Menstrual Pattern And Problems Among Rural Adolescent Girls

1 Associate Professor, Dept. of Obstetrics and Gynaecology, Rural Medical College & Pravara Rural Hospital, Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India 2 Professor , Dept. of Obstetrics and Gynaecology , Rural Medical College & Pravara Rural Hospital, Pravara Institute of Medical Sciences (Deemed University), Loni, Dist. Ahmednagar, Maharashtra, India 3 Professor and Head, Dept. of Obstetrics and Gynaecology , Rural Medical College & Pravara Rural Hospital, Pravara Institute of Medical Sciences (Deemed University), Loni Dist. Ahmednagar, Maharashtra, India

IJBAR (2013) 04 (08) www.ssjournals.com usually of 21 -35 days, measured from the first day of the menstrual period. The duration of bleeding is about 3-5 days and blood loss averages between 30 -80 ml. The menstrual cycle is often irregular during first few years after menarche due to an ovulatory cycle. By the age of 17-18 years, menstrual cycle usually become regular. 2 . According to a multicounty survey, menstrual disturbances were among first and fourth most commonly reported causes of morbidity among adult women 3,4 In rural India, where a female child and its problems are neglected, there is an urgent and unmet need to understand menstrual pattern and problems of adolescents and include it into the primary health care program. The present prospective observational study was planned with the following objectives.
1. To study the menstrual patterns among adolescent girls.
2. To study the incidence of various menstrual problems among them & their approach towards that.
3. To assess the type of materials used as absorbant during menstruation.

4.
To evaluate knowledge level of mothers of adolescent girls regarding menstrual hygiene.

5.
To assess knowledge about various aspects of menstruation among adolescent girls within age group of 15-19 years.

Material and Methods
Prospective observational study was conducted in secondary schools situated in rural area in Maharashtra. Information on various aspects of menstruation was obtained from adolescent girls in the age group of 15 to 19 years, with the help of pretested and validated questionnaire. The information about personal details, age of menarche in years, menstrual cycle pattern and whether they experience any menstrual problems was collected.They were also asked to indicate whether they had sought medical advice or treatment for their menstrual problems. They were also asked to indicate the materials they use as absorbent and the average number of days absent from school during menstruation.Their mother's level of knowledge about various aspects of menstruation was also noted. All the data was collected and compiled in MS Excell.The data was analyzed using percentages and proportions through tables .

Results
A total of 323 menstruating adolescent girls in the age group of 15 to 19 years were interviewed .The mean age of menarche was 14.02 years with 11 and 18 years being the lowest and highest age for attaining menarche respectively .Maximum number of girls (68.7%) had attained menarche at 14 -16 years of age, followed by 29.1% at the age of 11-13 years and 2.2% at 17 -19 years of age. (Table no. 1) Majority of them (92.9%) had intermenstrual interval of 28 -35 days, 6.2% had inter-menstrual interval of 35-40 days with only 0.9% had inter-menstrual interval of >40 days. (Table no. 2) It was observed that, 289 (89.5%) girls used hygienic sanitary pads, whereas 34 (10.5%) girls used cloth as an absorbant during menses. Maternal education was only upto 10 th class in 31(91.2% ) among cloth users (34 girls) and only 3(8.8%) mothers were educated upto 12 th class. It was further observed that out of 323 girls, majority (94.4%) had their mothers as a primary source of information regarding menstruation and menstrual hygiene .Other sources being friends (4.6%) teachers (0,6%) and books (0.2%).

Discussion
Adolescence is a period of transition from puberty to early adulthood. Transition phase involves major physical and emotional changes in the individual .In a traditional family setting in developing countries, mothers are usually the care takers of their daughters during these critical phase of physical and emotional development. In a conservative society and in rural population, the subject of menstruation and its hygiene is still considered a taboo subject for discussion. In the present study, it was observed that the mean age of menarche was 14.02 years. Chaturvedi et al 5 reported 13.7 years as the mean age of menarche, which is comparable to the findings of the present study. Patil M S 6 and Durge PM 7 have reported mean age at menarche as 13.45 and 13.5 years respectively. In the present study 68.7% adolescents had attained menarche between 11-13 years, 29% in 14-16 years and 2.2 % in 17 -19 years of age. Patil M S 6 in her study reported that, 41.9% adolescent attained menarche at 11-13 years, whereas, 58.1% had attained menarche at 14-16 years. The differences observed could be related to environmental, geographical and nutritional variations of study population.
On studying the menstrual pattern of these 323 adolescent girls, it was observed that 94.4% had regular menstrual cycles and 5.6% had irregular cycles.In a recently conducted study on adolescent girls in rural area of Bijapur in Karnataka state, by Patil M S 6 on 440 adolescent girls showed comparable results with 92.5% girls having regular cycles and only 7.5 % having irregular cycles' Kulkarni 8 reported 88.84% regular and 88.84% irregular cycles among adolescent girls in his study. Intermenstrual interval was 28-35 days in 92.9%, >35 days in7.1% in the present study. The results are comparable with study done by. Patil M S 6 with 92.7% having intermenstrual interval 28-35 days and 6.8% having >35 days intermenstrual interval. The present study showed that duration of blood flow was <5 days in 96.3% and >5days in 3.7% of the girls which is again comparable to study by Manjula S. Patil 6 .
Dysmenorrhoea (18.3%). was the most common menstrual complaint in the study population. Nearly similar incidence was reported by Durge PM 7 (20.4%) and Patil M S 6 (27.9%).M Kulkarni 8 and Mohite R V et al 9 had reported 53.6% and 49.13% incidence of dysmenorrhoea .The difference may be due to better tolerance of pain in rural girls compared to urban girls. Other menstrual problems in adolescent population were menorrhagia (3.7%), oligomenorrhoea (2.2%) and premenstrual syndrome (3%). Similar incidence of menorrhagia (4%) and oligomenorrhoea (1.1%) was reported by Fakeye O 10 in a study carried out in Nigeria.
Present study revealed that 89.5% of girls were using sterile sanitary pads as absorbant, whereas 10.5% used old home cloth as absorbant. It was noted that only 8.8% of mothers of cloth users were educated upto 12 th class, whereas 91.2% were educated up to 10 th class only. This highlights the role of maternal education influencing the menstrual practices among adolescent girls. The major source of knowledge about menstruation and related problems was mothers in 94.4% of adolescents, friends in 4.6%, teachers (0.6%) or books (0.3%) in only few of them. This further signifies the role of educated mother for better understanding of menstruation and hygiene.

Conclusion
Attainment of menarche at right age is an important milestone during adolescence ,which signifies the normal functioning of the female reproductive system. Study revealed that majority of adolescent girls had attained menarche at appropriate age. The duration of bleeding and the cycle interval was normal in majority of girls. Dysmenorrhoea was the commonest problem among the adolescents. Mother was the commonest source of information for adolescents regarding knowledge about menstruation and hygiene. The use of hygienic sanitary pads as absorbant was prevalent in majority of adolescent girls. In rural areas, inhibitions still exists that prohibit adolescents from discussing their queries related to menstrual and problems with their parents, teachers or peers. There is strong need of education to adolescent population related to reproductive health. It will help in their development as healthy and responsible adults.