​ INTRODUCTION

● DYSMENORRHEA: ​Dysmenorrhea is a cyclical lower abdominal

or pelvic pain which may also radiate to the back and thighs; it
occurs before or during menstruation, or both (​Raine-Fenning,
2005​). Cramps and pain are experienced in the lower abdominal
after regular ovulation is established. It begins soon after
menarche (​Reddish, 2006​). It is the most common gynecologic
complaint among adolescent and adult females17 ​.​The worldwide
prevalence of dysmenorrhea varies considerably among countries,
ranging between 50% and 90%.21 It was found to be 72.4%
among university students from India,​5​ 70%11

Menstrual disorders are a common presentation by late adolescence,

75% of girls experience some problems associated with menstruation
(1). Dysmenorrhea is a common problem in women of reproductive age.
Primary dysmenorrhea is defined as painful menses in women with
normal pelvic anatomy, usually begins during adolescence (2). It is
unusual for symptoms to start within first six months after menarche.
Affected women experience sharp, intermittent spasm of pain usually
concentrated in the supra- pubic area. Pain may radiate to the back of
the legs or the lower back. Systemic symptoms of nausea, vomiting,
diarrhea, fatigue, mild fever and headache or lightheadedness are fairly
common. Pain usually develops within hours of the start of the
menstruation and peaks as the flow becomes heaviest during the first
day or two of the cycle (3). It is usually possible to differentiate
dysmenorrhea from pre menstrual syndrome (PMS) based on patients
history. The pain associated with PMS is generally related to breast
tenderness and abdominal bloating rather than a lower abdominal
cramping pain. PMS symptoms begin before the menstrual cycle and
resolve shortly after menstrual flow begins (3). Painful menstruation with
pelvic pathology is defined as secondary
dysmenorrhea.7.Dysmenorrhea is highly prevalent among university
students and is related to school absenteeism, ability to participate in
and enjoy daily activities, and limitations in social activities/functioning.8.
Adolescent girls tended to have a higher prevalence of primary
dysmenorrhea than older women. 13
Based on this pathogenesis, the most common medications used to
relieve dysmenorrhic pain is non-steroidal anti-inflammatory drugs such
as ibuprofen and diclofenac sodium.14
Dysmenorrhea occurred significantly (p <0.01) more often in women not
using oral contraceptives. A significant correlation (p < 0.01) was found
between early menarche and an increased severity of dysmenorrhea. 5
There are 2 types of dysmenorrhea
1. Primary dysmenorrhea:
The primary dysmenorrhea is one where there is no identifiable pelvic
pathology.

Incidence​: The incidence of primary dysmenorrhea of sufficient

magnitude with incapacitation is about 15–20 percent. With the advent of
oral contraceptives and non-steroidal anti-inflammatory drugs, there is
marked relief of the symptom. Causes of pain: The mechanism of
initiation of uterine pain in primary dysmenorrhea is difficult to establish.
But the following are too often related. ​
● Mostly confined to adolescents. ​
● Almost always confined to ovulatory cycles. ​
● The pain is usually cured following pregnancy and vaginal delivery.
● The pain is related to dysrhythmic uterine contractions and uterine
hypoxia.
1. Psychosomatic factors of tension and anxiety during adolescence;
lower the pain threshold.
2. Abnormal anatomical and functional aspect of myometrium. Uterine
myometrial hyperactivity has been observed in cases with primary
dysmenorrhea.
The outer myometrium and the subendometrial myometrium are found to
be different structurally and functionally. The subendometrial layer of
myometrium is known as Junctional Zone (JZ). There is marked
hyperperistalsis of the JZ in women with endometriosis and
adenomyosis. In women with dysmenorrhea significant changes in JZ
are seen. These include irregular thickening and hyperplasia of smooth
muscle and less vascularity. This is known as Junctional zone
hyperplasia. Dysperistalsis and hyperactivity of the uterine JZ are the
important mechanisms of primary dysmenorrhea.
3. Imbalance in the autonomic nervous control of uterine muscle. There
is overactivity of the sympathetic nerves → hypertonicity of the circular
fibers of the isthmus and internal os. The relief of pain following dilatation
of the cervix or following vaginal delivery may be explained by the
damage of the adrenergic neurons which fail to regenerate.

