Stress Relationship with Menstrual Pattern on Nursing Students

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Published on International Journal of Health, Nursing, & Medicine
Publication Date: May 21, 2019

Maria Goretik, Rachmadhi Purwana & Darnialis Darwis
Postgraduate Faculty of Public Health, University of Respati Indonesia
Faculty of Public Health, University of Respati Indonesia

Journal Full Text PDF: Stress Relationship with Menstrual Pattern on Nursing Students.

Abstract
Adolescence is a transition period in the form of physical, emotional and psychological changes, or a period of maturation of the human reproductive organs (puberty). There are several problems related to growth and development biologically and behavior is often a burden on adolescents such as puberty, chronic health conditions, other deviant behaviors, and menstrual disorders. The aim of the study identified a relationship between stress and menstrual pattern Insan Dharma Nursing Academy Student. This study used an observational analytic research design with a cross-sectional approach to identify stressful relationships with menstrual patterns. The research was conducted at the Dharma Insan of Nursing Academy of Pontianak, from April until May 2016. The sampling technique used total sampling, a total of 156 respondents. The majority of respondents experienced mild stress 83 respondents (85%). There is a stressed relationship with menstrual patterns p-value 0.00 (p <0.05), (OR = 4,109) indicating respondents who are at risk of stress 4,109 higher experience irregular periods. The conclusion of the study is that there is a positive relationship between stress, weight, exercise, nutritional status with menstrual patterns and no relationship between age of menarche, sleep patterns, hereditary diseases with menstrual patterns. The recommendation of this study is that respondents can increase their knowledge about stress management, menstrual disorders and apply it so that stress can be overcome and menstrual disorders experienced can be reduced.

Keywords: Menstrual Patterns, Stress.

1. INTRODUCTION
Adolescence is a transition period characterized by changes in physical, emotional and psychological, or a period of maturation of the human reproductive organs (Hasdianah & Sandu, 2013). Adolescence is physical changes occur as a result of being functioning of the endocrine glands that produce hormones that affect the overall growth and especially sexual organs. Adolescence or transition period, crisis period and identity seeking period (Notoatmodjo, 2011). Adolescence is a time when things are not stable. There are several problems related to growth and development biologically and behavior becomes a burden for adolescents such as puberty, chronic health conditions, other deviant behaviors and menstrual disorders (Soetjiningsih, 2014).
Each menstrual cycle there are three main periods known, the menstrual period for 2-8 days, the proliferation period during the 14th day and the period of secretion (Winkjosastro, 2012). Menstrual cycles vary for each woman and nearly 90% of women have a 25–35 day cycle and only 10-15% have a 28 day menstrual cycle, but some women have irregular menstrual cycles. Menstrual cycle irregularities or changes in the menstrual cycle consist of Polymenorrhea, Oligomenorrhea, and Amenorrheea (Syafrudin, 2012). This change in the menstrual cycle is influenced by several factors including stress. Stress can affect a woman’s reproductive system so that she experiences irregular menstrual cycles and disminorrhea, whereas in men he will experience a decrease in sexual arousal, reduction in sperm production and impotence.
Based on the data obtained by the Pontianak City Health Service, cases of menstrual disorders, in general were 857 cases that occurred in adolescents. Based on a preliminary study of students of the Dharma Insan Nursing Academy totaling 156 students. The researcher conducted interviews with 50 students aged 19-23 years. The researchers found 38 (76%) of their menstrual cycle students were regular and 12 (24%) irregular menstruation or experienced changes3 (7.89%) experienced polymenorrhea, amenorrhea and oligomenorrhea 29 (76.31%). Most students have experienced stress such as facing exams and many assignments. The aim of the study was to identify the relationship between stress and menstrual patterns in female students of the Dharma Insan Nursing Academy.

2. METHODOLOGY
This study used an observational analytic design with a cross-sectional approach to identify the relationship between stress and menstrual patterns. The study was conducted at the Dharma Insan Nursing Academy and from April until May 2016. The target population in this study were Dharma Insan Nursing Academy students. The actual population in this study were students of the Dharma Insan Nursing Academy, especially the second and fourth semester. The sampling technique used total sampling (sampling saturated) is used as the sample population members. A total of 156 students consisting of 74 students (semester II) and 82 students (semester IV). The inclusion criteria were the Dharma Insan nursing academy students in Pontianak especially semester II and IV, the average menstrual cycle every month was normal (21-35 days) and not physically disabled.
The instrument uses a questionnaire that refers to the parameters that have been made in accordance with the research that will be conducted. Demographic data include age, place of residence, nutritional status. Stress questionnaire during menstruation is a closed-ended type of questionnaire, Modified Depression Anxiety Stress Scale 42 (DASS 42) questionnaire is an instrument to determine the level of depression, anxiety, and stress. The researcher only chose a questionnaire that measured stress, which was 14 questions. The number of questionnaires consisted of 42 statements. The menstrual pattern questionnaire contains open and closed questions regarding menstrual patterns (Wiknjosastro 2015). The researcher classified menstrual patterns into 6 normal cycles, normal cycles with dysmenorrhoea, short cycles, short cycles with dysmenorrhoea, long cycles, long cycles with dysmenorrhea.

