Gopika Ambily Vijayan, George Sobha, Rose Brilly Michael, Olickal Jeby Jose, Thankappan Kavumpurathu Raman
Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
BMJ Public Health. 2025 Aug 25;3(2):e002281. doi: 10.1136/bmjph-2024-002281. eCollection 2025.
Comprehensive studies on attitudes towards menstruation and the prevalence of premenstrual syndrome (PMS) and its associated factors among adolescents are limited. Since both attitudes and responses towards PMS are shaped by psychosocial and cultural factors, this study was conducted to assess attitude towards menstruation, prevalence of PMS and coping mechanisms adopted to manage PMS among adolescent girls in Kerala, with a focus on psychosocial experiences rather than the biological aspects of PMS.
An institution-based cross-sectional study was conducted among 1100 adolescent girls (aged 13-19 years), selected through multistage cluster sampling. Menstruation-related attitudes were measured using the Menstrual Attitude Questionnaire, which categorises attitudes as positive or negative, while PMS symptoms were assessed using the Premenstrual Symptoms Screening Tool. Multivariable analyses identified the factors associated with attitudes towards menstruation and severe PMS.
In our study, 51% reported a negative attitude towards menstruation (95% CI 47.8% to 53.8%). Severe PMS was reported by 36.8% (95% CI 33.9% to 39.7%). Severe PMS was significantly associated with negative menstrual attitudes (adjusted prevalence ratio (APR) 1.31, 95% CI 1.12 to 1.54)), nuclear family; defined as those living with only parents and siblings, (APR=1.25, 95% CI 1.04 to 1.51), Muslim religion (APR=1.58, 95% CI 1.03 to 2.42) and low maternal education (APR=1.28, 95% CI 1.03 to 1.59) compared with their counterparts. Adolescents who belonged to the Muslim religion (APR=1.20, 95% CI 1.05 to 1.37) and those from nuclear families (APR=1.21, 95% CI 1.05 to 1.39) were more likely to report negative attitudes towards menstruation compared with their counterparts.
More than half of the adolescents reported a negative attitude towards menstruation, and a considerable proportion experienced severe PMS. Implementing targeted educational programmes for adolescents, particularly those from the Muslim religion, nuclear families and with less-educated mothers, may enhance menstrual awareness, promote healthier attitudes and support better coping mechanisms in managing PMS.
关于青少年对月经的态度、经前综合征（PMS）的患病率及其相关因素的综合研究有限。由于对PMS的态度和反应均受社会心理和文化因素影响，本研究旨在评估喀拉拉邦青春期女孩对月经的态度、PMS的患病率以及为应对PMS所采取的应对机制，重点关注社会心理体验而非PMS的生物学方面。
采用多阶段整群抽样法，对1100名13 - 19岁的青春期女孩进行了一项基于机构的横断面研究。使用月经态度问卷测量与月经相关的态度，该问卷将态度分为积极或消极，同时使用经前症状筛查工具评估PMS症状。多变量分析确定了与月经态度和严重PMS相关的因素。
在我们的研究中，51%的人报告对月经持消极态度（95%CI 47.8%至53.8%）。36.8%的人报告有严重PMS（95%CI 33.9%至39.7%）。严重PMS与消极月经态度（调整患病率比（APR）1.31，95%CI 1.12至1.54））、核心家庭（定义为仅与父母和兄弟姐妹生活在一起的家庭，（APR = 1.25，95%CI 1.04至1.51））、穆斯林宗教（APR = 1.58，95%CI 1.03至2.42）以及母亲低教育水平（APR = 1.28，95%CI 1.03至1.59）显著相关。与同龄人相比，属于穆斯林宗教的青少年（APR = 1.20，95%CI 1.05至1.37）和来自核心家庭的青少年（APR = 1.21，95%CI 1.05至1.39）更有可能报告对月经持消极态度。
超过一半的青少年报告对月经持消极态度，相当一部分人经历了严重的PMS。为青少年，特别是来自穆斯林宗教、核心家庭且母亲受教育程度较低的青少年实施有针对性的教育计划，可能会提高月经意识，促进更健康的态度，并支持更好的应对PMS的机制。
