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APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v6.i1.2019.8-14 

ISSN 2412 - 3188 

Original Article                                                                                  

Prevalence of dysmenorrhic pain among 

students; Its impact and management  
Uzma Firdous, Noaima Fatima, Ghazala Yasmeen & Lubna Naz 
Department of Physiology, University of Karachi 
 
 

Abstract 
Background: Dysmenorrhoea is a common gynecological problem affecting 60-
70% of the adolescent menstruating females. It has been widely neglected but it 
known to affect the quality of life and is the major cause of absenteeism among 
adolescent females. This study was conducted to assess the prevalence and impact 
of dysmenorrhea and the management strategies used by the students.  
Methodology: This cross-sectional study was conducted from March to December 
2015 at University of Karachi. A total of 350 female university students were 
randomly selected and dysmenorrhea was assessed using a self-administrated 
questionnaire. Data regarding demographic characteristics like age, physical 
measurements, dietary habits, family history, menstrual history, pattern of pain, 
pain intensity, stress and use of pharmacological agents used for coping was 
collected and statistically analyzed using SPSS Version 20. 
Results: A total of 350 female students were enrolled in the study, of which 300 
reported having dysmenorrhea with high prevalence in follicular phase i.e. 36%. 
The pain characteristics were also recorded and cramping pain was reported by 
20.6% of students followed by stabbing (18.6%) and abdominal distention (9.3%). 
Among the major associated systemic complaints with dysmenorrhea were 
headache (54.7%), nausea (50%), low back pain (LBP) (50%) and bloating (43.3%). 
Majority of females preferred medication for pain relief, ibuprofen was the drug 
of choice (14%) followed by paracetamol (12%). Among non-pharmacological 
approaches, relaxing therapy was ideal according to 18.6% of students.   
Conclusion: Dysmenorrhea is a prevalent cause of distress among the female 
students, although the condition is prevalent it is considered as a general 
complaint and mostly neglected. This menstrual complication is coupled with 
various symptoms that affect daily activities and quality of life. 

Keywords 
Dysmenorrhea, Abdominal Cramps, Menstrual Cycle, Management. 

 

 

 

 

 

Citation: Firdous U, Fatima N, Yasmeen 
G, Naz L. Prevalence of dysmenorrhic 
pain among students; its impact and 
management. APP. 2019; 6(1):8-14 
 
Corresponding Author Email: 
uzma.firdous1@gmail.com 
 
DOI: 10.29052/2412-3188.v6.i1.2019.8-14 
 
Received 10/02/2019  
 
Accepted 25/06/2019  
 
Published 12/10/2019 
 
Copyright © The Author(s). 2019 This  
 is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors 
have declared that no competing 
interests exist. 
 

https://doi.org/10.29052/2412-3188.v6.i1.2019.7-13
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Introduction  
Menstruation is a normal physiological 
process controlled by hypothalamopituitary 
hormones; it is one of the major signs of 
puberty. Several cultural norms had been 
linked to this reproductive event. It is taken 
as a gift and is celebrated in few cultures in 
order to destigmatize and minimize the 
associated shame and trauma1 while the 
others consider it impure and held their 
women in isolation and restricted diet and 
social interaction2-4.  Menstruation is often 
associated with irregular and/or excessive, 
painful bleeding scientifically referred as 
dysmenorrhea, pain sensation in pelvis 
directly linked with menstruation 
accompanied by many other symptoms5.  
 
Dysmenorrhea is categorized as primary 
dysmenorrhea and secondary 
dysmenorrhea. Primary dysmenorrhea is 
typically reported at the beginning of 
ovulatory cycles, in the first year of 
menarche6. Increased levels of prostanoids 
with eicosanoids results in hypercontractility 
of the uterus which leads to hypoxia and 
ischemia of the uterine muscles. Which in 
turn causes impaired and dysrhythmic 
contractions of the uterus which is believed 
to be the cause of underlying physiology of 
primary dysmenorrhea7. While secondary 
dysmenorrhoea is associated with certain 
pathological condition, women in 30’s and 
40’s are more likely to develop secondary 
dysmenorrhea8.  
 
For many years, menstruation has been a 
psychological trigger for young females due 
to the associated hormone fluctuations 
leading to anxiety, fear, anger, confusion, 
shame and depression9,10. Although 
complaints associated with menstrual cycle 
are high, but still these complaints are 
neglected and are given less priority in 
healthcare assessment7. The major symptom 
of lower abdominal pain or cramping is 
complicated by other systemic disturbances 
including various degrees of headaches, 
migraine, dizziness, vomiting, nausea, 
diarrhea, bloating, backache, legs pains, 

shivering and mood swings9,11. Which not 
only affect the routine activities and quality 
of life of female during the respective time 
duration but it has also become the major 
cause leading to gynecological visits, adding 
to the health related financial burden12,13. 
Age, low body mass index (BMI), tobacco 
consumption, early menarche, extended or 
irregular menstrual flow, infections, 
psychological and genetic factors are the 
major contributors for dysmenorrhea14,15.  
 
