Introduction:
Adolescence is a special phase in a girl’s life that signifies the transition from girlhood to womanhood. It often symbolizes the onset of menstruation and pubertal development. Menarche is considered as an important biological milestone in the growth and development of a girl and draws much physical, physiological, psychological as well as social and cultural significance. The variability in the age at which a girl attains menarche shows many socioeconomic, environmental, nutritional and geographical differences in the societies.
India which was for long associated with undernutrition-based morbidities and mortality, is now reeling under the ‘double burden’ of undernutrition and overnutrition, thanks to the changing demographics and lifestyle of its population. The prevalence of overweight and obesity among the young is steadily on the rise, particularly in the urban setting. At the same time, undernutrition cases are also explicitly seen.
On the other hand, menstrual irregularities also seem to be on the rise among young Indian girls, but often go underreported. Menstrual cycle is one of the prime determinants of a woman’s health. Though the onset of menstruation is part of the maturation process; variability in menstrual cycle characteristics and menstrual disorders are widely prevalent in the female population. These problems include psychological adjustment with menstruation, premenstrual and menstrual symptoms and disorders of menstruation. Menstrual disorders include menstrual irregularity, menorrhagia, dysmenorrhoea, and other related symptoms. The medical and social consequences of premenstrual, menstrual symptoms and disorders of menstruation influence not only the individual but also her family and society. In case of adolescent girls, it may manifest as loss of school / college days leading to poor progress in education or restriction of daily activity.
Need and Significance of the Study
Menstrual cycle is a very important indicator of women’s reproductive health and of their endocrine function. Menstruation, and the menstrual cycle are characterized by variability in volume, pattern and regularity. Albeit, menstrual problems among adolescent females are common and a significant source of morbidity in this population; any variation in the pattern based on the stage of adolescence, is quite unclear.
Menstrual irregularities seem to be on the rise among young Indian girls owing to the changing demographics and lifestyle, but often go underreported. Similarly, the prevalence of overweight and obesity among the young is also steadily on the rise. According to WHO, worldwide, the apparent increase in the BMI of adolescents in the 12 to 17 years age group from 5.7% on 2009 to 11.1% on 2011 has had a profound impact on the female reproductive health[1].
At times, menstrual problems can be symptoms of certain conditions like polycystic ovarian syndrome and endometriosis, which if undiagnosed and untreated may have profound long-term sequelae in adult life. If ignored, menstrual problems can become a major gynaecological problem and a source of anxiety. An understanding of the menstrual pattern can help to initiate timely intervention, if needed.
The present study therefore aims to assess the nutritional status (based on BMI) and menstruation (menstrual pattern and menstrual disorders) among college girls in Chennai.
Objectives of the Study
- To assess the weight status of the sample, using Body Mass index (BMI).
- To determine the menstrual pattern of adolescents.
- To assess the prevalence of menstrual problems among the sample.
- To examine specific practices among the sample during the period of menstruation.
- To assess the association between age and menstrual irregularity and BMI and menstrual irregularity.
Methodology
A cross-sectional descriptive research design was adopted for the study. The study was carried out in Chennai city, a major metropolitan city in South India. The sample comprised of 560 girls selected by stratified random sampling from different colleges in Chennai.
A self-formulated questionnaire was used as the tool for the study. The tool consisted of 25 questions. The first section included questions to elicit the personal details and the anthropometric profile of the respondents. The second section mainly concentrated on questions related to the menstrual pattern and the prevalence of the signs and symptoms of menstrual disorders - Premenstrual Syndrome, Dysmenorrhoea; as well as the dietary practices, medical help, absenteeism during menstruation, among the adolescent girls who participated in the study.
The investigator administered the questionnaire to the sample after explaining the purpose of the study and obtaining their consent. The anthropometric measurements of height, weight and circumferences were taken by the investigator as per the standard procedure. The items in the questionnaire were then explained and the duly filled - in questionnaires were collected from them. The data collected was then subjected to statistical analysis using SPSS package version.
Results and Discussion
Personal Details of the Sample
The personal details of the study participants are summarised in Table -1.
| Table-1: Personal details of the sample |
| Sociodemographic variables |
Particulars |
N (N=560) |
% |
Age (in years) |
17 – 19 |
445 |
79.5 |
20 – 22 |
115 |
20.5 |
Religion |
Hinduism |
359 |
64.1 |
Islam |
113 |
20.2 |
Christianity |
84 |
15.0 |
Others |
4 |
0.7 |
The age of the sample ranged between 17 to 22 years of age with a mean of 18.6 (±1.163). Majority of the study participants (79.5%) were in the 17-19 years age group. 64.1% of the participants were Hindus followed by Muslims (20.2%), Christians (15%) and others (0.7%).