4. Role of prostaglandins In ovulatory cycles, under the action of

progesterone, prostaglandins (PGF2 α, PGE2 ) are synthesized from the
secretory endometrium. Prostaglandins are released with maximum
production during shedding of the endometrium. PGF2 α is a strong
vasoconstrictor, which causes ischemia (angina) of the myometrium.
Either due to increased production of the prostaglandins or increased
sensitivity of the myometrium to the normal production of prostaglandins,
there is increased myometrial contraction with or without dysrhythmia.
The possible cause of pain owing to JZ change is shown schematically
below.

5. Role of vasopressin: There is increased vasopressin release during

menstruation in women with primary dysmenorrhea. This explains the
persistence of pain in cases even treated with antiprostaglandin drugs.
The mechanism of action is yet to be explored. Vasopressin increases
prostaglandin synthesis and also increases myometrial activity directly. It
causes uterine hyperactivity and dysrhythmic contractions → ischemia
and hypoxia → pain.

6. Endothelins causes myometrial smooth muscle contractions, specially

in the endomyometrial Junction (JZ). Endothelins in endometrium can
induce PFG2α. Local myometrial ischemia caused by endothelins and
PGF2α aggravate uterine dysperistalsis and hyperactivity.

7. Platelet-activating factor (PAF) is also associated with the etiology of

dysmenorrhea as its concentration is found high. Leukotrienes and PAFs
are vasoconstrictors and stimulate myometrial contractions.

Patient profile​: Primary dysmenorrhea is predominantly confined to

adolescent girls. It usually appears within 2 years of menarche. The
mother or her sister may be dysmenorrheic. It is more common amongst
girls from affluent society.

Clinical features​: The pain begins a few hours before or just with the
onset of menstruation. The severity of pain usually lasts for few hours,
may extend to 24 hours but seldom persists beyond 48 hours. There
were 23 symptoms grouped under four areas, such as, gastrointestinal
symptoms (GI), psychological symptoms (PS), eliminational symptoms
(ES), and other physical symptoms. The gastrointestinal symptoms were
loss of appetite, increased appetite, nausea, vomiting, anorexia, and
gaseous distension of abdomen. The psychological symptoms were
depression, excitability, irritability, inability to concentrate on work, and
nervousness. Elimination symptoms were: constipation, diarrhea,
frequency of micturition, and profuse sweating. Other physical symptoms
were lethargy and tiredness, headache, sleeplessness, increased sleep,
fullness and tenderness of breasts, feeling of heaviness in the lower
abdomen, pain and swelling in the ankle and knee joints, and swelling of
face.

These 23 symptoms associated with menstruation anddysmenorrhea

was ranked from the most commonly found at the day before
menstruation and to the day after stoppage of menstruation. This ranking
was done on the basis of the percentage of the girls who experienced
each symptom, and the ten most commonly occurring symptoms on the
day before, on the first day of menstruation, and the day after the
stoppage of menstruation are presented in Table 2.

Three most common symptoms present on both days, that is, the day
before and first day of menstruation were lethargy and tiredness (first),
depression (second), and inability to concentrate on work (third),
whereas, the ranking of these symptoms on the day of menstruation
showed headache and anorexia as the eighth common symptom.
Irritability was the second-most common symptom during the day before
menstruation, and it become less on the first day of menstruation and
the day after menstruation. Swelling of face was the least experienced
problem by the girls, among the total of 23 listed symptoms.10 Although
the use of oral contra- ceptives is another well-known alleviating factor of
dysmenorrhea.12
 2. SECONDARY DYSMENORRHEA (Congestive)
. Secondary dysmenorrhea is menstrual pain associated with underlying
pathology, and its onset may be years after menarche. It can be caused
by any of a dozen or so disorders such as endometriosis, pelvic
inflammatory disease, intra-uterine devices, irregular cycles or infertility
problems, ovarian cysts, adenomyosis, uterine myomas or polyps,
intrauterine adhesions, or cervical stenosis.1.​ About 5–8% of women
thus suffer from severe premenstrual syndrome (PMS); most of these
women also meet criteria for premenstrual dysphoric disorder (PMDD).
Mood and behavioural symptoms, including irritability, tension,
depressed mood, tearfulness, and mood swings, are the most
distressing, but somatic complaints, such as breast tenderness and
bloating, can also be problematic.24
Numerous epidemiologic studies have demonstrated that premenstrual
disorders (PMDs) begin during the teenage years. At least 20 % of
adolescents experience moderate-to-severe premenstrual symptoms
associated with functional impairment. Premenstrual syndrome (PMS)
consists of physical and/or psychological premenstrual symptoms that
interfere with functioning. Symptoms are triggered by ovulation and
resolve within the first few days of menses. 23

