Introduction
Abnormal Menstrual Bleeding (AMB) is defined as bleeding from uterine corpus that is abnormal in regularity, volume, frequency or duration and occurs in absence of pregnancy.1
AMB includes heavy menstrual bleeding (HMB) and intermenstrual bleeding (IMB) or both.2 IMB is defined as bleeding which occurs between clearly defined cyclic and predictable menses. It includes unpredictable random bleeding episodes and those which occur at same time in each cycle.3
About 1 in 20 women of age 30-49 years seek help annually for menstrual problems.4 30% of gynaecological complaints are AMB.5 AMB varies with age, being higher in adolescents and fifth decade of life.3
Normality and abnormality regarding menstruation depends upon women’s understanding of menstruation and their perception of its function.2 It is important to gain understanding of women's views, misconceptions, and awareness of the treatments available. Due to impracticality of the quantitative measurement of Menstrual Bleeding(MBL) in clinical practice, National Institute of Health and Clinical Excellence guidelines now subjectively define HMB as ‘excessive blood loss interfering with woman’s physical, emotional, social and material Quality of life(QoL).4 Hence, there is a need to study the impact of AMB particularly on women's QoL.
Objectives
To assess the knowledge and behaviour of the women towards AMB and it’s impact on various aspects of their life.
Materials and Methods
This study was conducted at the OPD of the OBGY department of the medical college of tribal region of central India. It is a ‘cross sectional descriptive study’. Women attending OBGY OPD during the study period were included in the study except for the pregnant ladies, ones with h/o hysterectomy and those who denied consent. The participants were given pre designed questionnaires. Permission from the IEC has been sought prior to the start of the study. Verbal consent has been obtained from every participant.
The study will explore the in-depth knowledge of women in tribal regions towards AMB. This may help women to come out with their views regarding MBL without hesitation which will ultimately allow healthcare professionals to know the impact of AMB on qoL of women and hence provide proper treatment options.
Result and Discussion
The questionnaire revealed most bothersome factors playing a role in qoL associated with AMB Complaints like pain, heaviness, irregularity, breast pain, breast swelling, physical weakness, irritability, mood changes, stress and loss of confidence were asked. Regarding to knowledge and attitude of AMB, the participants were asked about normal and abnormal menses, awareness of the condition, its consequences, knowledge and seriousness of treatment. The practices of participants were evaluated by contraceptive practices and methods of sanitation (pad/ cloth) and other factors like age, occupation, education and marriage which might influence their practices.
Table 1
In comparison with the study of Harpreet Kaur et al, the percentage that the above complaints consist in women with AMB are 53% for pain, 91% for heaviness, 37% for mood changes, 74% for irregularities, 13% for breast complaints the rest constituting 5%, this study has a distribution as shown in the following graph.
Table 2
|
Knowledge and attitude criterias |
Present (%) |
Absent (%) |
|
Knowledge about AMB |
81 |
19 |
|
Know what is AMB |
85 |
15 |
|
Consequences |
41 |
59 |
|
Available treatment |
70 |
30 |
|
Seriousness of treatment |
82 |
18 |
Knowledge about AMB, compared with Harpreet Kaur et al study (97.7%), this study has awareness in 81% of its participants. This might be attributed to the tribal setting of the study, where education is not well established. This might also apply to the seriousness of treatment, (100% in Harpreet Kaur study).
According to Mahboobeh Kafei study, both extremes of BMI are associated with menstrual disorders. Also, duration of menstruation was significantly related to anthropometric indices of obesity.6 Also according to Rinayash Ganesh study, duration is related to BMI but BMI doesn't affect bleeding amount and interval between two menses.7 As per Ahamed et al. study, AMB was significantly related to occupation and contraceptive use. Abnormalities were seen more in housewives and women who do not practice contraception.8 Also dysmenorrhea was the main complaint so as in our study. Myths regarding menstruation always have been a 'taboo’ in India.
This has an impact on women's social, emotional state, mentality and QoL and health.9 According to Suneela Garg study, not entering 'puja room’ and kitchen are the major restriction among urban girls and rural girls respectively.9 Majority women in our study have similar myths and misbeliefs irrespective of their education or occupation.
Table 3
Conclusion
In conclusion this study provides recent epidemiological information about the knowledge, attitude and practices of women suffering from AMB residing in the tribal regions. This research highlights the significant problems arising with AMB, most common being pain which incapacitates the ability of these women to perform their daily work. Study also focuses on assessing the knowledge of the participants about the disease, its consequences and whether they seek medical care at the right time. This study suggests that women belonging to the study region have a lesser understanding of the seriousness of treatment. Hence, there is an increased need to provide health and reproductive education in the peripheries to improve the qoL of these women.
