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An Evaluation of Hot Water Intake and Relief from Menstrual Cramps among Healthy Females-A Cross Sectional Study

Background: Primary dysmenorrhea is menstrual pain that very women undergo during her menstrual phase. It may vary in its frequency and duration in each and every woman. Many home remedies have been followed by females to combat these menstrual cramps. One such treatment is intake of hot water for three days during the menstrual phase Objective: To aim of the study is to observe the changes experienced by female who consume hot water regularly during menstruation Methods: The study was conducted in 100 female subjects with regular cycles of menstruation. The participants were administered with a self developed questionnaire consisting of 16 questions relating to the menstrual cramps and the remedies they chose and their regularity of hot water intake and the relief they obtained. The responses were collected using google forms. Descriptive statistics, frequency analysis and chi square test was used to analyze the data. Results: The study observed that female subjects experienced better results after regular hot water intake during menstruation. It relieves menstrual cramps and improves mental health. Conclusion: The present study concluded that the majority of the population had a regular habit of taking hot water and experienced improvement and relief from menstrual cramps. Original Research Article Rajaselin et al.; JPRI, 33(58B): 319-327, 2021; Article no.JPRI.74343 320


INTRODUCTION
Menstrual cramps happen when a chemical called prostaglandin makes the uterus contract (tighten up) [1]. The uterus, the muscular organ where a baby grows, contracts throughout your menstrual cycle [2]. During menstruation, the uterus contracts more strongly [3]. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to muscle tissue. You feel pain when part of the muscle briefly loses its supply of oxygen [4].
The burden of dysmenorrhea is greater than any other gynecological complaint [5]. Dysmenorrhea is the leading cause of gynecological morbidity in women of reproductive age [6]. The effects extend beyond individual women to society, resulting annually in an important loss of productivity [7,8]. Thus, the World Health Organization estimated that dysmenorrhea is the most important cause of chronic pelvic pain from the follicular phase to the luteal phase [9].. Elevated prostaglandin levels were found in the endometrial fluid of women with dysmenorrhea and correlated well with the degree of pain [7]. An increase in endometrial prostaglandins further increase occurring during menstruation [10]. The increase in prostaglandins in the endometrium following the fall in progesterone in the late luteal phase results in increased myometrial tone and excessive uterine contractions [11].
Taking pain medication such as ibuprofen or paracetamol may help to relieve menstrual cramps and pain [12]. Using a heating pad may also help. NSAIDs are commonly used as an effective treatment for dysmenorrhea, but it poses a greater risk of adverse effects namely indigestion, headaches, and drowsiness [13]. Our team has extensive knowledge and research experience that has translate into high quality publications [14][15][16][17][18][19][20][21][22][23].
The aim of the study is to observe the variations seen in the female subjects taking warm water regularly during menstruation.

MATERIALS AND METHODS
The study involved 100 participants who had regular cycles of menstruation. A descriptive cross-sectional study was done to analyze the . The survey was conducted among 100 healthy female subjects who take hot water regularly during menstruation. Female subjects with PCOS and other health issues were excluded. A self-developed questionnaire was prepared consisting of 16 questions relating to the menstrual cramps and the remedies they chose and their regularity of hot water intake and the relief they obtained. The responses were collected using google forms and analysed using SPSS Software version 23. Descriptive statistics, frequency analysis and chi square test was used to analyze the data. The results were represented in pie charts and bar charts.

RESULTS
The frequency analysis revealed the following results. 68.8% of the female subjects experienced menstrual cramps before menstruation. whereas 13.4% of the female subjects had menstrual cramps on the 1st day of menstruation. 8% of the respondents had menstrual cramps on the 2nd day. 9.8% of the female subjects suffered from menstrual cramps during all the days of the menstruation.75.5% of the female subjects have answered that their menstruation lasts for 7 days. 19.1% of the female subjects have answered that their menstruation lasts 5 days. 3.4 % of the female subjects go through 10 days of menstruation. 45% of the female subjects face emotional disturbances during menstruation. 55% of the female subjects face diarrhea, headache, dizziness and constipation. 86.5% of the female subjects did not have any health issues. 10.8% of the respondents had irregular cycles. 3.5% of the female subjects had PCOS and other health issues. 44.6% of the female subjects use analgesic to relieve menstrual cramps whereas 45.4% of the female subjects do not take analgesic during menstrual cramps.40.4% of the female subjects are not relieved and experience side effects after intake of analgesics during menstrual cramps. 10.6% of the female subjects gets relief of menstrual cramps. 49% of the female subjects get mild relief after intake of analgesics during menstrual cramps. 86.6% of the female subjects are absent from work. 82.9% of the female subjects do regular physical activity during the menstrual cycle. 17.1% of the respondents are not active during menstruation.46.4% of the female subjects bleeding amount is scanty, 42.9% of the female subjects bleeding amount is moderate. 10.7% of the female subjects faced heavy blood flow during menstruation.69% of the female subjects responded that there is relief after the intake of hot water during menstrual cramps. 31% of the female subjects do not know/ no relief after intake of hot water. 86.5% of the female subjects take hot water regularly whereas 11.5 % of the female subjects take hot water very rarely. (Fig.  1) 87% of the female subjects take hot water regularly. 10% of female subjects rarely take hot water. 3% of the respondents do not take hot water regularly. (Fig. 2) 87% of the female subjects have improved. 8% of the respondents did not have any relief after intake of hot water. 4% of them may have relief after intake of hot water. (Fig. 3) 90% of the female subjects had complete relief from menstrual cramps after intake of hot water. Only 10% of the female subjects had mild relief from menstrual cramps after intake of hot water during menstruation which is represented in green in the pie chart. (Fig. 4).

