Upsala Journal of Medical Sciences.

2010; 115: 138145

ORIGINAL ARTICLE

Prevalence of dysmenorrhea and its effect on quality of life among

a group of female university students

ALAETTIN UNSAL1, UNAL AYRANCI2, MUSTAFA TOZUN3, GUL ARSLAN4 &

ELIF CALIK5
1

Eskisehir Osmangazi University, Public Health Department, Meselik-Eskisehir, Turkey, 2Osmangazi University,
Medico-Social Center, Meselik-Eskisehir, Turkey, 3Ministry of Health, Community Health Center, Yenikent-Eskisehir,
Turkey, 4Eskisehir Osmangazi University, Eskisehir Vocational College of Health Services, Meselik-Eskisehir, Turkey,
and 5Dumlupinar University, College of Nursing, Kutahya, Turkey

Abstract
The objective was to evaluate the prevalence of dysmenorrhea and determine its effect on health-related quality of life
(HRQoL) among a group of female university students. This cross-sectional study was conducted between 15 March and 15
April 2009 at Dumlupinar University, Kutahya, Health High School, Western Turkey. The study group included 623 female
students. The severity of dysmenorrhea was determined with a 10-point visual analog scale. The Short Form-36 (SF-36) form
was used to determinate HRQoL. Chi-square test, Students t test, and logistic regression and variance analyses (ANOVA)
were used for statistical analyses. The average age of the study group was 20.8 1.8 years (range 1730). Prevalence of
dysmenorrhea was found to be 72.7% and was signicantly higher in coffee consumers, females with menstrual bleeding
duration 7 days, and those who had a positive family history of dysmenorrhea when compared to the others (P < 0.05, for each
one). By multivariate analysis, coffee consumption (OR 2.084), menstrual bleeding duration 7 days (OR 1.590), and positive
family history of dysmenorrhea (OR 3.043) were important risk factors for dysmenorrhea. Except for social functioning, role
emotional, and mental health domains, the SF-36 points received from the other domains were higher in females with
dysmenorrhea (for each one P < 0.05). With the exception of the scores received from physical functioning and roleemotional
domains, the scores received from the other domains of the SF-36 scale showed a decrease with increasing severity of
dysmenorrhea (P < 0.05, for each one). Dysmenorrhea is a common health problem, having negative effects on the HRQoL
among university female students.

Key words: Dysmenorrhea, female students, quality of life, SF-36, VAS

Introduction
Dysmenorrhea may be categorized into two distinct
types: primary and secondary. Primary dysmenorrhea
is dened as painful menses in women with normal
pelvic anatomy, usually beginning during adolescence
(1). Secondary dysmenorrhea is menstrual pain associated with underlying pathology, and its onset may be
years after menarche. It can be caused by any of a dozen
or so disorders such as endometriosis, pelvic inammatory disease, intra-uterine devices, irregular cycles
or infertility problems, ovarian cysts, adenomyosis,

uterine myomas or polyps, intra-uterine adhesions,

or cervical stenosis.
Dysmenorrhea is characterized by crampy pelvic
pain beginning shortly before or at the onset of menses and lasting 13 days (2). Some 24 days before
menstruation begins, prostaglandins proceed into the
uterine muscle where they build up quickly at menstrual onset and act as smooth muscle contractors that
aid in the expulsion of the endometrium (3).
There is a wide variation in the estimate of dysmenorrhea from studies around the world reporting a
range between 28% and 71.7% (4,5). In similar studies

Correspondence: Dr Unal Ayranci, Kurtulus Aile Sagligi Merkezi, Vatan Cd. 12/A, Eskisehir, Turkey. Fax: +90-222-233 82 25. E-mail: [email protected]
(Received 1 July 2009; accepted 2 November 2009)
ISSN 0300-9734 print/ISSN 2000-1967 online  2010 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS)
DOI: 10.3109/03009730903457218

