Association of menstrual pattern with lifestyle factors among female medical students

Garima Namdev; Sabiha Naz

doi:10.4103/mjmsr.mjmsr_33_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 12 | Issue : 2 | Page : 75-79

Association of menstrual pattern with lifestyle factors among female medical students

Garima Namdev¹, Sabiha Naz²
¹ Department of Community Medicine, MIMS and R, Bhopal, Madhya Pradesh, India
² Department of Biochemistry, MIMS and R, Bhopal, Madhya Pradesh, India

Date of Submission	05-Aug-2021
Date of Acceptance	18-Sep-2021
Date of Web Publication	28-Feb-2022

Correspondence Address:
Dr. Garima Namdev
Ganga Ashram, Near District Hospital, Sehore - 466 001, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/mjmsr.mjmsr_33_21

Abstract

Introduction: Menstrual disorders are more frequently observed among young females, especially medical students nowadays. Various lifestyle factors such as frequent consumption of fast foods, dietary habits, physical exercise, and yoga practicing play a very great role in alteration of menstruation pattern. All of these variables are affected by weight gain which is determined by body mass index (BMI), which itself affect menstrual pattern. Aims and Objectives: The aim of this study was to determine the association of menstrual pattern with lifestyle factors and BMI among medical students. Materials and Methods: A cross-sectional observational study was done among sixty undergraduate female medical students with the help of pretested and predesigned questionnaire consisting of menstrual pattern, premenstrual syndrome (PMS), and dysmenorrhea along with details about lifestyle factors. Anthropometric measurements such as weight, height, and BMI were also taken. Chi-square test was applied to test the association between menstrual pattern and lifestyle factors. Results: Out of total, 60% of students had regular cycle, 63% had dysmenorrhea, and 75% possess PMS. Majority of obese (65.2%) students had irregular cycle and 52.1% suffered from dysmenorrhea. Maximum 91% and 77.4% of students had regular cycle practicing yoga and physical exercise, respectively, whereas 86.2% of students suffered from PMS among those not exercising regularly. All of these findings were found statistically significant. Conclusion: More than half of students possess regular cycle. Overweight and obesity were found to be associated with irregular menstrual cycle and dysmenorrhea. Lifestyle factors such as yoga practicing, frequent consumption of fast foods, and regular physical exercise affect menstrual pattern in the present study.

Keywords: Body mass index, dysmenorrhea, fast foods, menstruation, premenstrual syndrome, yoga

How to cite this article:
Namdev G, Naz S. Association of menstrual pattern with lifestyle factors among female medical students. Muller J Med Sci Res 2021;12:75-9

How to cite this URL:
Namdev G, Naz S. Association of menstrual pattern with lifestyle factors among female medical students. Muller J Med Sci Res [serial online] 2021 [cited 2023 Jun 4];12:75-9. Available from: https://www.mjmsr.net/text.asp?2021/12/2/75/338499

Introduction

Menstruation is a fundamental physiological phenomenon of normal sexual and reproductive function.^[1] It is an important indicator of women's reproductive health and her endocrine function.^[2],[3] Abnormal menstrual pattern is frequently observed among young females. It might vary in interval, duration of flow, or quantity of blood flow with different conditions named amenorrhea, oligomenorrhea, heavy menstrual bleeding, frequent menstrual cycles, irregular cycle, pain, and premenstrual symptoms.^[4],[5]

Menstruation disorders are commonly observed among young adolescent girls which is one of the leading causes of academic absenteeism.^[6],[7] Out of them, dysmenorrhea and premenstrual symptoms are the most common disorders found. Medical students are reported to be under constant academic stress which may result in menstrual disorders in female students.^[8],[9],[10]

Few variables such as body mass index (BMI), dietary habits, physical exercise, yoga, and psychological stress can affect menstrual pattern.^[11] Many studies have shown the association between menstrual disorders and lifestyle.^{[12],[13],[14]} Early interventions at etiological level such as BMI, dietary habits, physical exercise, and psychological stress may prevent menstrual disorders.^[1] These factors need to be studied which may modify the risk of developing menstrual disorders.

Therefore, the present study was designed with an aim to understand the association of menstrual pattern with these lifestyle factors such as BMI, dietary habits, physical exercise, yoga practicing, and frequent consumption of fast foods.

Objectives

To study the menstrual pattern of study subjects
To study the association of menstrual pattern with BMI and lifestyle factors.

