Introduction
The menstrual cycle is a natural and regular process in females, characterized by the periodic shedding of the progestational endometrium along with the loss of blood when fertilization does not occur [1]twenty-eight (7 %. It happens once a month, remains as a normal physiological phenomenon from the onset of menarche to menopause and considered as a crucial aspect of women’s reproductive health [2]hormonal, neuromuscular, and environmental factors. Herein, we describe a case of 12-year-old scoliotic girl with a double curve of initially 26° thoracic and 23° lumbar, seeking chiropractic care.
The therapy was provided three times/twice a week for 6 months. Adjustments of the spine through chiropractic, both soreness and mbility, were shown to improve. A total correction in Cobb angle of 6° (23%. Female menstruation is controlled by a highly coordinated hypothalamic-pituitary-ovarian (HPO) axis, involving intricate hormonal feedback loops that prepare the female body for conception and pregnancy [3]ovulatory, and luteal.
Menstrual disorders are prevalent issues within the field of gynecology [4], impacting women of reproductive age and influencing their daily activities [2]hormonal, neuromuscular, and environmental factors. Herein, we describe a case of 12-year-old scoliotic girl with a double curve of initially 26° thoracic and 23° lumbar, seeking chiropractic care. The therapy was provided three times/twice a week for 6 months. Adjustments of the spine through chiropractic, both soreness and mobility, were shown to improve. A total correction in Cobb angle of 6° (23%. In recent times, there is a noticeable increase in menstrual disorders across both developing and developed nations [5]. Several factors contribute to the regularity and amount of blood loss during a woman’s menstrual cycle; including changes in female sex hormones, genetic factors, serious medical conditions, body mass index (BMI), lifestyle choices, and stress levels [6].
Disruptions in the menstrual cycle can pose risks for various health conditions such as miscarriage, infertility, breast and ovarian cancer, diabetes, cardiovascular disease, and fractures. Abnormal menstruation reduces productivity levels. Furthermore, women experiencing heavy menstrual bleeding are at a higher risk of developing anemia [7]but high levels of PA reduce the odds of HMB. WHAT IS KNOWN ALREADY: Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies. STUDY DESIGN, SIZE, DURATION: Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women’s Health (ALSWH.
The duration of the menstrual cycle is a significant factor in assessing the regularity of cycles. It can be influenced by external factors and exhibits variations among different individuals. Several factors contribute to these variations, such as ovarian biomarkers, lifestyle-related exposures, environmental influences, endocrine-disrupting chemicals, and the use of medications or presence of metabolic syndrome [8][9]. In light of these considerations, the present study aims to investigate the prevalence of irregular menstruation and its potential correlation with some biological and lifestyle factors among KUST students.
Methodology
Study Design
This research was conducted with female college students to investigate the incidence of irregular menstruation cycle. It aimed to examine how irregular menstruation relates to various lifestyle factors, such as marital status, energy drink consumption, exercise habits, psychological stress, and smoking. Additionally, the study explored potential connection of irregular menstruation with certain biological factors, including bleeding disorders, family history of hypertension, autoimmune disease, anemia, and lipid profile status.
Study Population
This study is confined to female students enrolled at KUST during the academic year 2022-2023. These participants were aged between 20 and 30 years, chosen randomly from various departments after they were provided with clear explanations and details of the study.
Study Participants and Data Collection
A total of two hundred and fifty students took part. The participants were asked to answer self-reported questionnaires to gather information about their medical history and lifestyle habits. Additionally, they were given a contact number through which they could arrange for a blood sample collection on the second day of their next menstruation. Fresh whole blood samples were putted in EDTA tubes, mixed thoroughly and subjected to immediate hematological analysis. Simultaneously, another portion of the blood was allowed to coagulate in evacuated gel tubes at room temperature. The resulting serum fractions were obtained through centrifugation at 2500 RPM for 15 minutes and then stored in a refrigerator at -20°C until they were utilized for evaluating the lipid profile status.
Definitions and Measurements of Dependent Variables Body Mass index
The height and weight of all the study participants was recorded using a stadiometer and standardized weighing scale for calculating the BMI. The BMI was determined using the World Health Organization’s BMI classification from 2004. The BMI categories that below 18.5 kg/m2 was considered underweight, 18.5 to 24.9 kg/m2 fell within the normal range, above 25 kg/m2 indicated overweight, 25 to 29.9 kg/m2 represented pre-obesity, and a BMI exceeding 30 kg/m2 indicated obesity[10].
