3.1. Students’ Demographic, Clinical and Menstrual Characteristics
Out of the 859 female students studying nursing, a total of 637 women (74.16%) agreed to participate in the study. However, 6 of them reported having a menstrual cycle duration of over 50 days so they were excluded from the analysis yielding several 631 participants. Table 1
shows the demographic and clinical characteristics of the sample. The mean age of the participants was 23.88 ± 7.34 years (range, 18–55 years). Most of our sample was within the 21–29 age group (43.5%) and the 18–20 age group (41.5%) whereas only 7.1% and 7.6% were aged between 30–39 and over 40 respectively. The vast majority were not married (85.7%), lived alone (22.3%), with their parents (62.4%) or co-habited with their partner (4.3%) whereas only 9.8% were married. 63.2% of them were from Athens whereas only 36.7% were from other places in Greece or abroad. Most of the sample reported having a Greek nationality (89.5%). Regarding the financial situation, 15.5% of the students reported a yearly family income of less than 5000 € whereas most students reported a yearly family income of less than 10,000 € (43.6%). Moreover, a relatively high rate of participants were first year students (37.2%) whereas only 6% were in their fourth year of study and 14.9% reported being students for more than four years.
Regarding health, 32.2% of the participants reported smoking, 54% of them reported exercising regularly and 59.2% reported following a healthy diet. The mean BMI was 22.66 ± 4.33 kg/m2 (range, 14.51–44.46). 65% of the students had a normal weight whereas 14.8% and 6.6% were overweight and obese, respectively.
Finally, regarding menstruation characteristics, the mean menarche age was 12.74 ± 1.57 years, the mean duration of menstruation was 5.85 ± 1.23 and the average menstrual cycle duration was 28.76 ± 3.4 days.
3.2. Prevalence and Characteristics of Dysmennorhea.
The prevalence of menstrual pain experience in the present sample was 89.2% (563 out of 631 women). Table 2
shows the pain intensity and dysmenorrhea characteristics in the subsample that reported having menstrual pain.
The prevalence of dysmenorrhea severity across the clinical and menstrual characteristics was also assessed (Table 3
). There were no significant differences on smoking, exercising, BMI and Menstrual Cycle duration across mild pain, moderate pain, severe pain, and no pain groups (p
> 0.1). There was a marginal effect of duration of menstruation on dysmenorrhea status (p
= 0.051). Z
tests with Bonferroni correction revealed no significant differences among the groups. However, it revealed a significant difference between the < 7 days and 7 ≥ days of menstruation on the severe pain group (p
< 0.05). The count of the 7 ≥days subgroup was higher than the expected count (112 > 100.1 participants, z
= 2.1) whereas the count of the < 7 days subgroup was lower than the expected count (179 < 190.9 participants, z
= −2.1) suggesting a possible association of menstruation duration over 7 days and pain severity.
There were significant effects of healthy nutrition, family history of dysmenorrhea, menarche age, and participants’ age (p < 0.05). Z tests with Bonferroni correction on healthy nutrition showed no significant differences among groups on nutrition. Post-hoc Z tests on family history revealed that the severe group tended to report family history of dysmenorrhea more frequently (count: 73 > expected count: 58.6, z =2.9) than the no pain group (count: 7 < expected count: 14, z = −2.2) (p < 0.05) but no other differences among groups were noticed. Post-hoc comparisons on menarche age revealed that in the subgroup that reported experiencing their first menstruation at 13–15 years, there was a statistically significant difference between the severe pain and no pain groups (p < 0.05) in which the count of the severe group was lower than the expected count (104 < 117.3 participants, z = −2.2) whereas the count of the no pain group was higher than the expected one (36 > 27.3 participants, z = 2.3). No other differences across dysmenorrhea groups were noticed. However, regarding the differences across the menarche age subgroups, in the severe pain group, there was a statistically significant difference between the ≤12 age and the 13–15 age subgroups, where the count of the first subgroup was higher than the expected count (156 > 138.5 participants, z = 2.8) and the count of the second subgroup was lower than expected (104 < 117.3 participants, z = −2.2) showing that more participants of the severe group reported experiencing their first menstruation at age younger than 13 years old than experiencing at older ages. Finally, multiple comparisons on the age effect revealed that in the over 40 years subgroup, the severe group differed significantly with a lower frequency than the expected one (count: 13 participants < expected count: 20.9 participants, z = −2.4) from the no pain group (count: 12 participants > expected count: 4.6 participants, z = 3.7) (p < 0.05). Moreover, in the no pain group, the over 40 years subgroup had a higher count than the expected (count: 12 participants > expected count: 4.6 participants, z = 3.7) relatively to what was observed in both the 18–20 years (count: 23 participants < expected count: 25.3 participants, z = −0.6) and the 21–29 age subgroups (count: 20 participants < expected count: 26.7 participants, z = −1.8) (p <.05). This analysis suggests that in the present sample women over 40 years old experience less frequently severe menstrual pain than women younger than 30 years old. No other differences were yielded regarding participants’ age.
