INTRODUCTION:

Menstruation and menstrual cycle

According to the World Health Organization, adolescence is defined as the age between 10 and 19 years and is a transitional stage between childhood and adulthood, during which significant physical and mental changes occur. Enormous physical and psychological changes in young women can be seen in adolescence. In this age group serious gynaecological pathology is rare, but menstrual disturbances are common and may add further disruption to this difficult phase for adolescents and their families^[1].

Menstruation is a periodic and cyclical shedding of progestational endometrium accompanied by loss of blood, which is a normal physiological process in women of reproductive age that begins during adolescence and may be associated with various symptoms.

Often it is referred to cause physical discomfort and psychological upset. The modern scientific era has contributed a better understanding to its physiological importance, it is viewed with a scientific perspective nevertheless, differences in attitudes still persists among different population and culture groups ^[2].

The menstrual cycle is a powerful tool to the assessment of normal development and the exclusion of pathological conditions. The normal menstrual pattern starts at the age of menarche which is less than 16 years, length of menstrual cycle is 24-32 days and the amount of blood flow per period is ≤ 80 mL^[3]. Normal menstrual function depends on the complex interaction between the hypothalamic pituitary ovarian axis and endogenous hormones for woman who has reached menarche. Alterations in these hormones can affect menstrual cycle characteristics, such as cycle length, bleeding patterns, and regularity^[4]. It is irregular during the first year of menarche due to an ovulatory cycle and becomes regular within 2-3 years. The average menstrual cycle lasts for about 5 days, which accounts to approximately 67 months of menstrual bleeding over a lifetime^[5].

Menstruation related disturbances may have considerable psychological and physical consequences in student community. These conditions contribute to school absenteeism and can give rise to the problems faced by adolescents and their families during this difficult stage of development^[6].

Menstrual disorders

Menstrual disorders are one of the major problems faced by women all around the world and are generally perceived as minor health concerns and it is a reason for increasingly 1% of gynecological visit. Many reasons have been deduced as the factors responsible for the low public attention attracted to menstrual disorder and discomfort. Some women see menstruation as a ‘taboo’ and subject not to be discussed publicly^[7-9] and could cause distress.

There are many types of menstrual disorders such as oligomenorrhea, hypomenorrhea, menorrhagia, metrorrhagia, dysmenorrhea, pre-menstrual syndrome (PMS), amenorrhea and polymenorrhea^[10]. Common menstrual disorders include heavy flow (menorrhagia), unusually light (hypomenorrhea), unusually frequent (polymenorrhea), unusually infrequent (oligomenorrhea) and unusually painful (dysmenorrhea) ^[3]. The most prevalent menstrual disorders among adolescents are excessive uterine bleeding, dysmenorrheal and premenstrual syndrome. Premenstrual syndrome greatly affects daily life activity of young women especially the student population. These disorders may cause significant anxiety^[11].

An abnormally heavy and prolonged menstrual period at regular intervals is known as menorrhagia. It may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of endometrial lining of the uterus. The absence or suppression of a menstrual period in a woman of reproductive age either temporary or on a permanent basis is known as amenorrhea. It is classified into primary and secondary amenorrhea. Primary amenorrhea is defined as no menarche by 16 years of age and secondary amenorrhea is the absence of menses for 6 months^[12].

A condition in which a person suffers from very scanty bleeding during her menstrual periods is known as hypomenorrhea. As a consequence of this problem the duration of the menstrual period may also become shortened. The problem may be hereditary and in a few cases in some woman, the problem results from the fact that the area of the surface within the reproductive tract from which bleeding takes place during the menstrual period is itself restricted. Oligomenorrhea is irregular (or, in occasional usage, very light or infrequent) menstruation. It is menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year. The duration of such condition may vary. The condition may be caused by a number of disorders including Graves’s disease, thyrotoxicosis or a pituitary tumor^[13]. In short, amenorrhea is defined as the absence of menstrual bleeding; the cycles longer than 35 days are called as Oligomenorrhea. Dysmenorrhea is defined as pelvic pain directly related to menstruation, and is associated with symptoms ranging from headache and back pain to nausea, vomiting and diarrhea^[12]. The severity of dysmenorrhea was defined as inhibition of the daily activities associated with systemic symptoms.

