Menstrual patterns and problems in association with body mass index among adolescent school girls.

BACKGROUND: Menstruation is a normal physiological phenomenon for females indicating her capability for procreation. Menstrual problems are common in adolescent girls, which may affect their life and outdoor activities. Adolescent girls with abnormal body mass index (BMI) suffer even more often.
OBJECTIVES: To assess the relationship between menstrual patterns and problems with BMI among adolescent school girls of Delhi.
MATERIALS AND METHODS: This study was a cross-sectional study conducted among 210 adolescent school girls of Delhi. Permission was obtained from principal of the school and written informed consent was taken from the parents of the school girls before taking part in the study. All the data were collected, entered, and analyzed in SPSS 17.0. The data were analyzed using percentages and proportions through tables.
RESULTS: Out of 210 adolescent girls, 114 (54.3%) were having BMI <18.5, which implies that >50% of the girls were undernourished. Only 13 (6.2%) of adolescent girls were overweight. Adolescent girls who had BMI <18.5 experienced more symptoms and problems associated with menstrual cycles. This difference was statistically significant.
CONCLUSION: Menstrual problems especially dysmenorrhea are frequent among adolescent girls. BMI play a very vital role for menstrual cycle regularity. Consequently, adolescent girls have to be given healthy and balance nutrition, which leads to maintenance of their normal BMI and regulate their menstrual cycle. Copyright:

Introduction

World Health Organization (WHO) defines “Adolescence” as the time period between 10 and 19 years of life characterized by critical physical and psychological changes leading to adulthood.[1] This age group requires adequate nutrition, education, counseling, and guidance to ensure their development into healthy adults.[2]

Menstruation is one of the most important changes during adolescent years. It occurs once a month as a regular rhythmic period and remains as a normal physiological phenomenon from menarche to menopause.[3] Menstrual disorders are frequent among adolescent girls as they are closely coupled with the processes involved in the pubertal development of females. The menstrual cycle is an essential indicator of a women's reproductive health and of her endocrine functions.[4]

Menstruation is characterized by variability in regularity, volume, and pattern. A survey reported about 64% girls having at least one problem related to menstruation.[5] The prevalence of menstrual disorders in India has been recorded as high as 87%.[6] Various types of menstrual disorders are prevalent, viz. menstrual irregularity, menorrhagia, polymenorrhea, oligomenorrhea, dysmenorrhoea, etc., It has been observed that most of the girls face some or the other problem, which are individual specific. Dysmenorrhea is the most common menstrual disorder among women, with a prevalence of 60%–93%.[7]

A number of medical conditions can cause irregular menstruation, which can be diagnosed and treated at early stage. However, this part of women's health is mostly neglected. More than 90% of menstrual problems are preventable just by early detection and appropriate treatment.[8]

Factors that frequently play a role in the regularity, and flow of a woman's menstrual cycle include hormonal changes, genetics, serious medical conditions, and body mass index (BMI).[910]

Many studies have been conducted earlier to address the problems related to menstrual abnormalities in young students, yet few reports are available on relationship between menstrual problems and BMI. An etiological relationship between menstrual disorders and BMI may be sought for further evaluation. This study was carried out to assess the relationship between menstrual irregularities and BMI among adolescent school girls of Delhi.

Materials and Methods

A cross-sectional study was carried out among adolescent school girls of Delhi. For the purpose of studying menstrual patterns and problems of adolescent students, a total of among 210 adolescent students were included. This study is confined only to girls who had attained menarche.

Respondents were made comfortable and clarified about details of the study. They were briefed about the questionnaire. Permission was obtained from the principal of the school and written informed consent was taken from the parents of the school girls before taking part in the study.

Menstruation-related information was collected, such as personal details, age of menarche in years, regularity, and problems during menstruation cycle. Confidentiality of responses was maintained.

