Menstrual characteristics and its association with socio-demographic factors and nutritional status: a study among the urban slum adolescent girls of West Bengal, India
DOI:
https://doi.org/10.2478/anre-2019-0008Keywords:
menstrual characteristics, nutritional status, adolescent girls, urban slum, West BengalAbstract
Menstrual health is one of the major areas of concern in reproductive health, and affects a large number of women throughout their reproductive life from adolescence. Menstruation is a biological phenomenon imbued with social-cultural, nutritional and personal significance. The present study aims to focus on the menstrual characteristics and its association with socio-demographic factors and nutritional status among the urban slum adolescent girls of North 24 Parganas district, West Bengal. This community-based study was conducted among a group of 90 Bengali speaking Hindu adolescent girls aged between 16 to 18 years. A pre-tested structured schedule was used to collect detailed information about the socio-economic conditions and menstrual characteristics. All anthropometric measurements were taken using the standard procedures. Results of the study revealed that underweight girls attained menarche comparatively in later age (12.67±1.23) than that of healthy and overweight girls. Mean length of the menstrual cycle, mean duration of menstrual bleeding and mean number of days of peak discharge were maximum among the girls whose BMI was below 5th percentile, i.e. underweight. Majority of the underweight (75%) and healthy (50%) girls experienced heavy discharge during their menstrual days. Disorders like premenstrual syndrome (PMS) (78.8%) and dysmenorrhea (85.5%) were the major prevalent menstrual problems among these girls and occurrence of the symptoms of these disorders significantly varied based on their BMI. A highly significant difference (p<0.01) was found among underweight, healthy and overweight girls in terms of duration of menstrual bleeding, mean number of days of peak discharge and occurrences of PMS. Result of linear regression and step wise logistic regression (backward elimination) shows that various socio-economic and anthropometric variables are the influential predictors of menstrual characteristics like duration of menstrual discharge, cycle length, days of peak discharge as well as menstrual problems like cycle irregularity and heavy flow (p<0.05). Therefore, the present study unwraps a podium to focus on the menstrual health issues of the adolescent girls and enforce health education as well as instigates nutritional intervention programme to fortify the existing menstrual health status.
Downloads
References
Adolescence Merriam-Webster.com. 2012. Available at https://www.merriam-webster.com (Accessed August 18, 2018).
View in Google Scholar
Agarwal AK, Agarwal A.2010. A Study of dysmenorrhea during menstruation in adolescent girls. Indian J Community Med 35(1):159–64.
View in Google Scholar
Bao Y, Lu J, Wang C, Yang M, Li H, Zhang X, et al. 2008. Optimal waist circumference cutoffs for abdominal obesity in Chinese. Atherosclerosis 201(2):378–84.
View in Google Scholar
Barlow SE. 2007. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(4):S164–S192. Available through Centers for Disease Control and Prevention website https://www.cdc.gov/nccdphp/dnpao/growthcharts/training/bmiage/page4.html (Accessed August 8, 2018).
View in Google Scholar
Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, et al. 2011. A better index of body adiposity. Obesity 19(5):1083–89.
View in Google Scholar
Bhattacherjee S, Ray K, Biswas R, Chakraborty M. 2013. Menstruation: experiences of adolescent slum dwelling girls of Siliguri city, West Bengal, India. Journal of Basic and Clinical Reproductive Sciences 2(2):85–91.
View in Google Scholar
Campbell M, McGrath P.1997. Use of medication by the adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 151(9):905–12.
View in Google Scholar
Chatterjee S, Hadi AS. 2006. Regression Analysis by Example. 4th edition. Hoboken, New Jersey: Wiley Interscience a John Wiley & Sons, Inc., Publication.
View in Google Scholar
Chaturvedi S, Kapil U, Gnanasekaran N, Sachdev HP, Pandey RM, Bhanti T. 1996. Nutrient intake amongst adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan. Indian Pediatr 33(3):197–01.
View in Google Scholar
Chauhan GD, Kodnani AH. 2016. A study of prevalence and impact of dysmenorrhea and its associated symptoms among adolescent girls residing in slum areas of Vadodara city, Gujarat. Int J Med Sci Public Health 5(3):510–15.
View in Google Scholar
Choudhary S, Mishra CP, Shukla KP. 2009. Correlates of nutritional status of adolescent girls in the rural area of Varanasi. The Internet J of Nutr and Wellness 7(2):1–10.
