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Menstrual Health Literacy and Management Strategies in Young Women in Australia: A National Online Survey of Young Women Aged 13-25 Years

Published:November 11, 2020DOI:https://doi.org/10.1016/j.jpag.2020.11.007

      Abstract

      Study Objective

      To explore key aspects of menstrual health literacy and menstrual management in young women at school or in tertiary education.

      Design

      Cross-sectional online survey.

      Setting

      Australia-wide.

      Participants

      A total of 4202 adolescent and young women (13-25 years of age; median age 17 years), having reached menarche, living in Australia and currently attending school (n = 2421) or tertiary education (n = 1781).

      Interventions

      Online survey hosted by Qualtrics between November 2017 and January 2018. Data were collected on contraceptive use, management strategies, sources of information, and knowledge of menstruation.

      Main Outcome Measures

      Information on prevalence and effectiveness of different management strategies, health-seeking behavior, knowledge about menstruation, and common menstrual disorders such as endometriosis.

      Results

      The majority of young women did not seek medical advice for their menstrual symptoms, but used information from the Internet (50%) and engaged in self-management, most commonly with over-the-counter medications such as paracetamol (51%) or ibuprofen (52%). Oral contraceptive use was relatively common (35%), and mostly for reduction of menstrual pain (58%). Despite having significant dysmenorrhea, approximately one-half of the participants (51%) thought that their period was normal. Women with higher pain scores were more likely to rate their period as “abnormal” (P < .0001) but not more likely to consult a doctor (P = .13). Only 53% of those at school had heard of endometriosis.

      Conclusion

      Self-management of menstrual symptoms is common, but a significant minority of women are underdosing or choosing ineffective methods. Most women do not seek medical advice even when symptoms are severe, and cannot identify symptoms suggestive of secondary dysmenorrhea. Improved education on menstruation is vital.

