A STUDY TO EFFECTIVENESS OF PHYSICAL EXERCISES ON MENSTRUAL PAIN PERCEPTION AMONG ADOLESCENT GIRLS WITH PRIMARY DYSMENORRHEA AT SELECTED
SCHOOL IN MADURAI
M.Sc (NURSING) DEGREE EXAMINATION
BRANCH – IV COMMUNITY HEALTH NURSING
COLLEGE OF NURSING
MADURAI MEDICAL COLLEGE, MADURAI - 20
A dissertation submitted to
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI – 600 032.
In partial fulfillment of requirement for the degree of
MASTER OF SCIENCE IN NURSING
JULY 2011
CERTIFICATE
This is to certify that dissertation entitled “EFFECTIVENESS OF PHYSICAL EXERCISES ON MENSTRUAL PAIN PERCEPTION AMONG ADOLESCENT GIRLS WITH PRIMARY DYSMENORRHEA AT SELECTED SCHOOL IN MADURAI .” is submitted to the faculty of Nursing the TamilNadu Dr. M.G.R. Medical University, Chennai by MS. LAVANYA .T in partial fulfillment of requirement for the degree of Master of Science in Nursing, Branch IV, Community Health Nursing under our guidance and supervision during the academic period from 2009-2011.
Dr. PRASANNA BABY M.Sc., (N), Ph.D., DEAN,
Principal, Madurai Medical College, College Of Nursing, Madurai-20.
Madurai Medical College, Madurai.
A STUDY TO EFFECTIVENESS OF PHYSICAL EXERCISES ON MENSTRUAL PAIN PERCEPTION AMONG ADOLESCENT GIRLS WITH PRIMARY DYSMENORRHEA AT SELECTED
SCHOOL IN MADURAI.
APPROVED BY DISSERTATION COMMITTEE ON:
PROFESSOR IN NURSING RESEARCH:
Dr. PRASANNA BABY M.Sc (N).,Ph.D Principal,
College of Nursing, Madurai Medical College, Madurai.
PROFESSOR IN CLINICAL SPECIALITY:
Mrs. S. JAHITHA ,M.Sc (N) Lecturer,
Dept of Community Health Nursing, College Of Nursing,
Madurai Medical College, Madurai.
MEDICAL EXPERT :
Dr.P. MANIMEGALAI ,MBBS, DCH.
Medical Officer, Urban Health Post, Munisalai,
Madurai.
A dissertation submitted to
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI, In partial fulfillment of requirement for the degree of
MASTER OF SCIENCE IN NURSING JUNE 2011
TABLE OF CONTENTS
CHAPTER TITLE PAGE NO
I INTRODUCTION
1.1 Need for the study 1.2 Statement of the problem 1.3 Objectives of the study 1.4 Operational definitions 1.5 Hypothesis
1.6 Assumption 1.7 Limitation
3 6 6 7 8 8 8
II REVIEW OF LITERATURE 2.1 Review of related literature 2.2 Conceptual framework
9 17
III METHODOLOGY
3.1 Research approach 3.2 Research design 3.3 Variables under study 3.4 Setting of the study 3.5 Population of the study 3.6 Sample
3.7 Sample size
3.8 Sampling technique
3.9 Criteria for selection of sample
3.10 Development and description of the tool 3.11 Testing of the tool
3.12 Pilot study
3.13 Procedure for data collection 3.14 Plan for data analysis 3.15 Protection of human subjects 3.16 Schematic representation of the research study
20 20 20 21 21 21 21 21 21 22 22 23 23 25 25 26
IV DATA ANALYSIS AND INTERPRETATION 27 V
VI
DISCUSSION
SUMMARY AND RECOMMENDATIONS 6.1 Summary
6.2 Conclusion 6.3 Implications 6.4 Recommendations 6.5 Limitations
50
54 56 56 58 59
BIBLIOGRAPHY 60
APPENDICES
LIST OF TABLES
TABLE NO TITLE PAGE NO
1. Distribution of subjects according to their demographic
variables 28
2. Distribution of subjects according to the Details of
menstruation 33
3. Description of subjects according to pre test menstrual
pain perception 38
4. Description of subjects according to post test menstrual
pain perception 40
5. Description of Subjects According to pre test menstrual
Pain perception 43
6. Description of Subjects According to post test menstrual
pain perception 45
7. Comparison of Mean Pre and Post test menstrual pain
perception of subjects 47
8. Association between pretest pain perception and
Demographic variables of Subjects 48
9. Association between the post test menstrual pain
perception with the details of menstruation 49
LIST OF FIGURES
FIGURE NO TITLE PAGE NO
1 Conceptual Framework Based on Ernestine Wiedenbach’s
Helping Art of Clinical Nursing Theory (1970) 19 2 Schematic representation of the data collection procedure 26 3
Distribution of subjects according to their Age 30 4 Distribution of subjects according to Type of family 30 5 Distribution of subjects according to their Food habits
31 6 Distribution of subjects according to the Family history of
dysmenorrhoea 31
7 Distribution of subjects according to Body mass index 32 8 Distribution of subjects according to Age at menarche
35 9 Distribution of subjects according to Days of menstruation
35 10 Distribution of subjects according to Type of material used for
menstruation 36
11 Distribution of subjects according to Previous remedies for
dysmenorrhoea 36
12 Distribution of subjects according to Support during
menstruation 37
13 Distribution of subjects according to pretest menstrual pain
perception 39
14 Description of subjects according to post test menstrual pain
perception 41
15 Comparison of the subjects according to their pretest and
posttest level of menstrual pain perception 42 16 Description of Subjects According to pre test menstrual pain
perception 44
17 Description of Subjects According to post test menstrual pain
perception 46
18 Comparison of Mean Pre and Post test menstrual pain
perception of subjects 47
LIST OF APPENDICES
APPENDIX TITLE A. Data collection tool (English)
B. Data collection tool (Tamil) C. Description of Intervention
D. Copy of Letter seeking permission to Conduct the Study
E. Copy of Letter seeking Content Validity F. Copy of Certificate of Content Validity G. List of Experts
LIST OF ABBREVIATIONS
S.NO. ABBREVIATIONS
1 WHO – World Health Organization 2 SP6 -- San Yin Jiao Point
3 VAPS -- Visual Analogue Pain Scale 4 PG -- Prostaglandin
5 USA -- United States Of America
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ACKNOWLEDGEMENT
Primarily, I submit my heartfelt thankfulness-gratitude in the feet of our CREATOR CARE TAKER-GOD ALMIGHTY for His fountain of blessings grace and nourishing me with His spirit of wisdom.
The real success of the work lies in its recognition .Even though they Didn’t know about the final fruit of this work the persons portrayed here backed up, supported, guided and given their shoulders for me as it pays much contribution.
