|Year : 2013 | Volume
| Issue : 2 | Page : 66-70
Age at menarche and prevalence of menstrual abnormalities among adolescents in Zaria, northern Nigeria
Hajaratu U Sulayman, Nkiruka Ameh, Adebiyi G Adesiyun, Ijeoma C Ozed-Williams, Austin O Ojabo, Solomon Avidime, Nosa E Enobun, Afolabi I Yusuf, Abdulsalam Muazu
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
|Date of Web Publication||23-May-2014|
Hajaratu U Sulayman
Department of Obstetrics and Gynaecology, ABUTH, Zaria, Shika-Zaria
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Nigerian adolescents constitute about 20% of the total population. Problems associated with menstruation affect 75% of adolescent females in both the developing and the developed world.
Objectives: The objective of this study is to establish the age at menarche and menstrual abnormalities among adolescents in secondary schools in Zaria.
Materials and Methods: A descriptive cross sectional study in which a self-administered pretested, semi-structured questionnaire in english was administered to 535 female secondary school students in Zaria, northern Nigeria. The students were selected from five schools that were chosen by simple random sampling from a list of schools in Zaria metropolis. Information obtained included age at menarche and menstruation related issues.
Results: Of the 535 female secondary school students interviewed, 448 (83.7%) were in senior secondary school. The mean age of the respondents was 15.35 ± 1.48 years. The average age at menarche was 12.53 ± 1.33 years. Most respondents, 369 (69.0%) experienced regular menses. The average duration of menstruation was 5.45 ± 1.81 days in 354 (66.2%) of the respondents. Three hundred and forty-four (64.3%) of the respondents had dysmenorrhea, and it was severe in 229 (66.6%) of them. Only, 137 (25.6%) experienced premenstrual symptoms, the most common symptom being breast tenderness in 62 respondents (45.2%).
Conclusion: The age at menarche and the menstrual pattern amongst adolescents in Zaria, northern Nigeria is similar to findings from other parts of Nigeria as well as from other parts of the world. Further studies are however needed to explore the full range of menstrual abnormalities that can occur in the adolescent age group.
Keywords: Abnormalities, adolescent, menstrual pattern
|How to cite this article:|
Sulayman HU, Ameh N, Adesiyun AG, Ozed-Williams IC, Ojabo AO, Avidime S, Enobun NE, Yusuf AI, Muazu A. Age at menarche and prevalence of menstrual abnormalities among adolescents in Zaria, northern Nigeria. Ann Nigerian Med 2013;7:66-70
|How to cite this URL:|
Sulayman HU, Ameh N, Adesiyun AG, Ozed-Williams IC, Ojabo AO, Avidime S, Enobun NE, Yusuf AI, Muazu A. Age at menarche and prevalence of menstrual abnormalities among adolescents in Zaria, northern Nigeria. Ann Nigerian Med [serial online] 2013 [cited 2021 May 6];7:66-70. Available from: https://www.anmjournal.com/text.asp?2013/7/2/66/133099
| Introduction|| |
The onset of menstruation represents a landmark event in pubertal development of the adolescent girl. Menstruation is an important and much valued event in the reproductive life of most women particularly, Nigerian women. ,, Menarche, the first menstrual period, is only a single event in the transition to reproductive capability that occurs at puberty; however, it is the most dramatic and therefore, more easily remembered than thelarche and puberache. ,,
Menstruation and the menstrual cycle are characterized by variability in volume, pattern and regularity, which at the earlier stages of the development of the adolescent, can create emotional discomfort particularly to the poorly informed girl. 
Puberty is a period of human development during which secondary sexual characteristics appear, skeletal growth spurt occurs, behavioral attitudes are modified, and the capacity for fertility is realized. ,,,
Normal menstruation depends on a highly coordinated interaction between the hypothalamus, the pituitary gland, the ovaries and the endometrium. When these organs all function in tandem, the following major events of the reproductive cycle occur in their normal sequence; cyclical ovarian follicular development, selection of a dominant follicle in each cycle, proliferative changes in the uterine endometrial lining, ovulation, luteal function, development of secretory glands on the endometrium, luteolysis and then menstruation. All these events usually occur in a cycle time frame of 21-35 days. Variability in cycle length is the norm during the peri-menarcheal and the peri-menopausal years. ,,
Puberty has been defined as the state of being functionally capable of procreation. This term is generally used in a more comprehensive sense however, to refer to the whole period of time during which secondary sexual characteristics develop, menstruation begins and the psychosexual outlook of the individual changes. ,
Disturbances of menstruation, which includes dysmenorrhea, irregular menses and excessive menstrual bleeding, are the commonest presenting complaints in adolescent gynecology clinics.  Of these, dysmenorrhea is commonly experienced by most adolescent girls. 