Dysmenorrhea is classified into primary and secondary dysmenorrhea. Primary dysmenorrhea is defined as painful menses in women which has normal pelvic anatomy, usually begins during adolescence. Primary dysmenorrhea characteristically begins when adolescents attain their ovulatory cylces; generally with the first year after menarche^[14]. The initial onset of primary dysmenorrhea is usually shortly after or at menarche, when ovulatory cycles are established. Women who are affected experience a sharp, intermittent spasm of pain usually concentrated in the supra pubic area. Pain may radiate to the lower back or back of the legs. Systemic symptoms such as nausea, vomiting, diarrhea, fatigue, mild fever and headache or light headedness are fairly common. Within hours of the start of the menstruation, pain usually develops and peaks as the flow becomes heaviest during the first day or two of the cycle^[15]. Secondary dysmenorrhea is considered when the pelvic pain is associated with unidentifiable pathological condition, such as ovarian cysts, endometriosis, pelvic inflammation, myomas or intrauterine devices. This category is likely to occur years after the onset of menarche and can occur at pre-menstrual as well as during menstruation. As stated above, dysmenorrhea with an identifiable cause is termed as secondary, where as one without any identifiable cause are primary. In vivo and in vitro studies have reported that painful cramps are caused due to over production of prostaglandin^[16].

PMS is defined as physical cognitive behavioural or moral cycle of changes with symptoms such as acne, pain, limbs edema, fatigue, abdominal bloating, breast tenderness, insomnia, anger and moodiness^[17]. Among all menstrual disorders, dysmenorrhea is the most common, being reported among students, which is characterized by recurrent, crampy abdominal pain, headache, nausea, vomiting, diarrhea, and back pain. This being the major cause leads to activity restriction^[18,19] and absenteeism from school or university, for which few of the adolescents consult physician or may adopt self-medication with over-the-counter medicines or home remedies ^[20-22].

Menstrual irregularity was also reported in girls during the first year of menstruation and in some it persists for three to five years. Those students who suffer from irregular menstrual cycle may have a significant impact on the physical and social health of those affected^[7]. These menstrual disorders frequently affect the quality of life of adolescents and young adult women, especially those who suffer dysmenorrhea and heavy menstruation^[20]. Delayed, irregular, painful, and heavy menstrual bleeding are common occurrence among younger age and are the leading reasons for physician office visits by adolescents^[23]. The World Health Organization reported that 18 million women aged 30–55 years perceive their menstrual bleeding to be excessive^[24].

Menstrual patterns are influenced by a wide variety of factors ^[25] which can be responsible for menstrual disorders, among them are, significant weight gain or loss, over-exercise, poor nutrition which consist of a diet too high in carbohydrates or oily food, smoking, drug use, caffeine, excessive alcohol use which interferes with the metabolism of estrogen and progesterone in the liver, eating disorders, increased stress, hormonal imbalance, medications, recent childbirth or miscarriage, breastfeeding and so on ^[26]. Factors such as eating disorder, malnutrition, and intensive physical activity are associated with the irregular menstrual cycles experienced by students nowadays. These irregularities in menstrual cycle directly influence the rise of menstrual disorders ^[16].