Thank You is not at all sufficient for their matchless alms. But it is uttered with ultimate gratitude. The path will be pleasant when those companions are our beloved ones. I like to thank all my beloved ones who walk over through this long journey and made my work worthful.
I would like to express my deep and sincere gratitude to our Dr. Edwin Joe M.D,B.L Dean Madurai Medical College, Madurai, for granting me permission to conduct the study in this esteemed institution.
I express my heartfelt gratitude to Professor Dr.Prasanna Baby M.Sc (N)., Ph.D., Principal, College of Nursing, Madurai Medical College, Madurai who was always there to listen and to give advice. She is responsible for involving me in this thesis. She showed me different ways to approach research problem and need to be persistent to accomplish any goal. I hope that one day I would become as good an advisor to my students as madam has been to me.
This is my proud privilege to record my deep sense of gratitude and faithful thanks to Mrs.S.Poonguzhali M.Sc (N), Vice Principal, College of Nursing, Madurai Medical College, Madurai. I have been amazingly fortunate to have any advisor who gave me the freedom to explore on my own and at the same time guidance to recover when my steps faltered.
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I am grateful to Mrs.S.Jahitha M.Sc (N), Lecturer, Department of Community Health Nursing, College of Nursing, Madurai Medical College, Madurai for giving insightful comments and constructive criticism at different stages of my thesis, were thought provoking and they helped me to focus my ideas and achieve this grand task. I am deeply indebted for her extensive guidance and consultation, continued help, encouragement right from the selection of the problem to the conclusion of this study.
I would like to gratefully acknowledge the support of a very special individual Dr.P.Manimegalai, MBBS, DCH, Medical officer, Urban Health Post, Munichalai, Madurai. He helped me immensely by guiding me to complete this study. He mirrored back my ideas so that I hear them aloud, an important process to share this thesis paper. It is my long felt desire to express my heartiest gratitude to him for devoting his attention, time and support, which gave me an impetus to complete this study
My deep sense of gratitude is to the dissertation committee members for their judgment, valuable suggestions and healthy criticism.
I owe my sincere gratitude to experts Dr.Gopinath, MBBS., DPCP., Block Medical Officer, Govt Primary Health Centre, Samayanallur, Madurai, Dr.M.Gandhimathi, D.G.O, Medical Officer, Urban Health Post, Madurai who validated the content for tool. Their expert suggestions and wisdom are reflected in this study tool, which has added more light to this study.
Mrs. Juliet Sylvia M.Sc (N), Head of the Department of Community Health Nursing, Sacred Heart College of Nursing, Mr.Y. John Sam Arun Prabhu, Head of the Department of Community Health Nursing, C.S.I Jayaraj Annapackiyam College Of Nursing and also Mrs. Bharatha Sorubha Rani M.Sc (N), Reader, Matha College of Nursing, who are the ladder who lift me to high standards and key for presenting ideas by providing content validity for the tool used in this study and this content is focused with great light through their suggestions.
My heartful gratitude to Mr. Parthasarathi, statistician for his valuable suggestions in analyzing and interpreting the data.
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I feel a deep sense of gratitude to Librarian Mr. kalaiselvan, College of Nursing, Madurai Medical College for the source of computer searches and articles which made it possible to update the content.
I utilize this occasion as an opportunity to thank a special persons Chief Educational Officer, Head Mistress ,Lourdu Annai Girls Higher Secondary School for permitting me to perform this study in their institution.
I extent my thanks to All the Adolescent Girls who have participated in the study.
I deeply utter this hear felt thanks to my classmates, friends As they backed up, opened different doors of approach, thinking as they should be valued here.
Most importantly none of these would have been possible without the love and patience of my parents and my husband to whom this dissertation is dedicated to have been constant source of love, concern, support and strength all these years and for reminding me that research should always be useful and serve good purposes for all humankind.
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ABSTRACT
The present study is to identify the effectiveness of physical exercises on menstrual pain perception among adolescent girls with primary dysmenorrhea at selected school in Madurai. During the year 2010-11 in partial fulfillment of the requirement for the degree of MASTER OF SCIENCE IN NURSING at COLLEGE OF NURSING, MADURAI MEDICAL COLLEGE, MADURAI which is affiliated to THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI.
Objectives: 1) To assess the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea before giving physical exercises. 2) To determine the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea after giving physical exercises. 3) To compare the effectiveness of physical exercises on pain perception among adolescent girls with primary dysmenorrhea before and after giving physical exercises.4) To associate the post test level of menstrual pain perception among adolescent girls with primary dysmenorrhoea with selected demographic variables. Design: Quasi experimental, pre test and post test design. Setting: Lourdu Annai Girls Higher Secondary School, K.
Pudur, Madurai. Sample: 60 adolescent girls during menstruation were selected for the study. Conceptual Frame Work: Modified Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory (1970) was framed. Outcome Measures: Menstrual Pain perception level was measured of by using visual analogue pain scale. Intervention:
Physical exercise programme – 30 minutes;Warm up exercises: 10 minutes stretching – 5 repetitions
Toning exercises: 15 minutes stretching- 6 repetitions &Cool down exercises: 5 minutes – 2 repetitions. Results: Adolescent girls who had physical exercises during menstruation reported significant reduction on pain perception of 2.466 in post test than 5.266 in pre test. Conclusion: The result supported that physical exercises are very suitable and practicable therapy of non pharmacological measure of reduction in pain perception during menstruation. The findings suggest that physical exercises can be an effective, cost-free intervention for reducing pain and anxiety during dysmenorrhoea, and recommend its use for self-care of primary dysmenorrhoea.
Keywords:, primary dysmenorrhoea, anxiety, physical exercises, menstrual pain, nursing
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CHAPTER I INTRODUCTION
“IMPROVE WOMEN’S HEALTH- IMPROVE THE WORLD”
Women have been and continue to be the primary health care providers and decision makers for themselves and their families. Many women perform multiple roles including caring for the elderly relatives & young children. Also for women to function in this role, they themselves must remain healthy.
Adolescence is a crucial time for girls today and profoundly influences the women and mothers that they will become tomorrow. The behaviors’ developed during adolescence are often determined by the social and economic environment in which adolescents grow up. Today, these environments are too often neither safe nor supportive. Actions are needed to ensure that societies and their health systems respond appropriately to the health and development needs of adolescent girls. (World Health Organization 2009).
The term adolescence refers to the psychological maturation of the individual, whereas puberty refers to the point when reproduction is possible. Adolescence is the period of transition from childhood to adulthood usually between 13 and 18 years of age but sometimes extending until graduation from college. This period is characterized by a steady progression of physical, social, cognitive, psychological and moral changes. (Potter & Perry 2003).