According to studies dysmenorrhea disrupts, the educational and social life of women, especially young girls. Due to dysmenorrhea, absenteeism (28-48%) and perceived quality-of-life losses are prevalent among adolescent girls. In the United States, dysmenorrhea has been estimated to be the greatest cause of time lost from work and school.  A study from Ile Ife showed that 28% of those with severe dysmenorrhea missed school. 
Disorders of menstruation may be treated with antibiotics, analgesics, and hormonal agents. The role of good counseling cannot be overemphasized.
Teenage girls with gynecological problems must be dealt with sensitively if they are to be encouraged to come forward and communicate their anxieties and problems, with the ultimate aim of protecting their health. 
Disturbances of menstruation, either actual or perceived, are the most common presenting complaint of adolescents attending gynecology clinics. Problems associated with menstruation actually affect 75% of adolescent females and are a leading cause of such visits to physicians. Though similar studies on age at menarche and menstrual abnormalities among adolescents have been done both within and outside the country, few where done in north western Nigeria, where Zaria is located, hence the need for this study.
| Materials and Methods|| |
This was a descriptive cross-sectional study. Five secondary schools were selected by using stratified random sampling from a list of secondary schools in Zaria. Three female only and two mixed schools were chosen from a total of 17 secondary schools in Zaria. Permission was obtained from the schools' authorities to conduct the study as well as ethical clearance from the Ethics Committee of the Ahmadu Bello University Teaching Hospital, Zaria.
The minimum sample size was determined using the formula sample size = Z 2 pq/d 2 (Z = the standard normal deviation usually set at 1.96, which corresponds to 95% confidence level, p = prevalence, q = 1-p, d = sampling error of 5%). Using prevalence of menstrual abnormalities of 45.6% in school girls by Adinma and Adinma,  the minimum required sample size was 382. Five hundred and fifty school girls were surveyed because of the anticipated diversity in types of menstrual abnormalities and to accommodate for attrition.
Representative distribution of the questionnaire was done to the schools resulting in 110 questionnaires per school. The schools used had similar population size. In each school, the classes were listed and selected by simple random sampling. The survey was conducted during school hours after a brief explanation of the study to the students. Consecutive female students aged 10-19 years who were present in their classrooms at the time of the study were surveyed (convenient sampling). The instrument for the survey was a self-administered pretested, semi-structured questionnaire in English administered by the authors. The questionnaire was previously pretested in another school in Zaria (not include in this study), corrections made, and the final clean copy used in this study.
The questionnaire had sections on demographic characteristics, age at menarche, and menstrual related problems. The variables of interest were dysmenorrhea, defined as any type of pain or discomfort related to menses and if they took any drugs for it, duration of menstrual flow, time to expect menstruation, premenstrual syndrome, which comprises a set of symptoms including abdominal bloating, breast tenderness, insomnia, social withdrawal, poor concentration, and irritability. The data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc, USA). The level of statistical significance was set at P < 0.05.
| Results|| |
A total of 550 questionnaires were administered, but only 535 were properly filled and analyzed giving a response rate of 97.3%. Four hundred and forty-eight (83.7%) of the respondents were in the senior secondary school, while (87) 16.3% were in the junior secondary school.
About 75.1% (402) of the respondents were between the ages of 15-19 years, and 133 (24.9%) students were between 10 and 14 years [Table 1]. The mean age of the respondents was 15.39 ± 1.48 years.
The average age at menarche was 12.53 ± 1.33 years, with a range of 10-17 years. Three hundred and forty-one respondents (63.7%) could remember their last menstrual periods, while 194 (36.3%) could not. A total of 338 respondents (63.1%) knew the time to expect their next menses.
Most respondents, 369 (69.0%) experienced regular menses. The average duration of menstruation was 5.45 ± 1.81 days in 354 respondents (66.2%). Ninety three respondents (17.4%) menstruated for 3 days or less, while 18 (3.3%) menstruated for more than 7 days; 70 (13.1%) did not respond to this question. Three hundred and sixty-nine (69.0%) respondents menstruated once every 28-30 days, 150 (28.0%) menstruated once in 35 days or more; while 16 respondents (3.0%) menstruated once in 21 days or less.
