RELAXATION TECHNIQUES TO REDUCING MENTRUAL PAIN

YOUNG WOMAN’S IN SENIOR HIGH SCHOOL 3 MURUNG

Nani Mulyati1, Eline Charla S. Bingan, SST., M.Kes2, Hj. Siti Saudah, SKM., M.Kes3
1,2Health Polytechnic of Palangka Raya
3Midwifery Academy Betang Asi Raya of Palangka Raya

E-mail: nanimulyati054@gmail.com

ABSTRACT

Background: Various problems that arise in menstruation is gynecological problems often

complained in adolescents, such as menstrual irregularities, menorrhagia, dysmenorrhoea, and
other related symptoms. Among these complaints, dysmenorrhea most commonly reported,
occurring in 60% -90% of adolescents, and the most common cause of school absenteeism
reasons and reduction of daily activities.
Objective: To find relaxation techniques to the reduction of menstrual pain Young Women’s
in Senior High School 3 Murung.
Method: This study was analytical research, this type of study is Quasi Experiment with one
group pretest and posttest design. The population in this study is female students in Senior
High School 3 Murung and the sample size of this study as many as 19 people, The statistical
test used in this study was Wilcoxon test.
Results: Statistical test results obtained p value = 0.000 <a (0:05), meaning that there is an
influence of relaxation techniques on reducing menstrual pain Young Women’s in Senior
High School 3 Murung.
Conclusion: There is an influence of relaxation techniques on reducing menstrual pain Young
Women’s in Senior High School 3 Murung.

