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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 12  |  Page : 39-42

Patterns and predictors of management strategies of dysmenorrhea among ghanaian undergraduate students


1 Department of Pharmacology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
2 Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Olabisi Onabanjo University, Ago-Iwoye, Nigeria

Date of Web Publication19-Nov-2018

Correspondence Address:
Ayokunle Osonuga
Department of Pharmacology, School of Medical Sciences, University of Cape Coast, Cape Coast
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_14_18

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  Abstract 


Background and Aim: Dysmenorrhea is a major medical problem as it is the most common gynecological disorder of females of reproductive age and a major complaint of women presenting to a gynecologist. It has a repertoire of negative consequences, which can be severely incapacitating, even though not life-threatening. Our study was an attempt to understand the way Ghanaian undergraduate students managed dysmenorrhea and to see if differences exist in the way medical and nonmedical students managed it. Methodology: The study was a descriptive cross-sectional study involving 200 female undergraduate students (100 medical and 100 nonmedical students) of the University of Cape Coast, Ghana. Data were analyzed using standardized and acceptable statistical tools. P < 0.05 was considered statistically significant. Results: Only 8.9% of the women with menstrual pain sort formal medical advice for dysmenorrhea, while others either practiced self-management or did nothing (88.7%). Females with severe dysmenorrhea were more likely to seek medical help (P < 0.05). Nonmedical students were more likely to seek medical help than their counterparts in medical school. Although analgesic use was high in this study (58.9%), with the use of nonsteroidal anti-inflammatory drugs predominating (72.1%), only 28.2% had very effective control of menstrual pain. This resulted in the high use of combination of pharmacologic and nonpharmacologic means in pain control in 53.3%. Conclusion: Pain relief was grossly inadequate in this study; we advocate for widespread health education on the management of dysmenorrhea among females and their families. Healthcare personnel are also encouraged to treat patients with dysmenorrhea with empathy and offer them the best care available so as to improve their quality of life.

Keywords: Dysmenorrhea, Ghana, management, nonsteroidal anti-inflammatory drugs


How to cite this article:
Osonuga A, Ekor MN, Odusoga OA. Patterns and predictors of management strategies of dysmenorrhea among ghanaian undergraduate students. N Niger J Clin Res 2018;7:39-42

How to cite this URL:
Osonuga A, Ekor MN, Odusoga OA. Patterns and predictors of management strategies of dysmenorrhea among ghanaian undergraduate students. N Niger J Clin Res [serial online] 2018 [cited 2020 Oct 24];7:39-42. Available from: https://www.mdcan-uath.org/text.asp?2018/7/12/39/245784




  Introduction Top


Dysmenorrhea is defined as painful menses (of varying severity) usually beginning in adolescence, and it is characterized by cramping pelvic pain beginning shortly after the onset of menses which lasts for 1–3 days.[1],[2]

It can be either primary when pelvic anatomy is normal or secondary when the pain has an underlying cause, commonly endometriosis, leiomyoma, adenomyosis, ovarian cysts, and pelvic congestion syndrome.[3],[4]

It is a major medical problem as it is the most common gynecological disorder of females of reproductive age and a major complaint of women presenting to a gynecologist. Furthermore, it has academic and socioeconomic consequences as studies have shown that it is a major cause of school absenteeism, poor academic performance, impairment in activities of daily living, diminished quality of life, and economic loss to household and nations – for instance, the United States loses about two billion dollars a year due to inability of women in pain to go to work.[3],[5],[6]

Various management strategies have been tried including nonpharmacologic approaches such as use of exercise, warm compress, massage and rest, and red bean pillows.[1] Dietary modification with foods rich in omega-3 oil has also been found to reduce pain and could be useful.[7] Transcutaneous electrical nerve stimulation, acupuncture, and acupressure have been used in some studies.[1]

Pharmacologically, the main stay of management of dysmenorrhea is the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, and piroxicam. Paracetamol and oral contraceptive pills (OCPs) have used to control dysmenorrhea; this, however, depends on the severity of pain and etiology.[2],[6]

Despite these negative consequences, though not life-threatening but severely incapacitating, the knowledge and management of dysmenorrhea among females are perceived to be inadequate from Sub-Saharan Africa.[1] As there exists a paucity of studies on dysmenorrhea in Ghana, this study attempts to describe the pain management strategies, source of information for the management of dysmenorrhea, and adequacy of these strategies (in terms of pain control) adopted by Ghanaian undergraduate students.


  Methodology Top


The study was descriptive cross-sectional study involving 100 female undergraduate medical students and another group of 100 females drawn from other faculties of the University of Cape Coast (UCC), Ghana. Data were collected using a pretested questionnaire to elicit the severity of dysmenorrhea and the pattern and adequacy of management of dysmenorrhea. Furthermore, ethical waiver was granted by the UCC ethical review board before the study. The questionnaire, however, included a consent section in which the respondent appended her signature after the aims and objectives of the study were explained. Assurance of participant's confidentiality was considered, and the report included exactly what the respondent gave. No words or images that could depict or reveal the identity of the respondents were included in the study.

