either published, peer-reviewed articles or grey literature such as working papers, reports and dissertations. Studies must have been published on or after 2000, employed an intervention or exposure that attempted to address a gender-related barrier to schooling, analyzed the effects of the intervention/exposure on at least one of our primary outcomes of interest, and utilized data from LMICs to be included.

Data Collection and Analysis

A team of reviewers was grouped into pairs to independently screen articles for relevance, extract data and assess risk of bias for each included study. A third reviewer assisted in resolving any disputes. Risk of bias was assessed either through the RoB 2 tool for experimental studies or the ROBINS-I tool for quasi-experimental studies. Due to the heterogeneity of study characteristics and reported outcome measures between studies, we applied the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach adapted for situations where a meta-analysis is not possible to synthesize the research.

Results

Interventions rated as effective exist for three gender-related barriers: inability to afford tuition and fees, lack of adequate food, and insufficient academic support. Promising interventions exist for three gender-related barriers: inadequate school access, inability to afford school materials, and lack of water and sanitation. More research is needed for the remaining 12 gender-related barriers: lack of support for girls' education, child marriage and adolescent pregnancy, lack of information on returns to education/alternative roles for women, school-related gender-based violence (SRGBV), lack of safe spaces and social connections, inadequate sports programs for girls, inadequate health and childcare services, inadequate life skills, inadequate menstrual hygiene management (MHM), poor policy/legal environment, lack of teaching materials and supplies, and gender-insensitive school environment. We find substantial gaps in the evidence. Several gender-related barriers to girls' schooling are under-examined. For nine of these barriers we found fewer than 10 relevant evaluations, and for five of the barriers-child marriage and adolescent pregnancy, SRGBV, inadequate sports programs for girls, inadequate health and childcare services, and inadequate MHM-we found fewer than five relevant evaluations; thus, more research is needed to understand the most effective interventions to address many of those barriers. Also, nearly half of programs evaluated in the included studies were multi-component, and most evaluations were not designed to tease out the effects of individual components. As a result, even when interventions were effective overall, it is often difficult to identify how much, if any, of the impact is attributable to a given program component. The combination of components varies between studies, with few comparable interventions, further limiting our ability to identify packages of interventions that work well. Finally, the context-specific nature of these barriers-whether a barrier exists in a setting and how it manifests and operates-means that a program that is effective in one setting may not be effective in another.

Authors' Conclusions

While some effective and promising approaches exist to address gender-related barriers to education for girls, evidence gaps exist on more than half of our hypothesized gender-related barriers to education, including lack of support for girls' education, SRGBV, lack of safe spaces and social connections, inadequate life skills, and inadequate MHM, among others. In some cases, despite numerous studies examining interventions addressing a specific barrier, studies either did not disaggregate results by sex, or they were not designed to isolate the effects of each intervention component. Differences in context and in implementation, such as the number of program components, curricula content, and duration of interventions, also make it difficult to compare interventions to one another. Finally, few studies looked at pathways between interventions and education outcomes, so the reasons for differences in outcomes largely remain unclear.

The effect of yoga on pain level in primary dysmenorrhea

This study was conducted to evaluate the effect of yoga on pain levels in female students with primary dysmenorrhea. This study is a randomized experimental study with control group and pretest post-test practice. This study included 60 volunteer female students (30 experimental and 30 control groups). The patients in the experimental group took part in the yoga program a total of 12 sessions, once per week for 12 weeks. "Personal Information Form", "Visual Analog Skala (VAS)" and "Dysmenorrhea Monitoring Form (DMF)" were used in data collection process. To measure dysmenorrhea pain, the students were requested to mark a number between 1 and 10 on the VAS scale according to the severity of their pain on the menstruation starting date. The yoga applications were used for three menstrual cycles. The mean age of the students in the experimental group was 20.30 ± 0.46, while the mean age of the students in the control group was 20.46 ± 0.50. The difference between the pain levels of the students in the experimental group in the first, second, third and fourth measurements was found to be statistically significant (p < 0.001). It was determined that the difference between the pain levels of the students in the control group in the first, second, third and fourth measurements was not statistically significant (p > 0.05). Yoga can be used as an effective intervention in reducing menstrual pain in women with primary dysmenorrhea.

