背景:月经症状主要在成年人中进行研究,但可能在初潮后直接发生。青少年月经保健,然而,因此,人们提倡将月经症状作为青少年健康的决定因素进行更多研究。
目的:本研究旨在调查月经症状及其对初潮后青少年日常生活和幸福感的影响。
方法:对1644名女学生进行了随机调查,来自斯德哥尔摩116所初中(7年级和8年级)的人口项目,瑞典。月经症状(即,痛经,大量出血,不规则时期,情绪障碍,其他一般症状)通过多项选择题进行调查,并根据其对日常生活的影响定义为轻度(很少受影响),中度(受影响但可能应付)和重度(受影响且难以应付)。主观幸福感是用世界卫生组织五大幸福感指数衡量的。初潮后的受访者有资格进行分析;那些结果数据不完整或使用激素避孕的人被排除在外。不同初潮后年份症状的频率和严重程度(第1,2nd,3rd,第四,初潮后或第5年以上)用卡方和肯德尔的tau统计进行了研究。使用方差分析来研究月经症状与世界卫生组织五个幸福指数得分之间的关联。通过主成分分析获得综合月经健康指数变量,并用于研究月经症状对回归分析中幸福感的总体影响。
结果:1100名初潮后女孩(平均年龄,14.1±0.7年),93.2%报告月经症状,81.3%有至少1种中度症状,31.3%有至少1种严重症状。最常见的症状是痛经(80.4%)和情绪障碍(81.1%),其次是不规则时期(67.9%),大量出血(60.4%),和其他一般症状(60.4%)。在整个初潮后的岁月里,痛经的频率和严重程度(P<.001)显著增加(τ=0.148),大量出血(τ=0.134),情绪障碍(τ=0.117),和其他一般症状(τ=0.110),但不是不规则周期(τ=-0.0201;P=.434)。有月经症状的女孩的世界卫生组织五个幸福指数得分明显低于没有症状的女孩(平均差异,-17.3;95%置信区间,-22.4至-12.3)。方差分析显示,每种检查的月经症状与世界卫生组织五个幸福指数得分之间存在显着关联(P<.001)。在与没有症状的同龄人进行事后配对比较时,在有严重症状的女孩中,世界卫生组织五项幸福指数评分的下降幅度最大(平均差异:痛经,-20.72;大量出血,-15.75;不定期,-13.81;情绪障碍,-24.97;其他一般症状,-20.29),但即使是中度或轻度症状也存在显著差异.综合月经健康指数与世界卫生组织5个幸福指数得分回归分析显著相关,独立于年龄,初潮年龄,身体质量指数,吸烟,身体活动,自己和父母的出生国,双亲照顾,和社会经济地位。
结论:尽管人们越来越认识到月经与女性健康的相关性,未满足的月经健康需求是对青少年福祉的潜在威胁。教育,筛选,和临床能力是减轻青春期月经症状负担和防止长期后果的重要工具。开发新的以人为中心的策略应成为青少年月经健康临床实践和研究的重点。
BACKGROUND: Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated.
OBJECTIVE: This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents.
METHODS: A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall\'s tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses.
RESULTS: Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, -17.3; 95% confidence interval, -22.4 to -12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls with severe symptoms (mean difference for: dysmenorrhea, -20.72; heavy bleeding, -15.75; irregular periods, -13.81; mood disturbance, -24.97; other general symptoms, -20.29), but significant differences were observed even for moderate or mild symptoms. The composite menstrual health index was significantly associated with World Health Organization Five Well-Being index scores in regression analysis, independently of age, age at menarche, body mass index, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status.
CONCLUSIONS: Despite growing awareness about the relevance of menstruation to women\'s health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.