Reviews

1.

Hoerster, Katherine D. Chrisler, Joan C. Rose, Jennifer Gorman (2003) studied the experience and attitude
towards menstruation among women residing in US and India. Sixty-seven women students who were
attending a university in southern India and 61 women students who were attending a liberal arts college in
New England volunteered to participate in this study. The women supplied demographic information,
information about their knowledge and levels of preparedness prior to menarche, and sources of their
information about the menstrual cycle. They also completed the Menstrual Attitude Questionnaire (Indian
version), the Menstrual Distress Questionnaire, and a test of knowledge about the menstrual cycle. American
women scored significantly higher than Indian women on the knowledge test, and they also reported that
they had better preparation for menarche than Indian women did. Indian women scored significantly higher
than American women on the attitude subscales: Menstruation as a Natural Event and Denial of the Effects
of Menstruation. Implications of these findings are discussed in light of cultural messages women receive.

2.

Bramwell, R. S. Biswas, E. L. Anderson, C. (2003).The Menstrual Attitude Questionnaire (MAQ) was

developed on US undergraduates and has been used in a variety of cultural contexts. This study uses
confirmatory factor analysis to investigate whether the factor structure is confirmed in a British (response rate
86%, N = 112) and a (largely Hindu) Indian (100% response, N = 127) female undergraduate sample. The
British data did not show good fit (comparative fit index 0.52), although the signs for the factor loadings were
consistent with those found with the US sample and the sizes were often similar. The fit for the Indian
sample is extremely poor (comparative fit index 0.21), and the signs of the factor loadings were often
different to those for the US and British samples. British students showed stronger agreement with items on
premenstrual changes. The Indian students showed stronger agreement with items about tiredness and not
expecting so much of oneself. The findings are consistent with previous research with Indian samples. The
results suggest that the MAQ factor structure is not appropriate to other cultures. Future quantitative crosscultural research in this area should avoid simple comparisons of factor scores and use more sophisticated
statistical modelling techniques now available.

3.

Bramwell, Ros Zeb, Rabia(2006) studied the Attitudes towards and experience of the menstrual cycle across
different cultural and religious groups. The aim of this study was to explore the impact of culture
on menstrual attitudes and experience by distinguishing the separate issues of ethnicity and religious cultural
identity. A total of 170 women living in Britain aged 1385 (M = 36, SD = 16) participated in the study; 76
(44.7%) were culturally Christian, 48 (28.2%) culturally Muslim and 46 (27.1%) culturally Hindu.
Respondents completed the Menstrual Attitudes Questionnaire (MAQ) and Menstrual Distress Questionnaire
(MDQ). MANCOVA (controlling for the language of completion) showed no significant main effects of age
group (over versus under 30) and no significant interaction between age and religious group, but did show a
significant main effect of religious group on both MAQ (F(10, 314) = 5.1, p<0.01) and MDQ (F(16, 310) = 3.2,
p<0.01) scores. Between-subject effects for the MAQ were significant for four of the five attitude subscales
and Bonferroni t'-tests indicated that Hindus were significantly different to both Christians and Muslims.
Between-subject effects for the MDQ were significant for five of the eight subscales. Bonferroni t'-tests
showed that whilst Muslims scored higher than both Hindus and Christians on the control subscale, Hindus
scored significantly higher on pain than Christians and significantly lower on arousal than both Muslims
and Christians. The results are consistent with a bio-psychosocial model of menstrual cycle experience but
also demonstrate that culture should be defined not only in terms of ethnicity but also in terms of other
cultural factors such as religious heritage. The similarity between Christians and Muslims may be explained
by the shared roots of these faiths, in contrast with the very different beliefs of Hindus.

4.

