Knowledge and Beliefs

regarding Menstruation
among Saudi Nursing
Students
By: Sarah Mae Bernales
Jessabel Arienda
 INTRODUCTION

METHODOLOGY
CONTENTS
REVIEW OF RELATED
LITERATURE

RESULTS AND
DISCUSSIONS
INTRODUCTION
INTRODUCTION

This study was undertaken to assess the knowledge and beliefs of

Saudi female nursing students towards menstruation. A cross
sectional survey was conducted on a sample of 40 students, the
data was collected using a self-administered questionnaire. The
results revealed that a considerable percentage lacked the
knowledge and correct beliefs regarding menstruation. Furthermore
a significant relationship was found between the marital status,
academic year and the score of knowledge and beliefs but not with
age. Although the source of information among the majority of the
participants was derived from their mother, those who had good
knowledge were the participants who belonged to the above 3rd
academic year. In conclusion, it is essential to emphasize the
importance of compulsory reproductive health education from an
early age to help adolescent girls manage menstrual symptoms and
increase their awareness; this could be achieved by adding a course
of reproductive health course beginning at the intermediate school
level.
 Background of Study

The menstrual cycle in females is an indicator of changes occurring during the adolescent stage.
The menstrual cycle is a component of natural changes that occur in the uterus and ovaries as
an essential part of sexual reproduction and it is accompanied by a change in the physical,
psychological and social aspects of a woman’s life. Menarche, the first onset of menstruation
occurs between the ages of 11 and 15 years old with an average age of 13 years old.Girls at the
age of puberty need to have educational sessions about the changes occurring to their bodies as
well as inclusion of their mothers in this process so that mothers can provide healthy advice to
their daughters about menstruation.The topic of menstruation still remains taboo in many
countries and discussions of problems related to menstruation are treated as shameful. The
attitude and behavior towards menstruation among girls is influenced by her socio-economic,
cultural and religious background and moreover her knowledge about menstruation.
METHODOLOGY
 METHODOLOGY

Sampling Procedures

Research Design
This chapter described the methods and means
Research Locale
by which the researchers carried out the study.
It contained the research design and
methodology utilized in the study, such as the Data Collection
research locale, sampling procedure, the
instrument used, and the data gathering
Statistical Analysis
procedure

Ethical Consideration
Sampling Procedures

n = N / (1+Ne2)

01
(n) = sample size
N = population size
e = margin of error

The respondents in this study are women who came and work in
the hospital. Based on the information provided 40 respondents.
The researchers used a combination of random sampling and
stratified sampling techniques. By using stratified sampling, the
researchers can ensure that participants from various ethnic
backgrounds within the target person are adequately represented
in the sample.
 Research Design
Descriptive correlational research is a type of research design
that tries to explain the relationship between two or more
variables without making any claims about cause and efffect

Quantitative research is a method of research that relies on

measuring variables using a numerical system, analyzing these
measurements using any of a variety of statistical models, and
reporting relationships and associations among the studied
variables

Descriptive research designs are used when researchers

want to describe specific behavior as it occurs in the
environment
The user can demonstrate on a
projector or computer, or print the
Correlational research isand
presentation a research
makewhich
it filmpurposeis to
find out the relationship between two or more variables
and their cause and effect
 Research Locale

Dr.Sulaiman Al Habib Medical

Group-Assuwaidi Branch

located in Hamzah Muttalib

Zahrah Al Zarah,Al
Swedi,Riyadh KSA.
Data collection

01The 02 using a valid, self-administered,

data was collected
anonymous questionnaire, included demographic data,
knowledge and beliefs questions about menstruation, all the
questions were close ended. The content validity was achieved
by reviewing the previous similar studies.

04 03
Statistical Analysis

The collected data were extracted in

the Microsoft Excel sheet format.
Regression analysis was applied for a
reliable way of determining which
variables have an impact on this
topic.
Ethical Consideration

Voluntary
Participation Confidentiality

Informed
Validity
Consent
REVIEW OF RELATED LITERATURE
 REVIEW OF RELATED
LITERATURE
The purpose of this literature review is to provide a general overview that searches into topics related to knowledge,
hygiene practices, and superstitions regarding menstruation. This chapter includes a summary of underpinning theory,
findings of literature reviews related to the research variables that were utilized as a guide and support the study.

