الفهرس 
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Abstract
Adolescence is a transition stage from childhood to adult life along with pubertal development and sexual maturation. Menstrual disorders in adolescence may present diagnostic and management challenges for the gynecologist. Such disorders frequently affect the quality of life of adolescents and young adult women and can be indicators of serious underlying problems. Menstrual disorder include menstrual cycle irregularities(of duration or length) hypo-or hyper menorrhea, poly-or oligomenorrhea, dysmenorrhea, amenorrhea, menorrhagia and premenstrual syndrome (PMS).
The aim of the present study was:
To study menstrual disorders among secondary schools adolescents in Alexandria.
To describe menstrual pattern .
To estimate the prevalence of menstrual disorders.
To identify some determinants for menstrual disorders.
To describe medical seeking behaviors.
Across sectional study was carried out on 800 secondary school adolescent girls in Alexandria and the following results were obtained
Regarding the mothers’ education, most of the them(85.5%) were high educated
More than half of mothers were not working (53.6%) Nearly two thirds (64.9%) of the selected students’ families were of high social class. Normal average BMI represented the largest frequency among the students(77%) Nearly two thirds of the students(63.8%) practiced physical activity once per week. While more than half(53.7%) practiced for about 30 min. More than two third(67.9%) of the students reached the age of menarche at 12-14years of age while more than one fourth(29.5%) of students reached age of menarche at age less 12 years and only 2.6% of students reached the age of menarche at 15 years or more. The mean age of menarche was 12±1.1years. The highest recorded body changes associated with menarche were breast enlargement (82.2%). About two thirds of the students (65.6% ) received their knowledge about menarche from their mothers while 17.3 %, 12% and9% received it from their sisters, friends and internet respectively. Regular menses was recorded in more than two thirds (69.9%) while 30.1% had irregular menses. Normal, long and short intermenstrual intervals were recorded in 78.7%,13.3%, 8% respectively. Regarding the duration of menses more than three quarters of students(78%), had normal average durations (3-7days), while abnormal durations was recorded in18.7%,3.3%(long and short durations) respectively. Hyper- menorrhea was recorded in 16.5% while hypo-menorrhea was recorded in 1.8%. Dysmenorrhea was recorded in 95%; severe degree16.8%, moderate degree 57.8% and mild degree 20.4 %.Most of studied sample (97.8%) have premenstrual syndrome. Stopping of menses during the first year after menarche constituted 27.4%,while stopping of the menses after the first year constituted 16.3%. psychological status was affected in 67.6% followed by lack of concentration (49.5%) and interfere with daily activity (46.1%).The least effect involved doing duties (25.9%). On the other hand relieving pain was carried out by having hot drinks (65%), taking analgesics (57%) and taking rest (47.1%).The least tool of pain relive was ignoring it 4%. More than half of the selected sample(53.3%) run after mother’s advice followed by physician’s advices(33.2%). Physical and emotional symptoms of PMS. In this table. The highest physical symptoms were back pain (78.5%), tiredness (70.5%), acne (67.5%),abdominal pain( 67.4%), headache (61.1%), and breast Pain( 40.5%). Emotional changes represented by feeling depression among (74.2%), lack of concentration (68.2 %), and anxiety (60.6%). According to the effect of premenstrual syndrome on some activities., high frequency of the selected sample(84.9%) had psychological upset followed by changes in social relations (47.9%).On the other hand, more than half of the selected sample(58.6%) had an effect on their daily activities, and less than half on physical activities (46%). Session concentration changes constituted 58.2%. Most of the students (92.2%) had medical problem in the form of weight changes (40.6), anemia (36.8%), breast diseases( 7.7%) and cardiac disease (2.8%). On the other hand, most of the students don’t receive any drugs (88.2%). only 4.2 receive drugs for hormonal disturbances and 3.1% for milk coming from the breast. A small percent (0.6%) receive iron supplement for anemia and about 3.2% of students receive drugs for chronic conditions( asthma and renal).
