“A STUDY TO ASSESS THE EFFECTIVENESS OF AROMATHERAPY ON DYSMENORRHEA AMONG ADOLESCENT GIRLS IN SELECTED SCHOOLS AT MYSORE”
6 BRIEF RESUME OF THE INTENDED WORK
The period of adolescence is transition from childhood to adult life along with pubertal development and sexual maturation. During puberty hormonal, psychological, cognitive and physical changes occur simultaneously .The period of adolescence for a girl is a period of physical and psychological transformation for motherhood. One of the major physiological changes that take place in adolescent girls is the onset of menarche. After that many girls faces problems of irregular menstruation, excessive bleeding & dysmenorrhea. In that dysmenorrhea is the most common problem experienced by most of the adolescent girls. Menstrual pain is a common complaint, something that an estimated 25–97% of women experience 1.
Several complementary therapies have been used to treat menstrual pain, including acupuncture, herbal medicine, and spinal manipulation. Another option is aromatherapy massage. Aromatherapy is the practice or use of oil extracts from plants for their medicinal and aromatic benefits in order to improve psychological, spiritual and physical well being. 2
Aromatherapy is the therapeutic use of essential oils derived from plants. These oils can be absorbed into the body via the skin or the olfactory system. Massage therapy can be defined as a mean of manipulating soft tissues using pressure and traction and is reported as effective for menstrual pain. Aromatherapy is generally performed as combining with massage, and it is thought to be safe and effective in treating menstrual pain or dysmenorrhea.2
Aromatherapy is used in a wide range of settings from health spas to hospitals to treat a variety of conditions. In general, it seems to relieve pain, improve mood, and promote a sense of relaxation. Several clinical studies suggest that when essential oils were used by qualified midwives, pregnant women felt less anxiety and fear, had a stronger sense of well-being, and had less need for pain medications during delivery. Many women also report that peppermint oil relieves nausea and vomiting during labor. Massage therapy with essential oils (combined with medications or therapy) may benefit people with depression. The scents are thought by some to stimulate positive emotions in the area of the brain responsible for memories and emotions, but the benefits seem to be related to relaxation caused by the scents and the massage. A person's belief that the treatment will help also influences whether it works.4
In test tubes, chemical compounds from some essential oils have shown antibacterial and anti-fungal properties. Some evidence also suggests that citrus oils may strengthen the immune system and that peppermint oil may help with digestion. Fennel, aniseed, sage, and clary-sage have estrogen-like compounds, which may help relieve symptoms of premenstrual syndrome and menopause.4
6.1 NEED FOR THE STUDY
Various studies in India revealed that prevalence of dysmenorrhea varies from 33% to 79.67%. However, the true incidence and prevalence of dysmenorrhea are not clearly established in India. According to studies dysmenorrhea is interrupting their educational and social life. Due to dysmenorrhea sickness absenteeism (28- 48%) and perceived quality of life losses are prevalent among adolescent girls. In the United States dysmenorrhea has been estimated to be the greatest cause of time lost from work and school.1
Aromatherapy can be very helpful in relieving the pain and distress of menstrual cramps. Dysmenorrhea (painful menstruation) can also include symptoms such as headache, fatigue, bloating, and even nausea, vomiting, and/or diarrhea. Dysmenorrhea can be treated with a variety of drugs, including pain relievers, sedatives, antispasmodics, prostaglandin inhibitors, and oral contraceptives. However, these drugs can and do produce many unacceptable side effects. Aromatherapy is the therapeutic use of essential oils obtained from plants. When properly used, essential oils are very safe therapy for menstrual cramps without harmful side effect.4
The essential oils obtained from plant sources, are safe to use and have no serious side effects. Essential oils of lavender, clary sage, and rose can help improve symptoms of dysmenorrhea. To make an effective infusion, mix together 12 parts of the essential oil of lavender to one part each of clary sage and rose essential oils. This mixture is then mixed with an equal part of sweet almond oil, which acts as a carrier. Topical application or massage with this oil mix can help relieve cramps and relax the tense muscle.5
A cross sectional study was conducted to assess the prevalence of dysmenorrhea and its impact on quality of life among adolescent girls. A semi structured questionnaire was used to collect data. The sample size was 183 adolescent girls between 14-19years. Out of 183 adolescent girls 119 (65%) are dysmennorhic. Out of 81 adolescent girls with family history of dysmenorrhea 60 (74.1 %) adolescent girls are dysmennorhic. Sickness absenteeism is seen among 47.9% dysmennorhic girls. Quality of life is significantly reduced among dysmennorhic girls. Almost 73.1% of rural girls rely on self help technique to manage the dysmenorrhea as compare to urban girls (55.2%) 1