Materials and Methods

The present cross-sectional study was carried out on 1^st-year female medical students studying at Mahaveer Institute of Medical Sciences and Research, Bhopal. Total sixty female students were enrolled for the study willingly. The purpose of the study was already explained to students, and written informed consent was taken.

After taking ethical approval from the Institutional Committee, data were collected with the help of a predesigned, prestructured questionnaire consisting of menstruation pattern, premenstrual syndrome, dysmenorrhea, and various aspects of lifestyle factors. Menstrual pattern consists of cycle regularity, frequency of bleeding, duration of bleeding, and blood flow pattern. Premenstrual syndrome (PMS) is defined as symptoms experienced just a few days before the menstruation started such as abdominal pain, backache, nausea, vomiting, headache, flatulence, diarrhea, and feeling of heaviness, tenseness, emotional irritability, acne, and breast tenderness.

All eligible participants were subjected to anthropometric measurements including height and weight on the same day of the study. The weight was measured in kilogram, without footwear using a regularly standardized weighing machine having a precision of 0.1 kg. Checks on the scale were made routinely before recording the weight of each student. The height was also taken barefooted in centimeter using standard measuring tape fixed vertically and care was taken to see that there was no fold or tilting to any side. Height was recorded to the nearest 1 cm.

According to the WHO, BMI for South East Asians^[15] is an important tool to assess the nutritional status of adults and is calculated as weight in kg/height in m². As per this criterion, study subjects were classified as underweight, normal weight, overweight, and obese as BMI <18.5, 18.5–23, 23–27.5, and >27.5 kg/height in m², respectively.

The collected data were analyzed by using SPSS (version 23.0) (23 student version, Armomk, New York, USA). Association between all qualitative variables was observed by using Chi-square test (P < 0.05).

Results

The present study was done with the objective to find out menstrual pattern and its association with BMI and lifestyle factors. The mean age at menarche among study subjects was 12.3 years.

[Table 1] depicts that out of total, 60% of students have regular cycle, 63% suffer from dysmenorrhea, and 75% experience features of PMS.

Table 1: Menstrual pattern of study subjects (n = 60)

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Out of obese, 65.2% and, out of overweight, 46.7% of students have irregular cycle. Out of normal weight students, majority (94.6%) have regular cycle, whereas out of underweight, 75% follow regular cycles. It is found highly statistically significant (P = 0.001). About 52.1% of obese and 60% of overweight students suffer from dysmenorrhea which is not statistically significant [Table 2].

Table 2: Association of body mass index with menstrual cycle and dysmenorrhea (n=60)

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On analyzing lifestyle factors, it is found that 91% students had regularity in their menstrual cycle among those who practicing yoga regularly (P = 0.02), whereas 45.5% had PMS in this which remains not significant [Figure 1] and [Figure 2].

Figure 1: Association of lifestyle factors with cycle regularity (n = 60)

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Figure 2: Association of lifestyle factors with premenstrual syndrome (n = 60)

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About 31.8% of students were found to have irregular menstrual cycle (P = 0.04) and approximately 82% have PMS among those who frequently consume fast foods. Out of those students having mixed diet, 44.4% possess irregular cycle, whereas out of students taking strict vegetarian diet, 78.6% have PMS. It is not found statistically significant [Figure 1] and [Figure 2].

About 58.6% of students reported irregular cycle among those who do not exercise regularly. It is found highly statistically significant (P = 0.004). In contrast, 86.2% have PMS among those who do not exercise regularly and 64.5% have PMS among those who do exercise regularly which is found significant (P = 0.05) [Figure 1] and [Figure 2].

In the present study, 72.8% of students found no features of dysmenorrhea out of those who practicing yoga regularly, whereas 43.6% of students who take fast foods frequently, have dysmenorrhea. Out of those students having mixed diet, 61.1% of students suffer from dysmenorrhea. All of these findings are not significant [Figure 3].

Figure 3: Association of lifestyle factors with dysmenorrhea (n = 60)

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Discussion

The mean age of attainment of menarche in the present study is 12.3 years. Various studies have shown almost similar age of attainment of menarche such as 12.8 years,^[1] 12.6 years (Lakkawar et al.),^[16] 12.1 years (Desai et al.),^[11] 12.9 years (Karki et al.),^[17] and 12.5 years (Singh et al.).^[18]

In the present study, it is observed that 60% of students had regular cycles, whereas 40% had irregular cycles. Other studies done by Sreelakshmi et al,^[1] Desai et al,^[11] and Karki et al^[17] reported irregular cycles 38%, 36%, and 35.7%, respectively, which support our study but Verma et al.^[19] contradicts with our results with only 11.48% having irregular cycle.

