stress and menstruation

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Pak J Med Sci 2010 Vol. 26 No. 3 www.pjms.com.pk 619

Original Article

ATTITUDES TOWARDS MENSTRUATION

AMONG YOUNG WOMENFarhana Anjum1, Nishat Zehra2, Gulfareen Haider 3,

Shazia Rani4, Ambreen Amna Siddique5, Aftab Afroz Munir 6

ABSTRACTObject ive: To determine knowledge and different attitudes towards menstruation among young

women.

Methodology: A descriptive study was carried out at Isra University Hyderabad and villages

around the Isra University Hospital, from 1st April 2005 to 31st March 2006. Five hundred women

from villages around Isra University Hospital and students of Isra University Hyderabad were

selected by non-probability sampling who were of menstruating age irrespective of their

marital and literacy status. Women with menstrual irregularities or any other gynecological or

psychological problem were excluded. All information was recorded on a questionnaire Performaand analyzed on SPSS version 15.0.

Result s: Out of 500 participants, 438 (87.6%) regarded menstruation as a natural process;

whereas, 62 (12.4%) perceived it as a disease and curse from God. Out of 500, 415 (83%) of the

participants responded that the menstruation process is good for health; however, 85 (17%) felt

this process not healthy for themselves.

Conclusion: Ignorance, false perceptions and unsafe practices regarding menstruation are not

uncommon among young women, hence the importance of health education particularly of

women living in rural areas. Then they will be better prepared emotionally to experience

menstruation and will have less negative reactions.

KEY WORDS: Menarche, Menstruation, Attitudes, Young women.

Pak J Med Sci July - September 2010 Vol. 26 No. 3 619-622

How t o c i te t h is ar t i c le:

Anjum F, Zehra N, Haider G, Rani S, Siddique AA, Munir AA. Attitudes towards menstruation

among young women. Pak J Med Sci 2010;26(3):619-622

1. Dr. Farhana Anjum, FCPS

2. Dr. Nishat Zehra, FCPS

3. Dr. Gulfareen Haider, FCPS, M.S

4. Dr. Shazia Rani, FCPS

5. Dr. Ambreen Amna Siddique , FCPS

6. Dr. Aftab Afroz Munir, FRCOG

1-3: Department of Obstetrics & Gynecology,

Isra University Hospital Hyderabad

Correspondence:

Dr. Farhana Anjum,Senior Registrar, Dept. of Obstetrics & Gynecology,

Isra University Hospital Hala Road

Hyderabad Sindh, Pakistan

Email: [email protected]

* Received for Publication: September 7, 2009

* 1st Revision Received: January 20, 2010

* 2nd Revision Received: April 24, 2010

* Final Revision Accepted: April 26, 2010

INTRODUCTION

Menstruation is a phenomenon unique to thefemale1 and it defines the start and end of reproductive potential.2 Menstruation is a peri-odic and cyclic shedding of endometrium inresponse to the cyclic production of estrogenand progesterone from the ovaries, under the

influence of gonadotrophin releasing hormonefrom the hypothalamus, follicle stimulatinghormone and leutinizing hormone frompituitary gland.3 So intact hypothalamus-pituitaryovarian axis is essential formenstruation.

Concepts and attitudes towards menstruationmay vary among cultures4 and play an



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Farhana Anjum et al.

important role in the perception of menstrualdistress.5 Monthly menstruation has been social-ized and mythologized into being the unques-tioned natural, normal, and beneficial state forwomen.6 It is therefore no wonder that through-

out history, menstruation was assigned rolesthat ranged from defining a woman’s status andsocial role to being seen as a curse that woman-kind had to endure. No aspect of female physi-ology seems to be as a shrouded in mystique asis that of a women’s menstrual cycle. Althoughit is believed a woman’s cycle is influenced bylife style, activity level, nutrition, and aging theextent to which these factors are interactive isnot known.7

Menstrual cycles are considered indicators of women’s health more generally,8 and since men-

struation is not one discrete event but rather acycle of events across a life time, it is importantto consider menstruation across time.9 Attitudestowards menstruation may adversely affectwomen’s body image, perception of diseasecausation, diet, willingness to take medication,contraceptive use, and the ability to plan preg-nancies. As menstruation is a distinctive signof both reproductive potential and sexualmaturity, we hypothesized that the attitudes thewomen have towards menstruation will

correlates with their sexual attitudes, destinesand behavior.10

Discussing menstruation with peers wasrelated only to the degree to which menstrua-tion is perceived as a natural event, indicationthat sharing menstrual experiences enhancedthe perception of these experiences as natural.11

The barrier to unlocking of cultural and psy-chosocial taboos is a prevailing misunderstand-ing and at times ignorance of menstruationmeans to the individual woman and how herneeds and concerns can be best managed.

