Original Article

Menstrual hygiene among adolescent girls studying in a

university of Gujarat
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Vidhi Parikh1, Shashwat Nagar2

WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 04/19/2023

Departments of 1MBBS Intern and 2Community Medicine, Parul Institute of Medical Sciences and Research,
Parul University, Vadodara, Gujarat, India

A bstract
Background: Menstruation marks the beginning of the reproductive life of a girl. A poor menstrual understanding and its unhealthy
practices may increase the risk of reproductive infections, urinary tract infections, and even cancer. Therefore, the main objective
of this study was studying the knowledge and attitude regarding menstrual hygiene among adolescent girls so that it can be then
taken as a background for designing necessary interventions in the community. Objectives: 1) To study the knowledge and attitude
towards menstruation among adolescent girls and 2) to study the menstrual hygiene practices and health‑seeking behaviour of
the adolescent girls. Methods: This was a university‑based descriptive cross‑sectional study carried out by directly interviewing
the subjects using the interviewer‑administered questionnaire – pre‑tested and pre‑designed proforma. The data were analysed
statistically by simple proportions. Results: Among the study subjects, 79% had proper knowledge about menstruation. 82% had a
normal menstrual pattern. Nearly 96% used sanitary pads, and 2.36% used reusable cloths. Regarding restrictions, 74.80% restrained
themselves from visiting the places of worship, 21% avoided physical exercise, and 7.87% had to remain isolated with minimal social
contact. Nearly 19% made conscious efforts for dietary changes during menstruation. Conclusion: A majority of the subjects had
a regular menstrual cycle, but menstrual problems were found to be more among those having irregular periods, those changing
absorbents infrequently, with an inadequate frequency of cleaning, and those using plain water for cleaning. The study however
does reflect the fact that menstrual hygiene was unsatisfactory among adolescent girls. Therefore, they need to be educated about
the facts of menstruation and proper hygienic practices.

Keywords: Adolescent, menstrual hygiene, menstrual practices, menstruation

Introduction the hypothalamic pituitary axis.[2] It marks the beginning of

reproductive life of a girl. Menstrual hygiene is a taboo which
Adolescence marks a period of rapid growth and development often women are uncomfortable discussing.[3] What is meant for
during which many changes at the physical, physiological, and women and adolescent girls is to be able to manage menstruation
behavioural levels occur. Adolescence estimates worldwide hygienically and with dignity includes them using clean menstrual
are at about 1.2 billion, and they constitute about 21% of the management materials to absorb or collect menstrual blood, which
Indian population.[1] Menstruation is a cyclical shedding of can be changed as often as needed in privacy for the duration
the endometrium under the hormonal influence controlled by of a menstrual cycle, washing the body as necessary with soap
and water, and having access to safe and convenient disposal
Address for correspondence: Dr. Vidhi Parikh,
facilities for used menstrual management materials.[4] Poor
Jasdeep Bunglow, Besides Rangoli Playcentre, Luhana Mahajan
Wadi Lane, Ellorapark, Vadodara, Gujarat ‑ 390023, India. menstrual practices lead to the development of various morbid
E‑mail: [email protected] conditions such as reproductive tract infections and urinary tract
infections. Learning about menstrual hygiene is an important
Received: 25‑11‑2021 Revised: 08‑02‑2022 part of health education in order to prevent various ill effects of
Accepted: 11‑02‑2022 Published: 22-07-2022
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DOI: How to cite this article: Parikh V, Nagar S. Menstrual hygiene among
10.4103/jfmpc.jfmpc_2303_21 adolescent girls studying in a university of Gujarat. J Family Med Prim
Care 2022;11:3607-12.

© 2022 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow 3607
 Parikh and Nagar: Menstrual hygiene among adolescent girls