3. RESULT
A. Univariate Analysis
Table 1. Distribution of characteristics of respondents (n = 150)
The majority of respondents were abnormal weight 92 respondents (61.3%), the majority of respondents were in the range of good nutrition 90 respondents (60.0%), the majority of respondents sleep patterns for> 8 hours 91 respondents (60.7%), the majority of respondents never sport that is 95 respondents (63.3%), the majority of menarche age ≤ 13 years 104 respondents (69.3%), the majority of respondents there were no hereditary diseases namely 137 respondents (91.3%), the majority of respondents were mild stresses namely 83 respondents (85.0%), the majority of regular menstrual patterns were 108 respondents (72.0%).

B. Bivariate Analysis
Table 2. Independent Variable Cross Table with Menstruation pattern
There is a correlation between nutritional status and menstrual pattern p-value 0,000 (p <0,05), (OR = 0,130) indicating respondents have poor nutritional status at a risk of 0,130 higher having irregular menstruation than having normal nutritional status. There is no relationship between sleep patterns and menstrual patterns p-value 0.582 (p> 0.05). There was a relationship between exercise and menstrual patterns p-value 0.002 (p <0.05) (OR = 0.250) respondents never exercised regularly risked having irregular periods. There is no relationship between age of menarche and menstrual pattern p-value 0.458 (p> 0.05). There is a stress relationship with menstrual patterns p-value 0.00 (p <0.05), (OR = 4,109) indicating respondents who are at risk of stress 4,109 higher experience irregular periods. C. Multivariate Analysis 1. Early models Table 3. First logistic regression analysis of body weight, nutritional status, exercise habits and stress with menstrual patterns (n = 150) Weight variable (p-value 0.144) and stress (p-value 0.507) were excluded from the modeling starting with the biggest variable, stress. The next multiple logistic regression analysis stress variables participated. Table 4. The second modeling stage without stress variables Table 5. Change OR after the stress variables issue. After the stress was released, there was no change in OR> 10%, so the modeling was continued to issue variables that had p-value> 0.05 in the second modeling of weight (0.136).
Table 6. The third Modeling Stage without Variable Weight
After the body weight is removed, there is no change in OR> 10%, and the remaining variables have p-value <0.05. 2. Final models Table 8. Final Model of Logistics Regression Analysis The final modeling of the influence on menstrual patterns is nutritional status and sports habits. The dominant variable influencing menstrual patterns is sports habits (OR = 0.354) meaning the respondents do not exercise have the opportunity for irregular menstruation 0.354. 4. DISCUSSION A. Characteristics of Respondents The majority of respondents have abnormal weight. According to Badriah (2011), the prevalence of a Body Mass Index is less than 30%-40%. Petite is a nutrition problem is generally more common in young women. The motto “thin is beautiful” for young women often go on a diet without supervision from a doctor or nutritionist so that important nutrients are not met. Though adolescence is a period of “nutrition-prone” because the need for nutrition is high. The majority of respondents are normal and overweight. As a result of lack of knowledge about balanced nutrition and the statement “thin is beautiful”, respondents limited nutrition to their bodies. Respondents were overweight because of the physical activity of those who never exercised. Excessive nutritional intake due to lack of knowledge of balanced nutrition so consumption of junk food and containing lots of fat such as fried foods, chocolate, instant noodles, etc. The majority of respondents have good nutrition (60%), according to Suharjo (2003) factors that influence nutritional status are basically determined by internal and external factors. Internal factors consist of genetic, food intake, and infectious diseases. External factors consist of agriculture, economics, social culture, and nutritional knowledge. According to Shaliha (2010), along with the development of technology, the use of chemicals in the food manufacturing process is increasingly widespread. In addition, daily activities and sports also influence. Technological developments have helped reduce children’s play activities, which has reduced mobility. The majority of respondents did not exercise (63.3%). Respondents who engage in irregular exercise habits are at risk of experiencing menstrual disorders. This can cause levels of prostaglandin and endorphins to accumulate which give the effect of pain. Women who exercise regularly at least 30-60 minutes every 3-5 times every week can prevent menstrual disorders. Every woman can just walk leisurely, swim, gymnastics or cycling according to conditions (Manuaba, 2010). B. Relationship between stress and menstrual patterns The majority of respondents experienced mild stress (55.3%). The average age of respondents 18 years, the amount of busyness and tasks obtained both from education and from the practice land causes stress that affects the menstrual cycle pattern. According to Walker (2002), the main causes of stress and problems that exist in adolescents come from friends and family, pressure and expectations in themselves and others, pressure in school and homework, economic pressure and tragedies that exist in life (death, divorce, and disease). Based on the results of the analysis there is a relationship between body weight and menstrual pattern. The majority of respondents are underweight, but respondents who are obese the menstrual cycle can be normal. This study is in line with Asniya (2012) the relationship of nutritional status with menstrual cycle disorders. According to Eny (2011) causes of menstrual disorders 1) Congenital abnormalities. 2) High-stress levels. 3) Use of oral contraceptives or injections, hormone replacement therapy. 4) Malnutrition (especially magnesium, zinc, and vitamins. 5) Weight due to excess fat cells makes excess estrogen. Based on the results of the analysis there is a correlation between nutritional status and menstrual patterns. This research is in line with Cholifah & Hadikasari (2015) that there is a relationship between nutritional status and Menstrual pattern disorders. Nutritional status is one of the risk factors that can cause a disruption of menstrual patterns. The results showed that there was a correlation between nutritional status and menstrual disorders. The majority of respondents experiencing menstrual pattern disorders have abnormal nutritional status. This is due to irregular eating patterns, suffering from illnesses or a wrong lifestyle. According to Dayanti (2008), good nutritional status is important in an effort to get a regular menstrual cycle. Based on the results of the analysis there is a relationship between exercise and menstrual patterns. Irregular exercise habits affect the occurrence of menstrual disorders. The results showed that there was a relationship between exercise habits and the occurrence of menstrual disorders. The majority of respondents who experience menstrual pattern disorders have irregular exercise habits. According to Anggraini (2011), the incidence of menstrual pattern disorders is caused by hormonal imbalance in women. The imbalance of these hormones causes disruption in the ovulation process so that it can cause disruption of menstrual patterns. Based on the results of the analysis there is a relationship between stress and menstrual patterns. This research is in line with Desti (2010), disorders of menstrual patterns involve integrated regulatory mechanisms that affect biochemical and cellular processes throughout the body including the brain and psychology. The influence of the brain in hormonal reactions occurs through the hypothalamic-pituitary-ovarian pathway which includes multiple effects and feedback control mechanisms. Stress conditions cause activation of the Amygdala in the limbic system. This system will stimulate the release of hormones from the hypothalamus, namely corticotropic releasing hormone (CRH). This hormone will directly inhibit the hypothalamic GnRH secretion from its production site in the arcuate nucleus. This process is likely to occur through the addition of the secretion of endogenous opinoid. Increased CRH will stimulate the release of endorphins and adrenocorticotropic hormone (ACTH) into the blood. Endorphins are known to be endogenous opiates whose role has been shown to reduce pain. Increased ACTH levels cause an increase in blood cortisol levels. Women with symptoms of hypothalamic amenorrhea showed hypercortisolism caused by an increase in CRH and ACTH. These hormones, directly and indirectly, cause a decrease in GnRH levels, so stress causes a disruption of the menstrual cycle. Normal menstrual cycles become oligomenorrhea or polymenorrhea. The clinical symptoms that arise depend on the degree of emphasis on GnRH. These symptoms are generally temporary and usually return to normal if the stress can be overcome.

