6.

BRIEF RESUME OF THE INTENDED WORK Introduction Adolescents are not monsters, they are just people trying to learn how to make it among the adults in the world who are probably not so sure themselves
- Virginia Satire

Adolescence is the time when there is sudden transformation in the body and many questions arises in the minds of the adolescents. Firstly, they are not able to cope with the changes and secondly the changes bring along problems with them. The most challenging problems are related to menses, in girls1. Menstruation is a periodic and cyclic shedding of uterine endometrium accompanied by loss of blood and unfertilized ovum11. High risks of menstrual problems have been found in under weight and overweight girls but evidence is consistent especially in relation to the effect of onset of obesity10. 6.1 Need for the study Though menstruation is a regular phenomenon in females, almost all of them face some or the other kinds of problem, during these times 2. Menstrual conditions are many that may require physicians attention or any other healthcare professionals attention. A descriptive study conducted in Madras city revealed that 42% of college going students reported menstrual problems3. The most common menstrual disorders are pre-menstrual syndrome, dysmenorrhoea, amenorrhoea, menstrual cycle length disorders, oligomenorrhoea and polymenorrhoea.1 These teenage menstrual problems are diverse in aetiology and if detected early they can be remedied. The adolescent girl is a very shy person and often hesitates to seek help regarding her problems. 4 Adolescence is a period of heightened concern regarding obesity. Obesity has a strong association with infertility and menstrual irregularities5. Body mass index provided a

simple numeric measure of a persons fatness and thinness, allowing health professionals to identify over and under weight problems. BMI is a simple index of
weight-for-height that is commonly used. It is defined as the weight in kilograms divided by the square of the height in metres6 . Menstrual cycle length is a non-invasive clinical marker of reproductive
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function. This menstrual cycle length is also related to BMI. A study was conducted to see the relationship between menstrual cycle and adiposity measures in Indian populations. Sample size was about 415 between the age group of 22-40 years, residing in Delhi. The adiposity was assessed by BMI and by using bio-electric impedance method. The information regarding their physical activity pattern and menstrual cycle was recorded and age at menarche was obtained through recall method. Results revealed that a decrease in BMI and an increase in the age at menarche were found with increase in the duration of menstrual cycle. Majority of women with 25-35 days duration of menstrual cycle in the present study were distributed in all the categories of BMI.7 A cross-sectional study was conducted on menstrual disorders in adolescent girls in sixty two secondary schools and junior colleges. A 27-point structured questionnaire was used. Of the 5561 participants, 23% reported irregular cycles. Results revealed that oligomenorrhoea was the most frequently reported problem (5.3%) and polymenorrhoea was much less prevalent (2%). With increasing body mass index(BMI) there was a significant increase in the prevalence of oligomenorrhoea whereas polymenorrhoea was more prevalent in the girls with low BMI.8 From experience and review of literature the researcher has observed that many adolescent girls are suffering from menstrual problems. This motivated the investigator to identify menstrual problems and its relation with BMI among adolescent girls in a selected college at Mangalore. 6.2 Review of literature A prospective study was conducted to assess the predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at the age 15 years and oligo-amenorrhoea at the age 18 years in a general population. The sample was divided into two groups - regular menstrual cycle group and irregular menstrual cycle group. Results showed that 2% of adolescents with regular menstrual cycle developed oligomenorrhoea and 12% of those with irregular menstrual cycles did so. The study concluded that increase in body mass index, concentration of LH, testosterone and PCOS were associated with persistence of oligomenorrhoea.9

