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Magnitude of menstrual problems among young females of medical and paramedical college

Most women bleed for 2 to 7 days during their first menses. Most normal cycles range from 21 to 45 days, despite variability even in the first gynaecologic year, although short cycles of fewer than 20 days and long cycles of more than 35 days may occur. By the third year after menarche, 60% to 80% of menstrual cycles are 21 to 34 days long, as is typical of adults. Menstruation is a physical manifestation of complex endocrine axis .Thus, the regularity and frequency of the menstrual cycle is sensitive to endocrine disturbances that may otherwise remain sub clinical.

abnormal, with potential health consequences. 5 Factors that often 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. The aim therefore is to keep BMI within the normal range to promote regular and healthy menstrual cycles. 6 Menstrual cycle irregularities and anovulation have been found to occur with increased frequency in women who deviate considerably from normal weight.
A number of studies have shown that higher obesity grades were associated with higher probabilities of irregular pattern of menstrual cycles. 7 In many instances, young patients seek medical attention for menstrual irregularities, which actually fall within the normal range. Menstrual problems are generally perceived as only minor health concern and thus irrelevant to the public health agenda particularly for women in developing countries who may face life threatening conditions. Menstrual cycle is a normal physiological process that is characterized by periodic and cyclic shedding of progestational endometrium accompanied by loss of blood which adds a powerful tool to the assessment of normal development and the exclusion of pathological conditions in adolescent and young girls. 8 Some variety of menstrual dysfunction occurs in adolescent girls which may affect normal life of adolescent and young adult women. Physical, Mental, Social, Psychological and Reproductive problems are often associated with menstrual irregularities and menstrual problems. Due to change in life style, habits, diet, the prevalence of obesity has increased in the developed world which has resulted in decreased age at menarche. 9 Though menstruation is a regular phenomenon in females, almost all of them face some or the other kinds of problem, during these time. Menstrual conditions are many that may require physician's attention or any other healthcare professionals' attention. The most common menstrual disorders are pre-menstrual syndrome, dysmenorrhoea, amenorrhoea, menstrual cycle length disorders as oligomenorrhoea and polymenorrhoea etc. 10 These teenage menstrual problems are diverse in aetiology and if detected early they can be remedied. The young girl is a very shy person and often hesitates to seek help regarding her problems. Current study is planned to determine the magnitude of menstrual problem among young females of medical and paramedical college.

METHODS
The present study has been conducted on 300 young female students studying in the department of obstetrics and gynaecology in collaboration with paramedical and nursing college, Uttar Pradesh. RIMS and R. Saifai, Etawah over a period of 18 months January 2015 to July 2016, with an objective to determine the magnitude of menstrual problem among on young female students of age group 17-25 years.

Sample size
Within the 5% of its actual parameters the estimated sample size with 95% of confidence interval was approximately 300.

Inclusion criteria
Inclusion criteria for current study were; young females in the age group of 17-25 years, unmarried girls and those who were willing to participate in the study.

Exclusion criteria
Exclusion criteria for current study were; the young females who were not willing to participate, those who were on treatment for menstrual problems, married females, those having primary amenorrhoea and those who have undergone pelvic surgery.

Procedure
Structured questionnaire was used to determine the occurrence of menstrual problems among young females. Permission was taken from the selected colleges. Consent was taken from the selected students and a structured questionnaire was given to identify menstrual problems. The questionnaire consisted detailed history of the cases like present age, daily calorie intake, socioeconomic status, daily intake of junk foods, their detailed history of menstrual cycle pattern, age of menarche (on recall basis), dysmenorrhoea, passage of clots, hypomenorrhoea, menorrhagia, premenstrual symptoms if any, medical and drug history family history, etc. Detailed history of menstrual cycle was evaluated to find out the menstrual abnormality among these theoretically described ones. Short cycles (polymenorrhoea) with cycle length less than 21 days, long cycles (oligomenorrhoea) with cycle length more than 35 days, normal cycles from 21 to 35 days, normal duration 2 to 7 days were taken. Amount of bleeding was assessed by number of pads used/day and presence and absence of clots. A thorough general examination with special attention to pallor, icterus, thyroid enlargement, per abdominal examination was done.

Statistical analysis
The collected data was analysed using descriptive (mean, median and standard deviation) and inferential statistics and the results are presented by using diagrams, graphs and tables. The relationship between the parameters i.e. BMI and menstrual abnormality was tested using the Chi square test and independent sample t-test, p>0.05 was considered as non significant, p<0.05 as significant and p<0.01 as highly significant.

