Awareness about Early Menarche and Its Associated Problems among Female Medical Students of a Tertiary Care Hospital in Chennai, Tamil Nadu

Background: In many developing countries, the age of menarche is declining due to various factors. Early pubertal development or early menarche among girls could be associated with higher risks of poor health, so it is important to bring awareness and gain knowledge about early menarche and it's associated problems. Aim: To assess the awareness and knowledge about early menarche and its associated problems among female medical students. Settings and Design: Cross-sectional study was done among the 1st year, 2nd year and 3rd year girls studying in a medical college in Chennai. Methods: This study was conducted among 232 participants. A convenient sampling method was used. A pretested semi-stricter questionnaire was used to assess the knowledge and awareness about early menarche and its associated problems. Statistical Analysis Used: Data was entered in an excel spreadsheet and analysed using SPSS software version 16, statistical analysis was done using the Chi-square test. Results: Out of 232 participants 33.7% had good knowledge about early menarche and its associated problems. There was a significant association between the year of study and the level of knowledge of the participants. 42.35% were aware that “early menarche can lead to breast cancer and ischemic heart disease”. Original Research Article Siva and Archana; JPRI, 33(64A): 130-136, 2021; Article no.JPRI.76015 131 Conclusion: Thus, this study helps us to bring more awareness about early menarche and its associated problems and to prevent it by gaining knowledge about the factors resulting in early menarche.


INTRODUCTION
The first menstrual bleeding is referred to as menarche. Age at menarche plays a significant role in a girl's life as early puberty can predispose to many problems in the future life. In recent times it was seen that there is a secular trend in the declining of age at menarche. And in a study conducted in India [1], Korea [2], Mexico [3] and Thailand [4] showed evidence of a decline in the age at menarche. In some studies, it had been seen that young adolescents are not ready to face puberty and menstruation [5]. And also the prevalences of cardiovascular disease [6], breast cancer [7] and psychosocial problems [8] were higher among adolescents with early menarche. Also, the incidence of preeclampsia and eclampsia were higher in those girls who had attained menarche earlier [9]. It has been seen that in many low and high-income countries attainment of menarche leads to early marriage among girls when compared to high-income countries [10], due to early marriages the adolescents can undergo complications such as early pregnancies, abortions and stress which may affect the quality of their life. Though in many developed countries the awareness about menstruation and puberty were adequate, the amount of knowledge related to precocious puberty and its risk factors were very little. Hence the management of risk factors can lead to good quality of life in adolescents. So the present study was conducted to assess the awareness and knowledge about early menarche and its associated problems among female medical students of a tertiary care hospital in Chennai, Tamil Nadu. And also in the present study the attitude of the adolescents towards early puberty and its associated complications were discussed.

METHODS AND MATERIALS
This cross-sectional study was done among female medical students in a tertiary care hospital in Chennai, India. Students who were willing to participate were included in the study. Those who were not willing to participate were excluded. The study duration was about 6 months. A total of 232 participants were studied. A convenient sampling method was used. The participants were assured that participation was voluntary, and confidentiality would be maintained. The questionnaires were given after describing the purpose of the study. A pretested semi-structured questionnaire was devised and validated. The first part of the questionnaire covered the socio-demographic details. The second part of the questionnaire included questions about their awareness and knowledge about early menarche and its associated problems. After obtaining the data, it was entered in an excel spreadsheet and analysed using SPSS software version 16, statistical analysis was done using the Chi-square test.

RESULTS
The present study was conducted among female medical students in a medical college. A total of 232 girls participated in the study. Among the participants 31.03% were from the 1st year,28.01% were from the 2nd year and 39.6% were from 3rd year. The mean age of the participants was 21.2 years.
In this study, 90.3% and 9.6% of the participants were living in urban and rural areas respectively. According to modified BG prasad socioeconomic classification, 95.3% were belonging to the upper class,3.6% to the upper-middle-class and 0.5% to the lower class. 33.7% of the participants had good knowledge about early menarche and its associated problems, whereas 35.9% of them had fair knowledge and 30.2% of them had poor knowledge about early menarche and its associated problems. From Table, there is a significant association was found between grade and the level of knowledge among the participants in this study.