A study was conducted to investigate the relationship between childhood and adolescent body mass index, with reproductive health of a women in London. Height, weight (at 7, 11, 16, 23 & 33 years) and reproductive data were collected from 5799 females. Body mass index (BMI) was calculated as weight/height2. Age-specific cutoffs were used to define overweight and obesity. The study revealed that obesity in childhood and adolescents both independently increased the risk of menstrual problems. Other than menstrual problems childhood and adolescent body mass index had little impact on the reproductive health of women10. A questionnaire survey was conducted on the prevalence of menstrual problems in adolescent girls and their health-seeking behaviour in secondary schools in the catchment area of a tertiary teaching hospital in Hong Kong. Sample size was about 5609. Results revealed that the prevalence of menorrhagia was 17.9%, dysmenorrhoea was 68.7%, and menstrual symptoms was 37.7%. The prevalence of menstrual symptoms and dysmenorrhoea increased with gynaecological age. The study concluded that the prevalence of menstrual problems in Hong Kong Chinese girls was high.11 A study was conducted on evaluation of irregular menses in perimenarcheal girls in New York. Sample size was about 178 girls. Personal, family medical and menarcheal history was assessed, and findings on physical and laboratory examination performed were evaluated. Of the 178 girls still perimenarcheal at presentation, 47 were the focus of this study. Of these, 39 had no significant findings on physical examination, while three had signs of functional ovarian hyperandrogenism (FOH) including obesity, hirsutism, and moderate acne with corresponding LH/FSH ratios >3, although pelvic ultrasound examination revealed normal ovaries. Other laboratory abnormalities included microcytic, hypochromic anaemia in patients, and an elevated Erythrocyte Sedimentation rate in a patient later diagnosed with a rheumatologic disorder. Results revealed that obesity, acne, or pallor are the treatable causes of menstrual irregularities.12

A retrospective study was conducted on the causes of menstrual disorders among adolescent girls in the outpatient endocrinological clinic. Only the girls at least 2 years after menarche or with amenorrhoea primaria were included. Sample size was

about 76. The following parameters were analyzed: age, age of menarche, height and, BMI, evidences of androgen excess, hormone levels, gynaecological and ultrasound examination. Results revealed that The girls were coming to the clinic most often because of rare menses, most rarely because of primary lack of menstruation. Depending on the type of disorders they were divided into five groups: Group I: amenorrhoea primaria - 4 patients (5.3%); Group II: amenorrhoea secundaria - 14 patients (18.4%); Group III: oligomenorrhoea - 38 patients (50%); Group IV: polymenorrhoea - 8 patients (10.5%); Group V: mixed disorders - 12 patients (15.8%)13. A descriptive cross-sectional study was conducted on menstrual pattern and common menstrual disorders among students between 19-25 years in Dinajpur medical college, Bangladesh. Purposive sampling technique was used. Sample size was about 174 young college girls. Results revealed that 152 (87.4%) respondents had regular menstrual cycle whereas 22 (12.7%) had irregular menstrual cycle. Menstrual flow was average in 100 (57.5%), scanty in 72 (41.4%), and heavy in 2 (1.2%) respondents. At least 106 (60.9%) girls had dysmenorrhoea with a varying degree of severity.14 Statement of the problem A descriptive study on occurrence of menstrual problems and its relation with BMI among adolescent girls in a selected college at Mangalore. 6.3 Objectives of the study The objectives of the study are:
1. 2.

to determine the occurrence of menstrual problems among adolescent girls. to identify the BMI of adolescent girls by using standardised weighing machine and inch tape.

3.

to find out the relationship between occurrence of menstrual problems and score of BMI among adolescent girls.

4.

to find out the association of scores of menstrual problems with selected demographic variables

5.

to find out the association of BMI score with selected demographic variables.

6.4 Operational definitions

Body mass index: BMI is defined as weight in kilograms divided by the square of the height in meters (kg/m2) and is measured by using a standardised weighing machine and inch tape.

Menstrual problems: It refers to the diseases that are related to menstruation such as oligomenorrhoea, amenorrhoea, polymennorrhoea, dysmenorrhoea, menstrual cycle disorders and is identified by using a check list.

Colleges: It refers to the institutions where the adolescent girls studying degree courses.

6.5 Assumptions The study assumes that,

Menstrual problems are common among adolescent girls. Menstrual problems are related to BMI. Delimitations The study is delimited to adolescent girls in the age group of 17-20 years in a

6.6

selected college at Mangalore.

6.7

Hypotheses All hypotheses will be tested at 0.05 level of significance.

H1:

There is a significant correlation between the occurrence of menstrual problems and the score of BMI.

H2:

There is significant association between menstrual problems and selected

demographic variables. H3: There is a significant association between BMI score and selected demographic variables. 7 Material and methods 7.1 Sources of data Data will be collected from adolescent girls in the age group of 17-20 years studying in a selected degree college at Mangalore. Research approach The research approach is survey approach. 7.1.1 Research design A descriptive correlational approach would be used to identify the occurrence of menstrual problems and its relation with BMI among adolescent girls. 7.1.2 Setting The study will be conducted in the selected degree college at Mangalore.

