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J Farkhanda Inst Nurs Pub Health
January - June 2023
ORIGINAL ARTICLE
:
:
PREVALENCE OF DYSMENORRHEA AND ITS EFFECTS ON QUALITY OF LIFE AMONG STUDENT
NURSES
Saeeda Akbar1, Roheeda Amanullah Khan2, Ayaz Ayub 3, Syed Afzal Shah4, Nazima Bibi5, Bibi Sultania6
Correspondence
1Saeeda Akbar, Principal, NCS
College of Nursing, Peshawar
+92-340-9226207
saeedaakbar03@gmail.com
2Director Nursing, Abasyn University,
Peshawar
3Associate Professor, Institute of
Public Health & Social Sciences,
Khyber Medical University, Peshawar
4Lecturer Abasyn University, Peshawar
5Nursing Tutor, Post Graduate College
of Nursing, Hayatabad Peshawar
6Nursing Tutor, Post Graduate College
of Nursing, Hayatabad Peshawar
How to cite this article
Akbar S, Khan RA, Ayub A, Shah SA,
Bibi N, Sultania B. Prevalence of
Dysmenorrhea and its Eects on
Quality of Life among Student Nurses.
J Farkhanda Inst Nur Pub Health.
2023;3(1): 16-20
ABSTRACT
OBJECTIVES
The objective of this study was to determine the prevalence of dysmenorrhea
and its eects on quality of life of nursing students at a nursing school.
METHODOLOGY
A descriptive cross-sectional survey was carried out at one nursing school in
Peshawar, Pakistan. A sum of 179 student nurses participated in this
research. Censes method was used following the inclusion and exclusion
criteria. Approval for conducting this study was obtained from Ethics Review
Board of Khyber Medical University. Data was collected by pre tested
validated questionnaire WHOQOL BREF scale. SPSS version 22 was used to
analyze the data.
RESULTS
The participants average age was 25.58 years. The majority (60.3%) of the
participants reported having Dysmenorrhea. A great portion (63.5%) of
respondents reported Dysmenorrhea in age group 18-25 years. 63.4%
Participants reported Dysmenorrhea among unmarried participants.
Participants with Dysmenorrhea had scores in the Generic BSN, PRN, and
MSN education categories of 78(64.5%), 21(48.8%), and 9(60%)
respectively. There was no correlation between dysmenorrhea and QOL (p -
value =.377).
CONCLUSION
Dysmenorrhea is quite prevalent among nursing students, along with severe
lower abdomen pain, however there is no correlation between dysmenorrhea
and Quality of Life.
KEYWORDS: Student Nurses, Nursing Schools, Quality of Life,
Dysmenorrhea, Pain
INTRODUCTION
Dysmenorrhea is dened as intense, uncomfortable
cramps in the lower abdomen that can occasionally be
accompanied by headache, bloating, diarrhea, and leg
pain just before or during the menstrual cycle.1 16 to
91% of women who are of reproductive age are
affected. Among other gynecological problems, it is
regarded as a common gynecological issue among
women in reproductive age and approximately 2 to
29% of the women experience severe pain.2 There are
two types of dysmenorrhea: primary and secondary.
When there is no pathogenic consequences, such as
Fibroids, Endometriosis, or Pelvic Inammatory
Disorders, Dysmenorrhea is referred to be Primary.