Causes of pain​: The pain may be related to increasing tension in the

pelvic tissues due to pre-menstrual pelvic congestion or increased
vascularity in the pelvic organs.

Common causes of secondary dysmenorrhea​: Cervical stenosis,

chronic pelvic infection, pelvic endometriosis, pelvic adhesions,
adenomyosis, uterine fibroid, endometrial polyp, IUCD in utero and
pelvic congestion. Obstruction due to mullerian malformations are the
other causes.

Patient profile​: The patients are usually in their thirties; more often
parous and unrelated to any social status.
Clinical features​: The pain is dull, situated in the back and in front
without any radiation. It usually appears 3–5 days prior to the period and
relieves with the start of bleeding. The onset and duration of pain
depends on the pathology producing the pain. There is no systemic
discomfort unlike primary dysmenorrhea. The patients may have got
some discomfort even in between periods. There are symptoms of
associated pelvic pathology. Abdominal and vaginal examinations
usually reveal the offending lesion. At times, the lesion is revealed by
laparoscopy, hysteroscopy or laparotomy.

PREMENSTRUAL SYNDROME (PMS)

Premenstrual syndrome (PMS) is a psychoneuroendocrine disorder of
unknown etiology, often noticed just prior to menstruation. There is cyclic
appearance of a large number of symptoms during the last 7–10 days of
the menstrual cycle. It should fulfil the following criteria (ACOG) :
● Not related to any organic lesion.
 ● Regularly occurs during the luteal phase of each ovulatory
menstrual cycle.
● Symptoms must be severe enough to disturb the life style of the
woman or she requires medical help.
● Symptom-free period during rest of the cycle. When these
symptoms disrupt daily functioning they are grouped under the
name premenstrual dysphoric disorder (PMDD).

Pathophysiology:
The exact cause is not known but the following hypotheses are
postulated:
(a) Alteration in the level of estrogen and progesterone starting from the
midluteal phase. Either there is altered estrogen : progesterone ratio or
diminished progesterone level.
(b) Neuroendocrine factors :
Serotonin is an important neurotransmitter in the CNS. During the
luteal phase, decreased synthesis of serotonin is observed in women
suffering from PMS.
Endorphins: The symptom complex of PMS is thought to be due to
the withdrawal of endorphins (neurotransmitters) from CNS (see ch. 7)
during the luteal phase.
γ-aminobutyric acid (GABA) suppresses the anxiety level in the
brain. Medications that are GABA agonist, are effective.
(c) Psychological and psychosocial factors may be involved to produce
behavioral changes.
(d) Others: Variety of factors have been mentioned to explain the
symptom complex of PMS. These are thyrotrophin releasing hormone
(TRH) prolactin, renin, aldosterone, prostaglandins, and others.
Unfortunately, nothing is conclusive.

Dysmenorrhea is very common in young girls.

The prevalence of dysmenorrhea according to severity as follows;
Without dysmenorrhea-13%
1-4 mild dysmenorrhea-22.92%
5-7 moderate dysmenorrhea-57.08%
8-12 severe dysmenorrhea-20.00%

The WALIDD scale..In this study,WALIDD is used the questionnaire for

dysmenorrhea is a validated & versatile 4 item questionnaire.The
WALIDD estimates the prevalence of dysmenorrhea recognizes the
existence (objective and subjective manifestation of dysmenorrhea).In
the questionnaire, there are 2 questions focused on subjective and same
number of question to rule out objective manifestation individual
questions based on subjective & objective have 4 options to give a
response, which are recorded from 0 to 3 points summing up the scores
by a simple additive manner,also generating mild, moderate & severe
scores ,each varying from 0 to 12 points.Use of WALIDD scores: if the
score of the questions is between 1-4 then it is diagnosed as mild
dysmenorrhea and if the score of the questions is between 5-7 then it is
diagnosed as moderate dysmenorrhea and 8-12 scores were diagnosed
as severe dysmenorrhea.
Family history ;the risk of dysmenorrhea is higher in those who have a
history of dysmenorrhea in their family.
In the study by wiam Rifati and Trini sudiarti(2020) it was reported that
family history of dysmenorrhea was dominant determinant for
dysmenorrhea among adolescents.(OR=6.80)