View in Google Scholar
Dars S, Sayed K, Yousufzai Z. 2014. Relationship of menstrual irregularities to BMI and nutritional status in adolescent girls. Pak J Med Sci 30(1):140–44.
View in Google Scholar
Dasgupta A, Sarkar M. 2008. Menstrual Hygiene: How Hygienic is the Adolescent Girl? Indian J Community Med 33(2):78–80.
View in Google Scholar
Deshpande NS, Karva D, Agarkhedkar S, Deshpande S. 2013. Prevalence of anaemia in adolescent girls and its correlation with demographic factors. International Journal of Medicine and Public Health 3:235–39.
View in Google Scholar
Diaz A, Laufer MR, Breech LL. 2006. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 118(5): 2245–50.
View in Google Scholar
Douchi T, Kuwahata R, Yamamoto S, Oki T, Yamasaki H, Nagata Y. 2002. Relationship of upper body obesity to menstrual disorders. Acta Obstet Gynecol Scand 81:147–50.
View in Google Scholar
Frisch RE. 1987. Body fat, menarche, fitness and fertility. Hum Reprod 2(6):521–33.
View in Google Scholar
Frisch RE. 1990. The right weight: body fat, menarche and ovulation. Baillieres Clin Obstet Gynaecol 4(3):419–39.
View in Google Scholar
Frisch RE. 1994. The right weight: body fat, menarche and fertility. Proc Nutr Soc 53(1):113–29.
View in Google Scholar
Frisch RE, McArthur JW. 1974. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science 185(4155):949–51.
View in Google Scholar
Fujiwara T. 2005. The discrepancy between BMI and self-recognition of adequate body weight may cause insufficient food intake and habits in young women in Japan. Bulletin of Ashiya College; 27:75–80.
View in Google Scholar
Fujiwara T, Nakata R. 2004. Current problems of food intake in young women in Japan: their influence on female reproductive function. Reprod Med Biol 3(3):107–14.
View in Google Scholar
García CB, Gónzalez VA, Frías GE, Arana CC, Díaz ME, Tolmo MD. 2010. An Pediatr (Barc) 73(6):320–26.
View in Google Scholar
Gharakhanlou R, Farzad B, Agha-Alinejad H, Steffen LM, Bayati M. 2011. Anthropometric measures as predictors of cardiovascular disease risk factors in the urban population of Iran. Arq Bras Cardiol (online). Available at: http://www.scielo.br/pdf/abc/2012nahead/en_aop00212.pdf (Accessed August 15, 2018).
View in Google Scholar
Gopalakrishna PK, Purushothaman S, Reghunath S, Pushkar B, King KI. 2015. Association of age at menarche with body mass index and waist–hip ratio. Int J Med Sci Public Health 5(8):1631–34.
View in Google Scholar
Hanson M, Gluckman P. 2006. Evolution: Development and timing of puberty. Trends Endocrin Met 17 (1):7–12.
View in Google Scholar
Harlow SD, Park M. 1996. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol 103(11):1134–42.
View in Google Scholar
Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. 1979. The association of obesity with infertility and related menstrual abnormalities in women. Int J Obes 3:57–73.
View in Google Scholar
Hartz AJ, Rupley DC, Rimm AA. 1984. The association of girth measurements with disease in 32,856 women. Am J Epidemiol 119:71–80.
View in Google Scholar
Hossain MG, Islam S, Aik S, Zaman TK, Lestrel PE. 2010. Age at menarche of university students in Bangladesh: secular trends and association with adult anthropometric measures and socio-demographic factors. J Biosoc Sci 42(5):677–87.
View in Google Scholar
Hossain MG, Sabiruzzaman M, Islam S, Hisyam RZ, Lestrel PE, Kamarul T. 2011. Influence of anthropometric measures and sociodemographic factors on menstrual pain and irregular menstrual cycles among university students in Bangladesh. Anthropol Sci 119(3):239–46.
View in Google Scholar
Houston AM, Abraham A, Huang Z, D’Angelo LJ. 2006. Knowledge, attitudes, and consequences of menstrual health in urban adolescent females. J Pediatr Adolesc Gynecol, 19(4):271–75.
View in Google Scholar
Indira A, Kantha K. 2017. Correlation of body mass lndex levels with age at menarche in women in, selected rural areas of Nellore: a cross sectional study. IJRSR 8(3):16297–99.
