Press "Enter" to skip to content

Risk Factors Associated With Irregular Menstrual Cycle Among Women Of Age Group 30-40 Year In Karachi Pakistan

Research Article                                          Vol:2, Issue:1

Mubashir Zafar, Naureen Latif, , Maryam Marufia, Kanwal Shehzadi ,Yusra Maqbool, Aisha Iffat, Marium Amir, Rabeeya Qutubuddin, Waqas Shafiq, ,Gauhar Fatima, Marium Naeem, , Sadia Allah Baksh, Uzma Hamid, Sidra Shauqat, Rabail Yaseen.

Abstract

Disorders of menstrual cycles are one of the most common reasons for women to attend their general practitioner and its major risk for sexually transmitted disease. There are many risk factors of the abnormal menstrual cycle including age, smoking and alcohol, stress, hormonal imbalance, pregnancy and contraception. The aim of the study is to determine associated risk factors for irregular menstrual cycle among age group 30-40 years in Karachi, Pakistan. It’s a cross-sectional study and convenient sampling was used. 183 subjects were selected, women whose age group 30-40 years were included and structured validated questionnaire was used. Logistic regression analysis was used to show association between socio-demographic characteristics and abnormal menstrual cycle. Mean age and standard deviation of study participants was 24.5 +/- 1.5 years. After adjusting the covariates in logistic regression Those women who have 6-9 children more than two times {OR 2.78, CI 1.96-8.07}, past medical history more than one times {OR 1.33, CI 1.38-2.92}, have any type of addicted substance have more than five times {OR 5.41, CI 1.72-16.97},  use of any type of contraceptive have more than one times {OR 1.21, CI 1.65-3.10} and those have any cancer history had more than 3 times {OR 3.61, CI 2.99-5.10}had abnormal menstruation. Those women have high parity, used of addicted substance and contraceptive users are the major determinants for irregular menstrual cycles which are the major cause of sexually transmitted infection. Awareness of women regarding above determinants will prevent the disorder of menstrual cycle.

Key Words: Irregular Menstrual Cycle, Contraceptive, Addicted Substance, High Parity

SAJMED.2017; 2(1):46-55                                                            PDF Download

Introduction

Mmenstruation is the monthly cycle of blood loss per vagina resulting from the breakdown of uterine lining when implantation of fertilized ovum does not occur.[1]Duration of normal menstrual cycle ranges from 22 to 36 days[2] and its lost approximately 50 ml of blood [1] Disorders of menstrual cycles are one of the most common reasons for women for age group between 30-40 years to attend their general practitioner and subsequently a gynecologist due to sexual transmitted infection. Although its rarely life threatening but it can cause major social, psychological and occupational upset.[3]  Abnormal menstrual cycle is defined as menstruation as either outside the normal range for a particular women, or markedly different from the average regularity of a woman’s own menstrual cycle.[4] Common symptoms of an abnormal menstrual cycle include dysmenorrhea i.e. pain during menstruation, oligomenorrhea or menorrhagia i.e. abnormal length of bleeding, abnormal quantity of blood flow, infertility or abnormal cycle length or amenorrhea i.e. absence of menstruation [5][6][7]. The major reason for irregular periods is due to hormonal imbalance. There are many risk factors of abnormal menstrual cycle including age, smoking and alcohol, stress, hormonal imbalance, pregnancy and contraception.[8] A study was conducted in North Carolina on 3941 premenopausal women aged between 21 to 40 years, participant of study were not taking any oral contraceptives and not currently pregnant or breastfeeding found that highest incidence of irregular menstrual cycles and was less common with after 40 years of age[9]. A study was conducted in California on 408 women according to which heavy smoking (at-least 20 cigarettes per day) was associated with nearly 4 times the risk of abnormal menstrual cycle length.[10] A study was conducted on 766 women age between 29 to 38 years which showed that long menstrual cycles were more common among women who drank alcohol than among non-drinking women.[11] A study was conducted in John Hopkins’s University on 166 college women which showed that women with a history of long menstrual cycles were during the exam days or when in stress situation.[12] According to a study published British Medical Journal, the frequency of menstruation was reduced to ones every three months in 196 women by continuous administration of oral contraceptive pills[13]. In Pakistan, High burden of Maternal and child health problem which include high prevalence of sexual transmitted infection among women of 30-40 years of age, which is the common reason for women visiting health centers and this lead to various social, economic burden of already poor household. Health system also bears the cost for treatment of this issue.  There are no any study was conducted among women of 30-40 years of age which identify the risk factors for irregular menstrual cycle. There is a need for identifying the risk factors for high prevalence of STD  it will help the health professional to look into these kinds of problems and provide effective treatment to a patient, it also provides evidence to policymaker to make a policy to improve the health of mothers.