Anemia Assessment
WHO standard cut off point was used to identify anemia [11]6. Non-pregnant women 15 years of age and above with hemoglobin (Hb) values of <12.0 g/dl were considered as anemic.
Smoking, Energy drink Consumption and Exercise
Current smokers were identified as individuals who presently engage in smoking (cigarettes, shisha, or vaping) at least once per day. Energy drinkers were classified as participants who consume more than one bottle of any locally available energy beverage per week. Regular exercise was characterized as performing an intense physical activity for a minimum of 1 hour, three times a week.
Menstrual Cycle Characteristics
The different patterns of menstrual cycles were classified as follows: Regular menstrual cycles: The length between 3 and 6 weeks in the past year. Irregular menstrual cycles: At least the length of two or more cycles ≥ 6 weeks or ≤ 3 weeks within the past year. Additionally; for each girl with irregular menstruation, the average length of her menstrual cycle was estimated and further classified according to [12]. Oligomenorrhoea: average cycle length between 42 and 180 days. Amenorrhoea: the absence of menstruation for >180 days. Polymenorrhoea: The average cycle length was less than 21 days.
Statistics
The collected data were inputted into Microsoft Excel and examined using SPSS version 26.0. The findings were derived from percentages and proportions of the participants involved in the study. To assess the statistical significance association between irregular menstruation and other variables, a Chi-square test was conducted. Any association deemed statistically significant had a P-value of < 0.05.
Results
Distribution of study participants according to departments were shown in Table 1.
Table 1
Distribution of participants by departments.
Study participants were further classified based on their BMI, marital status, consumption of energy drink, performing of exercise, daily psychological stress, smoking habit, presence of bleeding disorder, history of family hypertension, medication-treated autoimmune disease, anemia, lipid profile status, regularity of menstruation cycle and characteristics of irregular menstruation Table 2.
Table 2
Frequency of sample distributions according to various demographic variables
The variables of BMI, serum lipid profiling, psychological stress and marital status showed that the majority of respondents are with normal weight, normal serum lipids, having daily psychological stress and single (65.2%, 96%, 69.6% and 87.2% respectively).
Results also showed subjects that not consume energy drinks, not illustrate regular daily exercises, never smoked, not having history of family hypertension and autoimmune disease were obviously higher than those answered with yes.
Approximately; one-third of students (33.2%) were reported their menstruation as irregular. It was also noted that among irregular menstruation samples; most of them reported of having oligomenorrhoea (24.4%), amenorrhoea (5.6%) and the rest polymenorrhea (3.2%).
Table 3 summarizes the prevalence of menstrual-irregularity among 250 samples. Besides; the analysis performed between students having irregular menstruation in relation with the variables that involved in this study.
Table 3
The Frequency distribution of menstrual regularities among study participants and associations with various deographic variables was tested using Chi-square test.
There is a significant correlation (p < 0.05) between the regularity of menstrual cycle with variables of BMI, psychologic stress, bleeding disorder and anemia, The rest of other variables showed no significant correlation (p > 0.05). furthermore; positive correlation was observed between irregular menstruation and energy drinking, but did reach a statistically significant (p > 0.05).
Discussion
In this research, we explored the associations between disturbances of menstruation cycle with certain medical and lifestyle factors among college students at KUST over a span of one year.
The overall occurrence of irregular menstrual periods is approximately one-third; this discovery aligns with a with previously conducted study which indicated that the prevalence of irregular menstruation can range from 5% to 35.6%, depending on factors like age, occupation, and country of residence [13]. The variations in this prevalence might be attributed to variations in how irregular menstruation is defined by researchers and the distribution of participants’ ages [14]the regularity, the amount of menstruation and the intensity of dysmenorrheal were assessed and the symptoms were classified according to their intensity and persistence. Women’s awareness of PMS and the physician consultations were also evaluated. RESULTS: The approximate prevalence of PMS by the World Health Organization’s International Classification of Disease (ICD-10. Consistent with our study’s outcomes, a previous investigation [1]twenty-eight (7 % delved the correlation between irregular menstruation and BMI as well as nutritional status in adolescent girls. It concluded that the socioeconomic status of society can impact both the onset of menarche and the frequency of menstrual irregularities in the population.