Woman may feel self conscious during theirmenses because they view menstruation as asocial stigma.12 Understanding the cultural andmedical aspects of menstruation in our societyis not common and talking about menstruationis considered as a taboo. As one of the problemin Pakistani Muslim women is because of socioeconomic stigma, the woman neither

wants to disclose their problem nor they reachto gynecologist so they continue to experienceproblem like excessive blood loss resulting insever anemia.13

As compared to western society, our adoles-

cent girls are not educated well in time for thisimportant change in their lives, and they canreact to it in a different way.14 In our society ahost of mixed messages about menstruation aregiven to prepubertal girls. Available informa-tion is often contradictory in that it congratu-lates girls on their entry into womanhood whileat the same time suggest that “it” be keptsecret.15 Rationale of this study was by know-ing the attitudes towards menstruation inyoung women, will enable health care provid-

ers to educate young women and assist them inmaking healthy choices.

METHODOLOGY

The study was conducted among youngwomen. Study cases were taken from thevillages around the Isra University Hospital andthe students of Isra University Hyderabad wascarried out from 1st April 2005 to 31st March 2006.Total 500 young women of menstruating ageirrespective of their literacy rate and marital

status were recruited for administering ques-tionnaire in this study. Convenience (Non-prob-ability) sampling technique was employed toenroll women in the study.

Women with menstrual irregularities andwith other gynecological or psychological prob-lem were excluded from study. Patient infor-mation was collected on predesigned proformaregarding age, marital status, address, occupa-tion and educational status of women andknowledge and attitudes toward menstruation

was assessed. All analyses were conducted byusing the Statistical package for social scienceSPSS (Release 15.0, standard version, copyright© SPSS; 1989-02). Age was presented by Meanand standard deviation. Relevant descriptivestatistics; frequency and percentage were com-puted for presentations of qualitative out putresponse variables.



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Menstruation among young women

RESULTS

The data was analyzed for 500 for the studyparticipants who comprised of young women.The mean + SD age is found to be 23.94 + 5.03years; whereas the median, mode and range

were 22, 20, & 24 years respectively. The maxi-mum age of participants in this study was 38years while the minimum age was 14 years. Thedescriptive analysis of socio-demographic vari-ables was done to describe the characteristicsof our study population. Two hundred and fifty(50%) women had monthly household incomemore than 10,000 rupees. Among the study par-ticipants 262 (52.4%) were married; whereas, 238(47.6%) were unmarried (Table-I). Regardingthe locality of the participants that 249 (49.8%)

belongs to urban area while 251 (50.2%) belongsto rural area. Among 500 study participants only5.2% were working whereas, 94.8% of thewomen who had no occupation. The mean +SD age at the time of menarche was found to be12.82 + 1.15 years; whereas the median, modeand range were 13, 12, & 7 years respectively.The maximum age at the time of menarche of participants in this study was 16 years while

the minimum age at menarche was 09 years.Table-II shows the menstrual characteristics of study participants. About the emotionalresponse at menarche, most of the participants266 (53.2%) shared the feelings of being embar-

rassed. Most of the females 191(38.2%) reportedthat they avoid Sex, 82 (16.4%) avoided bath, 85(17%) avoided physical activity during men-strual period. Around 387 (77.4%) females re-sponded that they don’t take special food dur-ing menstruation; whereas, other 113 (22.6%)reported that they take soups, fruits and veg-etables. Two hundred sixty five (53%) of thestudy participants reported that they don’tavoid any food during menstruation process;however, others 235 (47%) reported that theyavoid meat, eggs, prickle, fish, milk, yogurt, lady

finger and cold drinks in this period. Respon-dent were inquired about the effect of menstrua-tion on daily physical activity. They reportedthe extent of effect as nil, mildly, moderately,and severely as 248 (49.6%), 168 (33.6%), 73(14.6%), and 11 (2.2%) respectively.