Secondary Dysmenorrhea is associated with Fibroids,
Endometriosis, or Pelvic Inammatory Diseases.3 In
addition, depending on the level of pain experienced,
dysmenorrhea can be categorized as mild, moderate, or
severe.4 Dysmenorrhea is associated with a variety of
complications. The most common associated problems
of dysmenorrhea are Irritable Bowel Syndrome,
Fibromyalgia, Migraines, and Digestive Symptoms.5
Dysmenorrhea has been linked to psychological and
emotional Issues, such as emotional instability, an
unfavorable attitude toward sex and menstruation.6
Clinical and experimental research, however, has
identified its physiological cause, namely prostaglandin
formation. The Endometrium’s excessive prostaglandin
production is the cause of the pain experienced during
menstruation.7 Women with severe dysmenorrhea and
during the rst two days of menstruation have
increased quantities of prostaglandins in their
menstrual secretions.8 The severity of Dysmenorrhea
is strongly correlated with earlier Menarche, longer
Menstrual Cycles, Obesity, Smoking, and Alcohol
consumption.9 Increased levels of Stress, Worry,
Sadness, and Social Network Disturbance can all
considerably increase the likelihood of developing
Dysmenorrhea.10 Primary Dysmenorrhea often resolves
after childbirth and in the third decade of a Woman’s
Reproductive life, but it’s unclear whether the degree
of Secondary Dysmenorrhea has any bearing on its
Prognosis.11 Dysmenorrhea is a complex set of
symptoms that has an adverse eect on Women’s
Quality of Life and productivity. Due to menstrual
pain, 50% of women missed at least one day of school
or work.12 Girls who have primary Dysmenorrhea
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17 J Farkhanda Inst Nurs Pub Health January - June 2023
experience acute, Spasmodic Pain that comes and goes,
commonly centered in the supra pubic area.13 Pain
typically starts few hours before and a few hours after
the start of monthly Menstruation.14 The Quality of Life
for women may be impacted by all these
Dysmenorrhea-related side eects. Poor Quality of
Life is experienced by Women who have
Dysmenorrhea.15 According to statistics,
Dysmenorrhea can aect as much as 90% of women
worldwide or as less as 43%. In Pakistan, girls of
reproductive age are unable to carry out their everyday
tasks eectively during menstruation for cultural and
societal reasons, therefore many choose not to seek
medical attention.16 This study was aimed to determine
the prevalence and Impact of dysmenorrhea on quality
of life of students nurses. Data on dysmenorrhea’s
prevalence and quality of life in Pakistan, particularly
in Khyber Pakhtunkhwa, are scarce.
METHODOLOGY
Cross-sectional research was conducted at one nursing
school in Peshawar. Data was collected in three
sections of nursing sciences (BSN, MSN, and Post
RN). Overall, 179 female students were recruited in the
study using Censes Method. Female students enrolled
in INS, KMU and willing to participate in the Research
were included to Participate in the Study. Participants
with Secondary Dysmenorrhea, Breastfeeding Mothers,
or Pregnant Participants were excluded from the Study.
The KMU Ethical board approval obtained. The
Director of the concerned institute approved the
collection of data. Participants were informed of the
study’s goals and objectives. All of the included
individuals conrmed their consent. To determine the
association between dysmenorrhea and various
categories, the chi-square test was used. The
WHOQOL Questionnaire has Total Twenty-Six
Questions which cover Quality of Life all aspect such
as Psychological, Physical, Social, and Environmental
respectively. This Study was conducted in October
2020 to February 2021.
RESULTS
The majority (60.3%) of the participants were having
dysmenorrhea while 39.7% were not experiencing
dysmenorrhea (Table 1).
Figure 6: Pie-Chart Depicting Prevalence of Dysmenorrhea
The majority (63.5%) participants reported
dysmenorrhea in age group 18-25 years. while in the
26–30 and 31-45-year age categories, 35.3% and
57.1% participants reported dysmenorrhea. 63.4%
participants reported dysmenorrhea among unmarried
participants. Seventy-eight (64.5%), twenty-one
(48.8%), and nine (60%) participants with
dysmenorrhea, respectively, fell into the categories of
generic BSN education, PRN, and MSN In
dysmenorrhea group. Pathan Hindko, Punjabi, Chitrali,
and others were recorded as 90 (60.4%), 5 (55.5%), 4
(36.4%), 7 (87.5%), and 2 (100%) correspondingly in
the ethnicity. One hundred and ve (63.3%) members
in the group for dysmenorrhea were Musli ms, whereas
only three (25%) were Christians (Table 1).
Participants, n=179.