Weight Status of the Sample
Body mass index, an anthropometric assessment measure, serves as a valuable indicator of the nutritional status of a person. Based on BMI, the study participants were categorised as Normal, Underweight, Overweight and Obese.
| Table – 2: Weight status of the sample |
| Anthropometric Variable |
N (N=560) |
% |
Body Mass Index (BMI) |
< 18 (Under Weight) |
112 |
20.0 |
19 – 24 (Normal) |
328 |
58.6 |
25 – 29 (Over Weight) |
106 |
18.9 |
=30 (Obese) |
14 |
2.5 |
The mean Body Mass Index (BMI) of the girls was found to be 21.03 ± 3.66. Though around 58.6 per cent of the participants fell in the normal BMI category, it wasn’t a pleasant revelation to note that 41.4 per cent girls were distributed over the two ends of the malnutrition spectrum. In the present study, girls with higher BMI (21.4%) marginally overshoot the number of underweight cases (20%). Thus, the study reaffirmed the co-existence of underweight and overweight / obesity among the college girls in India, particularly in the urban setting.
These findings are almost similar to that of Thapa B and Shrestha T (2015)[2] who observed in their study that out of 253 adolescent girls, 61.3% belonged to normal weight distribution, 22.9% were under weight and 15.8% were overweight.
Menstrual Details of the Sample
| Table – 3: Menstrual details of the sample |
| Variables |
% (N=560) |
Age at Menarche |
10-12 years |
43.4 |
13-15 years |
56.6 |
Menstrual Pattern |
Regular |
89.1 |
Irregular |
10.9 |
Duration of Menstruation (days) |
<3 days |
13.2 |
3 – 5 Days |
61.8 |
6 – 7 Days |
16.8 |
> 7 Days |
8.2 |
Average menstrual flow |
Heavy |
11.96 |
Normal |
80.0 |
Scanty |
8.04 |
Average menstrual cycle length |
<25 days |
2.1 |
25-34 days |
87 |
35-60 Days
|
7.7 |
>60 days |
3.2 |
Menstrual Problems |
|
Dysmenorrhoea |
Mild |
67.2 |
Moderate |
19.1 |
Severe |
2.7 |
Premenstrual Syndrome |
Yes |
69.5 |
No |
30.5 |
The results presented in Table – 3 reveals that the age of menarche for more than half of the sample (56.6%) was between 13-15 years of age. Menstrual irregularity was noticed in 10.9% of the study participants while the remaining 89.1% reported regular monthly periods. Majority (80%) of the girls had normal menstrual flow, nearly 12% of girls reported heavy bleeding and only around 2% of girls had scanty bleeding. It can also be noted that dysmenorrhoea was experienced by majority of the study participants (89%) either in mild, moderate or severe form, and the remaining 11% did not admit dysmenorrhoeal symptoms / problems. Symptoms related to Premenstrual syndrome was reported by 69.5% of the sample.
In a study by Ravi R et al (2016)[3] among 350 school students in Thiruvallur district, Tamilnadu, irregular menstrual cycle was reported in 31.7% of the participants. Kanotra, S K, Bangal, V and Bhavthankar, D (2013) [4] observed that the prevalence of menstrual irregularity was 5.6 % among a sample of 323 girl students in the age group of 15 to 19 years.
The above Figure -1 highlights the symptoms / problems related to Pre-menstrual syndrome and dysmenorrhoea, encountered by the study sample. An introspection of the table clearly shows that Dysmenorrhoea was the predominant complaint reported by the participants. Among the problems associated with dysmenorrhoea, pelvic pain and back pain were the main complaints reported closely followed by body pain, leg cramps and fatigue, changes in sleep pattern and emotional outbursts consecutively. Nausea, vomiting, breast engorgement, diarrhoea, constipation and overeating were among the minimally reported symptoms of dysmenorrhoea.
Premenstrual symptoms were comparatively lesser in the present study group. Among the premenstrual problems, acne was the main complaint followed by back pain, leg cramps and mood swings. All other symptoms were less reported. Symptoms reported to have experienced both before and during menstruation, by the study participants were – back pain, fatigue, leg cramps, changes in sleep pattern, mood swings and emotional outbursts. On the whole, in the present study dysmenorrhoea was widely noticed than premenstrual syndrome.
Specific Practices of the Sample During Menstruation
| Table - 4: Specific practices of the sample during menstruation |
| Variables |
Particulars |
N (N=560) |
% |
Food Cravings |
Yes |
79 |
14.1 |
No |
481 |
85.9 |
Food Avoidances |
Yes |
17 |
33.9 |
No |
33 |
66.1 |
Inclusion of specific foods |
Yes |
7 |
20.7 |
No |
43 |
79.3 |
Self-medication / Oral Home remedies |
Yes |
34 |
6.1 |
No |
526 |
93.9 |
Other home remedies resorted for pain relief |
Heat pads |
76 |
13.6 |
Acupressure |
32 |
5.7 |
Yoga |
21 |
3.8 |
Seeking medical help |
Yes |
12 |
2.1 |
No |
548 |
97.9 |
Absenteeism |
Yes |
54 |
9.6 |
No |
506 |
90.4 |
An observation of the Table – 5 shows that 66.1% of students do not avoid any foods during menstruation, while 20.7% of students included certain specific foods during menstruation. The foods commonly avoided by the sample included oily foods, sweets, chicken, egg, papaya, spicy foods, and peanuts. Foods included constituted of egg, fenugreek, milk, pomegranate, black cumin seeds, oregano, fruit juices and nuts.
