RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

1. / NAME OF THE CANDIDATE AND ADDRESS / MS.J.SUDHA
GAYATHRI COLLEGE OF NURSING, KOTTIGEPALYA
BANGALORE
2. / NAME OF THE INSTITUTION / GAYATHRI COLLEGE OF NURSING,
KOTTIGEPALYA
BANGALORE
3. / COURSE OF STUDENT AND SUBJECT / FIRST YEAR M.SC NURSING
OBSTETRIC AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 05-06-2008
5. / TITLE OF THE TOPIC / A COMPARATIVE STUDY TO ASSESS THE RELATIONSHIP BETWEEN MENSTRUAL PAIN AND BODY MASS INDEX (BMI) AMONG ADOLESCENTS IN SELECTED COLLEGE, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK: -

“Women are strong pillars in our society who have proved time and again that they can do anything they put their mind into”

INTRODUCTION: -

“Women’s natural health is very fragile even if women are strong about it and there are times when if you extend your body a bit of help it will reward you with health and peace of mind”

By this quotation we come to know the importance of women’s health. But they have so many health problems such as breast problems, cystitis, endometritiasis, fat around the middle, fibroids, heavy periods, hysterectomy, infertility, irregular periods, menopause, miscarriage, no periods, osteoporosis, ovarian cysts, painful menstruation, premenstrual syndrome, polycystic ovary syndrome, uterine prolapse, thrush, vaginal infection, weight control.

Now a days menstrual pain is the one of the common problem among women. Particularly girls in their teens or early twenties. Usually the pain starts a day or two days before the menstrual flow and tends to cease after one or two days of menstruation. It also known as primary dysmenorrhoea. Women get menstrual pain because the lining of the uterus releases a substance called prostaglandins. It causes contractions often causes the uterus to go into spasms, which causes pain, and may even lead to tiredness dizziness and nausea

Dysmenorrheal is thought to result form excessive production of prostaglandins which causes painful contraction of the uterus and arteriolar vasospasm. Psychological factors such as anxiety and tension may also contribute to dysmenorrhoea. As women grow older dysmenorrhoea often decreases and frequently completely resolves after child birth.

Dysmenorrhoea or painful menstruation occurs at or a day before the onset of menstruation and disappears by the end of mensus. Painful menstruation, particularly in the lower abdomen and back and usually of a cramping nature, is known as dysmenorrhoea. Dysmenorrhoea is most prevalent in the first three years after menarche. Although it can arise later in any woman’s reproductive life. Dysmenorrhoea is classified as primary and secondary.

Thousands of women within North Americans are over weight. Over weight related illness are the causes for the number of death with in the continent. In order to look into the ways that weight may cause severe menstrual pain and cramps. Body Mass Index (BMI) higher than 30kg that is considered as obese.

The relationship between prevalence of dysmenorrhoea with sociodemographic factors such as mean age and parity, lifestyle factors including smoking, alcohol consumption, and stress, physical factor such as Body Mass Index( BMI ) and health factor such as infertility, obesity, smoking and alcohol consumption did not show any significant relationship with dysmenorrhoea.

The irregularity of the menstrual cycle and menstrual pain was reported by 40% of respondents at an early postmenarcheal age. The risks for irregular menstrual cycles and menstrual pain were BMI <17.5kg/m2 95% confidence interval. Menstrual irregularity and menstrual pain at an early post menarcheal age can be considered as an indicator of difficulties in psychosocial adaptability of managed females.

Calculation of BMI is achieved by dividing the clients weight in kilograms by height in meter squared. Weight in kg divided by height2(m2).

BMI = Weight in kg

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(Height in meter2)

A body mass index of greater than 25 defines the upper boundaries of healthy weight and places a client at higher medical risk of respiratory disease, tuberculosis, digestive system and some cancer. Body mass index maintaining a healthy or ideal body weight requires a balance between the expenditure of energy and the intake of nutrients. Generally when energy requirements of a individual equate with the daily caloric intake, the body weight remains stable.