School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys

Reports of school and work absences due to unmet menstrual needs have prompted increased attention to menstruation in policy and practice. However, there appear to be few quantitative studies reported in published literature capturing the prevalence of this hypothesised absenteeism. This study undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020 (PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation. Among women and adolescent girls aged 15–49 years who had worked outside the household in the past month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively, reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing school in the past year due to menstruation. Findings support the assertion that menstruation is a source of absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed. In presenting this data we also reflect critically on the performance of questions regarding menstrual-related absenteeism in national monitoring surveys. Future monitoring efforts should consider the interpretability of similar survey data when many respondents did not attend any school or work and were ineligible to answer questions regarding absenteeism. Further, without additional research identifying the reasons for absenteeism, findings from similar survey questions may be difficult to interpret with relevance for policy decision making.

Analysis of survey on menstrual disorder among teenagers using Gaussian copula model with graphical lasso prior

A high prevalence of menstrual disturbance has been reported among teenage girls, and research shows that there are delays in diagnosis of endometriosis among young girls. Using data from the Menstrual Disorder of Teenagers Survey (administered in 2005 and 2016), we propose a Gaussian copula model with graphical lasso prior to identify cohort differences in menstrual characteristics and to predict endometriosis. The model includes random effects to account for clustering by school, and we use the extended rank likelihood copula model to handle variables of mixed-type. The graphical lasso prior shrinks the elements in the precision matrix of a Gaussian distribution to encourage a sparse graphical structure, where the level of shrinkage is adaptable based on the strength of the conditional associations among questions in the survey. Applying our proposed model to the menstrual disorder data set, we found that menstrual disturbance was more pronouncedly reported over a decade, and we found some empirical differences between those girls with higher risk of developing endometriosis and the general population.

Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

BACKGROUND

Dysmenorrhea is a health problem with a high impact on health and society. Some drugs have been shown to be effective at treating dysmenorrhea. Therapeutic exercise is another option for reducing the symptomatology of this health problem, with a low cost and the absence of side effects.

PURPOSE

The purposes of this review were to study the efficacy of physical exercise for pain intensity in primary dysmenorrhea and to assess its effectiveness in decreasing the duration of pain and improving quality of life.

DATA SOURCES

Searches were conducted between February 2017 and May 2017 in the databases Web of Science, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, CINAHL, and Dialnet, using the terms dysmenorrhea, exercise therapy, exercise movement technique, exercise, physical therapy, physical therapy speciality, treatment, primary dysmenorrhea, prevention, etiology, epidemiology, and pain.

STUDY SELECTION

We included randomized controlled trial studies conducted on women who were 16 to 25 years old and had primary dysmenorrhea, studies that included exercise as a type of therapy, studies that assessed the intensity and duration of pain and quality of life, and studies published in English or Spanish. Studies that included women with irregular cycles, women diagnosed with a gynecological disease, women who had had surgery, women with serious diseases, or women who used intracavitary or oral contraceptives were excluded. We started with 455 studies; 16 were included in the systematic review, and 11 were included in the 3 meta-analyses that were carried out.

DATA EXTRACTION

Two authors selected the studies and extracted their characteristics (participants, intervention, comparators, and outcomes) and results. The evaluation of the methodological quality of the studies was carried out by PEDro scale.

DATA SYNTHESIS

There was moderate evidence that therapeutic exercise can be considered a useful tool in the treatment of primary dysmenorrhea in terms of a reduction in pain intensity. Regarding the duration of pain and quality of life, there was low evidence and very low evidence, respectively. In the 3 meta-analyses, the results were significantly positive in favor of exercise for decreases in both the intensity and the duration of pain.

