RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISERTATION 1. NAME OF THE CANDIDATE AND ADDRESS Ms. PUSHPALATHA. P. I YEAR M. Sc NURSING, E.T.C.M. COLLEGE OF NURSING, P.O. BOX No. 4, KOLAR-563101, KARNATAKA 2. NAME OF THE INSTITUTION E.T.C.M. COLLEGE OF NURSING, P.O. BOX No. 4, KOLAR-563101, KARNATAKA. 3. COURSE OF STUDY AND SUBJECT M. Sc NURSING, OBSTETRICS AND GYNECOLOGICAL NURSING 4. DATE OF ADMISSION TO COURSE 01/07/2011 5. TITLE OF THE TOPIC “EFFECTIVENESS OF MINT LEAVES PASTE
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISERTATION
1.NAME OF THE CANDIDATE
AND ADDRESS
Ms. PUSHPALATHA. P.
I YEAR M. Sc NURSING,
E.T.C.M. COLLEGE OF NURSING,
P.O. BOX No. 4, KOLAR-563101,
KARNATAKA
2.NAME OF THE
INSTITUTION E.T.C.M. COLLEGE OF NURSING,
P.O. BOX No. 4, KOLAR-563101, KARNATAKA.
3.COURSE OF STUDY AND
SUBJECT
M. Sc NURSING,
OBSTETRICS AND GYNECOLOGICAL NURSING
4. DATE OF ADMISSION TO
COURSE
01/07/2011
5. TITLE OF THE TOPIC
“EFFECTIVENESS OF MINT LEAVES PASTE ON
DYSMENORRHEA AMONG ADOLESCENT
GIRLS”
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Adolescence is a transition period from childhood to adulthood and is
characterized by a spurt in physical, endocrinal, emotional, and mental growth, with a
change from complete dependence to relative independence. The period of
adolescence for a girl is a period of physical and psychological preparation for safe
motherhood. As the direct reproducers of future generations, the health of adolescent
girls influences not only their own health, but also the health of the future population.
Almost a quarter of India's population comprises of girls below 20 years. 1
One of the major physiological changes that take place in adolescent girls is
the onset of menarche, which is often associated with problems of irregular
menstruation, excessive bleeding, and dysmenorrhea. Of these, dysmenorrhea is one
of the common problems experienced by many adolescent girls.1
Globally adolescents account for 1/5th of the population that is more than 1
billion. 4 out of 5 adolescents live in developing countries. According to Population
Bureau in 1996, 30% of the total population was that of adolescents (284.02 million).
Due to gradual decrease in the growth rate of the overall population, there is little
increase in the number of adolescents in population projections till the year
2016(Population projection 1996-2016) census of India.2
The first menstrual period is called menarche. It usually starts between the ages
11 and 14. But it can happen as early as age 9 or as late as 15. Menarche is the sign of
growing up. In the days before the periods start, the adolescent may feel tense or
emotional, gain water weight and feel bloated, pain in the abdomen, back or legs that
lasts few hours or more.3
Menstruation is a normal, healthy occurrence for many years in life. Yet many
women, across a range of different cultures, experiences menstrual problem that range
from mild discomfort to acute pain. Although most women have some physical or
emotional changes or discomfort linked to menstrual cycle, a small number of about
5% find that the problems are more serious and may have to seek some kind of
treatment.2
The term dysmenorrhea is derived from the Greek words ‘dys’ meaning
difficult/painful,‘Meno’ meaning month and ‘rrhea’ meaning flow. Dysmenorrhea is
defined as pain or discomfort (cramps) during or just before a menstrual period. Two
types of dysmenorrhea are primary and secondary dysmenorrhea. When the menstrual
cycle begins prostaglandins are released by the endometrial cells as they are shed
from the uterine lining causing the uterine muscles to contract. If excessive
prostaglandin is present, the normal contraction response can become strong and
painful spasm. Uterine muscles deprive for oxygen and cause cramps.4
Dysmenorrhea is the most common gynecological problem in women in all ages.
