Knowledge, Attitudes, and Consequences of Menstrual Health in Urban Adolescent Females

doi:10.1016/j.jpag.2006.05.002

Journal of Pediatric and Adolescent Gynecology

Volume 19, Issue 4, August 2006, Pages 271-275

https://doi.org/10.1016/j.jpag.2006.05.002 Get rights and content

Abstract

Purpose

There is a lack of current information concerning the knowledge and attitudes of urban adolescents regarding menstruation. The purpose of this research was to determine: (1) The prevalence of dysmenorrhea, premenstrual symptoms and other menstrual disorders among adolescents who receive their health care at an urban adolescent health center; (2) The attitudes and expectations adolescents have relating to their menstrual period; and (3) The relationship between teens' attitudes and expectations regarding menses and actual menstrual-related morbidities such as school absenteeism.

Methods

A 35-item, survey was administered to postmenarcheal adolescents ages 12–21 years. Descriptive analysis of the prevalence of the menstrual disorders was completed. Chi-square testing was used to compare the prevalence of menstrual-related morbidities with the level of adolescents' expectations regarding menstruation.

Results

91.5% of the respondents were African-American. Premenstrual syndrome (PMS) was the most prevalent reported menstrual disorder (84.3%) followed by dysmenorrhea (65%), abnormal cycle lengths (13.2%), and excessive uterine bleeding (8.6%). Only 2% of teens report receiving information about menstruation from their health care provider. Negative expectations regarding menstruation were associated with higher rates of school absenteeism and missed activities (P = 0.0790 and P = 0.0297 respectively).

Conclusions

PMS and dysmenorrhea are prevalent medical disorders among urban adolescents. Morbidities, including school absenteeism, are higher among those with negative period expectations. Since only 2% of teens received information regarding menstruation from their health care provider, it is imperative that health care providers increase their anticipatory guidance regarding normal menstruation. This may aid in the prompt diagnosis and treatment of menstrual disorders, and decrease their associated morbidities.

Introduction

Menstrual disorders affect 75% of adolescent females and are a common reason for them to seek medical care.¹ Menstrual related complaints are also a major reason for school absenteeism among teens.2, 3 The most prevalent menstrual disorders among adolescents are excessive uterine bleeding, dysmenorrhea, and pre-menstrual syndrome.

Excessive uterine bleeding is defined as irregular, painless, un-patterned menstrual bleeding.⁴ Although approximately 30% of adult women complain of menorrhagia,⁵ the prevalence of excessive uterine bleeding in adolescents is not known. Dysmenorrhea is characterized by recurrent, crampy abdominal pain, nausea, vomiting, diarrhea, and back pain. It affects between 60% and 93% of adolescents.3, 6, 7, 8 Pre-menstrual syndrome (PMS) refers to symptoms such as acne, fatigue, bloating, anger, and moodiness.⁹ PMS affects between 14% and 89% of adolescents.10, 11

Scott et al. reported that twice as many African-American adolescents felt unprepared and did not receive information about menarche when compared with Caucasian teens.¹² Previous studies about menstrual cycles in teens have been conducted using mainly Caucasian, suburban, or multi-ethnic populations.2, 6, 7, 8, 9, 10, 11, 13, 14, 15 No recent studies have examined menstrual cycle-associated disorders and morbidities among urban and primarily African-American adolescents. Moreover, there is limited information concerning the knowledge and attitudes of African-American adolescents regarding menstruation. The age of menarche continues to decrease in this population, increasing the probability that menstrual-associated morbidities may have a greater negative impact on their lives. Therefore, it is important to study the effects of menstrual disorders among these adolescents.¹⁶

One study showed that decreased preparation for menarche led to negative expectations toward this pubertal milestone.¹² Another study that examined menstruation expectations and experiences in both premenarcheal and postmenarcheal girls concluded that “premenarcheal expectations of menarche… contributed to the prediction of longer-term experiences of negative changes.”¹³ On the basis of this previous research, we postulated that if an adolescent expects pain with menses prior to menarche, she is more likely to report experiencing dysmenorrhea.

The purpose of this study was to determine the prevalence of excessive uterine bleeding, dysmenorrhea, and PMS among adolescents who received primary and gynecologic care at an urban tertiary care adolescent health center. The purpose was also to assess the knowledge, attitudes, and expectations of these adolescents regarding menstruation. We hypothesized that there is an association between the knowledge, attitudes, and expectations regarding menstruation, and the occurrence of excessive uterine bleeding, dysmenorrhea, and PMS. We also hypothesized that adolescents' expectations regarding menstruation influence their experiences of menstrual related morbidities including school absenteeism and missed activities.