poor menstrual hygiene practices, which may lead to reproductive The questionnaire had different sections consisting of
tract infections, infertility, miscarriages, toxic shock syndrome, socio‑demographic profiles, questions about their menstrual
and cancer.[5] Most of adolescent girls are uncomfortable when cycles, and various problems associated with them, assessing
it comes discussing about menstruation, and thus, they do not their understanding regarding menstruation and their menstrual
have access to adequate information about this social taboo.[6] hygiene practices and also perceptions regarding various rituals
Moreover, the lack of knowledge further impairs a girl’s daily and dietary practices during menstruation.
activities, affects her attendance in college, and thus leads to
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poor academic performance. The reproductive health decisions Approval from institutional ethics committee was sought before
which they will make today will affect the health of the upcoming the commencement of the study dated 18.9.2019. The data were
generations.[7] Women who have good knowledge about menstrual entered and analysed in MS Excel 2007. Basic descriptive statistics
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hygiene are less liable to suffer from reproductive tract infections.[8] and proportions were calculated and presented. Chi squared test
Reproductive tract infections and sexually transmitted infections was used to draw associations between variables at a 5% level
are fairly common in primary care settings. Adequate knowledge of significance.
regarding menstruation and menstrual hygiene is of paramount
importance among adolescent girls in a given community as it will Inclusion criteria
have a directly impact on reducing the burden of reproductive 1. Students of medical and nursing studying at Parul University
tract infections/sexually transmitted infections in primary in their first academic year of undergraduate studies.
care practice.[9-10] This study is therefore aimed at studying the 2. Those providing written consent/assent for the study.
knowledge and perceptions regarding menstrual hygiene among
the adolescent girls so that it can be then taken as a background Exclusion criteria
for designing necessary interventions in the community so as to
reduce its burden in family/primary care practice. 1. Those not providing written and verbal consent/assent for
the study.
Methods Results

A cross‑sectional descriptive university‑based study was carried As per Graph 1, the mean age of the study subjects was
out in western India. The study included students pursuing 18  ±  0.70  years as the subjects were college‑going students.
medicine and nursing disciplines in the university. The data were The mean age of menarche was 14 ± 2 yrs. Graph 2 shows that
collected by directly interviewing the subjects. The study was most (i.e., 80%) of the study subjects had a regular menstrual cycle
conducted between July and December 2019, that is, for a total and 20% had an irregular cycle. Duration of flow among the study
duration of 6 months. As the study was carried out among medical subjects ranged from 1 to 7 days. Table 1 shows that 78.7% had
allied students, to ensure a non‑biased opinion, only the first‑year proper knowledge about menstruation. About 31.3% of the girls
students were interviewed as “Menstrual Hygiene” is a part of received information from the school, 39.8% from their parents,
their curriculum in the succeeding years. All the female students 3.9% from their friends, and the rest (around 3.1%) from other
studying in first year who consented for the study were included. sources. In the case of menstrual irregularity, only 23.6% received
treatment in any form for the cause and among them, 11.8%, 11%,
A written consent was sought from the study subjects aged and only 0.8% received treatment from the doctor, pharmacy,
more than 18 years. For those below 18 years of age, an assent and mother, respectively. As per Table 2, a majority of the study
was taken from their local guardians for the study. The data subjects (96.06%) used sanitary pads, 2.36% used reusable cloths,
were collected using a pre‑tested, pre‑structured, and validated 3.15% used fresh cloths, 1.57% used tampons, and 0.7% used
proforma. menstrual cups. Only a small proportion of study subjects (11.7%)
changed the absorbent material more than thrice in a day, whereas
3.96X 50X50 9900 2% changed it thrice, 73% changed it twice in a day, and 10.2%
changed it only once in a day. 90.6% practised disposing the
Z = ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ = ‑‑‑‑‑‑‑ = 396 absorbent material in the trash can, whereas 5.5%, 2.4%, 3.1%,

5X5 25 60.0 Percent

51.2
50.0
For the calculation of sample size, P was taken as 50% because of
40.0
the lack of true estimation of population parameters. From this, the
30.0
sample size derived after putting in the below‑mentioned formulae 24.4 24.4
was 396. As there was a limitation with respect to resources for data 20.0

collection procedure, it was decided to survey 30% of the sample 10.0

size for the study. Therefore, the minimum sample size decided 0.0
17 18 19
for the survey was 119 students. At the end of the survey, 127
students were surveyed after obtaining their consent for the study. Graph 1: Age of the study subjects (n = 127)

Journal of Family Medicine and Primary Care 3608 Volume 11 : Issue 7 : July 2022
 Parikh and Nagar: Menstrual hygiene among adolescent girls