LIMITATIONS

Limitations of this study include the great heterogeneity of the interventions applied in the studies in terms of type of exercise, in combination or alone, and dosage. This review includes a small number of studies with risk of bias, so the present findings must be interpreted with caution.

CONCLUSIONS

Therapeutic exercise reduces pain intensity in patients with primary dysmenorrhea.

Dysmenorrhea among high-school students and its associated factors in Kuwait

Background

Although dysmenorrhea is not a life-threatening condition, it can cause a substantial burden on individuals and communities. There is no data on the prevalence of dysmenorrhea in Kuwait. This study aimed to estimate the prevalence of dysmenorrhea among female public high-school students in Kuwait and investigate factors associated with dysmenorrhea.

Methods

A cross-sectional study using multistage cluster sampling with probability proportional to size method was conducted on 763 twelfth grade female public high-school students (aged 16–21 years). We used face-to-face interview with a structured questionnaire to collect data on dysmenorrhea and presumed risk factors. Weight and height of the students were measured using appropriate weight and height scales in a standardized manner. The association between dysmenorrhea and potential risk factors was assessed using multiple logistic regression.

Results

The one-year prevalence of dysmenorrhea was found to be 85.6% (95%CI: 83.1–88.1%). Of the participants with dysmenorrhea, 26% visited a public or a private clinic for their pain and 4.1% were hospitalized for their menstrual pain. Furthermore, 58.2% of students with dysmenorrhea missed at least one school day and 13.9% missed at least one exam. Age of menarche (p-value = 0.005), regularity and flow of the menstrual period (p-value = 0.025, p-value = 0.009; respectively), and drinking coffee (p-value = 0.004) were significantly associated with dysmenorrhea in multivariable analysis.

Conclusion

Dysmenorrhea seems to be highly prevalent among female high-school students in Kuwait, resembling that of high-income countries. Because of the scale of the problem, utilizing school nurses to reassure and manage students with primary dysmenorrhea and referring suspected cases of secondary dysmenorrhea is recommended.

Menarche and menstrual problems are associated with non-suicidal self-injury in adolescent girls

Menstrual problems and non-suicidal self-injury (NSSI) are common in adolescent girls. This study examined whether onset of menstruation and menstrual problems were related to NSSI in Chinese female adolescents. A total of 5696 adolescent girls participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort (SABHC) study in Shandong, China. A structured questionnaire was used to ask about participants' lifetime and last-year NSSI, age at menarche, menstrual cycle interval, menstrual flow length, menstrual irregularity, period pain, body weight and height, and demographics. Impulsivity was assessed by the Eysenck I7 impulsiveness scale. Internalizing and externalizing problems were measured by the Youth Self-Report of Child Behavior Checklist. The mean age of the sample was 15.0 years (SD = 1.4). The prevalence of lifetime and last year NSSI were 28.1% and 21.4% in Chinese adolescent girls. After adjusting for adolescent and family covariates (age, body mass index, impulsivity, internalizing and externalizing problems, paternal education, and family economic status), onset of menstruation was significantly associated with increased risk of lifetime NSSI (OR = 1.62, 95%CI = 1.20-2.20) and last year NSSI (OR = 1.92, 95%CI = 1.37-2.67). Among adolescent girls who had menarche, often irregular menstruation and period pain were significantly and independently associated with lifetime NSSI (OR = 1.36, 95%CI = 1.03-1.79; OR = 1.29, 95%CI = 1.05-1.58) and last year NSSI (OR = 1.46, 95%CI = 1.07-1.98; OR = 1.29, 95%CI = 1.03-1.61). Our findings suggest that onset of menarche, irregular periods, and period pain appear to be associated with increased risk of NSSI. These findings highlight the importance of menstruation hygiene education and treatment of menstrual problems to reduce the risk of NSSI among adolescent girls.

