Report on Challenges faced during menstruation.

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ABSTRACT
Menstruation and menstrual practices still face many social, cultural, and religious
restrictions which are a big barrier in the path of menstrual hygiene management. In many
parts of the country especially in rural areas girls are not prepared and aware about
menstruation so they face many difficulties and challenges at home, schools, and work
places. While reviewing literature, we found that little, inaccurate or incomplete knowledge
about menstruation is a great hindrance in the path of personal and menstrual challenge
management. A survey was carried out to study the common menstrual problems faced by
women during their menstrual period. 190 individuals of various regions were surveyed with
a standard questionnaire. Students were surveyed majorly than professionals. The statistical
analysis was performed using SPPS software. The level of significance was analyzed using
chi-square test where the results emphasized that 53.4 % (101response) had their first menses
at the age between 11 and 13, maximum number of respondents (47.1%) experiences pain
and 85.9% showed medium bleeding. Most of them experienced psychological problems
which affects their routine life. The most prevalent was psychological problems (69.4%). Of
the individuals surveyed most of them (58.1%) had pain before the onset of menstrual cycle.
Work life has a significant effect on bleeding, bleeding in between two successive periods,
days of menses, pain, fatigue, increased appetite, fainting, indigestion and forgetfulness.
97.4% use sanitary pads to collect their menstrual flow.

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CHAPTER 1
INTRODUCTION
What is menstruation?
Menstruation or having your period is when blood and tissue from your uterus comes
out of your vagina. It usually happens every month. Your menstrual cycle helps your body
prepare for pregnancy every month. It also makes you have a period if you’re not pregnant.
Your menstrual cycle and period are controlled by hormones like estrogen and progesterone.
You have 2 ovaries, and each one holds a bunch of eggs. The eggs are super tiny and too
small to see with the naked eye.
During your menstrual cycle, hormones make the eggs in your ovaries mature —
when an egg is mature, that means it’s ready to be fertilized by a sperm cell. These hormones
also make the lining of your uterus thick and spongy. So if your egg does get fertilized, it has
a nice cushy place to land and start a pregnancy. This lining is made of tissue and blood, like
almost everything else inside our bodies. It has lots of nutrients to help a pregnancy grow.
About halfway through your menstrual cycle, your hormones tell one of your ovaries
to release a mature egg, this is called ovulation. Most people don’t feel it when they ovulate,
but some ovulation symptoms are bloating, spotting, or a little pain in your lower belly that
you may only feel on one side. Once the egg leaves your ovary, it travels through one of your
fallopian tubes toward your uterus.
If pregnancy doesn’t happen, your body doesn’t need the thick lining in your uterus.
Your lining breaks down, and the blood, nutrients, and tissue flow out of your body through
your vagina. it’s your period! If you do get pregnant, your body needs the lining, that’s why
your period stops during pregnancy. Your period comes back when you’re not pregnant
anymore.
When in life do periods start and stop?
Most people get their first period between ages 12 and 14, but some people get them
earlier or later than that. There's no way to know exactly when you’ll get it, but you may feel
some PMS symptoms a few days before it happens. If you don't get your period by the time
you're 16, it’s a good idea to visit a doctor or nurse.
Most people stop getting their period when they’re between 45 and 55 years old —
this is called menopause. Menopause can take a few years, and periods usually change

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gradually during this time. After menopause is totally complete, you can’t get pregnant
anymore. Your period may start and stop around the time it did for other people you’re
related to, like your mom or sisters.
They usually last from three to five days. Besides bleeding from the vagina, you may have:
 Abdominal or pelvic cramping pain
 Lower back pain
 Bloating and sore breasts
 Food cravings
 Mood swings and irritability
 Headache and fatigue

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1.1OBJECTIVESOF THE STUDY
 To study the problems faced during menstruation in adolescent girls.
 To study the age at menarche and duration of the menstrual cycle.
 To study the level of bleeding and the intensity of cramping pains.
 To study the physical and mental problems faced during menstruation.

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1.2METHOD OF THE STUDY
A cross-sectional study was carried out on 190 females working and non – working from
various regions in Coimbatore city. The selected women were explained about the protocol
and the purpose of the study and were requested to complete the questionnaires to elicit
information relating to demographic features, menarche age, and menstrual characteristics,
menstrual problems etc.
Study Type
A research study was conducted by a cross-sectional study method.
Study Population
Adolescent girls those are working and non- working in and around different regions of South
India and fit to the inclusion criteria were included in the study.
Inclusion criteria:
 Unmarried, non-pregnant, non- lactating adolescent girls
Exclusion criteria:
 Not willing
 Married, pregnant, lactating adolescent girls
Data collection
A pre-designed, pre-tested, semi-structured questionnaire was used. Extra care was
taken to ensure the respondents’ privacy and confidentiality. The pre-tested questionnaire was
administered under the supervision of the investigator to prevent the participants from sharing
the responses. The semi-structured questionnaire includes topics related to knowledge
regarding menstruation, source of information regarding menstruation, and problems faced
during menstruation. Following data collection, queries from the participants related to
menstrual cycle and reproduction were clarified by the investigator.
Data Analysis
The data were analyzed using Microsoft Excel and Excel Add-in. data is reported in
the form of descriptive statistics. Descriptive statistics were used to determine mean and
percentages wherever applicable. Statistical analysis was done by using frequency.

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1.3SCOPE OF THE STUDY
Based on this research’s findings, a need for more information to be available to girls and
women concerning the biological/physiological processes of menstruation as well as the
beliefs and taboos that generate feelings of shame and impurity is indicated. It is assumed that
the extent to which educational interventions directly address the knowledge deficits of
beneficiaries, the more effective they will be. For this reason, deeper study into the extent of
lack of knowledge and the dominance of beliefs would need to be identified in each specific
context, especially in regard to its impact on the empowerment, the self-perception etc. of
women – educational inputs can be tailored accordingly. Training could also be provided to
those who are responsible for guiding young women on how to accept menstruation as a
natural biological process and integrate this experience into a positive self-image – again
context specific. This is also the chance to address issues such as self-respect, dignity,
empathy and informed choice regarding use of products. The concept of privacy
and confidentiality about speaking out about periods should be dismantled as it is high time
that girls should be proud to speak up about their reproductive and menstrual problems.