By far, the most reliable management 
modality preferred by both the sufferers and 
the healthcare providers is medication 
including non-steroidal anti-inflammatory 
drugs (NSAIDS) and oral contraceptives and 
lifestyle modifications like low fat 
consumption, is known to relief menstrual 
cramps16. Physical activity has been strongly 
recommended for females with complaints of 
dysmenorrhea. With respect to the local 
perspective, the condition is rarely known 
and considered by our females. Therefore, 
the present study was planned to investigate 
the prevalence of dysmenorrhea, associated 
symptoms and characteristics and preferred 
management options among the female 
students. 
 

Methodology 
This cross-sectional study continued for 9 

months from March to December 2015 at 

University of Karachi, Pakistan. Total 350 

female university students were randomly 

selected and enrolled in the study, while 

married females and those diagnosed with 

pelvic disease were excluded from the study. 

Data was collected using a structured 

questionnaire including details regarding 

sociodemographic characteristics, menstrual 

details like menarche age, menstrual cycle 

regularity, duration, flow, pain sensation 

description, phase of cycle with maximum 

pain feelings, severity of pain, other systemic 

symptoms experienced and the preferred 

approach to relief dysmenorrhea.  



 

   

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Menstruation was described as regular if 

cycle repeats every 28–32 days and continues 

for 5-7 days. Pain intensity was measured on 

a scale of 0–10 during menstruation, 

categorized as mild dysmenorrhea if lies 

between 1 and 3 point, moderate when 

between 4 and 7, and severe if falls between 8 

and 10 points 2. Written informed consent 

was taken from all participants prior to the 

study and the confidentiality was 

maintained.  

The collected data was analyzed using SPSS 

version 20, where quantitative variables were 

displayed using mean and standard 

deviation and frequency and percentages 

were used for qualitative variables. Pearson 

Chi-square test was applied to measure the 

association between different variables and 

p<0.05 was considered statistically 

significant.  

Result 
Out of 350 enrolled females, dysmenorrhea 

was reported by 300(86%) females while only 

50(14%) had no complaints of pain during 

menstruation.  190(63.3%) out of 300 

dysmenorrhic females hit puberty in between 

11-12 years. Irregular menstrual cycle was 

observed among 37% of the enrolled females. 

203(67.6%) females had 28-35 days cycle and 

mostly reported 5-7 days bleeding.  

Maximum dysmenorrhic pain was 

experienced during the follicular phase of the 

cycle i.e. 108(36%) while 86(28.6%) reported 

dysmenorrhea both in Ovulation & Luteal 

phase of the cycle. Cramping with lower 

abdominal discomfort, stabbing and burning 

were the most frequent complaints of 

dysmenorrhic females. 

 
Table 1: Description of menstruation and the characteristics of dysmenorrhea  

among female students 
Variables   n=300 

Dysmenorrhea  Present  300(85.7) 
Absent  50(14.2) 

Menarche Age (Years) 
 

<11 76(25.3) 
11-12 190(63.3) 
>12 34(11.3) 

Menstrual Cycle Regular 188(62.6) 
Irregular 112(37.3) 

Duration of Cycle (Days) 
 

<28 22 (7.3) 
28-35 203(67.6) 

>35 75(25) 

No of days of menstrual flow  <5 41(13.6) 
5-7 222(74) 
>7 37(12.3) 

Pain intensity   Mild 41(27.3)  
Moderate  84(56) 
Severe  25(16.6) 

Prevalence of dysmenorrhea 
during different menstrual 
phases  

Follicular  108(36) 
Ovulation  9(3) 
Luteal  80(26.6) 
Follicular & Ovulation  4(1.3) 
Follicular & Luteal  6(2) 
Ovulation & Luteal  86(28.6) 
Follicular, Ovulation & Luteal  6(2) 



 

   

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Characteristics of 
dysmenorrhic pain  

Burning 26(8.6) 
Cramping 62(20.6) 
Stabbing 56(18.6) 
Pulling 18(6) 
Breaking down  16(5.3) 
Abdominal distention  28(9.3) 

*Values are given as n(%)  
 
Headache (54.7%) was the most frequently reported symptom associated with dysmenorrhea 

(p<0.05) followed by nausea (50%), LBP (50%) and bloating (43.3%). Moderate pain (56%) was 

reported by most of the dysmenorrhic patients. 

