Introduction

Menstruation is a biological process experienced by half of the world’s population at some stage in their life. As a physiological condition, it affects health and well-being and is linked to dignity and equality. The WHO recognizes menstruation as a significant issue and recommends actions to address it under the three SDG goals: 3 (health), 5 (gender equality), and 6 (water and sanitation) (World Health Organization, 2022).

According to gynecologists, menstruation is one of the physiological indicators of teenage girls' health. (Mohamadirizi & Kordi, 2015). Adolescence is an age of physical growth and development, and menstrual issues affect the quality of life of girls.

During adolescence, the hypothalamic-pituitary-ovarian axis is still developing, which can result in irregular menstruation. Almost 90% of teenage girls experience menstrual cycles with lengths of 21 and 45 days or brief cycles every 20 days or so. By the age of three years, the menstrual cycle length ranges from 21 to 34 days and becomes normal by the age of 19-20 years (ACOG Committee, 2006).

Menstrual issues impact women's psychology, reproduction physiology, quality of life, family income, and community has been reported by various studies. (Mohamadirizi & Kordi, 2015). Menstruation abnormalities can be attributed to eating disorders reported in a study that poor eating habits adversely affect menstrual cycles (Amagin& Neupane, 2019). Eating disorders lead to weight loss, decreased body fat, hyperleptinemia, inappropriate eating attitudes, behaviors, exercise, and psychological stressors (Kotecha et al., 2014), which may be linked to menstrual disorders. During adolescence, girls have the opportunity to shape their health and prepare for motherhood. Considering the growth spurt during adolescence, the nutritional, medical, and educational requirements are high and should be met at the right time. Adolescence is a critical phase for developing daily routines and behaviors that last a lifetime; cultivating healthy eating habits becomes essential for physical growth (Fujiwara et al., 2007).

In India, 118.9 million adolescent girls (aged 10–19 years) constitute 20.2% of the total population (National Commission on Population, 2020). It is essential to investigate the menstrual health issues that affect the growth, health, and education of adolescents in the Indian context. Additionally, in West Medinipur, 56% of women aged 20-24 were found to be married before the age of 18 (Ashok et al., 2022). Given that nutritional status, influenced by diet, plays a significant role in lifestyle and quality of life and is crucial for growth and development (Viswanathan et al., 2017), it warrants study in adolescent girls in West Medinipur. Researchers are investigating the potential connection between menstrual irregularities and dietary habits. To date, few Studies have been conducted to assess this relationship.

This study was conducted with objectives: 1) to evaluate the menstrual disorders among teenage girls, 2) to determine the eating patterns of teenage girls, and 3) to determine whether BMI/ eating habits and menstruation disorders are related in adolescent girls.

Methods

A cross-sectional study was conducted among 231 adolescent girls from an urban high school in West Midnapur, West Bengal, India, to analyze the association between dietary habits and menstrual disorders among adolescent girls. According to the WHO definition, the adolescent age range is 10-19 years; however, in this study, the age group of 10-12 years was excluded due to the high school setting, as sample selection was conducted using a non- probability purposive sampling technique. The data collection period spanned from October 2018 to November 2019. A modified women's health questionnaire and daily diary entries were used to collect the data. A pre-tested questionnaire was used to conduct interview schedules for data collection, preventing misunderstandings and ensuring truthful answers. Data analysis was performed using Excel, and descriptive statistics were recorded for socio-demographic information, menarcheal age, menstrual cycle pattern, premenstrual symptoms, dysmenorrhea, dietary habits, and related symptoms. BMI was estimated by dividing the weight (in kilograms) by the height (in meters squared). Individuals were considered malnourished if their BMI was less than 18.5, regular from 18.5 to 24.9, and overweight if ≥ 25. The association between dietary habits, BMI, and menstrual disorders was determined using a Chi-square test, with significance at p < 0.05. Statistical analysis was performed using Excel. P- values were calculated using the X2 test, and p < 0.05 was considered significant.

Results

Two hundred thirty-one girls participated in this study. Menarche marks the beginning of puberty's biological changes. Girls have both veg and non-vegetarian. When stratified by age groups, 98 (42%) girls were aged 14–15 years, 84 (36.4%) were> 16 years of age, and 50 (21.6%) were 12–13 years of age. The mean ± SD age of the 14 participants was 1.58. Distribution according to the age of menarche reveals that 71 (30.7%) girls reported menarche at the age of 12–13 years, 120 (51.9%) girls between 14 and 15 years, and 40 (17.3%) girls by the age of 16 years. The mean ± SD age at menarche reported by the participants is 14 ± 1.58 (Table 1).

Table 1: Distribution of Adolescent Girls as per Age and Menarche

The study reported the prevalence of menstrual disorders during the menstrual cycle among 82.3% (n=190) of adolescent girls. Among these 190 girls, 41.1% (n=95) reported lower abdominal pain as the main problem, followed by body aches (16.5%) and anorexia (11.7%). Other participants (30.7%) reported backache, headache, malaise, mood swings, and nausea with vomiting as less common menstrual problems experienced during their menstrual cycle. The details are given in (Table 2).

The findings on the dietary habits of the 231 adolescent girls indicated that only 55.4% (n = 128) of the girls were following a healthy diet. Among the participants, 91.8% (n = 212) of adolescent girls preferred a non-vegetarian diet. Out of the 231participants, the habit of taking tea/ coffee was found in 85.7% (n=198) participants, 84.4% (n=195) girls were eating junk food more than 4 days per week, and 77.9 % (n=180) of total adolescent girls reported intake of food according to regular mealtimes (Table 3).

Table 3: Distribution of Adolescent Girls as per Dietary Pattern

The hypothesis testing to ascertain the association of BMI/dietary habits with mental disorders among girls was ascertained by X²test. A statistically significant association (p<0.0001) was reported by this study. This study revealed that the occurrence of menstrual disorders was found to be higher in obese adolescent girls, followed by overweight, underweight, obesity, normal weight, respectively and (Table 4).

*p value < 0.05 indicates a statistically significant association

Table 4: Association of Body Mass Index with Menstrual Disorders in Adolescence Girls

Discussions

Adolescent girls' menstrual health is crucial in preparing them for motherhood in the future. The key element that affects the experience during menstruation is diet (Yadav &Masand, 2018). In this study, 82.3% of teenage girls experienced menstrual problems during their menstrual cycle out of a total of 231 participants. Similarly, out of all the menstrual illnesses, over 41.1% of teenage girls reported lower abdominal pain as the most common issue. The ensuing less frequent menstruation issues that occurred during their menstrual cycle were back pain, headache, body pain, anorexia, malaise, mood swings, and nausea and vomiting.

The study's findings are consistent with those of many other studies. This study also shows a positive association of BMI/eating habits with menstrual issues. A previous study by Amagin and Neupane (2019) reported that menstrual issues were substantially correlated with non-vegetarian diets and more prevalent in non- vegetarian diets than in vegetarian diets (p < 0.001). The menstrual issues experienced by 87.9% of the participants, with 80.7% reporting lower abdomen pain, 65.7% headaches, and 20.7% mood fluctuations, similar to this study. (Amagin& Neupane, 2019) According to a similar study by P.V. Kotecha et al., 35% of the females had a fast-food eating habit, and half of them consumed chocolate, soft drinks, and fast food (Kotecha et al., 2014). However, in this study, 84.4% of girls consumed fast food, and 22% had irregular food habits.