Fig. 3. Knowledge about early menarche and its associated problems
Among the participants, 68.24% stated that "attainment of menarche less than 8 years of age as early menarche". The level of awareness among the participants was 66.1%, while 33.8% did not have prior knowledge about early menarche and its associated problems. Knowledge from mothers (31.83%) and from teachers (20.2%) were the predominant sources of knowledge about early menarche and its associated problems. 10.9% from doctors, 1.2% from the internet, 0.57% from friends have gained their knowledge about the problems associated with early menarche. Among the participants, 42.35% were aware that "early menarche can lead to breast cancer and ischemic heart disease" while 52.36% agreed that "early menarche can lead to psychosocial health problems like anxiety disorders and risky sexual behaviours". 37.2% of the participants agreed that "menarche is influenced by genetic factors". 28.3% of the participants knew that "early puberty can lead to short stature".
Among the participants, 54.68% answered that "obesity influences the onset of menarche". 38.7% of the study subjects were aware that "conditions like hormonal disorders and tumours of the pituitary gland and adrenal gland leads to precocious puberty". 36.4% of the study subjects agreed that "sedentary lifestyle and intake of high-fat diet leads to early menarche". 27.3% of the participants agreed that "early menarche can predispose to diabetes mellitus". For the question "will you attend any awareness program about early puberty and problems related to it?" 78.23% of the participants answered "yes".

DISCUSSION
The first menstrual bleeding is referred to as menarche, and age at menarche is the most significant period of a girl's life, and it involves a complex process of physical and emotional development. Early menarche can lead to problems such as anxiety/depression, substance use and suicidal behaviour in adolescents and it can also cause diseases like breast cancer and ischemic heart disease in the future. And evidences also suggests that early menarche may lead to early fusion of the epiphyseal growth plates resulting in short stature which may affect the future of the adolescent. This project represents the awareness and knowledge about early menarche and its associated problems among the female students of a medical college.
In the present study, the level of awareness about early menarche and its associated problem was 66.1%. 31.83% of the participants obtained knowledge from mothers and it was similar to a study conducted by venkatraman Chanra-Mouli et al. [11] in which the information about menarche was majorily obtained from mothers and female family members. In the present study 42.35% were aware that "early menarche can lead to breast cancer and ischemic heart disease",While in the previous study conducted by Canoy et al. [12], the risk of coronary heart disease incidents was highest in the groups that had early menarche and in a study conducted by Gold berg et al.
[13] women with early menarche had a 30% geater risk of breast cancer compared with women without early menarche.In the present study 28.3% of the partipants knew that "early puberty can lead to short stature" similarlry in a study conducted by Sol kang et al. [14] 22.3% participants had early menarche and the prevalence of short stature was higer among them compared to the participants without early menarche.
Around 52.36% of the participants agreed that "early menarche can lead to psychosocial health problems like anxiety disorders and risky sexual behaviours",similar result was seen in the study conducted by Mobolaji Ibitoye et al. [8] it stated that early menarche leads to early sexual initiation, early pregnancy and sexually transmitted infections. And in a study conducted by Fang Deng et al. [15] higher frequency of depression,anxiety and behavioral problems were seen in the participants with early menarche.
In the present study 36.4% of the study subjects agreed that "sedentary lifestyle and intake of high fatty diet leads to early menarche", While in the study conducted by Balaji ramraj et al. [16] the incidence of early menarche was higher among the participants with sedeantary lifestyle. Around 27.3% of the participants agreed that " early menarche can predispose to diabetes mellitus" in another study conducted Baek et al. [17] the prevalences of dysglycemia, prediabetes, and diabetes were higher in middle-aged Korean women who had early menarche when compared to woman who had menarche at mean age. Among the participants 54.68% answered that "obesity influences the onset of menarche". In another study conducted by Jannatul Malitha et al. [18] it revealed that significantly heavier and taller girls attained menarche earlier than the other girls. 78.2% of the participants answered "yes" for the question "will you attend any awareness program about early puberty and problems related to it?" and so from the above answer it is observed that though the knowledge about early menarche was adequate among the participants they had a positive attitude towards acquiring knowledge about the topic.

CONCLUSION
Therefore the study assessed the awareness and knowledge about early menarche and the complications associated with it among the female students of a medical college. From the study, we observed that though the knowledge about early menarche was moderate the attitude towards being aware of the condition was more and so many awareness programs can be conducted. In this way, we can prevent adolescent girls from early menarche and its associated problems.

ETHICAL APPROVAL AND CONSENT
Ethics clearance from Institutional Ethics Committee (IEC) was applied for and obtained and Informed consent was obtained from all the participants of the study.