7.1.3

Population The population in this study would consist of adolescent girls. Variables Research variables: Body mass index and menstrual problems Extraneous variables: Age, education, and place of residence.

7.2 7.2.1

Method of data collection Sampling procedure

The sampling procedure will be purposive sampling. 7.2.2 Sample size In this study the sample consist of 150 adolescent girls. 7.2.3 1. 2. 7.2.4 7.2.5 Inclusion criteria Adolescent girls in the age group of 17-20 years. Adolescent girls who can understand English. Exclusion criteria The adolescent girls who are not willing to participate. Adolescent girls who are on treatment for menstrual problems. Instruments intended to be used Check list is used to determine the occurrence of menstrual problems among adolescent girls. Standardised weighing machine and inch tape will be used to identify the BMI of adolescent girls. 7.2.6 Data collection method The researcher will obtain the permission from the selected college. A checklist is given to identify menstrual problems. Standardised weighing machine and inch tape will be used to determine the BMI among adolescent girls having menstrual problems only. After the study an informational pamphlet will be provided for the participants. 7.2.7 Data analysis plan The collected data will be analysed using descriptive (mean, median and standard deviation) and inferential statistics and the result will be presented by using diagrams, graphs and tables. Karl Pearson correlation coefficient and chi square test will be used. 7.3 Does the study require any investigation or intervention to be conducted on
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patients or other humans or animals? Yes, the occurrence of menstrual problems will be identified by check list and BMI will be measured by using standardised weighing machine and inch tape. 7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes (enclosed).

List of references 1. Myers. Menstrual disorders in adolescent girls. [online]. Available from: URL:http://www.childdevelopmentinfo.com/health_safety/MenstrualDisorders-Adolescent-Girls.shtml(accessed on 5.12.10). 2. Menstrual problems information. [online]. available from: URL:www.iloveindia.com/symptoms-menstrualproblems.htm/. [accessed 6.12.10) 3. Gupta SD. Adolescent reproductive health in India-status, policies, programmes and issues. [online]. 2003 Jan. Available from: URL:www.policyproject.com/pubs/country reports/ARH India. [accessed 6.12.10) 4. Bhayani BS, Singhal A, Tripathy KG, Saraiya U. Teenage menstrual problems-

genital

tuberculosis

strong

possibility.

[online].

Available

from:

URL:http://www.bhj-org/journal/special issuetb/sp-21.htm Larsen GP. Obesity-related knowledge, attitudes, and behaviors in obese and nonobese urban Philadelphia female adolescents. Obesity Research 2001;9:1128. 5. 6. Kantachuvessiri A. Obesity in Thailand. J Med Assoc Thai 2005;88(4):554-62. Sinha R, Kapoor AP, Kapoor S. Adiposity measures and menstrual cycle: Do we envisage a relation. [online]. available from: URL:www.hindawi.com/journals/janth/aip.314147.pdf. [accessed 5.12.10]. 7. Agarwal A, Venkt A. Questionnaire study on menstrual disorders in adolescent girls in Singapore. Journal of Paediatric and Adolescent Gynaecology 2009 Dec;22(6):365-71.

8.

Van Hoof M H A, Voorhorst F J, Kaptein M B H, Hirasing R A, Koppenaal, Schoemaker J. Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 for oligo-amenorrhoea at age 18 years. Oxford Journals;19(2):383-92.

9.

Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997 Jun;21(6):432-8.

10.

Chan SCS, Yiu KW, Yuen PM, Sahota DS, Chung KHT. Menstrual problems and health seeking behaviour in Hong Kong Chinese girls. Hong Kong Med J 2009;15:18-23.

11.

Browner-Elhanan KJ, Epstein J, Alderman EM. Evaluation of irregular menses in perimenarcheal girls: a pilot study. J Pediatr Adolesc Gynecol 2003 Dec;16(6):365-8

12.

Bieniasz J, Zak T, Laskowska-Zietek A, Noczyska A. Causes of menstrual

disorders in adolescent girls-a retrospective study. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2006;12(3):205-10. 13. Begum J, Hossin MDA, Nazeem AS. Menstrual pattern and common menstrual disorders among students in Dinajpur medical college. Dinajpur Med J 2009 Jul:2(2):37-43.

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