A cross sectional study was carried to assess the effectiveness of regarding aromatherapy massage on abdomen for menstrual pain among high school girls. 55 samples were there. Visual analogue scale was used to assess their pain level. The pain was significantly reduced in the aromatherapy massage treatment group over the control group. Aromatherapy massage was strongly associated with reduction of pain. Subjects in the aromatherapy massage group showed greater reduction of pain after twenty-four hours compared with subjects in the control group who took acetaminophen.2
A cross sectional study was conducted to assess the effect of aromatherapy to decrease pain, anxiety, and depression and to promote an increased sense of well-being among hospice patients .The sample size was 17. Vital signs as well as levels of pain, anxiety, depression, and sense of well-being were measured (using 11-point verbal analogs). Results reflected a positive, yet small, change in blood pressure and pulse, pain, anxiety, depression, and sense of well-being after both the humidified water treatment and the lavender treatment6.
6.2 REVIEW OF LITERATURE
Review of literature is organized under following headings.
Prevalence of dysmenorrhea.
Effectiveness of aromatherapy on dysmennorrhea.
Effectiveness of aromatherapy on pain.
Prevalence of dysmenorrhea:
A cross sectional study was conducted to assess the impact and health seeking behavior of pre-menstrual symptoms and dysmenorrhea among women. The sample size was 1236 women. A structured questionnaire was administered to collect the data. In that 879(72%) women were experiencing low back ache, 484 (40%) were experiencing depressed mood, 268 (22%) were experiencing head ache, 218 (22%) experiencing nausea. 465 (38%) experiencing mild dysmenorrhea ( 0-3 in the pain scale ), 42% were experiencing moderate pain (4-7), 248 (20%) were experiencing severe pain (8-10). Treatments sought were: 496(56%) were using conventional medicine, 285 (32%) were using house hold medicines, 90 (10%) were using herbal medicine, 125 (14%) were using homeopathic medicine. Conventional medicines was used by more educated women and was perceived to be effective more often other modalities.7
A cross-sectional descriptive study was conducted to assess the prevalence of dysmenorrhea among adolescent girls. A structured questionnaire was administered to collect data. Nine hundred and seventy adolescent girls of age 15 to 20 years were selected for the study. The prevalence of dysmenorrhea in adolescent girls was found to be 79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. In this study, 6.32%, 30.37% and 63.29% participants were suffering from severe, moderate and mild grades of dysmenorrhea. The three most common symptoms present on both days, that is, day before and first day of menstruation were lethargy and tiredness (first), depression (second) and inability to concentrate in work (third), whereas the ranking of these symptoms on the day after the stoppage of menstruation showed depression as the first common symptoms.8
A cross-sectional study was conducted to assess the prevalence of dysmenorrhea and determine its effect on health-related quality of life among a group of female university students. A structured questionnaire was used to collect the data. The questionnaires included visual analogue scale (VAS) questions and multidimensional scoring system (MSS) to assess the severity of dysmenorrhea .The study group included 623 female students. Prevalence of dysmenorrhea was found to be 72.7% and was significantly higher in coffee consumers, females with menstrual bleeding duration ≥7 days, and those who had a positive family history of dysmenorrhea when compared to the others. The distribution of the severity of dysmenorrhea cases was as follows: mild 33.8% (n = 153), moderate 42.4% (n = 192), and severe 23.8% (n = 108).About 50% of students reported having a family history of dysmenorrhea. No difference between menstrual characteristics and status of dysmenorrhea was revealed except for menstrual bleeding duration and family history. Dysmenorrhea is a common health problem, having negative effects on the health-related quality of life among university female students.9
A cross sectional study was conducted to assess the prevalence, impact and treatment of primary dysmenorrhea among university students. A multiple-choice questionnaire was administered to 1539 students in six university programs. The result is shown that the prevalence of dysmenorrheal, mild in 36.1% of women, moderate in 43.8% and severe in 20.1%. Nursing students showed an intensity of pain that was significantly higher than that of medicine and dentistry students (p < 0.05). Sixty-five percent of the women with dysmenorrhea reported that it limited their daily activities, and 42.1% reported school absenteeism (SA) as a result. Of those who experienced dysmenorrhea, 25.9% consulted a physician, and 61.7% practiced self-medication (SM). 10
