Hindawi

International Journal of Reproductive Medicine

Volume 2018, Article ID 9730328, 5 pages
https://doi.org/10.1155/2018/9730328

Research Article
Dysmenorrhea among University Health Science Students,
Northern Ethiopia: Impact and Associated Factors

Teshager Aklilu Yesuf , Nigist Assefa Eshete, and Eskinder Ayalew Sisay
Department of Pharmacy, College of Health Sciences, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia

Correspondence should be addressed to Teshager Aklilu Yesuf; [email protected]

Received 28 September 2017; Accepted 25 December 2017; Published 21 January 2018

Academic Editor: Robert Gaspar

Copyright © 2018 Teshager Aklilu Yesuf et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Background. It is estimated that more than half of all women in adolescence age suffer from dysmenorrhea and it often interferes
with their daily physical and emotional aspects. It is the leading cause of short-term school absenteeism and is associated with a
negative impact on academic and daily activities. Objectives. To investigate impacts of dysmenorrhea, factors associated with it, and
its self-management strategies used by health science students. Methods. A cross-sectional institution based study was conducted
among 246 Mekelle University health science students selected by stratified random sampling technique. Data were collected using
self-administered semistructured questionnaire. Data were analyzed using SPSS 16. Results. The prevalence of dysmenorrhea was
71.8%. Participants who had long menstrual cycle interval, long menses flows, and positive family history and who were alcohol
users were more likely to had dysmenorrhea. Participants reported that 28.6% feel depressed, 16.2% are absent from class, and 22.9%
had poor personal relationship due to dysmenorrhea and 78.2% of them practiced self-medication. Conclusion. Dysmenorrhea is
common among Mekelle University health science students and it is major problem representing the cause of feeling depressed,
poor personal relationship, and class absenteeism. Majority of the study participants used self-medication to treat dysmenorrhea.

1. Introduction occurred on 37% of the menstrual dates on average and

was unrelated to irregularity of menstrual cycles [8]. The
The term dysmenorrhea refers to severe painful cramping symptoms of primary dysmenorrhea begin a few hours before
sensation in the lower abdomen often accompanied by sweat- menstruation begins and may peak during the heaviest flow
ing, tachycardia, headache, nausea, vomiting, diarrhea, and during menstruation [9]; the most common symptoms are
tremulousness occurring just before or during the menses. stomach cramp (78.0%), backache (58.9%), and mood change
It is a common gynecological problem among adolescent (56.9%) [10].
females which is severe enough to affect their functioning [1– Younger age, low body mass index, smoking, early menar-
3]. che, prolonged or aberrant menstrual flow, premenstrual
Since the pain results from uterine vasoconstriction and somatic complaints, pelvic infections, psychological distur-
contractions mediated by prostaglandins, the most relia- bance, genetic influence, and a history of sexual assault influ-
ble and effective treatment of dysmenorrhea is to inhibit ence the prevalence and severity of dysmenorrhea [3, 11].
prostaglandin synthesis using nonsteroidal anti-inflamma- A study conducted in Jordan indicated that underweight,
tory drugs (NSAIDs) [4]. If symptoms do not respond to having a low family income, living in a rural area, and family
NSAIDs for three menstrual periods, combined oral contra- history of dysmenorrhea were associated with dysmenorrhea
ceptive pills for three menstrual cycles can be tried [5, 6]. [9]. A study conducted in Vietnam showed mean age and age
Several studies have shown that prevalence of dysmen- at menarche, educational status, and religion were associ-
orrhea varies greatly depending on methods of data collec- ated with dysmenorrhea [12]. A study conducted in Turkey
tion. According to a study done in Jordan, the prevalence showed that dysmenorrhea was significantly higher in coffee
of dysmenorrhea was 90.1% [7]. In China, dysmenorrhea consumers, females with menstrual bleeding duration greater
2 International Journal of Reproductive Medicine