Emotional factors (stress) It is seen that stress increases the risk of

dysmenorrhea in females.In the study by Prashant Naik et al (2015) it
was reported that there was a significant variation in dysmenorrhea
during stress and non stress condition in college going girls.(values of
124 & 76.7 respectively)

BMI In this study by madhubala reported that relation between

dysmenorrhea and BMI was found to be significant (p<0.01) with
increased prevalence in the low BMI group.Hense, poor nutritional status
of adolescent girls leads increase dysmenorrhea.
Excessive sugar intake habit, age, sexual intercourse, early menarche
and heavy menstrual periods had significant association occurrence of
dysmenorrhea.

Another risk factor of dysmenorrhea in female is cigarette smoking.It is

seen that nicotine reduced endometrial blood flow & its common in
women with dysmenorrhea & smoking is known cause of
vasoconstriction.Hense smoker experiences more menstrual problems
such as prolong periods than do not smokes.

Numerous scientific researches highlight the effectiveness of

physiotherapy in the aid of dysmenorrhea.most recent report suggest
that a physiotherapy procedure obtains a positive outcome in most of the
patient (with the exercise and kinesio tap application).

NEED OF STUDY
Young girls under age of 20 are having greater risk of develop
dysmenorrhea.Therefore,there is a necessity of the survey, to estimate
the prevalence of dysmenorrhea as well as its type on the college going
females of ahmedabad physiotherapy college ,c m patel college ,and
sarda ben nursing college, because it adversely affects lifestyle and
health of women , moreover, to treat the condition with physiotherapeutic
interventions.
AIM AND OBJECTIVE
 ​AIM
To estimate the prevalence of dysmenorrhea by using WALIDD scale in
college going girls.

​OBJECTIVE
To determine the prevalence of dysmenorrhea and attitudes and
behaviour towards dysmenorrhea in the female students of university.
REVIEW Of LITERATURE
 REVIEW OF LITERATURE

1)Anibal A Tehran and luis Gabries pineros et al (2018) WALIDD score a

new tool to diagnose dysmenorrhea & predict medical leave in university
students .
In this study for validation of WALIDD , 585 young medical student were
enrolled in a two multidimensional scale including VRS & WALIDD . The
data from this study were statistically analysed to check WALIDD
internal consistency and the result of WALIDD were correlated strongly
with VRS scores (pain & drug subscales)
So,the researchers concluded that WALIDD score showed larger effect
size than the VRS (pain & drug score ) in the medical students & used
as outcome measure in clinical trial.

2. Moolral kavr and Naziya Nagori Noor et 91 (2015) Menstrual

Characteristic and prevalence of dysmenorrhea in college going girls.
This study involves 310 girls aged 18-25 years with a cross sectional
study. The collected data from 310 girls were assessed & the result was
that the number of girls reporting dysmenorrhea was 261 with the overall
prevalence of 84.2% they concluded that dysmenorrhea is found to be
highly prevalent among college going girls.

3.Wiam Rifati & Trini sudiarti (2020).A family history as dominant factors
associated with dysmenorrhea among adolescent.
Her objective for the study was to determine the dominant factors
associated with dysmenorrhea in adolescents.She used the following
methodology.A cross sectional study has been conducted among 177
female students in high schools Bekasi,Indonesia The multistage
sampling method was used to select the subject.After that data were
analysed using chi-square two mean difference,correlation,and multiple
logistic regression analysis.She concluded this: It is our conclusion that
family history of dysmenorrhea is the dominant for dysmenorrhea among
adolescent after controlling age of menarche & breakfast habits.So our
study concluded that positive family history is directly proportional to the
development of dysmenorrhea.
4.Prashant naik and Aashka Tanna et al (2015) variations of
dysmenorrhea during stress and non stress condition in college going
girls in belgium city : A cross sectional study.
In this study 400 college going adolescent girls were screened for
primary dysmenorrhea.And confirmation of primary dysmenorrhea was
done using Moos menstrual distress questionnaire after
confirmation,study results showed that there was a positive and
significant co-relation between each component taken in MMDQ.With
the mean values peaking mostly in stress group.Than in non stress
group so they concluded that there was significant variation in
dysmenorrhea during stress and non stress condition in college going
girls.