Data gathered were carefully coded and entered into Statistical Package for the Social Sciences version 2.0 (IBM, Armonk, NY, United States of America). Chi-square analysis was used to test the association between the variables of interest. Inference was made using 95% confidence interval with 5% error margin, and a P < 0.05 was considered statistically significant. One sample t-test was also used to compare the significance difference within some variables of interest in the study.


  Results Top


The commonly used analgesics by respondents are paracetamol (27.9%) and NSAIDs (72.1%), mostly diclofenac, aspirin, naproxen, and mefenamic acid.

About 53.3% of the respondents used medication with other strategies (e.g., rest, exercise, and dietary modification).


  Discussion Top


The aim of this study was to understand the pattern of management of different grades of dysmenorrhea and to determine if there were differences in the way medical and nonmedical students managed it.

From [Table 1], only 8.9% of the females with menstrual pain sort formal medical advice for dysmenorrhea, while others either practiced self-management or did nothing (88.7%). This is similar to 6% reported by Chia et al.[8] Formal help was sort in only 2.7% of the respondents in another study.[9] Furthermore, the severity of dysmenorrhea significantly (P < 0.05) influenced the kind of help sort for dysmenorrhea. Females with severe dysmenorrhea were more likely to seek formal medical advice (28.6%) than those with mild (1.7%) and moderate (9.4%) dysmenorrhea. Those with mild dysmenorrhea (51.7%) were less likely to undertake any form of intervention. This finding is consistent with the data from another study.[2] The reasons for these can be explained as follows; dysmenorrhea is often considered as an inescapable plight no matter how excruciating or incapacitating. The affected female would, therefore, hesitate in seeking medical help and prefer avoiding medical contact as far as possible due to embarrassment.[6],[10] It is also reasonable to propose at this point that social withdrawal associated with dysmenorrhea may be a contributing factor to the low rate of seeking formal help.
Table 1: Management practices and the severity of dysmenorrhea

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Interestingly, fewer medical students (2.8%) with dysmenorrhea sort formal help, and 50% of the time, the female had severe dysmenorrhea (not shown) against 14.9% of the nonmedical student with dysmenorrhea [Table 2], with 45.5% having severe dysmenorrhea (not shown).
Table 2: Difference in management strategies between medical and nonmedical students

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The significantly lower percentage observed among the medical students may be due to perceived larger repertoire of knowledge about the medical management of dysmenorrhea by virtue of their training or stronger feeling of embarrassment of seeing a senior colleague for “menstrual cramps.” These reasons may also explain the significantly higher percentage [73.6%, [Table 2]] of medical students who practiced self-management when compared with their nonmedical counterparts [41.9%, [Table 2]]. This is similar to 72% observed in the Hong Kong study.[10] The medical students [19.4%, [Table 2]] were also less likely to do nothing about dysmenorrhea compared to the nonmedical students [41.9%, [Table 2]].

Our study showed that analgesic use was the most common method of managing dysmenorrhea [58.7%, [Table 1]]. The use of NSAIDS was higher (72.1%) than the use of paracetamol (27.9%) in this study. This is slightly different from one Ghanaian study that reported more than half of the respondents using paracetamol (51.5%)[3] and less than the over 70% NSAID use reported in the Georgian study.[5] In addition, NSAID use was low in the Hong Kong study (23%).[10] Perhaps, the fear of the side effects of the NSAIDs may have contributed to the low acceptance in this study.

The standard management of dysmenorrhea is NSAIDs though paracetamol may give some relief. This is due to its effect on prostaglandin synthesis, which has been implicated in the etiology dysmenorrhea.[1],[7],[11]

Furthermore, the medical students used more analgesics than the nonmedical students (76.1% vs. 41.4%). Interestingly, medical students did not use OCPs and herbal medication for managing dysmenorrhea [Table 2]. The medical knowledge they have acquired may suggest again the reason why medical students were not using herbal medications for dysmenorrhea. However, OCPs have been used to manage dysmenorrhea in other studies.[2],[12]

Herbal medicine has been used to control pain over the years.[13],[14],[15] Findings indicated that most students did not prefer the herbal medication (as in our study) and the few who used it did so on recommendation from their family.[1]

In the present study, only 28.2% of the females reported having very effective pain relief from the method of pain relief used [Table 1]. Nonmedical students (19.7%) and medical students (36.9%) experienced very effective pain relief [Table 2]. The difference between medical and nonmedical students managing dysmenorrhea effectively may again be attributed to their knowledge of pharmacology.