and 0.8% practised the wash and reuse method, burning the association between different factors and prevalence of menstrual
absorbent, flushing it in the toilet, and disposing it in the incinerator, problems was not significant statistically, a majority of the problems
respectively. The frequency of washing and cleaning the genital area were found more among those not having regular periods, those
for hygiene with a frequency of more than 5 times a day was found with more duration of flow, those with either scanty or excessive
in about 10% of the subjects only. About 12% practised cleaning menstruation, and those changing absorbents infrequently, with
less than twice a day. Nearly half of them used water for cleaning, an inadequate frequency of cleaning. As per Table 5, a majority of
whereas 9.4%, 9.4%, and 30.5% used soap and water, Dettol, and them (92.9%) had menstruation for 2–7 days, whereas 3.1% had
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other agents (wash and other specific medicated soaps), respectively. bleeding for more than 7 days and 1.6% for less than 2 days during
There were many menstrual problems faced by the study subjects. a particular cycle. About 82% had normal menstruation, whereas
As per Table 3, the most common of those included mood swings, 7.1% faced excess and normal quantities of menstruation. 33.9%
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lower abdominal pain, tiredness, and lower backache. The other of the study subjects passed blood clots during the menstruation.
complaints commonly experienced were excessive sleepiness, foul
smelling discharge, increased frequency of micturition, burning Discussion
micturition, and rashes in genital areas. Other minor complaints
It is known that menarche is an important milestone in a girl’s
included itching, nausea, and vomiting. Regarding restrictions,
life as it marks the beginning of the reproductive phase. In
Table 4 shows that about three quarters avoided themselves from
this study, a total of 127 subjects were studied, out of which
visiting the places of worship, 43%avoided attending marriages or
a majority were in the age of 18 years (51.2%), 24.4% were in
other rituals, 20.47%were not allowed to cook/serve food, 17.32%
the age of 17 years, and 24.4% were in the age of 19 years.
stayed indoors, 21% avoided physical exercise, and 7.87% had to
The mean age of menarche was 14 ± 2 years. Another study
remain isolated with minimal social contact. There were conscious by Thakre et al.[11] showed that the age of menarche ranged
efforts for dietary changes with increased intake of nutritious food from 12 to 17 years.
such as fresh fruits and vegetables during menstruation, and these
were practiced by about 19% of subjects. About 15% consumed The patterns of the menstrual cycle including the regularity, flow,
more iron, and 21.26% consumed more protein. Even though the and amount of bleeding were also analysed in the present study,
and it was observed that 80.3% had a regular cycle, whereas in a
Regular Irregular study carried out by Wasnik et al.[12] in the Amravati district, 78.2%

Table 2: Details regarding menstrual practices (n=127)

20% Frequency Percentage
Type of absorbent used during menstruation
Sanitary pads 122 96.06
Reusable cloth 3 2.36
Fresh cloth 4 3.15
Tampons 2 1.57
MS 1 0.79
Frequency of changing the absorbent
80% material as practised by subjects
Once 13 10.2
Twice 93 72.7
Thrice 3 2.3
Graph 2: Type of menstrual cycle (n = 127) More than thrice 15 11.7
Total 124 96.9
Disposal of the absorbent material
Table 1: Knowledge and source of information regarding Throwing in the trash can 115 90.6
menstruation among study subjects (n=127) Wash and reuse 7 5.5
Frequency Percentage Burn 3 2.4
Knowledge about menstruation Flush out in the toilet 4 3.1
Yes 100 78.7 Disposal in the incinerator 1 0.8
No 27 21.3 Frequency of cleaning/day
Total 127 100.0 0 1 0.8
Source of information 1 16 12.6
School 40 31.3 2‑3 63 49.6
Parents 51 39.8 4‑5 30 23.6
Friends/Peers 5 3.9 6‑7 16 12.6
Others 4 3.1 10 1 0.8
Total 127 99.2 Total 127 100.0

Journal of Family Medicine and Primary Care 3609 Volume 11 : Issue 7 : July 2022
 Parikh and Nagar: Menstrual hygiene among adolescent girls

Table 3: Menstrual problems experienced by study had a regular menstrual cycle and 21.8% had an irregular cycle.
subjects (n=127) In a study by Jailkhani et al.,[13] 75.7% girls had regular menses.
Menstrual problems Frequency Percentage
The duration of menstrual flow among the study subjects varied
Itching 18 14.17
Rashes 28 22.05
from 1 to 7 days.
Staining of cloths 5 3.94
Sleepy 41 32.28 In this present study, a majority of the adolescent girls (79%)
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Tiredness 61 48.03 had proper knowledge about menstruation. In this study, it was
Mood swings 94 74.02 found out that the mother was the first informant in a majority
Foul smelling discharge 30 23.62 of the cases. 31.3% of the subjects had received information
from the school, 39.8% from their mother, 3.9% from their
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Lower abdominal pain 82 64.57

