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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 76-79

Association of menstrual patterns with perceived stress score in college-going female students of a South Indian Town


1 Department of Physiology, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
2 Department of Physiology, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India
3 Department of Botany and Microbiology, College of Science, Riyadh, Saudi Arabia
4 Department of Nursing, Government Erode Medical College, Erode, Tamil Nadu, India
5 Department of Physiology, Government Erode Medical College, Erode, Tamil Nadu, India

Date of Submission04-Apr-2021
Date of Decision29-Apr-2021
Date of Acceptance02-May-2021
Date of Web Publication17-May-2021

Correspondence Address:
Panneerselvam Periasamy
Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_29_21

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  Abstract 

Background: A natural phenomenon involving the discharge of blood through the vagina from the uterus, occurring at more or less monthly at regular intervals during the reproductive life of females is called menstruation. A normal menstruation occurs for the first time in the adolescent period between 11 and 14 years of age generally, with a period length of around 7 days, with a normal cycle length ranging between 21 and 45 days with an average blood loss of 20–80 ml. Materials and Methods: This was a cross-sectional study of 3-month duration (February 2019 to June 2019), in which 291 students from the various courses including medical, nursing, physiotherapy, and art and science students of a tertiary care hospital participated. Results: Two hundred and ninety-one students were included in the study, among which the age of the students was between 18 and 23 years of age with the majority of students between 20 and 21 years (43.99%). Most of them belong to rural backgrounds (40.55%) and majority of them are day scholars (86.25%). Discussion: This study was pointed to find a relation between stressful life events and menstrual patterns among college-going students of different courses of undergraduate college. Previous studies till now have reported a higher percentage of distress among postgraduates (32.8%) and resident doctors of hospitals (36.4%). Conclusion: Despite high levels of stress in undergraduate students, other factors can also play a significant role in maintaining their menstrual cycle.

Keywords: Adolescence, menstruation, perceived stress


How to cite this article:
Periasamy P, Suganthi V, Karuppiah P, Gunasekaran S, Chandrabose A, Subha K C, Thamizhvanan P. Association of menstrual patterns with perceived stress score in college-going female students of a South Indian Town. Apollo Med 2021;18:76-9

How to cite this URL:
Periasamy P, Suganthi V, Karuppiah P, Gunasekaran S, Chandrabose A, Subha K C, Thamizhvanan P. Association of menstrual patterns with perceived stress score in college-going female students of a South Indian Town. Apollo Med [serial online] 2021 [cited 2021 Aug 3];18:76-9. Available from: https://www.apollomedicine.org/text.asp?2021/18/2/76/316403


  Introduction Top


A natural phenomenon involving the discharge of blood through the vagina from the uterus, occurring at more or less monthly at regular intervals during the reproductive life of females is called menstruation.[1] A normal menstruation occurs for the first time in the adolescent period between 11 and 14 years of age generally, with a period length of around 7 days, with a normal cycle length ranging between 21 and 45 days with an average blood loss of 20–80 ml.[2] Menstrual abnormalities affect around 2%–5% of childbearing women globally, which is considerably higher among the females under constant stress during a cycle.[3] The menstrual cycle of a woman typically follows a 28-day cycle, which ends by shedding the uterine lining, leading to bleeding.[4] Normal menstrual cycle is the indication of functioning of hormones in a proper manner, which is significant of a healthy hypothalamo-pituitary axis with a normal uterus. Nevertheless, a number of conditions such sudden over-exercising, weight loss, medical conditions such as Polycystic ovarian disease, and even stress can have unpleasant effects on a woman's ability to experience a normal menstrual cycle.[5] From most of the existing literature, it is evident that both longer duration of menstrual bleeding and irregular cycles are associated with major depression.[6] Even though there seems to be an existing relationship between the type and severity of the stress with respect to the proportion of women who develop menstrual problems, it is difficult and can also be impossible to identify a threshold at which stress will interfere with the normal cycle.[7] Their individual response to the abnormality in body function can be intensified due to psychological and biological characteristics.[8] Therefore, this study was designed to demonstrate a correlation between the levels of perceived stress and its effect on the menstrual cycle.