Abnormal Uterine Bleeding in Adolescents

Abnormal uterine bleeding (AUB) is the most common gynecologic complaint of adolescents admitted to hospital. Heavy menstrual bleeding (HMB) is the most frequent clinical presentation of AUB. Anovulatory cycles, owing to immature hypothalamic-pituitary-ovarian axis, is the leading etiology of HMB and there is an accompanying bleeding disorder in almost 20% of patients with HMB. Additionally, endocrine disorders such as hypothyroidism, hyperprolactinemia and polycystic ovary syndrome are possible causes of AUB. Exclusion of bleeding disorders, especially of von Willebrand disease is important for diagnosis and treatment of HMB, particularly in cases with AUB, which has been present since menarche. Management of HMB is based on the underlying etiology and severity of the bleeding. After other causes are excluded, anovulatory heavy bleeding can be treated successfully with combined oral contraceptives and iron supplementation either as an outpatient or in hospital depending on the clinical findings and level of anemia. The epidemiology, clinical presentation, diagnostic approach and treatment of HMB is discussed and our clinical experience in this field is presented in this review.

Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary dysmenorrhea is cramping abdominal pain associated with menses. It is prevalent, affects quality of life, and can cause absenteeism. Although evidence-based medical treatment options exist, women may not tolerate these or may prefer to use nonmedical treatments. Physical activity has been recommended by clinicians for primary dysmenorrhea since the 1930s, but there is still no high-quality evidence on which to recommend its use.

OBJECTIVE

We sought to determine the effectiveness of physical activity for the treatment of primary dysmenorrhea.

STUDY DESIGN

Systematic literature searches of MEDLINE, Embase, Cochrane, Web of Science, CINAHL, PsycINFO, SPORTDiscus, PEDro, Allied and Complimentary Medicine Database, World Health Organization International Clinical Trials Registry Platform, Clinicaltrials.gov, and OpenGrey were performed, from database inception to May 24, 2017. Google searches and citation searching of previous reviews were also conducted. Studies were selected using the following PICOS criteria: participants were nonathlete females experiencing primary dysmenorrhea; intervention was physical activity delivered for at least 2 menstrual cycles; comparator was any comparator; outcomes were pain intensity or pain duration; and study type was randomized controlled trials. Study quality was assessed using the Cochrane risk of bias tool. Random effects meta-analyses for pain intensity and pain duration were conducted, with prespecified subgroup analysis by type of physical activity intervention. Strength of the evidence was assessed using GRADE.

RESULTS

Searches identified 15 eligible randomized controlled trials totaling 1681 participants. Data from 11 studies were included in the meta-analyses. Pooled results demonstrated effect estimates for physical activity vs comparators for pain intensity (-1.89 cm on visual analog scale; 95% CI, -2.96 to -1.09) and pain duration (-3.92 hours; 95% CI, -4.86 to -2.97). Heterogeneity for both of these results was high and only partly mitigated by subgroup analysis. Primary studies were of low or moderate methodological quality but results for pain intensity remained stable during sensitivity analysis by study quality. GRADE assessment found moderate-quality evidence for pain intensity and low-quality evidence for pain duration.

CONCLUSION

Clinicians can inform women that physical activity may be an effective treatment for primary dysmenorrhea but there is a need for high-quality trials before this can be confirmed.

Menstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls

STUDY OBJECTIVE

To determine the cross-sectional characteristics of menstruating girls, dysmenorrhea, and the frequencies of related problems.

DESIGN

Descriptive, cross-sectional study.

SETTING

Randomly selected primary, junior, and high schools in the city center of Kayseri.

PARTICIPANTS

Two thousand female adolescents of ages between 9 and 18 years.

MAIN OUTCOME MEASURES

We used a questionnaire addressing the epidemiological characteristics of menstruation, such as age at menarche, duration of menstrual intervals, average days of bleeding, and any menstrual problems and their frequencies.