      Key Words

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      References

        • Armour M.
        • Parry K.
        • Manohar N.
        • et al.
        The prevalence and academic impact of dysmenorrhea in 21,573 young women: a systematic review and meta-analysis.
        J Womens Health (Larchmt). 2019; 28: 1161
        • Parker M.A.
        • Sneddon A.E.
        • 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
        • Subasinghe A.K.
        • Happo L.
        • Jayasinghe Y.L.
        • et al.
        Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women.
        Aust Fam Physician. 2016; 45: 829
        • Armour M.
        • Ferfolja T.
        • Curry C.
        • et al.
        The prevalence and educational impact of pelvic and menstrual pain in Australia: a national online survey of 4202 young women aged 13-25.
        J Pediatr Adolesc Gynecol. 2020; 33: 511
        • Institute of Medicine
        Health Literacy: A Prescription to End Confusion.
        National Academies Press, Washington, DC2004
        • Armour M.
        • Dahlen H.G.
        • Smith C.A.
        More than needles: the importance of explanations and self-care advice in treating primary dysmenorrhea with acupuncture.
        Evid Based Complement Alternat Med. 2016; 2016: 3467067
        • Banikarim C.
        • Chacko M.R.
        • Kelder S.H.
        Prevalence and impact of dysmenorrhea on hispanic female adolescents.
        Arch Pediatr Adolesc Med. 2000; 154: 1226
        • Wong L.P.
        Attitudes towards dysmenorrhoea, impact and treatment seeking among adolescent girls: a rural school-based survey.
        Aust J Rural Health. 2011; 19: 218
        • Houston A.M.
        • Abraham A.
        • Huang Z.
        • et al.
        Knowledge, attitudes, and consequences of menstrual health in urban adolescent females.
        J Pediatr Adolesc Gynecol. 2006; 19: 271
        • Akinnubi C.F.
        Influence of dysmenorrhea and menorrhagia on academic performance among female students in tertiary institutions in Ondo State Nigeria.
        World J Soc Sci. 2016; 3
        • Wijesiri H.S.
        • Suresh T.S.
        Knowledge and attitudes towards dysmenorrhea among adolescent girls in an urban school in Sri Lanka.
        Nurs Health Sci. 2013; 15: 58
        • Hillen T.I.
        • Grbavac S.L.
        • Johnston P.J.
        • et al.
        Primary dysmenorrhea in young western australian women: prevalence, impact, and knowledge of treatment.
        J Adolesc Health. 1999; 25: 40
        • Johnson N.P.
        • Hummelshoj L.
        • Adamson G.D.
        • et al.
        World Endometriosis Society consensus on the classification of endometriosis.
        Hum Reprod. 2017; 32: 315
        • Hall N.
        Indigenous girls missing school during their periods: the state of hygiene in remote Australia.
        2017 (Available at:)
        • Hawkey A.J.
        • Ussher J.M.
        • Perz J.
        • et al.
        Experiences and constructions of menarche and menstruation among migrant and refugee women.
        Qual Health Res. 2017; 27: 1473
        • Metusela C.
        • Ussher J.
        • Perz J.
        • et al.
        "In my culture, we don't know anything about that": sexual and reproductive health of migrant and refugee women.
        Int J Behav Med. 2017; 24: 836
        • Smith A.
        • Schlichthorst M.
        • Mitchell A.
        • et al.
        Sexuality education in Australian secondary schools 2010.
        Monograph Series. 2011; 80 (Melbourne: La Trobe University, the Australian Research Centre in Sex, Health & Society)
        • Australian Bureau of Statistics
        1249.0 Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG).
        2019 (Available at)
        https://www.abs.gov.au/ausstats/[email protected]/Latestproducts/1249.0Main%20Features12019?opendocument&tabname=Summary&prodno=1249.0&issue=2019&num=&view=
        Date accessed: February 2, 2020
        • Chalmers K.J.
        • Catley M.J.
        • Evans S.F.
        • et al.
        Clinical assessment of the impact of pelvic pain on women.
        Pain. 2017; 158: 498
        • Armour M.
        • Parry K.
        • Al-Dabbas M.A.
        • et al.
        Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: a systematic review and meta-analysis.
        PLoS One. 2019; 14e0220103
        • French L.
        Dysmenorrhea in adolescents: diagnosis and treatment.
        Paediatr Drugs. 2008; 10: 1-7
        • Marjoribanks J.
        • Ayeleke R.O.
        • Farquhar C.
        • et al.
        Nonsteroidal anti-inflammatory drugs for dysmenorrhoea.
        Cochrane Database Syst Rev, 2015: CD001751
        • Daniels S.E.
        • Paredes-Diaz A.
        • An R.
        • et al.
        Significant, long-lasting pain relief in primary dysmenorrhea with low-dose naproxen sodium compared with acetaminophen: a double-blind, randomized, single-dose, crossover study.
        Curr Med Res Opin. 2019; 35: 2139
        • Chen C.X.
        • Carpenter J.S.
        • LaPradd M.
        • et al.
        Perceived ineffectiveness of pharmacological treatments for dysmenorrhea.
        J Womens Health (Larchmt). 2020; (Epub ahead of print)https://doi.org/10.1089/jwh.2020.8581
        • Chen C.X.
        • Draucker C.B.
        • Carpenter J.S.
        What women say about their dysmenorrhea: a qualitative thematic analysis.
        BMC Womens Health. 2018; 18: 47
        • Li A.D.
        • Bellis E.K.
        • Girling J.E.
        • et al.
        Unmet needs and experiences of adolescent girls with heavy menstrual bleeding and dysmenorrhea: a qualitative study.