Regular menstruation was high (70.3%) among girls whose their mothers were highly educated while irregular menstruation was higher(34.4%) among girls whose their mothers were middle educated. in spit of There was no significant difference between different educational levels. Short inter menstrual interval was highly frequent among student’s of illiterate mothers(11.5%), while long inter menstrual interval was high frequent among student’s of high educated mothers(14%), the difference was not statistically significance. Excessive blood loss was more(18.1%) among students whose mothers had high level of education, while little blood loss was present more(3.1%) among students whose their mothers had middle level of education, the difference between groups was not statistically significance p=(0.021). There was no statistically significance difference between dysmenorrhea and PMS among different educational levels of mothers. Early age of menarche <12y and late age of menarche ≥15y were significantly associated with obesity and underweight respectively Irregularity of menstrual cycle was significantly associated with obesity among students Short inter menstrual interval was significantly associated with overweight among students. Long duration of menstrual cycle was significantly association with normal weight students. Excessive amount of blood loss per cycle was significantly associated with underweight among students. Dysmenorrhea was more frequent among obese students, it was not significantly associated with BMI. Also, PMS was not significantly associated with BMI. In addition, health seeking behavior and physician consultation were not significantly associated with BMI. Only both the duration of menstrual cycle and pain during menstrual cycle were significantly associated with scholastic achievement of the students
Regularity of menstruation was the only variable significantly associated with practicing physical activities of students. Regular menstruation was high (74.6%) among girls whose age of menarche <12 years,. while irregular menstruation was high (61.9%) among girl whose age of menarche 15+ years. The difference was statistically significant. (p=0.002). Long inter menstrual interval was more (28.6%) at the age of menarche ≥15y. Short inter menstrual interval were more(9.4%) at age of 12-14y. The difference between groups was statistically significant (p=0.007). Long duration of menstruation presented more with menarche under 12 y (24.2%),while short duration of menstruation was presented more(19%) at age of menarche over 15y. The difference was statistically significant (p=0.000). Excessive blood loss was presented more at age of menarche <12y (19.9%) and ≥ 15y (19%).The difference was statistically significant (p=0.003). Severity of dysmenorrhea was increased with increase age of menarche 15+y but the difference was not statistically significant (p=0.307). PMS was less to occur with the higher age of menarche ≥ 15y, the difference was statistically significant (p=0.003). There was no statistically significant difference between different ages of menarche and physician consultation. However the higher age of menarche, the increase health seeking behaviors of the students but it was not statistically significant.
There was statistically significant differences between the duration of menstruation and long inter menstrual interval, long duration of menstruation, scanty blood loss per cycle and moderate pain (dysmenorrhea) during menses p≤0.005. On the other hand there was no statistical differences between duration of menstruation and irregularity of menstrual cycle, PMS, physician consultation and health seeking behaviors. There was significant association between dysmenorrhea among students and duration of menstrual cycle, amount of blood loss and health seeking behaviors. On the other hand regularity of menstruation, inter menstrual interval, PMS, consultation of physician and experiences about menses were not significant associated with student’s dysmenorrhea. There was no significant association between PMS among students and their other menstrual troubles. On the other hand consultation of physician and past experience about menses were significantly associated with PMS. There were no significant association between family history of menstrual troubles and that of their daughter menstrual troubles (irregular menstrual cycle, intemenstrual interval, duration of menstruation, amount of blood loss and PMS). Dysmenorrhea of the students, was the only menstrual troubles associated significantly with troubles among family. Families with menstrual troubles were significantly associated with health seeking behaviors among their daughters. Students had incomplete experience about menstruation were significantly associated with family history of menstrual troubles.
There was significant association between family history of dysmenorrhea and that of their daughters. Also, there were significant association with intermenstrual interval, duration of menstruation, amount of blood loss, and health seeking behaviors. On the other hand there was no significant association between family history of dysmenorrhea and their daughter’s PMS, consultation of physician and experiences about menstruation.
In conclusion, menstrual dysfunction is a common cause of referral to the gynaecology clinic and the problem has a considerable impact on the health status and the quality of life of women. Menstrual disorders and the private nature of the data related to menstruation, however, does not attract the attention of the public health community. A high percentage of student suffered from different kind of menstrual disorders; irregular menstruation, experienced dysmenorrhea and PMS. Painful menstruation and premenstrual symptoms were serious enough to affect their daily activities or academic attendance in many cases. Menstrual pain was often cited as the main single cause of school absenteeism among adolescent girls. Also numerous studies have indicated that a considerable proportion of women of reproductive age suffered from menses associated health problems, such as premenstrual symptoms, dysmenorrhea and irregular menstrual cycles The differences in the degree of pain severity may be related to cultural differences in pain perception and variability in pain threshold.
The introduction of a reproductive health component into school health education programme could help in providing information, education and support to students regarding reproduction in general and menstrual problems in particular. It is essential to make treatment available for girls. Many girls may feel shameful and reluctant to report dysmenorrhoea and consequently, do not seek medical advice. It is one of the roles of school health care providers to ask about and screen for dysmenorrhea and offer treatment if necessary. These could be an important means of providing information about treatment options.