In the present study, out of total, 30% of students have normal amount of menstrual flow, 55% scanty flow, and 15% heavy blood flow. These findings are almost similar to a study done by Sangeeta et al.^[11] with normal flow in 23.9%, scanty flow in 74.8%, and heavy flow in 1.25% of students. Few studies oppose these findings like Verma et al.^[19] observed 86.34%, 6.6%, and 7.1% while Sreelakshmi et al.^[1] reported 81%, 5%, and 14%, respectively.

The abovementioned studies are showing differences mainly due to environmental, geographical, nutritional, and lifestyle factors in study population.

Majority of students (95%) had normal length of menstrual cycle of 26–31 days with only 10% have length more than 31 days and very few 5% of students have length <25 days. Few studies support our findings such as Verma et al.^[19] (81.4%, 18.6%, and 2.1%), Karki et al.^[17] (86%, 10%, and 4.1%), and Sreelakshmi et al.^[1] (66%, 20%, and 14%), respectively.

Premenstrual syndrome is a multifactorial syndrome characterized by manifestation of psychological, physical, and behavioral symptoms. The typical symptoms include irritability, lack of concentration, mood swings, depression, stress, anxiety, abdominal bloating, breast tenderness, and fatigue.

In the present study, 75% have premenstrual symptoms and majority of them have abdominal pain, irritability, and mood swings. Excessive fatigue and lack of concentration are also reported by few 27% of students. Sreelakshmi et al.^[1] reported that 75% of students had PMS which is exactly the same observation with the present study. Other studies like Karki et al.^[17] found 67.3%, Verma et al.^[19] 85.24% and 76% by Desai et al.^[11] Few studies reported very less prevalence such as Rumana et al.^[20] reported 31.1% and Raval et al.^[21] obtained 18.4%. Few studies reported very less prevalence such as Rumana et al.^[20] reported 31.1% and Raval et al.^[21] obtained 18.4%. Slight variation in prevalence of PMS is because of variations in sample size, methodology, regional variation, and selection criteria of students in the study.

Dysmenorrhea is also an important sign of functional disturbance in the hypothalamic–pituitary–ovarian axis. Recently, it became an important public health problem among female population. It is characterized by localized pain in the abdominal inferior quadrants. In the present study, the prevalence of dysmenorrhea is 63% which is comparable with other studies such as 57% by Sreelakshmi et al.,^[1] 60.66% by Verma et al.,^[19] and 53.9% by Arpana et al.^[22] whereas Sangeeta et al.^[11] reported much higher prevalence (82%) of dysmenorrhea.

BMI with cycle and dysmenorrhea

On analyzing BMI with menstrual cycle regularity, a highly statistically significant association was found (P = 0.001), but with dysmenorrhea, it was not significantly associated. Sreelakshmi et al.^[1] found a significant association with both features whereas Karki et al.^[17] observed a significant association with BMI and cycle regularity with P < 0.05.

Arpana et al.^[22] reported a significant association of BMI with dysmenorrhea with P = 0.0043 which is in contrast with our findings.

Lifestyle factors with cycle regularity, premenstrual syndrome, and dysmenorrhea

On analyzing between exercise and PMS, a significant association was found (P = 0.05), but Verma et al.^[19] found no association between these variables.

There is no significant association found between fast food and PMS. It is a similar finding with a study by Verma et al.,^[19] but Nirmala et al.^[16] found a significant association in their study.

A significant association was found between fast food and cycle regularity (P = 0.04) but not with dysmenorrhea. Other studies such as Fujiwara et al.^[23] and Nirmala et al.^[16] reported a significant association between dysmenorrhea and frequent consumption of fast food.

In the present study, a statistically significant association was found between yoga and cycle regularity (P = 0.02). These findings are opposite to the findings obtained by Sangeeta et al.^[11] in which no significant association was found. It might be due to taking different parameters for measuring yoga practicing and physical exercise in various studies.

Conclusion

Majority of medical students complain of having irregular cycles and dysmenorrhea in the present study. About one-third of students suffer from PMS. Obese students are more prone to have irregular cycle which is a statistically significant finding. Frequent consumption of fast foods and lack of regular physical exercise play a very great role in having irregular cycles as well as PMS. Although, dysmenorrhea is not affected by any lifestyle factors in our study.