Three hundred and forty-four (64.3%) of the respondents had dysmenorrhea. Dysmenorrhea was said to be severe in 229 (66.6%) of those who had it and mild in 115 (33.4%). Premenstrual symptoms were experienced by 137 (25.6%) respondents, while 398 (74.4%) did not have such symptoms. Symptoms experienced include abdominal bloating, breast tenderness, insomnia, social withdrawal, poor concentration, irritability, food cravings, etc. The most common premenstrual symptom reported was breast tenderness and this was reported by 62 respondents (45.2%); as shown in [Figure 1].
|Figure 1: Menstrual abnormalities. Abdominal bloating 10 (7.3%), breast tenderness 62 (45.2%), insomnia 12 (8.8%), social withdrawal 5 (3.6%), poor concentration 6 (4.4), irritability 27 (19.7%), food craving 5 (3.6%), others 10 (7.3%); total 137|
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Respondents who experienced menstrual symptoms were more likely to use over the counter analgesics, and this was statistically significant (P < 0.001).
| Discussion|| |
Age at menarche and menstrual disorders of varying prevalence and severity have been reported in adolescent girls in several studies. ,,,,,,,, The findings in this study is in agreement with some of the previous surveys done in both the developed and the developing world.
About 75% (75.1%) of the respondents were between the ages of 15-19 years, which is the age at which most normal adolescents would have started menstruating. A similar mean age of 15.8 was found in adolescents in Turkey.  Majority of the respondents were in the senior secondary school, which is similar to the findings in south eastern Nigeria amongst 550 secondary school girls where the majority of the study population (75.6%), were aged 15-17 years. 
The average age at menarche was 12.53 ± 1.33 years. Similar findings were found in Warwick  (12.8 years), Ghana  (13.9 years) and Jordan  (13.1 years); however, a higher age at menarche (15.8 years) was found in Ethiopia. This may be due to sociocultural and environmental differences.
The average duration of menstruation in more than half of the respondents (66.2%) was 5.45 ± 1.81 days, with a range of 4-7 days, and is similar to that reported in the Ethiopian study. 
Nearly 64% of the respondents (64.3%) had dysmenorrhea, and this was said to be severe in more than half of those who had it. This is higher than the 36.4% prevalence reported in a previous study carried out by Sule et al.  in Zaria. This variation may be explained by the fact that their study was among women and not adolescents who are known to have less dysmenorrhea especially after childbirth. Severe dysmenorrhea of 45.1% leading to school absenteeism was seen in a Singaporean study. 
A study in Dharan found spasmodic dysmenorrhea in 67.0% of girls, but their daily activity was hampered only in 20.0% of the respondents.  In the study from South Eastern Nigeria, abdominal pain/discomfort was the most common medical problem encountered by 66.2% of the respondents.  A study from Lagos, south western Nigeria found a higher prevalence of 71.8% of any grade of dysmenorrhea when compared with figures from developed countries;  though a similar study from another part of south western Nigeria, Ile Ife, showed a lower prevalence of dysmenorrhea of 62.5%.  Another study in Port Harcourt; Southern Nigeria found that in addition to dysmenorrhea, menorrhagia leading to anemia was another common problem among adolescents. 
Most respondents, 369 (69.0%) experienced regular menses. This is similar to a study in Ibadan where the majority of respondents, (63.3%), experienced normal cycle length.  A quarter of the respondents (25.6%) experienced premenstrual symptoms, this was similar to 23.4% seen in the Zaria study.  Almost half (46.6%) of the 3000 girls who were recruited in a Turkish study experienced premenstrual problems;  while 74.6% of respondents had experienced premenstrual syndrome in a Malaysian study.  This is not unexpected as premenstrual symptoms are suspected to be commoner in Caucasians probably due to environmental and genetic factors. The most common premenstrual symptom seen was breast tenderness 45.2%; this was slightly lower than the 50% found by Sule et al.  in Zaria.
