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The Menstrual Disorder of Teenagers

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The Menstrual Disorder of Teenagers DOI: 10.1111/j.1471-0528.2009.02407.x General gynaecology www.bjog.org The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population- based study of Australian teenagers MA Parker,a AE Sneddon,a P Arbonb a Australian National University Medical School, Garran, Canberra, Australia b Faculty of Health Sciences, Flinders University, Adelaide, Australia Correspondence: Ms MA Parker, Canberra Endometriosis Centre, Department of Obstetrics and Gynaecology, The Canberra Hospital, PO Box 11, Woden ACT 2606, Australia. Email [email protected] Accepted 10 September 2009. Published online 29 October 2009. Objective The aim of this study was to: (1) establish the typical school absence. These associations indicate that approximately experience of menstruation for senior high school girls and (2) 25% of the sample had marked menstrual disturbance: 21% determine how many experience considerable menstrual experienced severe pain; 26% school absence; 26% suffering five disturbance that could require further investigation and or more symptoms; ‡24% reporting moderate to high interference management of underlying pathology. with four out of nine life activities. Approximately 10% reported atypical symptoms associated with menstruation. Diagnosis of Design Cross-sectional study. menstrual pathology in the sample was low, even though 33% had Setting Senior High Schools in the Australian Capital Territory seen a GP and 9% had been referred to a specialist. (ACT), Australia. Conclusions Menstrual pain and symptoms are common in Population A total of 1051 girls aged between 15 and 19 years. teenagers. Girls indicating moderate to severe pain in association with a high number of menstrual symptoms, school absence and Methods Data based on a quantitative survey. interference with life activities should be effectively managed to Main outcome measures Self-reports of menstrual bleeding minimise menstrual morbidity. Those girls who do not respond to patterns, typical and atypical symptoms and morbidities. medical management should be considered for further investigation for possible underlying pathology, such as Results Typical menstruation in adolescence includes pain (93%), endometriosis. cramping (71%), premenstrual symptoms (96%) and mood disturbance (73%). Highly significant associations were found Keywords Adolescence, dysmenorrhoea, endometriosis, menstrual between increasing severity of menstrual pain, number of disturbance, menstrual pain, menstruation, teenage. menstrual-related symptoms, interference with life activities and Please cite this paper as: Parker M, Sneddon A, Arbon P. The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2010;117:185–192. Introduction Severe menstrual pain has been reported to occur in 14– 23% of teenagers.1,4,5,7,9 Teenage girls with menstrual pain regularly present to physi- In those reporting severe pain there is a higher rate for cians. The experience of pain with menstruation is common school absences, which may be as high as 50–54%.4,9 for 70–91% of teenagers.1–6 Also, there are a number of Endometriosis has been reported in 47–73% of adoles- physical, psychological and emotional symptoms that occur cent girls with severe menstrual or pelvic pain with no premenstrually and during menstruation, which are response to non-steroidal anti-inflammatory drugs (NSA- reported by 96% of teenagers.5,7,8 Menstrual pain and symp- IDs) or the oral contraceptive pill (OCP).11–14 A number toms cause school absence in 14–51% of teenagers1,3–6,8–10 of teenage girls presenting to physicians with menstrual and interference with life activities for 15–59%.1–3,5,6 pain will be suffering from endometriosis, and take a ª 2009 The Authors Journal compilation ª RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology 185 Parker et al. median of 12.1 years to obtain a diagnosis if aged menstruation, and the use and effectiveness of analgesia; £19 years, in comparison with women aged ‡30 years who physical and emotional symptoms experienced during the will take 3.3 years to be diagnosed.15,16 In that time, the menstrual cycle; interference of menstruation with various disease may prolong their studies, disrupt their career, life activities; and true/false statements regarding various affect their relationships, interfere with sexual function, aspects and perceptions surrounding menstruation. cause infertility and lead to bowel, bladder or ureteric com- A mixture of question types were used, including single plications. The importance of decisions made by primary and multiple response, rating scales, true/false statements health clinicians concerning the treatment and referral of and, at the end, an open-ended question. The nine life teenage girls with menstrual pain should not be underesti- activities listed in the interference section were: attending mated. school; completing school work; social activities; sport and As a result of the overlap between dysmenorrhoeic, pre- exercise; casual paid work; relationship with family; rela- menstrual and some endometriosis symptoms there is diffi- tionship with partner; relationship with friends; and sexual culty distinguishing normal pain and symptoms from those activity. Those participants whose questionnaire indicated a that result from pathological disease. Although there is a requirement for further investigation, and who consented continuing misconception that teenagers rarely have endo- to being contacted, were offered follow-up. metriosis the disease is increasingly being diagnosed in The questionnaire was piloted in eight age-appropriate teenagers.17 An accurate non-invasive diagnostic tool is not girls, which resulted in alterations to the structure and yet available. order of some of the questions, as well as the addition of a Although some large studies have examined menstrual glossary. The questionnaire was then piloted with a further pain and symptoms in teenagers, little research has been 20 teenage girls, following which a formatting change to carried out to explore menstrual pain and indicators for one of the questions required an additional page to be menstrual disturbance requiring investigation. The aims of added (totalling six pages), which improved the overall lay- this study were to: (1) establish contemporary data on the out and readability. typical experience of menstruation for a large teenage sam- ple and (2) determine the number of teenagers suffering Procedure significant menstrual disturbance that requires manage- For data collection, three schools provided access to all ment, and should potentially be investigated for underlying girls enrolled at the school. At the fourth school teachers pathological disorders such as endometriosis. could volunteer their class to participate, and girls were approached in the cafeteria on a given day. Two schools Methods gave access during en masse gatherings in the school hall, a third school through English classes over a 2-day period to Participants and setting cover all girls enrolled in English, and the fourth school Four out of nine government senior high schools were through various classes and the cafeteria. Girls present at selected based on their high number of enrolments, and school on the day of data collection were given a question- were located in a North, South, East, West spread across naire and consent form on entering the hall, or 20 minutes the Australian Capital Territory (ACT). Participant and before the end of class (after male students were dis- parent information sheets were distributed at en masse missed). Teenagers signed a consent form before participat- information sessions at the participating schools 1–3 weeks ing in the study, which was collected separately from the prior to data collection. Parents could elect for their questionnaire for de-identification purposes. Completing daughters not to participate by signing and returning a the questionnaire was voluntary. Questionnaires were col- ‘Non-participation’ section of the parent information sheet. lected directly after completion and before leaving the hall Only five ‘Non-participation’ forms from parents were or classroom to maximize the response rate. returned to the research team. Ethics and data analysis Questionnaire Approval to conduct the study was obtained from the ACT The menstrual disorder of teenagers (MDOT) questionnaire Health Human Research Ethics Committee, the University was designed specifically for this study (see Appendix S1). of Canberra Committee for Ethics in Human Research, and The questionnaire took 20 minutes or less to complete, and the ACT Department of Education and Training. Data were was structured with repetitions in themes and questions entered into a Statistical Package for Social Sciences throughout to gauge the consistency of responses. The ques- (SPSS) 14.0 database. Categorical data were assessed using tionnaire collected data about the characteristics of: a ‘usual’ chi-square tests, and one independent-samples Student’s period in terms of regularity, duration and heaviness; school t-test was carried out. For these tests a P-value of <0.05 absence due to menstruation; the pain experienced with was considered significant. 186 ª 2009 The Authors Journal compilation ª RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology The MDOT study Results down or depressed, 52% feeling teary, 32%
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