Further it can be inferred that around 94% of students did not consume any self-prescribed medication / nutritional supplements. While approximately 6% of students opted for mild medications / nutritional supplements / home remedies. Further interaction pointed to intake of specific foods like cumin water, fenugreek, butter milk, and application of sesame oil and castor oil, in order to alleviate the menstrual problems experienced by them. With regard to the remedial measures adopted at home by the students to relieve from menstrual cramps, it was noticed that use of heat pads was the more common practise (13.6%) comparatively. Acupressure was resorted as an effective option by 5.7 % of the participants. Yoga was practised for relief by 3.8%.
It can also be noticed that 9.6% of the college girls absented themselves at least for a day owing to the menstrual related problems experienced by them.
Age and Menstrual Pattern
| Table – 5: Association between Age and Menstrual Pattern |
| Age Group(in years) |
Average Menstrual Cycle |
Chi SquareValue |
Level of Significance |
Regular |
Irregular |
N |
% |
N |
% |
17 – 19 |
396 |
89 |
49 |
11 |
.819 |
NS |
20 – 22 |
100 |
87 |
15 |
13 |
| NS – Not Significant |
No significant association was noted between age and menstrual irregularity among the participants of the present study.
BMI and Menstrual Pattern
| Table – 6: Association between BMI and Menstrual Pattern |
| Body Mass Index |
Average Menstrual Cycle |
Chi Square Value |
Level of Significance |
Regular |
Irregular |
N |
% |
N |
% |
Underweight |
103 |
92 |
9 |
8 |
11.336 |
p < 0.05* |
Normal |
299 |
91.2 |
29 |
8.8 |
Overweight |
89 |
84 |
17 |
16 |
Obese |
8 |
57.1 |
6 |
42.9 |
| *Significant at 5% level |
It can be interpreted from Table-6 that though menstrual irregularity was observed among girls from all categories of the BMI classification, it was found to gradually increase with increase in BMI values. A higher percentage of menstrual irregularity was reported in overweight (16%) and obese girls (42.9%). A perusal of the table also clearly indicates a significant association between the body mass index and menstrual irregularity among the girls included in the study. Studies by Danasu R et al (2016)[5] and Thapa B and Shrestha T (2015) [2] also ascertained an association between the body mass index and menstrual irregularities among adolescent girls. Dars S et al(2014)[6] also observed in their study that overweight girls had infrequent periods.
No significant association was noticed between age, BMI and the menstrual complaints of the participants in the present study.
Conclusion
It can be concluded from the present study that a significant association existed between the BMI and menstrual irregularity among the college girls in Chennai. Higher the BMI, higher the reported cases of menstrual irregularity. A combined occurrence of both these problems may increase the risk for disorders like Polycystic Ovary Syndrome (PCOS). Menstrual irregularity can be an outcome of hormonal anomalies or anaemia. A neglect of these problems can even affect the reproductive health of women or lead to other adverse complications later in life. This underlines the significance of early identification of menstrual problems and the need to bring right interventions at the adolescent stage to avoid crucial consequences in the later stages of life.
References
- Canadian health measures survey 2009-2011. WHO
- Thapa B, Shrestha T. Relationship between Body Mass Index and Menstrual Irregularities among the Adolescents. International Journal of Nursing Research and Practice. 2015;2(2):7-11.
- Ravi R, Shah P, Palani G, Edward S, Sathiyasekaran BW. Prevalence of Menstrual Problems among Adolescent School Girls in Rural Tamil Nadu. Journal of Pediatric and Adolescent Gynecology. 2016 Dec;29(6):571-57
- Kanotra SK, Bangal D, Bhavthankar D. Menstrual Pattern and Problems Among Rural Adolescent Girls. 2013 Aug. Available at: https://www.researchgate.net/publication/276379652_Menstrual_Pattern_And_Problems_Among_Rural_Adolescent_Girls.
- Danasu R, Rajalakshmi S, Christina MA. A study to assess the relationship between body mass index (BMI) and menstrual irregularities among adolescent girls at selected nursing colleges, Puducherry. International Journal of Information Research and Review. 2016;3(8):2725-2729.
- Dars S, Sayed K, Yousufzai Z. Relationship of menstrual irregularities to BMI and nutritional status in adolescent girls. Pak J Med Sci. 2014;30(1):141-144.
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