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1.4 LIMITATIONS OF THE STUDY
 There are several factors that limit the survey examining women's menstrual
hygiene management. The survey was conducted through an online
questionnaire. Since it wasn’t a personal interview type questionnaire, many
didn’t even try to attend it.
 It became clear that participants did not always state their real income – tending
to understate income possibly for fear of this having implications for their
government benefits – this may lead to some data distortions concerning
conclusions relating to economic factors.
 The occupation of participants could not be further specified, since the survey
only provided the options “professional” or “student”, but none concerning the
particular profession.
 Regarding question of emotional discomfort, the survey failed to distinguish
discomforts that arise pre-menstrual from those that arise during menstruation.
 In hindsight, conducting the survey with such a wide age range presented greater
complexity in data analysis.

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1.5 RESEARCHMETHODOLOGY
DESCRIPTIVE RESEARCH
The research design specifies the method of study. Research design is prepared after
formulating the research problem. The study follows descriptive research method.
Descriptive studies aim at portraying accurately the characteristics of a particular group or
situation. Descriptive research is concerned with describing the characteristics of a particular
individual or a group. Here the researcher attempts to present the existing facts by collecting
data.
RESEARCH DESIGN
A research design is the process of action throughout the procedure, which provides
guidelines for the rest of research process. It is the map of blueprint according to which, the
research is to be conducted. It minimizes the error and maximizes the accuracy.
SOURCES OF DATA
Data collected using a structural questionnaire also through the desk research. Data
are the raw materials in which marketing research works. It includes collection of primary
and secondary data.
PRIMARY DATA
Data collected by the investigator himself/ herself for a specific purpose. The study is
mainly based on the primary data, i.e. the survey questionnaire.
SECONDARY DATA
Data collected by someone else for some other purpose (but being utilized by the
investigator for another purpose). The secondary data is collected from the reference books
and websites provided in the bibliography.
SAMPLING METHOD
Sampling is the process of selecting a representative group from the population
under study. The target population is the total group of individuals from which the
sample might be drawn. Sampling technique used in the study is ‘Random Sampling’.

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SAMPLE SIZE
A sample is the group of people who take part in the investigation. The people who
take part are referred to as “participants”. The sample size taken for this study is 190.
Working and non- working adolescent girls are taken as samples in the study.
TOOLS FOR ANALYSIS
The various tools that are used for the analysis of the data. The main tool used for data
analysis is percentage method.

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CHAPTER – 2
STUDY PROFILE
Menstruation describes the female period. The menstruation cycle begins when a
woman gets her periods. The menstrual blood which leaves her body are products shed from
the uterus (the uterine lining also called the endometrium). During the remainder of the
menstrual cycle the uterine lining regrows. It does so in preparation for pregnancy, which
occurs if the egg (oocyte) a woman releases about half way through her menstrual cycle is
fertilized. When fertilization occurs, the lining stays in place to nourish the fertilized egg.
When fertilization does not occur the menstrual cycle continues and the uterine lining is shed
marking the start of the woman’s next menstrual period. Women begin menstruation at an
average age of 13 (called menarche) and on average continue menstruating till age 51
(called menopause).
Menstruation involves highly complex hormonal interactions. The key hormones involved in
menstruation are estrogen and progesterone (produced by the ovaries) and luteinizing
hormone and follicle stimulating produced by the pituitary gland, under the influence of
hormones secreted by the hypothalamus. The interactions between these organs are referred
to as the hypothalamic-pituitary-ovarian axis (HPO axis).
Phases of the menstrual cycle
The menstruation cycle refers to the cycles in which a woman’s uterus grows and
sheds a lining (the endometrium) which could support the development of a fertilized egg. It

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typically occurs in 28 day cycles, so a woman generally gets her period every 28 days.
However, cycle length may be as short as 21 days or as long as 40 days in some women. The
inner lining of the uterus (the endometrium) goes through three phases during the typically
28-day menstrual cycle: the menstrual phase (days 1-5), the proliferative phase (days 6-14)
and the secretory phase (days 15-28).
The ovarian cycle, refers to the cycle in which a woman’s ovaries prepare an egg to
be released during ovulation. It is divided into two phases: the follicular phase (days 1-14)
and the luteal phase (days 15-28), during which different levels of hormones are released.
These two cycle occur in a synchronized manner; day 1 of the ovarian cycle is always also
day 1 of the menstrual cycle.
Day 1 of the menstrual cycle coincides with the start of a woman’s period (menstrual
bleeding) in which the uterus sheds the lining (endometrium) built up in the previous
menstrual cycle. The lining of the uterus is regrown during each menstrual cycle. Menstrual
bleeding typically continues for 3-5 days in what is known as the menstrual phase of the
cycle. Between 50-150ml of blood is released during this period.
After the woman’s period, the proliferative phase of the menstrual cycle begins. The
uterine lining is regenerated in preparation for receiving a fertilized egg (should fertilization
occur). The regrowth of the lining each month is needed to create an environment suitable for
development of a fertilised egg. If the egg released during ovulation is fertilised and the
woman becomes pregnant, the uterine lining stays in place and nourishes the fertilised egg.
If the egg is not fertilised then the menstrual cycle continues for another 14-15 days (the
secretory phase). This period is usually the same length, regardless of the total length of the
woman’s menstrual cycle. Levels of oestrogen, progesterone, luteinizing hormone and
follicle stimulating hormone all decline. This causes the blood vessels supplying the uterine
lining to deprive the endometrium of the nutrients and oxygen it needs to survive. The cells
of the endometrium begin to die and shed, resulting in menstrual bleeding and the
commencement of a new menstrual cycle.
As the uterus is preparing its lining in the proliferative phase, the woman’s ovaries are
preparing an egg for release. Her oestrogen levels rise stimulating the growth of several
ovarian follicles. Each of the follicles contains one egg (oocyte) which matures as the follicle
grows. Usually only one follicle (known as the dominant follicle) fully matures and releases
the egg it contains. The release of the egg is referred to as ovulation. Rarely a woman will
develop and release two or more eggs, and this is when multiple pregnancy occurs (e.g.
triplets, depending on the number of eggs released).

