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Normal menstrual cycles are often associated with difficult and painful menstruation known as dysmenorrhea. The term dysmenorrhea is derived from Greek words dys meaning difficult/painful/abnormal; meno meaning month; and rrhea meaning flow. Dysmenorrhea may be accompanied by nausea, vomiting, diarrhea, headache, irritability or anorexia. It is a common complaint in around 50% of post pubescent females (Karim and Popat ,2009). It may be primary or secondary depending on the cause. When the patient acquires her symptoms at an early age, immediately after the onset of regular ovulation, dysmenorrhea is termed as primary. On the other hand secondary dysmenorrhea is associated with detectable organic defect. Karim A. Calis and Vaishali Popat (2009) in their study indicated that secondary dysmenorrhea is usually observed in women aged 30 – 45 years. According to E.S.E.Hafez (1998) it is primary in 75% of cases (with no pelvic disorder). Whereas, in 25% of cases dysmenorrhea is secondary with pelvic disorders or some structural abnormalities in the ovaries. The asset of primary dysmenorrhea is usually 6-12 months after menarche, which coincides with the occurrence of regular ovulatory cycles. According to Rostami Maryam (2007) 15% of women suffered from dysmenorrhoea which disturbed their daily activities and was not improved by analgesics. The reduction in work hours as well as school days among young girls as a result of dysmenorrhoea has been repeatedly reported to be of national and economic concern. It could also lead to personal and family disruption. Also, it is found that girls suffering from dysmenorrhea have lower achievements and more school adjustment problem than non-dysmenorreic girls do.
The present cross sectional study was conducted in adolescent school girls of age group (10-15 yrs.) from four different regions of Aligarh city. The sample was selected on the basis of Multi stage, purposive random sampling. A total of 700 out of 26,540 secondary school girls (as per the records of Distt. Basic education officer, 2004-05) were selected, which was calculated out to be 2.6% of the total. The study was conducted during October 2005 to October 2006. As menarche is the event occurring during early adolescent phase of females; girls between ages 10-15 years were selected. Based on the age at menarche, the sample was classified into three groups as early (9.5-11.5); normal (11.6-13.5) and late matures (13.6 –15) years.Out of 700 selected girls, 400 (57.2%) had attained menarche, and were selected for further study. The study was carried out using a pre-tested and modified questionnaire, piloted on a sample of 20 girls before the final study. The questionnaire included questions regarding the subject’s age, whether pre-menarcheal or post menarcheal, age at menarche (in post menarcheal girls), anthropometry, food habits, dietary intake and the Socioeconomic Status. Information regarding duration and severity of menstrual pain, duration of bleeding, medical attention and use of analgesics and pain killer tablets were also inquired into. All the subjects were ensured that the information gathered through the survey would be kept confidential. Apart from assessing the age from the subject herself, her exact date of birth was ascertained from school records. The age was rounded off to the nearest preceding year. Hence 11 years was referred to all those, 10.01 through 10.12 years with an approximate mean of 10.06 years. Age at menarche was noted in completed years and months. Standing height was measured using a stediometre and the reading was noted up to the nearest cm. Weight was measured up to the accuracy of 500 gms, by a standard personal weighing machine. BMI was calculated using Quetlet Index (wt/ht2). ICMR (2002) classification was used to grade BMI accordingly. A 24 hour dietary recall method was applied to arrive at the total calorie intake. The subject’s food habits, whether vegetarian or non-vegetarian was also noted. Chi square test, Linear Regression analysis and ANOVA test were used to determine the correlation between the four grades of dysmenorrhea and its’ biological variables. Statistical package for the Social Sciences (SPSS-12.0) software was used for this purpose.
Out of the 400 post menarcheal girls, the overall mean age at menarche was calculated to be 12.36 ± 1.15 yrs. It was found that 257 (64.3%) of the post menarcheal girls experienced either of the degree of dysmenorrhea. Among these, 257 subjects (64.3%) suffered from different degrees of dysmenorrhea which disturbed their daily activities and needed the use of analgesics or painkillers. However, 143 subjects (35.7%) experienced no dysmenorrhea (Table 1). Table 1: Prevalence of dysmenorrhea according to age at menarche.
The results of the study revealed that there was no significant correlation between menarche age and severity of dysmenorrhea (Table 2). It was also observed that no significant correlation was found between mean height and mean weight and the severity of dysmenorrhea (Table 3). Further analysis showed that the relation ship between the degrees of dysmenorrhea and BMI was found to be statistically insignificant as shown in Table 4 (P>0.05). Table 2: Distribution of dysmenorrhea according to age at menarche.