5.Abebaw Abeje muluneh & Tewodros seyaom Nigussie et al (2018)

prevalence & associated factors of dysmenorrhea among secondary &
preparatory school students in debremarkos town north west ethiopia.
Enrollment of 539 students in a institutional based cross sectional study
from secondary and preparatory school students asked to attend a self
administered questionnaire includes 4 parts 1) socio demographic
information 2) life style in behavioural issue 3)Reproductive issue &
menstrual pattern.
After collecting data were checked coded & entered in epi data version
3.1& exported to SPSS version 20 for analysis and concluded that
prevalence of dysmenorrhea was 69.3%and added that age physical
activity, sexual intercource early menaeche &heavy menstrual periods
had significant association with occurrence of dysmenorrhea.
6.LU-LU Qin & Zhao Hv et al (2020) association between cigarette
smoking the risk of dysmenorrhea:
27091 female aged above 15 years were enquired till nov
2019(accordant with the Moose guidelines),out of which 11,731 women
found to suffer from dysmenorrhea.The prevalence rate was
43.3%.Results showed that the smokers were 1.45 times more likely to
develop dysmenorrhea than non-smokers.(according to the individual
classification of currently smokers & former smokers ,currently smokers
were 1.50 times more develop dysmenorrhea than the never smokers &
former smokers was 1.31 times more develop dysmenorrhea than the
never smokers).In addition they concluded that significant association
between cigarette smoking (both current & former smoking) And
dysmenorrhea and adverse effect of smoking provide further support for
prevention of dysmenorrhea.

7. Madhubala chauhan and jyoti kala (2012) relation b/w DYS and BHI in
adolescents at rural versus urban variation.
In this cross-sectional study 400 population was taking. In this 200 rural
and 200 urban samples. School going adolescents (12-18 years) were
taken. The sample collected from 2 school of udaipur and bedia district
rajasthan. The data for BMI was collected by the measurement of height
Recorded by the stadiometer in CM as per ICMR guidelines 1957,
maintaining an accuracy of 0.5 cm and weight measured and balanced
beam scale with light clothes and no shoes up to 100 cm. A self
administered questionnaire include socio- demographic factors history
adn family history. Internal pain was assessed by the multidimensional
scoring system of anderson and milsom (1982) study results showed
that was very high (81.5% rural and 76% urban) In rural girls with mild
dysmenorrhea 71.84% had BMI < 16.5 with underweight moderate and
severe dysmenorrhea had BMI < 16.5. And in urban setup mild
dysmenorrhea 38.05% had BMI < 16.5 and moderate dysmenorrhea
80% had BMI 16.5% so the author concluded that relation b/w
dysmenorrhea and BMI was found to be significant (p<0.01)
Prevalence in the low BMI group and added that improve the nutritional
status of adolescent girls may reduce dysmenorrhea.

8. B pavithra and a sangeetha et 91 (2020) prevalence of menstrual

symptoms and primary dysmenorrhea among medical undergraduates in
south indian population.
In this study the sample were taken according to willingness for
participations informed consent were taken prior to data collection and
they were informed purpose and protocol of study before the distribution
of study. She used the following methodology - a cross selection study
was carried out among the medical undergraduates in saveetha medical
college and hospital. It includes 60 girls with the volunteered to
participate in the study.
A self report questionnaire was used and results showed that primary
dysmenorrhea was found in 43.9%. So they concluded that the primary
dysmenorrhea was highly prevalent among undergraduate medical
females.