Burning micturition 8 6.30 friends, and the rest (around 3.1%) from unknown sources such
Increased frequency 17 13.39 as sisters, internet, and so forth. Although in a study conducted
Lower backache 54 42.52 by Dudeja et al.[14] in western Maharashtra 60.7% girls revealed
Muscle cramps 24 18.90 their mother as their source of information, 31.8% said that they
Nausea/Vomiting 4 3.15
obtained information from their friends.
Abdominal pain 69 54.33

Unhealthy menstrual practices may increase the risk of

Table 4: Habits and restrictions during reproductive tract infections, urinary tract infections, and
menstruation (n=127) cervical cancer. The present study reflects the practices regarding
Habits during menstruation Frequency Percentage menstruation hygiene among the adolescent girls, from the
Not attending schools/marriages/other rituals 55 43.31 127 respondents, and a majority of them (96.06%) used sanitary
Not serving/cooking food 26 20.47 pads, 2.36% used reusable cloths, 3.15% used fresh cloths,
Practising dietary restrictions 16 12.60 1.57% used tampons, and 0.7% used menstrual cups. The choice
Avoidance of visit to places of worship 95 74.80 of using a sanitary pad was because it has a higher rate of
Staying indoors 22 17.32 absorbancy and efficacy; however, because sanitary pads are
Being isolated at home 10 7.87 expensive, girls in rural areas prefer to use cloths. However, in a
Discontinuation of physical exercise 27 21.26 similar study conducted by Dasgupta et al.,[15] the use of sanitary
pads was much less, that is, only (11.25%) girls used sanitary
Table 5: Association between various practices and pads during menstruation. However, in a study conducted by
menstrual problems among adolescent girls Jewitt et al.[16] in Kenya, it was found out that sanitary pads and
Variables Menstrual Test Value P
clean cloths were not popular, but instead, cotton wool, plastic
problems bags, dried leaves, cow dung, and paper were used. However,
Yes No in a study conducted by Adhikari et al.[17] in Nepal, it was found
Regularity of the menstrual cycle out that the girls were using cloths as a means of absorbance
Regular 93 9 χ2* 0.26 but were not cleaning them properly before the usage, leading
Irregular 25 0 1.22 to infections.
Duration of flow
<2 days 2 0 Fisher’s exact test 1.00 Disposal methods as practised by the study subjects were quite
2‑7 days 111 8 0.31 varied. A majority of them (90.6%) practised disposing the
>7 days 5 1 absorbent material in the dustbin when compared to study by
Amount of menstruation Patil et al.,[18] where 51.67% of the subjects disposed the material
Scanty 9 0 χ2 0.68 in the dustbin. However, 5.5%, 2.4%, 3.1%, and 0.8% practised
Normal 96 8 0.74 the wash and reuse method, burning the absorbent, flushing it in
Excess 13 1
the toilet, and disposing it in the incinerator, respectively. Those
No. of times the absorbent is
changed
who used cloths and reused them during the next cycle had a
Once a day 13 0 χ2 0.52 practice of washing them with water, followed by drying them
Twice a day 88 8 1.282 under the sun to use for the next cycle.
More than twice a day 17 1
Frequency of cleaning the genital One of the other practices of menstrual hygiene among the girls
area during menstruation studied was the frequency of cleaning, where it was found that
<2 times 40 4 χ2 among the subjects, 11.7% changed the absorbent material more
>2 times 78 5 0.41 0.52 than thrice in a day, whereas 10.2% changed once during a day and
Agents used for cleaning the majority (72.7%) changed more than thrice in a day. A higher
Plain water 59 5 χ2 frequency of change in the usage of the absorbent material is
Soap/disinfectants 59 4 0.103 1.00
considered a good menstrual hygiene practice. These practices

Journal of Family Medicine and Primary Care 3610 Volume 11 : Issue 7 : July 2022
 Parikh and Nagar: Menstrual hygiene among adolescent girls

need to be encouraged as menstrual hygiene is known to be a more protein. However, the number practising them is meagre
very important risk factor for reproductive tract infections.[19] and needs to be more widely prevalent among them to improve
their nutritional status during menstruation. This clearly reflects
The adolescent girls were assessed for the cleaning practices of the lack of awareness regarding certain areas of menstrual
the external genitalia. Nearly half of them used water only for hygiene practices prevalent among the study population. Primary
cleaning, whereas 9.4%, 9.4%, and 30.5% used soap and water, care and community care providers can reflect on this and design
Dettol, and other agents, respectively. In a study conducted by strategies for future actions.
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Dasgupta et al.,[15] it was found that 97.5% girls used both soap
and water for cleaning. These differences in practices could be Conclusion
because the students are being taught the basics of hygienic
practices as a part of their curriculum. Menstruation is an important indicator of reproductive health
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and development; thus, menstrual hygienic practices are of major