Adolescence is a stressful developmental period filled with major changes in physical maturity and sexuality, cognitive processes (ways of thinking and thought content), emotional feelings, and relationships with others. Addressing the healthcare needs of this age group requires not only addressing identified health concerns, but also considering the complicated interactions of developmental changes on healthcare needs, the effectiveness of treatment, health education, and health promotion.
As adolescents begin to take responsibility for their own health, education and promotion of preventive healthcare is very important. Teaching preventive healthcare
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(about topics such as pregnancy prevention, sexually transmitted diseases, the effects of smoking, the need for immunizations, and substance use) and providing health education regarding specific healthcare needs to adolescents requires special consideration and effort to ensure understanding and encourage compliance to shape their future. (Caring for kid’s health 2010).
Adolescence is a time of intense preoccupation with the self, which is growing and changing daily, and represents a period doing which women make important choices about lifestyle behaviors. (Brag 1997).
WHO’s department of Child and Adolescent Health and Development (CAH) envisions a world in which children and adolescents enjoy the highest attainable standard of health and development, a world that meets their needs, as well as respects their rights, enabling them to live to their full potential. (WHO)
Primary dysmenorrhea occurs without pelvic pathology affecting about 50%
of women 10% of women have pain severe enough to incapacitate them for 1 to 3 days each month. The onset is 6 months to 2 years after menarche with improvement by 25 years and declining incidence after 30 to 35 years. It occurs more frequently in unmarried women.(Dawood 1990).
Dysmenorrhea, painful menstruation is characterized by pain that occurs shortly before the onset of or during menstrual flow, persisting for one to several days during menses. It is one of the most common gynecological problems, affecting more than 50% of women at sometime in their lives and causing incapacitation for 1 to 3 days each month in about 10% of these women. 25% of absenteeism of adolescence has been reported from school because of dysmenorrhea. (Dunnihoo 1992).
The intervention for dysmenorrhea can include a number of non pharmacological self care measures and over the counter and prescription medications. The non pharmacological self care measures include application of heat, giving exercises, massage, sleep and rest, relaxation techniques and Chinese medicines. (Reeder, Martin Koniak, Griffin 1997).
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Primary dysmenorrrhea is characterized by frequent severe abdominal and pelvic menstrual discomfort due to uterine contractions often exercise is an effective way to reduce uncomfortable symptoms and to increase physical and emotional well being. Exercise promotes healthy blood flow to the muscles and releases endorphins, the body’s natural pain killer. (Amanda Jones 2009).
Primary dysmenorrrhea is a extremely common problem. According to the American academy of family physicians as many as 90% of menstruating women experience this disorder on some level, usually in adolescence. Exercise may alleviate primary dysmenorrhea. (Wanda Marie Thibodeaux 2009).
The community health nurse has an important task in conducting school health programme and educating adolescent girls as well as community regarding the various non pharmacological measures and its effectiveness in controlling menstrual pain preception and to create awareness regarding reproductive health among adolescent girls, parents, and teachers. In turn such education helps the adolescent girls to be equipped with adequate knowledge and to practice the simple available techniques to manage the menstrual pain.
1.1 NEED FOR STUDY
Worldwide there are some 1.2 billion adolescents aged between 10 and 19 years. Around 90% of them live in developing countries, and approximately 600 million are female. The health and development of these girls is very important now, and continues to be important as they mature into adults. The health of adolescents sets the stage for their future health and well-being, as well as for the health of their children and development of their societies. (World health organisation 2009).
In world, primary dysmenorrhea may affect upto 75% of women and 5-6%
may have incapacitating pain. The extent of pain incapacitating from her daily activity the pain is usually experienced in lower abdomen but may extend to back and thighs.
In United States, it was found that 91% of surveyed high school adolescents had dysmenorrhea. Among respondents, symptoms affected academic work in 55% of and
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sometimes resulted in missed classes (26%) it express the burden of disease in the country. (Freeman& Lawlis 2003).
Dysmenorrhoea is painful menstruation associated with ovulation that is not related to pelvic disease. It is the common gynecological complaint and a leading cause of absenteeism from school (affecting 10% of high school girls each month) and work (an estimate of 140 million work hours lost annually). The incidence peaks in women in their early 20’s. (Lippincott Williams & Wilkins 2005).
The prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students’
management strategies, and their knowledge of available treatment. A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The reported prevalence of dysmenorrhea among these girls was 80%; out of which 53% of those girls with dysmenorrhea reported that it limited their activities. In particular, 37% said that dysmenorrhea affected their school activities. The most common medication used by those reporting dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for dysmenorrhea. (Thirza I.J Hillen 1998).
Dysmenorrhea in a multiethnic population of adolescent Asian girls 74.5% of the girls who had reached menarche had dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance. Ethnicity and form at school were significantly associated with the poor concentration, absenteeism, and restriction of social and recreational activities attributed to dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. (LP Wonga EM Khoob 2009).
Dysmenorrhoea is the most common of gynaecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population. A cross-sectional descriptive study conducted on 107 female medical students at a Medical college in Madhya
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Pradesh reported that the prevalence of dysmenorrhoea was 73.83% approximately 4.67% of dysmenorrhic subjects had severe dysmenorrhoea. Among female medical students 31.67% were frequently missing college & 8.68% were missing classes and has limitations on daily activities. (Amita Singh etal 2008).
The prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India. A cross-sectional survey conducted on primary health centre at Goa reported that out of 2262 women, more than half reported dysmenorrhoea and 755 participants reported moderate to severe dysmenorrhoea. The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.(Vikram patel etal 2006).
The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the condition—prevalence estimates vary from 45% to 95%. However, dysmenorrhoea seems to be the most common gynaecological condition in women regardless of age and Nationality. Absenteeism from work and school as a result of dysmenorrhoea is common (13% to 51% women have been absent at least once and 5% to 14% are often absent owing to the severity of symptoms). Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work.
and psychological disturbance. (Michelle Proctor, Cynthia Farquhar 2006).
A comparative cross-sectional study among adolescent school girls (101 girls in urban areas and 79 girls in rural areas) in the district of Karimnagar. The prevalence of dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas) (X 2df = 0.1, P = 0.05). Sickness absenteeism (28-48%), socio economic losses, and perceived quality of life losses are more prevalent among girls in urban areas than in girls in rural areas. Girls in rural areas resort to physical labor and other natural methods to obtain relief while the girls in urban areas are mainly depending on medications. (Avasarala AK, Panchangam S 2008).
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Dysmenorrhea generally does not occur until ovulatory menstrual cycles are established. Maturation of the hypothalamic-pituitary-gonadal axis leading to ovulation occurs at different rates; approximately 18 to 45 percent of teens have ovulatory cycles two years postmenarche, 45 to 70 percent by two to four years, and 80 percent by four to five years .The prevalence of dysmenorrhea among adolescent females ranges from 60 to 93 percent. Many adolescents report limitations on daily activities, such as missing school, sporting events, and other social activities, because of dysmenorrhea . However, only 15 percent of females seek medical advice for menstrual pain, signifying the importance of screening all adolescent females for dysmenorrhea. (Sports Med 2008).
