Prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, North-West Ethiopia

Dysmenorrhea is a pain associated with menstruation which can be abdominal pain, backache, stomach cramp, waist pain and/or thigh pain [1‐4]. It can be primary, in the absence of an identifiable organic pathology, or secondary, with demonstrable pathology [5‐7]. Primary dysmenorrhea usually started at or shortly after (6 to 12 months) menarche, when ovulatory cycles are established [7, 8]. The pain usually starts along with menstrual bleeding and lasts from 48 to 72 h [9].

Dysmenorrhea is the most commonly reported menstrual disorder [10] and one of the most common gynaecologic disorders [11, 12]. It affects a large proportion of women of reproductive age [10]. It is usually sever enough to result in a significant socioeconomic dysfunction and disability particularly in adolescents and young women. It has a major impact on women’s quality of life, work productivity, and health-care utilization [13]. It is the leading cause of morbidity leading to limitation of daily activities and recurrent school absenteeism among adolescents [6, 14]. Generally, it has a negative impact on social, academic, and sport activities of many female adolescents [5, 15]. Hence, failure to address dysmenorrhea causes a major social and financial burden for families, neighbors, communities and the glob at large.

Understanding the full range of dysmenorrhea among adolescent girls is a crucial point in developing appropriate management and preventive strategies. But studies on the status of dysmenorrhea and associated factors are scarce in Ethiopia. Hence, this study was aimed to determine the prevalence of dysmenorrhea and identify associated factors among secondary and preparatory school students in Debremarkos town.

In this survey, a total of 539 individuals were included with a response rate of 94.8%. Thirteen participants were not voluntary to participate and 15 questionnaires were found to be incomplete and excluded from the analysis.

The prevalence of dysmenorrhea in this study was found to be 69.3% with 95% CI of (65.2, 73.4%). This was in line with 66.8% in Debre Berhan University [2], 71.8% in Mekelle University [10] and 72% among secondary school adolescents in Dabat and Koladiba, northwest Ethiopia [19]. It was also comparable with 65.4, 69.8 and 72.7% reported among university students in Egypt [5], Nigeria [17] and Turkey [20, 21] respectively. However, it was higher than 64% among university students in Mexico [22], 45% among young college Nursing students in India [8] and 61.27% in Rural South Africa [23]. This difference may be explained by the sociocultural differences of the study groups in pain perception and threshold as well as the difference in life style. It was also less than that of in university of Gondar and Bahr Dar University, northwest Ethiopia [5, 24] which reported a prevalence rate of 77.6 and 85.1% respectively. This inconsistency is probably due to the fact that the prevalence of dysmenorrhea increases with age up to the pick age (24 years) where the age in Bahir Dar University ranges 17 to 24 with mean age of 20.4 ± 1.2 years but in this study it was 14-24 and 17.55 ± 1.62 years respectively. Moreover, this difference may be resulted from the absence of universally accepted or standardized method of defining dysmenorrhea or from its subjective measurement. Furthermore, this study revealed a lower prevalence of dysmenorrhea than 73.83% reported among university students in India [14] which may be because of the sociocultural differences of the study groups in pain perception and threshold, life style and age.

The prevalence of dysmenorrhea, in this study, increased with increasing age, AOR (95% CI) =1.38(1.15, 1.65). This is supported by studies conducted in Isfahan University in Iran [25], Lebanese [26] and among Mexican university students [22] which identified a statistically significant association between age and dysmenorrhea. Similarly, a highly significant difference between the ages of the women with and without dysmenorrhea was reported in Turkey [7]. However, no significant difference was observed between the mean age of women with and without dysmenorrhea in south India [27]. The inconsistency might be because of the difference in the age of the study participants. The age in this study was from 14 to 24 year, but it was from 11 to 28 years in south India which include both the age ranges below and above the pick age.

This study identified a statistically significant association between the occurrence of dysmenorrhea and positive family history of dysmenorrhea, AOR (95% CI) 9.79 (4.99, 19.20). This is consistent with the findings of similar studies in Serbia [1], Turkey [10, 20, 21], India [11], Lebanese [25], Mekelle [10] and Bahir Dar Universities in Ethiopia [24]. This is probably related to genetic factors, which needs further studies.

In this study, physical activity was found to have a statistically significant association with the occurrence of dysmenorrhea, AOR (95% CI) = 0.399 (0.19, 0.85), which was consistent with the findings in a systematic review of randomized controlled trials, which confirms as exercise reduces the symptoms associated with dysmenorrhea [28]. But, no statistically significant association was observed between physical activity and dysmenorrhea in Egypt [4]. The difference may be because of measurement difference; i.e. in this study physical activity was measured by self-report of the participants’ habit of physical activity as not at all, irregularly or regularly, where as in Zagazig University, Egypt participants were asked as if they were athletes, active in physical activity or sedentary.

In this study, a statistically significant association between excessive sugar intake and the presence of dysmenorrhea was observed, AOR (95% CI) =2.94(1.54, 5.61), which was similar with the result of a cross-sectional surveys in Turkey [20]. This is also supported by statistically significant association between dysmenorrhea and consumption of more than four glasses of tea per day among Debre Berhan University students in Ethiopia [12]. This is probably because food items reach in sugar may contain the precursors of prostaglandins which are presumed to be the cause of dysmenorrhea. This requires further investigations.

A statistically significant association between age at menarche and dysmenorrhea was identified in this study. This was supported by studies conducted among high school students in Mexico, and university students in Mexico, Serbia, Palestinian and Egypt [1, 2, 4, 22]. Early menarche was related to an increase in the prevalence of dysmenorrhea, AOR (95% CI) =4.10(1.21, 13.09). Whereas, late menarche was associated with the decrease in the prevalence of dysmenorrhea, AOR (95% CI) =0.50(0.27, 0.91). This is also supported by the thought that dysmenorrhea is caused by the release of inflammatory factors during menstruation [29] and started after the establishment of ovulatory menstrual cycles [30].

In this study, a statistically significant association between the presence of dysmenorrhea and heavy menstrual flow was observed, AOR (95% CI) = 2.91(1.59, 5.35), which was consistent with a report among Mexican high school students [2], Heavy menstrual flow was related to increased prevalence of dysmenorrhea which is also in line with the thought that dysmenorrhea is caused by the release of inflammatory factors during menstruation [29]. This is further strengthened by a more likelihood of having dysmenorrhea during long menstrual flow periods in Mekelle University [10].

The prevalence of dysmenorrhea among secondary and preparatory school students in Debremarkos town was high.

Dysmenorrhea was more common with increasing age, among ladies with positive family history of dysmenorrhea, excessive sugar intake habit, early menarche and those having heavy menstrual periods. Whereas, physical activity, late menarche and sexual intercourse were found to be protective factors for the occurrence of dysmenorrhea.