A cross sectional study was conducted to assess the prevalence of dysmenorrhoea, its impact, and treatment-seeking behavior of rural adolescent girls. A structured questionnaire was administered to collect data. 1295 adolescent girls (aged 13–19 years) were the samples.Dysmenorrhoea was reported in 76.0% of the participants.76.1% believed that dysmenorrhoea is a normal part of the female menstrual cycle and only 14.8% sought medical treatment.11
A cross sectional study was conducted to assess the prevalence and the effect of menstrual disorders on daily routine and their treatment-seeking behavior among unmarried students. Of 276 undergraduate girl students, 112 were sampled by stratified random sampling. All the consenting participants were given a pretested semi structured questionnaire to collect their responses by personal interviews. The data collected were analyzed. Premenstrual syndrome (67%) and dysmenorrhea (33%) were perceived by the study subjects as the most distressing problems associated with menstruation. The most common effect of menstrual problems on daily routine reported by the study subjects was in the form of prolonged resting hours (54%) followed by inability to study (50%). More than half (52%) of the subjects discussed their problems with their mother, and 60% of the study subjects were opted for allopathic treatment for their menstrual problems.12
A correlative study was conducted to assess the prevalence of dysmenorrhea among women of rural village. Dysmenorrheal was a common menstrual problem affecting the women and disrupting their work. About 40–70% of women of reproductive age suffers with dysmenorrhoea and is associated with significant psychological, physical, behavioral and social distress.13
Effectiveness of aromatherapy on dysmenorrhea:
A cross sectional study was conducted to investigate the effect of self-aromatherapy massage on menstrual pain and anxiety among staff nurses. The subjects were 63 female nurses who rated their menstrual pain >5 on a 10-point visual analogue scale. Subjects were non-randomly allocated into three groups. . Menstrual pain and anxiety levels were assessed using a visual analogue scale, and we assessed the menstrual pain 4 times during a short time period. The menstrual pain was significantly lower in the aromatherapy group than in the other two groups after 24h. Using multiple regression analysis, the use of aromatherapy was found to be associated with the changes in menstrual pain levels. These findings suggest that self-aromatherapy massage of the abdomen using topically applied essential oils may be an effective treatment that decreases menstrual pain and the level of anxiety.14
A cross sectional study was conducted to explore the effect of aromatherapy on menstrual cramps and symptoms of dysmenorrhea among college students. The study was a randomized placebo-control trail. The sample size was 67 female college students. The visual analogue scale was used to assess their pain level with a verbal multidimensional scoring system. The menstrual cramps were significantly lowered in the aromatherapy group than in the other groups at both post test points. The findings suggest that aromatherapy using topically applied lavender, clay sage, rose is effective in decreasing the severity of menstrual cramps. Aromatherapy can be offered as part of the nursing care to women experiencing menstrual cramps or dysmenorrhea.15
A study was conducted to investigate the effect of aromatherapy massage on dysmenorrhea among nursing students. The study used a quasi –experimental design. The sample size was 438 nursing students. The visual analogue scale was used to assess the pain level of the sample. This study showed that massage was effective in reducing dysmenorrhea .In addition ,this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage.16
Effectiveness of aromatherapy on pain
An evaluative study was conducted to examine the contribution of aromatherapy on the promotion of maternal comfort during labor and as a tool to improve the quality of midwifery care. It was a longitudinal study. The sample size was 8,058 antenatal mothers .Routine datas were collected. More than 50% of mothers rated it as helpful, and only 14% found it unhelpful. More than 8% of primigravidae and 18% of multigravidae used no conventional pain relief during labor after using essential oils. During the years of the study, the use of pethidine in the study center declined from 6% to 0.2% of women. The study also showed that aromatherapy may have the potential to augment labor contractions for women in dysfunctional labour. A very low number of associated adverse symptoms were reported (1%).17
A study was conducted to evaluate the effect of aromatherapy in treating post operative pain among patient undergone breast biopsy. The sample size was 50 patients between 18 -65 years . Pain intensity was evaluated with a numeric rating scale. Patients were assessed for pain at 5, 30, and 60 minutes after arrival in the post anesthetic care unit . Patients after breast biopsies have a low incidence of pain and or side effects. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group .18
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of aromatherapy on dysmenorrhea among adolescent girls in selected schools at Mysore.