Table 1: Dysmenorrhea and Socio-Demographic Prole of the
Items Dysmenorrh
ea N (%)
No
Dysmenorrh
ea N (%)
P-
Value
Age
Categories
-18 25 age 94(63.5%) 54(36.5%)
0.077
26-30 age 06(35.3%) 11(64.7%)
31-45 age 08(57.1%) 06(42.9%)
Marital
Status
Unmarried 92(63.4%) 53(36.6%) 0.079
Married 16(47.1%) 18(52.9%)
Generic 78(64.5%) 43(35.5%) 0.198
PRN 21(48.8%) 22(51.2%)
MSN 09(60%) 06(40%)
Geographic
Rural 53(68.8%) 24(31.2%) 0.044
Location Urban 55(53.9%) 47(46.1%)
Pathan 90(60.4%) 59(39.6%)
0.164
Hindko 05(55.6%) 04(44.4%)
Punjabi 04(36.4%) 07(63.6%)
Chitrali 07(87.5%) 01(12.5%)
Others 02(100%) 0(0 %)
Religion Islam
105(63.3%)
61(36.7%)
0.015
Christian 03(25%) 09(75%)
Hindu 0(0%) 01(100%)
Level of
Education
on
Ethnicity
Moreover, in the dysmenorrhea among women, 64.9%
reported having pain before to menstruation, whereas
47.9% reported none. In addition, 71.3% of women
reported experiencing menstrual pain. 71.4% of
patients in the dysmenorrhea group reported
experiencing nausea or vomiting. Most individuals
(70.8%) reported having lower abdomen pain73.5% of
the participants were reported with lower abdominal
pain pointed towards legs. In dysmenorrhea group, all
the participants were reported cramps. The majority
(79.2%) of the participants in the dysmenorrhea group
were described as experiencing lower abdomen
heaviness (Table 2).
Prevalence of Dysmenorrhea and Its Eects on Quality of Life
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J Farkhanda Inst Nurs Pub Health
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Table 2: Dysmenorrhea and Associated Problems among the
Participants, n=179.
Items Dysmenorrh
ea N (%)
Lower
abdominal Pain
Yes
No
97(70.8%)
11(26.2%)
Pain before
menses
Yes
No
85(64%)
23(47.9%)
Nausea or
vomiting
during MC
Yes 55(71.4%)
No 53(52%)
Pain during
MC
Yes 107(71.3%)
No 01(3.4%)
Abdominal
pain pointed
towards legs
Yes 86(73.5%)
No 22(35.5%)
Cramps in
abdomen
Yes 108(100%)
No 0(0%)
Lower
abdominal
heaviness
Yes 84(79.2%)
No 24(32.9%)
No
Dysmenorrhea
N (%)
P-
Value
40(29.2%)
31(73.8%)
<0.05
<0.05
<0.05
<0.05
<0.05
<0.05
(100%)
46(35.1%)
25(52.1%)
22(28.6%)
49(48%)
43(28.7%)
28(96.6%)
31(26.5%)
40(64.5%)
0(0%)
71
22(20.8%) <0.05
49(67.1%)
With a p-value of 0.377, the QOL and dysmenorrhea
are not signicantly correlated. Sixty -seven (40.6%) of
the participants in the group without dysmenorrhea and
98 (59.4%) of the participants with dysmenorrhea have
satisfactory QOL. Dysmenorrhea group ten (71.4%)
and No Dysmenorrhea group four (28.6%) both have
poor quality of life (Table 3).
Table 4: Association among Quality of life and Dysmenorrhea,
n=179
QOL Dysmenorrh
ea
No
Dysmenorrhea T otal P-
Value
Good
QOL 98(54.7%) 67(37.4%) 165(92.1%)
0.377
Bad
QOL 10(5.6%) 04(2.2%) 14(7.8%)
Total 108(60.3%) 71(39.6%) 179(100%)
DISCUSSION
A total of 179 participants from one nursing school
participated in this cross-sectional study, which was
conducted to evaluate the quality of life in females with
dysmenorrhea. Out from these 179 participants, 60.3%
have dysmenorrhea and 39.7% do not. However, in a
dierent study, the results were completely dierent,
with 83.6% having dysmenorrhea and 16.4% not
having it.17 Another study in the same context revealed
that 69% of people have dysmenorrhea.18 According to
a study conducted in Ethiopia, 69.26% of participants
there reported having dysmenorrhea, which supports
the ndings of the current study. 19 Our study found no
significant dierence in QOL between the groups with
and without dysmenorrhea; the good QOL in the
dysmenorrhea group was 59.4%, while the bad QOL
was 71.4%. These ndings are almost identical to those
of a study conducted in 2019 at a university in Spain.
