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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 9
| Issue : 3 | Page : 103-108 |
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Prevalence and determinants of dysmenorrhea: A cross-sectional study
DV B. Anusha1, K Shridevi1, P Manoj1, A Goparaju2
1 Department of Community Medicine, RVM Institute of Medical Sciences and Research Center, Siddipet, Telangana, India
2 RVM Institute of Medical Sciences and Research Center, Siddipet, Telangana, India
| Date of Submission | 11-Feb-2021 |
| Date of Decision | 11-Mar-2021 |
| Date of Acceptance | 01-May-2021 |
| Date of Web Publication | 25-Sep-2021 |
Correspondence Address:
Dr. K Shridevi
Department of Community Medicine, RVM Institute of Medical Sciences and Research Center, Laxmakkapally Village, Mulugu, Siddipet - 502 279, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_13_21
Background: Dysmenorrhea is a medical condition of pain during menstruation. A variety of factors effect dysmenorrhea which include early menarche, younger age, diet, prolonged and aberrant menstrual flow, psychological disturbances, and pelvic infections; these interfere with dysmenorrhea symptoms. Genetic factors, exertion, and activity patterns affect prevalence and severity of dysmenorrhea. Various studies in India revealed that the prevalence of dysmenorrhea varies from 33 to 79.67.
Objective: To study the prevalence, characteristics, and determinants of dysmenorrhea.
Materials and Methods: Community-based cross-sectional study was carried out which included 165 women from urban field practice area who have attained menarche but not completed menopause aged 15-50 years. Data were collected using semi-structured questionnaire by direct interview. The data were analyzed by percentages, proportions. Chi-square test was used.
Results: The prevalence of dysmenorrhea was 60%. The correlation between the age and the dysmenorrhea grades was statistically not significant while the correlation between the age at menarche and the dysmenorrhea grades was found to be statistically significant. Majority of the participants had less than two hours of pain (33.3%) and most of them experienced the pain in the abdomen region (36.4%) and majority, i.e. 46.5% had mild pain. The duration of menstruation and duration of menstrual cycles were comparable in two groups but the heavy flow was significantly more in dysmenorrhea group compared to the normal group (P < 0.05)
Conclusion: The prevalence of dysmenorrhea was high and it was related with age at menarche. Heavy flow was significantly more in dysmenorrhea patients.
Keywords: Dysmenorrhea, menarche, menopause, menorrhagia
How to cite this article:
B. Anusha D V, Shridevi K, Manoj P, Goparaju A. Prevalence and determinants of dysmenorrhea: A cross-sectional study. MRIMS J Health Sci 2021;9:103-8 |
| Introduction | |  |
Dysmenorrhea is a medical condition of pain during menstruation. Dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive.[1]
This article uses the dysmenorrhea definition as menstrual pain that interferes with daily activities.[2] Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off.[3]
Primary dysmenorrhea is a common gynecological disorder in young women.[4] In general, it occurs within 6–12 months after encompassing menarche and characterized by cramp pelvic pain beginning shortly before or at the onset of menses lasting for 1–3 days.[5] Pain occurs due to prostaglandins secretion that causes uterine smooth muscle to contract and set in the menstruation and expulsion of the endometrium.[6] A variety of factors effect dysmenorrhea which include early menarche, younger age, diet, prolonged and aberrant menstrual flow, psychological disturbances and pelvic infections; these interfere with dysmenorrhea symptoms. Genetic factors, exertion, and activity patterns affect prevalence and severity of dysmenorrhea. Various studies in India revealed that the prevalence of dysmenorrhea varies from 33 to 79.67.[7],[8],[9],[10]
However, the true incidence and prevalence of dysmenorrhea are not clearly established in India and also exact characteristics are also not clearly known. Hence, the study was undertaken with the objectives to know the prevalence of dysmenorrhea and to know the characteristics and determinants of dysmenorrhea.
| Materials and Methods | | |
Study design
Community-based cross-sectional study.
Study area
Urban Field practice area of MRIMS, Shapurnagar, Hyderabad.
Study period
October-November, 2014.
Study population
Women of age 15–50 years (from menarche to menopause) in urban field practice area of a medical college, Hyderabad.
Sample size
Considering the prevalence of dysmenorrhea as 72%[10] with 95% confidence interval and allowable error as 10% of prevalence using the formula (4pq/L2 = 4 × 72 × 28/7 × 7 = 165); the sample size came out to be 165.
Sampling technique
Convenient sampling.
Ethical considerations
Institution Ethics Committee permission was obtained. Informed consent was taken from participants. Health education was imparted at the end of the interview.
