Why Do Some Spanish Nursing Students with Menstrual Pain Fail to Consult Healthcare Professionals?

Juan Diego Ramos-Pichardo, Ángela María Ortega-Galán, María Teresa Iglesias-López, Ana Abreu-Sánchez, Elia Fernández-Martínez, Juan Diego Ramos-Pichardo, Ángela María Ortega-Galán, María Teresa Iglesias-López, Ana Abreu-Sánchez, Elia Fernández-Martínez

Abstract

Dysmenorrhea is a problem that affects a large percentage of young women worldwide. Alarmingly, the majority of these women choose to self-medicate rather than consult a healthcare professional, despite the risks involved. The present study aimed to explore the reasons why undergraduate nursing students do not consult health care professionals regarding their menstrual pain. A qualitative study was conducted using an open question: "Why didn't you consult a healthcare professional?" within the context of a research project on primary dysmenorrhea among nursing students at the University of Huelva, Spain. The responses of 202 women were analyzed using content analysis. Three categories were identified: assessment of the pain experienced, expectations, and experiences of professional care and selfcare. We found a striking normalization of the problem; notably, students downplayed the importance of the problem, considering that it was not worth consulting a physician. Furthermore, there was a notable degree of self-medication using non-steroidal anti-inflammatories (NSAIDs). These results may be useful for orienting policies to raise social awareness of this problem and for designing health education strategies aimed at women with primary dysmenorrhea.

Keywords: dysmenorrhea; menstrual pain; pain management; qualitative research.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Main reasons why women with dysmenorrhea do not seek health consultations and proposed health policies to address this issue.