Theoretical Framework Conceptual Framework

 Theoretical Framework

The underpinning of this study

was anchored by the Health Belief
Model that was created during the
1950s
 Health Belief Model
utilized in the study to guide health promotion and disease prevention programs. This will help investigate womens' health beliefs and
perceptions regarding menstruation and help explore their level of menstrual knowledge, hygiene and superstitious practices that greatly
affects their overall health

• the study by Michael et al. (2020) in • the study by Parle & Khatoon (2019)

l
Quetta city, Pakistan concluded that in selected schools of the Chitwan
poor access to health-related education

ru a district found that a significant

t
contributed to misconceptions about proportion of adolescent girls had
menstruation, leading to improper
management practices. The study
e s
n d ge
poor menstrual hygiene practices and
inadequate knowledge. It highlights

M wle
emphasizes the need for effective the importance of advocacy and

e
education provided in residential areas, awareness programs to strengthen
healthcare facilities, and religious

n o g i en their menstrual knowledge and

K Hy
centers to address these misconceptions. protect them from reproductive tract
infections.

d es
an actic
Pr
 Health Belief Model

• Maulingin-Gumbaketi et al. (2022) • Mukherjee et al. (2019) conducted a

conducted a study focusing on women in study in Kathmandu valley, Nepal,
Pacific Island Countries and Territories. examining socio-cultural perceptions
They found that social and cultural regarding menstrual restrictions. The
study revealed the presence of deep-

l
beliefs, practices, and norms

a
significantly affect women's ability to rooted religious and cultural
effectively manage their menstrual
health and hygiene. The study
s t ru s
superstitions, gender inequalities,
and social discrimination that
emphasizes the importance of
e n ti o n continue to impact women during

M rsti
incorporating effective education and menstruation. The researchers
programs on menarche into sexual and highlight the need for interventions
reproductive health planning to address

p e such as education, awareness, and

Su
these cultural and social factors. gender sensitization to bring about
practical changes in attitudes,
knowledge, and cultural practices
surrounding menstruation.
 Conceptual Framework
This chapter aimed to identify the potential variables stated in the study and how they have been associated to the study performed by
the researchers in assessing the level of menstrual knowledge, hygiene practices and superstitious beliefs regarding menstruation
among women in Riyadh,KSA

The explanation of the conceptual

framework provided relates to the Health
Belief Model (HBM) in several ways. The
Health Belief Model is a widely used
theoretical framework that aims to
understand and predict health behaviors
based on individuals' beliefs and
perceptions. In the given explanation, the
independent variables (demographic
profile) can be seen as influencing the
perceived susceptibility, severity, benefits,
and barriers related to menstrual
knowledge, hygiene habits, and menstrual
superstitions, which are key components
of the Health Belief Model.

Conceptual Framework showing the relationship between the different variables.

RESULTS AND DISCUSSIONS
 Demographic profile of the Respondents

AGE MARITAL STATUS

20
5 ACADEMIC YEAR MOTHERS EDUCATION
27.5
32.5
45 40

55

60
42.5
72.5

<18 18-20 21-23

>23 Single Married Foundation 3rd year < Intermediate
> 3rd year > Intermediate

The results in Table 1 showed that the majority of the students were between 21-23 years old
(42.5%) and 55% were single; according to academic level, 40% were in foundation,the rest were
in different academic levels also the majority of them the mothers’ level of education was
intermediate (20%) but also 55% have secondary level and 17.5% the mother cannot read and
write also 7.5% of them the level of mother education was university.
 Demographic profile of the Respondents
VARIABLES N %

AGE OF MENARCHE
6 15
11
12 30
12
14 35
13
7 17.5
14
1 2.5 These results for table 2 indicate a lack of
15
knowledge and beliefs about menstruation
whatever their source of information. As shown in
many previous studies, the information and beliefs
DAYS CYClE towards menstruation are transferring from
21 52.5
15-30
16 40 generation to generation by mothers, no matter
31-45
60-75
2 5 what the educational level of participants with such
1 2.5
90-105 a result of 80% which is more than the data that
they gather before. The results also of the current
study showed that the majority of participants
DURATION OF MENSTRUATION
menarche is between the age of 12-14 years, and
3-4 days 8 20 the majority of them having had a normal onset of
5-6 days 17 42.5
7-8 days 12 30 menstruation every month with 52.5 %.
9-10 days 3 7.5