Characteristics of pain across dysmenorrhea status groups are shown in Table 4
. There was no significant association between the Pain Onset and pain intensity (p
= 0.43). However, there were significant differences between the groups on pain duration, the use of pain relievers and the number of pain relievers received (p
< 0.05). Post-hoc comparisons in the pain duration revealed that for the less than 1 day pain duration subgroup, the mild pain group had a significantly higher percentage (69.9%, count: 55 > expected count: 28.5, z
= 6.7) than both the moderate pain (35.8%, count: 68 = expected count: 65.9, z
= 0.2) and the severe pain groups (25.8%, count: 75 < expected count: 102.6, z
= −4.9) (p
< 0.05). For the 1–3 days pain duration, the mild pain group showed a significantly smaller percentage (29.6%, count: 24 < expected count: 46.9, z
= −5.6) than both the moderate pain (57.2%, count: 107 = expected count: 108.4, z
= −0.3) and the severe pain groups (66.3%%, count: 193 > expected count: 168.7, z
= 4.2) (p
< 0.05). Moreover, in the mild pain group, significantly more participants reported a pain duration of less than 1 day than a duration of 1–3 days or more than 4 days (p
< 0.05). In the severe pain group, women reported significantly more frequently than expected a pain duration of 1–3 days and over 4 days (6.9%, count: 20 > expected count: 14.1, z
= 2.3) relatively to reporting a less than 1 day of pain duration (p
< 0.05). This showed that women with moderate and severe pain tend to report a longer pain duration than women with mild menstrual pain.
Multiple comparisons on pain relievers use, showed that a significantly higher percentage of participants in the severe pain group reported using pain relievers (86.3%, count: 252 > expected count: 208.6, z = 8.1) than in the mild pain (36.6%, count: 30 < expected count: 58.6, z = −7.6) and the moderate pain groups (63.4%, count: 118 < expected count: 132.9, z = −3.0). Similarly, the mild pain group reported a significantly less frequent pain relievers use than the moderate pain group (p < 0.05). Post-hoc p correcting testing on the number of different pain relievers used during menstruation also revealed than the severe pain group reported using more different pain relievers in combination than the mild pain (z = −7.68, p < 0.0005) and moderate pain groups (z = −4.49, p < 0.0005). The moderate pain group also reported receiving more such drugs than the mild pain group (z = −4.07, p < 0.0005).
Finally, there was a significant association between time periods during menstruation with no pain and dysmenorrhea intensity (p < 0.0005). Post-hoc testing revealed that significantly more women with severe pain reported never experiencing a time period with no pain (35.6%, count: 104 > expected count: 75.9, z = 5.4) than women with either mild (12%, count: 10 < expected count: 21.6, z = −3.1) or moderate menstrual pain (17.1%, count: 32 <expected count: 48.6, z = −3.4). More women with moderate pain reported experiencing a pain free time period for a few times (72.7%, count: 136 > expected count: 116.5, z = 3.6) than women with mild (55.4%, count: 46 < expected count: 51.7, z = −1.4) and severe pain (57.5%, count: 168 > expected count: 181.9, z = −2.4). However, significantly more women with mild pain reported having pain free time periods quite frequently (30.1%, count: 25 > expected count: 8.9, z = 6.2) than women with either moderate (10.2%, count: 19 > expected count: 29, z = −0.3) or severe pain (5.5%, count: 16 > expected count: 31.2, z = −4.1).
3.3. Dysmenorrhea Intensity and Impact on Social Functioning, Exercising and Nursing Academic Life
shows the impact of dysmenorrhea on wellbeing (exercising, socializing) and academic functioning). No significant differences between dysmenorrhea groups were noticed on exam absenteeism and clinical placement absenteeism (p
> 0.1). However, there was a marginal effect of dysmenorrhea on failing a module due to menstrual pain (p
= 0.08). Z
tests with Bonferroni correction revealed no significant differences among the groups. However, it revealed a significant difference between the less affected and more affected subgroups on the severe pain group where the count of the more affected subgroup was higher than the expected count (18 > 12.9 participants, z
= 2.1) whereas the count of the less affected subgroup was lower than the expected count (266 < 271.1 participants, z
= −2.1) suggesting a possible impact of severe pain on exam performance.
However, there were significant effects of dysmenorrhea intensity on absenteeism from school, Days being absent from school, postponing personal studying, postponing exercising, and refraining from socializing (p < 0.05). Multiple comparisons on absenteeism showed that menstrual pain affected attending school more in the severe pain group (count: 35 participants > expected count: 25 participants, z = 3) than in the moderate pain group (count: 10 participants < 15.9 participants, z = −1.9). Post-hoc testing on the duration of absenteeism showed that severe pain group reported being absent from school more days than both the moderate pain group (z = −4.3, p < 0.0005) and the mild pain group (z= −5.41, p < 0.0005). Multiple comparisons on personal studying variable revealed that more women with severe pain reported stopping studying due to menstrual pain (27.3%, count: 78 participants > expected count: 52.1 participants, z = 5.7) than women with either mild (9.6%, count: 8 participants < expected count: 15.1 participants, z = −2.2) or moderate pain (8.1%, count: 15 participants < expected count: 33.7 participants, z = −4.4). Similarly, regarding exercising, the severe pain group reported significantly more frequently postponing physical exercising (50.9%, count: 144 participants > expected count: 116 participants, z = 4.9) than both the mild pain (23.2%, count: 19 participants < expected count: 33.6 participants, z = −3.6) and the moderate pain groups (33.7%, count: 62 < expected count: 75.4 participants, z = −2.5). Finally, the severe pain group also reported impact of dysmenorrhea on socializing significantly more frequently (29%, count: 82 participants > expected count: 50.4 participants, z = 7) than the mild pain (3.7%, count: 3 participants < expected count: 14.6 participants, z = −3.6) and the moderate pain groups (7%, count: 13 participants < expected count: 33 participants, z = −4.7).