DISCUSSION
Women with primary dysmenorrhea have a significantly reduced quality of life, poorer mood and poorer sleep quality during menstruation compared with their pain-free follicular phase, and menstruation phase of pain-free control women [24]. The prescribed first-line therapy for menstrual pain remains non-steroidal antiinflammatory drugs [25]. Menstrual cramps is a natural and physiologic process that is managed based on various socio-cultural habits and home remedial behaviors [26]. Girls develop a negative attitude to menstruation or with less readiness for menarche and are more absent and delete some activities. They seem to be much depressed, irritable and develop more anxiety during episodes of menstrual cramps [27,28].
Menstruation poses a wide variety of uncomfortable symptoms namely the PMS. Premenstrual syndrome (PMS) encompasses common issues like mild cramping and fatigue. The main reason for PMS being higher is the level of prostaglandin, the more severe the menstrual cramps [29,30]. Pain usually begins one or two days in the pelvic region or lower abdomen before you get your period or when bleeding actually starts [31,32]. You may feel pain ranging from mild to severe in the lower abdomen, back or thighs [33]. Pain can typically last 12 to 72 hours, and you might have other symptoms, such as nausea and vomiting, fatigue, and even diarrhea [34]. Common menstrual cramps may become less painful as you get older and may stop entirely after pregnancy [35]. Hot water keeps your body healthy and hydrated. [36,37].Some people claim that hot water specifically can help improve digestion, relieve congestion, and even promote relaxation [38]. drinking hot water helps improve central nervous system functions, further improves mental health [29,39].

Fig. 5. bar graph showing comparison of responses between different age groups and female subjects who consume hot water during menstrual cramps. X-axis represents the age groups (12-17, 18-22 , 22-27,above 30) of the respondents and Y-axis represents the number of responses who consume hot water regularly during menstruation (blue -always, green-very
rarely, beige-never) . Female subjects of the age group 18-22 yrs always had the habit of taking hot water regularly compared to all other age groups and the association was found to be statistically significant. Pearson chi-square test value p = 0.022 (p<0.05)

Fig. 6. Bar graph showing comparison of responses between different age groups and female subjects overall experience after hot water intake during menstruation. X-axis represents the age groups(12-17, 18-22 , 22-27,above 30) of the female subjects. Y-axis represents the number of responses for overall experience after hot water intake. (green -better relief. Bluegood relief) Subjects of the age group 18-22 yrs had good relief from menstrual cramps after
hot water intake compared to the other age groups and the association was found to be statistically significant. Pearson chi-square value p= 0.015 (p<0.05) Female subjects experienced positive results after hot water intake [40]. It relieved menstrual cramps [41]. Hot water is usually better for cramps [42]. Drinking hot water can reduce bloating during your period and alleviate some of the pain it causes [43]. Also, drinking hot water can increase blood flow throughout your body and relax your muscles [43,44]. This can lessen cramps caused by uterine contractions.

LIMITATIONS OF THE STUDY
The limitation of study includes only students of age group 12-30 years were included in the study. This population does not represent the total female population. But this survey reported that overall relief from menstrual cramps was obtained after hot water intake.

CONCLUSION
The study concluded that the majority of the female subjects had a regular habit of taking hot water and experienced an improvement of mental health and cramps during menstruation. Drinking hot water can reduce bloating and alleviate menstrual cramps. Also increases blood flow throughout your body and relaxes the contraction of uterine muscles. Women suffering from cramps are encouraged to take hot water instead of analgesics which may cause side effects.

ETHICAL APPROVALS
We conducted our research after obtaining proper IEC approval.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).