Table-I: Socio demographic data.

Variables No. of Patients Percentage (%)

Age (Years)< 20 250 50

21-30 200 40

>30 50 10

Socioeconomic status.

Monthly household

income (PKR)

Poor (<5000 ) 202 40.4

Middle 48 9.6

(5000-10,000)

Upper 250 50

(>10,000)Educational Status

Nil 298 59.6

Primary 8 1.6

Middle 2 0.4

Metric 3 0.6

FA/FSC 5 1

Graduate 184 36.8

Table-II: Menstrual Characteristics.

Information Regarding No. of Percentage Menstruation Participants (%)

No information 116 23.2

Mother 276 55.2Sister 66 13.2

Teacher 05 1

Literature 05 1

Others 32 6.4

Perception of Menstruation

Natural process 438 87.6

Others 62 12.4

(Disease & curse from God)

Menstruation Good For Health

Yes 415 83

No 85 17 Is Menstruation necessary for women?

Yes 393 78.6

No 107 21.4

Opinion About Cessation of

Menstruation with Drugs

Yes 20 04

No 480 96



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Farhana Anjum et al.

DISCUSSION

This study showed that there are number of practices, conceptions and misconceptionsamong young women that also have beenreported by other studies conducted in differ-ent countries.

About the emotional response at menarche,most of the participants 266 (53.2%) shared thefeelings of being embarrassed, while in a study by Tang CS et al16 showing the similar resultsin which participant’s emotional reactions tomenarche were largely negative, with almost85% reporting feeling annoyed andembarrassed.

Regarding the question of the perceptionabout the phenomena of menstruation, 438

(87.6%) of the females regarded it as a naturalprocess of cleaning but Mc Master et al17 foundthat only 12% of women consider menses as tocleanse the system.

We found that different practices whichwomen avoid during the menses include avoid-ing sex by most of the females 191 (38.2%), 82(16.4%) avoided bath and 85 (17%) avoidedphysical activity during menstrual period, whilestudy by Snow LF18, showed 37.5% thoughtwater and cold air should be avoided during

menstruation.CONCLUSION

It is concluded from this study that educationabout menstruation needs to start at an earlyage, before girls reach puberty. When taught beforehand, girls are better prepared emotion-ally for the experience of menstruation and havefewer negative reactions. They also are betterable to care for themselves duringmenstruation.

REFERENCES

1. Drakshayani Devi K, Venkata Ramaiah P. A study onmenstrual hygiene among rural adolescent girls.Indian J Med Sci 1994;48:139-43.

2. Kubba A. Menstruation, cultural attitudes andmedical aspects: An over view. Gynaecol Forum2003;8:3-6.

3. Chohan A. Puberty, menstruation, and ovulation. In:Fundamentals of Gynaecology. Lahore MARPublications 2000:15-20.

4. Lu ZJ. The relationship between menstrual attitudesand menstrual symptoms among Taiwanese women.

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14. Dan AJ. What have we learned? An historical view of the society for menstrual cycle research. NWSA J

2004;16:45-55.15. Beausang CC, Razor AG. Young western women’s

experiences of menarche and menstruation. HealthCare Women Int 2000;21:517-28.

16. Tang CS, Yeung DY, Lee AM. Psychological correlatesof emotional responses to menarche among Chineseadolescent girls. J Adolesc Health 2003;33:193-201.

17. McMaster J, Cormie K, Pitts M. Menstrual andpremenstrual experiences of women in a developingcountry. Health Care Women Int 1997; 18:533-41.

18. Snow LF, Johnson SM. Modern day menstrualfolklore: Some clinical implication. J Am Med Assoc1977;237:2736-9.

Author’s Contribution:NZ conceived, designed & did statisticalanalysis & manuscript writing GF and SR didediting of manuscript AAM did review & finalapproval of manuscript.

stress and menstruation

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