SOURCE OF INFORMATION IN MENTRUATION

32 80
Mother
0 0
Friends
4 10
School Teacher
4 10
I have not received
 Demographic profile of the Respondents

VARIABLES N %

Regarding the physical complaints during

menstruation, majority 85% of girls experienced
Having PMS(Pre- Menstrual Syndrome) Symptoms
Yes
34 85 the PMS(Pre- Menstrual Syndrome) with the
6 15 symptoms of stomach ache, pain in lower back,
No
swollen and tender breast ,acne , and some stated
feeling fatigue . On being questioned about
psychological complaints such as
Loss of interest to work/study
30 75
tension/stress/palpitation, majority of samples
Yes 71.33% experiencing palpitation and stress and
10 25
No
28.67% did not have such complaints. It was found
that, during the menstruation, 75% sample
experienced less interest in work and study. And
Loss of interest in sex
38 95 95% of women less interest in sex.
Yes
2 5
No
 Demographic profile of the Respondents
VARIABLES N %
There were many social and religious restrictions on girls
I am taking shower during my period during menstruation that revealed in table 4. Girls
10 25
Yes received these instructions for do's and dont’s from
30 75
No
mothers, elder sisters, and friends. The questioned being
asked regarding the hygiene during menstruation; it was
I am using sanitary napkin
Yes
14 35 generally found to be lacking. In this study, 65 % of
26 65 subjects use reusable clothes to absorb menstrual blood
No
and they are usually torn from old saris.Only 35% was
I am washing my bikini every time I use bathroom
18 45
using sanitary napkins. Restrictions particularly related to
Yes prohibitions in going to religious places, offering prayers
22 55
No
and keeping fast. Most of women here believe that taking
shower and washing bikini especially with soap can lead
I am using feminine wash
Yes
12 30 to sickness.And they are not allowed to do intercourse
28 70 during period,but some did.
No

I avoid sex during period

35 87.5
Yes
5 12.5
No
 Demographic profile of the Respondents
ME
STATEMENTS N %
AN
A=14
Certain foods like eggs, dry fruits, and yoghurt and PA=8
352 2.1
green leafy vegetables can stop the menstruation UA=1
045
8

Taking shower during menstruation will increase A=23 57.

The results in Table 1 showed that the
the intensity of pain and results in discontinuation
of menstrual bleeding
PA=1
2UA=
530
12.
1.5
5 majority of the students were between 21-
5 5
23 years old (42.5%) and 55% were single;
Women with period are not allowed to join any
family gathering/party
A=29
PA=7
72.
517
1.3
8 according to academic level, 40% were in
UA=4 510
A=22
foundation,the rest were in different
Its not allowed to remove the unwanted hair during
menstruation
PA=1
2UA=
553
015
1.6 academic levels also the majority of them
6

Do not take vitamin c because it will discontinue

A=19
PA=1
47.
537 1.6
the mothers’ level of education was
the menstrual bleeding 5UA=
6
.51
5
6 intermediate (20%) but also 55% have
Its not allowed to divorce the women in her period
A=18
PA=1
452
7.5 1.8
secondary level and 17.5% the mother
1UA=
11
27.
5
3
cannot read and write also 7.5% of them
A=21 52.
Making a women(married) mad or sad can cause
sickness to her partner
PA=9
UA=1
522
.52
1.7
3
the level of mother education was
0
A=15
5
37.
university.
Doing Yoni Steam(vaginal steam) can remove the PA=1 535
1.9
odor 4UA= 27.
11 5
A=19 47.
Having sex during menstruation can cause health PA=1 525
1.8
problems to the couple 0UA= 27.
11 5
A=37 92.
Women (Islam) is forbidden to do prayers In her 1.0
PA=3 57.
period 8
UA=0 50
 Demographic profile of the Respondents
ME
STATEMENTS N %
AN
A=14
Certain foods like eggs, dry fruits, and yoghurt and PA=8
352 2.1
green leafy vegetables can stop the menstruation UA=1
045
8

Taking shower during menstruation will increase A=23 57.