Most adolescence experience dysmenorrhea in the first 3 years after menarche. Young
adult women ages 17 to 24 years are most likely to report painful menses between
50% and 80%of women report some level of discomfort associated with menses and
10 to 18% report severe dysmenorrhea. It has been estimated that up to 10% of
women have severe pain which interfere with their functioning for 1-3 days a month.5
Dysmenorrhea generally does not occur until ovulatory menstrual cycles are
established. Maturation of the hypothalamic-pituitary-gonadal axis leading to
ovulation occurs at different rates; approximately 18 to 45 % of teens have ovulatory
cycles two years post menarche, 45 to 70 percent by two to four years, and 80 percent
by four to five years. Dysmenorrhea occasionally accompanies anovulatory cycles,
especially if heavy bleeding and clots are present. The prevalence of dysmenorrhea
among adolescent females ranges from 60 to 93 %. Many adolescents report
limitations on daily activities, such as missing school, sporting events, and other
social activities, because of dysmenorrhea. However, only 15 % of females seek
medical advice for menstrual pain, signifying the importance of screening all
adolescent females for dysmenorrhea.6
Menstrual disorders are a common presentation by late adolescence, 75% of girls
experience some problems associated with menstruation. 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. 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
suprapubic 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 light
headedness 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. During the first two year after menarche, most cycles are an ovulatory.
Despite this, they are somewhat regular within a range of approximately 21 to 42
days, in contrast to an adult woman, whose cycles typically range between 21 and 35
days. The mean duration of menses is 4.7 days; 89% of cycles last 7 days, the average
blood loss per cycle is 35 ml. 7
Dysmenorrhea is the most common of gynecologic complaints. It affects half of
all female adolescents today and represents the leading cause of periodic
college/school absenteeism among that population. A cross-sectional descriptive
study was conducted in Rewa, Madhya Pradesh to evaluate the menstrual problem
specially dysmenorrhea and its severity in female medical students and its effect on
their regular activities. The study was conducted among 107 female medical students,
all participants were given a questionnaire to complete; questions were related to
menstruation elucidating variations in menstrual patterns, history of dysmenorrhea
and its severity, pre-menstrual symptom and absenteeism from college and /or class;
to detect the severity of dysmenorrhea verbal multi-dimensional scoring system was
used, the participants were given 20 minutes to complete the questionnaire. The mean
age of subjects at menarche was 12.5 (±1.52) years, with a range of 10-15 years. The
prevalence of dysmenorrhea was 73.83%; approximately 4.67%of dysmenorrhic
subjects had severe dysmenorrhea. The average duration between two periods and the
duration of menstrual flow were 28.34 (±7.54) days and 4.5 (±2.45) days respectively.
Prevalence of other menstrual disorders like irregularity, prolonged menstrual
bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and
3.73% respectively. Among female medical students who reported dysmenorrhea
31.67% and 8.68% were frequently missing college & classes respectively.
Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08%
reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among
female medical students, it is related to college/class absenteeism, limitations on
social, academic, sports and daily activities. Maximum participants do not seek
medical advice and self treat themselves with prostaglandin inhibitors; like
Ibuprofen.7
A total of 1648 adolescent girls from six districts of Karnataka were surveyed
to find out the incidence of dysmenorrhoea in Karnataka state. The survey showed
that the incidence of dysmenorrhoea was 87.87 percent among the adolescent girls. 8
The treatment available in the present scenario is not giving enough relief
from dysmenorrheal estimates of the effectiveness of current treatments including oral
Contraceptives and nonsteroidal anti-inflammatory drugs ranging from 64 to 90% of
patients but some women have intolerable side effects like upset and infertility. The
available treatments decrease impairment but not to the non menstruating level of
productivity for all women. Some patients resort to surgical treatment. The long-term
and associated health risks of dysmenorrhea have not been studied. Using of treatment
with different mechanism of action for the treatment of dysmenorrhea may benefit
some women to have complete relief from dysmenorrhea.9
Menstrual problem is one among the commonly found health disorders in
women. Irregularity of menstrual cycle in women may occur as temporary or as
permanent. Depending upon the cause and occurrence of problem, irregularity in
menstrual cycle is divided into versatile types like dysmenorrhea, endometriosis,
oilgomenorrhea and amenorrhea. Symptoms shown by a person suffering from
menstrual problem vary from one person to another. Common symptoms shown as a
result of menses problem include irritability; back ache, bloating, acne and food
cravings.10
Herbal supplement is found to be very beneficial for the treatment of
menstrual problems. Prolonged result with zero adverse action on user is one among
the main advantages of using herbal cures. Some of the herbs like mint leaves,
sesame seeds, and bark extract of ashoka tree etc are best recommended cures for the
treatment of menstrual problems.10
Mint is one of the herbs. It grows like a weed, is perfectly safe for use, and is
an excellent remedy for reducing symptoms related to digestion. It is well known for
its properties related to indigestion, stomach cramps, menstrual cramps, flatulence,
upset stomach, nausea, vomiting, and colic in children. 11
A pre experimental study was conducted to assess the effectiveness of the mint
extract upon dysmenorrhea among the students at Apollo school of Nursing, Chennai.