  Materials and Methods Top


This was a cross-sectional study of 3-month duration (February 2019 to June 2019), in which 291 students from the various courses including medical, nursing, physiotherapy, and Art and Science students of a tertiary care hospital participated. Young female students of the mentioned courses (aged between 18 and 23 years), who were willing to participate were included in the study. Females with chronic health illnesses, psychiatric illnesses, or any type of diagnosed pelvic pathology (fibroids and pelvic inflammatory disease), etc., were excluded from the study.

After getting an Ethical approval from the institution, the participants were asked to complete a self-administered questionnaire comprising demographic details, menstrual history, and Perceived Stress Scale anonymously. The questionnaire was designed and validated from the previous studies, including items related to the student demographic details, and concerned their menstrual pattern (menarche age, cycle length in days, duration of flow in days, and menstrual regularity) and perceived stress scale. PSS10 was used, which is found to be very reliable for determining the role of stress in the etiology of disease and behavioral disorders.[9] This PSS 10 is inferred as scores ranging from 0 to 13 indicate low perceived stress, 14–26 as moderate perceived stress, and 27–40 as high perceived stress. A written consent was obtained before filling the questionnaire and all the students were assured of their identity being kept confidential.

Statistical analysis

The data obtained from the completely filled questionnaires were analyzed using Statistical Package for Social Sciences for Windows, Version 24.0 (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. IBM Corp.). Descriptive statistics were applied to establish the demographic data and menstrual patterns in the young female college students. The Chi-square test was used to compare the presence or absence of menstrual irregularity in the students with various menstrual problems, and a P < 0.05 was considered statistically significant. Correlation between stress and various menstrual problems was carried out through Spearman Pearson's correlation coefficient.


  Results Top


Two-hundred and ninety-one students were included in the study, among which the age of the students was between 18–23 years of age with the majority of students between 20 and 21 years (43.99%). Most of them belong to rural backgrounds (40.55%) and majority of them are day scholars (86.25%). Among all of them, 31.62% belonged to nursing courses, 27.15% belonged to MBBS, 23.02% belonged to physiotherapy courses, and 18.21% belonged to arts and science courses. Majority of them belong to the co-education type of education (66.7%). All this demographic profile is described in [Table 1].
Table 1: Demographic profile

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Regarding the menstrual pattern, which is described in [Table 2], most of them attained menarche between 11 and 14 years (47.08%) and majority of them experience regular menstrual cycle (70.45%). About 41.58% of the students have their length of menstrual cycle between 25 and 28 days and there was no premenstrual spotting in majority of the students (67.35%). About 68.73% of the study population had their menstrual flow in between 3 and 5 days and the amount of flow was moderate in majority of the students (65.64%).
Table 2: The menstrual cycle pattern of medial, nursing, physiotherapy, and art and science students

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Out of the 291 students, 53 students (18.21%) had a PSS score >20 which means high levels of stress, while 145 students (49.83%) had a score ≤20, which means moderate levels of stress [Table 3]. The students with PSS >20 were further evaluated for the menstrual irregularities such as long cycle length (>35 days), short cycle length (<21 days), heavy menstruation (menorrhagia) and the results are demonstrated in [Table 4]. The Chi-square test and the Fisher's Exact test were applied between stress levels and menstrual patterns where no association was found in students with PSS >20 with menorrhagia (heavy menstruation), dysmenorrhea (painful menstruation), long cycle length, and short cycle length. Even though an association was established between high-stress levels (PSS >20) and heavy menstrual cycles (P = 0.001), as shown in [Table 4].
Table 3: The perceived stress levels among the study population

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Table 4: The association between menstrual cycle and their perceived stress score of medical, nursing, physiotherapy, and art and science students

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  Discussion Top


This study was pointed to find a relation between stressful life events and menstrual patterns among college-going students of different courses of undergraduate college. Previous studies till now have reported a higher percentage of distress among postgraduates (32.8%) and resident doctors of hospitals (36.4%).[9] Between 8.2% and 10.6% of students at the Cambridge University have been reported to be suffering from depression according to a recent study conducted there.[10] In this present study, about 18.21% of the students had higher stress levels (PSS >20). An association was established between high-stress levels and heavy menstrual cycles (menorrhagia) using the Chi-square test, which was statistically significant with a P = 0.001.