The results in Table 1 showed that the
the intensity of pain and results in discontinuation
of menstrual bleeding
PA=1
2UA=
530
12.
1.5
5 majority of the students were between 21-
5 5
23 years old (42.5%) and 55% were single;
Women with period are not allowed to join any
family gathering/party
A=29
PA=7
72.
517
1.3
8 according to academic level, 40% were in
UA=4 510
A=22
foundation,the rest were in different
Its not allowed to remove the unwanted hair during
menstruation
PA=1
2UA=
553
015
1.6 academic levels also the majority of them
6

Do not take vitamin c because it will discontinue

A=19
PA=1
47.
537 1.6
the mothers’ level of education was
the menstrual bleeding 5UA=
6
.51
5
6 intermediate (20%) but also 55% have
Its not allowed to divorce the women in her period
A=18
PA=1
452
7.5 1.8
secondary level and 17.5% the mother
1UA=
11
27.
5
3
cannot read and write also 7.5% of them
A=21 52.
Making a women(married) mad or sad can cause
sickness to her partner
PA=9
UA=1
522
.52
1.7
3
the level of mother education was
0
A=15
5
37.
university.
Doing Yoni Steam(vaginal steam) can remove the PA=1 535
1.9
odor 4UA= 27.
11 5
A=19 47.
Having sex during menstruation can cause health PA=1 525
1.8
problems to the couple 0UA= 27.
11 5
A=37 92.
Women (Islam) is forbidden to do prayers In her 1.0
PA=3 57.
period 8
UA=0 50
 STATEMENTS N % MEAN

A=14 35
Certain foods like eggs, dry fruits, and yoghurt and green
leafy vegetables can stop the menstruation
PA=8
UA=18
20
45
2.1
Demographic profile of the Respondents
Taking shower during menstruation will increase the A=23 57.5
intensity of pain and results in discontinuation of menstrual PA=12 30 1.55
bleeding UA=5 12.5

Table 5 provides helpful insight regarding the superstitions

A=29 72.5 and beliefs during menstrual cycle of the students.
Women with period are not allowed to join any family
gathering/party
PA=7
UA=4
17.5
10
1.38 According to the survey,45% of students are not aware of
changing diets during period, even taking vitamin c are
A=22 55
strictly forbidden for those who have period with the rate of
Its not allowed to remove the unwanted hair during
menstruation
PA=12 30 1.6 47.5 %.The majority of students with the percentage of 57.5,
UA=6 15
also believed that taking shower can lead to sickness.The
A=19 47.5 table reveals that giving stress and discomfort for women
Do not take vitamin c because it will discontinue the
menstrual bleeding
PA=15
UA=6
37.5
15
1.66 with period can cause misfortune and sickness to their love
ones.About religion,92.5% believe that the women with
A=18 45 period are restricted to go on any religious places and offer
Its not allowed to divorce the women in her period PA=11 27.5 1.83
UA=11 27.5 prayers because they consider it as uncleaned.

A=21 52.5
Making a women(married) mad or sad can cause sickness
PA=9 22.5 1.73
to her partner
UA=10 25

A=15 37.5
Doing Yoni Steam(vaginal steam) can remove the odor PA=14 35 1.9
UA=11 27.5

A=19 47.5
Having sex during menstruation can cause health problems
PA=10 25 1.8
to the couple
UA=11 27.5

A=37 92.5
Women (Islam) is forbidden to do prayers In her period PA=3 7.5 1.08
UA=0 0
 Demographic profile of the Respondents
STATEMENTS N % MEAN
The results about the knowledge about menstruation were
showed in Table 6. According to the question about the
Menstruation, often known as a period, is a regular A=34
vaginal bleeding that happens once a month as part PA=5
851
1.18
menarcheal age in Saudi, 45% answered less than 12 years
2.5 old and 55% more than 13, also about the menstruation
of a women’s cycle. UA=1
2.5
duration, 20% answered less than 3 days, 37.5% more than
7 days, according to the menstruation cycle 52.5% of the
When a girl experiences menstruation, it indicates
A=32 participants answered between 15-30 days, 40% between 31-
that she has physically entered puberty in which 802 1.2
she is capable of getting pregnant.
PA=8
00
45 days,5% between 60-75 days and the least is 2.5% for 90-
UA=0 105 days. In addition,67.5% of the participants are aware
about the normal duration of mentruation,and 35% believe
67.
A=27 517 that they should change their napkin every 3 to 4 hours. 92.5
Menstrual bleeding usually lasts about 4-5 days 1.48 % of the participants believe also that the blood of
PA=7 .51
UA=6 5 menstruation is dirty and bleeding is useful and good to
release this dirty from body , also 35% of the participants
A=14 353
I regularly change sanitary pads or any period trust on the benefits about some kind of food omission
PA=1 7.5
supplies that I use every 3-4 hours or more if my 1.93
period is heavy.
5UA= 27. during menstruation, and 57.5% believe that during
11 5
menstruation no shower should be taken. And lastly 30% of
A=7P 17. participants believe that they should monitor or tract their
I believe that the use of more than 6 to 8 pads
A=18 545 period.
regular-sized menstrual pads per day is indication 2.2
UA=1 37.
of heavy menstrual flow.
5 5