Pre experimental design was adopted and purposive sampling method was used and
35 students were selected as samples. Self administered questionnaire on
dysmenorrhea was administered. The levels of dysmenorrhea were assessed before
and after mint extract administration for consecutive days, 5 days before menstruation
and 3 days after menstruation. The pre test level dysmenorrhea score of students wear
high, M =6.46, SD=2.57 in comparison with the score of post test were M=1.2,
SD=1.26 the difference between the experimental pretest and post test is found to be
statistically proven to be significant (p<0.001). There was no significant association
between the selected demographic variables and pretest post test level of
dysmenorrhea score. The result could be attributed to the effectiveness of the mint
extract.12
A study was conducted to assess the effectiveness of mint leaves paste on
dysmenorrhea among adolescent girls at selected schools kanyakumari district, An
experimental design was adopted and purposive sampling method was used based on
the selection criteria 34 adolescent girls in experimental group and 16 adolescent
girls in control group. No intervention was given to control group, so the effective
participants in experimental group was 30, pre and post test were conducted after the
mint leaves administration. The data were collected using self administered
questionnaire the obtained mean difference between the pre test and post test
regarding dysmenorrhea score was 15.3, the obtained ‘t’ value t=9.89 (P<0.05) was
significant. Data on post mean dysmenorrhea score among adolescent girls in
experimental on control group was 8.81. The obtained‘t’ value t=4.01 (P<0.01) was
significant. Therfore it was inferred that adolescent girls in experimental group had
significant reduction in dysmenorrhea score compare to control group and mint leaves
paste was effective in reducing dysmenorrhea.13
6.2 REVIEW OF LITERATURE.
The literature relevant to this is reviewed and arranged in the following section
1. Literature related to dysmenorrhea among adolescents.
2. Literature related to mint Leaves ( Peppermint)
3. Literature related to mint leaves on Dysmenorrhoea
1. Literature related to dysmenorrhea among adolescents
A cross sectional study was conducted from Jan 2011 to May 2011 among 183
Adolescent girls (14-19years) in Schools and colleges of Kadapa town to estimate the
prevalence of dysmenorrhea among adolescent girls (14-19yrs) and also to study the
various symptoms of dysmenorrhea and its impact on quality of life of adolescent
girls. Out of 183 adolescent girls 119 (65%) are dysmennorhic, 68.4% and 61.2% are
from the urban and rural areas respectively. Out of 81 adolescent girls with family
history of dysmenorrhea 60 (74.1%) adolescent girls are dysmennorhic. Sickness
absenteeism is seen among 47.9% dysmennorhic girls. Quality of life is significantly
reduced among dysmennorhic girls. Almost 73.1% of rural girls rely on self help
technique to manage the dysmenorrhea as compare to urban girls (55.2 %).The study
was concluded that the dysmenorrhea is a very common problem among adolescent
girls; it affects their quality of life. It can be better managed by mental preparation and
by appropriate change in life style like regular physical exercise and with assurance to
the urban girls.14
A prospective study was aimed to investigate the prevalence of dysmenorrhea
in female college students in North Sichuan Medical College. Menstruation-related
diary data were obtained from 2640 female college students; dysmenorrhea and
related factors were analyzed. Dysmenorrhea occurred in 56.4% of students; 6.5% of
dysmenorrheal students suffered from “hard to bear” (unbearable) menstrual pain, and
6.5% had pre-menstrual dysmenorrhea. The more severe dysmenorrhea was, the
longer dysmenorrhea lasted, and the longer the duration of menstruation and the
larger the amount of menstrual blood flow appeared to be. Dysmenorrhea occurred on
37% of the menstrual dates on average and was unrelated to irregularity of menstrual
cycles. The percentages of students taking medicine with mild, moderate and
unbearable dysmenorrhea were 4.0%, 13.3% and 23.7%, respectively.15
A study was conducted to examine the prevalence, determinants, impacts,
and treatment practices of dysmenorrhoea, 664 female students in secondary schools
in urban and rural areas were studied. Data was collected through a self-
administered questionnaire. About 75% of the students experienced dysmenorrhoea
(mild 55.3%, moderate 30.0%, and severe 14.8%). Most did not seek medical advice
although 34.7% treated themselves. Fatigue, headache, backache and dizziness were
the commonest associated symptoms. No limitation of activities was reported by
47.4% of student with dysmenorrhoea, but this was significantly more reported by
students with severe dysmenorrhoea.16
An explorative survey was done among, 970 adolescent girls of age 15 to 20