RESULTS

This study consists of a sufficient number of participants from all age groups. Of the participant (n = 2000) girls, 63.7% (n = 1274) had started menstruating. The mean age at menarche was 12.74 (±1.03) years. With a prevalence of 84.8% (n = 1080), dysmenorrhea was the most prevalent menstrual problem and the average pain score was 5.87 (±2.45). Of the menstruating girls, 34% (n = 439) used painkillers, the most commonly used was acetaminophen; during their period the prevalence of nonmedical methods to relieve pain was 35.2%; the rate of seeking medical help for dysmenorrhea was 9.3% (n = 119). In menstruating participants, 90.8% discussed their menstrual problems with their mothers. The rate of school absenteeism in menstruating girls was 15.9% in general and 18% in those with dysmenorrhea.

CONCLUSION

Problems related to menstruation are common in adolescents and these problems affect their social life. In adolescent girls, the most common menstrual problem is dysmenorrhea and it affects school performance and attendance. Girls with menstrual problems showed a low rate of seeking medical help.

Effects of menstrual pain on the academic performance and participation in sports and social activities in Turkish university students with primary dysmenorrhea: A case control study

AIM

The primary aim of this study was to investigate the pain characteristics, academic performance and participation in sports and social activities among students with primary dysmenorrhea (PD) who have different pain intensities and to compare dysmenorrhea-related life impact with pain-free students.

METHODS

The present study was conducted on 471 university students with and without PD. Based on Visual Analog Scale score, participants were categorized into four groups: no-pain (n = 60), mild pain (n = 83), moderate pain (n = 165) and severe pain (n = 163). Data on the pain characteristics, impact of dysmenorrhea on university absence, class concentration, participation in sports and social activities were obtained and analyzed with the Kruskal-Wallis, Mann-Whitney U and chi-square tests.

RESULTS

University absence, loss of class concentration and the impact on sports and social activities were higher in severe pain group than in no-pain, mild and moderate pain groups (P < 0.001). There were statistically significant differences in the duration of pain, the pattern of pain and the day when maximum pain is perceived among mild, moderate and severe pain groups (P < 0.05).

CONCLUSION

The results of the present study present that PD negatively influences academic performance and participation in sports and social activities. Furthermore, pain characteristics differed among the patients with mild, moderate and severe pain. There is a need for further studies that improve treatment options for PD in order to minimize the influence of pain on academic performance and social activities.

Evaluation and management of heavy menstrual bleeding in adolescents

PURPOSE OF REVIEW

Heavy menstrual bleeding (HMB) is a common condition in women of reproductive age; however, adolescents with this issue present unique challenges in both diagnosis and management. Much of the research into this topic focuses on the adult population, with variable applicability to adolescents. There are currently no standard guidelines for the work up and treatment of adolescents with HMB.

RECENT FINDINGS

Current research into this topic has explored the utilization of standardized protocols in the evaluation of HMB in adolescents, the efficacy of various hormonal, nonhormonal, and surgical treatment modalities, and the benefits of a multidisciplinary approach. Recent literature has focused on adolescents found to have an underlying bleeding disorder, recommending more comprehensive bleeding disorder work up to identify these patients in a timely manner and initiate effective treatment plans.

SUMMARY

Providers in the primary care setting should be aware of the definitions for normal menses, and be able to recognize abnormal bleeding and HMB. Early recognition of HMB in adolescents can then lead to appropriate diagnosis of underlying disorders, and current research has proposed standard protocols to assist with the evaluation, ultimately leading to effective long-term management into adulthood.VIDEO ABSTRACT.

Early Menarche and Menstrual Problems Are Associated with Sleep Disturbance in a Large Sample of Chinese Adolescent Girls

Study Objectives

Little is known about the association between menstruation and sleep disturbance in adolescent girls. This study examined sleep duration, insomnia symptoms, and sleep quality in relation to age at menarche and menstrual problems in a large sample of Chinese adolescent girls.