Materials And Methods

Operational Definition

Women were considered having irregular menstrual cycle whose cycle length was less than 21 days or more than 35 days with having less blood flow(less than 2 pad/tampons) or very severe blood flow(more than 4/5 pads/tampons)

Study Setting:

This study was conducted in Department of Gynecology and Obstetrics of tertiary care hospital Karachi, which is the largest hospital of Karachi. The number of patients which comes in Out Patients Department is approximately 300-400 per day and number of beds in the ward is 200.

Study Design: Cross-sectional study

Sampling Technique:

This is a Non- random, purposive sampling.

Sample Selection:

Inclusion Criteria:

The women aged 30-40 years, those having menorrhagia of more than 2 months duration, those having other irregularities in the menstrual cycle and those taking any method of contraception were included.

Exclusion Criteria:

The patients who are pregnant and aged above 40 years were excluded. Also, patients having any co-morbidity i.e. Hypertension, any thyroid disease, liver disorder or any clotting disturbances and any uterine diseases were excluded.

Independent variables:

Age, ethnicity, educational level, occupational status, no. of children, addiction of substance, use of contraceptive methods, menorrhagia of 2 or more months, age and menstrual irregularities are the independent variables.

Outcome Variable:

Irregular menstrual cycle

Sample Size:

A sample size of 183 was calculated by the formula

n=(100-p)

D2(N-1)+z2*p*(100-p)

(n=sample size, D=Margin of Error, N=Total papulation, Z2(level of significance, P= proportion of prevalence in previous study)

The sample size was calculated based on the proportion of irregular menstrual cycle among women of age group 30-40 years reported by a previous study (14).It was estimated by using the proportion of depression as 40% at confidence level 95% and bound of error 3%.

Data Collection Procedure

The permission was taken from the respective ward, the time taken from each participant and interview was conducted of given time. Consent was taken before starting the interview each percipient.

Data Collection Tool

The study instrument was a validated questionnaire which comprised of two sections. Part 1 was related to the socio-demographic characteristics, part 2 related to menstrual related problems and sexual history and contraceptive information. The questionnaire was prepared in English version and translated to Urdu language.

Data Analysis

The data were checked for completeness and any incomplete or misfiled questions were sent back for correction. Data were double entered in Epi Data software version 1.3, through this missing values were cleaned and error rate was determined accordingly. Data analysis was performed using computer programmed SPSS version 16.0. Those variables which are quantitative were calculated as frequency and percentages. Logistic regression was run to determine the association of outcome and independent variables.

 

Ethical Consideration

The study was approved by the competent authority of department and permission was taken from the respective department before start data collection. Questions were asked after taking informed consent and taking part in this study is completely voluntary. The patient may skip any questions that they do not want to answer and are free to withdraw at any time. There were no specific benefits to the patients but it will help us to find the causes of menstrual irregularities in women and refer to treatment.

Results

Table 1 Shows Socio-demographic characteristics of study participants. Mean of age of study participants was 24.5years.  Most of the study participants were 30-40 years ( 53%). 90.7% females were married out of which 69.3 % female got married early, 57.9% of were illiterate , 78.7 % were housewives , 58.5% women were addicted   86.9% used 1-5 tampons Dysmenorrhea  was common in 82.5% of , 53% had ever user of contraception . TABLE 2 shows the association of Socio demographic characteristics and abnormal menstrual cycle. The study participants who were married had more than one times have abnormal menstrual cycle (COR 1.31 CI 1.01-3.84). Females who had C-section more than one times have irregular menstrual cycle ( COR 1:1:53, CI 1.188-3.847). Results shows women who used any contraceptive method have significant relation with irregular menstrual cycle ( COR 141:1 , CI 1.143-3.102). Those women who ever user of nicotine had more than five times had irregular menstrual cycle ( COR 5.413 , CI1.726 – 16.979). Those women have any cancer history had more than four time had irregular menstrual cycle. ( COR 4.6 , CI 2.81 – 5.22). TABLE 3 Shows the association of Socio demographic characteristics and abnormal menstrual cycle(Multivariate). The study participants who were married had more than one times have abnormal menstrual cycle (AOR 1.55 CI 1.35-3.74). Those women who ever user of nicotine had more than seven times had irregular menstrual cycle ( AOR 7.21 , CI 4.72 – 10.97), those women who had more than six children more than one times had irregular menstrual cycle ( AOR 1.48 , CI 1.26 – 6.07)Results shows women who used any contraceptive method have significant relation with irregular menstrual cycle ( AOR 1.21 , CI 1.65-3.07), Results shows women who had any cancer history have significant relation with irregular menstrual cycle ( AOR 3.6121 , CI 2.99-5.10). All other values were statistically insignificant.