years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior
shows that the prevalence of dysmenorrhea in adolescent girls was 79.67%. Most of
them, 37.96%, suffered regularly from severe dysmenorrhea. The three most common
symptoms present on both days, that is ,day before and first day of menstruation were
lethargy and tiredness (first), depression (second) and inability to concentrate in work
(third), whereas the ranking of these symptoms on the day after the stoppage of
menstruation showed depression as the first common symptoms.17
In an epidemiologic study of an adolescent population (aged 12-17 yrs), showed
a prevalence of dysmenorrhea of 59.7%. Of patients reporting pain, 12% described it
as severe; 37%, as moderate; and 49%, as mild. Dysmenorrhea caused 14% of
patients to miss school frequently. Although black adolescents reported no increased
incidence of dysmenorrhea, they were absent from school more frequently (23.6%)
than whites (12.3%), even after adjusting for socioeconomic status.18
A descriptive study was conducted among 26 high schools located in Erzurum,
Northeastern Turkey a total of 1951 single female adolescents, aged 13 to 18 years,
were selected for this study. The prevalence of dysmenorrhea was high among female
adolescents (68.1-72.2%). Pain mostly lasted for one to three days (56.6%), followed
by less than 1 day (23.5%) and more than 4 days (14.9%), respectively. Several
symptoms were observed including sweating, appetite loss, headache, distraction,
nausea/vomiting, dizziness, diarrhoea, and fainting. School performance was
negatively affected by dysmenorrhea. Findings of this research suggested that
dysmenorrhea prevalence was high among female adolescents. The duration and
intensity of pain adversely affected school and social attitudes towards their families
and friends.19
Most females experience some degree of pain and discomfort during menstrual
period, which can impact on their daily activities, and disturb their productivity at
home or at their workplace. During menstruation, they should consult a doctor and
take medications to relieve their pain and other relevant symptoms of dysmenorrhea.
Vomiting, diarrhea, headache, weakness and fainting. It is reported to be the most
common reason for females to visit a doctor in gynecology. According to reports, the
prevalence of dysmenorrhea is very high; at least 50% of women experience this
problem during their reproductive years. This problem not only causes discomfort in
approximately one-fifth of the female population, but also causes many social,
physical, psycho logic and economic problems for women all around the world. The
results of recent studies showed nearly 10% of females with dysmenorrhea
experienced an absence rate of 1 to 3 days per month from work or were unable to
perform their regular/daily tasks due to severe pain. Dysmenorrhea is considered the
main cause of absence from school, among young females.20
A Study on Prevalence of dysmenorrhea and its effect on quality of life
among a group of female university students in Turkey. A cross-sectional study was
conducted between 15 March and 15 April 2009 at Kutahya, High School. The study
group included 623 female students. Prevalence of dysmenorrhea was found to be
72.7% and was significantly higher in coffee consumers, females with menstrual
bleeding duration > or =7 days. Dysmenorrhea is a common health problem, having
negative effects on the Health related quality of life among university female
students.21
A Survey was conducted by Dalhousie University, Canada to determine the
adolescents medication usage to manage menstrual discomfort in a Public high
school on a sample of 386 adolescent girls 93% reported menstrual discomfort during
the last 3 menstruations and 70% of these had used over-the-counter (OTC)
medications to manage the discomfort. Users of OTC medications reported greater
symptom severity and disability than non-OTC users. Seventy-five percent of the
OTC medication users took within the recommended dose of 1 to 2 pills, but 57%
took medication less often than the maximum daily frequency. Seventy-one percent of
the prescription drug users took the prescribed amount, 13% took less, and 16% took
more. The study was concluded that the adolescent girls frequently suffer from
menstrual discomfort and use OTC medications to manage the discomfort, but they
may not be using OTC medications effectively. There are possible explanations for
medicating behavior and future research directions should be considered.22
A Cross-sectional survey was done to determine the impact and healthcare-
seeking behaviour of women with dysmenorrhoea in a Medical college, nursing
college, hospital (staff and patient attendants), schools and suburbs of Islamabad of
Population 1236 women aged 16–50.showed Prevalence of premenstrual symptoms
that are low back pain 879 (72%), depressed mood 484 (40%), headache 268 (22%),