View in Google Scholar
International Institute for Population Sciences and ORC Macro. National Family Health Survey (NFHS-4), India, 2015–16. District Fact Sheets of Kolkata. IIPS: Mumbai (Available at http://rchiips.org/nfhs/FCTS/WB/Kolkata.pdf Retrieved on August 30, 2018).
View in Google Scholar
Jena P, Panda J, Mishra A, Agasti N. 2017. Menstrual pattern and body mass index in adolescent school girls; a cross-sectional study. GJRA 6(6):29–31.
View in Google Scholar
Joshi SM, Likhar S, Agarwal SS, Mishra MK, Shukla U. 2014. A study of nutritional status of adolescent girls in rural area of Bhopal district. National Journal of Community Medicine. 5(2):191–94.
View in Google Scholar
Ju H, Jones M, Mishra GD. 2015. A U-shaped relationship between body mass index and dysmenorrhea: a longitudinal study. PLoS One. 10(7): e0134187.
View in Google Scholar
Kaczmarek M. 2011. Conceptual frameworks and methodological tools for multidisciplinary approach to the adolescent health research. In: M. Kaczmarek (ed.) Health and Well – Being in Adolescence. Part one Physical Health and Subjective Well-Being. Poznań: Bogucki Wydawnictwo Naukowe, 19–43.
View in Google Scholar
Kanotra SK, Bangal VB, Bhavthankar DP. 2013. Menstrual pattern and problems among rural adolescent girls. IJBAR 4(8):551–54.
View in Google Scholar
Karlberg J. 2002. Secular trends in pubertal development. Horm Res. 57 (Suppl 2):S19–30.
View in Google Scholar
Katzmarzyk PT, BarreiraTV, Broyles ST, Chaput JP, Fogelholm M, Hu G, et al. 2015. Association between body mass index and body fat in 9–11-year-old children from countries spanning a range of human development. Int J Obes Suppl 5(2): S43–S46.
View in Google Scholar
Kaur TJ, Kochar GK, Agarwal T. 2007. Impact of nutrition education on nutrient adequacy of adolescent girls. Stud Home Comm Sci 1(1):51–55.
View in Google Scholar
Khanna A, Goyal RS, Bhaswar R. 2005. Menstrual practices and reproductive problems: a study of adolescent girls in Rajasthan. J Health Manag 7(1):91–107.
View in Google Scholar
Khodakarami B, Masoumi SZ, Faradmal J, Nazari M, Saadati M, Sharifi F, Shakhbabaei M. 2015. The severity of dysmenorrhea and its relationship with Body Mass Index among female adolescents in Hamadan. Iran J Midwifery Reprod Health 3(4):444–50.
View in Google Scholar
Kulkarni MV, Durge PM. 2011. Reproductive health morbidities among adolescent girls: breaking the silence. Stud Ethno Med 5(3):165–68.
View in Google Scholar
Kumbhar SK, Reddy M, Sujana B, Reddy RK, Bhargavi DK, Balkrishna C. 2011. Prevalence of dysmenorrhea among adolescent girls (14–19 yrs) of Kadapa district and its impact on quality of life: A cross sectional study. National Journal of Community Medicine 2(2):265–68.
View in Google Scholar
Kutner MH, Nachtsheim CJ, Neter J, Li W. 2005. Applied Linear Statistical Models. 5th edition. Chicago, IL; Boston, MA: Wc-Graw-Hill/Irwin.
View in Google Scholar
Lacroix AE, Whitten RA. 2018. StatPearls review books, Menarche. [e-book] StatPearls Publishing LLC. Available through: The National Center for Biotechnology Information Bookshelf website https://www.ncbi.nlm.nih.gov/books/NBK470216/ (Accessed August 22, 2018).
View in Google Scholar
Lohman TG, Roche AF, Martorell R. 1988. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.
View in Google Scholar
Lu Z. 2006. The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women. J Adv Nurs 33:621–28.
View in Google Scholar
Mamun AA, Hayatbakhsh MR, O’Callaghan M, Williams G, Najman J. 2009. Early overweight and pubertal maturation pathways of association with young adults’ overweight: a longitudinal study. Int J Obes (Lond) 33(1):14–20.
View in Google Scholar
Meenal VK, Durge PM, Kasturwar NB. 2012. Prevalence of Anemia among Adolescent girls in an Urban Slum. National Journal of Community Medicine 3(1):106–11.