During the school health programme the investigator observed that most of the girls complained that they have severe pain during menstruation and many of them reported that they are often missing classes, absenteeism, and limitation of activities.
They were requesting for pain relief measures and expressing their intolerance to pain. It motivated the investigator to act on and implement pain relief measures for adolescent girls and empower them to manage dysmenorrhea. So, the investigator decided to give physical exercises which is considered as an effective technique in order to reduce menstrual pain perception of the adolescent girls and which does not rise to any complication as well as not costly. It can be practised by adolescent girls themselves and need not to have any special measures.
1.2 STATEMENT OF THE PROBLEM:-
A study to assess the effectiveness of physical exercises on menstrual pain perception among adolescent girls with primary dysmenorrhoea at the selected school at Madurai.
1.3 OBJECTIVES OF THE STUDY:-
¾ To assess the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea before giving physical exercises.
¾ To determine the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea after giving physical exercises.
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¾ To compare the effectiveness of physical exercises on pain perception among adolescent girls with primary dysmenorrhea before and after giving physical exercises.
¾ To associate the post test level of menstrual pain perception among adolescent girls with primary dysmenorrhoea with selected demographic variables.
1.4 OPERATIONAL DEFINITION:- Effectiveness:-
It refers to the outcome of physical exercises which will be validated by the decrease in the level of menstrual pain perception.
Physical exercises:-
It refers to the exercise program of about 30 minutes which consist of stretching, toning and cool down exercises of the body given after the menstrual period three days per week.
Menstrual Pain:-
It refers to the subjective and unpleasant sensation of discomfort perceived by the adolescent girls at menstruation lasting for 1-3 days as measured by visual analogue pain scale.
Adolescent Girls:-
It refers to the girls studying in 9th standard in the selected school between the age of 13 – 15 years and those attained menarche.
Primary Dysmenorrhoea:-
It refers to the painful menstruation in girls with normal pelvic anatomy characterized by spasmodic pelvic pain at the onset of menstruation and lasting for 1 – 3 days.
xxi 1.5 HYPOTHESIS:-
There is a significant reduction in menstrual pain perception among adolescent girls with primary dysmenorrhoea who received physical exercises than those who do not receive
1.6 ASSUMPTION:
• During menstruation adolescent girls are in need of special attention
• Threshold of pain perception will be different for each individual
1.7 LIMITATION:
This study is limited to a period of 1 month.
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CHAPTER-II
REVIEW OF LITERATURE
2.1 Review of literature is discussed under following headings as follows:
• literature related to dysmenorrhoea in adolescent girls
• literature relevant with non-pharmacological menstrual pain relief interventions
• literature pertaining to exercises for menstrual pain management in dysmenorrhoea
LITERATURE RELATED TO DYSMENORRHEA:
Hong-Gui Zhou, Zheng-Wei Yang,(2010) conducted a prospective study on prevalence of dysmenorrhea in female students in a Chinese university. This study aimed to investigate the prevalence of dysmenorrhea in a prospective approach.
Menstruation-related diary data were obtained from 2640 female college students in North Sichuan Medical College; dysmenorrhea and related factors were analyzed.
Dysmenorrhea occurred in 56.4% of students; 6.5% of dysmenorrheal students suffered from “hard to bear” (unbearable) menstrual pain, and 6.5% had pre- menstrual dysmenorrhea. The more severe dysmenorrhea was, the longer dysmenorrhea lasted, and the longer the duration of menstruation and the larger the amount of menstrual blood flow appeared to be. Dysmenorrhea occurred on 37% of the menstrual dates on average and was unrelated to irregularity of menstrual cycles.
The percentages of students taking medicine with mild, moderate and unbearable dysmenorrhea were 4.0%, 13.3% and 23.7%, respectively.
Anil K Agarwal, Anju Agarwal (2010) conducted a study about the prevalence of dysmenorrhea in high school adolescent girls of Gwalior. Nine hundred and seventy adolescent girls of age 15 to 20 years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior. The prevalence of dysmenorrhea in adolescent girls was found to be 79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. The three most common symptoms present on both days, that is, day before and first day of menstruation were lethargy and tiredness (first), depression (second) and inability to concentrate in work (third), whereas the
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ranking of these symptoms on the day after the stoppage of menstruation showed depression as the first common symptoms.
S. Ohde etal (2008) conducted a prospective cohort study using a health diary in a sample representative of Japanese women. Information on health care use was also collected. Among 823 enrolled participants (age range, 18–51 years), dysmenorrhea (mean duration 1.75 days; range 1–5 days) was reported in 15.8%
(95% CI, 13.3–18.3) during the 1-month study period. Common associated symptoms included headache (10.77%), back pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a physician, while 51.5% of the women used self- medication, and 7.7% used complementary/alternative medicine. Dysmenorrhea is common in Japanese women. In our study, about half used self-medication, while some preferred complementary/alternative medicine. Dysmenorrhea is significantly associated with younger age and employment status.
Maryam Rostami (2007) conducted a study dysmenorrhoea in the high school girls in Masjed Solayman Khzestan Province in Iran. Six hundred sixty high school students living in Masjed Soleiman in Khuzestan province in Iran participated in this study. The results indicate that 85 respondents (14.4% participants) suffered from dysmenorrhoea which disturbed their daily activities and was unimproved by the use of analgesics. The results of the study also indicate that there was a significant correlation between dysmenorrhoea and certain biological factors, between menarche age and the severity of dysmenorrhoea and the duration of menstrual flow.
Furthermore, early menarche was related to an increase in the severity of dysmenorrhoea.
A-H. El-Gilany,1 K. Badawi 2 and S. El-Fedawy 2(2005) conducted a study on Epidemiology of dysmenorrhoea among adolescent students in Mansoura, Egypt to examine the prevalence, determinants, impact and treatment practices of dysmenorrhoea, we studied 664 female students in secondary schools in urban and rural areas. Data was collected through a self-administered questionnaire. About 75%
of the students experienced dysmenorrhoea (mild 55.3%,moderate 30.0%, severe 14.8%). Most did not seek medical advice although 34.7% treated themselves.
Fatigue, headache, backache and dizziness were the commonest associated symptoms.
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No limitation of activities was reported by 47.4% of student with dysmenorrhoea, but this was significantly more reported by students with severe dysmenorrhoea.
Significant predictors of dysmenorrhoea were older age, irregular or long cycle and heavy bleeding.