References

    1. Iacovides S., Avidon I., Baker F.C. What we know about primary dysmenorrhea today: A critical review. Hum. Reprod. Update. 2015;21:762–778. doi: 10.1093/humupd/dmv039.
    1. Fernández-Martínez E., Onieva-Zafra M.D., Parra-Fernández M.L. Lifestyle and prevalence of dysmenorrhea among Spanish female university students. PLoS ONE. 2018;13:e0201894. doi: 10.1371/journal.pone.0201894.
    1. Fernández-Martínez E., Onieva-Zafra M.D., Abreu-Sánchez A., Fernández-Muñóz J.J., Parra-Fernández M.L. Absenteeism during menstruation among nursing students in Spain. Int. J. Environ. Res. Public Health. 2020;17:53. doi: 10.3390/ijerph17010053.
    1. Chang S.-F., Chuang M. Factors that affect self-care behaviour of female high school students with dysmenorrhoea: A cluster sampling study. Int. J. Nurs. Pract. 2012;18:117–124. doi: 10.1111/j.1440-172X.2012.02007.x.
    1. Barcikowska Z., Rajkowska-Labon E., Grzybowska M.E., Hansdorfer-Korzon R., Zorena K. Inflammatory markers in dysmenorrhea and therapeutic options. Int. J. Environ. Res. Public Health. 2020;17:1191. doi: 10.3390/ijerph17041191.
    1. Fernández-Martínez E., Onieva-Zafra M.D., Parra-Fernández M.L. The Impact of Dysmenorrhea on Quality of Life Among Spanish Female University Students. Int. J. Environ. Res. Public Health. 2019;16:713. doi: 10.3390/ijerph16050713.
    1. Armour M., Parry K., Manohar N., Holmes K., Ferfolja T., Curry C., MacMillan F., Smith C.A. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. J. Women’s Health. 2019;28:1161–1171. doi: 10.1089/jwh.2018.7615.
    1. Schoep M.E., Adang E.M.M., Maas J.W.M., De Bie B., Aarts J.W.M., Nieboer T.E. Productivity loss due to menstruation-related symptoms: A nationwide cross-sectional survey among 32 748 women. BMJ Open. 2019;9:e026186. doi: 10.1136/bmjopen-2018-026186.
    1. Libarle M., Simon P., Bogne V., Pintiaux A., Furet E. Management of dysmenorrhea. Rev. Med. Brux. 2018;39:264–272.
    1. Stosic R., Dunagan F., Palmer H., Fowler T., Adams I. Responsible self-medication: Perceived risks and benefits of over-the-counter analgesic use. Int. J. Pharm. Pract. 2011;19:236–245. doi: 10.1111/j.2042-7174.2011.00097.x.
    1. Sugumar R., Krishnaiah V., Channaveera G.S., Mruthyunjaya S. Comparison of the pattern, efficacy, and tolerability of self-medicated drugs in primary dysmenorrhea: A questionnaire based survey. Indian J. Pharmacol. 2013;45:180–183. doi: 10.4103/0253-7613.108312.
    1. Oladosu F.A., Tu F.F., Hellman K.M. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: Epidemiology, causes, and treatment. Am. J. Obstet. Gynecol. 2018;218:390–400. doi: 10.1016/j.ajog.2017.08.108.
    1. Armour M., Smith C.A., Steel K.A., MacMillan F. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: A systematic review and meta-analysis. BMC Complement. Altern. Med. 2019;19:22. doi: 10.1186/s12906-019-2433-8.
    1. Armour M., Parry K., Al-Dabbas M.A., Curry C., Holmes K., MacMillan F., Ferfolja T., Smith C.A. Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLoS ONE. 2019;14:e0220103. doi: 10.1371/journal.pone.0220103.
    1. Bernardi M., Lazzeri L., Perelli F., Reis F.M., Petraglia F., Bernardi M., Lazzeri L., Perelli F., Reis F.M. Dysmenorrhea and related disorders. F1000Research. 2017;6:1645. doi: 10.12688/f1000research.11682.1.
    1. Osayande A.S., Mehulic S. Diagnosis and initial management of dysmenorrhea. Am. Fam. Physician. 2014;89:341–346.
    1. Arakawa I., Momoeda M., Osuga Y., Ota I., Koga K. Cost-effectiveness of the recommended medical intervention for the treatment of dysmenorrhea and endometriosis in Japan. Cost Eff. Resour. Alloc. 2018;16:12. doi: 10.1186/s12962-018-0097-8.
    1. Ballard K., Lowton K., Wright J. What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis. Fertil. Steril. 2006;86:1296–1301. doi: 10.1016/j.fertnstert.2006.04.054.
    1. Powell J. The approach to chronic pelvic pain in the adolescent. Obstet. Gynecol. Clin. N. Am. 2014;41:343–355. doi: 10.1016/j.ogc.2014.06.001.
    1. Al Essa M., Alshehri A., Alzahrani M., Bustami R., Adnan S., Alkeraidees A., Mudshil A., Gramish J. Practices, awareness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia. Saudi Pharm. J. 2019;27:235–239. doi: 10.1016/j.jsps.2018.11.004.
    1. Burnett M., Lemyre M. Primary Dysmenorrhea Consensus Guideline. J. Obstet. Gynaecol. Can. 2017;39:585–595. doi: 10.1016/j.jogc.2016.12.023.
    1. DiVasta A.D., Vitonis A.F., Laufer M.R., Missmer S.A. Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood. Am. J. Obstet. Gynecol. 2018;218:324.e1–324.e11. doi: 10.1016/j.ajog.2017.12.007.
    1. Hersh E.V., Pinto A., Moore P.A. Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin. Ther. 2007;29:2477–2497. doi: 10.1016/j.clinthera.2007.12.003.
    1. Bajalan Z., Moafi F., MoradiBaglooei M., Alimoradi Z. Mental health and primary dysmenorrhea: A systematic review. J. Psychosom. Obstet. Gynecol. 2018;40:185–194. doi: 10.1080/0167482X.2018.1470619.
    1. SEGO Gynecological history-taking and physical examination in adolescents (updated January 2013) Progresos Obstet. Ginecol. 2014;57:375–379.
