Original Study
Menstrual Disorders in Adolescent School Girls in Enugu, Nigeria

https://doi.org/10.1016/j.jpag.2010.04.001Get rights and content

Abstract

Study Objective

To determine the prevalence, pattern of menstrual disorders, treatment practices, and the effect of menstrual disorders on school attendance in adolescent school girls in Enugu, Nigeria.

Design

Cross-sectional survey.

Setting

Randomly selected secondary schools.

Participants

Postmenarcheal adolescent school girls aged 10–19 years.

Methodology

Pretested, semi-structured questionnaires were used to survey 500 consenting students. The main outcome measures were menstrual disorders. Data was analyzed using SPSS for windows version 15. Data was compared using chi-square test and P ≤ 0.05 was regarded as statistically significant.

Results

Four hundred ninety-five students responded giving a response rate of 99%. The mean age of the girls was 14.9 ± 1.7 years. Most were Christians (99.2%) and their mean age of menarche was 12.7 ± 1.3 years. The prevalence of menstrual disorders was 69.4% and dysmenorrhea, premenstrual dysphoric disorder, and short menstrual cycles were the commonest disorder. Being older, later age of menarche, and being domiciled in the boarding house were significantly associated with menstrual disorders (P < 0.05). Dysmenorrhea was responsible for the greatest number of school abscences. The mean days of school absenteeism was 1.8 ± 1.2. In 80% of cases paracetamol, aspirin, or piroxican were the drugs used for symptom relief. Only 16.3% of respondents ever consulted a doctor for their menstrual disorders.

Conclusion

There was a high prevalence of menstrual disorders as well as a high rate of non-expert treatment of the disorders. This underscores the need for awareness creation. Parents and adolescents should consult trained practitioners when significant menstrual disorder occurs in order to rule out or treat associated or underlying medical conditions.

Introduction

Menstruation is due to cyclical hormonal changes in the female, under the control of hypothalamic-pituitary ovarian axis.1 The onset of menstruation in adolescent is an important developmental milestone and an evidence of fully developed reproductive ability. Varying proportions of different menstrual associated disorders have been reported in both developed and developing countries.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 These include premenstrual syndrome or premenstrual dysphoric disorders, dysmenorrhea, prolonged menstrual bleeding, and emotional disturbances. In a study by Klein and Litt in Philadelphia, 56% of 2699 adolescent girls surveyed had dysmenorrhea.2 Campbell and McGrath in a more recent study however reported a higher prevalence of 93%.3 In Nigeria, two studies by Thomas et al4 and Odujinrin and Ekunwe5 in the western region equally reported high prevalence of dysmenorrhea among adolescent girls. Jacks et al6 and Sule et al,7 however, reported much lower prevalence of 45% and 36.4% among postmenarcheal school girls in Maiduguri and Muslim women in Zaria, Nigeria, respectively. The prevalence and proportion of various types of menstrual disorders differ in different adolescent population, suggesting sociocultural and regional variation. The pattern of menstrual disorder in the eastern part of Nigeria needs to be studied.

Menstrual problems in some adolescents may lead to disruptions in personal relationships and school activities, and reduction in academic performance. Studies in the U.S. in which 374 reproductive age women were surveyed showed that premenstrual syndrome in women is associated with considerable use of health care resources, time loss from work, and decreased productivity.9, 15, 16, 17 Studies across the globe in adolescents suggest that menstrual disorders are a common reason for seeking medical care and for school absenteeism.8, 10, 18, 19

A survey of 2883 adolescents in Bangladesh reported menstrual problems to be the most commonly reported reproductive health disorders.20 In a survey of self treatment patterns among adolescents in New York, O'Connell et al reported that 46% of 66 school attendees missed school for a day or more in one month.21 Ninety-three percent of their participants used at least one medication to treat dysmenorrhea. Ninety-one percent used over the counter drugs and only 21% obtained their medication by prescription. In many of them the dosing was subtherapeutic.21 In another study most (98%) used nonpharmacological methods such as rest, heat, or distraction to treat dysmenorrhea.3 There is paucity of studies in sub-Saharan Africa emphasizing the treatment needs and practices for menstrual disorders among adolescents.