Inclusion criteria
All the women who have attained menarche till menopause and the age of the women < 50 years. Women who have agreed to participate in the study.
Exclusion criteria
Women attained menopause, and women who have not attained menarche.
Methodology
The selected women were explained about the protocol and purpose of the study and were interviewed by interacting in local language. Interview was conducted with the help of pretested, semi-structured questionnaire. The questionnaire included:
- Demographic assessment which included type of family, income, education, occupation, age, age at menarche, socioeconomic status classification was assessed with B.G. Prasad's classification[11]
- Determinants of dysmenorrhea: Age at menarche, age at parity, family history of dysmenorrhea, symptoms other than dysmenorrhea, regular physical exercise, and stress full events
- Assessment of menstrual characteristics included menstrual blood flow, cycles, length of flow, and menstrual hygiene
- Assessment of health seeking behavior.
Dysmenorrhea was assessed in four categories: No dysmenorrhea (No pain during menstruation), mild (pain but no need of medication), moderate (pain but relieved with medication), and severe (painful and not relieved even with medication).
After interview, the doubts of the participants were cleared and imparted correct knowledge during the session. The filled questionnaire with ticked answers was collected and then the collected data was entered on Microsoft excel. The data were divided into two groups; one group with symptoms of dysmenorrhea and the other group without symptoms of dysmenorrhea. The two groups were compared using percentages, proportions, Chi-square, and Spearmen correlation.
| Results | | |
[Table 1] shows relationship of age, and age at menarche with the severity of dysmenorrhea. The correlation between the age and the dysmenorrhea grades was statistically not significant while the correlation between the age at menarche and the dysmenorrhea grades was found to be statistically significant. | Table 1: Relationship of age, and age at menarche with severity of dysmenorrhea
Click here to view |
[Table 2] shows the distribution of study subjects according to symptoms of dysmenorrhea. Majority of the participants had less than two hours of pain (33.3%) and most of them experienced the pain in the abdomen region (36.4%) and majority, i.e. 46.5% had mild pain. | Table 2: Distribution of study subjects according to symptoms of dysmenorrhea
Click here to view |
[Table 3] shows the comparison of menstrual characteristics between women with and without dysmenorrhea. The duration of menstruation and duration of menstrual cycles were comparable in two groups but the heavy flow was significantly more in dysmenorrhea group compared to normal group (P < 0.05). | Table 3: Comparison of menstrual characteristics between women with and without dysmenorrhea
Click here to view |
| Discussion | | |
The prevalence of dysmenorrhea was found to be 60% in the study, similar findings were reported by Kumbhar et al.'s study in Kadapa, Andhra Pradesh (65.02%),[12] Sharma et al. (67.2%),[10] McKay and Diem (67%),[13] Sundell et al. (67%).[14] Comparatively lower prevalence had been reported by Sharma et al. (33%),[7] Nag (33.84%),[15] Singh et al. (40.7)[16] and in Omidvar and Begum study prevalence was found to be higher (72.9%).[17]
Respondents were divided into two groups based on the symptom of dysmenorrhea as one with symptoms of dysmenorrhea and the other without symptoms of dysmenorrhea. Women who participated in the study were between 11 and 50 years of age and average age of respondents was 29.88 years in dysmenorhoic women group and 30.22 years of age in women without dysmenorrhea. There was no significant difference in age between the two groups, which was similar to Omidvar and Begum[17] study having no significant difference in age among both the groups, however, range of age was narrower, who were between 18 and 28 years and average age was also lesser 21 ± 1.65 years. In Okoro et al.'s study,[18] the average age of participants in the study was 22.2 years.
The severity of dysmenorrhea was correlated negatively with age of menarche having a significant association. This observation was similar to Okoro et al.'s[18] study, where it was negatively correlated but without significant association.
Dysmenorrhea was not significantly associated with parity of women (Chi-square = 0.6007 with P = 0.3594) where as in Okoro et al.'s study;[18] Dysmenorrhea prevalence was less in women who have at least one child.
Education pattern was almost the same in both the groups where 35% of women with dysmenorrhea and 42% of women without dysmenorrhea were illiterates. According to BG Prasad's classification,[11] majority of the women in both the groups belonged to Class IV (58% in dysmenorhoic women and 56% in women without dysmenorrhea). Majority of respondents in both the groups were homemakers (81.8% and 92.4%, respectively). There was no association found with respect to income, education, and occupation with dysmenorrhea which was also similar to Ohde et al. study[19] where no association was found. However, several studies reported a positive association of dysmenorrhea with income, education, and occupation.[20]
The association of dysmenorrhea with type of family was computed with Chi-square test and found to be of not statically significance with P = 0.0563 whereas in Omidvar and Begum study[17] dysmenorrhea showed a significant association with family type.