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In a typical 28-day cycle, ovulation or the release of a mature egg occurs on Day 14,
marking the end of the follicular phase. Ovulation will occur earlier in shorter cycles and later
in longer cycles. Ovulation occurs when levels of luteinising hormone (a hormone secreted
by the pituitary gland in the brain) in the woman’s body rise rapidly. The surge in luteinising
hormone signals the ovaries to release the mature egg/s and marks the beginning of the luteal
phase of the ovarian cycle. Once released from the ovaries an egg may be fertilised by male
sperm, in which case it will be nourished by the uterine lining and establish a pregnancy.
Pregnancy changes the woman’s hormonal balance and interrupts the menstrual and ovarian
cycles. If the egg is not fertilised it will exit the woman’s body and the ovarian and menstrual
cycles continue.

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qCHAPTER – 3
REVIEW OF LITERATURE
Review literature is a systematic identification and summary of written materials that
contain information on research problems. It is a key step in research. It refers to an
extensive, exhaustive and systemic examination of publications relevant to research project.
The literature for the present study is organized under the following headings:
 Heavy periods could soon be a thing of the past.
 Girls who start puberty earlier more likely to experience depression as adults.
 Cramps usually begin after a girl starts menstruating, but commonly improve
as she gets older.
1. Heavy periods could soon be a thing of the past
-- Sabrina Barr, Independent (journal)
Women who suffer from heavy periods can attest how terrible it feels when their time
of the month comes around. Researchers from the University of Edinburgh, funded
by Wellbeing of Women, explored how the shedding of the endometrium (the womb lining)
is linked to dropping levels of oxygen during menstruation. “Heavy bleeding is a debilitating
and common condition that affects thousands of women and girls but too often gets
dismissed,” Tina Weaver, CEO of Wellbeing of Women, also stressed how many individuals
will benefit from these new findings.
2. Girls who start puberty earlier more likely to experience depression as adults
-- Olivia Petter, Independent (journal)
Girls who get their periods early are more likely to develop psychological problems in
adulthood, a new study suggests.Researchers at Cornell University tracked nearly 8,000 girls
from adolescence into their late 20s and found that those who started puberty at a young age
were more susceptible to depression, anxiety, eating disorders and substance abuse.The
study, which was published in the journal Pediatrics, suggests these issues could persist for
years.In addition to being more likely to experience psychological problems, researchers
found that girls who start their periods around the average age or younger (studies show that
some women start their periods as early as eight years old) are more likely to engage in
antisocial behaviors such as rule-breaking and delinquency.Plus, they found that these
behaviors only worsened with age.The study’s authors collected their findings by analyzing

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data from the National Longitudinal Study of Adolescent Health, which contains information
on 7,800 women.
3. Cramps usually begin after a girl starts menstruating, but commonly improve as
she gets older
-- Rebecca Deans, Independent (journal)

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CHAPTER – 4
DATA ANALYSIS& INTERPRETATION
5.1. Age of Participant
Table (5.1.1)
PARTICULARS FREQUENCIES PERCENTAGE
BELOW 18 YEARS 6 3.12
18 – 20 YEARS 140 73.96
ABOVE 20 YEARS 44 22.92
TOTAL 190 100
Graph (5.1.2)
INTERPRETATION
From the table 5.1.1, 22.92 % of the respondents are above 20 years of age, 73.96 %
of the respondents are 18-20 years of age and 3.12 % of the respondents are below 18 years
of age.

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5.2. Occupation of the Respondent
Table (5.2.1)
STUDENTS 180 94.8
PROFESSIONALS 10 5.2
TOTAL 190 100
Graph (5.2.2)
INTERPRETATION
From the table 5.2.1, 94.8 % of respondents are students and only 5.2% of
respondents are professionals.

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5.3. Occurrence of Menarche
Table (5.3.1)
YES 186 97.9
NO 4 2.1
TOTAL 190 100
Graph (5.3.2)
INTERPRETATION
From this table 5.3.1, out of 190 respondents, 97.9% of respondents have started their
periods and only 2.1% of respondents have not yet started their periods.

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5.4. Age of Menarche
Table (5.4.1)
BELOW 11 YEARS 24 12.6
11 TO 13 YEARS 101 53.4
14 TO 15 YEARS 58 30.4
ABOVE 15 YEARS 7 3.7
TOTAL 190 100
Graph (5.4.2)

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INTERPRETATION
From the table 5.4.1, out of 191 respondents, 12.6 % of respondents started their
period below 11 years of age, 53.4 % of respondents started their period at 11 to 13 years of
age, 30.4% of respondents started their period at 14 to 15 years of age and 3.7% of
respondents started their period above 15 years of age.
Girls start menstruating at the average age of 12. However, girls can begin
menstruating as early as 8 years of age or as late as 16 years of age. Women stop
menstruating at menopause, which occurs at about the age of 51. At menopause, a woman
stops producing eggs (stops ovulating). This does not mean that all girls start at the same age.
Most of the time, the first period starts about 2 years after breasts first start to develop. If a
girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast
growth started, she should see a doctor.

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5.5. Duration of Menstrual Cycle
Table (5.5.1)
I DAY 1 0.5
3-5 DAYS 141 74.2
5-7 DAYS 44 23.2
MORE THAN 7 DAYS 4 2.1
TOTAL 190 100
Graph (5.5.2)

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INTERPRETATION
From the table 5.5.1, out of 190 responses, monthly cycle of 74.2% respondents last
for 3-5 days, monthly cycle of 23.2% respondents last for 5-7 days, monthly cycle of 2.1%
respondents last for more than 7 days and monthly cycle of only 0.5 % of respondents last for
one day.
Period will come about 12 to 16 days after you ovulate, assuming you did not get pregnant,
but there are a few factors that could affect the length of your period. Sometimes, though,
lifestyle changes, birth control methods, and certain medical problems can affect your period
more significantly. It’s important to see your doctor if your bleeding is lasting more than
seven days. Heavy bleeding, too, is an indication to see your doctor.
Signs of heavy bleeding include:
 Soaking through one or more tampons or pads every hour for several hours in a row
 Wearing more than one pad at a time to control bleeding
 Changing pads or tampons at night
 Periods with blood clots that are the size of a quarter or larger

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5.6. Menstrual Cycle – Regular or Irregular?
Table (5.6.1)
REGULAR 166 87.8
IRREGULAR 24 12.2
TOTAL 190 100
Graph (5.6.2)