Keywords: Relaxation, Menstrual Pain, and Adolescence

Poltekkes Kemenkes Palangka Raya

INTRODUCTION
Adolescence is a period where there is
a development of the body shape both
physically and in terms of hormonal. One
such development is the growth hormone,
Gonadotropin Releasing Hormone
(GnRH). This hormone stimulates the
blood flow through the anterior pituitary to
secrete gonadotropin hormones such as
Follicle Stimulating Hormone (FSH) and
luteinizing hormone (LH), which is
episodic and pulsatif. Gonadotropin
hormone will stimulate the gonads to
produce the hormone estrogen in women.
In prepubertal state of very low levels of
this hormone, while the onset of puberty
the amplitude and frequency of GnRH
hormone secretion increased rapidly so that
the hormone gonadotropin and sex steroids
also increased to stimulate the growth of
secondary sex signs and prepare
fertilization (Suryawan, 2010). Girls
puberty marked by the appearance of
menses. First menstruation usually occurs
in women aged 12-16 years. Every woman
is different time in getting menarche or
first menstuasi. Today there are women
who menstruate first time at the age of 8
years, there are also at the age of 9-10
years and that most of the 60% of women
have an average age of menarche 12 to 15
years. This is influenced by several factors,
including heredity, race, climate,
environment, nutrition, and socio-
economic background of parents (Asrinah
et al, 2011). Today there are women who
menstruate first time at the age of 8 years,
there are also at the age of 9-10 years and
that most of the 60% of women have an
average age of menarche 12 to 15 years.
This is influenced by several factors,
including heredity, race, climate,
environment, nutrition, and socio-
economic background of parents (Asrinah
et al, 2011). Today there are women who
menstruate first time at the age of 8 years,
there are also at the age of 9-10 years and
that most of the 60% of women have an
average age of menarche 12 to 15 years.
This is influenced by several factors,
including heredity, race, climate,
environment, nutrition, and socio-
economic background of parents (Asrinah
et al, 2011).
Various problems that arise in
menstruation is gynecological problems
often complained in adolescents, such as
menstrual irregularities, menorrhagia,
dysmenorrhoea, and other related
symptoms. Among these complaints,
dysmenorrhea most commonly reported,
occurring in 60% -90% of adolescents, and
the most common cause of school
absenteeism reasons and reduction of daily
activities (Zegeye D, 2009). Pain and
cramps suprapubis that can spread to
lumbosacralis and upper limbs. In the
pelvic area can sometimes feel a full
sensation or sensation of heartburn and had
difficulty walking. In addition menstrual
complaints often arise include nausea,
vomiting, headache, irritability or
emotional tend highly sensitive and even
fainting. Pain is felt this,
According to the WHO in 2015, the
percentage figure menstrual pain an
average of more than 50% of women in
every country. While in Indonesia the
figure is estimated 55% of women of
reproductive age who suffer from pain
during menstruation. The incidence of
dysmenorrhea in Indonesia amounted to
64.25% comprising 54.89% 9.36% primary
dysmenorrhoea and secondary
dysmenorrhoea (Praise, 2011).
Profile DHO Murung Kingdom there
are no data on Adolescent Reproductive
Health-related disorders including pain
menstrual periods.
Based on the Survey preliminary
SMAN 3 Murung is one SMAN located in
the region Puskesmas Puruk Cahu
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Seberang where researchers work, in
Puskesmas Puruk Cahu across two SMAN,
SMAN 2 Murung and SMAN 3 Murung,
researchers chose to conduct research in
SMAN 3 moody because the school there
is a coaching program from the clinic in
posyandu activities of Youth, in posyandu
this one is counseling adolescent
reproductive health, which are frequent
complaints are menstrual disorders,
including pain during menstruation
(dismenorhoe), Number of students who
attend school in SMAN 3 moody as many
as 139 students, from field studies
didapatakan 108 students have a history of
menstrual pain with pain scale that
varies.Pain during menstruation interferes
with the activity at the school on the first
and second periods and often leave a
lesson for menstrual pain that is unbearable
and some of them stated to take medicine
first and then rested so that the abdominal
pain may be lost.This is in line with
research conducted in Manado by Hesti
Lestari, et al that of the 200 respondents
199 respondents (98.5%) of whom had
dysmenorrhoea during menstruation. Most
respondents (94.5%) had mild pain and
40.7% of young women experience
dysmenorrhea accompanied by associated
symptoms.
To overcome these problems there are
several ways that can be done by
pharmacological and non-pharmacological
therapy. Pharmacologically to do with drug
use, such as: Nonsteroidal Anti-
Inflammatory Drugs (NSAIDs),
cyclooxygenase II inhibitors, oral
contraceptives, glyceryl trinitrate,
magnesium, calcium antagonists, vitamin
B, and vitamin E. 4 While the non-
pharmacological approaches to do by
providing TENS, heat therapy, compress,
acupuncture, akupressur, relaxation or
distraction, and exercise. Non-
pharmacological pain management is safer
to use because no side effects and the
process occurs physiologically (Rigi et al.,
2012).
Relaxation techniques are used in pain
management is to breath deeply. The
advantage of deep breathing relaxation
techniques, among others, can be done at
any time anywhere and anytime, it is very
easy and can be done independently
without a media. Deep breathing relaxation
technique is one of the actions that can be
menstimualsi body to release endorphins
and endogenous opioids that enfekalin
which has properties such as morphine the
analgesic effect (Smeltzer, 2009).
Deep breathing relaxation techniques
are believed to reduce pain intensity
through a mechanism that is by relaxing
skeletal muscles undergo spasm caused by