A=12 303
PA=1 2.5
I need to tract and monitor my period. 2.08
3UA= 37.
15 5
 DISCUSSION
The body of knowledge surrounding women’s menstrual cycle remains tainted by age-old myths and taboos. Saudi females like other adolescents girls often lack knowledge
regarding reproductive health, including menstrual hygiene, which can be due to sociocultural barriers and restrictions in which they grow up, as few studies conducted in
Saudi show. Despite the number of the studies conducted about menstruation among adolescents, in Middle East and especially in Saudi Arabia, the need for highlighting this
subject is an essential and necessary requirement. Majority of the girls in Saudi Arabia lack scientific knowledge about menstruation and puberty. Adolescent girls are often
reluctant to discuss this topic with their parents and often hesitate to seek help regarding their menstrual problems.

The findings in the previous study showed that after health education, participants reported a significant improvement in “high knowledge and beliefs” scores also in
overall good menstrual practices they also reported a significant improvements in the regularity of their menstrual cycle and fewer complications during menstruation.
These results demonstrate the feasibility of implementing a health education program for the adolescents.
 CONCLUSION
The results of this study indicate that as a whole, the girls in Riyadh of Saudi Arabia were unaware of the information relating to
menstruation. This included the importance of increasing awareness and giving accurate information using scientific sources, such as schools,
colleges or health team members. It is required to discuss the issue related to menstruation early in the physiology of the hormones course to be easy
to understand during the course of reproductive health .
By addressing knowledge gaps, promoting proper hygiene practices, and challenging superstitious beliefs, we can work towards
enhancing menstrual health, overall well-being, and empowerment for all individuals. The results indicate a positive correlation between knowledge
and hygiene practices, highlighting the importance of educational interventions in improving menstrual hygiene. However, it is important to
acknowledge that addressing superstitious practices requires a more comprehensive approach beyond the mere dissemination of knowledge. Cultural
sensitivity, active community engagement, and involvement of key stakeholders are essential in effectively challenging deeply ingrained beliefs and
customs.
The interventions specifically targeting the students and individuals in the eldest birth order can further enhance hygiene practices.
Additionally, addressing superstitious practices among individuals from specific income backgrounds is crucial, as previous studies have shown the
influence of income on the prevalence of such beliefs. By combining evidence-based education, community involvement, and cultural sensitivity, we
can empower individuals to make informed decisions, promote reproductive health, and liberate themselves from harmful and unfounded beliefs.
Ultimately, these efforts will contribute to fostering a healthier and more progressive society.we can use also some other sources such as media outlets
may be used to increase awareness among the mothers in the community. This may aid in preventing any future physical problems, increasing self-
confidence, and improving the quality of life.
 Recommendations
Based on the conclusions given the following recommendations are listed below:
Students. Integrate menstrual education into school curricula at various educational stages to ensure students have a
comprehensive understanding of menstruation, including awareness, management, and hygiene practices.
For Instructors. Provide professional development opportunities for instructors to enhance their knowledge and confidence in
teaching proper menstrual management and dispelling superstitious beliefs as well as incorporate interactive and engaging
teaching methods to make menstrual education more engaging and relatable for students.
For the Ministry of Health. Collaborate with educational institutions to develop a standardized menstrual education program that
can be implemented nationwide and provide resources and training to teachers to effectively deliver menstrual education to
students.
For the Government. Establish partnerships with schools to implement community-based programs that raise awareness about
proper menstrual hygiene and debunk common menstrual superstitions. Additionally, allocate resources to support the
implementation of menstrual education initiatives in schools.
For the community. Organize community workshops and awareness campaigns to educate parents, caregivers, and community
members about menstruation, its importance, and proper hygiene practices.
For Future Researchers. This study will help them in conducting further research to explore the long-term impact of menstrual
education programs on students' knowledge, attitudes, and behaviors.
Thank you for
listening