Recommendations

Abrupt changes in lifestyle factors induce certain hormonal changes which are responsible for abnormal menstrual pattern among female medical students. Comprehensive education programs should be conducted regularly on lifestyle modifications such as regular physical exercise, practicing yoga, and promoting healthy eating habits. Students should be motivated to avoid excessive weight gain for preventing future health-related risks.

Timely diagnosis and early management of menstrual disorders can help medical students to lead a healthy life so that they can do their duties in a sincere way and prove to be a healthier clinician for the community.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sreelakshmi U, Bindu VT, Subhashini T, Saritha K. Impact of dietary and lifestyle choices on menstrual patterns in medical students. Int J Reprod Contracept Obstet Gynecol 2019;8:1271-6.
2.	American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care; Diaz S, Laufer MR, Breech LL. Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Pediatrics 2006;118;2245.
3.	Kulie T, Slattengren A, Redmer J, Counts H, Eglash A, Schrager S. Obesity and women's health: An evidence-based review. J Am Board Fam Med 2011;24:75-85. doi:10.3122/jabfm. 2011.01.100076.PMID:21209347.
4.	Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod 2007;22:635-43.
5.	Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol 2007;20:3-12.
6.	Gagua T, Tkeshelashvili B, Gagua D. Primary dysmenorrhea -leading problem of adolescent population of Tbilsi, Georgia and risk factors. J Turk Ger Gynecol Assoc. 2012;13:162-8.
7.	Shete JS, Warbhe P, Radmini D. Class absenteeism among female medical students: A study reflecting its association with common menstrual disorders. Int J Recent Sci Res 2015;6:5307-09.
8.	Nisar N, Zehra N, Haider G, Munir AA, Sohoo NA. Frequency, intensity and impact of premenstrual syndrome in medical students. J Coll Physicians Surg Pak 2008;18:481-4.
9.	Issa BA, Yussuf AD, Olatinwo AW, Ighodalo M. Premenstrual dysphoric disorder among medical students of a Nigerian university. Ann Afr Med 2010;9:118-22. [PUBMED] [Full text]
10.	Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6.
11.	Desai SS, Gohil P, Desai M, Sawant VD. To study the impact of lifestyle over menstrual pattern in medical students. Indian J Obstet Gynecol Res 2019;6:159-64.
12.	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.
13.	Karout N, Hawai SM, Altuwaijri S. Prevalence and pattern of menstrual disorders among Lebanese nursing students. East Mediterr Health J 2012;18:346-52.
14.	Anandha Lakshmi S, Saraswathi I, Saravanan A. Ramamchandran C. Prevalence of premenstruak syndrome and dysmennorhea among female medical students and its association with college absenteeism. Int J Biol Med Res 2011;2:1011-16.
15.	WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
16.	Lakkawar NJ, Jayavani RL, Arthi PN, Alaganandam P, Vanajakshi N. A study of menstrual disorders in medical students and its correlation with biological variables. Sch J App Med Sci 2014;2:3165-75.
17.	Karki PK, Gupta R. Menstrual pattern and disorders among female students of Kathmandu medical college. Int J Contemp Med Res 2017;4:1-3.
18.	Singh A, Kiran D, Singh H, Nel B, Singh P, Tiwari P. Prevalence and severity of dysmenorrhea: A problem related to menstruation, among first and second year female medical students. Indian J Physiol Pharmacol 2008;52:389-97.
19.	Verma I, Gaurika J, Dinesh S, Menstrual problems in undergraduate medical students: A cross-sectional study in a medical college of North India. J South Asian Feder Obst Gynae 2020;12:85-90.
20.	Rumana AM, Sudharani M, Kallupurackal SJ, Ramya V, Nagendra GM, Suryakantha AH. Prevalence of premenstrual syndrome among medical students. Natl J Community Med 2017;8:292-4.
21.	Raval CM, Panchal BN, Tiwari DS, Valu AU, Bhatt RB. Prevalance of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujrat. Indian J Psychiatry 2016:58:164-70.
22.	Arpana A, Lokeshwari K, Rashmi BM. Menstrual characteristics and association of body mass index with dysmenorrhoea among the medical students in South India. Indian J Obstet Gynecol Res 2019;6:155-8.
23.	Fujiwara T, Sato N, Awaji H, Sakamoto H, Nakata R. Adverse effects of dietary habits on menstrual disorders in young women. Open Food Sci J 2007;1:24-30.