Respondents who experienced menstrual symptoms were more likely to use over the counter analgesics and this was statistically significant (P < 0.001). The use of over the counter medications is not peculiar to menstrual symptoms alone. This is a common practice in the developing world where there are no stringent laws prohibiting such practices.
| Limitations|| |
The limitations of this study include recall bias which is common to all questionnaire-based studies. The effect of this may not be so obvious in this study as the respondents were adolescents and their menarchial age was recent and any abnormality experienced is still on going. The sampled population was adolescents in secondary schools, so the result may not reflect the situation among young adolescents in the community; a situation that is commonly seen in developing countries. This study also did not look at the full range of symptoms that can be grouped under premenstrual dysphoric disorders. It did not also ascertain what type of analgesia was used to treat dysmenorrhea and the effect of dysmenorrhea on normal daily activities.
| Conclusion|| |
The prevalence of menstrual disorder among adolescent population in our environment is high. The age at menarche and the menstrual pattern amongst adolescents in Zaria, northern Nigeria is similar to findings from other parts of Nigeria, as well as from other parts of the world. Further studies are however needed to explore the full range of menstrual abnormalities that can occur in the adolescent age group.
| References|| |
|1.||Adinma ED, Adinma JI. Perceptions and practices on menstruation amongst Nigerian secondary school girls. Afr J Reprod Health 2008;12:74-83. |
|2.||Eveleth DB, Tanner JM. Worldwide Variation in Human Growth (Textbook). London, United Kingdom. Cambridge University Press; 1976. p. 213-9. |
|3.||Marinho AO, Marinho JO. Menarcheal age, height, weight, dysmenorrhoea and menstrual regularity in Nigeria school girls. Trop J Obstet Gynaecol 1984;4:1-7. |
|4.||Harlow SD, Campbell B, Lin X, Raz J. Ethnic differences in the length of the menstrual cycle during the postmenarcheal period. Am J Epidemiol 1997;146:572-80. |
|5.||Omigbodun A. Menstrual disorders. Trop J Obstet Gynaecol 1995;12:57-61. |
|6.||Garden SA, Topping J. Pubertal growth and development. In: Garden SA, Topping J, editors. Paediatric and Adolescent Gynaecology for the MRCOG and Beyond. Liverpool: RCOG Press; 2001. p. 1-3. |
|7.||Demir SC, Kadayýfçý TO, Vardar MA, Atay Y. Dysfunctional uterine bleeding and other menstrual problems of secondary school students in Adana, Turkey. J Pediatr Adolesc Gynecol 2000;13:171-5. |
|8.||Gilbert P. Menstruation in schoolgirls-1: The normal menarche. Prof Care Mother Child 2000;10:35-6. |
|9.||Suresh KK, Mrudula R, Sujana B, Roja RK, Divya BK, Balkrishna C. Prevalence of dysmenorrhea among adolescent girls (14-19 yrs) of Kadapa District and Its impact on quality of life: A cross sectional study. Natl J Community Med 2011;2:265-8. |
|10.||Esimai O, Esan GO. Awareness of menstrual abnormality amongst college students in urban area of Ile-Ife, Osun state, Nigeria. Indian J Community Med 2010;35:63-6. |
|11.||Nwankwo TO, Aniebue UU, Aniebue PN. Menstrual disorders in adolescent school girls in Enugu, Nigeria. J Pediatr Adolesc Gynecol 2010;23:358-63. |
|12.||Sharma M, Gupta S. Menstrual pattern and abnormalities in the high school girls of Dharan: A cross sectional study in two boarding schools. Nepal Med Coll J 2003;5:34-6. |
|13.||Bata MS. Age at menarche, menstrual patterns, and menstrual characteristics in Jordanian adolescent girls. Int J Gynaecol Obstet 2012;119:281-3. |
|14.||Zegeye DT, Megabiaw B, Mulu A. Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia. BMC Womens Health 2009;9:29. |
|15.||Adadevoh SW, Agble TK, Hobbs C, Elkins TE. Menarcheal age in Ghanaian school girls. Int J Gynaecol Obstet 1989;30:63-8. |
|16.||Sule ST, Umar HS, Madugu NH. Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria. Ann Afr Med 2007;6:68-72. |
|17.||Agarwal A, Venkat A. Questionnaire study on menstrual disorders in adolescent girls in Singapore. J Pediatr Adolesc Gynecol 2009;22:365-71. |
|18.||Odujinrin OM, Ekunwe EO. Epidemiologic survey of menstrual patterns amongst adolescents in Nigeria. West Afr J Med 1991;10:244-9. |
|19.||Barr F, Brabin L, Agbaje S, Buseri F, Ikimalo J, Briggs N. Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutr 1998;1:249-57. |
|20.||Fawole AO, Babarinsa IA, Fawole OI, Obisesan KA, Ojengbede OA. Menstrual characteristics of secondary school girls in Ibadan, Nigeria. West Afr J Med 2009;28:92-6. |
|21.||Lee LK, Chen PC, Lee KK, Kaur J. Menstruation among adolescent girls in Malaysia: A cross-sectional school survey. Singapore Med J 2006;47:869-74. |
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