Table 2: Relationship between dysmenorrhea and associated systemic symptoms 

Symptoms Dysmenorrhea p-value 

Present  Absent  

Nausea 75(50) 16(10) 0.001 

Vomiting 43(28.6) 15(10) 0.01 

Bloating 65(43.3) 21(14) 0.15 

Diarrhea 39(26) 12(8) 0.08 

Mood Changes 35(23.3) 7(4.7) 0.11 

Low Back Pain 75(50) 35(23.4) 0.09 

Headaches 82(54.7) 6(4) 0.04 
*Values are given as n(%)  
*p-value <0.05 is considered significant 

Table 3 shows the medicine and therapies preferred to address dysmenorrhic pain. Non 

pharmacological relaxing therapies (18.6%) were the most preferred management strategy for 

controlling dysmenorrhea. The frequently used pharmacological approaches include ibuprofen 

(14%) followed by paracetamol (12%) and herbal medicines (8.9%). Ponston, aspirin and buscopan 

were among the other rarely used pharmacological agents. 

Table 3: Preferred treatment options for dysmenorrhea 

Treatment Option  n(%) 

Ibuprofen  42(14) 

Paracetamol  36(12) 

Buscopan  10(3.3) 

Aspirin  8(2.6) 

Ponston  19(6.4) 

Herbal Medicine  27(8.9) 

Relaxing Therapy  56(18.6) 

Discussion 
This study aimed to identify the incidence of 

dysmenorrhea and associated systemic 

symptoms, pain severity, characteristics and 

its treatment among students. Our results 

highlighted that dysmenorrheal pain was 

relatively a common complaint in young 

females that is about 85.7% (Table 1), which 

is comparable to previous literature i.e. the 

reported prevalence among university 

students was 34% in Egypt, 70.2% in India, 

85% among Hispanic female adolescents, and 

93% in Australia17,18-20. There is a wide 

variation in the reported statistics worldwide 

as the protocols describing the 

dysmenorrheal pain and the 



 

   

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sociodemographic characteristics are 

different for each individual locale. 

Moreover, there are wide variety of 

perceptions and myths that undermine the 

significance of this female health issue which 

is the major reason behind negligence21. 

The scale of symptoms accompanying 

menstrual pain ranges from digestive 

disturbances like nausea, abdominal cramps, 

vomiting, aches and pains, tiredness and 

dizziness22. We found, the most complained 

symptoms included headache, LBP, nausea, 

and bloating which consistent to an Indian 

study, according to which tiredness (56.8%) 

was the major symptom associated with 

dysmenorrhea followed by back pain 

(40.1%)19. In contrast, a Palestinian study 

reported physical fatigue and emotional 

instability manifested as 

nervousness/irritability as the major 

symptoms observed among the 

dysmenorrhic females23. 

Majority of the respondents (47.2%) reported 

use of pain medication for relief (Table 3), 

similar results were produced in a study, 

where approximately 58% of dysmenorrheal 

students opted pain killer pills22. While 18.6% 

prefer relaxing therapy and a very few prefer 

herbal medication (8.9%). Whereas, in India, 

pharmacological management is less 

preferred by students (25.5%) while use of 

herbal medicine and other 

nonpharmacological approaches to relief 

pain are commonly practiced19. Women do 

not usually seek medical help for 

dysmenorrhea and mostly follow 

nonpharmacological approach including 

heat application24. 

This study was conducted with the aim to 

estimate the prevalence of dysmenorrhea 

among students, the impact and 

management associated with it. Although 

high prevalence of dysmenorrhea was 

observed among the females enrolled in our 

study but there were several limitations. The 

sample size of the study was too small and 

the study site was restricted to single center 

so the findings cannot be generalized for all 

local females of Karachi.   Nevertheless, the 

findings offered valuable information about 

menstrual health, its care, associated issues 

among students.  

Conclusion 
It can be concluded from the results that 

dysmenorrhea is prevalent among young 

females, complicated by a number of 

symptoms involving other systems that may 

affect sports activity, social activities, daily 

chores and quality of life as well and is 

becoming the leading cause of absenteeism in 

educational sector. Although dysmenorrhea 

significantly affects the quality of life, 

adolescent girls rely on self-care to ease the 

symptoms of dysmenorrhea without tracking 

the adverse drug reaction. Therefore, it is 

essential to organize and promote awareness 

programs among students regarding this 

restricting health condition, its associated 

impacts and the negative effects of 

consuming drugs without prescription and 

over the counter drugs (OTC). 

Acknowledgement  
Authors would like to thank Department of 

Physiology for their insight into the present 

study and to the women who participated in 

the study. 

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