The exact etiologies of menstrual disorders are yet to be established. They are thought to be linked to fluctuations in the levels of estrogens and progesterone and local prostaglandins.22 Primary dysmenorrhea or menstrual associated pain with no pelvic pathology has been linked to ovulatory cycle.22 Primary dysmenorrhea is thought to be due to uterine ischemia from uterine hypercontractility during menstruation. This is probably related to high levels of prostaglandins and leucotrines found in menstrual fluid and uterine tissues.22 Psychological factors may be contributory, because menstrual morbidities and school absenteeism are higher among adolescent with negative expectations.15 Emotional anxiety due to academic or social demands may act as cofactors. Montero et al reported increased risk of menstrual morbidities with some sociodemographic characteristics.23

The objective of this study was to determine the prevalence and pattern of menstrual disorders, treatment practices, and the effect of menstrual disorders on school attendance in adolescent school girls in Enugu, in southeastern Nigeria.

Section snippets

Materials and Methods

Enugu is the capital of Enugu State in southeastern Nigeria; most of the inhabitants are Christians. There are forty secondary schools in the metropolis with a total student enrollment of 50,822 comprising 22,089 males and 28,733 females. For this study, girls only and coeducational secondary schools were listed and three schools were selected by simple random sampling. The selected schools had populations of 1,931, 3,744, and 1,614 female students. A minimum sample size was determined using

Results

Out of 500 questionnaires, 495 were properly filled, giving a response rate of 99%. The general characteristics of respondents and age of menarche are shown in Table 1. The mean age of respondents was 14.9 ± 1.7 years; the range was 10–19 years. Four hundred ninety-one (99.2%) of the respondents were Christians. Most of the respondents (92.9%) reside outside the school; only 7.1% were boarders. Tertiary education was the highest parental level of educational attainment in most of the

Discussion

Menstrual disorders of varying prevalence and severity have been reported in young postmenarcheal adolescent girls.2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 25 In agreement with studies that reported high prevalence, this study found a prevalence of menstrual disorders in adolescent girls of 69.3%.2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14 This was much higher than the finding in two previous studies among school girls and Muslim women in northern Nigeria that reported prevalence of 45% and 36.4%

References (27)

  • M.A. Campbell et al.

    Non-pharmacologic strategies used by adolescents for management of menstrual discomfort

    Clin J Pain

    (1999)
  • O.M. Odujinrin et al.

    Epidemiologic survey of menstrual pattern amongst adolescents in Nigeria

    West Afr J Med

    (1991)
  • T.H. Jacks et al.

    Dysmenorrhea and menstrual abnormalities among postmenarcheal secondary school girls in Maiduguri Nigeria

    Afr J Med Med Sci

    (2005)
  • Cited by (42)

    • The prevalence and risk factors of menstrual pain of married women in Anhui Province, China

      2018, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      In this study, there was no significant association between age and dysmenorrhea which was in accordance with previous studies [41,43,44]. However, some researches showed that older was a protective factor for dysmenorrheal [45,46]. Respondents in these studies were younger in contrast with this study might explain discrepancy.

    • Evaluating dysmenorrhea in a sample of Turkish nursing students

      2014, Pain Management Nursing
      Citation Excerpt :

      With respect to this interference, most of the participants stated that dysmenorrhea caused a reduction of concentration in lessons. Similarly, dysmenorrhea and the symptoms experienced were reported to increase school absenteeism in adolescents and cause lack of concentration in the classroom and a decrease in school performance in many studies (Chang & Chen, 2009; Eryılmaz et al., 2010; Ortiz, 2010; Nwankwo et al., 2010; Wong & Khoo, 2010). In addition, there are studies that reveal that dysmenorrhea affects a young woman’s quality of life in areas such as daily living activities, mental health and general health perception, and social and physical functions (Oskay et al., 2008; Unsal et al., 2010).

    View all citing articles on Scopus
    View full text