(19). Additionally, there was no noticeable dierence
in the means between the two groups in the areas of
physical, psychological, social, and environmental
factors. In our study, there were 63.4% of unmarried
participants and a lower percentage of 47.1% of
married participants reported dysmenorrhea. 64.5% of
the general population had dysmenorrhea as stated.
Similar to other studies, which had more participants,
85.9% of them were single and had dysmenorrhea.20
There was a considerable dierence in the percentage
of women reporting menstrual cycle pain between the
two groups. In the dysmenorrhea group, 71.3% of
women experienced menstrual cycle pain, whereas just
3.4% reported no menstrual cycle discomfort. 46.2% of
763 participants in a survey stated that they always
having pain in menstruation.21 In contrast to the 53
participants who reported no such issues, 55
participants (71.4%) reported experiencing nausea,
vomiting, and diarrhea during their menstrual cycle.
Similar to the current study, nausea and diarrhea was
reported among 18.2% and 29.5% participants.22
Similarly, a recent study in the dysmenorrhea group
noted nausea of 30.4%, vomiting of 11.3%, and
diarrhea of 17.1.18 There was a signicant dierence
because the p value is less than 0.05 in the lower
abdomen discomfort between the groups with and
without dysmenorrhea; in the dysmenorrhea group,
70.8% had lower abdominal pain and 26.2% had none.
In a study, the group of individuals with dysmenorrhea
experienced lower abdomen pain in 98% of cases.15
With regard to variable lower abdomen discomfort
pointing towards the legs, there was a noteworthy
dierence between the two groups. In the group with
dysmenorrhea, 73.5% reported having this sort of pain,
while 35.5% reported none. In a related study, only
12% of individuals reported having pain that was
directed towards their leg.21 One hundred and eight
(100%) of the participants in the group with
dysmenorrhea reported having cramps, compared to the
100 percent of participants in the group without
dysmenorrhea who said they had none. The lower
abdomen heaviness between the two groups was also
significantly dierent, with 79.2% of participants in the
dysmenorrhea group reporting lower abdominal
heaviness .Supporting current ndings of the study, a
study reported that 96% participants with
dysmenorrhea experience pain and 81% experience
heaviness in their abdominal area.23 Patients with and
without dysmenorrhea were not signicantly dierent
in terms of quality of life in the current study. A study
reported totally die rent ndings and reported that the
women experience reduced quality of life with
dysmenorrhea.24 Similarly, another study also reported
impacted quality of life with dysmenorrhea.25
Prevalence of Dysmenorrhea and Its Eects on Quality of Life
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January - June 2023
LIMITATIONS
The article may have a limited sample size, which may
not be representative of the overall population of
CONCLUSIONS
Dysmenorrhea is very common among nursing
students, along with severe lower abdomen pain,
although there is no correlation between dysmenorrhea
and quality of life. Unmarried was discovered to have
minimal but substantial risk factor for dysmenorrhea.
Improved health education can minimize the eects of
dysmenorrhea and can improve quality of life in
dysmenorrhea. Therefore, it is recommended that
health education, personal hygiene should be improved
to minimize the eects of Dysmenorrhea, and
Dysmenorrhea topic should be added in schools and
collages curriculum.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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CONTRIBUTORS
1. Saeeda Akbar - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision;
Supervision; Final Approval
2. Roheeda Amanullah Khan - Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision;
3. Ayaz Ayub - Supervision; Final Approval
4. Syed Afzal Shah - Data Acquisition; Data Analysis/Interpretation;
Critical Revision
5. Nazima Bibi - Drafting Manuscript; Critical Revision
6. Bibi Sultania - Drafting Manuscript; Critical Revision
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Prevalence of Dysmenorrhea and Its Eects on Quality of Life