than or equal to seven days, and those who had a family Table 1: Demographic characteristics of participants.
history of dysmenorrhea [13]. Prevalence of dysmenorrhea
decreased with increase in age [14, 15]. An experimental Variables Frequency Percent
study conducted in Iran showed that regular physical activity Department
significantly reduced dysmenorrhea [16]. Medicine 95 39.3
Dysmenorrhea affects the physical, psychological, and Pharmacy 24 9.9
social status of female adolescents. According to study con- Public health 25 10.3
ducted in India among female medical students who reported Nursing 81 33.5
dysmenorrhea, 31.67% and 8.68% were frequently missing Dentistry 17 7.0
college and classes, respectively [17]. A study done in South Academic year
India showed that ibuprofen was taken by 80.95% of students First year 74 30.6
[2] while a study done in Taiwan and Ghana showed that
Second year 56 23.1
paracetamol was the most effective strategies in relieving
dysmenorrhea [15, 18]. According to Egyptian study, fresh Third year 70 28.9
ginger was effective in relieving menstrual pain [19]. Fourth Year 36 14.9
The objective of this study was to determine the preva- Fifth year 6 2.5
lence of dysmenorrhea and assess its impact and management Religion
strategies used among Mekelle University health science Orthodox 179 74.0
students. Muslim 28 11.6
Protestant 31 12.8
2. Methods and Participants Other 4 1.7
Marital status
2.1. Study Design. A cross-sectional study was conducted
Unmarried 222 92.9
from April to May 2014 in Mekelle University, College of
Married 17 7.1
Health Sciences, Northern Ethiopia. There were a total of 535
health science female students (medicine, pharmacy, public Mothers’ educational level
health, nursing, and dentistry). Considering 95% confidence Unable to read and write 26 11.0
interval, 5% margin of error, 10% contingency for nonre- Able to read and write 65 27.4
sponse rate, and 50% expected prevalence of dysmenorrhea, a High school 40 16.9
sample of 246 students was calculated using single proportion Diploma and above 106 44.7
formula. A two-step stratified random sampling technique
was used to select study participants: sampling from each
Table 2: Menstrual characteristics of participants, 2014.
department and then sampling from each academic year
based on appropriate proportion of the respective field of Variable Frequency Percent
study. Menstruation cycle
Pretested self-administered semistructured question- 21 days or less 37 15.4
naire which was prepared in English was used to collect data.
23 to 34 days 188 78.3
Ethical clearance was obtained from the institutional review
35 or greater days 15 6.2
board of Mekelle University and consent was sought from
each participant. Data were coded and entered using SPSS 16 Menstruation cycle regularity
(SPSS Inc., Chicago, USA) for analysis. Frequencies, means, Regular 163 67.4
and standard deviations were calculated where appropriate Irregular 79 32.6
for each of the variables. Binary logistic regression was done Menstruation bleeding duration
to determine factors associated with dysmenorrhea and 𝑝 2-3 days 54 22.4
value less than 0.05 was considered statistically significant. 4-5 days 155 64.3
6-7 days 32 13.3
3. Results Experience of dysmenorrhea
Yes 173 71.8
3.1. Participants’ Background Information. Out of a total of
No 68 28.2
246 participants recruited to the study, 4 were excluded
Family history of dysmenorrhea
because of failure to complete the questionnaire, resulting in
a response rate of 98%. The mean age of the study participants Yes 129 54.4
was 20.5 ± 1.16 years. Most participants were freshman No 108 45.6
accounting 74 (30.6%) (Table 1).
Majority of participants 173 (71.8%) experienced dysmen-
orrhea. More than half of the students (54.4%) reported duration of menses flow as well as menstrual cycle interval
having a family history of dysmenorrhea (Table 2). were significantly associated with dysmenorrhea (Table 3).
Multivariate logistic regression analysis showed that field Most participants have lower abdominal pain (67%). The
of study, alcohol use, family history of dysmenorrhea, and majority of participants who had dysmenorrhea experienced
International Journal of Reproductive Medicine 3

Table 3: Factors associated with dysmenorrhea, 2014.

Variables AOR (95.0% CI) 𝑝 value

Field of study 0.047∗
Medicine Reference
Pharmacy 1.95 (0.479, 7.90) 0.352
Public health 1.86 (0.55, 6.30) 0.321
Nursing 0.52 (0.19, 1.38) 0.188
Dentistry 0.05 (0.01, 0.85) 0.039
Alcohol use 0.016∗
Yes 0.06 (0.01, 0.59)
No Reference
Menstrual cycle 0.030∗
Less than or equal to 21 days 5.62 (1.01, 31.37) 0.049
22–34 days 1.36 (0.31, 5.99) 0.685
Greater than or equal to 35 days Reference
Duration of menses 0.033∗
2-3 days 4.20 (1.01, 17.61) 0.050
4-5 days 1.34 (0.36, 5.01) 0.663
6-7 days Reference
Family history of dysmenorrhea 0.001∗
Yes 0.27 (0.13, 0.59)
No Reference
Constant 0.06 0.529
∗
Statistically significant at 𝑝 value < 0.05; AOR: adjusted odds ratio.