Dysmenorrhea among Turkish students

from Turkey, the prevalence of dysmenorrhea has been
reported to be between 58.2% and 89.5% (6,7).
Studies on the prevalence of menstrual pain have
shown that many factors are related to this disorder.
These factors include a younger age, low body mass
index (BMI), smoking, early menarche, prolonged or
aberrant menstrual ow, perimenstrual somatic complaints, pelvic infections, previous sterilization, somatization, psychological disturbance, genetic inuence,
and a history of sexual assault inuencing the prevalence and severity of dysmenorrhea (8,9).
Emotional and behavioral problems may exacerbate menstrual cycle problems and dysmenorrhea.
For example, depression and/or anxiety symptoms
are reported to have an impact on menstrual cycle
function and dysmenorrhea. Due to the negative
effects of dysmenorrhea on an individuals psychological status, health-related quality of life (HRQoL)
may be disrupted among adolescent women (10).
Furthermore, dysmenorrhea is a common cause of
sickness absenteeism from both classes and work by
the female student community (11).
The aim of this study was to evaluate the prevalence
of dysmenorrhea and its effect on HRQoL among
female students of a university situated in western
Turkey.

139

participate in the research (n = 9), and not being at

classes at the time of the study (n = 32). The remaining
93.8% (623/664) women constituted the study group.

Procedures
All 623 students surveyed at school completed the
questionnaires and inventories during a class period.
After distributing the questionnaires to students at the
school, they were informed of how the questionnaires
were to be lled in and then were requested to make a
choice applicable to themselves. The students completed questionnaires and inventories in the presence
of a member of the research team. The data collected
was self-reported by the students. All subjects
(n = 623) were told that participation in the investigation was strictly voluntary, and that the data collected would not be used for anything except for this
research study, and they were given the questionnaire
and inventory to complete. The duration for completing the questionnaire and inventory was between
35 and 40 minutes per subject. The principal investigators met daily with the data collectors to ensure
the quality of data collected.

Development of the questionnaires

Methods
Setting
Kutahya is a semi-rural province situated in the western part of Turkey, with a population of 565,884. The
socio-economic level of the city is average compared
with other cities of the country. There are signicant
disparities in the socio-economic characteristics of the
quarters of the city. The city includes one university
and has a cosmopolitan structure in terms of student
population. The university where the study was conducted, Dumlupinar University, has 19 faculties and
colleges with about 30,000 students.

Sampling
This cross-sectional study was conducted between 15
March 2009 and 15 April 2009 in the Health College
giving education at the Dumlupinar University, a
public university located in the west of Turkey. The
number of the students studying in that college was
946, most of them (n = 664, 70.2%) girls. The study
was performed on a total of 623 students who agreed to
participate in the research. Of the 664 students, 41
were excluded from the survey due to: unwillingness to

The questionnaire, prepared with reference to previous studies in the literature (7,12,13), included three
parts. In the rst part of the questionnaire, students
were asked to state their socio-demographic and
medical characteristics, and dysmenorrheal status
and habits. The second part of the questionnaires
included visual analogue scale (VAS) questions and
multidimensional scoring system (MSS) (Table I) to
assess the severity of dysmenorrhea (1416), and the
last part included the questions of the Outcomes
Study Short Form-36 (SF-36) Health Survey Questionnaire to determine to HRQoL of the students.
The VAS using a 10-cm line represented the continuum of the female students opinion of the degree of
pain. One extremity of the line represented
unbearable pain, and the other extremity represented no pain at all. The participants were asked
to rate the degree of pain by making a mark on the
line. The scores received from the scale were classied
into mild dysmenorrhea if it was between 13 points,
moderate between 47 points, and severe between
810 points (16). The MSS system was dened as
mild, moderate, and severe based on pain and limited
activities, as shown in Table I (14). If an adolescent
had pain in the abdominal, groin, and lumbar region
on the day before the menstrual period and/or the rst

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A. Unsal et al.

Table I. Verbal multidimensional scoring system for assessment of dysmenorrhea severity.

Severity grading

Working ability

Systemic symptoms

Analgesics

Grade 0: Menstruation is not painful and daily activity is unaffected.

Unaffected

None

None required

Mild (Grade 1): Menstruation is painful but seldom inhibits

normal activity; analgesics are seldom required; mild pain.