View in Google Scholar
Midi H, Sarkar SK, Rana S. 2010. Collinearity diagnostics of binary logistic regression model. Journal of Interdisciplinary Mathematics 13(3):253–67.
View in Google Scholar
Mitra D, Banerji S. 2016. Evaluation of the status of ponds in Duttabad slums of Salt Lake city, Kolkata, India. International Journal of Water Research 6(1):1–9.
View in Google Scholar
Mohite RV, Mohite VR, Kumbhar SM, Ganganahalli P. 2013. Common menstrual problems among slum adolescent girls of western Maharashtra, India. Journal of Krishna Institute of Medical Sciences University 2(1):89–97.
View in Google Scholar
Mohite RV, Mohite VR. 2013. Common menstrual problems among slum adolescent girls of western Maharashtra, India. Journal of Krishna Institute of Medical Science University 2(1):89–97.
View in Google Scholar
Mukherjee P, Mishra SK and Ray S. 2014. Menstrual Characteristics of Adolescent Athletes:A Study from West Bengal, India Coll Antropol 38(3):917–23.
View in Google Scholar
Munster K, Schmidt L, Helm P. 1992. Length and variation in the menstrual cycle: A cross sectional study from a Danish county. Br J Obstet Gynaecol 99(5):422–29.
View in Google Scholar
Nagata C, Hirokawa K, Shimizu N, Shimizu H. 2005. Associations of menstrual pain with intakes of soy, fat and dietary fiber in Japanese women. Eur J ClinNutr 59(1):88–92.
View in Google Scholar
Nwankwo M, Danborno B and Hamman WO. 2018. Relationship between Body Mass Index and timing of maturation. J Exp Clin Anat 14(2):95–100.
View in Google Scholar
Omidvar S, Amiri FN, Bakhtiari A, Begum K. 2018. A study on menstruation of Indian adolescent girls in an urban area of South India. JFMPC 7(4):698–02.
View in Google Scholar
OnisMde, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. 2007. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 85(9):661–67.
View in Google Scholar
Pejhan A, Moghaddam HY, Najjar L, Akaberi A. 2013. The relationship between menarche age and anthropometric indices of girls in Sabzevar. Journal of Pakistan Medical Association 63(1):81–4.
View in Google Scholar
Peter AB, Ocholi SG. 2017. Body mass index and incidence of menorrhagia among adolescent female undergraduate students in Nigeria. IJMRHS 3(7):75–79.
View in Google Scholar
Rahman MM, Kabir M, Shahidullah M. 2004. Adolescent self-reported reproductive morbidity and health care seeking behaviour. J Ayub Med Coll Abottabad 16(2):9–14.
View in Google Scholar
Recommended BMI-for-age Cutoffs. Growth Chart Training. Available through Centers for Disease Control and Prevention website https://www.cdc.gov/nccdphp/dnpao/growthcharts/training/bmiage/page4.html (Accessed August 18, 2018).
View in Google Scholar
Rowland AS, Baird DD, Long S, Wegienka G, Harlow SD, Alavanja M et al. 2002. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology 13(6):668–74.
View in Google Scholar
Samir N, Abd el fattah H, Sayed EM. 2015.The correlation between body mass index and menstrual profile among nursing students of Ain Shams University. Egyptian Journal of Nursing 10(1):27−39.
View in Google Scholar
Sandhu J, Ben-Shlomo Y, Cole TJ, Holly J, Smith GD. 2006. The impact of childhood body mass index on timing of puberty, adult stature and obesity: A follow-up study based on adolescent anthropometry recorded at Christ’s Hospital (1936–1964). Int J Obes 30(1):14–22.
View in Google Scholar
Sanyal S, Ray S. 2008. Age variation in menstrual characteristics of adolescent girls of West Bengal, India. Singapore Med J 49(7):542–50.
View in Google Scholar
Scott EC, Johnston FE. 1982. Critical fat, menarche, and the maintenance of menstrual cycles: a critical review. J Adolesc Health Care 2(4):249–60.
View in Google Scholar
Seedhom AE, Mohammed ES, Mahfouz EM. 2013. Life Style Factors Associated with Premenstrual Syndrome among El-Minia University Students, Egypt. ISRN Public Health 2013; Article ID: 617123:1–6.
View in Google Scholar
Available at: http://www.hindawi.com/isrn/ph/2013/617123 (Accessed August 18,2018].