the increase in prostaglandin causing
vasodilation of blood vessels and increases
blood flow to areas experiencing spasms
and ischemia. Another statement noted that
the reduction of pain by relaxation
techniques deep breath is caused when a
person's relaxation deep breathing to
control the pain that is felt, then the body
will increase the component of the
parasympathetic nervous as a stimulant, it
caused a decrease in levels of the hormone
cortisol and adrenaline in the body that
affect the level of stress someone that can
improve concentration and make the client
feel at ease to set the rhythm of respiration
becomes irregular (Smeltzer, 2009).
The above theory can be proved by
research conducted by Dwi Yani Nanda in
Pontiank in 2016, found that the results
showed no effect of deep breathing
relaxation therapy to decrease the level of
dismenorhoe. In addition, research Fidhi
Aningsih in Malang in 2018 stated that the
provision of deep breathing relaxation
techniques administered over 15 minutes to
give the effect of a sense of comfort,
reduce tension uterus and blood
Poltekkes Kemenkes Palangka Raya
circulation. So from the above background, reducing menstrual pain using Wilcoxon
the authors are interested in doing research test.
titled "Techniques of relaxation to the
reduction of menstrual pain SMAN- 3 RESULTS
Murung Young Women". 1. Univariate Analysis
Based on the description above, the A univariate analysis performed to
problem in this research is how relaxation describe the characteristics of each of
techniques to the reduction of menstrual the variables studied. The results of the
pain in adolescent girls SMAN 3 Murung. univariate analysis can be seen in the
The purpose of this study was to table below:
determine the relaxation techniques to the
reduction of menstrual pain in adolescent Table 1. Frequency Distribution
girls SMAN 3 Murung. Overview Young Women
menarche history SMAN- 3
METHOD Murung 2019
This study is a quasi-experimental
research (quasi Experiment), with the No History menarche F %
approach of one group pre-test and posttest .
design is a technique to determine the 1 <12 years 12 63.2
effects before and after treatment 2 ≥ 12 years 7 36.8
(Sugiyono, 2012). Total 19 100
This research was conducted in
SMAN 3 Murung Murung this study in Based on the above data from 19
January and March 2019. respondents, the majority have a history
The population in this study were from of menarche at age <12 years of the 12
SMAN 3 Murung amounted to 139 people. respondents (63.2%) whereas menarche
Number of samples in this study is the at age ≥ 12 years of 7 respondents
division of the group with 17 respondents (36.8%).
relaxation techniques to avoid the drop out
was added 10% of the total samples that Table 2. Frequency Distribution
amounted to 19 samples. Overview long history of
The sampling technique in this study menstrual Young Women
used a non-probability sampling with SMAN- 3 Murung 2019
purposive sampling technique. sampling
uncertain-kan in which researchers No. Lama Haid F %
sampled by specifying the particular 1 ≤ 7 days 8 42.1
characteristics to suit the purpose of 2 > 7 days 11 57.9
research that is expected to solve the Total 19 100
problems of research (Nursalam, 2013).
In this study, univariate analysis is Based on the above data from 19
used to explain or describe data by using a respondents, the majority has a long
formula determining the amount of history of menstrual ≤ 7 days, as many
percentage. Categorical data will be as 8 respondents (42.1%) while long
displayed in the form of proportions. The menstrual> 7 days as many as 11
bivariate analysis in this study to determine respondents (57.9%).
the effect of relaxation techniques on
Poltekkes Kemenkes Palangka Raya
Table 3. Frequency Distribution 2. Bivariate Analysis
Overview Dysmenorrhea Table 5. Effect of Relaxation
Before Relaxation Technique Techniques Against
Guide In Young Women Menstrual Pain Reduction In
SMAN- 3 Murung 2019 Young Women SMAN- 3
Murung 2019
No. menstrual F %
pain Posttest-pretest
1 Light 2 10.5 Z -3.542
2 Moderate 11 57.9 Asymp. Sig. 0,000
3 Weight 6 31.6 (2-tailed)
Total 19 100
Based on the data above, shows the
Based on the above data from 19 test results obtained statistical p value of
respondents intensity of menstrual pain 0.000 (p <0.05) means that there is the
before relaxation techniques majority of effect of relaxation techniques on
pain intensity were as many as 11 reducing menstrual pain in Young
respondents (57.9%), pain intensity Women SMAN- 3 Murung.
weigh as much as 6 respondents
(31.6%) and mild pain intensity as DISCUSSION
much as 2 respondents (10 , 5%). 1. Frequency distribution of menarche
Historical Overview of the Young
Table 4. Frequency Distribution Women SMAN- 3 Murung 2019
Overview Dysmenorrhea Based on the results in Table 1
After Relaxation Technique show of 19 respondents, the majority
Guide In Young Women have a history of menarche at age <12
SMAN- 3 Murung 2019 years of the 12 respondents (63.2%)
whereas menarche at age ≥ 12 years of
No. Relaxation F % 7 respondents (36.8%). Menarche is one
techniques sign that the teenager has undergone a
1 Light 16 84.2 change in itself.
2 Moderate 3 15.8 Research Aditiara (2018) states that
3 Weight 0 0 there is a relationship between the age
Total 19 100 of menarche with menstrual pain. This
is because of the premature menarche
Based on the above data from 19 age (<12 years) can lead to
respondents intensity of menstrual pain unpreparedness and a problem for teens
after doing relaxation techniques that feel pain during menstruation
majority of mild pain intensity as many because the reproductive organs are not
as 16 respondents (84.2%), pain developed to the maximum.
intensity was as much as three According to Smeltzer & Bare
respondents (15.8%). (2009), one of the risk factors of
dysmenorrhea is a history of menarche
at an earlier age of <12 years since
menarche at an earlier age cause
reproductive organs not functioning