    1. SEGO Ciclo Menstrual y Visita Ginecológica. [(accessed on 21 March 2020)]; Available online: .
    1. Chen C.X., Draucker C.B., Carpenter J.S. What women say about their dysmenorrhea: A qualitative thematic analysis. BMC Womens Health. 2018;18:47. doi: 10.1186/s12905-018-0538-8.
    1. Chen C.X., Shieh C., Draucker C.B., Carpenter J.S. Reasons women do not seek health care for dysmenorrhea. J. Clin. Nurs. 2018;27:e301–e308. doi: 10.1111/jocn.13946.
    1. Wilson E., Haver J., Torondel B., Rubli J., Caruso B.A. Dismantling menstrual taboos to overcome gender inequality. Lancet Child Adolesc. Health. 2018;2:e17. doi: 10.1016/S2352-4642(18)30209-8.
    1. Yagnik A. Theorizing a model information pathway to mitigate the menstrual taboo. Health Promot. Int. 2019;34:410–419. doi: 10.1093/heapro/dax089.
    1. Tan D.A., Haththotuwa R., Fraser I.S. Cultural aspects and mythologies surrounding menstruation and abnormal uterine bleeding. Best Pract. Res. Clin. Obstet. Gynaecol. 2017;40:121–133. doi: 10.1016/j.bpobgyn.2016.09.015.
    1. de la Fuente Ballesteros S.L., García Granja N., Hernández Carrasco M., Hidalgo Benito A., García Álvarez I., García Ramón E. Tele-medicine consultation as a tool to improve the demand for consultation in Primary Care. Semergen. 2018;44:458–462. doi: 10.1016/j.semerg.2018.05.006.
    1. Báez Montilla J.M., Sánchez Oropesa A., Garcés Redondo G., González Carnero R., Santos Béjar L., López de Castro F. Motivos y condicionantes de la interconsulta entre atención primaria y especializada. Semergen. 2013;39:89–94. doi: 10.1016/j.semerg.2012.02.013.
    1. Parra-Fernández M.L., Onieva-Zafra M.D., Abreu-Sánchez A., Ramos-Pichardo J.D., Iglesias-López M.T., Fernández-Martínez E. Management of Primary Dysmenorrhea among University Students in the South of Spain and Family Influence. Int. J. Environ. Res. Public Health. 2020;17:5570. doi: 10.3390/ijerph17155570.
    1. Chen C.X., Kwekkeboom K.L., Ward S.E. Beliefs About Dysmenorrhea and Their Relationship to Self-Management. Res. Nurs. Health. 2016;39:263–276. doi: 10.1002/nur.21726.
    1. Coyne I. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J. Adv. Nurs. 1997;26:623–630. doi: 10.1046/j.1365-2648.1997.t01-25-00999.x.
    1. Graneheim U.H., Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ. Today. 2004;24:105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Lincoln Y., Guba E. Naturalistic Inquiry. SAGE; Beverly Hills, CA, USA: 1985.
    1. Brantelid I.E., Nilvér H., Alehagen S. Menstruation During a Lifespan: A Qualitative Study of Women’s Experiences. Health Care Women Int. 2014;35:600–616. doi: 10.1080/07399332.2013.868465.
    1. Wood J.M., Koch P.B., Mansfield P.K. Is my period normal? How college-aged women determine the normality or abnormality of their menstrual cycles. Women Health. 2007;46:41–56. doi: 10.1300/J013v46n01_04.
    1. Seear K. The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay. Soc. Sci. Med. 2009;69:1220–1227. doi: 10.1016/j.socscimed.2009.07.023.
    1. Tavallaee M., Joffres M.R., Corber S.J., Bayanzadeh M., Rad M.M. The prevalence of menstrual pain and associated risk factors among Iranian women. J. Obstet. Gynaecol. Res. 2011;37:442–451. doi: 10.1111/j.1447-0756.2010.01362.x.
    1. Omidvar S., Begum K.B.-A. Characteristics and determinants of primary dysmenorrhea in young adults. Am. Med. J. 2012;3:8–13.
    1. Ozerdogan N., Sayiner D., Ayranci U., Unsal A., Giray S. Prevalence and predictors of dysmenorrhea among students at a university in Turkey. Int. J. Gynecol. Obstet. 2009;107:39–43. doi: 10.1016/j.ijgo.2009.05.010.
    1. eCIE-Maps-CIE-10-ES Diagnósticos. [(accessed on 22 March 2020)]; Available online: .
    1. Sánchez Galán L., Carbajo Sotillo M.D. INSS Incapacidad Temporal. 4th ed. Instituto Nacional de Seguridad Social; Madrid, Spain: 2020.
    1. Chang Y.T., Chen Y.C. Study of menstrual attitudes and distress among postmenarcheal female students in Hualien County. J. Nurs. Res. 2009;17:20–29. doi: 10.1097/JNR.0b013e3181999d25.
    1. Tanaka E., Momoeda M., Osuga Y., Rossi B., Nomoto K., Hayakawa M., Kokubo K., Wang E.C.Y. Burden of menstrual symptoms in Japanese women—An analysis of medical care-seeking behavior from a survey-based study. Int. J. Womens. Health. 2014;6:11–23. doi: 10.2147/IJWH.S52429.
    1. Hansson L., Jormfeldt H., Svedberg P., Svensson B. Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? Int. J. Soc. Psychiatry. 2013;59:48–54. doi: 10.1177/0020764011423176.
    1. Wahl O., Aroesty-Cohen E. Attitudes of mental health professionals about mental illness: A review of the recent literature. J. Community Psychol. 2010;38:49–62. doi: 10.1002/jcop.20351.
    1. Arroyo J.M.G., Psiquiatra M. Aspectos subjetivos de la mujer con dismenorrea primaria. Rev. Chil. Obstet. Ginecol. 2017;82:271–279. doi: 10.4067/s0717-75262017000300271.
    1. SEGO Primera Menstruación. [(accessed on 21 March 2020)]; Available online: .
    1. Hanson B., Johnstone E., Dorais J., Silver B., Peterson C.M., Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: A review. J. Assist. Reprod. Genet. 2017;34:167–177. doi: 10.1007/s10815-016-0836-8.

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