9.Seyda celenay & Afra Alkan et al(2020) Effects of kinesio tape

application on pain,anxiety,menstrual complaint in women with primary
dysmenorrhea;A randomised sham controlled trial
A literature documented “difficult monthly flow amongst 51 turkish
women, based on shamed tape(ST)kinesio tape (KT) and control
groups. In this tape were not used in control groups,the result showed
that the decreases pain, anxiety & menstrual complaints were higher in
the (KT) group(p<0.05).They concluded that the KT application is
effective to reduce the pain anxiety levels & menstrual complaints in the
turkish women.

10.Ananda Vaiyapuri & Loganathan et al (2016) home based exercise

management in primary dysmenorrhea;
In this experimental study ,49 subject aged 18 to 25 years were enrolled
in a NPRS (self questionnair) and exercise:(cat stretch ,lower trunk
rotation ,buttock stretch, abdominal strengthening). NPRS were used to
assess the pain level as pretest & post test.
The data from this study were statistically analysed by paired t test to
compare the outcomes for NPRS(p<0.05) results showed that the
significant difference of questionnaire (p<o.oo1)after exercise.so
researchers concluded that exercise decreases duration & severity of
pain in primary dysmenorrhea.
MATERIALS
Study design: A cross-sectional observational study.
Sample Design: simple random sampling
Sample size:275
Source of data:sainath hospital bopal, ahmedabad.
C.m patel college gandhinagar ,gujrat.
Sarda nursing hospital.

MATERIAL USED:
1.Pen
2.pencil
3.Eraser
4.WALIDD scale
5.chair
6.consent form
7. Table

INCLUSION CRITERIA
● Subject willing to participate
● Age between 18-25 years
● Patient who can understands English,Hindi and Gujarati language.
● Patient with symptoms of primary dysmenorrhea including
abdominal pain,cramping,nausea,vomiting,headache,
diarrhea,breast heaviness,low back pain,medial or anterior thigh
pain,Onset pain within 6 to 12 hours after onset of
menses.Abdominal and pelvic pain lasting for 9 to 12 hours.

● Exclusion criteria
● Female with irregular menstrual cycle.
● Females who were following any other pharmacological drugs.
● Female with PCOS/PCOD
● Having any pelvic or gynecological abnormalities.
● Undergoing treatment by physician.
● Having respiratory or spinal problem.
● Diagnosed with secondary dymenorrhea.
● Having any endocrine disorder.
 ​ METHODOLOGY

After acquiring permission from authorities of ahmedabad physiotherapy

college ,ahmedabad to conduct a study in ahmedabad physiotherapy
college and others ,a cross sectional study was attempted by selecting
subjects who fulfilled the inclusion criteria and were taken in to
consideration then demographic data was listed and NPRS was taken.
Next to that the subjects were explained about dysmenorrhea and
WALIDD scale; moreover, the participants were made aware of their
participation in the survey through consent form in which the consent
was obtained by the signature of the respondent.

All criteria and details of females like age between 18-25 ,family history,
underlying pathology were confabulated through an interview while
addressing a WALIDD scale.The prevalence and type of dysmenorrhea
were determined by using the WALIDD scale, which is validated and
also an accurate 4 question questionnaire. 275 respondents were
selected in the period of 4 months that is jan to april 2020.The obtained
data were analyzed by using M.S excel. After that, a statistic was
consulted,and the data was analyzed through which the result was
inferred that more than half of the subjects were having dysmenorrhea
with a fraction of 87%.
 STATISTICAL ANALYSIS

The prevalence of dysmenorrhea was diagnosed by a WALIDD

scale,used to calculate mild moderate and severe dysmenorrhea.The
data of 275 samples were collected considering the age and
criterias.Simple random sampling design was used to collect the data
and were entered ,compiled and analysed in Microsoft Excel
spreadsheet version 2007 to find the prevalence of dysmenorrhea in
young females.
RESULTS
 RESULT

Total 275 participants were enrolled and 239 had dysmenorrhea.The

overall prevalence of dysmenorrhea in this study was 87% as presented
in pie chart.

The mean age of participants is 22years.In table 1, out of 239 subjects,

who are having dysmenorrhea,total 55,137,48 are having mild
,moderate,severe dysmenorrhea respectively.

