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Prevalence of Menstrual Disorders and its Relationship With Quality of Life in Female High School Students

Background: Menstrual disorders in female students in the early years after menarche affect their physical, emotional and social functions. Objective: This study aimed to investigate the prevalence of menstrual disorders among female high school students and its relationship with their Quality of Life. Methods: This cross-sectional study was conducted on 1000 high school girls in Qazvin, Iran during 2017-2018. Their menstrual disorders and quality of life were evaluated by a demographic checklist and KIDSCREEN questionnaire, respectively. Data were analyzed using independent t-test. Findings: The mean age of high school girls was 15.9±0.93 years. The most common disorder was Premenstrual Syndrome (PMS) with a prevalence of 60%. Their quality of life had a significant relationship with PMS, menorrhagia, metorrhagia, dysmenorrhea, spotting, hypermenorrhea (P<0.001), polymenorrhea (P=0.005), hypomnorrhea (P=0.002) and amenorrhea (P=0.025). The quality of life of girls with these disorders were poorer compared to the girls with no menstrual disorder. Conclusion: Menstrual disorders are highly prevalent among female students, and have a considerable impact on their quality of life. Since this impact has the potential to have longer-term consequences, more efforts are needed to address and treat menstrual disorders in female students.


Introduction
enstruation is a monthly physiological process. Menstrual disorders may occur under the influence of various factors [1]. Studies have shown that the twothirds of women have regular menstrual cycles [2]. Menstrual disorders are one of the main complaints of women which, in addition to having negative effect on their performance, affects their family and society [3]. Primary dysmenorrhea is defined as cramping pain in the lower abdomen occurring just before or during menstruation, in the absence of other diseases. Its prevalence in Iran was estimated at 85% [4]. Premenstrual Syndrome (PMS) refers to emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve within a few days of the onset of bleeding [5].
Primary Amenorrhea is defined as the failure of menses by age 15-16 years or the absence of secondary sexual characteristics by age 14 years [8]. rhea is used for irregular menstrual periods, and polymenorrhea is a term used to describe menstrual cycles with intervals shorter than 21 days [11]. Metrorrhagia is uterine bleeding at irregular intervals, particularly between the expected menstrual periods, and menorrhagia refers to the blood loss of 80 mL per a menstrual cycle [12]. Other terms are hypomenorrhea (bleeding for 2-3 days) and hypermenorrhea (bleeding for longer than 7 days) [2].

Materials and Methods
This cross-sectional study was carried out on 1000 high school girls during 2017-18. They were selected from 20 high schools in Qazvin, Iran by a stratified random sampling technique (using random number table). Inclusion criteria were: Being female, and studying in high school. The girls with chronic systemic diseases and those with no willingness to participate in the study were excluded from the study. Data were collected by a demographic checklist and the KIDSCREEN questionnaire for measuring the subjects' quality of life. Cronbach's alpha coefficient for different dimensions of this questionnaire has been reported 0.78-0.84 [16]. The collected data were analyzed in SPSS V. 16 software using descriptive statistics, chi-square test, and independent t-test by considering a significance level at 0.05.

Results
The participants had a Mean±SD age of 15.9±0.93 years and a Mean±SD body mass index of 21.76±3.27 Kg/m 2 .  Table 1 shows the results of examining relationship between menstrual disorders and the quality of life in girls. The quality of life score of those with menstrual disorders was significantly lower compared to those with no any menstrual disorder, but there was no statistically significant relationship between the quality of life and oligomenorrhea (P=0.074).

Conclusion
This purpose of this study was to investigate the prevalence of menstrual disorders and its effect on the quality of life of high school girls (n=1000). The most common disorder was reported PMS with a prevalence of 60%. In Azurah et al.'s study, the most common menstrual disorder was dysmenorrhea (34.8%) [17]. This discrepancy may be due to difference in the study population; in our study, it consisted of all female students in high schools, while in Azurah et al.'s study, it consisted of females referred to a gynecology center for treatment of menstrual disorders. Many patients with a menstrual disorder such as PMS may not seek treatment. Difference in the number of samples and their economic status can also be effective.
The quality of life of female students in our study had a statistically significant relationship with having PMS, menorrhagia, metrorrhagia, dysmenorrhea, spotting, hypermenorrhea, polymenorrhea, hypomenorrhea and amenorrhea. The quality of life of girls with these disorders was significantly poorer than that of those with no any menstrual disorder. A study conducted by Shahin et al. on 1008 students in Turkey also showed that the quality of life score of girls with PMS were significantly lower than girls who had no any menstrual disorder [19]. In our study, the results revealed that menstrual disorders had a significant negative impact on the quality of life of female students.
Due to the high prevalence of menstrual disorders among female high school students, and the association of these disorders in the early years after menarche with some serious gynecological diseases, menstrual disorders in adolescent girls need to be diagnosed and treated. Screening and treatment of these disorders can prevent their long-term complications. Furthermore, due to the significant negative impact of menstrual disorders on the quality of life of high school girls, it is recommended to provide psychological counseling to them to reduce the psychological burden of these disorders. Further studies are recommended to investigate the causes and eliminate them. It is also suggested that more studies be conducted on the effectiveness of treating menstrual disorders in improving the quality of life in adolescent girls.

Compliance with ethical guidelines
This study is approved by the Research Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1395.262).

Funding
This study was extracted from the MD. thesis of third author approved by Qazvin University of Medical Sciences.

Authors' contributions
Selecting the subject of study and summarizing the contents: Hamideh Pakniat and Ezzatalsadat Hajiseyedjavadi, Writing and analyzing data: Hananeh Mirgaloybayat and Ali Emami, Editing, supervising and project management: Ezzatalsadat Hajiseyedjavadi, Draft Article: Ali Emami.

Conflicts of interest
The authors declare no conflict of interest.