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INTERPRETATION
From the table 5.6.1, 87.8% of respondents have regular menstrual cycle and 12.2%
of respondents have irregular menstrual cycle.
Having irregular periods can mean a variation in the number of days you have your period or
that your period arrives early, late or even skips a few months. Actually, most women will
experience irregular bleeding at some point in their life. A period showing up unexpected or
delayed does not always mean something serious is going on. But your period showing up
whenever it wants can be stressful.
In the first 2-3 years after a girl's period has started, periods can be irregular, as it can take
a year or two for the cycle to regulate. Once regular, periods tend to begin around the same
time each month (on average every 26-29 days), but can be as often as three weeks apart or as
far apart as eight weeks. You can still be ovulating either regularly or irregularly right up
until your period stops at menopause. The 4 most common causes that can cause a delayed or
early period thus causing an irregular menstrual cycle:
1. – Medication
2. – Stress and anxiety
3. – Puberty or menopause
4. – Hormonal birth control such as contraceptive pills or emergency contraception

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5.7. Occurrence of irregular cycles
Table (5.7.1)
TWICE IN A MONTH 91 48.1
ONCE IN 3 MONTHS 47 25
ONCE IN 6 MONTHS 4 1.9
ONCE IN 9 MONTHS 4 1.9
ONCE IN A YEAR 26 13.5
NEVER HAD BLEEDING
AFTER FIRST TIME
18 9.6
TOTAL 190 100
Graph (5.7.2)

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INTERPRETATION
From the 5.7.1, for 48.1% of respondents, irregular cycles occur twice in a month, for
25% of respondents, irregular cycles occur once in 3 months, for 13.5% of respondents,
irregular cycles occur once in a year, for 9.6% of respondents, they never had bleeding after
the first occurrence, for 1.9% of respondents, irregular cycles occur once in 6 months and for
1.9% of respondents, irregular cycles occur once in 9 months.
Your menstrual cycle is controlled by hormones, which, if imbalanced, can cause
irregularities to your menstrual cycle and period flow. The most common cause is a
fluctuation in your hormones (especially when it affects your estrogen levels):
1. – Stress, travelling and a hectic lifestyle can release stress hormones, which can
disrupt the production of estrogen and cause a late or missed period.
2. – Your diet and unhealthy eating can impact your body and your flow. Similarly,
sudden weight gains or loss, as well as malnourishment, can cause an irregular
menstruation.
3. – Medication and contraception; hormonal birth control methods such as the pill or
the injection can affect your period.
4. – Puberty, Menarche and Menopause, are phases in your life where high hormonal
fluctuation is normal.
5. – Excessive exercising can often cause periods to be delayed or not come at all.

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5.8. Duration Between Two Cycles
Table (5.8.1)
28 DAYS 70 36.6
MORE THAN 28 DAYS 77 40.9
SUCCESSIVE PERIODS
LESS THAN 28 DAYS
43 22.6
TOTAL 190 100
Graph (5.8.2)
INTERPRETATION
From the 5.8.1, for 40.9% of respondents, there are more than 28 days between two
cycles. For 36.6% of respondents, there are 28 days between two cycles. For 22.6% of
respondents, there have successive periods less than 28 days.

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5.9. Color of Menstrual Flow
Table (5.9.1)
BROWN SHADES 91 48
RED SHADES 99 52
TOTAL 190 100
Graph (5.9.2)

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INTERPRETATION
From the table 5.9.1, 52% of respondent have red shades of menstrual flow and 48 %
of respondents have brown shades of menstrual flow.
Anything from the length of your cycle to the textures and colors you see may
indicate something important about your health. You may see colors of blood ranging from
black to bright red, brown to orange. Although most colors can be considered “normal” or
“healthy,” others may be reason to see your doctor. Your period may change colors from the
beginning to the middle to the end. You may even have different colors from month to month
or at different times throughout your life. There are a number of factors involved, even when
your periods are totally “healthy.”
In most cases, the variation from bright red to dark red to brown has something to do
with the flow and time the blood has been in the uterus. Your flow may be faster at the
beginning of your period and trail off toward the end. You may have dark red blood after
laying down for a long time, too. You may see bright red blood on your heaviest days.
This doesn’t mean that all changes in color are normal. If you see a shade that’s
unfamiliar or gray — especially if you have other symptoms — there’s no harm in making an
appointment to get checked out. And any bleeding during pregnancy is reason to touch base
with your doctor.

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5.10. Blood Clotting
Table (5.10.1)
YES 89 46.4
NO 101 53.6
TOTAL 190 100
Graph (5.10.2)

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INTERPRETATION
From the table 5.10.1, 53.6% of respondent’s experience blood clotting during
menstruation and 46.4% of respondents do not experience blood clotting during
menstruation.
Besides color, the texture of your blood may change throughout your period. And
your periods from month to month may be different textures as well. Clots aren’t necessarily
a reason for concern. They happen as your uterus sheds its lining. Size matters, though. If you
see clots that are bigger than a quarter in size, you may want to let your doctor know. Same
goes with clots that accompany heavy bleeding.
Watery period blood is thin and likely new blood flowing quickly from the uterus.
Some women may experience particularly heavy flow, which is called menorrhagia. Clots
may or may not accompany the bleeding with this condition. Look out for signs of anemia,
like fatigue or shortness of breath.
Blood-tinged discharge that happens around the time of ovulation may be mixed
with cervical mucus, giving your blood an egg white or gelatinous texture. This discharge
may also be described as wet and slippery.

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5.11. Level of Bleeding
Table (5.11.1)
LIGHT 17 8.9
MEDIUM 163 85.9
HEAVY 10 5.2
TOTAL 190 100
Graph (5.11.2)

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INTERPRETATION
From the table 5.11.1, 85.9% of respondents have medium bleeding, 8.9 % of
respondents have heavy medium and only 5.2% of the respondents have light bleeding.
Light flow and heavy flow can be subjective descriptions -- meaning light and heavy
flow to you don’t always mean light and heavy flow to your best friend. Generally, menstrual
flow is considered too heavy when you need to change your pad or tampon every hour for a
few hours in a row. Bleeding like this is a reason to head to see your healthcare provider right
away. Light flow (in my opinion) is when you really don’t have to change your pad or
tampon every four hours, but you should to keep yourself clean and to prevent odors and
infections.
Your first periods may be light because your body is getting used to building up that
uterine lining and regulating all of the hormones that play a role in making your period
happen. Once it is regular, most periods last between three and seven days with a day or two
of heavier flow (where you need to change your pad every four hours or so), then tapering off
toward the end. When periods are very heavy or you are experiencing “flooding” or passing
big clots you have what doctors call menorrhagia.