Rarely affected

None

Rarely required

Moderate (Grade 2): Daily activity is affected; analgesics required

and give sufcient relief so that absence from
school is unusual; moderate pain.

Moderately affected

Few

Required

Severe (Grade 3): Activity clearly inhibited; poor effect of analgesics;

vegetative symptoms (headache, fatigue, vomiting,
and diarrhea); severe pain.

Clearly inhibited

Apparent

Poor effect

day of menstrual period, it was considered to be

dysmenorrhea (13).
If an adolescent experienced menstrual bleeding in
equal intervals between 21 and 35 days, it was evaluated as regular menstruation (normal); if the menstruation interval was less than 21 days, it was
considered to be short; if the menstruation interval
was more than 35 days, it was considered to be long.
Menstruation of less than 2 days was accepted as
short, between 2 and 6 days as normal, and more
than 6 days as long.
The SF-36 scale is the most widely used generic
instrument for rating HRQoL. The validity and reliability of this instrument has been established for
measuring HRQoL in large populations of both healthy
and diseased individuals. The original questionnaire
was developed by Ware and Sherbourne (17), and
reliability and validity studies for the Turkish version
of SF-36 were performed by Kocyigit et al. (18). It is a
self-evaluation instrument consisting of 36 items which
provide assessment in eight domains: physical functioning, social functioning, role limitations due to
emotional problems (roleemotional), role limitations
due to physical problems (rolephysical), bodily pain,
vitality, mental health, and general health perception.
In our study, we used the Turkish version of SF-36,
which showed good reliability and validity in the Turkish validation study (18). The subjects gave appropriate
answers for the questions in the SF-36 scale for their
depression status during the last 4 weeks. Scores changed from 0 to 100 for each domain separately. The high
scores obtained from the scale shows that the HRQoL
increases in a positive way.
Following the completion of the questionnaires and
inventory, the participants body mass indexes
(BMIs) were calculated by measuring their heights
and weights. Each students body weight was measured
with domestic scales and height with a meter rule.
Those who had a BMI of 18.024.9 kg/m2 were classied as normal weight, adolescents with BMI values
that corresponded to a BMI of 25.029.9 kg/m2 were
classied as overweight (preobese), adolescents with

BMI values that corresponded to an adult BMI of

30.0 kg/m2 were classied as obese, and adolescents
with BMI values that corresponded to <18.0 kg/m2 as
underweight (19).
In addition, those smoking at least one cigarette a
day were evaluated as smokers, those consuming at
least 30 g ethyl alcohol in a week as alcohol consumers, those consuming at least 4 glasses of tea in a day
(75 cc  4) as those consuming tea, those consuming
at least 3 cups of coffee in a day (150 cc  3) as those
consuming coffee, those consuming at least a glass of
cola in a day (200 cc  1) as those consuming cola,
and those eating at least 2 bars of chocolate in a day
(150 cc  3) as those consuming chocolate.
The presence of dysmenorrhea in an adolescents
mother or sister was accepted as a positive family history
of dysmenorrhea. Those unemployed, housewife, and
retired were considered to be not working. The student
allowances were grouped as enough, medium, or
insufcient in the students own statements. The
statistical package for social sciences (SPSS) version
15.0 (Chicago, IL, USA) was used to enter and analyze
the data on a personal computer. The statistical analysis
was carried out using chi-square, Students t test, backward stepwise logistic regression analysis, and one-way
ANOVA test. A value of P < 0.05 was considered
statistically signicant.

Ethical approval
Permission for the study was obtained by making a
petition prior to collecting data. This was achieved by
contacting and receiving approval from the Director
of the Institution of Eskisehir Osmangazi University.
Participants completed an informed consent form in
which they were assured of the condentiality of their
responses following which they provided informed
verbal consent that participation was voluntary and
anonymous. It was also stated that the participant
responses were unidentiable. All students gave their
informed consent prior to their inclusion in the study.

Dysmenorrhea among Turkish students

141

Table II. Some socio-demographic characteristics of students by status of dysmenorrhea.