Wong, Li Ping(2011) studied Attitudes Toward Menstruation, Menstrual-Related Symptoms, and

Premenstrual Syndrome Among Adolescent Girls. Folk culture surrounding menstrual-related matters has
considerable implications for symptom expression and treatment-seeking behavior. A cross-sectional survey
of 1,295 rural adolescent girls aged 13 to 19 years was conducted between February 4 and April 16, 2009 to
examine these associations. With a higher score indicating a more positive attitude toward menstruation, the
mean attitude score was 3.84 (SD 1.62) out of a maximum of six. No significant association was observed
between the severity of menstrual symptoms and attitudes. Most (63.1%) of the participants identified
themselves as having premenstrual symptoms, and 61.1% viewed premenstrual symptoms as a normal part
of menstrual cycle. Participants with a higher severity of symptoms in the premenstrual (OR 1.05, 95% CI
1.01-1.10) and menstrual phase (OR 1.04, 95% CI 1.01-1.07), were more likely to consult a physician for
premenstrual symptoms, and having a divorced/separated parents was associated with a reduced odds of
consulting a physician compared to those having parents that were married (OR 0.19, 95% CI 0.05-0.83).
The findings imply the need for education to help adolescent girls manage menstrual symptoms and
increase awareness of the benefit of treating them. Given that menstrual-related information was widely
available from mothers, family, and social culture are potentially important in shaping good menstrual
attitudes

5.

Malleshappa, K. Krishna, Shivaram, Nandini, C.(2011) studied the Knowledge and attitude about
reproductive health among rural adolescent girls in Kuppam mandal: An intervention study. Adolescents in
rural areas may face troubles due to lack of right kind of information regarding their own physical and or
sexual developments. The need to address this problem through health education by health professionals
needs to be ascertained. The objective is to determine the effectiveness of a reproductive health education
intervention programme in improving the knowledge of adolescent girls aged between 14-19 years in
Kuppam mandal, chittoor dt, Andhra Pradesh. The study was carried out over a period of 8 months. A total of
656 girls in the age group of 14-19 years were randomly selected from 3 high schools (class X) & 3
intermediate colleges(class XI &XII) in kuppam mandal, chittoor dt, Andhra Pradesh. The reproductive health
education package developed in consultation with parents, teachers & adolescents was used to educate the
girls. A 50 item structured questionnaire was used to test the knowledge of all the participants about the
reproductive health before & after the education session. The data was tabulated & analyzed using SPSS
version 11.0 for windows .Findings were described in terms of proportions & percentages, chi square test
was used to test the effect of intervention. Reproductive health Knowledge score improved significantly after
intervention. A significant increase in overall knowledge regarding menstrual cycle, ovulation, fertilization &
pregnancy by 44.5% was noted (95%CI=42.5,46.5;P<0.001); knowledge regarding contraception improved
remarkably from 33.7% to 97.4%(P<0.0001);A significant improvement in the knowledge about transmission
& prevention of STDs was noted after intervention (P<0.0001). A reproductive health education intervention
programme improves the knowledge & attitude among rural adolescent girls regarding reproductive health.

6.

Wong Li, Khoo (2011) studied Menstrual-Related Attitudes and Symptoms Among Multi-racial Asian
Adolescent Females. Menstruation has important implications on the physical and emotional well-being of
adolescents' reproductive health.This study aimed to investigate the perception towards menstruation and
premenstrual syndrome (PMS), to provide insight into menstrual-related education information in order to
help adolescent girls manage the physical and psychological changes associated with menstruation. This
cross-sectional study included 1,092 adolescent females from 94 schools in the Federal Territory of Kuala
Lumpur, Malaysia. A self-administered semi-structured questionnaire was used in the data collection.
Results: The results showed the mean scores on the menstrual attitude questionnaire to be 2.80 (SD 1.88)
out of six. A total of 80.7% and 83.6% of the participants experienced one or more affective and somatic
symptoms respectively in the premenstrual phase. Irritability, mood swing and tension were the three most

frequently reported affective symptoms, while fatigue and menstrual cramps were highly prevalent somatic
symptoms in both the premenstrual and menstrual phases. The effects on functional impairment and quality
of life, in order of importance, include poor class concentration, restriction of social and recreational
activities, difficulty to mingle with friends, and poor class performance. Despite the evident impact, only
10.3% of adolescent girls consulted doctors for PMS symptoms, while one-third did nothing about their
condition. There were ethnic differences in the seeking of treatment for PMS. Conclusion: The study calls for
an education program related to PMS and menstrual-related disorders to provide information and support to
adolescents. This will help them to cope better with menstrual-related problems, and encourage positive
attitudes to menstruation.
7.