View in Google Scholar
Sheetu MKJ, Naik JD, Thakur MS, Langre SD, Pandey VO. 2014. Patterns and problems of menstruation amongst the adolescent girls residing in the urban slum. Sch J App Med Sci 2(2A):529–34.
View in Google Scholar
Shidfar F, Alborzi F, Salehi M, Nojomi M. 2012. Association of waist circumference, body mass index and conicity index with cardiovascular risk factors in postmenopausal women. Cardiovasc J Afr 23(8):442–45.
View in Google Scholar
Slaughter MH, Lohman TG, Boileau R, Horswill CA, Stillman RJ, Van Loan MD, et al. 1988. Skinfold equations for estimation of body fatness in children and youth. Hum Biol 60:709–23.
View in Google Scholar
Symons JP, Sowers MF, Harlow SD. 1997. Relationship of body composition measures and menstrual cycle length. Ann Hum Biol 24(2):107–16.
View in Google Scholar
Tayebi N, Yazdanpanahi Z, Yektatalab S, Pourahmad S, Akbarzadeh M. 2018. The relationship between body mass index (BMI) and menstrual disorders at different ages of menarche and sex hormones. J Natl Med Assoc 110(5):440–47.
View in Google Scholar
Taylor RW, Jones IE, Williams SM, Goulding A. 2000. Evaluation of waist circumference, waist-to-hip ratio, and the Conicity Index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr 72(2):490–95.
View in Google Scholar
Teixeira A, Oliveira E,and Dias M. 2013.Relationship between the level of physical activity and premenstrual syndrome incidence. Rev Bras Ginecol Obstet 35(5):210–14.
View in Google Scholar
Thapa B and Shrestha T. 2015. Relationship between Body Mass Index and menstrual irregularities among the adolescents. Int J Nurs Res 2(2):7–11.
View in Google Scholar
Tienboon P, Wahlqvist M. 2002. A prospective study of weight and height going from infancy to adolescence. Asia Pacific J Clin Nutr 11(1):42–47.
View in Google Scholar
Towne B, Czerwinski SA, Demerath EW, Blangero J, Roche AF, Siervogel RM. 2005. Heritability of age at menarche in girls from the Fels Longitudinal Study. Am J Phys Anthropol 128(1):210–19.
View in Google Scholar
VanItallie TB, Yang MU, Heymsfield SB, Funk RC, Boileau RA. 1990. Height-normalized indices of the body’s fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Clin Nutr 52:953–9.
View in Google Scholar
Vasanthi G, Pawashe AB, Susie H, Sujatha T, Raman L. 1994. Iron nutritional status of adolescent girls from rural area and urban slum. Indian Pediatr 31(2):127–32.
View in Google Scholar
Wang H, Liu A, Zhao T, Gong X, Pang T, Zhou Y et al. 2017. Comparison of anthropometric indices for predicting the risk of metabolic syndrome and its components in Chinese adults: a prospective, longitudinal study. BMJ Open 7(9):1–10.
View in Google Scholar
Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. 2004. Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia? Am J Obstet Gynecol 190(5):1224–29.
View in Google Scholar
Wei S, Schmidt MD, Dwyer T, Norman RJ, Venn AJ. 2009. Obesity and Menstrual Irregularity: Associations With SHBG, Testosterone and Insulin. Obesity 7(5): 1071–76.
View in Google Scholar
West S, Lashen H, Bloigu A, Franks S, Puukka K, Ruokonen A et al. 2014. Irregular menstruation and hyper androgenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: Northern Finland Birth Cohort 1986 Study. Hum Reprod 29(10): 2339–51.
View in Google Scholar
Winderlich M. The link between weight and menstrual cycles. Available at https://www.everydayhealth.com/pms/weightand-your-cycle.aspx (Accessed August 20, 2018).
View in Google Scholar
World Health Organization Task Force on Adolescent Reproductive Health. 1986. World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. I. A multicenter cross-sectional study of menarche. J Adolesc Health Care 7(4):229–35.
View in Google Scholar
World Health Organization. 2000. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation of Obesity: Switzerland. Available at: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ (Accessed August 14, 2018).
View in Google Scholar
Wronka 2010. Association between BMI and age at menarche in girls from different socio-economic groups. Anthropol Anz 68(1):43–52.
View in Google Scholar
Ziv A, Boulet JR, Slap GB. 1999. Utilization of physician offices by adolescents in the United States. Pediatrics 104(1):35–42.
View in Google Scholar
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Anthropological Review
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.