Dysmenorrhea
Yes (%)a

No (%)a

Total (%)b

Statistical analysis, chi-square; P

1719

14 (74.0)

40 (26.0)

154 (24.7)

0.320; 0.956

20

93 (72.1)

36 (27.9)

129 (20.7)

21

97 (73.5)

35 (26.5)

132 (21.2)

2230

149 (71.6)

59 (28.4)

208 (33.4)

Yes

412 (72.3)

158 (27.7)

570 (91.5)

No

41 (77.4)

12 (22.6)

53 (8.5)

Good

129 (70.1)

55 (29.9)

184 (29.5)

Middle

298 (73.2)

109 (26.8)

407 (65.3)

Bad

26 (81.3)

6 (18.8)

32 (5.1)

Nuclear

399 (72.2)

154 (27.8)

553 (88.8)

Large

54 (77.1)

16 (22.9)

70 (11.2)

Total

453 (72.7)

170 (27.3)

623 (100.0)

Socio-demographics
Age group (year)

Social insurance
0.400; 0.527

Family income status

1.857; 0.395

Family type
0.549; 0.459

Percent for the row.

Percent for the column.

Results
The average age of the participants was
20.8 1.8 years (range 1730 years). More than
45.4% of the students (n = 283) were in the age group
of 20 and below. A total of 8.5% (n = 54) of the
students were deprived of social health insurance,
and 5.1% (n = 32) of students reported that their
family income status was poor. The proportion
of those whose family was of a nucleus type was
88.8% (n = 553). The students prevalence of
dysmenorrhea was found to be 72.7% (n = 453).
In this study, there was no statistically signicant
difference between those with dysmenorrhea and
those without (P > 0.05). More detailed sociodemographic characteristics of those with and
without dysmenorrhea are shown in Table II.
In the study group, the prevalence of smoking
cigarettes was 10.3% (n = 64), with a 4.8% (n = 30)
proportion of students consuming alcohol. The
number of students who drank four or more cups of
tea in a day was 399 (64.0%). Nearly one-third of the
students (30.3%, n = 189) reported that they
consumed at least three cups of coffee in a day;
401 students (64.4%) reported consuming at least
one glass of cola a day, and 361 students (57.9%)
reported consuming at least two bars of chocolate
a day. The mean BMI of the students was

21.05 2.6 kg/m2 (min 14.84, max 37.46), and the

prevalence of overweight/obesity was 6.4% (n = 40).
Altogether 54 students (8.7%) reported having a
chronic disease necessitating continuous medicine
use. There was statistically no difference between
habits and medical characteristics of students by status
of dysmenorrhea, except for coffee consumption
(P < 0.001). More detailed habits and medical characteristics of students by status of dysmenorrhea are given
in Table III.
The students average menarche age was
13.38 1.20, ranging from 10 to 18. Most students
menarche age was between 13 and 14 (63.2%). About
80% reported experiencing regular menstruation
(79.8%).
The average menstrual cycle duration of the
students in the study group was 28.73 7.25 days
(min 10, max 90), and many students menstrual
cycle duration was between 21 and 34 days
(87.5%). Their average menstrual bleeding duration
was 5.73 1.34 days, ranging between 3 and 10. Most
students menstrual bleeding duration was less than
7 days (68.7%). Only 8.3% students reported using
medicine regulating menstruation. About 50% of
students (47.4%) reported having a family history
of dysmenorrhea. No difference between menstrual
characteristics and status of dysmenorrhea was
revealed except for menstrual bleeding duration

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A. Unsal et al.

Table III. Some habits and medical characteristics of students with/

without dysmenorrhea.
Dysmenorrhea
Some
habits

Yes (%)

No (%)

Total (%)

Yes

48 (75.0)

16 (25.0)

64 (10.3)

No

405 (72.5)

154 (27.5)

559 (89.7)

Statistical
analysis,
chi-square; P

Smoking
0.082; 0.775

Alcohol consumption
Yes

23 (76.7)

7 (23.3)

30 (4.8)

No

430 (72.5)

163 (27.5)

593 (95.2)

0.083; 0.773

Tea consumption
Yes

291 (72.9)

108 (27.1)

399 (64.0)

No

162 (72.3)

