Menstrual Health of In-School Adolescents in Ibadan: Knowledge, Attitudes and Consequences. *KM Owonikoko 1 , MA Okunlola 2 , OO Ogunbode 2 , OO Enabor 2 , TAO Oluwasola 2 and AO Arowojolu 2 . Nigerian Medical Practitioner Vol. 55 No 5, 2009 (80 - 83) *Correspondence 1 . Department of Obstetrics & Gynaecology, Ladoke Akintola University of Technology, College of Health Science, Osogbo, Osun State, Nigeria. 2 . Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria. 80 Nigerian Medical Practitioner Vol. 55 No 5, 2009 Introduction Adolescence marks the onset of attainment of gonadal maturity, associated changes in body habitus and psychological adjustment to adult life. It encompasses puberty which includes the occurrence of thelarche, puberche and menarche (1). A normal menstrual cycle depends on complex interactions between the hypothalamus, pituitary, ovaries and endometrium and abnormalities in these organs results in menstrual dysfunction. In adolescent females, menstrual disorders affect up to 75% and are a common reason for seeking medical attention (2). They are also a major cause of short-term school absenteeism (3-5). The most prevalent disorders among teens are dysmenorrhea, irregular menses and pre- menstrual syndrome (PMS) (5,6). Dysmenorrhea is usually associated with recurrent abdominal cramps, nausea, vomiting and back pain. It affects about 60-90% of adolescents (4,5,7-9). PMS has also been found to be highly prevalent among teenagers with 73% of a surveyed population reporting at least one pre-menstrual symptom, most frequently fatigue and irritability (10). Poor preparation for menarche leads to negative expectations; an adolescent is more likely to report dysmenorrhea and pre-menstrual syndrome (PMS) pain prior to menarche if she expects pain (6,11,12). Morbidity due to dysmenorrhea and PMS represents a substantial public health burden (13). Various studies have shown that symptoms of these disorders are a significant cause of school absence and lost working hours (13). Despite the implications of these findings, surveys have found that many adolescents do not report their symptoms. Klein reported that only 14% of teens in the United States of America (US) with dysmenorrhea sought help from a physician (4); in another study, 57% of girls that took OTC drugs for pain used medications less often than the maximum daily dosage (9). Majority of girls in an Australian school survey received advice to use non- pharmaceutical treatment such as hot water bottles, exercise or bed rest (8). This study was undertaken to evaluate the knowledge, attitudes and expectations of in-school adolescents regarding menstrual health. We also assessed the pattern of drug use for menstrual complaints and the effect of symptoms on school attendance and performance. Methods and Materials This cross-sectional study was conducted between 15 th September and December 15 th , 2008 in 210 secondary schools in 11 Local Government Council Areas of Ibadan, Southwest Nigeria during one academic term. Approval was obtained from the State Ministry of Education. Questionnaires were pre-tested and validated in 3 schools before administration. The respondents were female adolescents in Senior Secondary School classes 1-3. For this study, adolescents were females between the ages of 10 and 19 years of age at the time of enrolment (1). The questionnaires were self administered. It contained items on demographic data and assessed the respondents’ knowledge and attitudes to menstruation, drug use during menses and effects of menstrual disorders on school attendance. The questionnaire was written in English and designed to include simple terminology for easy Summary We evaluated the knowledge, attitudes to and consequences of menstrual morbidities among in –school adolescents in Ibadan and determined their effect on school attendance. The pattern of drug use for menstrual symptoms was also assessed. Self-administered questionnaires were given to 1194 respondents in secondary schools chosen by randomization. The mean age of respondents was 15.7 + years while 86.1% were aged between 10-17 years. The most prevalent menstrual disorder was dysmenorrhea (87.3%). The commonest source of information about the menstrual cycle was from mothers (71%) while 0.5% of adolescents obtained information from health care givers. Menstrual symptoms were treated with non-pharmacological means in 53.1%. Of girls using pharmacologic agents 44% of them obtaining over the counter medications (OTC). Forty four percent of respondents missed school for 6-7 weeks per session following dysmenorrhea while 19% of them required hospital admission. It was concluded that there is insufficient knowledge of the menstrual cycle and its abnormalities among adolescents. Menstrual health should be introduced as part of reproductive health programs in school curricula in Nigeria. Key Words: Menstrual health, adolescents, Ibadan