Adolescents is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological(ie pubertal), social and psychological changes though the biological or physiological ones are the easiest to measure objectives. Historically, puberty has been heavily associated with teenagers and the onset of adolescent development. In recent years, however, the start of puberty has seen in increase in preadolescent and extension beyond the teenage years making adolescent less simple to discern.

6.1. NEED FOR THE STUDY

Obese individuals often experience distruption of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with menstrual cycle.

The prevalence of menstrual irregularity at an early post menarcheal age and various bio psychosocial factors associated with menstrual irregularity. The irregularity of the menstrual cycle was reported by 40% respondents at an early postmenarcheal age. The risks for irregular menstrual cycles were BMI <17.5kg/m2.

The prevalence of menstrual pain in western is relatively high and has been shown to be related to many factors eg age, menarche age, parity, menstrual cycle regularity, cigarette smoking, dietary habits. However, less data are available for traditional societies within which here are presumably not as many potentially disturbing factors that could influence menstrual symptoms. The main factor related to menstrual pain was the age at which woman first give birth. It is hypothesized that an earlier start to reproductive life in some way decreased the sensitivity of the uterus to prostaglandins.

Low fat, vegetarian diet reduces dysmenorrhoea and premenstrual symptoms. In a cross design, 33 women followed a low fat vegetarian diet for two menstrual cycles. For two additional cycles, they followed their customary diet while taking a supplement placebo pill. Dietary intake, body weight, pain duration and intensity and premenstrual symptoms were assessed during each study phase. Near body weight was lower during the diet (66.1-+11.3kg) compared with the supplement phase (67.9+or – 12kg) to diet phase (2.7+ or – 1.9) days compared with change from base line to supplement phase 3.6 + or – 1.7 days. Pain intensity fell significantly during the diet phase, compared with baseline , for the worst, second worst and third worst days and the mean durations of premenstrual concentration, behavioural change, and water retention symptoms were reduced significantly compared with the supplement phase. A low fat-vegetarian diet was associated with reductions in body weight, dysmenorrhoea duration and intensity and premenstrual symptom duration. Anecdotal reports indicate that a low-fat vegetarian diet might reduce menstrual pain in some individuals. The present study tested the hypothesis that a low fat vegetarian diet reduces dysmenorrhoea and premenstrual symptoms in women with moderate to severe menstrual pain.

A study investigated the epidemiology of dysmenorrhoea in Japanese women of menstrual age. Among 823 enrolled participates are range 18-51 years dysmenorrhoea was reported 15.8% during the one month period. Common associated symptoms included headache, back pain, fatigue, dysmenorrhoea is significantly associated with younger age and employment status.

Hirata M, Kumabe K, Inone Y, conducted a study, many female adolescents are suffering from menstrual pain and their daily activities are often adversely affected. It is therefore, necessary to clarify what factors are associated with menstrual pain in order to assist in improving their quality of life. The prevalence of menstrual pain among the college women was very high, 82.8% , the frequency being greatest in the underweight group (BMI<19.8). Current trend among young women is to wish to be thin and the fact that nearly half of Japanese females age 15 to 24 are already lean. This study suggests that it is very important to take measures to counteract young women’s enthusiasm for excessive dieting or other approaches to weight loss since this will help reduce their menstrual pain and improve their quality of life.

The American physician found the prevalence of dysmenorrhoea is highest in adolescent women, with estimates ranging from 20 to 90%. The prevalence of dysmenorrhoea of 90% in women 19 years of age and 67% in women 24 years of age 10% of 24years old reported pain that interfered with daily function. Most adolescents self medicate with over the counter medicines and few consult a physician about dysmenorrhoea.

Sharma P, Malhotra C, Taneja D K, Saha R, conducted a study on the problems related to menstruation among adolescent girls. The types and frequency of problems on daily routine. Dysmenorrhoea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of premenstrual syndrome. Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite 17.24% had to miss a class and 25% had to abstain from work. Conclusion stated that screen adolescent girls for menstruation related problems and provide them with counseling services and relevant information on possible treatment options. Besides, there is a need to emphasis on designing menstrual health programmes for adolescents.

