Menstrual Disorders and Body Mass Index among Adolescent Girls at Secondary School in Baghdad City

INTRODUCTION

    The journey from girlhood to adolescence and motherhood is a critical phase in a female’s life. The World Health Organization (WHO) defines adolescents as individuals between 10 and 19 years of age, while 'Youth' covers the 15 to 24-year age group, and 'Young People' encompasses those aged 10 to 24 years. Adolescents comprise a significant portion of the population, with approximately 360 million in the Southeast Asia Region alone, accounting for 20%.

Menstrual health is a vital determinant of a woman’s overall reproductive health. Menstrual cycle irregularities or disorders are one of the most common gynecological issues, especially among adolescents, and are a significant source of concern for both individuals and their families. Tracking and understanding menstrual patterns can aid in the clinical evaluation of gynecological conditions and offer important insights into adolescent and adult women's reproductive health (Harlow & Campbell, 2004).

The transition from childhood to adulthood is marked by substantial physical, sexual, psychological, and social changes, all of which occur simultaneously. While this period brings opportunities for growth and development, it also poses risks to health and well-being (WHO, 2023). Menstruation is a normal physiological process for women of reproductive age; however, menstrual disorders such as dysmenorrhea, menorrhagia, and amenorrhea are widespread across the globe and are a leading cause of gynecological visits (Ansong et al., 2019).

Early menarche, or the onset of menstruation, has been linked to various adverse outcomes during adolescence, such as eating disorders, depression, substance abuse, risky sexual behaviors, and teenage pregnancy (Bhattarai et al., 2018). For adolescent girls, menstrual disturbances can lead to absenteeism from school, exemption from physical activities, and emotional distress. Irregular, delayed, painful, and heavy periods are common complaints among adolescents and are frequently the reason for physician visits (Ansong et al., 2019).

Given the significance of BMI in influencing menstrual patterns, this study aims to assess Body Mass Index among secondary school adolescent girls and examine its impact on menstrual patterns. The findings will provide a better understanding of how BMI may contribute to menstrual irregularities, offering opportunities for early intervention and improved adolescent health.

Methodology

Research Design:

This study employed a descriptive-analytic design between March 6, 2022, and June 8, 2022, to evaluate the relationship between Body Mass Index (BMI) and menstrual patterns among adolescent girls.

Sample:
A purposive, non-probability sample of 150 adolescent girls was selected based on their willingness to participate. The sample was drawn from three secondary schools: Al-Rafidain Secondary School, Haifa Secondary School, and Al-Khansa Secondary School in Baghdad.

Setting:
The study was conducted in Baghdad's three secondary schools: Al-Rafidain Secondary School, Haifa Secondary School, and Al-Khansa Secondary School.

Validity of the Instrument:

A panel of nine experts validated the study instrument, all faculty members from the College of Nursing, University of Baghdad. The experts, with an average of 18.33 ± 8.93 years of experience, reviewed the questionnaire for content relevance and adequacy. Minor revisions were made based on their recommendations to ensure the questionnaire's validity.

Data Collection:

Data were collected using a structured questionnaire administered through interviews. The questionnaire comprised four sections:

• Part 1: Demographic Characteristics – This section included questions on the participants' age and BMI.
• Part 2: Food Habits – This section assessed the participants' dietary habits, including the consumption of tea, coffee, high-fat foods, junk food, and liquid juices, as well as the presence of overweight family members.
• Part 3: Menstrual Cycle Patterns – Questions in this section gathered information on age at menarche, regularity, frequency, duration of menstrual cycles, dysmenorrhea severity, and the number of sanitary pads used.
• Part 4: Symptoms and Signs of Menstrual Disorders – This section focused on common symptoms of menstrual disorders, such as pain, fatigue, headache, nausea, vomiting, and more.

Statistical Analysis:
Data were analyzed using descriptive statistics through Microsoft Excel. The following statistical methods were employed:

• Frequencies and Percentages to represent demographic characteristics, menstrual patterns, and symptoms.
• Mean and Standard Deviation (SD) to describe continuous variables like age and BMI.
• A four-point Likert scale was used to rate the severity of symptoms and signs of menstrual disorders, ranging from 'Not Found' to 'Severe.'

RESULTS

The study sample consisted of 150 adolescent girls aged between 13 and 21 years, with a mean age of 15.93 ± 1.93 years. The results from the data analysis are presented in the following subsections.

1. Body Mass Index (BMI)

The majority of participants (66.67%) had a normal BMI, falling within the range of 18.50–25 kg/m², with a mean BMI of 22.40 ± 4.59 kg/m². A smaller proportion of the girls were either underweight (14.66%) or overweight (14%). Only 4.66% of the participants were categorized as obese (BMI ≥30 kg/m²).

2. Menstrual Cycle Characteristics

• Age at Menarche: The majority of the girls (73.3%) reported experiencing their first menstrual period between the ages of 11 and 13 years, with a mean menarche age of 12.60 ± 1.09 years. A smaller group (4.7%) reported menarche before age 11, while 22% began menstruation between 14 and 16 years of age.
• Menstrual Regularity: Approximately 63.33% of the participants reported having a regular menstrual cycle, while 36.66% experienced irregular cycles.
• Cycle Frequency and Duration: Most girls (65.33%) had a menstrual cycle lasting between 4 and 7 days, while 14.66% reported a cycle lasting three days or less. The remaining 20% had cycles longer than seven days, with a mean cycle length of 5.33 ± 1.53 days. Additionally, 36.66% reported frequent menstrual periods occurring every 21-28 days.