62 (27.7)

224 (36.0)

0.027; 0.870

Coffee consumption

received from HRQoL scale, with the exception of

the domains of physical functioning (P < 0.05), role
physical (P < 0.05), bodily pain (P < 0.001), general
health perception (P < 0.05), and vitality (P < 0.05). In
those with dysmenorrhea the scores received from all
the domains of HRQoL were lower. More detailed
data received from SF-36 domains by status of dysmenorrhea are given in Table VI.
The average scores that students received from the
SF-36 scale by severity of dysmenorrhea are given
in Table VII. The distribution of the severity of
dysmenorrhea cases was as follows: mild 33.8%
(n = 153), moderate 42.4% (n = 192), and severe
23.8% (n = 108).

Discussion

Yes

156 (82.5)

33 (17.5)

189 (30.3)

No

297 (68.4)

137 (31.6)

434 (69.7)

13.205; 0.000

Coke consumption
Yes

292 (72.8)

109 (27.2)

401 (64.4)

No

161 (72.5)

61 (27.5)

222 (35.6)

0.006; 0.937

Chocolate consumption
Yes

273 (75.6)

88 (24.4)

361 (57.9)

No

180 (68.7)

82 (31.3)

262 (42.1)

3.665; 0.056

Overweight/obese
Yes

24 (60.0)

16 (40.0)

40 (6.4)

No

429 (73.6)

154 (26.4)

583 (93.6)

2.831; 0.092

Any chronic disease necessitating the use of any medicine

Yes

44 (81.5)

10 (18.5)

54 (8.7)

No

409 (71.9)

160 (28.1)

569 (91.3)

Total

453 (72.7)

170 (27.3)

623 (100.0)

1.833; 0.176

and family history. The distribution of students with

and without dysmenorrhea according to a range of
more detailed menstrual characteristics is given
in Table IV.
According to the bivariate analysis results, signicant differences were revealed between the existence
of dysmenorrhea and the students consumption of
coffee, having a 7-day or more menstrual bleeding
duration, and positive family history of dysmenorrhea.
Backward stepwise logistic regression analysis performed with the above variables, which showed signicantly important ndings, is given in Table V.
According to this analysis, coffee consumption (OR
2.084), 7 days menstrual bleeding duration (OR
1.590), and family history (OR 3.043) were signicantly important risk factors for dysmenorrhea.
There was no difference between the average scores
that students with and without dysmenorrhea

The present study found a high prevalence of dysmenorrhea (72.7%) reported among female students;
this gure is consistent with previous studies reporting
rates between 28% and 89.5% (47). Similarly, previous studies conducted in Turkey indicated that the
prevalence of dysmenorrhea among the same age
group of women ranged between 23.4% and 89.5%
(2022). A reason for the variation in these estimates
may be the use of selected groups of women, and the
absence of a universally accepted method of dening
dysmenorrhea, which was probably as greatly responsible for the disparity as the methods of collecting
data, the study denitions of dysmenorrhea and pain,
and the study populations themselves (23).
In this survey, approximately two-thirds of the
women (66.2%) described their dysmenorrhea as
severe and moderate, in line with the study by
Burnett et al. (4). This indicates that dysmenorrhea
is still an important public health problem and that
these female students in rural areas experience
severe or moderate dysmenorrhea, which may have
a negative effect on HRQoL, social environment,
work, and psychological status.
Many studies determined that the prevalence of
dysmenorrhea showed a decrease with increasing
age, indicating that primary dysmenorrhea peaks in
late adolescence and the early 20s and the incidence
falls with increasing age (4,13,24). However, this
study did not nd any connection between age groups
and the prevalence of dysmenorrhea (P > 0.05). This
is probably because the students in the study group
may not be in a higher range of years.
Epidemiological studies (25) have shown a link
between dysmenorrhea and several environmental
risk factors, including current cigarette smoking.
However, this study did not nd any relationship
between cigarette use and dysmenorrhea (P > 0.05).

Dysmenorrhea among Turkish students

143

Table IV. Some menstrual characteristics of students with/without dysmenorrhea.