Hart (2005) Primary dysmenorrhea is caused by increased prostaglandin production by the endometrium in an ovulatory cycle. This hormone causes contraction of the uterus, the levels tend to be higher in women with severe menstrual pain than women who experience mild or no menstrual pain. These levels are highest during the first two days of menses when symptoms peak.
Alzuabaidi & calis (2004) Dysmenorrhea refers to painful menstruation. The term is derived from the greek word dys, meaning difficult (painful) abnormal and rrhea, meaning flow. It may affect more than half of menstruating women.
Clark & Steele (2004) Affected women experience sharp, intermittent spasms of pain, usually in the suprapubic area. Pain may radiate to the back of the legs or the lower back. Systemic symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache or dizziness are fairly common. Pain usually develops within hours of start of menstruation and peaks as the flow becomes heaviest during the 1st day or two of the cycle.
Reddy, Rani and others (2000) surveyed 274 adolescent school going girls in Tirupati town of Andhra Pradesh to study awareness and perception about menarche, and menstrual problems. 200 of the 232 post menarcheal girls reported 232 problems experienced before menstruation. Dysmenorrhoea (backache) was felt by 50% of the adolescents prior to as well as during menstruation. Bad odour of menstrual blood was the prominent problem reported by 57% of the adolescent girls. Profuse menstrual bleeding was complained by 31% of the adolescent girls. Calf muscle pain was the number one complaint felt prior to as well as during menstruation by more than a quarter of the adolescent girls. Tiredness was the number two problem experienced prior to the menstruation by 20.5% of the adolescent girls and this complaint had declined to 6% during menstruation. Irritability was third in rank reported by 20.5%
adolescent girls before and 21.3% girls during menstruation.
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Thirza I.J Hillen etal (1998) conducted a study on the prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students’ management strategies, and their knowledge of available treatment. The reported prevalence of dysmenorrhea among these girls was 80%; 53% of those girls with dysmenorrhea reported that it limited their activities. In particular, 37% said that dysmenorrhea affected their school activities. The most common medication used by those reporting dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for dysmenorrhea.
LITERATURE RELEVANT WITH NON-PHARMACOLOGICAL MENSTRUAL PAIN RELIEF INTERVENTIONS:
Zhu etal (2008) Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative. The main objective is to determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment.
Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea.
Bandolier (2007) was asked to comment on a media report that vitamin E had proved to be a useful treatment for dysmenorrhoea, and because vitamin E is sold as a nutritional treatment. Three studies were found, one from 1955 performed in Cardiff and two recent studies from Tehran. All of them studied young women, for between two and four months, using different doses of vitamin E, for different periods before and during menstruation, and used different measures of pain. All three studies found that menstrual pain was diminished by vitamin E more than placebo, and the two longer studies found that maximum effect occurred by about three months. The two longer studies had dichotomous outcomes, of pain reduction by a useful amount or
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non-use of analgesics. A good result occurred in 155/176 (88%) of women on vitamin E and 20/174 (11%) of women on placebo by three or four months. The relative benefit was 7.7 (95%CI 5.1 to 12) and the number needed to treat for one woman to benefit compared with placebo was 1.3 (1.2 to 1.4).
Dr. Katharine O'Connell (2006)Acupuncture may be a useful therapy in the treatment of dysmenorrhea. A preliminary trial reported that 86% of women treated with acupuncture for dysmenorrhea had complete cessation of pain for three consecutive menstrual periods. Other preliminary trials have demonstrated similar results. A controlled clinical trial reported 91% efficacy with acupuncture compared to 36.4% efficacy with sham acupuncture (using fake acupuncture points) and 18%
efficacy in an untreated control group.
Viola Antao, etal (2005) Unlike low-frequency TENS, high-frequency TENS provides more effective dysmenorrhoea pain relief compared with placebo. High- frequency TENS may be considered as a supplementary treatment in women unable to tolerate medication.
Chen HM and Chen CM (2004) A recent trial at the College of Medical Technology, Tainan, Taiwan evaluated the efficacy of acupressure at the Sanyinjiao point for primary dysmenorrhea among adolescent girls. Dysmenorrhea is the most common gynecological disorder among adolescents. Sixty-nine female participants with no prior history of gynecological disease or secondary dysmenorrhea and with a pain score above 5 on a visual analogue scale (scale range 0-10) took part in the trial.
Thirty-five participants received acupressure, while 34 participants rested for 20 minutes. Fifty participants (30 experimental, 20 control) completed the 4- and 6-week follow-up sessions .Thirty-one (87%) of the 35 experimental participants reported that acupressure was helpful, and 33 (94%) were satisfied with effects of acupressure in relieving the pain and providing psychological support for dysmenorrhea. The findings suggest that acupressure at Sanyinjiao point can be an effective, cost-free intervention for reducing pain and anxiety during dysmenorrhea, and could be recommended for self-care of primary dysmenorrhea.
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Banikarim C, Chacko MR, Kelder SH (2000) determine the prevalence of dysmenorrhea among 706 Hispanic female adolescents; its impact on academic performance, school attendance, and sports and social activities; and its management.
85% reported dysmenorrhea. Of these, 38% reported missing school due to dysmenorrhea during the 3 months prior to the survey and 33% reported missing individual classes. Activities affected by dysmenorrhea included class concentration (59%), sports (51%), class participation (50%), socialization (46%), homework (35%), test-taking skills (36%), and grades (29%). Treatments taken for dysmenorrhea included rest (58%), medications (52%), heating pad (26%), tea (20%), exercise (15%), and herbs (7%). Fourteen percent consulted a physician and 49% saw a school nurse for help with their symptoms. Menstrual pain was significantly associated with school absenteeism and decreased academic performance, sports participation, and socialization with peers (P<.01).
LITERATURE PERTAINING TO EXERCISES FOR MENSTRUAL PAIN MANAGEMENT IN DYSMENORRHOEA:
Brown J, Brown S. (2010) To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea. Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < 0.05).
Blakey etal (2009) Anecdotal beliefs that exercise is an effective treatment for primary dysmenorrhoea have prevailed for many years. A questionnaire that assessed menstrual pain and levels of exercise was administered to 654 university students in Birmingham, UK. A response rate of 91.3% (597/654) was obtained.
Daley, Amanda J(2008)The notion that exercise is effective in preventing and treating symptoms has prevailed for many years and led to the promotion of anecdotal belief that exercise is beneficial. Behavioural interventions such as exercise may not only reduce dysmenorrhoea, but also eliminate or reduce the need for medication to control menstrual cramps and other associated symptoms. Evidence from
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observational studies was mixed. Several observational studies reported that physical activity/exercise was associated with reduced prevalence of dysmenorrhoea.
Susan Scott Ricci (2007) The treatment for dysmenorrhoea includes lifestyle changes such as daily exercise, limit salty foods, weight loss, smoking cessation and relaxation techniques. It gives sense of control over life.