Several studies have been investigated the prevalence of menstrual disorders among student population. Studies have shown a high prevalence of dysmenorrhea and menstrual irregularity among female students and that these problems affected the women’s social activities and school attendance^[22,27^]. A study among Iranian women showed that the prevalence of no, mild, moderate and severe menstrual pain as 10%, 41%, 28% and 22% respectively^[28]. A high proportion of women in other studies reported suffering oligomenorrhea or amenorrhea and these have been associated with body mass index (BMI) and other complications such as polycystic ovary syndrome (PCOS), hirsutism or infertility^[29-31]. Several studies have been conducted and evaluated the factors and related variables associated with menstrual disorders and have reported its relationships with diet and eating disorders^[32-33], exercise and BMI^[34-36], stress ^[37,38] and chronic diseases ^[39-42]. Menstrual cycle abnormalities may also be associated with psychological stress, strenuous physical exercise, low body weight and endocrine disturbance.

Studies on Menstrual patterns among students

Several studies were performed to determine the prevalence and the pattern of menstrual disorders among students in various countries and also to understand the knowledge and awareness toward menstrual disorders among the students. Chia et al^[43] evaluated the prevalence of dysmenorrhea, its impact, and management approaches in Hong Kong university students. The prevalence of dysmenorrhea was reported as 80% with a mean pain score of 5.0. The most common impacts on daily life included reduced ability to concentrate and/or disturbance with study and changes in normal physical activity. Only 6% sought medical advice, while 70% practiced self-medication. The commonest specific strategies used were a warm beverage (62%), paracetamol (57%), and sleeping (45%), while the most effective strategies were using non-steroidal anti-inflammatory drugs (100%), traditional Chinese medicine (93%), and dietary/nutritional supplements (92%). The study also compared between medical and non-medical students for any potential differences in coping strategies, the former used fewer pharmacological strategies among the various management approaches investigated. The authors concluded that dysmenorrhea is a very common condition having a significant impact in the Hong Kong community, primary care doctors should reassure young women with dysmenorrhea that it is a common experience in the same age-group. Health education on the existence of effective treatment from medical practitioners could help women whose dysmenorrhea was not controlled by self-management.

Adetokunbo et al ^[44] investigated the menstrual awareness of female secondary school students in Lagos and correlations between factors such as menarcheal age, frequency of menstruation, presence of pain during period (Dysmenorrhea), degree of incapacitations due to pain and other factors was studied using a structured self-administered questionnaire. Questions were asked regarding menarcheal age, source of information on menstruation, duration of menstruation (blood flow) and frequency of menstrual flow; whether there is associated pain which was further graded as mild, moderate or severe using the visual analogue scale. Menstrual pain was further stratified by its impairment of daily activity and the medication used. The source of information about medication for pain was also asked for. The mean age at menarche was reported as 12.80 years. The authors have found significant positive correlation between age at menarche, source of information about menstruation and frequency of menstruation. Girls have obtained the information on medications for menstrual pain from their family members, mothers, sisters and father. The authors concluded that the role of the family especially mothers in reproductive education of the very young girls is emphasized and early education on reproductive health at both primary and secondary school level is highly desirable to enable girls cope adequately with symptoms of menstruation.

Shah et al ^[45] carried out a cross-sectional study to find out the prevalence of primary dysmenorrhea in young nursing students. Students were asked about their menstrual history, menstrual pain and associated symptoms like nausea/vomiting, headache, dizziness or diarrhea through written questionnaire. Severity of pain and other associated symptoms were noted on 3 point scale as mild, moderate or severe. Abdomen and ultrasonographic examination was carried out for those having dysmenorrhea by gynecologist. The authors reported that mean age of menarche was 13 and 13.5 years with and without primary dysmenorrhea respectively. The prevalence of primary dysmenorrhea in their study was 45%, they also reported that 18% of students had mild, 40% had moderate and 42% had severe dysmenorrhea. The presence of other symptoms such as nausea/vomiting, headache, dizziness/ giddiness, diarrhea was found in the study population. The authors concluded that the prevalence of dysmenorrhea was high in their study population and such high prevalence makes dysmenorrhea a significant public health problem among young students that demands some attention from policy makers.