Poltekkes Kemenkes Palangka Raya

 optimally and not ready to be changes
so that there is pain when menstruation.
Results of research by Kristianingsih,
(2014) also states that women with
menarche age <12 years have reskio
more likely to experience dismenorhoe
3.6 times compared with age> 12 years.
2. Frequency Distribution Overview
long history of menstrual Young
Women SMAN- 3 Murung 2019
Based on the results in Table 2 of
the 19 respondents, the majority has a
long history of menstrual ≤ 7 days, as
many as 8 respondents (42.1%) while
long menstrual> 7 days as many as 11
respondents (57.9%). Long periods can
be caused by psychological and
physiological factors. Psychologically
usually associated with young women
emotional level unstable when the new
period. While physiological rather the
excessive uterine muscle contraction or
it can be said they are very sensitive to
these hormones as a result of the
endometrium in the phase of producing
the hormone prostaglandin secretion.
Due to excessive prostaglandin then the
resulting pain during menstruation
(Smeltzer and Bare, 2009).
This is consistent with the results of
research Kristianingsih., (2014), which
indicates that there is a relationship
between long periods with the incidence
of dysmenorrhea. Most respondents
who experienced dysmenorrhea ie those
who experienced long periods> 7 days,
as many as 122 (85.3%) and the lowest
among respondents with normal
menstrual period there were 21 (14.7%).
Sadiman study (2017) also stated
that the respondents who menstruate
elongated (> 7 days) are at risk of
experiencing dismenorhoe 2,536 times
compared to respondents who do not
menstruate lengthwise.
3. Frequency Distribution Overview
Dysmenorrhea Before Relaxation
Technique Guide In Young Women
SMAN- 3 Murung 2019
Based on the results in Table 3
show that out of 19 respondents
intensity of menstrual pain before
relaxation techniques majority of pain
intensity were as many as 11
respondents (57.9%), pain intensity
weigh as much as 6 respondents
(31.6%) and mild pain intensity as
much as 2 respondents (10.5%).
At the time of menstruation, uterine
muscle contractions that make the blood
flow to the muscles of the uterus is
reduced resulting in increased uterine
activity to satisfy his need for blood
flow, as well as the muscles of the
uterus that blood shortages earlier will
stimulate the nerve endings so painful.
Results Silviani, et al, (2018)
showed that of the 48 students who
dismenorhoe before the breath
relaxation techniques, there are 33
students (68.8%) had moderate pain, as
many as 9 students (18.8%) experienced
severe pain and there 6 students
experiencing mild pain (12.5%), some
of the causes are due to stress
dismenorhoe think of lessons and also
fear that students face less physical
activity as students after school did not
do homework, school holidays are long
enough so that students lack of exercis,
4. Frequency Distribution Overview
Dysmenorrhea After Relaxation
Technique Guide In Young Women
SMAN- 3 Murung 2019
Based on the results in Table 4
shows that 19 respondents intensity of
menstrual pain after doing relaxation
techniques majority of mild pain
intensity as many as 16 respondents
(84.2%), pain intensity was as much as
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three respondents (15.8%). According
to Smeltzer & Bare (2009), one of the
relaxation techniques are deep breathing
with relaxation techniques. Deep
breathing relaxation technique is a
technique to perform a deep breath,
slow breath and how to breathe slowly.
Deep breathing relaxation techniques
carried out repeatedly would give rise to
a sense of comfort. Their sense of
comfort is what ultimately will increase
a person's tolerance to pain. People who
have good pain tolerance will be able to
adapt to pain and will have the coping
mechanisms that good anyway. Deep
breathing relaxation techniques,
Smeltzer and Bare (2009) revealed that
the deep breathing relaxation purpose is
to improve the ventilation of the alveoli,
maintaining gas exchange, reduces
physical and emotional stress that
reduce the intensity of pain and reduce
anxiety. Decrease in pain by relaxation
techniques lies in the physiology of the
autonomic nervous system, which is
part of the peripheral nervous system
that maintains homeostatic internal
environment of the individual.
Another study conducted by
Rahmawati, et al, (2016) says that
diketegorikan respondents experiencing
moderate pain decreased from 13 (59,
1%) into three respondents (13.6%),
respondents who experienced severe
pain controlled diketegorikan decline of
8 respondents (36.4%) to one
respondent (4.5%). Changes in
menstrual pain level (dismenorhoe) on
the respondent after relaxation
techniques is a way that can be used to
relieve menstrual pain through
vasodilation of blood vessels, and
increased secretion of the hormone
endorphin block pain receptors that
serve the brain so that pain can be
reduced or lost.
5. The Influence of Relaxation
Techniques To Menstrual Pain