Sharon Smith & Emily Slone (2006) The non pharmacological measures to relieve pain such as frequent rest periods, application of heat to the lower abdomen, moderate exercise and a well balanced diet.
Leifer (2005)Treatment for primary dysmenorrhoea includes self care measures such as exercise, rest, heat and proper nutrition help some women. Bio feedback has also been used with some success.
Hart (2004) The treatment for dysmenorrhoea includes exercises, which increases endorphins and suppresses prostaglandin release. Practice of relaxation techniques to enhance the ability to cope with pain.
Burroughs (1997) Self care measures that can be done at home for primary dysmenorrhoea include starting an exercise program; using pelvic rocking exercise (which can decrease pain) and using heat such as warm baths, showers, or heating pads to decrease muscle spasms.
Choi PY, Salmon P (1995) Anecdotal accounts and unsystematic reports have suggested that women who exercise experience fewer premenstrual symptoms and less severe dysmenorrhoea than women who are sedentary. The present study tested this belief. Mood states and physical symptoms of 143 women were monitored for five days in each of the three phases of the cycle (mid-cycle, premenstrual and menstrual). The women were 35 competitive sportswomen, two groups of exercisers (33 high exercisers and 36 low exercisers) and 39 sedentary women. Principal component analysis of their responses to a mood and physical symptom checklist revealed five dimensions: positive effect, negative effect, physical symptoms, fatigue and irritability. Component-based subscale scores were calculated for all dimensions.
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In general mood and symptoms were worse menstrually and premenstrually than mid- cycle. The high exercisers experienced the greater positive affect and sedentary women the least. The high exercisers also reported the least negative effect. The differences between exercise groups were greatest during the premenstrual and menstrual phases. These results are consistent with the belief that women who frequently exercise may be to some extent protected from deterioration of mood before and during menstruation.
xxx CONCEPTUAL FRAME WORK
Conceptual framework for this study was developed on the basis of Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory. She proposed her theory in 1970 as a prescriptive theory of nursing. Prescriptive theory directs action toward an explicit goal. It consists of 3 factors. Central purpose, prescription and realities. A nurse develops a prescription based on a central purpose and implements it according to the realities of the situation.
A. Central purpose in the model refers to what the nurse wants to accomplish. It is the overall goal towards which a nurse strives; it transcends the immediate intent of the assignment or task by specifically directing activities towards the patients good.
B. Prescription refers to the plan of care for a patient. It specifies the nature of the action that will fulfill the nurse’s central purpose and the rationale for that action.
C. Realties refer to the physical, physiological, emotional and spiritual factors that come into play in a situation involving nursing actions. The five realties identified by Widenbach are agent, recipient, goal, means and framework.
¾ Wiedenbach’s Views nursing as an art based on goal directed care.
¾ Wiedenbach’s vision of nursing practice closely parallels the assessment, implementation and evaluation steps of the nursing process.
¾ According to her factual and speculative knowledge, judgment and skills are necessary for effective nursing practice.
According to Wiedenbach’s nursing practice consists of identifying a patient’s need for help, ministering the needed for help and validating that the need for help was met.
Wiedenbach views that the patient as an individual with unique experiences and understanding the patient’s perception of the condition. Determines a patients need for help based on the existence of a need whether the patient realizes the need what prevents the patient from meeting the need and whether the patient cannot meet the need alone.
xxxi The attributes adopted in this study are, CENTRAL PURPOSE:
The Central purpose of the study is to reduce the menstrual pain perceived by the adolescent girls during menstruation.
PRESCRIPTION:
The investigator plans the prescription that will fulfill the central purpose (reduction of menstrual pain) by identifying the various means to achieve the goal.
Thus the investigator selected the method, physical exercises which is considered as safe effectively reduces menstrual without serious side effects.
REALITIES:
1. Agent - Investigator
2. Recipient - adolescent girls with menstrual pain 3. Goal - Reduction of menstrual pain intensity 4. Means - physical exercises
5. Frame work - school IDENTIFICATION:
This includes identification of the need for reduction in pain perception among adolescent girls.
MINISTRATION:
It refers to providing physical exercises to reduce menstrual pain.
VALIDATION:
It refers to evaluation of the effectiveness of physical exercises. A positive outcome represents the satisfaction of the adolescent girls with decreased pain perception by physical exercises and the intervention is reinforced.
32
Fig. 1: Conceptual framework based on Modified Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory
IDENTIFYING NEED FOR HELP
MINISTERING THE NEED FOR HELP
VALIDATING THE NEED FOR HELP
ASSESSMENT OF ALL ADOLESCENT GIRLS
NEED OF RELIEF FROM MENSTRUAL
PAIN
ADOLESCENT GIRLS SATISFIED
WITH MAXIMUM PAIN REDUCTION GIVING PHYSICAL EXERCISES
Exercise programme – 30 minutes
Stretching exercises:
10 minutes stretching – 5 repetitions
Toning exercises:
15 minutes stretching- 6 repetitions
Cool down exercises:
5 minutes – 2 repetitions NURSING PRACTICE
AGENT : INVESTIGATOR
RECEIPIENT : ADOLESCENT GIRLS WITH MENSTRUAL PAIN
GOAL : REDUCTION OF MENSTRUAL PAIN INTENSITY
MEANS : PHYSICAL EXERCISES
FRAME WORK: SCHOOL
33
CHAPTER III METHODOLOGY
3.1 RESEARCH APPROACH:- PHASE 1:- DESCRIPTIVE SURVEY:-
To assess the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea at the selected school at Madurai.
PHASE 2:- EXPERIMENTAL APPROACH:-
To determine the effectiveness of physical exercises in reducing the level of menstrual pain perception among adolescent girls with primary dysmenorrhoea at the selected school at Madurai.
3.2 RESEARCH DESIGN:-
The Quasi-experimental, pretest and post test design was adopted for this study
O1 X O2
Pretest Intervention Posttest
O1 - Pretest assessment of the level of a menstrual pain perception X - Intervention -Physical exercises
O2 - Posttest assessment of the level of menstrual pain perception
3.3 RESEARCH VARIABLES:-
Dependent variable: - Level of pain perception during Menstruation.
Independent variable: - Physical exercises.
34 3.4 SETTING OF THE STUDY:-
The study was conducted among adolescent girls at Lourdu Annai Girl’s Higher Secondary School at K. Pudur, Madurai. Lourdu Annai Girl’s Higher Secondary School is located at 5 km from College of Nursing, Madurai Medical College, Madurai. The total school children are 1500. The school has adolescent girls at the age group of 13-15 yrs at 6 sections in ninth standard and each section have about 50 students totally 300 students.
3.5 POPULATION:-
The study population comprises of adolescent girls who had pain during the first day of menstruation between the age group of 13-15 years.