For anthropometric examination, weight was recorded using a standardized weighing scale (Krups weighing scale, New Delhi, India) that was kept on a firm horizontal surface. Weight was recorded to the nearest 500 g. Before the start of measurement day, zero error was eliminated. The weight of girls was measured barefoot with minimal clothes and warm clothing; shoes and socks were removed.[11]

Height was measured using a nonstretchable tape to the nearest 1 cm. The height of girls was measured barefoot. They were made to stand with heels together so that medial malleoli were touching and feet slightly spread. The position of shoulder was relaxed with minimal lordosis. Hands and arms were loose and relaxed with palms facing medially. The student was then asked to look straight ahead so that head was in Frankfurt's plane.[11]

BMI (kg/cm2) was calculated using WHO classification for BMI 2004. The BMI cut-off points are <18.5 kg/m2 (underweight), 18.5–24.9 kg/m2 (normal range), >25 (overweight), 25–29.9 kg/m2 (pre-obese), and >30 kg/m2 (obesity).[12]

All the data were collected, entered, and analyzed in SPSS 17.0. The data were analyzed using percentages and proportions through tables. Chi-square test was performed for testing statistical significance association among variables. The statistical significant association was considered when P < 0.05.

Results

Study participants were classified based on their BMI. Adolescent girls <18.5 kg/m2 were defined as underweight, who had BMI between 18.5 and 24.9 were considered as having normal BMI and who had >25 were considered as overweight. The Table 1 describes the prevalence of underweight and over weight in study participants. Almost 114 (54.3%) were having low BMI, which implies that >50% of the girls were undernourished. Only 13 (6.2%) of adolescent girls were overweight.

Table 1

Distribution of the study participants based on their body mass index

BMI	No (%)
<18.5	114 (54.3)
18.5-23	83 (39.5)
>23	13 (6.2)

Table 2 summarizes the prevalence of menstrual-related problems in relation with BMI. Dysmenorrhea was experienced more in adolescent girls who had lower BMI compared to others, out of 114 girls who had BMI <18.5, it was observed that 94 girls complained of dysmenorrhea, which was around 82.4%. It was observed less in adolescent girls who had normal BMI 36 (43.4%). This difference was statistically significant. Similarly, other symptoms of menstrual problems such as oligomenorrhea, irregular cycles, body ache, abdominal pain, and irritability were seen more in girls who had BMI <18.5 or >25 when compared with who had normal BMI.

Table 2

Menstrual patterns and problems in association with body mass index of the study participants

Variables	<18.5	18.5-24.9	>25	P
Dysmenorrhea				0.0001
Yes	94 (82.4)	36 (43.4)	08 (61.5)
No	20 (17.6)	47 (56.6)	05 (38.5)
Oligomenorrhea				0.02
Yes	5 (4.4)	01 (1.2)	05 (38.5)
No	109 (95.6)	82 (98.8)	08 (61.5)
Irregular cycles				0.0002
Yes	06 (5.6)	02 (2.4)	05 (38.5)
No	108 (94.4)	81 (97.6)	08 (61.5)
Amount of blood flow				0.004
Scanty	06 (5.2)	01 (1.2)	02 (15.3)
Moderate	73 (64.1)	70 (84.3)	05 (38.4)
Heavy	35 (30.7)	12 (14.4)	06 (46.3)
Intermenstrual period				0.001
<21 days	5 (4.4)	04 (4.8)	02 (18.2)
21-35 days	80 (70.3)	73 (87.9)	06 (3.8)
>35 days	29 (25.5)	06 (7.3)	05 (12.5)
Days of flow				0.0001
<3 days	05 (4.4)	01 (1.2)	05 (38.4)
3-5 days	74 (64.9)	77 (92.7)	03 (23.2)
>5 days	35 (30.7)	05 (6.1)	05 (38.4)
Body ache				0.0001
Yes	45 (39.8)	11 (13.3)	08 (61.5)
No	69 (60.2)	72 (86.7)	05 (38.5)
Abdominal pain/cramps				0.08
Yes	90 (78.9)	67 (80.7)	07 (53.8)
No	24 (21.1)	16 (47.1)	06 (46.2)
Irritability				0.0001
Yes	35 (30.7)	10 (12.1)	11 (84.6)
No	79 (69.3)	73 (87.9)	02 (15.4)

When assessed for duration of menstrual cycle and duration (days) blood flow and intermenstrual period were negatively associated with who had BMI <18.5 and these observations were statistically significant [Table 2].