The present study shows menstrual problems of the respondents. concern. It can be concluded from the study that a majority of
A majority of the respondents (74.02%) had got mood the study subjects had a regular menstrual cycle with a normal
swings during periods. About 14.17% suffered from itching, duration and amount. However, a small proportion did have
22.05% from rashes, 23.62% from foul smelling discharge, menstrual irregularities. A large proportion of the subjects
64.57% from lower abdominal pain, 6.3% from burning did have the knowledge of menstruation, but about one‑fifths
micturition, and 13.39% from increased frequency. However, did not have adequate information. Hence, it is very crucial to
in a study conducted in Taiwan by Chang et al.,[19] it was found educate girls about the physiological facts of menstruation,
out that girls suffered physical and emotional difficulties during wipe off false taboos, and lead them to proper hygienic
menstruation. practices to safeguard themselves against reproductive tract
infections. In most case scenarios, the source of information
As a traditional practice, most adolescent girls in India do observe was the family and school. The health‑seeking behaviour of
some restrictions during the menstrual period. The current study the subjects in the case of menstrual irregularity was primarily
also evaluated those restrictions practised by them. Many girls are to avoid seeking any form of treatment. Also, a very small
subjected to daily restrictions just because they are menstruating, proportion sought treatment from a doctor in the case of any
and such restrictions are followed because of the lack of proper such irregularity. A majority used sanitary pads and followed
knowledge. About 44% of the study subjects avoided attending a correct disposal technique. Only one‑third of the subjects
marriage/other rituals during menstruation, 20.47% were not used an appropriate cleaning method for genitals. Most of the
allowed to cook/serve food, 17.32% stayed indoors, 7.87% were complaints as experienced by the subjects included mood swings,
isolated, and 21.26% avoided physical exercise during the said generalized and lower abdominal pain, and lower backache. Not
period. A study by Sadiq et al.[20] found that 84.2% of the girls cooking or serving food, not visiting places of worship, and not
restrict their physical activity while menstruating. The commonest attending social functions were the main restrictions practised
restriction found in this study by the majority  (74.80%) was by the subjects during menstruation. Associations between the
not visiting the places of worship when compared to another menstrual cycle and various other factors were found not to be
study conducted by Rokade et al.,[21] where 68% in slum and significant, but the better practices were among those with a
70.16% in non‑slum girls avoided visiting the places of worship. normal menstrual cycle. A majority of the problems were found
The underlying basis of such a restriction is the traditional to be more among those not having regular periods, those with
belief of impurities associated with menstruation. In a study by more duration of flow, those with either scanty or excessive
Thakuri D S in Nepal, it was found out that household activities, menstruation, those changing absorbents infrequently, with
such as cooking meals, touching male family members, and inadequate frequency of cleaning, and those using plain water
attending cultural and religious ceremonies, were all forbidden to for cleaning. Menstrual morbidities are one of the common
adolescent girls during menstruation.[22] In a study conducted by morbidities found in the primary care settings, and the above
Mukherjee et al.[23] in Nepal, 47.8% of the participants reported factors reflect the main risk factors for them and need due
not touching food items such as fruits and vegetables during attention of policy makers and care givers.
menstruation. Such social restrictions create a harsh situation
for menstruating women.[24] Recommendations
The knowledge deficit with regard to menstrual problems and
It is known that inappropriate nutritional patterns in adolescence, subsequent health‑seeking behaviours are age old problems of
especially during menstruation, can predispose various health our country. Even though Rashtriya Kishor Swasthya Karyakram,
problems later on. In one study conducted by Kordi et al.,[25] it was launched on a large scale across the country, it has somewhere
was found out how irregular eating habits can lead to increased not been able to percolate the correct knowledge among the
menstrual distress in adolescent girls. From the present study, adolescents and correct their menstrual practices. This probably
only 18.90% of the respondents were aware and 18.90% made is also the reason that the interventions are not as well being
conscious efforts for dietary changes during menstruation, and practised and the information and correct practices have not well
from them, 14.96% consumed more iron and 21.26% consumed percolated in the community. Special focus on the adolescent girls

Journal of Family Medicine and Primary Care 3611 Volume 11 : Issue 7 : July 2022
 Parikh and Nagar: Menstrual hygiene among adolescent girls

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Journal of Family Medicine and Primary Care 3612 Volume 11 : Issue 7 : July 2022