Dysmenorrhea
Some characteristics

Yes, n (%)

No, n (%)

Total, n (%)

Statistical analysis, chi-square; P

12

106 (79.1)

28 (20.9)

134 (21.5)

3.899; 0.142

1314

282 (71.6)

112 (28.4)

394 (63.2)

15

65 (68.4)

30 (31.6)

95 (15.3)

Regular

359 (72.2)

138 (27.8)

497 (79.8)

Irregular

94 (74.6)

32 (25.4)

126 (20.2)

20

17 (63.0)

10 (37.0)

27 (4.3)

2134

396 (72.7)

149 (27.3)

545 (87.5)

35

40 (78.4)

11 (21.6)

51 (8.2)

Age at menarche (year)

Menstrual regularity
0.284; 0.594

Menstrual cycle duration (days)

2.135; 0.344

Menstrual bleeding duration (days)

6

298 (69.6)

130 (30.4)

428 (68.7)

155 (79.5)

40 (20.5)

195 (31.3)

6.565; 0.010

Use of medicine regulating menstruation

Yes

37 (71.2)

15 (28.8)

52 (8.3)

No

416 (72.9)

155 (27.1)

571 (91.7)

Yes

249 (84.4)

46 (15.6)

295 (47.4)

No

204 (62.2)

124 (37.8)

328 (52.6)

Total

453 (72.7)

170 (27.3)

623 (100.0)

0.010; 0.920

Family history

One explanation for this could be that in this study

we did not ask the dose of cigarettes used and the
period of smoking, in line with another study from
Turkey (24).
By both univariate and multivariate analyses, coffee
consumption was an important risk factor for dysmenorrhea, in line with some researchers studies (26),
and similarly menstrual bleeding duration of 7 days
and over was an important risk factor for

Table V. Signicant independent variables for dysmenorrhea

according to logistic regression analysis.
Variables

SE

Constant

0.202

0.137

0.411

OR

95% CI

2.084

1.3423.235

Coffee consumption (reference: no)

Yes

0.734

0.224

0.001

Menstrual bleeding duration (days) (reference: 6)

7

0.464

0.214

0.031

1.590

1.0442.421

0.000

3.043

2.0584.500

Family history (reference: No)

Yes

1.113

0.200

Hosmer and Lemeshow test: chi-square = 3.616; P = 0.606.

38.619; 0.000

dysmenorrhea. This nding is compatible with the

result showing that the risk of dysmenorrhea is higher
in women with long menstrual ows (27).
According to the bivariate and multivariate analysis,
those with family history of dysmenorrhea had a
signicantly higher prevalence of dysmenorrhea, a
nding which is consistent with some studies (7).
This result indicates that a family history of dysmenorrhea seems to be an important characteristic for
women with dysmenorrhea. As an explanation for
this, some researchers have reported that daughters
of mothers who have menstrual complaints also experienced menstrual discomfort, and that the reason for
this could be related with behavior that is learned from
the mother (7,10). The fact that family history was
shown to be a risk factor for dysmenorrhea may be
related to the risk for related conditions such as
endometriosis, which has already been shown to
have a familial pattern (13).
In this study, the scores received from many of the
SF-36 domains (physical functioning, rolephysical,
bodily pain, general health perception, and vitality)
were signicantly lower in students with dysmenorrhea. An explanation for why only some but not all of

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A. Unsal et al.

Table VI. Average scores students received from SF-36 domains by status of dysmenorrhea.
SF-36 score
Dysmenorrhea
Domains

Yes (n = 453) (mean SD)

No (n = 170) (mean SD)

Statistical analysis
t test; P-value

Physical functioning

81.53 17.85

84.87 16.74

2.115; 0.035

Rolephysical

77.37 33.86

84.71 29.57

2.490; 0.013

Bodily pain

60.01 18.73

69.41 20.34

5.450; 0.000

General health perception

56.02 17.78

60.34 17.91

2.696; 0.007

Vitality

52.16 16.13

55.77 16.28

2.476; 0.014

Social functioning

69.29 20.62

72.28 20.87

1.607; 0.108

Roleemotional

53.57 42.65

59.80 42.74

1.624; 0.105

Mental health

57.36 16.62

59.03 17.04

1.110; 0.267

Table VII. Connection between the severity of dysmenorrhea and mean scores of SF-36 domains.
Severity of dysmenorrhea
SF-36
Domains