3.6 SAMPLE:-
The sample consists of adolescent girls studying ninth standard between the age group of 13-15 yrs.
3.7 SAMPLE SIZE:-
The sample size consists of 60 adolescent girls studying ninth standard between the age group of 13-15 yrs.
3.8 SAMPLING TECHNIQUE:-
Non probability convenient sampling technique is used for the selection of samples in this study. 60 adolescent girls who have complained to have pain during the first day of menstruation were taken as the samples of this study.
3.9 CRITERIA FOR SAMPLE SELECTION:- Inclusion criteria:-
¾ Adolescent girls those who have menstrual pain at the first day of menstruation
¾ Adolescent girls who are between the age group of 13to 15 years studying in selected school and attained menarche.
¾ Those who are willing to participate in the study.
¾ Those who can communicate in Tamil and English
35 Exclusion criteria:-
¾ Those who have secondary dysmenorrhoea.
¾ Those who have irregular periods.
¾ Those who are absent from school during data collection.
3.10 DEVELOPMENT AND DESCRIPTION OF THE TOOL:- The tool consists of 2 sections as,
Section A: -
Demographic data of the adolescent girls consists of baseline information such as sample number, age, type of family, monthly income of the family, food habits, family history of dysmenorrhea, involvement in sports activities, body mass index.
It includes the details of menstruation such as age at menarche, days of menstruation, type of material used for menstruation, no of pads per day, previous remedies for dysmenorrhea, support during menstruation.
Section B: - Visual Analog Pain Scale.
Visual analog pain scale was framed by Chris Adams (2004). It consists of a 10 – cm horizontal scale with descriptors from no distress to unbearable distress. It is a useful device for accurately determine the level of pain perception and indicate the intensity of pain on a colored gradient and graduated line ranges from green ,yellow, orange and red .Subjects were asked to place a mark on the 10 cm line at a point that corresponded to the level of pain intensity they felt.
3.11 TESTING OF THE TOOL VALIDITY
The tool was given to three experts in the field of Nursing and Medicine for content validity. All suggestions were considered and appropriate changes were made and the corrected tool was found to be valid.
RELIABILITY
Spear man – Brown split-half method was used to check the reliability of the tool. The standardized visual pain scale was used and both tools are found to be valid.
36 3.12 PILOT STUDY
The pilot study was conducted for a period of one week from 21.10.2010 to 28.10.2010 among six adolescent girls. It was conducted in Lourdu Annai Girls Higher Secondary School. Results of the pilot study revealed the feasibility of the study.
3.13 PROCEDURE FOR DATA COLLECTION
A formal Prior permission was obtained from the Chief Educational officer, Madurai and also from head mistress of Lourdu Annai Girls Higher Secondary School at, Madurai by submitting an application furnishing assurance to abide by the rules and regulations that no personnel and professional inconvenience would be created because of this study and added that confidentiality is maintained and this study cannot be used for any other purpose.
The study was conducted for a period of four weeks. The investigator selected the samples that fulfilled the inclusion criteria in the selected schools .The purpose of the study was explained to the adolescent girls and consent was obtained.
Data are collected in two phases.
PHASE1: Descriptive survey.
PHASE2: Experimental phase.
A survey was conducted adolescent girls regarding menstrual pain perception for selecting samples. The investigator established rapport with the girls and interviewed them privately. As a pre test, pain intensity was assessed before giving physical exercises for the subjects with visual analog pain scale. Physical exercises were taught for about 30 minutes thrice weekly after the menstrual cycle stops. Post test was assessed after three weeks at the first day of menstruation at the next cycle.
Description of the intervention:
After pilot trial, this study was conducted in 3 phases.
I Phase - subjects selection.
II Phase - participating in the exercise program.
III Phase - post test scoring
37 I Phase
• A preliminary class had been conducted about dysmenorrhea for the students
• They were explained about the study protocol before their consent.
• They were given instructions about the data collection tools.
• The pretest score for menstrual pain were obtained on the first day of menstruation.
II Phase
• Selected subjects participated in the 45 minutes lecture cum demonstration session about “planned exercise program” to reduce their menstrual pain.
• They were motivated to follow the exercise program thrice weekly.
Exercise Programme:
Duration Activity
10 minutes warm up exercises 15 minutes toning exercises 5 minutes cool down exercises Warm up exercises: 10 minute stretching – 5 repetitions 1. Back stretch
2. Abdominal stretching 3. Torso stretch
4. Fore arms/wrists stretch 5. Triceps stretching 6. Chest stretch 7. Shoulder stretch
8. Lower back/ buttock stretch 9. Inner thigh stretch
10. Quads stretch 11. Calves stretch 12. Hamstrings stretch
38 Toning exercises: 15 minutes – 6 repetitions Middle body - Sit up
Isometric sit up
Alternating oblique sit up Lower body – Inner thigh lift
Outer thigh lift Power lift kick Calf lift
Cool down exercises: 5 minutes – 2 repetitions
III Phase
Post test scoring done with the same data collection tool on the first day of next menstrual cycle.
3.14 PLAN FOR DATA ANALYSIS:-
Data analysis will be done according to the objectives. Both descriptive and inferential statistics are used.
1. Analysis of demographic data - to be done by frequency and percentage.
2. Paired‘t’ test – to determine the difference between the pretest level of pain
& post test level of pain in terms of effectiveness of giving physical exercises.
3. Chi square – to determine the association between the selected demographic variables and post test level of pain perception.
3.15 PROTECTION OF HUMAN SUBJECTS:
The proposed study was conducted after the approval of the research committee of the college. The research procedure was explained to the subjects and written consent was obtained before intervention. Assurance was given to the study participants regarding the confidentiality of the data collected from them.
39
xl
CHAPTER – IV
ANALYSIS AND INTERPRETATION
The collected data regarding effectiveness of exercises on menstrual pain perception among adolescent girls during menstruation were organized, analyzed and interpreted as follows.
Section A : Distribution of subjects according to Demographic variables
Section B : Description of the subjects according to pretest and post test level of menstrual pain perception
Section C : Comparison of Mean pre test and post test menstrual pain perception
Section D : Association of post test pain perception with selected demographic variables.
.
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SECTION – A: DISTRIBUTION OF THE SUBJECTS ACCORDING TO THEIR DEMOGRAPHIC VARIABLES:
Table 1: Distribution of the subjects according to their Demographic variables:
Demographic variables No. of. Subjects (n=60)
Percentage
% 1. Age in years
a) 13 Yrs b) 14 Yrs c) 15 Yrs
3 48 9
5 80 15
2.