Women tend to believe they are best at values BMI between 20 to 22 and men are usually satisfied with a BMI of 23 to 25. If the BMI is between 17 to 22, life expectancy is longer than average. It does not need to lose weight. If the BMI is between 23 and 25 are not considered overweight by most people. But if BMI is 26 or more that is not good.

Menstrual pain is the most common gynecological complain of women and the main cause of women missing work, school and other activities. Statistics indicate that over 140 million working hours are lost annually as a result of dysmenorrhoea.

Women experience markedly compromised quality of life and inability to function in several setting. So, the researcher attempts to assess the relationship of BMI with menstrual pain. It will help to identify the factors and concentrate to improve the quality of life in women.

The researcher observed in many colleges that adolescents students are more attracted towards junk foods as compared to other age groups. In this age, they want to be independent and also want to experiment something. Some are more physique conscious. As they are the future of country, thus interest was aroused to assess the prevalence of BMI among adolescents.

“”Above all, Don’t worry, Be happy. It’s unhealthy to have anxiety over a les-than-perfect body image. And, if this calculator’s description of your body seems wrong for you, just trust your own judgment. A healthy mental attitude is just as important as physical fit and stress and dysmenorrhoea”.

6.2.REVIEW OF LITERATURE

The review of literature for the present study is organized under the following.

Strinic T, Bukovic D, Pavelic L , etal conducted a study to examined the prevalence of dysmenorrhoea in female adolescents and the influence of anthropological characteristics and life style factors on menstrual pain. Two hundred and ninety seven girls from several elementary and secondary schools were interviewed about the presence of the menstrual pain, their age, height, weight, menarcheal age, menstrual cycles quality, smoking and sexual activity. The group of dysmenorrheic adolescents there was infrequent missing activities and bed rest, but missing school was observed in 22% and taking pills for pain was observed in 96% of the subjects, young girls who experienced menstrual pain are good candidates for a prophylactic therapy, such as hormonal contraception. A replication of this study is needed for public health services in the future to improve the quality of life of the dysmenorrheic young women.

Vanhoff MH, Voorhorst FJ, Kaptein MB etal conducted a cross sectional population based study; the association between the menstrual pattern in ninth grade school girls and calendar age, gynaecological age, body mass index and historical parameters was investigated. The study result stated that gynaecological age was strongly associated with the prevalence of program could have been the source of the reduction in premenstrual syndrome of the experimental group of young adolescents girls.

Swallen K C, Reither EN, Haas SA etal conducted a study the childhood and adolescent overweight and obesity have increased substantially in the past 2 decades, raising concerns about the physical and psychosocial consequences of childhood obesity. The investigated the association between obesity and health related problems among adolescents. The study result stated that using a nationally representative sample found that obesity in adolescence is linked with poor physical quality of life. However, in the general population adolescents with above normal body mass index did not report poorer emotional, school or social functioning

Viner RM, Haines MM, Tahlor SJ etal conducted a study that investigated weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population based multi-ethnic sample of early adolescents. The study revealed that the high levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider culture differences in the relationship between body mass self –esteem and psychological distress.

Montero P, Bernis C, Fernandez V etal, conducted study revealed that using a cross-sectional sample of 1147 urban adolescents, aged between 14 to 20 years. The variability of some menstrual cycle indicators was related to weight and the results showed that attempting to lose weight is significant associated with increased prevalence of menstrual irregularity and menstrual pain. This finding is independent of body mass index.

The above studies and literature review have been useful for the researcher in understanding the depth and need for the proposed study and in getting insight on the study aspects. The review allows the resources to establish the need of study adopt the research design, develop the tools and strategies and decide on the pain for data analysis.

6.3 STATEMENT OF THE PROBLEM

A COMPARATIVE STUDY TO ASSESS THE RELATIONSHIP BETWEEN MENSTRUAL PAIN AND BODY MASS INDEX (BMI) AMONG ADOLESCENTS IN SELECTED COLLEGE, BANGALORE.