Table 4: Dysmenorrhea associated symptoms and sites of pain, Table 5: Impacts of menstrual pain, 2014.
2014.
Impact of menstrual pain Frequency Percent
Symptoms Frequency Percent
Poor concentration at class 62 11.0
Lower abdominal pain 163 67.4
Absent from class 91 16.2
Back pain 126 52.0
Poor personal relationship 129 22.9
Thigh pain 20 8.3
Headache 94 19.8 Feel depressed 161 28.6
Dizziness 131 27.5 Limitation of sleeping 36 6.5
Nausea, vomiting, and diarrhea 50 10.5 Limit your exercise 83 14.8
Decreased concentration 87 18.3
Loss of appetite 114 23.9
Table 6: Medications and home remedies used for managing
dysmenorrhea, 2014.

their symptoms at the onset of menstruation flow (36.4%). Management strategies Frequency Percent
Dizziness was the commonest associated symptom, reported Ibuprofen 137 48.0
by 27.5% respondents, and loss of appetite was the second
Paracetamol 34 12
commonest associated symptom reported by 23.9% respon-
dents (Table 4). Diclofenac 72 25.3
Most participants, 225 (94.1%), did not smoke cigarettes. Oral contraceptive pills 2 0.7
There were 27 (11.2%) participants who use alcohol. Majority Apply pad 71 16
of participants, 137 (56.8%), in this study have habit of
Bed rest 150 33.6
drinking coffee. Participants reported that 28.6% of them feel
depressed, 16.2% were absent from class, and 22.9% had poor Drink more water or tea 141 31.6
personal relationship because of dysmenorrhea (Table 5). Massage the site of pain 69 15.5
Ibuprofen was used by 48% of participants. The majorities Drink different fluids such as soft
of the study participants use bed rest (33.6%) and drink more 15 3.4
drinks especially coca cola
water or tea (31.6%) as a homemade remedy for dysmenor- 40 14
None
rhea (Table 6).
4 International Journal of Reproductive Medicine

4. Discussion Ghana (51.5%) [18]. Only 5.8% of the study participants had
consulted a physician in our study.
In this study, the prevalence of dysmenorrhea was 71.8%. NSAIDs are highly effective in treating dysmenorrhea
This is similar to what is previously reported by Ghanaian when they are taken before the onset of menses and continued
adolescent girls, 74.4% [18]. But dysmenorrhea was diagnosed through day two [18]. But our finding indicated that 73.7%
based solely on a girls’ perception of pain, which is difficult to of participants reported taking these medications when pain
quantify and could be related to nonmenstrual events. starts indicating the need for professional consultation.
Previous studies showed that the prevalence of dysmen-
orrhea decreases with increasing age and it is significantly 5. Conclusion
associated with early age of menarche [3, 10, 11]. But age at
first menarche had no association in our study. Length of Dysmenorrhea is a major problem representing the leading
menstrual cycle (𝑝 = 0.03) and duration of menses (𝑝 = cause of class absenteeism. Females with long menstrual
0.033) were found to be associated with dysmenorrhea. In bleeding duration and long menstrual cycle interval, positive
China, increased menstrual flows (median 4 days and 𝑝 < family history of dysmenorrhea, and alcohol drinking habit
0.05) have been reported to be associated with an increase in are more likely to experience dysmenorrhea. It is very
the severity of dysmenorrhea [8]. important to create awareness about the causes and treatment
Positive family history of dysmenorrhea (𝑝 < 0.01) was of dysmenorrhea via the education system and media. Health
significantly associated with dysmenorrhea. A similar result professional consultation must be promoted to help students
was obtained from India [2]. The fact that family history was who have dysmenorrhea.
shown to be a risk factor for dysmenorrhea may be related
to the risk for related conditions such as endometriosis and Conflicts of Interest
genetic factors [13]. Alcohol drinking was also associated with
dysmenorrhea (𝑝 = 0.016). In this study, regular exercise The authors declared no potential conflicts of interest with
was not associated with experience of dysmenorrhea. But an respect to the research, authorship, and/or publication of this
experimental study done in Turkey found that participating article.
in physical activity decreased the length of menstruation pain
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