Karout et al ^[46] conducted a survey among Lebanese nursing students to determine the prevalence and pattern of menstrual symptoms. The data was collected using self-administered, structured, anonymous questionnaire covering 21 items. The questionnaire covered information on demographics such as age, marital status, residence and presence of pregnancy and breastfeeding (to rule out the cause of amenorrhea if present) with close-ended questions. The participants were also asked about the characteristics of their menstruation: age of menarche; regularity/irregularity of menstruation in interval and duration; presence of amenorrhea (secondary); amount of blood loss (number of pads used); pain during menstruation and degree and location of pain; activity during menstruation; symptoms of PMS, whether the symptoms disappear after menstruation and the affect of PMS on activities of life. The response rate reported was 83.8% and two students were pregnant and 4 were breastfeeding during data collection. The mean menarcheal age was 13.2 years and 80.7% of the students reported suffering from one or more types of menstrual dysfunction. The most common problem was irregular frequency. Some students with regular cycles also reported oligomenorrhea and polymenorrhea and a small proportion of students (2.0%) reported hypomenorrhea, i.e. duration of menstruation usually < 3 days, and 11.6% experienced hypermenorrhea,i.e. duration usually > 7 days. The authors also reported that there was a high proportion of the students who suffered from dysmenorrhea (63.1%) and 54.0% reported having three of the signs of PMS. They concluded that high percentage of different menstrual disorders among young students in Lebanon. These disorders are not only likely to affect the quality of life and future productivity of women but may also be indicators of underlying problems that can become serious in the future and this is an important concern for reproductive health policy-makers. Health education on menstrual problems targeting female students and their parents, and including education on reproductive health in the school curriculum may assist in early detection of these disorders.

Amaza et al ^[12] conducted a self-descriptive cross-sectional study among medical students in Nigeria to determine the patterns of menstrual cycles; prevalence of menstrual disorders; and the effect of menstrual pain on social activities. The questionnaire included data such as age of menarche, menstrual pattern, severity of pain, marital status, effects of exercise, Body mass index (BMI) and diet. The minimum age at menarche was reported as 9 years while the maximum was 17 years. The authors reported that results for irregular menstrual cycle was found in peak in the age group of 17-19 years and irregular menstrual cycle length was higher in age group of 20-22 years. The authors also reported that the prevalence of dysmenorrhea was very high among the respondents, who suffered mild, moderate or severe grades of pain. Other common disorders reported in the study were abnormal menstrual flow, abnormal duration of flow followed by irregular length of cycle. They concluded that changes in normal menstrual pattern of women may affect their physical as well as mental well-being.

Fekr et al ^[47] conducted a study to compare the frequency of menstrual disorders among female athlete and non-athlete university students using questionnaire which was designed on the history of menstruation and subject’s sport background. The phenomenon of women sport and their participation in competitive and recreational activities is increasingly developed recently. However, one of the most important issues related to the participation of women in sport activities is their menstrual cycle. They also reported that the incidence of PMS in non-athletes was higher than athletes but the difference was not statistically significant. They concluded that in presence of negligible amount out of amenorrhea / oligomenorrhea among athlete/non-athlete students, exercise can cause to decrease/ cut the menstruation level and hence it is necessary for all coaches and physical activity teachers to warn their students about the correct nutritional conditions especially at their high intensity exercise periods. The authors also reported that sport can cause to the remedy of PMS and it is crucial for all students to follow many recommendations which could bring the joy ness of their physical activities.

Sood et al ^[48] studied the correlation between menstrual patterns and stress among undergraduate medical students. All subjects were trained to maintain a menstrual diary once every month for six months in which they recorded date of onset, number of bleeding days, and associated problems. They were also guided for completing a menstrual questionnaire evaluating detailed aspects of their menses at baseline, three and six months. The authors reported that medical students are at high risk for developing menstrual irregularities due to lifestyle with less sleep, irregular food and exercise habits. Menstrual irregularity over prolonged periods of time can lead to development of infertility, endometrial hyperplasia and problems due to prolonged anovulation, besides the deterioration in the quality of life. The authors concluded that there is no significant association between stress levels and menstrual changes among preclinical medical students. However, stress if present tends to decrease with time.