Dysmenorrhea Type Frequency Prevalence Rate

Mild 55 20%

Moderate 137 50%

Severe 48 17%

Total 239 87%

Later on,firstly, severe dysmenorrhea accounted for 20%. Secondly, by
moderate dysmenorrhea contributing 57%, mild dysmenorrhea 23% as
depicted in pie chart.
DISCUSSION
 DISCUSSION

It is estimated that prevalence of dysmenorrhea varies from 20% to 95%

Dysmenorrhea is the most common gynecological complaint among
adolescent and young females4.Dysmenorrhea in adolescents and
young adults is usually primary(functional),and is associated with normal
ovulatory cycles and with no pelvic pathology.The results of a study
showed that most women (60.0 %) had menstruated for the first time at
11 or 12 years of age.20.Dysmenorrhea associated with late or early
menarche,low body weight BMI,genetic predisposition,active and
passive cigarette smoking,stress,diet,mental illness.​Most of students
didn't use appropriate food during menstruation.9​Primary dysmenorrhea
is far the most common gynecological problem in this age group.studies
conducted on female adolescents
report the prevalence range of primary dysmenorrhea from 20% to 90%.

In this study, we obtained asset of 275 young college going girls, who
were enlisted as subjects, by WALIDD scale.Next to that, by gathering
and statistically analysed data, the result was that 239 subjects were
having positive symptoms of dysmenorrhea and 36 subjects were
normal with no difficulty during menstruation.In other words,
dysmenorrhea in women aged 18-25 has prevalence rate of
87%.Another study conducted in Indore India; to find people suffering
from dysmenorrhea along with risk factors reported a higher ratio of
dysmenorrhea was 84.2% aged between (18-25).Hence, our study also
confines to be in parallel with the above mention data from resources.
The prevalence of dysmenorrhea is not yet clearly established in india
due variations in study,different definition of condition,size of
sample,unawareness,time period of conduction of study.
Regardless of these findings, many of the studies revealed that females
did not have appropriate knowledge about the dysmenorrhea and
menstrual period hygiene, and as a result lead to unhealthy practices.25
Exact cause of dysmenorrhea is unknown.Epidemiological studies
showed a link between dysmenorrhea and several environmental risk
factors,including current cigarette smoking ,those with family history of
dysmenorrhea had a significantly higher prevalence,coffee consumption
may be an important factor for dysmenorrhea.

Different mechanisms have been proposed for the relation between

livebirth and dysmenorrhea. One is related to the pathogenesis of
primary dysmenorrhea of the cluterus following term pregnancy, due to
disappearance of uterine adrenergic nerves and a decrease in uterine
noradrenaline in the third trimester of pregnancy, may explain the
disappearance or reduction of menstrual pain after childbirth

uterus following term pregnancy, due to disappearance of uterine

adrenergic nerves and a decrease in uterine noradrenaline in the third
trimester of pregnancy, may explain the disappearance or reduction of
menstrual pain after childbirth.2

In some studies, mild to intermediate menstrual pain has been

considered sufficient to define dysmenorrhea. Others have considered
dysmenorrhea to be menstrual pain associated with “the need for
medication and the inability to function normally. These two definitions
are quite different, and the current study found that the intensity of
menstrual pain does not coincide with a need for medication or the
inability to function normally. Approximately 55% of the women in the
current study reported menstrual pain and a need for medication, with
poor social functioning or absenteeism (features of not functioning
normally) as a result of menstrual pain ranging from 32% to 40%. When
evaluating the most complete picture of dysmenorrhea characterized by
menstrual pain, absenteeism, and a need for medication, prevalence is
about 25%. How dysmenorrhea is defined will have an impact on figures
regarding its prevalence.3
The girls in urban areas cannot cope up dysmenorrhoea and they have
resorted to medication as also shown by El-Gilany AH, Badawi K,
El-Fedawy S. 17and Awasarala AK and Panchangam S.3 On the
contrary, the girls in the rural areas are adapting to the situation by
endurance and managing the problem without drugs to a large extent.
They are using self help techniques such as cold baths, lying supine, hot
fomentation, home remedies like eating Fenugreek etc. 6

study conducted in Iran supports use of physical activity had positive

impact on the most of primary dysmenorrhea symptoms.The present
study showed that most of the participants were using home remedies
as a nonpharmacologic treatment option for dysmenorrheal pain. As the
degree of pain increases, the use of home remedies increases.15