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5.12. Pain During Menstrual Cycle
Table (5.12.1)
CATEGORIES RESPONSES RESPONSE
PERCENTAGE
YES 90 47.1
NO 24 12.6
SOMETIMES 76 40.3
TOTAL 190 100
Graph (5.12.2)

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INTERPRETATION
From the table 5.12.1, 47.1% of respondents face pain during menstrual cycle
sometimes, 40.3% of respondents face pain during menstrual cycle, and 12.6% of
respondents do not face pain during menstrual cycle.
Menstruation occurs when the uterus sheds its lining once a month. The lining passes
through a small opening in the cervix and out through the vaginal canal. Some pain,
cramping, and discomfort during menstrual periods is normal. Excessive pain that causes you
to miss work or school is not.
Painful menstruation is also called dysmenorrhea. There are two types of
dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in women who
experience pain before and during menstruation. Women who have had normal periods that
become painful later in life may have secondary dysmenorrhea. A condition affecting the
uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.
There may not be an identifiable cause of your painful menstrual periods. Some women are at
a higher risk for having painful menstrual periods. These risks include:
 being under age 20
 having a family history of painful periods
 smoking
 having heavy bleeding with periods
 having irregular periods
 never having had a baby
 reaching puberty before age 11

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5.13. Duration of Menstrual Pain
Table (5.13.1)
1ST DAY 104 54.7
2ND DAY 39 20.6
FIRST 2 DAYS 1 0.6
FIRST 3 DAYS 39 20.6
ALL THE DAYS 7 3.5
TOTAL 190 100
Graph (5.13.2)
INTERPRETATION
From the table 5.13.1, 54.7% of respondents face pain only in the 1st day of their
menstrual cycle, 20.6% of respondents face pain only during 2nd day of their menstrual cycle,
0.6% of respondents face pain in the first 2 days, 20.6% of respondents face pain in the first 3
days and only3.5% of respondents face pain in all the days of menstrual cycle.

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5.14. Onset of Pain – Before or After
Table (5.14.1)
BEFORE 110 58.1
AFTER 80 41.9
TOTAL 190 100
Graph (5.14.2)

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INTERPRETATION
From the table 5.14.1, 58.1% of respondents face pain before the onset of their cycle,
and 41.9% of respondents face pain after the onset of their cycle.
The pain, also known as dysmenorrhea or period pains, ranges from dull and
annoying to severe and extreme. Menstrual cramps tend to begin after ovulation when an egg
is released from the ovaries and travels down the fallopian tube. Pain occurs in the lower
abdomen and lower back. It usually begins 1 to 2 days before menstruation and lasts from 2
to 4 days.
Pain that is only associated with the process of menstruation is known as primary
dysmenorrhea. If the cramping pain is due to an identifiable medical problem such
as endometriosis, uterine fibroids, or pelvic inflammatory disease, it is called secondary
dysmenorrhea.
 Menstrual cramps are pains felt in the lower abdomen, before and during menstruation.
 The pain can range from slight to severe.
 Emotional stress can increase the chance of experiencing menstrual cramps.
 Other symptoms include nausea, vomiting, sweating, dizziness, headaches, and diarrhea.
 Menstrual cramps can be treated with over-the-counter medicine, control treatments, and
some home remedies.

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5.15. Intensity of Stomach Pain
Table (5.15.1)
INTENSE 68 35.6
LESS INTENSE 40 21.1
SOMETIMES 82 43.3
TOTAL 190 100
Graph (5.15.2)
INTERPRETATION
From the table 5.15.1, 43.3% of the respondents face stomach pain sometimes during
their cycle, 35.6% of respondents face intense stomach pain during their cycle, and 21.1% of
respondents face less intense stomach pain during their menstrual cycle.

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5.16. Intensity of Hip Pain
Table (5.16.1)
PARTICULARS FREQUENCIES RESPONSE
PERCENTAGE
INTENSE 61 32
SOMETIMES 75 39.4
TOTAL 190 100
Graph (5.16.2)
INTERPRETATION
From the table 5.16.1, 39.4% of respondents face pain in the hip sometimes during
their cycle, 32% of respondents face intense hip pain during their cycle, and 28.6% of
respondents face less intense hip pain during their cycle.

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5.17. Intensity of Leg Pain
Table (5.17.1)
INTENSE 43 22.6
SOMETIMES 89 47
TOTAL 190 100
Graph (5.17.2)
INTERPRETATION
From the table 5.17.1, 47% of the respondents face leg pain sometimes during their
cycle, 30.4% of respondents face less intense leg pain during their cycle, and 22.6% of
respondents face intense leg pain during their cycle.

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5.18. Intensity of Joint Pain
Table (5.18.1)
INTENSE 25 13
SOMETIMES 105 55.6
TOTAL 190 100
Graph (5.18.2)
INTERPRETATION
From the table 5.18.1, 55.6% of respondents face joint pain sometimes only during
their menstrual cycle, 31.5% of respondents face less intense joint pain during their cycle,
and 13% of respondents face intense joint pain during their cycle.

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5.19. Physiological Problems
Table (5.19.1)
INTENSE 24 12.4
SOMETIMES 115 60.9
TOTAL 190 100
Graph (5.19.2)

43 | P a g e
INTERPRETATION
From the table 5.19.1, 60.9% of the respondents face physiological problems
sometimes during their cycle, 26.7% of respondents face less intense physiological problems
during their cycle. 12.4% of respondents face intense physiological problems during their
cycle.
We may experience a range of symptoms in the second half of your menstrual
cycle. This period of time after ovulation and before bleeding begins may trigger things like
headache, fatigue, and nausea. These symptoms are part of what’s called premenstrual
syndrome (PMS). Experts estimate that some 85 % of menstruating women experience at
least one or more symptoms of PMS each month.
We may feel nauseous as your body goes through hormonal changes before your period. The
usual cramps and headaches may also make you feel sick to your stomach and generally
unwell. Your cycle also triggers a group of chemicals in your body called prostaglandins that
may cause anything from headaches to nausea to diarrhea.