Mild (n = 153)
(mean SD)

Moderate (n = 192)
(mean SD)

Severe (n = 108)
(mean SD)

Statistical analysis
F test; P-value

Physical functioning

84.10 16.68

80.93 17.17

78.96 20.18

2.830; 0.060

Rolephysical

86.11 26.73

74.22 34.88

70.60 38.49

8.353; 0.000

Bodily pain

65.05 17.46

60.13 17.61

52.66 20.11

14.695; 0.000

General health perception

59.03 16.94

55.64 17.90

52.44 18.15

4.499; 0.012

Vitality

56.11 14.91

50.42 16.42

49.68 16.35

7.185; 0.001

Social functioning

72.79 20.13

66.60 21.45

69.10 19.22

3.894; 0.021

Roleemotional

58.39 42.80

48.79 43.40

55.25 40.55

2.281; 0.103

Mental health

60.59 16.48

55.87 16.99

55.43 15.62

4.450; 0.012

the parameters are affected could be that since dysmenorrhea is an important illness that primarily
affects physical health, domains of the SF-36 related
to physical health could only be affected. Social and
psychological parameters such as social functioning,
roleemotional, and mental health could not be
affected due to this fact.
In addition, with the increasing severity of dysmenorrhea, the average scores received from all the
domains of SF-36 showed decrease, consistent with
the study by Barnard et al. (28), indicating that
women with dysmenorrhea and the other menstrual
symptoms had lower HRQoL values.
The prevalence of dysmenorrhea among female
students was relatively high throughout our study,
reaching almost three-quarters (72.7%), and HRQoL
showed a decrease in the presence of dysmenorrhea
and with the increase in the severity of dysmenorrhea.
We are well aware of the limitations of the present
study. Firstly, it was performed in a single district, and
in a single university, therefore the sample may not
be representative of all Turkish female university

students. In other words, its comparability with community-based studies is weak, because the mean age of
the female students in the study group was rather low
compared to that of the general population. In addition, when taking into consideration that dysmenorrhea decreases with increasing age, its being done with
a determined age group hinders its applicability to all
women. Secondly, a further limitation is that this study
was a cross-sectional study, thus precluding inferences
of causality among variables. The last limitation is that
the nature of self-reporting may have resulted in underreporting of the conditions.
Acknowledgements
The authors wishes to thank the schools headmasters,
teachers, and the study students for their valuable
efforts and time.
Declaration of interest: The authors declare that
there are no competing interests, and also that there
were no funding organizations for this study.

Dysmenorrhea among Turkish students

References
1. Avasarala AK, Panchangam S. Dysmenorrhoea in different
settings: Are the rural and urban adolescent girls perceiving
and managing the dysmenorrhoea problem differently?
Indian J Community Med. 2008;33:2469.
2. Durain D. Primary dysmenorrhea: assessment and management update. J Midwifery Womens Health. 2004;49:5208.
3. Campbell M, McGrath P. Use of medication by adolescents
for the management of menstrual discomfort. Arch Pediatr
Adolesc Med. 1997;151:90512.
4. Burnett MA, Antao V, Black A, Feldman K, Grenville A,
Lea R, et al. Prevalence of primary dysmenorrhea in Canada.
J Obstet Gynaecol Can. 2005;27:76570.
5. Pitts MK, Ferris JA, Smith AM, Shelley JM, Richters J.
Prevalence and correlates of three types of pelvic pain in a
nationally representative sample of Australian women. Med J
Aust. 2008;189:13843.
6. Nur N, Smer H. Prevalence of dysmenorrhea and related
risk factors in adolescents. Surekli Tip Egitimi Dergisi
2008;7:2730.
7. Polat A, Celik H, Gurates B, Kaya D, Nalbant M, Kavak E, et al.
Prevalence of primary dysmenorrhea in young adult female
university students. Arch Gynecol Obstet. 2009;279:52732.
8. Tonini G. Dysmenorrhea, endometriosis and premenstrual
syndrome. Minerva Pediatr. 2002;54:52538.
9. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors
predisposing women to chronic pelvic pain: systematic review.
BMJ. 2006;332:74955.
10. Dorn LD, Negriff S, Huang B, Pabst S, Hillman J,
Braverman P, et al. Menstrual symptoms in adolescent girls:
association with smoking, depressive symptoms, and anxiety.
J Adolesc Health. 2009;44:23743.
11. Dawood YM. Dysmenorrhea. Clinical Obst Gynecol.
1990;33:16878.
12. Balbi C, Musone R, Menditto A, Di Prisco L, Cassese E,
DAjello M, et al. Inuence of menstrual factors and dietary
habits on menstrual pain in adolescence age. Eur J Obstet
Gynecol Reprod Biol. 2000;91:1438.
13. Patel V, Tanksale V, Sahasrabhojanee M, Gupte S,
Nevrekar P. The burden and determinants of dysmenorrhoea:
a population-based survey of 2262 women in Goa, India.
BJOG. 2006;113:45363.
14. Andersch B, Milsom I. An epidemiologic study of young
women with dysmenorrhea. Am J Obstet Gynecol.
1982;144:65560.