3. Dysmenorrhea and Menstrual Symptoms

• Dysmenorrhea: Moderate dysmenorrhea was reported by 48% of the girls, making it the most prevalent level of menstrual pain. Severe dysmenorrhea affected 20.66% of the participants, while 16.66% reported mild symptoms, and 14.66% reported no dysmenorrhea at all.
• Symptoms and Signs of Menstrual Disorders: The most commonly reported symptoms included abdominal pain (mean score of 2.59), fatigue (2.57), and vertigo (2.58). Menorrhagia (excessive menstrual bleeding) was reported by 48% of the girls, with a mean score of 2.85. Amenorrhea (absence of menstruation) had a mean score of 2.62. Additionally, 100% of the participants reported using 2-4 sanitary pads per day during menstruation.

4. Relationship Between BMI and Menstrual Disorders

• Girls with a normal BMI exhibited fewer menstrual irregularities compared to those with an overweight or obese BMI. Obese participants (BMI ≥30 kg/m²) were more likely to experience irregular cycles and severe dysmenorrhea.
• Underweight participants (BMI ≤18.50 kg/m²) showed a higher prevalence of delayed menarche and menstrual irregularities.

 Table (1): Distribution of the Study Sample according to Socio-Demographic Characteristics.

Figure (1): Body Mass Index (BMI) among Study sample.

 Table (2): Distribution of Study Sample According to Student's Food Habits.

Table (3): Distribution of Study Sample According to Menstrual Cycle.

Table (4): Distribution of Study Sample According to Student's Knowledge about Symptoms and Signs of Menstrual Disorders.

 DISCUSSION

adolescent girls. The high prevalence of dysmenorrhea necessitates further investigation into its causes and effective management strategies to improve the quality of life for affected adolescents.

The use of 2-4 sanitary pads per day, reported by 100% of the participants, was consistent with findings from Yassin (2012) in Egypt, where most girls followed similar menstrual hygiene practices. Proper menstrual hygiene is crucial for the prevention of reproductive tract infections and maintaining overall health during menstruation.

In terms of symptoms and signs of menstrual disorders, abdominal pain, fatigue, and vertigo were the most commonly reported symptoms, with mean scores ranging between 2.54 and 2.85. These findings are consistent with the study by Ghazal (2022), which identified cramping pain in the lower abdomen as the most prevalent symptom of dysmenorrhea. The high occurrence of such symptoms underscores the need for educational programs that raise awareness of menstrual health and provide effective management techniques for adolescents.

Menorrhagia (heavy menstrual bleeding) and amenorrhea (absence of menstruation) were also prominent in this study, with mean scores of 2.85 and 2.62, respectively. These findings are supported by research conducted by Ekpenyong et al. (2011) in Nigeria, which identified menorrhagia as the most common menstrual disorder. The high prevalence of these disorders highlights the importance of early diagnosis and treatment to prevent long-term health consequences.

CONCLUSION:

In conclusion, this study reinforces the significant relationship between BMI and menstrual disorders among adolescent girls. While most participants had a normal BMI, those who were underweight or obese exhibited higher rates of menstrual irregularities and symptoms. The study also underscores the need for targeted interventions to promote healthy BMI and adolescent menstrual health. Future research should focus on longitudinal studies to further explore the relationship between BMI, lifestyle factors, and menstrual health outcomes.

Recommendations

This study recommends encouraging adolescent girls to adopt a healthy diet, emphasizing the importance of reducing the intake of fatty foods and sugary drinks to prevent obesity and its associated health risks. It is crucial to incorporate health education programs into school curricula, focusing on the impact of obesity on health and the significance of maintaining a healthy weight. These initiatives should aim to raise awareness among adolescent girls about the relationship between BMI and menstrual health, promoting long-term well-being.

DECLARATION SECTION

Acknowledgments

The authors extend their gratitude to the anonymous reviewers for their valuable suggestions, which helped improve the quality of this manuscript.

Ethical Approval Statement

The research study titled "Menstrual Disorders and Body Mass Index among Adolescent Girls at Secondary Schools in Baghdad City," conducted by Rajaa Tareq Hasan and Iqbal M. Abbas, received ethical approval from the Nursing College Ethical Committee at the University of Baghdad. Informed consent was obtained from all participants, ensuring their understanding of the research’s purpose. Participants were assured of anonymity and confidentiality throughout the study.

Conflict of interest

The authors declare that they have no competing interests.

Funding:

This research was conducted without financial support from public, commercial, or non-profit funding agencies.

Data availability:

Data are available by contacting the corresponding author by email.

Authorship

All authors contributed equally to the conceptualization and design of the study. They were involved in data collection, analysis, and the drafting of the initial manuscript. All authors critically reviewed and revised the manuscript and approved the final version for submission.