Among university students, primary dysmenorrhea is highly prevalent, and its symptoms significantly interfere with academic performance, concludes a study by investigators from the Institute of Health Sciences of the Autonomous University of the State of Hidalgo, Mexico, that was published in Enfermería Clinica.
Dysmenorrhea is chronic, cyclical pelvic pain associated with menstruation. It is usually a cramp in the lower abdomen that occurs just before or during menstruation and can cause nausea, vomiting, headache, fatigue, and dizziness. Depending on its intensity or severity, the pain can be just as much of a problem as surgical pain. It is called primary dysmenorrhea when a pathology associated with pain has not been identified; it is called secondary dysmenorrhea when it is related to an identified cause.
Dysmenorrhea is highly prevalent. Worlwide, it has been estimated to affect more than two thirds of women (70.8%) who report menstrual pain, regardless of economic status and geographic location, so it should be considered a public health problem. The prevalence of dysmenorrhea in the Mexican population has been reported to be between 28% and 90%.
Menstrual disorders cause uncomfortable pain that can lead to inability (loss of functions and activities), disability (alteration of social role), and impaired quality of life. Dysmenorrhea has been shown to have a significant effect in reducing participation in academic activities and affecting school performance. Frequent episodes of absenteeism can lead to poor school performance, as well as dropping out and reduced educational achievement, which can have long-term consequences for gender equality.
Prevalence, Severity, Impact
The purpose of the current study was to determine the prevalence of primary dysmenorrhea and its severity and impact on the academic performance of university students.
A questionnaire was given to 2154 women between the ages of 18 and 33 years from seven university courses at the Institute of Health Sciences of the University of Hidalgo between August 2019 and March 2020. Dysmenorrhea, a “painful menstruation during the previous three months,” requires medical examination. Women with degenerative diseases and secondary dysmenorrhea were excluded from the study. The degree of pain was assessed with a visual analogue scale. Researchers also solicited information about demographics, menstrual cycle patterns, changes in daily activities, concentration on school activities, and absenteeism due to menstrual pain.
Among the participants, 78.9% reported experiencing dysmenorrhea; of these, 91% experienced moderate to severe pain.
An association was found between dysmenorrhea and long cycles (>30 days), long menstrual phase (>5 days), and large amount of menstrual flow, as well as with alcohol consumption. Most women (90.4%) reported that dysmenorrhea limited their daily activities in 4.4 ± 3.3 menstrual cycles per year, and 37% reported school absenteeism in 2.6 ± 2.1 menstrual cycles per year. Moreover, 91.5% reported inability due to symptoms for between 30 minutes and 6 hours per cycle, and 71.7% indicated an increase in symptoms in periods of great stress.
Only 28.4% of the young women consulted a doctor because of menstrual pain.
According to the authors, women with dysmenorrhea should receive educational therapy that includes drug prescription, adjuvant treatments, and risk factors.
Seeking the Cause
Mariana Robles, MD, a gynecologist at the Women Caring for Women clinic in Mexico City, who did not participate in the research, pointed out that the main contribution of this project is its calling attention to the experiences of menstruating women with regard to its influence on academic and social performance. “Strategies are needed to reduce the impact on our work and educational spaces, based on scientific evidence. We women did not invent this. The impact is real.”
Robles highlighted that medical staff tend to minimize the statements of their patients regarding the pain they suffer during menstruation. “There is a deficit in the treatment of women when we have a pain complaint. Studies show a decrease in the incidence of analgesic prescriptions for women, compared with men, when pain is manifest. It seems very important to me that the patient be believed and that an objective study be done where it is not taken for granted that because of being a woman, because of the size of the body or because of age, the pain is normal.
“It is also important that the symptoms not only be annihilated with analgesics. Since patients cannot live with drugs at every menstruation, the cause must be sought. This requires awareness of the different pathologies that could lead to dysmenorrhea. We must be diligent in the different diagnostic possibilities without bias of any kind,” said Robles.
Another factor that affects the high prevalence of dysmenorrhea is the normalization of menstrual pain in society, which is reflected in the low percentage of women with dysmenorrhea who seek medical care, even if the symptoms are severe and disabling. It also leads to the use of home remedies and self-medication, which can be mistaken.
Robles says that the feminist perspective is important in the training of medical staff. “If there is a feminist approach in training, it is easier to make visible and focus on women when a health aspect is attended to, not only on dysmenorrhea. The fact that there are adequate sources of information giving the correct perspective could enrich the medical knowledge that the patient will be able to access.”
The study did not receive any specific funding from financial institutions in the public, commercial, or nonprofit sectors. Robles has disclosed no relevant financial relationships.
This article was translated from the Medscape Spanish edition.
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