145

15. Wewers ME, Lowe NK. A critical review of visual analogue

scales in the measurement of clinical phenomena. Res Nurs
Health. 1990;13:22736.
16. Larroy C. Comparing visual-analog and numeric scales for
assessing menstrual pain. Behav Med. 2002;27:17981.
17. Ware JE, Sherbourne CD. The MOS 36-item short-form
health survey (SF-36). I. Conceptual framework and item
selection. Med Care. 1992;30:47383.
18. Kocyigit H, Aydemir O, Olmez N, Memis A. Reliability and
validity of the Turkish version of Short-Form-36 (SF-36).
Turkish J Drugs Therap. 1999;12:1026.
19. World Health Organization. Obesity: preventing and managing the global epidemic Report of a WHO consultation on
obesity. Technical report series, No 894. Geneva: World
Health Organization; 2000.
20. Vicdan K, Kukner S, Dabakoglu T, Ergin T, Keles G,
Gokmen O. Demographic and epidemiologic features of
female adolescents in Turkey. J Adolesc Health.
1996;18:548.
21. Cakir M, Mungan I, Karakas T, Girisken I, Okten A.
Menstrual pattern and common menstrual disorders
among university students in Turkey. Pediatr Int. 2007;49:
93842.
22. Chan SS, Yiu KW, Yuen PM, Sahota DS, Chung TK.
Menstrual problems and health-seeking behaviour in Hong
Kong Chinese girls. Hong Kong Med J. 2009;15:1823.
23. Tangchai K, Titapant V, Boriboonhirunsarn D. Dysmenorrhea in Thai adolescents: Prevalence, impact and knowledge
of treatment. J Med Assoc Thai. 2004;87Suppl 3:6973.
24. Aykut M, Gunay O, Gun I, Tuna R, Balci E, Ozdemir M,
et al. Biyolojik, sosyo-demograk ve nutrisyonel faktorlerin
dismenore prevalansina etkisi. Erciyes Tip Dergisi.
2007;29:392402.
25. Hornsby PP, Wilcox AJ, Weinberg CR. Cigarette smoking
and disturbance of menstrual function. Epidemiology.
1998;9:1938.
26. Chayachinda C, Rattanachaiyanont M, Phattharayuttawat S,
Kooptiwoot S. Premenstrual syndrome in Thai nurses.
J Psychosom Obstet Gynaecol. 2008;29:199205.
27. Di Cintio E, Parazzini F, Tozzi L, Luchini L, Mezzopane R,
Marchini M, et al. Dietary habits, reproductive and menstrual
factors and risk of dysmenorrhoea. Eur J Epidemiol.
1997;13:92530.
28. Barnard K, Frayne SM, Skinner KM, Sullivan LM. Health
status among women with menstrual symptoms. J Womens
Health (Larchmt). 2003;12:9119.