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5.20. Psychological Problems
Table (5.20.1)
YES 132 69.4
NO 58 30.6
TOTAL 190 100
Graph (5.20.2)

45 | P a g e
INTERPRETATION
From the table 5.20.1, 69.4% of the respondents face psychological problems during
their cycle, and 30.6% of respondents do not face any psychological problems during their
cycle.
It isn’t exactly clear what causes mood swings around the time of your period,
although it is widely accepted that hormones have an important part to play. However, which
hormones are involved and what effects they are having on other hormones and systems, isn’t
well understood.
Oestrogen is prone to fluctuating; around day 14 of the menstrual cycle estrogen
peaks in order to initiate ovulation. This is interesting in itself, as we believe this important
hormone is somewhat responsible for regulating our mood, so it makes sense to have optimal
amounts around the time of ovulation – this is when we should be at our happiest and ensure
relationships are going well if we want any chance of becoming pregnant!
However, after ovulation, estrogen starts to decline. It isn’t plain sailing though and
over the next two weeks it fluctuates, until it eventually decreases enough to initiate
menstruation. These fluctuations are thought to be critical – not only are the levels of
oestrogen important but also the ratio of oestrogen to progesterone at any one time. If this
ratio changes, it can result in one hormone becoming dominant over the other.
Estrogen dominance is thought to be associated with mood swings involving more
irritability and anger whilst progesterone dominance is more commonly associated with
feelings of low mood, weepiness, anxiety and low self-confidence. However, the interaction
and metabolism of other hormones around this time is also important, although again, not
completely understood. Serotonin is an example of this. A drop in serotonin is also thought to
give rise to mood swings and is another important implication.

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5.21. Intake of Drugs to avoid Pain
Table (5.21.1)
YES 16 8.4
NO 142 74.7
SOMETIMES 32 16.8
TOTAL 190 100
Graph (5.21.2)

47 | P a g e
INTERPRETATION
From the table 5.21.1, 74.7% of respondents do not take drugs to avoid pain during
menstrual cycle, and 16.8% of respondents sometimes take drugs to avoid pain during their
cycle, and 8.4% of respondents take drugs to avoid pain during cycle.
If your menstrual cramps are painful, you may think about taking some type of the
over-the-counter medication for 1 to 2 days. These medications are called “anti-
prostaglandins”. They help relieve the discomfort, make your flow lighter, and cause your
uterus to cramp less. Look for over-the-counter medications that contain ibuprofen or
naproxen sodium. Take this medicine when you first start to feel uncomfortable, and continue
taking it every 4-6 hours or as recommended by your HCP.
Since this kind of medicine can upset your stomach, you should take it with food.
Make sure you read the label to see how much and how often you should take the medication.
You shouldn’t take these products if you’re allergic to aspirin-like medicine or have stomach
problems. It’s important not to take more medicine than is recommended or prescribed.
Natural remedies such as a microwavable warm pack or a heating pad placed on your
abdomen (lower belly) may help too, just make sure it’s not too hot. Soaking in a warm bath
may also relieve uncomfortable cramps. Some teens find that increasing their physical
activity helps; others find that resting quietly for short periods of time helps.

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5.22. Intake of Drugs to Prepone/Postpone Periods
Table (5.22.1)
PARICULARS FREQUENCIES PERCENTAGE
YES 5 2.7
NO 185 97.3
TOTAL 190 100
Graph (5.22.2)

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INTERPRETATION
From the table 5.22.1, 97.3% of the respondents do not take drugs to
prepone/postpone periods, and only 2.7% of respondents take drugs to prepone/postpone their
periods.
Being a monthly natural occurrence, menstruation should never be messed up with.
However, there come times when we can’t help but wish to reschedule it to an earlier or a
later time in order to make our life a bit easier. In such dilemmas, sticking to the natural
remedies is always better as they do not pose the risk of adverse effects. According to
experts, consuming foods that warm up the body by inducing heat can prepone menstruation
while foods that are able to cool down the body can postpone it. This process is absolutely
safe and can be followed without a doctor’s guidance.
However, when it comes to rearranging the dates of menstrual cycles, most of the
women doubt the efficacy of natural remedies and incline towards synthetic drugs. As all of
these are hormonal medicines, they are sold only against doctors’ prescriptions instead of
over-the-counter (OTC). The morning after pills are often recommended by gynecologists for
this purpose to cause a decline in the level of progesterone in our body, which eventually
delay the periods from 2 to 7 days. If you are already taking a birth control pill regularly, all
you need to do is continue it for 3 consecutive weeks and skip the iron fillers in the fourth
week. Rather, start the cycle back, i.e. keep taking the pills without taking a week off. It will
postpone your period until you stop taking the pills and wish to have it.

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5.23. Breast Tenderness
Table (5.23.1)
YES 49 26
NO 141 74
TOTAL 190 100
Graph (5.23.2)

51 | P a g e
INTERPRETATION
From the table 5.23.1, 74% of respondents do not experience breast tenderness during
menstruation, and 26% of respondents ‘experience breast tenderness during menstruation.
Premenstrual breast swelling and tenderness, or cyclical mastalgia, is a common
concern among women. Tenderness and heaviness in both breasts are the main symptoms of
premenstrual pain and swelling. A dull aching in the breasts can also be a problem for some
women. Your breast tissue could feel dense or coarse to the touch. Symptoms tend to appear
the week before your period and disappear almost immediately when menstrual bleeding
begins. Most women do not experience severe pain.
In some cases, breast tenderness affects the everyday routines of some women of
childbearing age, and is not necessarily connected to the menstrual cycle. Due to the natural
change in hormone levels that occur as a woman ages, premenstrual breast swelling and
tenderness usually improves as menopause approaches.
Fluctuating hormone levels account for most episodes of premenstrual breast swelling
and tenderness. Your hormones rise and fall during a normal menstrual cycle. The exact
timing of the hormonal changes varies for each woman. Estrogen causes the breast ducts to
enlarge. Progesterone production causes the milk glands to swell. Both of these events can
cause your breasts to feel sore.
Estrogen and progesterone both increase during the second half of the cycle — days
14 to 28 in a “typical” 28-day cycle. Estrogen peaks in the middle of the cycle, while
progesterone levels rise during the week before menstruation. Medications that contain
estrogen can also cause breast changes such as tenderness and swelling.