Shabnam and Khyrunnisa ^[49] conducted a study to determine the patterns of menstrual cycles and its related problems, discomfort and working ability of girls during the periods among female students studying in various degree levels from undergraduate and postgraduate institutions in Mysore, India. The study also inferred the extent of awareness and sources for information regarding menstruation possessed by Indian girls before attaining puberty. The participants were requested to complete the questionnaires to elicit information relating to demographic features, menarche age, and menstrual pattern. Severity of dysmenorrhea was measured using the Visual Analogue Scale. Impact of menstrual disorder on working ability, the source of knowledge about menarche, and menstruation was also obtained using a pretested questionnaire developed for the purpose. Information regarding menstrual bleeding was obtained by interview method using a pictorial chart. The authors reported that the mean age of participants in their study was 20.6 ±1.32 years and the mean age of menarche was 13.36 ± 1.25 years; which was inconsistent with studies reported from other parts of India. Prevalence of dysmenorrhea among the selected group was 78.2%, and it was associated to early menarche age. The authors also found an extremely significant association between cycle length and frequency of irregularity and irregular menstrual cycles were frequent among girls who had cycle length >35 days. Although occurrence of dysmenorrhea was independent to cycle length, all those who had cycle length >35 days were dysmenorrheic. Their study results exhibited a small effect of age on severity of pain; however, it was statistically not significant. Immobility due to pain during menstrual period was seen in 7.3% of the dysmenorrheic girls including the various intensity of dysmenorrhea. 68.8% of the participants mentioned that their working ability was affected to moderate extent, the association between severities of pain limited work ability was statistically significant. Sixty percent of participants were aware of menstruation before attaining menarche. The source for information were from mothers, friends, television, magazines, and newspaper, nevertheless, the major sources were mothers and friends. The authors concluded that dysmenorrhea and menstrual irregularity were more prevalent among young females. Common symptoms of dysmenorrhea are tiredness, anger, and backache; the pain that is characteristic to dysmenorrhea varies in intensity. Those females who experienced severe pain suffered with abdominal cramps, vomiting, and loss of appetite including immobility. The authors suggested that a comprehensive school education program on menarche and menstrual problems may help girls to cope better and seek proper medical assistance.

Esimai and Esan ^[3] conducted a study to document menstrual abnormalities experienced by female college students, their awareness and health seeking behavior. The students were interviewed using semi-structured self-administered questionnaire. The mean age at menarche was 14.18 years. Irregular menstrual cycles were reported in 9.0%. Dysmenorrhea was present in 62.5%, and 12.5% reported school absenteeism. They also reported that only 10.5% decided to seek help for menstrual abnormalities, and awareness of menstrual abnormalities was poor among students. The awareness of students on menstrual abnormalities was significantly influenced by their age; however, age at menarche and level of study did not influence their awareness. History of dysmenorrheal and academic disturbance had significant influence on the health seeking behavior of the students. The authors concluded that, there was a general lack of information about menstrual issues and when to seek help, for which there is a need to educate female college students about menstrual issues.

Zhou et al^[50] investigated the prevalence of dysmenorrhea in a prospective approach among female students in a Chinese university. A diary table was distributed to the participants which was collected back after three months in which the students were requested to record their menstrual dates, amount of menstrual blood flow (too little, moderate or too much), dysmenorrhea (lower abdominal pain associated with menstruation) and medications taken for menstrual disorder). The authors reported that dysmenorrhea occurred in 56.4% of students; 6.5% of dysmenorrheal students suffered from “hard to bear” (unbearable) menstrual pain, and 6.5% had pre-menstrual dysmenorrhea. Dysmenorrhea occurred on 37% of the menstrual dates on average and was unrelated to irregularity of menstrual cycles. The percentages of students taking medicine with mild, moderate and unbearable dysmenorrhea were 4.0%, 13.3% and 23.7%, respectively. The authors also reported that the percentage of students taking medicine was less than 25% even with unbearable dysmenorrhea. The authors concluded that dysmenorrhea in the students was essentially primary dysmenorrhea since no students reported underlying pelvic pathology during the study.

