Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe stressful academic schedule of medical students poses an obvious challenge to their daily lifestyle. Psychosomatic discomfort poses a significant risk for inaccurate self-medication for ameliorating menstrual complications and feeling better, thus directly impacting personal and academic wellbeing.ObjectiveThe impact of menstrual disturbances on academic life is not extensively explored. Therefore, the primary objective of this research was to probe the prevalence of menstrual disturbances and assess the academic and social impact. Finally, the authors provide an overview of pharmacological and other interventions students adopt to reduce clinical symptoms.MethodsA database search was conducted from the year 2016 till September 2021 for the studies reporting the prevalence of menstrual disorders in all geographic locations of the world. Keywords used for searching databases included “menstrual disturbances” and “medical students,” “prevalence” OR “symptoms” of “Premenstrual syndrome” OR “Premenstrual dysphoric disorder” OR “Dysmenorrhea” in medical students. Prospero Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) protocols were followed. The protocol was registered in the International prospective register of systematic reviews (PROSPERO), the Center for Reviews and Dissemination, University of York (CRD42021277962). The quality of the methodologies used in selected studies was evaluated by a modified version of Newcastle Ottawa Scale (NOS).ResultsInitially, 1527 articles were available. After a review, 26 papers were selected for analysis. A total of 25 citations were identified for quantitative analyses, out of which 16 studies reported Pre-menstrual syndrome, 7 reported Pre-menstrual dysphoric disorder, and 13 articles reported dysmenorrhea. The pooled prevalence of Pre-menstrual syndrome was 51.30%, Pre-menstrual dysphoric disorder was 17.7%, and dysmenorrhea was 72.70%. Most common associated lifestyle factors were stress, excessive caffeine intake and lack of exercise. Painkillers, hot packs and hot beverages were amongst the common measures taken by the students to relieve their symptoms.ConclusionsThe current situation calls for action to accommodate students' needs and bridge the social gap regarding menstrual health. Proactive measures by medical educators and stakeholders are required for an inclusive, accommodating educational environment which will minimize the gender discrepancy in academic satisfaction and professional life.

Physical activity and combined hormonal contraception: association with female students’ perception of menstrual symptoms

“…Symptoms are not limited to females with menstrual disorders, such as oligomenorrhea and amenorrhea, but are also reported by females with a normal menstrual cycle (NMC) ( Roomruangwong et al, 2021 ; Righi and Barroso, 2022 ). During the late luteal phase, i.e., the premenstrual phase (PM), a systematic review reported a pooled prevalence of 51.3% of premenstrual syndrome in female students, with various reported self-perceived symptoms such as cyclic mood disorders, somatic or affective disorders, and severe fatigue ( Maity et al, 2022 ). This prevalence varies from 32% to 95%, with a majority of studies conducted outside Europe ( Yamamoto et al, 2009 ; Pinar et al, 2011 ; Hamaideh et al, 2014 ; Tolossa and Bekele, 2014 ; Romito et al, 2017 ; Bhuvaneswari et al, 2019 ; Hashim et al, 2019 ; Maity et al, 2022 ).…”

“…During the late luteal phase, i.e., the premenstrual phase (PM), a systematic review reported a pooled prevalence of 51.3% of premenstrual syndrome in female students, with various reported self-perceived symptoms such as cyclic mood disorders, somatic or affective disorders, and severe fatigue ( Maity et al, 2022 ). This prevalence varies from 32% to 95%, with a majority of studies conducted outside Europe ( Yamamoto et al, 2009 ; Pinar et al, 2011 ; Hamaideh et al, 2014 ; Tolossa and Bekele, 2014 ; Romito et al, 2017 ; Bhuvaneswari et al, 2019 ; Hashim et al, 2019 ; Maity et al, 2022 ). Always among female students, 72.7% report dysmenorrhea, i.e., painful menstrual cramps and other associated symptoms (low back pain, headache, vomiting, diarrhea, fatigue, or nausea) during the early follicular phase, occurring the first days of menses (ME) ( De Sanctis et al, 2016 ).…”

“…Always among female students, 72.7% report dysmenorrhea, i.e., painful menstrual cramps and other associated symptoms (low back pain, headache, vomiting, diarrhea, fatigue, or nausea) during the early follicular phase, occurring the first days of menses (ME) ( De Sanctis et al, 2016 ). This prevalence varies from 24% to 98% ( Maity et al, 2022 ), and in Europe, a recent study led in Spain reported a prevalence of 76% among university student ( Fernández-Martínez et al, 2019a ). Thirteen to 70% of females take hormonal contraception (HC), with a large majority taking oral combined estrogen-progestin oral contraceptives (CHC) ( Martin et al, 2018 ; Oxfeldt et al, 2020 ).…”

“…Exercise training appears to be accompanied by positive changes in food preferences in line with an overall improvement in appetite control ( Beaulieu et al, 2020 ), and we think it may reduce sugar/fat cravings during PM, although currently controversial ( Maged et al, 2018 ; Mohebbi Dehnavi et al, 2018 ). To relieve their symptoms, either during PM or ME, painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDS) and hot drinks are amongst the most common measures taken by the female students, and 61% have been reported to use analgesic drugs ( Maity et al, 2022 ). The absence of physical activity being often associated to dysmenorrhea ( Maity et al, 2022 ), it is possible that physical activity reduces cortisol and prostaglandins, and the need for NSAIDS.…”

“…To relieve their symptoms, either during PM or ME, painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDS) and hot drinks are amongst the most common measures taken by the female students, and 61% have been reported to use analgesic drugs ( Maity et al, 2022 ). The absence of physical activity being often associated to dysmenorrhea ( Maity et al, 2022 ), it is possible that physical activity reduces cortisol and prostaglandins, and the need for NSAIDS. It is to note that no study compared the effect of the level of physical activity on medication and self-reported diet changes during PM and ME.…”