Bhatt R. & Bhatt M. (2005) studied the Perceptions of Indian women regarding menstruation. Although
menstruation is still considered a natural event by women in India, perceptions about menstruation are
changing. They report on the study of 1150 urban and 850 rural women. The urban women included high
school and college students, professional women, and housewives. A 10-point questionnaire was pretested
in a clinic setting and then administered to the study group. The responses show that 80% of high school
and college students and professional women wish to have infrequent menses or no menses at all. In
contrast, 70% of rural women prefer to have monthly menses. The authors wish to initiate a debate on this
issue among health care providers and women's groups.

8.

Chothe Vikas, Khubchandani Jagdish, Seabert, Denise, Asalkar Mahesh, Rakshe Sarika, Firke Arti, Midha
Inuka, and Simmons Robert (2014) studied Students Perceptions and Doubts About Menstruation in
Developing Countries. Menstrual education is a vital aspect of adolescent health education. Culture,
awareness, and socioeconomic status often exert profound influence on menstrual practices. However,
health education programs for young women in developing countries do not often address menstrual
hygiene, practices, and disorders. Developing culturally sensitive menstrual health education and hygiene
programs for adolescent females has been recommended by professional health organizations like the
World Health Organization and UNICEF. These programs cannot be developed without understanding
existing myths and perceptions about menstruation in adolescent females of developing countries. Thus, the
purpose of this qualitative study from India was to document existing misconceptions regarding menstruation
and perceptions about menarche and various menstrual restrictions that have been understudied. Out of the
612 students invited to participate by asking questions, 381 girls participated by asking specific questions
about menstruation (response rate = 62%). The respondents consisted of 84 girls from sixth grade, 117 from
seventh grade, and 180 from eighth grade. The questions asked were arranged into the following
subthemes: anatomy and physiology, menstrual symptoms, menstrual myths and taboos, health and beauty,
menstrualabnormalities, seeking medical advice and home remedies; sanitary pads usage and disposal; diet
and lifestyle; and sex education. Results of our study indicate that students had substantial doubts about
menstruation and were influenced by societal myths and taboos in relation tomenstrual practices. Parents,
adolescent care providers, and policy makers in developing countries should advocate for comprehensive
sexuality education and resources (e.g., low-cost sanitary pads and school facilities) to promote menstrual
health and hygiene promotion.

9.

Kumar Anant, Srivastava Kamiya(2011) studied the Cultural and Social Practices Regarding Menstruation
among Adolescent Girls. The study attempts to find out the existing social and cultural practices regarding
menstruation, awareness levels, and the behavioral changes that come about in adolescent girls during
menstruation, their perception about menarche, how do they treat it, and the various taboos, norms, and
cultural practices associated with menarche. The study was conducted on 117 adolescent girls (age 1120
years) and 41 mothers from various communities and classes in Ranchi comprising residential colonies and
urban slums. The findings unfolds many practices: cultural and social restrictions associated with

menstruation, myth, and misconception; the adaptability of the adolescent girls toward it; their reaction,
reaction of the family; realization of the importance of menstruation; and the changes that have come in their
life after menarche and their resistance to such changes. The article also suggests the strategies to improve
menstrual health and hygiene among adolescent girls. The study concludes that cultural and social practices
regarding menstruation depend on girls' education, attitude, family environment, culture, and belief.\