Discussion

Irregularity of menstrual cycle are one of most common gynecological problems among women .The study found that married women, ever user of nicotine, women who have high parity and contraceptive user are the major risk factors for irregular menstrual cycle. [8, 15]            This study shows that female aged 30-40 years are among the majority of women, complaining of menorrhagia, out of which half (53%) were of age 30-35 years, showing that menorrhagia occurring more in this age group. However mean age of this study participates was 24.5 years. This finding of this study has been supported by a study, conducted in North Carolina on 3941 premenopausal women aged

 

between 21-40 years , showing  relation of irregular cycles  with age (at age 21-25, 3% ; at age 26-30, 14% ; at age 31-37, 26% ; at age 38-40,31 % ). [9, 16]

Approximately  58.5%  of women admitted to be addicted to smoking, beetle nuts or naswar, which is showing that more than half of women with menorrhagia are having some kind of addiction or nicotine users and so are more prone to develop menorrhagia that is more than seven times had irregular cycles (AOR 7.21 , CI 4.72-10.97) .This is also supported by  a study conducted in California on 408 women, according to which heavy smoking in women is associated with nearly 4 times increase risk of abnormal menstrual cycles [10,17]. Also in study conducted in North Carolina, we see that smoking is associated with irregular cycles. Odds of having irregular cycles were 3.6 among women who smoked more than a pack a day as compared with non-smokers (95% , CI=1.7-8.0 ) [9]. This study found that study participants, 52.5% have never used any kind of contraception while 47.2% use, out of which 75.3% take hormonal therapies within age 17-35 years, which were taken mostly for preventing pregnancy (65.5%) or gynecological diseases. this study showed that females using or ever had used any hormonal therapy have significant relation with irregular menstrual cycles (AOR 1.21 , CI 1.65-3.07 )  , as compared to the study published in British Medical Journal according to which frequency of menstruation reduce to once every three months in 196 women by continuous administration of OCPs ( in 1st  month-24% women had spotting,in 2nd month-16 % , in 3rd month-10% while in 4th consecutive month-4% ) [13,18]. In co-relation to socio-demographic characteristics of our study participants, 90.7% female presenting with complain of menorrhagia, were married out of which more than half (69.35%)  were married at early age (12-24 years) , showing that married women present more than one time with menorrhagia ( AOR 1.55, CI 1.35-3.74 )  than unmarried .Those women who had more than 6 children , present more than one time with irregular menstrual cycles (AOR 1.48 , CI 1.26-6.07 ). More than half of women (65.5%) complained of menorrhagia for 2 or more months, having bleeding days of 2-10 in majority women and with no skip cycles in 63.9% women, but menorrhagia associated with pain (dysmenorrhea) in 82.5% ,showing that menorrhagia is painful in majority of women[19]. In this study,57.4% females gave past history of diseases while 58.7% gave insignificant surgical history. Study found that females undergoing normal vaginal delivery are more prone to develop menorrhagia. So it shows that women who have gone through surgical methods, has seventy six times less chances of presenting with complain of menorrhagia (AOR 0.24 , CI 0.25-0.45) , as compared to those having insignificant past surgical history[20]. In contrast to our findings, a study was conducted by University Hospital Utrecht, The Netherlands on 182 healthy women, according to which menstrual blood loss significantly increase after age 40 (Mann-Whitney’s ranks sum test, P <0.05 ) and smoking appear to have no role in it [14] .However our study showed how menorrhagia complain becomes less common with increasing age and is associated with smoking and other addictions(beetle nuts, naswar etc). The limitations of this study must be acknowledged. Nature of this study is cross-sectional,  so the causal factors not determined accurate and the sample size is 183 due to time and resources constraint Secondly responses may be influenced by possibly recall bias or information bias or both.