RESULTS
The maximum number of cases was in the age group 21 to 23 years i.e. 160 cases (53.33%). 77 cases (25.66%) presented in the age group of 17 to 20 years. Least number of cases was found in 24 to 25 year group i. e. 21%. The mean age of study sample was found to be 21.98 years with a standard deviation of 2.0. There are maximum cases in 22 and 23 years of age i.e. 55 each. 40 cases belonged to 20 years and 25 years each. Minimum numbers of cases were present in the age 24 years. None of cases were present in 17 and 18 years (Table 1).      Bloating and swelling was present in 24 cases (8.0%) ( Table 6).

DISCUSSION
The mean age of study sample was found to be 21.98 years with a standard deviation of 2.0. There are maximum cases in 22 and 23 years of age i.e. 55 each. 40 cases belonged to 20 years and 25 years each. Minimum numbers of cases were present in the age 24 years. None of cases were present in 17 and 18 years. Maximum number of cases i.e.121 cases (40.3%) used 3 pads per day. 118 cases (39.3%) used only 2 pads per day. Only 8 cases (2.7%) had scanty blood flow during menses and required only one pad daily and 5 cases (1.7%) used 5 pads daily while 2 cases (0.7%) had to use 6 or more pads per day. Considering menorrhagia when the number of pads used per day was more than 4, total of 53 cases (17.33%) were present. Similar results were obtained by Naveen samir et al who found 11.7% cases of menorrhagia in his study. The mean age of menarche in the present study was 13.50±1.315 years, which was almost consistent with earlier reports from different geographical areas of India and different parts of the world. 11 Singh et al found cases (8.7%). Bloating and swelling was present in 24 cases (8.0%). Hirsutism was present in only 4 cases (1.3%). Acne was found to be less common and was present in only 36 cases (12%). Similar age of menarche (12.5±1.52 years). 12 Begum also got similar results, (12.6±1.0 years) Kavitha also reported age of menarche of 12.5 years. 9 16 Study conducted in Nigeria by Umeora also found that 63.5% respondents had regular and 36.5% had irregular menstrual cycles. 17 Mohite et al also reported 73.8% subjects with regular and 26.1% had irregular cycle among the college students. 18 The minor difference among the various studies was mainly due to environmental, racial, nutritional and lifestyle factors.
There were 214 cases (71.33%) with average days of menstrual flow of 4-6 days. 76 cases (25.33%) cases were present who had 2-3 days of menstrual flow. Only 10 cases (3.33%) had an average 7-8 days of flow. Dysmenorrhoea and premenstrual symptoms are common disorders that affect more than 50% of the menstruating women. 19 The proposed cause of pain in dysmenorrhoea is excess production of prostaglandins (PG) in the endometrium during the ovulatory cycle. It was shown that women with dysmenorrhoea have higher levels of PG in their plasma and menstrual discharge than women without dysmenorrhoea. 20 Pre-menstrual symptoms are experienced prior to menstruation due to changes in blood levels of estrogen as well as progesterone. 21 In the present study, dysmenorrhoea and premenstrual symptoms were experienced by significant number of students with normal body weight (50%). Dysmenorrhoea had no significant association with menstrual cycle pattern. The p value obtained was 0.289. It means that dysmenorrhoea is present in both the cases i.e. either with regular cycles or with irregular cycles. Similar results were obtained by a study conducted by Lakkawar on medical students in Pondicherry. 22 Out of other premenstrual symptoms, fatigue was found to be more common and was present in 163 cases (54.3%) while 137 cases (45.7%) had no such problem. 159 cases (53%) had the complaint of leg cramps during menses and 141 cases (47%) had no leg cramps. 48 cases (16%) had bladder and bowel problems like constipation, loose motions, and increased frequency of micturition. 41 cases (13.7%) cases had non specific mastalgia. 37 cases (12.3%) complained of giddiness during menses.

CONCLUSION
The mean age of menarche was found to be 13.50 years with standard deviation of 1.315. The average duration of normal blood flow for reproductive age group as estimated is 2-5 days. The mean of menstrual cycle length came out to be 29.79 days with a standard deviation of 4.87. The average amount of blood loss during each menstrual cycle was found to be 65.39 ml with a standard deviation of 11.81.