10. Yu-Ting Chang, Yueh-Chih Chen (2009) studied of Menstrual Attitudes and Distress Among Postmenarcheal
Female Students in Hualien County. : The purposes of this study were to assess menstrual attitudes and
menstrual distress and investigate factors associated with menstrual distress among postmenarcheal female
elementary students. A total of 129 female students from 12 elementary schools in Taiwan's Hualien County
participated in this study. A stratified cluster random sampling method was adopted. The questionnaire used
consisted of three sections asking questions regarding the individual's menstrual characteristics, menstrual
attitudes, and menstrual distress. Study results showed that most respondents experienced menstrual blood
seepage during the daytime and awakened at night during their periods due to worries about menstrual
blood seepage. This study found that indigenous students had significantly more frequent episodes of
menstrual blood seepage during the daytime and awakened at night during period than did nonindigenous
students. The mean score on the Menstrual Attitude Questionnaire was 1.88 {SD = 0.36, possible score =
1^). The three most prevalent symptoms of menstrual distress were dysmenorrhea, acne, and fatigue. The
mean score on the Menstrual Distress Questionnaire was 1.00 {SD = 0.76; possible score = 0^). Moreover,
there was a significantly negative correlation between menstrual attitudes and menstrual distress and
significantly positive correlations between menstrual distress and (a) time since menarche, (b) menstrual
blood seepage during the daytime, and (c) menstrual blood seepage while sleeping. Study results
recommend that families and elementary schools help postmenarcheal female elementary students to
accept menstruation as a natural process.

11. Linda Mason, Richard Rheingans, Elizabeth Nyothach, Kayla F. Laserson, Aisha Mohammed, Kelly
Alexander, Frank O. Odhiambo, Penelope A. Phillips-Howard, Alie Eleveld, John Vulule (2013) conducted a
Qualitative Study to Explore Young Schoolgirls Attitudes and Experiences with Menstruation in Rural
Western Kenya. Keeping girls in school offers them protection against early marriage, teen pregnancy, and
sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates schooldrop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual
experiences of young adolescent schoolgirls. Methods and Findings: The study was conducted in Siaya
County in rural western Kenya. A sample of 120 girls aged 1416 years took part in 11 focus group
discussions, which were analysed thematically. The data gathered were supplemented by information from
six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche;
maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping
with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were
unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with
menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information
sparse or inaccurate. Girls physical changes prompt boys and adults to target and brand girls as ripe for
sexual activity including coercion and marriage. Girls admitted others rather than themselves were absent
from school during menstruation, due to physical symptoms or inadequate sanitary protection. They

described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing.
Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing.
Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived
as harmful. Girls reported other girls but not themselves participated in transactional sex to buy pads, and
received pads from boyfriends. In the absence of parental and school support, girls cope, sometimes alone,
with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms
need to be included within a package of measures to enable adolescent girls to reach their potential.

12. ROS BRAMWELL, RABIA ZEB (2006) studied Attitudes towards and experience of the menstrual cycle
across different cultural and religious groups. The aim of this study was to explore the impact of culture on
menstrual attitudes and experience by distinguishing the separate issues of ethnicity and religious cultural
identity. A total of 170 women living in Britain aged 1385 (M536, SD516) participated in the study; 76
(44.7%) were culturally Christian, 48 (28.2%) culturally Muslim and 46 (27.1%) culturally Hindu.
Respondents completed the Menstrual Attitudes Questionnaire (MAQ) and Menstrual Distress Questionnaire
(MDQ). MANCOVA (controlling for the language of completion) showed no significant main effects of age
group (over versus under 30) and no significant interaction between age and religious group, but did show a
significant main effect of religious group on both MAQ (F(10, 314)55.1, p,0.01) and MDQ (F(16, 310)53.2,
p,0.01) scores. Between-subject effects for the MAQ were significant for four of the five attitude subscales
and Bonferroni t-tests indicated that Hindus were significantly different to both Christians and Muslims.
Between-subject effects for the MDQ were significant for five of the eight subscales. Bonferroni t-tests
showed that whilst Muslims scored higher than both Hindus and Christians on the control subscale, Hindus
scored significantly higher on pain than Christians and significantly lower on arousal than both Muslims
and Christians. The results are consistent with a bio-psychosocial model of menstrual cycle experience but
also demonstrate that culture should be defined not only in terms of ethnicity but also in terms of other
cultural factors such as religious heritage. The similarity between Christians and Muslims may be explained
by the shared roots of these faiths, in contrast with the very different beliefs of Hindus.