Menstrual symptoms and subjective well-being among postmenarchal adolescents

Abstract

BackgroundMenstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual health care, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated. Objective(s)To study menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents. Study Design: A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th-8th grade) in Stockholm, Sweden. Menstrual symptoms (i.e., dysmenorrhea; heavy bleeding; irregular periods; mood disturbance; other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organisation Five Well-Being Index (WHO-5). Postmenarchal respondents were eligible for analysis whereas those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and WHO-5 scores. A composite Menstrual Health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses. ResultsOf 1100 postmenarchal girls (mean age 14.1±0.7), 93.2% reported menstrual symptoms, 81.3% had at least one moderate symptom and 31.3% had at least one severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%) and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (p<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117) and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; p=.434). Girls with menstrual symptoms had significantly lower WHO-5 scores than those without symptoms (mean difference [MD] =17.3; 95%CI 12.3-22.4). Analysis of variance showed significant associations (p<.001) with WHO-5 scores for each of the examined menstrual symptoms. In post-hoc pairwise comparisons with peers without symptoms, the greatest reductions in WHO-5 score were found among girls with severe symptoms (MD for: dysmenorrhea -20.72; heavy bleeding -15.75; irregular periods -13.81; mood disturbance -24.97; other general symptoms -20.29) but significant differences were observed even for moderate or mild symptoms. The composite Menstrual Health index was significantly associated with WHO-5 scores in regression analysis, independently of age, age at menarche, BMI, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status. ConclusionsDespite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.