Type of family a) Nuclear family b) Joint family
58 2
96.60 3.33 3. Monthly income of the family
a) Rs. 2500& below b) Rs.2501- 3500 c) Rs.3501& above
43 8 9
71.66 13.33 15.00 4. Food habits
a) Vegetarian b) Non-vegetarian
21 39
35 65 5. Family history of
dysmenorrhea a) Yes b) No
46 14
76.66 23.33 6. Involvement in Sports
activities a) Yes b) No
11 49
18.33 81.66 7. BMI
a) Below 18.5 b) 18.5 – 24.9 c) 25 – 29.9 d) Above 30
27 31 2 -
45.00 51.66 3.33
-
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Table 1 describes the distribution of subjects according to the age,type of family, monthly income of the family, food habits, family history of dysmenorrhea, sports person, body mass index.
It is seen that among 60 subjects, regarding the age, most of the subjects were fourteen years old 48 (80%) 3(5%) subjects were 13 yrs old and 9(15%) subjects were 15 yrs old. In respect of the type of family, 58 (96.66%) subjects were from nuclear family and 2 (3.33%) subjects are in joint family.
With regard to monthly income 43 (71.66%) subjects were in the income group of Rs 2500 & below then 8(13.33%) subjects belong to the income group of Rs 2501- Rs 3500 and 9(15%) subjects were in the income group of Rs 3501 & above.
Regarding the food habits 39 (65%) subjects were non vegetarian and 21(35%) were vegetarian.
With regard to family history of dysmenorrhea 46(76.66%) of the subjects have positive history 14(23.33%) subjects have negative history. 11 (18.33%) subjects were involved in sports activities 49(81.66%) subjects were not involved in sports activities. Regarding the body mass index 31 (51.66%) were in the range of 18.5-24.9 then 27 (45%) subjects were in the range of below 18.5 and 2 (3.33%) subjects were in the range of 25-29.9.
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Figure 3 Distribution of subjects according to their Age
Figure 4 Distribution of subjects according to Type of family
xliv
Figure 5 Distribution of subjects according to their Food habits
Figure 6 Distribution of subjects according to the Family history of dysmenorrhoea
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Figure 7 Distribution of subjects according to Body mass index
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Table 2: Distribution of subjects according to the Details of menstruation
S.NO Details of menstruation No. of Subjects (n=60)
Percentage
% 1. Age at menarche
a) Below 11yrs b) 12 yrs c) After 13 yrs
4 18 38
6.66%
30%
63.33%
2. Days of menstruation a) Below 3 days b) 4 – 7 days c) Above 7 days
17 37 6
28.33%
61.66%
10%
3. Type of material used for menstruation
a) Used cloth b) Sanitary napkin
7 53
11.66%
88.33%
4. No of pads used / day a) Below 2 b) 2 – 3 c) Above 4
18 31 11
30%
51.66%
18.33%
5. Previous remedies for dysmenorrhea
a) Rest b) Hot pack c) Massage d) Medications
51 2
- 7
85%
3.33%
- 11.66%
6. Support during menstruation a) Mothers support
b) Family’s support c) Friend’s support
56 - 4
93.33%
- 6.66%
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With regard to details of menstruation 38 (63.33%) subjects reported after 13 years as the age at menarche 18 (30%) subjects at 12 yrs and 4 (6.66%) subjects at below 11 yrs.
Regarding the days of menstruation 37(61.66%) subjects have their days of menstruation between 4-7 days then 17 (28.33%) subjects had below 3 days and 6 (10%) subjects had above 7 days. 53 (88.33%) subjects used sanitary napkin during menstruation 7(11.66%) subjects used non sanitary napkin.
51 (85%) subjects preferred rest, 2 (3.33%) subjects preferred hot pack and 7 ( 11.66%) subjects used medications as the previous remedies of dysmenorrhea. 31 (51.66%) subjects used 2-3 pads/ day then 18 (30%) subjects used below 2 pads and 11 (18.33%) subjects used pads above 4.
Regarding the support during menstruation 56 (93.33%) subjects received mother’s support and 4 (6.66%) subjects received friends support during menstruation.
xlviii
Figure 8 Distribution of subjects according to Age at menarche
Figure 9 Distribution of subjects according to Days of menstruation
xlix
Figure 10 Distribution of subjects according to Type of material used for menstruation
Figure 11 Distribution of subjects according to Previous remedies for dysmenorrhoea
l
Figure 12 Distribution of subjects according to Support during menstruation
li
SECTION B: DESCRIPTION OF THE SUBJECTS ACCORDING TO PRETEST AND POST TEST LEVEL OF MENSTRUAL PAIN PERCEPTION
Table 3: Description of subjects according to pre test menstrual pain perception
Pre test score S.NO Level Of Pain Perception
n = 60 %
1.
2.
3.
4.
5.
6.
No pain (0)
Annoying (1-2)
Uncomfortable (3-4)
Dreadful (5-6)
Horrible (7-8)
Agonizing (9-10)
- 10
13
21
14
2
-
16.66
21.66
35
23.33
3.33
The table 3 depicts that 21 (35%) of the subjects had dreadful pain and 14 (23.33%) had horrible pain in the pretest score.
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Figure 13 Distribution of subjects according to pretest menstrual pain perception
The figure shows that 21 (35%) of the subjects had dreadful pain and 14 (23.33%) had horrible pain in the pretest score.
liii
Table 4: Description of subjects according to post test menstrual pain perception
Post test score S.NO Level Of Pain Perception
n = 60 % 1.
2.
3.
4.
5.
6.
No pain (0)
Annoying (1-2)
Uncomfortable (3-4)
Dreadful (5-6)
Horrible (7-8)
Agonizing (9-10)
12
17
25
4
2
-
20%
28.33%
41.66%
6.66%
3.33%
-
The table 4 depicts that 25 (41.66%) subjects had uncomfortable pain and 17 (28.33%) had annoying pain and 12 (20%) subjects reported no pain.
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Figure 14 Description of subjects according to post test menstrual pain perception
The figure showsthat 25 (41.66%) subjects had uncomfortable pain and 17 (28.33%) had annoying pain and 12 (20%) subjects reported no pain.
lv
Figure 15 Comparison of the subjects according to their pretest and posttest level of menstrual pain perception
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Table –5: Description of Subjects According to pre test menstrual pain perception SL.NO Level of pain perception
No. of. subjects n =60
%
1. Pre-test score
a)0 - 4
b)5 – 7
c)8 & above
23
24
13
38.33%
40%
21.66%
The table 5 depicts that 24 (40%) of the subjects had menstrual pain perception of the subjects between 5-7 and 23 (38.33%) of the subjects had the pain perceptionbetween 0-4
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Figure 16 Description of Subjects According to pre test menstrual pain perception
The figure shows that 24 (40%) of the subjects had menstrual pain perception of the subjects between 5-7 and 23 (38.33%) of the subjects had the pain perception between 0-4