Reduction In Young Women SMAN-
3 Murung 2019
Based on the results in Table 5
indicate that the test results obtained
statistical p value of 0.000 (p <0.05)
means that there is an influence of
relaxation techniques on reducing
menstrual pain in Young Women
SMAN- 3 Murung. Deep breathing
relaxation techniques can be believed to
reduce the intensity of pain experienced
through the skeletal musclenamely the
mechanism by relaxing muscle spasms
caused by the increase of prostaglandins
that increase occurred vasodilation of
blood vessels and increases blood flow
kedaerah experiencing spasms and
ischemia. Deep breathing relaxation
techniques can stimulate the body to
release endorphins and enkephalins are
endogenous. Relaxation involves the
muscular system and respires timeso it
does not require any other tool and easy
to do when or anytime.
This is in line with research by Dwi
Yani Nanda, (2016) about the influence
of deep breathing relaxation therapy
against dismenorhoe levels showed that
there is a difference in the average level
of dismenorhoe before and after
therapeutic intervention breath of 2.75.
Statistical test results obtained p value =
0.000, meaning that there is a
significant difference between the level
before and after the intervention
dismenorhoe relaxation therapy deep
breath.
In addition, research conducted by
Ratni Siregar, et al, (2014) in Medan
obtained the difference in the average
value of the intensity of pain before and
after treatment was 2.93. From the
analysis p = 0.001 <α = 0.05, it can be
Poltekkes Kemenkes Palangka Raya
 concluded that there is the effect of
deep breathing relaxation significant
reduction in pain intensity dismenorhoe.
Based on research by Marni (2015)
on the effectiveness of relaxation
breaths to decrease menstrual pain
showed that the average decline in the
provision of sports action at 2:03, while
the average value of menstrual pain
scale variables prior to the relaxation of
5.83 with a standard deviation of 1,642
and the average value after the
relaxation of 3.80 with a standard
deviation of 1.24 can be concluded that
after a deep breathing relaxation
technique decreased pain intensity.
Other research by Fidhi Aningsih,
et al, (2016) on the Effect of relaxation
techniques deep breathing to decrease
the intensity of menstrual pain
(dismenorhoe) to students in the
dormitory Sanggau Landungsari
Malang stated that the granting of
relaxation techniques deep breathing
can lower pain intensity (dismenorhoe)
3.317 times more effective. Test
results8tatistic significant difference
between before and after deep breathing
relaxation techniques against menstrual
pain found that the p value = 0.001 (p
<0.05), which means that there is an
influence before and after deep
breathing relaxation techniques to
decrease pain intensity on the students
in Sanggau hostel Landungsari Malang.
CONCLUSION
Based on the above it can be concluded
that:
1. The intensity of menstrual pain before
relaxation techniques majority of pain
intensity were as many as 11
respondents (57.9%), pain intensity
weigh as much as 6 respondents
(31.6%) and mild pain intensity as
much as 2 respondents (10.5%).
2. The intensity of menstrual pain after
doing relaxation techniques majority of
mild pain intensity as many as 16
respondents (84.2%), pain intensity was
as much as three respondents (15.8%).
3. Statistical test results obtained p value
of 0.000 (p <0.05) means that there is
the effect of relaxation techniques on
reducing menstrual pain in the Young
Women SMAN- 3 Murung.
SUGGESTION
1. For the Community
Especially for young women, when
experiencing menstrual pain are advised
to do relaxation techniques that can help
reduce pain during menstruation besides
maintaining a healthy lifestyle, keep
eating, regular exercise, not smoking,
not drinking and frequently checked
reproductive health to the health center.
It is expected that all students to
continue to do relaxation techniques in a
sustainable manner and to the
respondent who has been getting
treatment in order to spread the benefits
of deep breathing relaxation to women
in need
2. For Health Workers or Midwives
Expected for Health Personnel
especially those working on the ARH
(RH teenagers), in order to participate
to provide counseling and socialization
of dysmenorrhea to the students about
the knowledge of the risk factors,
causes, symptoms and how to prevent
or reduce adolescent health issues
particularly the issue of dysmenorrhea
so that students become know what the
risk factors that may affect
dysmenorrhea, so they can pay attention
to his health from now on.
Poltekkes Kemenkes Palangka Raya
3. For Further Research
It is expected that further research
in order to conduct research related
interventions adolescent menstrual pain
reduction which will produce some
alternative ways to cope with pain
during menstruation, with over
expanding the number of respondents
and add other variables.
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Poltekkes Kemenkes Palangka Raya