Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data

Rigon et al. Italian Journal of Pediatrics 2012, 38:38 http://www.ijponline.net/content/38/1/38 RESEARCH ITALIAN JOURNAL OF PEDIATRICS Open Access Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data Franco Rigon1, Vincenzo De Sanctis2, Sergio Bernasconi3, Luigi Bianchin4, Gianni Bona5, Mauro Bozzola6, Fabio Buzi7, Giorgio Radetti8, Luciano Tatò9, Giorgio Tonini10, Carlo De Sanctis11 and Egle Perissinotto12* Abstract Background: The most striking event in the whole process of female puberty is the onset of menstruation. To our knowledge, no large population-based studies have been performed on the topic of menstrual health among Italian adolescents in recent years. The aims of this study were to produce up-to-date information on the menstrual pattern of Italian girls attending secondary school, and to estimate the prevalence of menstrual cycle abnormalities in this population. Methods: This was a cross-sectional study on a population-based sample of Italian adolescents aged 13–21 years attending secondary school. Only girls who had already started menstruating were requested to participate. Information was collected by means of a questionnaire that included items on the girls’ demographic details, anthropometrics, smoking and drinking habits, use of contraceptive pills, and socioeconomic status. The questions on the girls’ menstrual pattern concerned their age at menarche, duration of the most recent menstruation intervals (<21, 21–35, >35 days, variable), average days of bleeding (<4, 4–6, >6 days), and any menstrual problems and their frequency. Results: A total of 6,924 questionnaires were administered and 4,992 (71%) were returned. One hundred girls failed to report their date of birth, so 4,892 subjects were analyzed. The girls’ mean age was 17.1 years (SD ±1.4); their mean age at menarche was 12.4 (±1.3) years, median 12.4 years (95%CI 12.3–12.5). In our sample population, 3.0% (95%CI 2.5%-3.4%) of the girls had menstruation intervals of less than 21 days, while it was more than 35 days in 3.4% (95%CI 2.9%-3.9%). About 9% of the girls (95%CI 7.7%-9.4%) said the length of their menstruation interval was currently irregular. Short bleeding periods (<4 days) were reported in 3.2% of the sample population (95%CI 2.7%-3.7%), long periods (>6 days) in 19% (95%CI 17.9%-20.1%). Menstruation-related abdominal pain was reported by about 56% of our sample. About 6.2% of the girls (95%CI 5.4%-7.0%) were suffering from dysmenorrhea. Conclusions: In conclusion, to the best of our knowledge, this is one of the largest studies on menstrual patterns and menstrual disorders among Italian adolescent girls. Adolescent girls referring persistent oligomenorrhoea, in first two years from menarche, had a higher risk for developing a persistent menstrual irregularity. They had longer bleeding periods (>6 days) and this has practical implications because it makes these adolescents potentially more susceptible to iron deficiency anemia. Clinicians need to identify menstrual abnormalities as early as possible in order to minimize their possible consequences and sequelae, and to promote proper health information. We recommend that adolescents should be encouraged to chart their menstrual frequency and regularity prospectively from the menarche onwards. Keywords: Menstrual pattern, Menstrual disorders, Menstrual cycle length, Bleeding length, Polymenorrhea, Oligomenorrhea, Dysmenorrhea, Adolescents * Correspondence: 12 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy Full list of author information is available at the end of the article © 2012 Rigon et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rigon et al. Italian Journal of Pediatrics 2012, 38:38 http://www.ijponline.net/content/38/1/38 Introduction Adolescence is the time of life between puberty and psychophysical maturity when crucial endocrinological, metabolic, somatic and psychological changes occur in girls. During this process, sequential phases mark the maturation of the complex endocrinological system that comprises the hypothalamus, pituitary gland, and ovary, and their interactions. Healthy reproductive function is the expected endpoint of this process [1-3]. The timing of this process is individual-specific, within a broad range of normality. The most frequent menstrual disorders are polymenorrhea, oligomenorrhea and dysmenorrhea [4-7]. Menstrual abnormalities are more common among younger girls, becoming less frequent as they grow older, 3–5 years after menarche [8-12]. Clinical evidence from the literature indicates that as of the third year after menarche the interval between bleeding periods is in the range of 21–34 days, with a flow lasting from 3 to 7 days and a mean menstrual blood loss of 35 ml (range 5–80 ml) [4-6]. Frequent anomalies outside normal references occasionally occur, or may become chronic, suggesting a shift from the normal endocrine-gynecological functional axis. Occasional deviations usually have temporary causes, such as psychological or physical stress, while chronic anomalies are much more likely to have pathological organic causes such as polycystic ovary, endometriosis, hypogonadism or cancer. Population-specific reference data are useful to establish what is normal and acceptable, and what is not. Few population studies have been conducted in Italy on normal and dysfunctional characteristics of menstrual cycles. Since a knowledge of their variability is needed for patient education purposes and to guide clinicians’ investigations, treatment and follow-up, a cross-sectional school survey was conducted in 16 Italian cities (all over the country). Methods Sample and questionnaire This was a cross-sectional study on a population-based sample of Italian adolescents aged 13–21 years attending secondary school. Information was collected by means of a questionnaire. A list of secondary schools was randomly selected in 16 Italian cities located all over the country (Brescia, Bolzano, Ferrara, Foggia, Lecce, Modena, Novara, Padova, Parma, Pavia, Reggio Emilia, Taranto, Torino, Trieste, Verona, Vicenza). All the schools agreed to take part in the study and a local investigator explained the aims of the survey and the questionnaire to the science teachers at each school, who relayed this information to their students and distributed the questionnaires. Only girls who had already started menstruating were requested to participate. Informed written Page 2 of 8 consent was obtained from the students and their parents/guardians. The girls were asked to complete an anonymous, selfadministered questionnaire. Details on the sampling strategy used and on the questionnai (...truncated)