Methods

This report represents the baseline data of an ongoing longitudinal study of the Shandong Adolescent Behavior & Health Cohort in Shandong, China. A total of 5800 girls aged 12-18 years (mean age = 15.0, standard deviation = 1.4) participated in the baseline survey. A structured questionnaire was used to assess participants' age at menarche, menstrual cycle interval, menstrual flow length, period irregularity, period pain, body weight and height, and demographics. Internalizing and externalizing problems were measured by the Youth-Self Report of Child Behavioral Checklist. Sleep duration, insomnia symptoms, and sleep quality were assessed by the items adapted from the Pittsburgh Sleep Quality Index.

Results

After adjusting for age, school, body mass index, internalizing and externalizing problems, and family covariates, irregular periods (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.06-2.02), period pain (OR = 1.99, 95% CI = 1.44-2.76), and menstrual flow length ≥7 days (OR = 1.21, 95% CI = 1.00-1.48) were significantly associated with insomnia symptoms. Irregular periods (OR = 1.72, 95% CI = 1.30-2.27) and period pain (OR = 1.78, 95% CI = 1.34-2.37) were significantly associated with poor sleep quality. Age at menarche ≤11 years (OR = 1.62, 95% CI = 1.05-2.50) was significantly associated with insomnia symptoms in 12- to 14-year-old girls.

Conclusions

Our results suggest that irregular periods and period pain appear to be associated with sleep disturbance and that early menarche may have short-term impact on sleep in adolescent girls.

Serum heme oxygenase-1 levels in patients with primary dysmenorrhea

PURPOSE

Primary dysmenorrhea effects the life-quality of women negatively. The aim of this study was to evaluate heme oxygenase-1 (HO1) activity together with malondialdehyde (MDA) and nitric oxide (NO) levels in patients with primary dysmenorrhea.

METHODS

A total of 28 nulliparous women with the diagnosis of primary dysmenorrhea and 26 healthy controls were included in this study. On the first day of menstruation, all patients underwent ultrasound examination to exclude pelvic pathology and the visual analogue scale was applied to patients. Patient's visual analogue scale (VAS) scores, age, body mass index (BMI), menstrual cycle length (day), length of bleeding (day) were recorded. In the same day, fasting blood samples were taken from each patient for biochemical analysis.

RESULTS

Serum MDA, NO and HO1 levels were found to be higher in women with primary dysmenorrhea compared to healthy controls (p = 0.012, p = 0.009, p < 0.001, respectively). There were no correlation among serum levels of HO1, NO and MDA, age, BMI, cycle length, pain score and menses duration in both groups. In Pearson's correlation analysis, positive correlation was found between HO1 levels with the NO levels (r = 0.316, p < 0.05) and VAS scores (r = 0.520, p < 0.01). Also, positive correlation was found between MDA levels and VAS scores (r = 0.327, p < 0.05).

CONCLUSIONS

Serum HO1, NO and MDA levels increase in patients with primary dysmenorrhea. Antioxidant support might be helpful to reduce pain severity in primary dysmenorrhea.

Autistic traits in women with primary dysmenorrhea: a case-control study

OBJECTIVES

Recent studies have shown that women with autism spectrum disorder have higher rates of menstrual problems, including irregular menstrual cycles, unusually painful periods (dysmenorrhea), and excessive menstrual bleeding. In this study, we investigated the autistic traits in female university students with primary dysmenorrhea (PD).

METHODS

Seventy females with PD and 70 females without PD were enrolled in the study. The Autism Spectrum Quotient (AQ) was used to measure autistic traits and the Brief Symptom Inventory was used for evaluating anxiety and depression levels. The dysmenorrheal pain was assessed by visual analog scale (VAS), coded from 0 to 10. Weight and height were measured, and the body mass index was calculated.

RESULTS

There were no statistical differences between the groups in terms of age, duration of education, and body mass index. Women with PD had higher AQ - Total, and AQ - Attention Switching subscale scores than subjects without PD. Spearman analysis revealed that AQ - Total and AQ - Attention Switching scores were correlated with VAS. According to the linear regression analysis, VAS was predicted only by AQ - Attention Switching subscale.

CONCLUSION

Our findings showed an association between autistic traits and dysmenorrhea in typically developing females.