The occurrence rates of oligomenorrhea, polymenorrhea, and amenorrhea were 24.4%, 3.2%, and 5.6% in that order. In contrast, a previous study [15] reported oligomenorrhea, polymenorrhea, and amenorrhea at 11.3%, 0.8%, and 0.3% respectively in 991 college students with an average age of 19.2 years. The disparities in these estimates were attributed by Study [7]but high levels of PA reduce the odds of HMB. WHAT IS KNOWN ALREADY: Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies. STUDY DESIGN, SIZE, DURATION: Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women’s Health (ALSWH to age, occupation, country of residence, and measurement methods. Interestingly, our findings align with the study [16], which similarly identified oligomenorrhea as the most prevalent menstrual disorder.
Numerous prior investigations conducted worldwide [17] [18] [19] [1]twenty-eight (7 % [20] that pointed out the link between irregular menstruation and BMI, indicating that females with higher BMI, particularly those classified as obese, are more prone to experiencing disruptions in their menstrual cycles compared to non-obese individuals. These observations align closely with our findings, which found a statistically significant connection between BMI and irregular menstrual patterns. BMI is widely recognized as a pivotal factor influencing menstrual regularity, as emphasized in [21]the transitional phase of physical and mental development between childhood and adulthood, is characterized by immense hormonal changes. Owing to the immaturity of the hypo-thalamo-pituitary-ovarian axis, menstrual cycles tend to be rather irregular. This variability poses a dilemma for physicians treating these girls and may result in a delay in the diagnosis and treatment of underlying problems. The purpose of this study was to collect data on the characteristics of menstrual cycles in Singapore adolescents to determine the prevalence of menstrual abnormalities and the pattern of use of medical treatments for these abnormalities. Design: Cross-sectional study using a self-administered, 27-point structured questionnaire. Setting: Sixty-two secondary schools and junior colleges in Singapore from January to December 2004. Participants: Data from 5561 girls, 12 to 19 years old, were included in the analysis. Results: Of the 5561 participants, 23.1% reported having irregular cycles. Oligomenorrhea was the most frequently reported problem (15.3% and [22]which may affect their life and outdoor activities. Adolescent girls with abnormal body mass index (BMI. Several earlier studies have explained the impact of BMI or obesity on menstrual disturbances in women; obesity impacts the hypothalamic-pituitary axis through excess estrogen. In the case of obese women, there’s an abundance of free estrogen due to peripheral androgen conversion, along with reduced availability of gonadotropin-releasing hormone. Furthermore, obesity is linked to a chronic systemic inflammatory response that affects ovarian function [18] and [4]. Both low and high levels of adiposity are found to have unfavorable effects on women’s menstrual patterns [17]. While a variety of sex hormones contributes to influencing menstrual cycles, studies have suggested that elevated BMI can lead to absent, irregular, excessive or prolonged and painful menstruation [6].
The present outcomes revealed a significant association between irregular menstruation and both daily psychological stress and job-related stress. This in congruence with findings from other research studies [13] and [15]. The precise mechanism by which stress affects menstrual function remains uncertain; however, according to [23]including age at menarche, body mass index (BMI, stress is believed to impact menstrual function by disrupting the functioning of the hypothalamic-pituitary-adrenal axis, which governs the body’s stress response. This disruption, in turn, leads to reciprocal interactions with ovarian hormones, ultimately influencing the regulation of a woman’s menstrual cycle. Moreover, a study conducted among female workers at Japan in 2011 found that stress played a prominent role in causing irregularities in menstrual cycles and menstrual pain [5].
In our study, 47 (18.8%) of the girls exhibited clinical anemia, and there was a significant link between the regularity of menstruation and the occurrence of bleeding disorders and anemia. The information about the menstrual attributes of women dealing with chronic illnesses is limited [20]. However, [24] and [25] indicate that occurrences of menorrhagia were more likely being accompanied by iron deficiency anemia.
As evidenced by this investigation, several studies have failed to establish connections between cycle length and factors such as smoking [26] and [27] and high blood pressure [28]. Variables like marital status, energy consumption, exercise, medication treated-autoimmune disease, and lipid profile displayed insignificant correlations with menstrual regularity. These observations are in contrast to the previous study that indicated associations between gynecological age and allergic disease with IMC [15], there’s a clear relevance of physical activity to menstrual function [25], and [28] demonstrated significant association between high TG, low HDLC, and irregular menstruation. These discrepancies could be attributed to variations in geographical conditions, socio-economic status, lifestyle choices, genetics, elevation above sea level, psychological factors, and so on [18]. Moreover, the disparity in age between our study and the referenced study could also contribute to these differences [6]. It’s also worth considering that students might not openly share their actual habits regarding smoking and energy consumption due to the influence of Kurdish traditional culture.