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5.24. Products used to collect Menstrual Flow
Table (5.24.1)
SANITARY PADS 186 97.4
TAMPONS 1 0.5
MANSTRUAL CAP 0 0
CLOTHES 3 2.1
TOTAL 190 100
Graph (5.24.2)

53 | P a g e
INTERPRETATION
From the table 5.24.1, 97.4% of respondents use sanitary pads to collect menstrual
flow, and 2.1% of respondents use clothes to collect menstrual flow, 0.5 % of respondents
use tampons to collect menstrual flow, and 0% of respondents use menstrual caps to collect
menstrual flow.
Pads are rectangles of absorbent material that attach to the insides of a girl's
underwear. They're sometimes also called sanitary pads or sanitary napkins. Some pads have
extra material on the sides (called "wings") that fold over the edges of your underwear to help
hold the pad in place and prevent leakage.
Unlike a pad, which catches menstrual blood after it leaves the body, a tampon
absorbs blood from inside the vagina. A tampon is also made of absorbent material, but it's
compressed into a tiny tubular shape. Like pads, tampons come in different sizes and
absorbencies for heavier and lighter periods (words like "super" or "ultra" on the packaging
usually mean that a tampon is designed for girls whose flow is heavier).
When deciding what type of protection to use, it's really up to you. Some girls like
tampons because they're easy to store in a purse or pocket. Tampons and cups are also helpful
for girls who participate in sports like swimming, since you can't wear a pad in the water.
Some girls prefer pads because they're easy to use and it's easier to remember when to change
them since you can see them getting soaked with blood.
Many girls switch back and forth: Sometimes they use tampons and sometimes they
use pads, depending on the situation, where they're going to be, and their menstrual flow.
Some girls use pads at night and tampons during the day. And some girls with heavy periods
use tampons together with pads or party-liners for added protection against leakage.

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5.25 CHI-SQUARE TEST
 Level of bleeding Ys Occurrence of pain during Menstrual cycle
H0: There is no significant relationship between the level of bleeding and occurrence of
pain during menstrual cycle of adolescent girls.
H1: There is significant relationship between the level of bleeding and the occurrence of
pain during menstrual cycle.
Table 5.25.1.
Table 5.25.2
Chi-Square Tests
Value df
Asymp. Sig. (2-
sided)
Pearson Chi-Square 3.907a
4 .419
Likelihood Ratio 5.437 4 .245
Linear-by-Linear Association .133 1 .715
N of Valid Cases 190
a. 3 cells (33.3%) have expected count less than 5.
b. The minimum expected countis 1.58.
level of bleeding * occurence of pain Crosstabulation
Count
occurence of pain
Totalyes no sometimes
level of bleeding light 5 0 7 12
medium 78 24 61 163
heavy 7 1 7 15
Total 90 25 75 190

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Graph 5.25.2
INTERPRETATION
From the table 5.25.1, the chi-square statistic value is 1.58.
The chi-square table value at degree of freedom 4 is 3.907. The tabulated value is
greater than the calculated value.
Hence, H0 is rejected. There is significant relationship between the level of bleeding
and the occurrence of pain during menstrual cycle.

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CHAPTER – 5
FINDINGS:
 22.92 % of the respondents are above 20 years of age, 73.96 % of the respondents are
18-20 years of age and 3.12 % of the respondents are below 18 years of age.
 94.8 % of respondents are students and only 5.2% of respondents are professionals.
 Out of 190 respondents, 97.9% of respondents have started their periods and only
2.1% of respondents have not yet started their periods.
 Out of 191 respondents, 12.6 % of respondents started their period below 11 years of
age, 53.4 % of respondents started their period at 11 to 13 years of age, 30.4% of
respondents started their period at 14 to 15 years of age and 3.7% of respondents
started their period above 15 years of age.
 Out of 190 responses, monthly cycle of 74.2% respondents last for 3-5 days, monthly
cycle of 23.2% respondents last for 5-7 days, monthly cycle of 2.1% respondents last
for more than 7 days and monthly cycle of only 0.5 % of respondents last for one day.
 87.8% of respondents have regular menstrual cycle and 12.2% of respondents have
irregular menstrual cycle.
 For 48.1% of respondents, irregular cycles occur twice in a month, for 25% of
respondents, irregular cycles occur once in 3 months, for 13.5% of respondents,
irregular cycles occur once in a year, for 9.6% of respondents, they never had
bleeding after the first occurrence, for 1.9% of respondents, irregular cycles occur
once in 6 months and for 1.9% of respondents, irregular cycles occur once in 9
months.
 For 40.9% of respondents, there are more than 28 days between two cycles. For
36.6% of respondents, there are 28 days between two cycles. For 22.6% of
respondents, there have successive periods less than 28 days.
 52% of respondent have red shades of menstrual flow and 48 % of respondents have
brown shades of menstrual flow.
 53.6% of respondent’s experience blood clotting during menstruation and 46.4% of
respondents do not experience blood clotting during menstruation.
 85.9% of respondents have medium bleeding, 8.9 % of respondents have heavy
medium and only 5.2% of the respondents have light bleeding.
 47.1% of respondents face pain during menstrual cycle sometimes, 40.3% of
respondents face pain during menstrual cycle, and 12.6% of respondents do not face

57 | P a g e
pain during menstrual cycle.
 54.7% of respondents face pain only in the 1st day of their menstrual cycle, 20.6% of
respondents face pain only during 2nd day of their menstrual cycle, 0.6% of
respondents face pain in the first 2 days, 20.6% of respondents face pain in the first 3
days and only 3.5% of respondents face pain in all the days of menstrual cycle.
 58.1% of respondents face pain before the onset of their cycle, and 41.9% of
respondents face pain after the onset of their cycle.
 43.3% of the respondents face stomach pain sometimes during their cycle, 35.6% of
respondents faces intense stomach pain during their cycle, and 21.1% of respondents
face less intense stomach pain during their menstrual cycle.
 39.4% of respondents face pain in the hip sometimes during their cycle, 32% of
respondents face intense hip pain during their cycle, and 28.6% of respondents face
less intense hip pain during their cycle.
 47% of the respondents face leg pain sometimes during their cycle, 30.4% of
respondents face less intense leg pain during their cycle, and 22.6% of respondents
face intense leg pain during their cycle.
 55.6% of respondents face joint pain sometimes only during their menstrual cycle,
31.5% of respondents face less intense joint pain during their cycle, and 13% of
respondents face intense joint pain during their cycle
 69.4% of the respondents face psychological problems during their cycle, and 30.6%
of respondents do not face any psychological problems during their cycle.
 74.7% of respondents do not take drugs to avoid pain during menstrual cycle, and
16.8% of respondents sometimes take drugs to avoid pain during their cycle, and
8.4% of respondents take drugs to avoid pain during cycle.
 97.3% of the respondents do not take drugs to prepone/postpone periods, and only
2.7% of respondents take drugs to prepone/postpone their periods.
 74% of respondents do not experience breast tenderness during menstruation and
26% of respondents’ experience breast tenderness during menstruation.
 97.4% of respondents use sanitary pads to collect menstrual flow, and 2.1% of
respondents use clothes to collect menstrual flow, 0.5 % of respondents use tampons
to collect menstrual flow, and 0% of respondents use menstrual caps to collect
menstrual flow.