Dietary history was taken and analyzed for consumption of balanced diet, and it was found that 80% of women without dysmenorrhea were consuming balanced diet compared to 21.21% of women with dysmenorrhea with Chi-square value = 44.262, with P < 0.0001 indicating the association of balanced diet with no symptom of dysmenorrhea. Studies say a low fat vegetarian diet was associated with a decrease in duration and intensity of dysmenorrhea.[21]
Exposure to a stressful event was enquired in both the groups and it was found that 8.08 percent of respondents with dysmenorrhea were exposed to stress full event compared to none among the respondents without dysmenorrhea (Chi-square = 3.99, P = 0.0458) showing statistical significant association of dysmenorrhea with stress. This observation was similar to Wang et al.'s study where stress was significantly associated with dysmenorrhea.[22]
Majority of the participants did not engage in regular physical exercise. Twelve respondents with dysmenorrhea and 6 respondents without dysmenorrhea were doing regular physical exercise and on the application of Chi-square test, no significant association was found in relation to dysmenorrhea (Chi-square = 0.374, P = 0.54) which is similar to Okoro et al.'s[18] study in Nigeria.
The characteristics of dysmenorrhea showed that majority, i.e. 50% were having pain for <2 h, but there were 10% of women with more than 8 h of pain per day and these women were advised for further evaluation of pathology behind. Majority, i.e. 38% were having pain over the abdomen, legs, and back, and 36% were having only abdominal pain.
Regarding the severity of pain, 40.6% were suffering from severe pain which was disturbing their daily activities and not relieved completely even on medication, 8.08% were having moderate pain which was relieved on medication and 50.5% were suffering from mild pain which is tolerable and does not require medication.
The relation of pattern of menstruation with dysmenorrhea showed that pattern of length of menstrual flow and duration of menstrual cycle were similar in both the groups (Chi-square = 0.255 and 0.33 and P = 0.61 and 0.56) whereas in Omidvar and Begum[17] study dysmenorrhea was related to length of flow but not with duration of cycle. Thirty-seven percent of women with dysmenorrhea were having heavy flow compared to only 4.5% of women without dysmenorrhea which exhibited significant association of heavy flow with dysmenorrhea (Chi-square = 20.151, P < 0.001) which was similar to Omidvar and Begum study.[17]
Dysmenorrhea seems to be familial problem with 40.40% of dysmenorrhea individuals having family history of dysmenorrhea compared to 18.18 of individuals without dysmenorrhea showing a significant association of dysmenorhoic women with family history (Chi-square = 9.06, P = 0.0026). Similar conclusion was made by Kumbhar et al.,[12] Avasarala and Panchangam in their study.[9]
81.81% of nondysmenorrhea women and 83.83% of dysmenorrhea women practice good menstrual hygiene practices and there was no significant difference found between both the groups with respect to menstrual hygiene (Chi-square = 0.063, P = 0.8). Results do not coincide with other studies wherein poor menstrual hygiene is related to secondary infection and dysmenorrhea.[23],[24],[25]
Symptoms other than dysmenorrhea which have occurred during menstruation were irritability (49% of dysmenorrhea women and 16% of normal women), loss of interest, reduced appetite, and reduced sleep (38% of women with dysmenorrhea and 12% of women without dysmenorrhea).
At the time of menstruation, 49% of women with dysmenorrhea do not go to their school, college or work and remain at home for rest whereas in women without dysmenorrhea 9.09% of them stay at home due to irritability and mood changes. In Kumbhar et al.'s[12] study, sickness absenteeism was 48% in dysmenorrhea women and 20.3% in nondysmenorrhea women.
Among the dysmenorhoic women, at the time of pain 49% used only self-help technique such as taking rest, sleeping, and massaging the lower abdomen 16% took medication from the chemist directly, 25% used some traditional healing techniques, like having curd and fenugreek seeds, etc., and only 10% approached health care worker. Similarly, in Kumbhar et al.'s[12] study also majority use self-help technique as a remedy for healing.
| Conclusion | | |
The prevalence of dysmenorrhea was 60%. Significant negative correlation of age at menarche with dysmenorrhea was observed. Intake of balanced diet, stress, genetic inheritance showed significant association with dysmenorrhea. Thirty-seven percent of women with dysmenorrhea having heavy flow and showed significant association with dysmenorrhea but not associated with length of flow and duration of cycle. Majority (70%) used self-help technique and traditional healing techniques for relief from dysmenorrhea. The study could not elicit statistically significant association of dysmenorrhea with income, education, occupation, parity, type of family, regular physical exercise, and menstrual hygiene.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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