5. CONCLUSION
The conclusion of the study is that there is a positive relationship between stress, weight, exercise, nutritional status with menstrual patterns and no relationship between age of menarche, sleep patterns, hereditary diseases with menstrual patterns. The most dominant factor is nutritional status, the better nutritional status, the more regular menstrual patterns. Recommendations in this study are that respondents can increase knowledge about stress management and menstrual disorders and apply it so that stress can be overcome and menstrual disorders experienced can be reduced. Researchers can then dig deeper into the menstrual pattern disturbance by adding more different variables such as levels of stress early adulthood The menstrual cycle period is influenced by age, weight, physical activity, stress levels, genetics and nutrition (Wiknjosastro, 2015). The average age of respondents 18-20 years with mild stress levels. Types of activities performed by the respondents include routine follow lectures, lab work, working on reports and assignments, participate in the organization. The first sign that the body shows in a stressful state is that the muscles in the body are filled with stress hormones that cause blood pressure, heart rate, body temperature and breathing to increase. The body will produce excessive adrenaline, estrogen, progesterone, and prostaglandin. Anxiety and emotional disturbances can cause a woman not to get menstruation. The menstrual cycle is influenced by a series of hormones produced by the body namely Luteinizing Hormone, Follicle Stimulating Hormone, and estrogen.