        J Pediatr Adolesc Gynecol. 2020; 33: 278
        • Wood J.M.
        • Barthalow Koch P.
        • et al.
        Is my period normal? How college-aged women determine the normality or abnormality of their menstrual cycles.
        Women Health. 2007; 46: 41
        • Scambler A.
        • Scambler G.
        Menstrual symptoms, attitudes and consulting behaviour.
        Soc Sci Med. 1985; 20: 1065
        • Cronjé H.S.
        • Kritzinger I.E.
        Menstruation: symptoms, management and attitudes in university students.
        Int J Gynaecol Obstet. 1991; 35: 147
        • Brantelid I.E.
        • Nilvér H.
        • Alehagen S.
        Menstruation during a lifespan: a qualitative study of women's experiences.
        Health Care Women Int. 2014; 35: 600
        • Hewison A.
        • van den Akker O.B.
        Dysmenorrhoea, menstrual attitude and GP consultation.
        Br J Nurs. 1996; 5: 480
        • Krusz E.
        • Hall N.
        • Barrington D.J.
        • et al.
        Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities.
        BMC Womens Health. 2019; 19: 146
        • Zahradnik H.-P.
        • Hanjalic-Beck A.
        • Groth K.
        Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review.
        Contraception. 2010; 81: 185
        • Proctor M.
        • Farquhar C.
        Diagnosis and management of dysmenorrhoea.
        BMJ. 2006; 332: 1134
        • Wong C.L.
        • Farquhar C.
        • Roberts H.
        • et al.
        Oral contraceptive pill for primary dysmenorrhoea.
        Cochrane Database Syst Rev. 2009; 4: CD002120
        • Grandi G.
        • Ferrari S.
        • Xholli A.
        • et al.
        Prevalence of menstrual pain in young women: what is dysmenorrhea?.
        J Pain Res. 2012; 5: 169
        • Santer M.
        • Warner P.
        • Wyke S.
        A Scottish postal survey suggested that the prevailing clinical preoccupation with heavy periods does not reflect the epidemiology of reported symptoms and problems.
        J Clin Epidemiol. 2005; 58: 1206
        • Latthe P.
        • Mignini L.
        • Gray R.
        • et al.
        Factors predisposing women to chronic pelvic pain: systematic review.
        BMJ. 2006; 332: 749
        • Knox B.
        • Ong Y.C.
        • Bakar M.A.
        • et al.
        A longitudinal study of adolescent dysmenorrhoea into adulthood.
        Eur J Pediatr. 2019; 178: 1325
        • Fingerson L.
        Girls in power: gender, body, and menstruation in adolescence.
        State University of New York Press, Albany, NY2006
        • Wong C.L.
        • Ip W.Y.
        • Choi K.C.
        • et al.
        Examining self-care behaviors and their associated factors among adolescent girls with dysmenorrhea: an application of Orem's self-care deficit nursing theory.
        J Nurs Scholar. 2015; 47: 219
        • Bush D.
        • Brick E.
        • East M.C.
        • et al.
        Endometriosis education in schools: a New Zealand model examining the impact of an education program in schools on early recognition of symptoms suggesting endometriosis.
        Aust N Z J Obstet Gynaecol. 2017; 57: 452
        • Chen C.X.
        • Groves D.
        • Miller W.R.
        • et al.
        Big data and dysmenorrhea: what questions do women and men ask about menstrual pain?.
        J Womens Health. 2018; 27: 1233
        • Bellis E.K.
        • Li A.D.
        • Jayasinghe Y.L.
        • et al.
        Exploring the unmet needs of parents of adolescent girls with heavy menstrual bleeding and dysmenorrhea: a qualitative study.
        J Pediatr Adolesc Gynecol. 2020; 33: 271
        • Suvitie P.A.
        • Hallamaa M.K.
        • Matomaki J.M.
        • et al.
        Prevalence of pain symptoms suggestive of endometriosis among Finnish adolescent girls (TEENMAPS Study).
        J Pediatr Adolesc Gynecol. 2016; 29: 97
        • Zannoni L.
        • Giorgi M.
        • Spagnolo E.
        • et al.
        Dysmenorrhea, absenteeism from school, and symptoms suspicious for endometriosis in adolescents.
        J Pediatr Adolesc Gynecol. 2014; 27: 258
        • DiVasta A.D.
        • Vitonis A.F.
        • Laufer M.R.
        • et al.
        Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood.
        Am J Obstet Gynecol. 2018; 218: 324.e1
        • Armour M.
        • Sinclair J.
        • Ng C.M.
        • et al.
        Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey.
        Sci Rep. 2020; 10: 16253
        • Armour M.
        • Lawson K.
        • Wood A.
        • et al.
        The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: a national online survey.
        PLoS One. 2019; 14: e0223316
        • Evans M.B.
        • Decherney A.H.
        Fertility and endometriosis.
        Clin Obstet Gynecol. 2017; 60: 497-502
        • Lawton T.
        Period Talk.
        (Available at:)
        https://periodtalk.com.au
        Date: 2019
        Date accessed: March 20, 2020
        • Pelvic Pain Foundation of Australia
        PEPP Talk.
        (Available at:)
        https://www.pelvicpain.org.au/schools-ppep-program/
        Date: 2020
        Date accessed: March 21, 2020
        • QENDO
        Schools Program.
        (Available at:)
        https://www.qendo.org.au/schools-program
        Date: 2020
        Date accessed: March 21, 2020
        • Endometriosis Australia
        Webinars.
        (Available at:)
        https://www.endometriosisaustralia.org/webinars
        Date: 2020
        Date accessed: March , 2020
        • Australian Bureau of Statistics
        2016 Census.
        2017 (Available at)
        https://www.abs.gov.au/census
        Date accessed: February 2, 2020