Table 3: Severity of dysmenorrhea according to mean height & weight.
Table 4: Severity of dysmenorrhea according to BMI
A significant correlation was found between the duration of bleeding as well as the length of menstrual cycle and the severity of dysmenorrhea. (Table 5, P<0.01). It is quite obvious from the table that the severity shows a steady increase with increasing duration of bleeding along with increasing length of menstrual cycle from 27 days in the girls experiencing no dysmenorrhea to 29, followed by 30 and lastly 34 days in mild, moderate and severe degrees respectively. Table 5: Severity of dysmenorrhea according to duration and length of menstruation.
Dysmenorrhea prevalence according to food habits is depicted in Table 6. The number of girls experiencing moderate and severe degrees of dysmenorrhea was found highest among the vegetarian population, whereas the number of girls having no dysmenorrhea complain or mild degrees was highest among the non-vegetarian group. On applying χ2 it was found that the degree of dysmenorrhea was significantly correlated with eating habits (p<0.01). Correlation between dysmenorrhea and total calorie intake was also found to be significant (P<0.01) as shown in Table 7. It is clear from the table that the total number of girls experiencing any of the degrees of dysmenorrhea decreased with increasing calorie intake from 179 to 45 followed by just 32 girls having the highest calorie intake. Table 6: Prevalence of Dysmenorrhea according to food habits
Table 7: Dysmenorrhea according to total calorie intake/day
According to Table 8, the SES was also found to be significantly correlated with dysmenorrhea (P<0.01). It is also noted that out of 400 menarcheal girls only 58 girls (14.5%) took analgesics or pain killed during menstrual periods as a treatment for dysmenorrhoea. On the other hand 199 (49.7%) dysmenorric girls have taken no medication. (Table 9) Also the number of girls taking medicines during dysmenorrhea was significantly much higher (19 girls) among the early matures (9.6-11.5 years) as compared to only 2 girls among the late matures (13.6-15 years). A strong negative correlation was found between age at menarche and medicine intake during dysmenorrhea. (F=46.2; P< 0.01). It is noted from table IX that as the age of attaining menarche increases, the percentage of age of girls taking medicines decreased gradually from 29.7% (early matures) to 23% (normal matures) followed by only 6.25% (late matures). Table 8: Severity of Dysmenorrhea according to SES
Table 9: Distribution according to age at menarche & medication during dysmenorrhea.
The pain of dysmenorrhea is difficult to measure as it is usually accompanied by other unpleasant sensation. In the present study the severity of dysmenorrhea was judged only by personal assessment method which took into account the severity of pain, and its effect on daily activities and analgesic requirement contrary to the present study, other studies pointed out significant correlation between age at menarche and severity of dysmenorrhea (Rostami Maryam 2007, Marjori banks J. and Proctor M.L. et al 2003) according to other studies (Ylikorkala O, Dawood M., 1998) the frequency of dysmenorrhoea ranged from 3% to 90%. This great variation in the reported frequencies is mainly due to the selective nature of previous investigation, present study showed the frequency of 64.3%. Present study showed positive significant correlation between severity of dysmenorrhoea and duration as well as length of menstruation as according to other studies (Rostami Maryam 2007). The present study results regarding the eating habits and calorie intake are well in accordance with the results shown by Gailey TA and Mc Donough (1995). Table VIII shows that the number of girls with no pain increased with increasing SES, whereas the total number of girls experiencing dysmenorrhea showed a decreasing trend with increasing SES. According to table IX, only 14.5% girls took medicines or consulted to doctors. This could be due to the reason that many women accept dysmenorrhoea as a normal part of female constitution and they may not believe in treatment for it.
The treatment of dysmenorrhea is designed to correct an organic cause, suppress ovulation via the use of contraceptive, or relieve pain. Pregnancy and delivery appears to inhibit the recurrence of dysmenorrhea. Improved understanding of the physiology of dysmenorrhea may result in the discovery of more effective treatment regimens. It will lead to reduction in the medical and social consequences of dysmenorrhea. The results open new dimensions of study as this area lacks sufficient literature. Other longitudinal and semi longitudinal studies could also be undertaken in other related areas such as effect of dysmenorrhea on the IQ levels and school achievements of adolescent girls.
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