Titilayo et al ^[51]carried out a study to assess the prevalence of menstrual cycle discomfort and its influence on daily academic activities and psychosocial relationship among female undergraduate students in a Nigerian University. They employed two levels of data collection; quantitatively by structured questionnaire and qualitatively by in-depth interviews techniques. The in-depth interviews guide was designed to investigate the issues of menstrual discomfort as it affects daily activities of the female students. The questionnaire included questions on whether the participants have experienced menstrual disorder(s), how this problem was perceived, perceived consequences of the disorder on their daily activities and interactions with others and steps taken towards addressing the menstrual problem. The authors reported the mean age at first menarche as 13.9±1.6 years. They also found that majority of the informants showed a good understanding of menstrual disorder and discomfort but with the possibility of little exaggeration. The occurrence of dysmenorrhea was found significantly frequent among female students whose menses were associated with dizziness, headache, depression, irritation and among those who claimed that menses discomfort ever called for medical attention. The incidence of menorrhagia was less frequent (21%) among the respondents than dysmenorrhea. It occurred more significantly with dizziness, and headache. There was a significant positive relationship between menstrual discomfort and interference in normal school activities. Dysmenorrheal and menorrhagia were significant predictors of psychosocial relationship of young women. They reported that, about 74.2% of the respondents were often disturbed from normal school activities and about 48.8% of the respondents experienced psychosocial problems during menstruation period. The authors concluded that there is a level of influence between menstrual discomfort and university female students’ normal school activities. They also envisaged that, an appropriate enlightenment and treatment mode for menstrual related cases should be made available to females in the school and out of school environment.

Begum et al ^[52] conducted a descriptive cross-sectional study among young college girls of Dinajpur Medical College, India through self-administered structured questionnaire with 25 items. The questionnaire included demographic features, menarche age, menstrual pattern, severity of dysmenorrhea and associated symptoms, impact of menstrual disorder on social, sport activities and college attendance, management strategy of the pain, the source of their knowledge about menarche and whether they require medical help from a doctor, nurse or midwife for menstrual disorder or not. Age of the respondents was between 19-25 years with a mean of 21.8±1.6 years. Minimum age at menarche was 9 years, while maximum age was 15 years with mean 12.6 ±1.0 years and median 13 years. It was observed that as many as 152 (87.4%) respondents had regular menstrual cycle, whereas 22 (12.7%) had irregular cycle. Menstrual flow was average in 100 (57.5%), scanty in 72 (41.4%) and heavy in 2 (1.2%) respondents. At least 106 (60.9%) respondents conceded that they had painful menstruation (dysmenorrhea) with a varying degree of severity. Of them, as many as 26 (24.5%) needed medical intervention either by analgesic and/or antispasmodic. About 56 respondents had family history of dysmenorrhea. The authors concluded that the prevalence of dysmenorrhea and menstrual irregularity was high, and most adolescents have inappropriate and insufficient information about menstrual problems. Hence, an education program is needed at the end of primary school about menarche and menstrual problems.

