Attitude towards menstruation, prevalence of premenstrual syndrome and coping mechanisms among adolescent girls in Kerala, India: a cross-sectional study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.