Discussion

Menstruation is one of the most important changes during adolescent years. It occurs once a month as a regular rhythmic period and remains as a normal physiological phenomenon from menarche to menopause. It is considered as an indicator of women's health, so adolescent girls need to have an understanding of menstruation pattern and the factors that may attribute in menstrual disorders or changes such as age, activities, and BMI. It is essential to increase their understanding of menstruation, appropriate management for it, and clarify the ignorance of menstruation issues.[13]

In this study, two-third of the adolescent girls had age of menarche ranged from 13 to 14 years, with the mean age at menarche of 13.45 ± 0.95 years.Studies conducted in India have observed an average age at menarche to be 12.4, 13.4, 13.5, and 13.6 years, which are similar to this study.[1415161718]

Age of onset of menarche is generally between 11 and 15 years. Slight variations in the age of menarche may occur depending on their hereditary pattern and nutritional status.[19] Another study reported that the delayed of menarche was present in girls with poor nutrition and earlier in girls with high-energy intake.[20]

Menstrual problems

In this study, 13 (6.1%) of adolescent girls had irregular menstrual cycle and 11 (5.2%) had oligomenorrhea. When assessed for intermenstrual period, 11 (5.2%) had cycles <21 days, and 40 (19.1%) had cycles after every 35 days. The finding is in congruence with the other study where the prevalence of irregular menstrual cycle, polymenorrhea, oligomenorrhea, secondary amenorrhea, and menorrhagia was 59.4%, 37.5%, 19.3%, 5.1%, and 11.7%, respectively.[21]

Variation with BMI

There was statistical significant difference in problems and symptoms of menstruation among underweight and overweight adolescent girls who had BMI <18.5 and >25 as compared with adolescent girls who had normal BMI.

In contrast with other studies, majority of girls with normal BMI and underweight had regular cycle (79.64%, 65.83%), whereas only 33.33% of overweight and obese had their cycles regularly indicating that BMI is an important factor affecting irregular menstrual cycles.[2223]

Majority adolescent 159 (75.7%) girls in this study had cycle length normal (21–35 days). Percentage of girls having shorter and longer menstrual intervals is higher among underweight compared to other BMI. The association between high BMI and menstrual cycle length was found statistically significant (P-value < 0.001). Similar finding was seen in other studies.[24]

In other studies, increased BMI was associated with infrequent cycles; however, no association was found with other menstrual disorders.[25] Significant association between increased BMI and irregular cycle has also been reported earlier.[26]

Our findings were consistent with the above reports. The girls with lower BMI experienced significantly irregular menstrual cycle and compared with their normal weight counterparts. This study emphasize on how important is the nutrition in adolescent age group, which, in turn, will have effect on BMI. Alma Ata declaration done in 1978 has outlined eight essential components for primary health care and proper nutrition, and food supply is one of the elements.[27] There are national health programs run by Government of India to combat nutrition deficiency and micronutrient deficiency.[28] Here should be holistic approach to treat menstrual problems in adolescent age group not just medicines but proper nutrition can also improve the menstrual problems in this age group.

Conclusion

Dysmenorrhea was the most common menstrual problem among adolescent girls. BMI plays a very vital role for menstrual cycle regularity. Consequently, adolescent girls have to be given healthy and balance nutrition, which leads to maintenance of their normal BMI and regulate their menstrual cycle.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.