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RECOMMENDATIONS
 Larger population based study should be conducted in order to evaluate changing
trend in adolescent menstruation pattern in South India.
 We also recommend that adolescent girls should chart their menstrual frequency and
regularity prospectively from menarche onwards to catch any menstrual problem.
 Specific region based study should be preferred in order to identify particular or
similar problems and solutions.
 Adolescent girls should be provided with enough knowledge about menstrual hygiene
and practices in order to face challenges faced during menstrual cycle.
 The best and simplest way to avoid menstrual problems is to eat well, have healthy
and varied diet, exercise particularly yoga and meditation, get good sleep of
minimum 8 hours, reduce intake of caffeine and manage your stress.
 Adolescent girls should not be prescribed to take drugs to avoid, prepone or postpone
periods. They should be prescribed with home remedies like ginger, movement and
meditation.
 Most of the girls have irregular menstrual cycles. It can be due to the change in
lifestyles, drugs and other supplements. These irregularities should be taken care of
and visit a doctor, if it continues.
 Even today, some girls use clothes to collect menstrual flow. They should be made
aware of other comfortable products such as sanitary pads and tampons.
 The color of menstrual flow is yet another important factor to check whether the body
is infected, different color indicates different signs and symptoms of pre-menstrual
disorders. Adolescent girls should be acknowledged with these indications.
 Menstrual problems are frequent among adolescent girls. However only few of them
seek medical advice. Factors leading to avoidance of health seeking behavior should
be further studied.

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CONCLUSION
Attainment of menarche at right age is an important milestone during adolescence,
which signifies the normal functioning of the female reproductive system. Study revealed that
majority of adolescent girls had attained menarche at appropriate age. The duration of
bleeding and the cycle interval was quite varying in majority of girls. Psychological problem
was the commonest challenge among the adolescents. Various color of menstrual flow was
reported. The use of hygienic sanitary pads as absorbent was prevalent in majority of
adolescent girls. The chi-square test explains that there is no significant relationship between
the level of menstrual flow and the occurrence of pain during the menstrual cycle. There is
strong need of education to adolescent population related to reproductive health. It will help
in their development as healthy and responsible adults. Study concludes that menstrual
problems among girls are highly prevalent. Adolescent girls should be offered possible
treatment options with adolescent friendly approach. Reproductive health education in the
school curriculum should be introduced for improving awareness regarding menstrual care
practices. Mentorship program in the school set-up may result in desired improvements
providing adolescent friendly health services for sharing their menstrual and other problems.

60 | P a g e
BIBLIOGRAPHY
 JOURNALS
ᴥ Gupta J, Gupta H. Adolescence and menstruation. J Family Welfare
ᴥ Khanna A, Goyal RS, Bhawsar R. Menstrual and reproductive problems: A
study of adolescent girls in Rajasthan. J Health Manag.
ᴥ Rebecca Deans,Independent
ᴥ Sabrina Barr, Independent
ᴥ Olivia Petter, Independent
 WEBSITES
ᴥ https://www.researchgate.net/publication/322411129_Prevalence_of_mens
trual_problems_and_their_association_with_psychological_stress_in_youn
g_female_students_studying_health_sciences
ᴥ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885123/
ᴥ https://www.ijcmph.com/index.php/ijcmph/article/view/1556

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ANNEXURE
QUESTIONNAIRE ON CHALLENGES FACED DURING MENSTRUATION
1. Name *
2. Age *
3. Occupation *
a) student
b) professional
4. Have you started your period? *
a) Yes
b) No
5. At what age, did you have your first period? *
6. On an average, how long is your monthly cycle? *
a) 1 day
b) 3-5 days
c) 5-7 days
d) more than 7 days
7. Is your Menstrual period: *
a) Regular
b) Irregular
a) If irregular:
a) Twice in a month
b) Once in 3 months
c) Once in 6 months

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d) Once in 9 months
e) Once in a year
f) Never have bleeding after 1st period
8. How many days between two cycles? *
a) More than 28 days
b) 28 days
c) successive periods Less than 28 days
9. what color is the blood? *
10. Do you experience clotting? *
a) Yes
b) No
11. How is your bleeding? *
a) light
b) medium
c) heavy
12. Do you face pain during your period? *
a) Yes
b) No
c) sometimes
13. How many days of severe pain? *
a) 1st day
b) first 2 days
c) first 3 days

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d) All the days
14. The onset of the pain is ---------- after your period? *
a) Before
b) after
15. Stomach pain: *
a) intense
b) less intense
c) sometimes
16. Pain in the hip: *
a) intense
b) less intense
c) sometimes
17. Pain in the legs: *
a) intense
b) less intense
c) sometimes
18. Pain in the joints: *
a) intense
b) less intense
c) sometimes
19. Physiological problems (fatigue, nausea, dizziness, constipation, headache,
constipation)? *

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a) intense
b) less intense
c) sometimes
20. Psychological Problems (anxiety, confused, depression, anger, irritation, mood
swings)? *
a) yes
b) No
21. Do you take medicines to avoid pain? *
a) Yes
b) No
c) Sometimes
22. Do you take drugs to pre/post pone your period? *
a) Yes
b) No
23. Do you experience any breast tenderness before, after or during your
periods? *
a) Yes
b) No
24. what do you normally use during your period? *
a) sanitary pad
b) tampons
c) menstrual cap
d) clothes

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