Section snippets

Methods

This cross-sectional study was approved by the Children's National Medical Center's Institutional Review Board, and was conducted at our urban tertiary adolescent health center from June 2004 to February 2005. A 35-item, self-administered questionnaire assessing the knowledge and perceptions of menstruation, as well as the nature of the subjects' menstrual experience, was developed for this study, and validated by expert consensus. The survey was administered to post-menarcheal adolescents ages

Results

The majority (91.5%) of the adolescents enrolled in this study were African-American. Nearly half (45%) of all the respondents were older adolescents (≥18 years). The mean age of the subjects was 15.6 years. Most (85%) reported that they received information regarding their periods from their mothers. Only 2% of adolescents stated that they received information regarding menstruation from their health care provider.

PMS symptoms and menstrual knowledge data are summarized in Table 1. PMS was the

Discussion

Menstrual disorders are common among adolescents. However, many teens lack the information necessary to recognize these symptoms as medical disorders that can be treated. Our study showed that only 2% report receiving information regarding menstruation from their health care providers. Previous studies had suggested that dysmenorrhea was more prevalent than PMS symptoms. However, our findings concur with a study by Wilson and Keye that demonstrated that PMS occurs in 86% of adolescents,⁶ making

Conclusion

PMS and dysmenorrhea are prevalent menstrual disorders among urban adolescents. Excessive uterine bleeding also occurs. Missed activities are significant menstrual-related morbidity in this population. School absenteeism appears to be trending towards a significant menstrual-related morbidity. Morbidity was higher among those study subjects that expected negative consequences from their periods. A significant finding of this study is that only 2% of adolescents report receiving information

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Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=−0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, −17.3; 95% confidence interval, −22.4 to −12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls with severe symptoms (mean difference for: dysmenorrhea, −20.72; heavy bleeding, −15.75; irregular periods, −13.81; mood disturbance, −24.97; other general symptoms, −20.29), but significant differences were observed even for moderate or mild symptoms. The composite menstrual health index was significantly associated with World Health Organization Five Well-Being index scores in regression analysis, independently of age, age at menarche, body mass index, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status.
Despite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.
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To compare menstrual health literacy among adolescents and young adults on the basis of family religious background and United States region
We conducted a cross-sectional online survey of post-menarcheal US adolescents and young adults aged 14-24 years who identified their family religious background, including Christian or non-religious, with recruitment via the social media platform TikTok. We asked participants several questions to assess their health literacy regarding common myths about the use of gonadal steroid hormones for menstrual suppression.
From 3250 online survey respondents, 2997 met the criteria for analysis, with 1989 identifying their family as Christian (66.4%) and 1008 identifying their family as non-religious (33.6%), with equal representation by US region. Health literacy was lower among those with a Christian family background, with concerns that menstrual suppression is unhealthy (16.4% vs 10.5% with non-religious background, P < .01), is unsafe (31.4% vs 24.2%, P < .01), and could lead to infertility (32.6% vs 20.0%, P < .01). Similarly, adolescents and young adults from the US South were worried that menstrual suppression is unhealthy (31.5%; P < .01) and would lead to infertility (33.8%; P < .01).
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Menstrual inequity—unequal access to menstrual health care or products—negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population.
This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory.
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This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.
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Lack of adequate menstrual health education is a well-documented problem in low and middle-income countries as well as here in the United States. Adolescents who are unprepared for menarche are more likely to experience body shame around menstruation, miss school or other activities, and develop unhygienic menstrual health practices [16,30,31]. Providers have the opportunity prompt discussions about menarche at the appropriate age and developmental stage and to offer patients scientifically accurate information about their bodies.
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Original StudiesKnowledge, Attitudes, and Consequences of Menstrual Health in Urban Adolescent Females

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Best Pract Res Clin Obstet Gynaecol

J Adolesc Health Care

J Adolesc Health Care

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

J Adolesc Health Care

J Adolesc Health

Epidemiology of adolescent dysmenorrhea

Pediatrics

Original Studies
Knowledge, Attitudes, and Consequences of Menstrual Health in Urban Adolescent Females