In a similar study among the Taiwanese nurses, where it was found 72.3% of the nurses had a high level of perceived job stress, that was significantly associated with irregular menstrual cycles and longer menstrual bleeding periods.[11] This present study also showed a significant relation between high-stress levels and heavy bleeding menstrual cycles. In a Hungaro study 2002, a nationwide representative survey reported that the majority of the participants experienced severe dysmenorrhea that limited their daily activity. It could be due to low job control, and low job security that would be found to be associated with a higher risk for dysmenorrhea.[12] However, this study has not established a relation between high-stress levels and dysmenorrhea.

In a study among the Japanese college students, where the ones who reported premenstrual symptoms and the experience of irregular menstrual cycles had higher stress scores than the students who did not have the symptoms. These results suggest that psychological stress is independently associated with premenstrual symptoms, due to which the students can experience irregular menstrual cycles.[13] In a similar manner, our study showed that the students with high-stress levels experienced irregular cycles more often than the ones with low stress.


  Conclusion Top


Through this study, an association between high-stress levels in students (PSS >20) and menstrual pattern could not be established notably. However, there was association established between high-stress levels (PSS >20) and menorrhagia (heavy menstrual bleeds). Consequently, despite high levels of stress in undergraduate students, other factors can also play a significant role in maintaining their menstrual cycle. Therefore, other causes must also be looked for among the young females complaining of menstrual problems before concluding them because of stress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J 2018;39:67-73.  Back to cited text no. 1
    
2.
Nagma S, Kapoor G, Bharti R, Batra A, Batra A, Aggarwal A, et al. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res 2015;9:QC01-3.  Back to cited text no. 2
    
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Bianco V, Cestari AM, Casati D, Cipriani S, Radici G, Valente I. Premenstrual syndrome and beyond: Lifestyle, nutrition, and personal facts. Minerva Ginecol 2014;66:365-75.  Back to cited text no. 3
    
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Poromaa IS. Physiological correlates of premenstrual dysphoric disorder (PMDD). Curr Top Behav Neurosci 2014;21:229-43.  Back to cited text no. 4
    
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Deliwala KJ, Shah HH, Shah BS. Evaluation of menstrual problems among urban females of Ahmedabad. J Clin Res Lett 2013;4:49-53.  Back to cited text no. 5
    
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Amu EO, Bamidele JO. Prevalence of menstrual disorders among adolescent girls in Osogbo, South Western Nigeria. Int J Adolesc Med Health 2014;26:101-6.  Back to cited text no. 6
    
7.
Karout N, Hawai SM, Altuwaijri S. Prevalence and pattern of menstrual disorders among Lebanese nursing students. East Mediterr Health J 2012;18:346-52.  Back to cited text no. 7
    
8.
Anandha Lakshmi S, Saraswathi I, Saravanan A. Ramamchandran C. Prevalence of premenstrual syndrome and dysmenorrhoea among female medical students and its association with college absenteeism. Int J Biol Med Res 2011;2:1011-6.  Back to cited text no. 8
    
9.
Yusoff B, Rahim A. Prevalence and sources of stress among postgraduate medical trainees: Initial findings. Asian J Psychiatry 2010;11:1-10.  Back to cited text no. 9
    
10.
Saini NK, Agrawal S, Bhasin SK, Bhatia MS, Sharma AK. Prevalence of stress among resident doctors working in medical colleges of Delhi. Indian J Public Health 2010;54:219-23.  Back to cited text no. 10
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11.
Chung FF, Yao CC, Wan GH. The associations between menstrual function and life style/working conditions among nurses in Taiwan. J Occup Health 2005;47:149-56.  Back to cited text no. 11
    
12.
László KD, Gyorffy Z, Adám S, Csoboth C, Kopp MS. Work-related stress factors and menstrual pain: A nation-wide representative survey. J Psychosom Obstet Gynaecol 2008;29:133-8.  Back to cited text no. 12
    
13.
Yamamoto K, Okazaki A, Sakamoto Y, Funatsu M. The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students. J Physiol Anthropol 2009;28:129-36.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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