The severity of dysmenorrhea significantly (P < 0.05) influenced the perceived effectiveness of the management strategy employed in managing pain. From [Table 1], we see that respondents with mild (42.9%), moderate (26.2%), and severe (0%) dysmenorrhea thought their pain management strategy was very effective. Similar trend was observed by Okoro et al.[2] The fact that no female with severe dysmenorrhea experienced effective pain relief has serious implications. Pain whether acute, cyclical, or chronic has consequences which even though may not be life-threatening may hamper productivity and the quality of life.[7],[11]

Furthermore, 46%, 33.9%, and 19.4% of the respondents knew about the management of dysmenorrhea from family/friends, personal research, and medical personnel's prescription, respectively. This significantly correlated with the severity of dysmenorrhea [Table 3]. Public education still holds the key for adequate management of dysmenorrhea as this study has shown a staggering 80% of information about dysmenorrhea management emanating from nonhealth personnel-based suggestions [Table 3].
Table 3: Source of knowledge of management of dysmenorrhea with its severity

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Nonpharmacological approaches are considered adjuvant or additional pain management strategies and should not substitute the use of appropriate analgesics.[1] The fact that about 53.3% of the respondents [Graph 1] combined medication with other nonpharmacological therapies further highlights the difficult nature of the management of dysmenorrhea. It is therefore necessary for on-going research on dysmenorrhea to derive an effective approach for pain relief.[1] Physical, social, psychological, and spiritual support may also be necessary for students with severe dysmenorrhea as pain is a multidimensional phenomenon and individuals respond to pain differently.[16]




  Conclusion Top


Effective pain relief is an important and a fundamental human right.[17] There is, therefore, the need for widespread public education to encourage females with dysmenorrhea to seek medical care. Healthcare workers' attitude to patients who report with dysmenorrhea should also be humane so as to encourage them to seek treatment, especially when it is severe.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aziato L, Dedey F, Clegg-Lamptey JN. Dysmenorrhea management and coping among students in Ghana: A qualitative exploration. J Pediatr Adolesc Gynecol 2015;28:163-9.  Back to cited text no. 1
    
2.
Okoro RN, Malgwi H, Ngong CK, Okoro GO. Dysmenorrhea: Ways of management among Nigerian University Students. Actual Gynecol 2012;4:106-13.  Back to cited text no. 2
    
3.
Gumanga SK, Kwame-Aryee RA. Menstrual characteristics in some adolescent girls in Accra, Ghana. Ghana Med J 2012;46:3-7.  Back to cited text no. 3
    
4.
Okoro RN, Malgwi H, Okoro GO. Self-reported knowledge of dysmenorrhoea and its negative academic impacts among a group of female students of university of Maiduguri, North Eastern Nigeria. Nov Sci Int J Med Sci 2012;1:220-5.  Back to cited text no. 4
    
5.
Gagua T, Tkeshelashvili B, Gagua D. Primary dysmenorrhea: Prevalence in adolescent population of Tbilisi, Georgia and risk factors. J Turk Ger Gynecol Assoc 2012;13:162-8.  Back to cited text no. 5
    
6.
Aziato L, Dedey F, Clegg-Lamptey JN. The experience of dysmenorrhoea among Ghanaian senior high and university students: Pain characteristics and effects. Reprod Health 2014;11:58.  Back to cited text no. 6
    
7.
Gagua T, Tkeshelashvili B, Gagua D. Primary dysmenorreah-leading problem of adolescent gynecology (review). Georgian Med News 2012;207:7-14.  Back to cited text no. 7
    
8.
Chia CF, Lai JH, Cheung PK, Kwong LT, Lau FP, Leung KH, et al. Dysmenorrhoea among Hong Kong university students: Prevalence, impact, and management. Hong Kong Med J 2013;19:222-8.  Back to cited text no. 8
    
9.
El-Gilany AH, Badawi K, El-Fedawy S. Epidemiology of dysmenorrhoea among adolescent students in Mansoura, Egypt. East Mediterr Health J 2005;11:155-63.  Back to cited text no. 9
    
10.
Okoro RN, Malgwi H, Okoro GO. Evaluation of factors that increases the severity of dysmenorrhea among university female students in Maiduguri, North Eastern Nigeria. Internet J Allied Health Sci Pract 2013;11:1-10.  Back to cited text no. 10
    
11.
Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014;36:104-13.  Back to cited text no. 11
    
12.
Proctor ML, Murphy PA, Pattison HM, Farquhar CM. Behavioral interventions for primary and secondary dysmenorrhoea (Cochrane Review). In: The Cochrane Library. 2007;18:CD002248.  Back to cited text no. 12
    
13.
Cheng HF. Management of perimenstrual symptoms among young Taiwanese nursing students. J Clin Nurs 2011;20:1060-7.  Back to cited text no. 13
    
14.
Chen HY, Lin YH, Su IH, Chen YC, Yang SH, Chen JL, et al. Investigation on Chinese herbal medicine for primary dysmenorrhea: Implication from a nationwide prescription database in Taiwan. Complement Ther Med 2014;22:116-25.  Back to cited text no. 14
    
15.
Andrieli Daiane Zd, Marjoriê DC, Hohenberger GF, Melo Silva M, Ceolin T, Heck RM. Menstrual cramps: A new therapeutic alternative care through medicinal plants. Health (1949-4998) 2013;5:1106-9.  Back to cited text no. 15
    
16.
Pasero C, McCaffery M. Pain Assessment and Pharmacologic Management. St. Louis: Mosby/Elsevier; 2011.  Back to cited text no. 16
    
17.
Cousins MJ, Brennan F, Carr DB. Pain relief: A universal human right. Pain 2004;112:1-4.  Back to cited text no. 17
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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