This study however found a significant association between a

respondent experiencing dysmenorrhea and the chronological as well as
gynecological ages which was also reported in other studies which
showed that incidence of dysmenorrhea decreases with increasing
chronological age or gynecological age.16
It would have been expected that the undesirable effects of
dysmenorrhea and menstruation associated symptoms on the activities
of respondents, would cause them to be eager to visit the hospital but
only 16.3% ever did so. Similar hospital attendance rates between 12.1
and 18.0% were reported in Iran, Malaysia, Nigeria, Turkey and the USA
. A mere 3% was even recorded in Oman . Self-treatment of menstrual
pain using mostly non-steroidal anti-inflammatory drugs and
antispasmodic drugs seem to be the most common practice in many
countries . The self-treatment of dysmenorrhea by many women rather
than visit a hospital is because many consider the pain as normal thus
not worth taking to a hospital where they may join long queues to consult
a physician.

The menstrual period was significantly longer in the dysmenorrhea group

(P<0.05), but the correlation of menstrual cycle length and
dysmenorrhea was not significant. This finding agrees with the study that
showed no correlation between menstrual period regularity and
dysmenorrhea27
A study from New Delhi, India showed that premenstrual syndrome and
dysmenorrhea were perceived as the most distressing symptoms
associated with menstruation by 67% and 33% unmarried
undergraduate medical students respectively (21). Dambhare DG et al
found that prevalence of dysmenorrhea and PMS was 56% in their cross
sectional study conducted on 1100 school adolescent girls in district
Wardha, Central India (11). Unsal A et al had found out that prevalence
of dysmenorrhea among college going students in western Turkey was
72.7% (n = 453). Prevalence rates of dysmenorrhea were found to be
72.7% in Turkey, 74.5% in Malaysia, 72% in Ethiopia and 53.3% in
Nigeria (8, 22-24). Thus, in a nutshell, prevalence of dysmenorrhea in
young female students is high and this finding of our study is in
concordance with others. 18

Our study showed that the prevalence of dysmenorrhea is slightly higher

than those previously reported in a Thai population by Tangchai K et al
(84.2%) and Chongpensuklert Y et al (84.9%). These studies conducted
in a younger age group of adolescents (16-19 years). Many previous
studies determined that the prevalence of primary dysmenorrhea falls
with increasing age. The present result was in concordance with
previous studies.19
 CONCLUSION

During the administration of survey, all most the all of the females were
experiencing dysmenorrhea.They believed it is a normal phenomenon
.However it is not with the WALIDD, we concluded that dysmenorrhea is
a common problem in females.From our study prevalence of
dysmenorrhea in females living in ahmedabad aged 18-25years is 87%.
In that according to the severity of dysmenorrhea, mild moderate and
severe dysmenorrhea 17%,20% and 50% respectively.To prevent
unnecessary suffering and interruption ,females should be made aware
of the dysmenorrhea,severity of dysmenorrhea,risk factors associated
with dysmenorrhea and treatment of dysmenorrhea to help them cope
with the challenges of dysmenorrhea and so that it can improve quality
of life.
SUMMERY
 SUMMERY

Dysmenorrhea is a condition which affects women

psychologically,physiologically and socially.Many women prefer to keep
such suffering to herself. In this research, a cross sectional observational
study was conducted to find the prevalence of dysmenorrhea in young
girls aged 18-25 years.(WALIDD) scale was filled by 275 young girls
based in ahmedabad (i.e sainath hospital,c.m patel college,sarda
nursing college)and gandhinagar college.It was observed that the
prevalence rate is 87% and in that moderate dysmenorrhea is most
common with 57%.It also indicated that it might be affecting their quality
of living and behaviour with family and friends.The need of
physiotherapy treatment was felt as it is an intervention which does not
affect the women mentally or physically, which is mostly seen when
person undergoes surgery.
LIMITATION OF STUDY
 LIMITATION OF STUDY

1.Small sample size to precisely identify the prevalence of

dysmenorrhea.
2.There is no translation of the WALIDD questionnaire into regional
language.
3.The treatment regime has not been discussed in this study.
4.There are several limitations to the current research. It was not
possible to discriminate between primary and secondary dysmenorrhea,
and menstrual pain as a whole was considered.
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