Cakir et al ^[20] analyzed the patterns of menstrual cycles in association with age of menarche, prevalence of menstrual irregularity, dysmenorrhea, prolonged menstrual bleeding, and effect of menstrual disorders, especially dysmenorrhea, on social activities and school attendance among the female students in Turkey. The authors reported that the mean age of the subjects at menarche was 12.8 ±1.3 years with a range of 9-17 years. The duration between two periods and the menstrual flow were 27.7 ± 2.5 days and 5.8 ±- 1.4 days, respectively. The prevalence of menstrual irregularity, prolonged menstrual bleeding and dysmenorrhea were 31.2%, 5.3% and 89.5%, respectively. Approximately 10% of dysmenorrheic subjects had severe dysmenorrhea; and school absenteeism and need to consult a physician were more common in those subjects. The first source of their knowledge about menarche and menstruation was their mothers in 211 subjects (54%); only 18 subjects (4.6%) were given a lecture about menstruation and menarche at school. The authors concluded that the prevalence of dysmenorrhea and menstrual irregularity was high, and most adolescents have inappropriate and insufficient information about menstrual problems and they suggested education program is needed at the end of primary school about menarche and menstrual problems.

Rajsinh et al ^[53] studied the frequency of common menstrual problems and determined the association between patterns of menstrual cycles with common menstrual problems, nutritional and economic status of rural college girls. Data was collected by personal interview method and clinical examination of respondents with the help of pretested structured proforma, weighing machine, height measuring scale, haemoglobin assessment strips. Questionnaire included close ended questions regarding regularity of menstrual cycle, common menstrual problems as well as physical/clinical examination of study respondents with the help of study tools. Lowest age at menarche was 12 years and highest 17 years with mean age at menarche 14.1 years. They found that 24 (22.4%) girls had dysmenorrhoea however 14 (58.3%) had regular and 10 (41.6%) had irregular menstrual cycles. Girls without dysmenorrhoea, 18(21.6%) had irregular menstrual cycles. Further they also showed, 62 (57.9%) girls were anemic and there was association existed between anemia and menstrual problems. Poor environmental stimulants, poor diet, nutritional anemia, low socioeconomic status, geographical distribution, psychosocial factors often associated with menstrual problems and age at menarche in the study population. They explained majority of factors are preventable, need positive attitude towards the health of adolescent and women at reproductive age groups in rural area of India through primary health care approach mainly emphasis on adolescent health.

Chung et al ^[54] studied the presentations, diagnoses, and outcomes in adolescents attending the clinic, with menstrual disorders. The physical examination performed at the first visit included: measurement of body weight, height, and calculation of the body mass index (BMI). Hirsutism and acne scores were assessed for amenorrhoeic or oligomenorrhoeic adolescents, using the Ferriman and Gallwey system. Primary and secondary amenorrhea was the presenting symptoms in 31% followed by 11% who had dysmenorrhea and 11% with oligomenorrhea. Those presenting with dysmenorrhea were all diagnosed with primary dysmenorrhea based on a history, physical examination, and pelvic ultrasound. The authors concluded that majority of adolescents with menstrual disorders in their study had menorrhagia, short cycles or prolonged menstruation. Less frequently they had secondary amenorrhea, dysmenorrhea, oligomenorrhea, and primary amenorrhea. They suggested that long-term follow up and management is necessary for adolescents with menstrual disorders.

CONCLUSION:

The available literature indicates, majority of these student population experiences menstrual related symptoms and disorders of various degrees. These symptoms can have unbearable effects on student quality of life and daily activities. However, race, ethnicity and culture may influence expression of menstrual symptoms and their severity. Most of the studies on menstrual symptoms and disorders among student communities have been conducted in Asian and African countries. It is concluded that dysmenorrhea is a very common problem that does exist in student populations. Menstrual disorders have a substantial social, occupational, academic, and psychological effect on students’ life and their families. A study on awareness and need of medical attention for menstrual disorders is necessary among the student population as today’s world is well advanced with technologies, which might promote these students for self-medication. Management of these disorders can be done through accurate diagnosis, proper diet, exercise and lifestyle changes along with the services of health care professionals. Hence it is imperative to examine the prevalence, severity, and most common symptoms of menstrual disorders among student populations to promote their quality of life, health and wellbeing of a women during reproductive age.

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Received on 16.03.2014 Modified on 01.05.2014

Research J. Pharm. and Tech. 7(6): June, 2014; Page 704-711