U.C. Igbokwe and Y.O. John-Akinola
Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.
Background: Menstrual disorders are physical or emotional problems that affect the normal menstrual cycle and bring about pain, unusually heavy or light bleeding and missed periods. They are one of the most occurring gynaecologic issues that affect women of child bearing age with a global prevalence of 30-70% and one of the frequent reasons women consult physicians worldwide.
Objectives: This study investigated the knowledge, prevalence of menstrual disorders, pattern of health seeking behaviours, association between age at menarche and prevalence of menstrual disorder, association between knowledge and health seeking behaviour among the female undergraduate students.
Methods: A descriptive cross-sectional study was employed to randomly select 381 respondents through a three-stage sampling technique. A pretested semi-structured questionnaire was used for data collection. Data collected were analysed using IBM SPSS version 20; statistical tests were conducted using Chi-square and fischer exact test.
Results: The mean age of the respondents was 20.45±2.66 and the mean age at menarche was12.90±1.84. Majority of the respondents (79.3%) had good knowledge of menstrual disorders. The overall prevalence of menstrual disorders among the respondents was 90.4%. and only 28.3% had sought help for menstrual disorders. Inferential analysis showed a statistically significant association between knowledge and health seeking behaviour of menstrual disorders (p<0.05).
Conclusion: Menstrual disorders are highly prevalent among young females of child bearing age in our environment; the role of mass media (Internet) and interpersonal relationships in health education is very acknowledgeable and should be harnessed to improve young females’ knowledge of positive health seeking behaviours with regard to menstrual disorders.
Keywords: Menstrual disorders, Knowledge, Prevalence, Health seeking behaviour, Female undergraduates
Menstrual disorders are one of the most predominant gynaecologic issues in reproductive health. While some women go through their monthly periods without fears or minor discomfort, others experience huge physical and emotional symptoms, before and during menstruation; from heavy flow to missed periods, mood swings and painful menstruation which interfere with the quality of life of a woman. 1
A menstrual disorder affects the normal menstrual cycle, with pain, unusually heavy or light bleeding, delayed menarche, or missed periods. Menstrual abnormalities include but are not limited to; amenorrhea, abnormal uterine bleeding (menorrhagia,oligomenorrhea, polymenorrhea, hypomenorrhea), dysmenorrhea and premenstrual syndrome which are the most recorded.2 Irregular menstruation, absence of menstruation and non-menstrual vaginal bleeding has many causes, but in women of reproductive age, pregnancy should always be suspected,3 although abnormal vaginal bleeding in non-pregnant women is evaluated differently from vaginal bleeding in pregnant women because polycystic ovarian syndrome can cause same symptoms as menstrual abnormalities.
Amenorrhea is the absence of menstruation, and can either be primary (absence of onset of menstruation by the age of 15) or secondary (lack of menses for three months or more after menarche).4 It is normal before puberty, during pregnancy and menopause not to menstruate but becomes a cause for concern between puberty and menopause. Primary amenorrhea is sometimes caused by low body weight associated with eating disorders, excessive exercise or medications. It can also be linked with problems of the ovaries or genetic abnormalities. Secondary amenorrhea can result from issues affecting oestrogen levels, including weight loss or gain, stress, illness or exercise.
Abnormal uterine bleeding may be heavy menstrual bleeding (menorrhagia) or bleeding in between periods (metrotrrhagia). The International Federation of Gynaecology and Obstetrics (FIGO) classified it according to PALM-COEIN system, and PALM represents structural causes: polyps, adenomyosis/ leiomyomas, malignancy and hyperplasia while COEIN represents non-structural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified.5 Menorrhagia is heavy or prolonged menstrual bleeding caused by hormone problem with the uterus or other health conditions (such as uterine fibroid) while metrorrhagia is bleeding at irregular intervals and it could be as a result of endometriosis, hormone imbalance, uterine fibroids or uterine cancer.6
Dysmenorhea is severe menstrual cramp occurring during menstruation. Normal cramps happen at the lower pelvis when the uterus contracts to squeeze blood vessels in order to shed the uterine lining, but severe or excess cramping is an indication to hormonal, ovarian or uterine problems which can interfere with fertility if not treated.7
Premenstrual Syndrome (PMS) can be described as the various physical and psychological symptoms associated with menstrual cycle such as headache, fatigue, nausea, abdominal cramps, constipation, anxiety, depression, and so on. Several factors influence menstrual patterns, which are responsible for menstrual disorders. This include significant weight gain or loss, poor nutrition, stress, drug use, excessive alcohol consumption, which interferes with metabolism of oestrogen and progesterone in the liver, hormonal imbalance, recent child birth or miscarriage, etc.8
Menstrual disorders affect women globally and they account for most of the morbidity that occurs in women of child bearing age. Seventy five percent (75%) of young women in both developed and developing countries have menstrual complications.9 These disorders are the basis for major visits to the physician, especially menorrhagia.10
A study carried out by Chia et al.11 revealed common impacts of menstrual disorders, which included, reduction in concentration ability, academic disturbance and changes in normal physical activities. Menstrual disorders led to restriction of activities and absenteeism, however only few sought medical help while majority resorted to self-medication which could be dangerous.12 Menstrual disorders could start as early as menarche sets in, and this could continue beyond the teenage years when further stressors brought about by life challenges, academics and relationships further worsen the symptoms. Menstrual problems are relatively common, yet unclear how people suffering from it seek help or information pertaining to it.13 Problems related to menstruation are perceived as normal among women and are regarded as a condition that does not require medical attention. The few that sought medical help are compelled to do so when the situation becomes unbearable.14Although many reasons have been given for inadequate attention to menstrual issues, some see it as a ‘taboo’ and not a subject for public discussion while others assume it is a personal affair.
Many studies have been carried out on menstrual disorders but further research is required for health seeking behavior (actions) of the affected population and not neglecting the fact that most of these females use over the counter (OTC) drugs which could be detrimental to their health. Hence this study assessed the prevalence, knowledge of menstrual disorders, health seeking behaviours, association between age at menarche and prevalence of menstrual disorder, association between knowledge and health seeking behaviour.