To assess the pain scores of adolescent girls with dysmenorrhea among experimental and control group.
To determine the effectiveness of aromatherapy on dysmenorrhea among adolescent girls in terms of reduction in pain score.
To determine the association of pain scores with their selected personal variables .
Effectiveness: In this study it refers to reduction in the pain scores related to dysmenorrhea after the aromatherapy as measured by visual analogue scale.
Aromatherapy: In this study aromatherapy refers to application of combination of 4 – 6 drops of lavender oil and 5 cc of almond oil over the abdomen for the adolescent girls with mild to moderate dysmenorrheal for 10 minutes.
Dysmenorrhea: In this study dysmenorrhea is the abdominal pain which occurs due to abdominal cramps during menstruation as measured by visual analogue scale.
Adolescent girls: In this study it refers to adolescent girls in the age group of 13-18 years and are inmates of selected hostels of schools in Mysore and who complaints of dysmenorrhea.
Selected personal variables: In this study, the personal variables include age, age of menarche, duration of menstruation ,frequency of menstruation, family history of dysmenorrhea, menstrual cycle .
H1: The mean post test pain scores of adolescent girls who have undergone aromatherapy will be significantly less than the mean pre test scores of pain.
H2: The mean post test scores of experimental group will be significantly less than mean post test scores of control group.
H3 : The pain scores of adolescent girls related to dysmenorrhea will be significantly associated with their selected personal variables.
Assumptions of the study are
Aromatherapy may reduce dysmenorrhea.
Adolescent girls may have dysmenorrhea that may affect their quality of life.
The study is delimited to aromatherapy with lavender oil and almond oil.
The study is delimited to adolescent girls between 13-18 years who are residing in hostel.
7.0 MATERIALS AND METHODS
Quasi experimental design –non equivalent pre test-post test control group design
In the present study the sample size is 60 adolescent girls (13-18 years), (30 in the experimental group and 30 in the control group).
METHOD OF DATA COLLECTION
Personal variable proforma to assess the sample characteristics.
Visual analogue scale to assess pain among adolescent girls undergoing aromatherapy.
PLAN OF DATA ANALYSIS
Data was planned to be analyze using descriptive and inferential statistics
Personal variables are analyzed in terms of frequency and percentage.
Mean, median and standard deviation will be computed for pain score among adolescent girls.
Paired t test will be used to compare the mean pretest and post test scores of experimental and control group
Independent t test is used to analyze the significant difference in the post test scores of adolescent girls.
Chi –square test will be computed to determine the association between the pain level and their personal variables.
7.3 Does the study requires any investigation or intervention to be conducted on patients or other human or animal? If so please describe briefly
Yes, aromatherapy will be applied in adolescent girls
7.4 Has ethical clearance being obtained from your institution?
Suresh k. Kumbhar et. al . Prevalence of dysmenorrhea among adolescent girls (14-19 yrs) of Kadapa district and its impact on quality of life. National journal of community medicine. 2011july-sept; 2(2): 265-268.
Myung - Haeng hur et.al. Aromatherapy massage on the abdomen for alleviating menstrual pain in high school girls: a prelimininary controlled clinical study. Evidence based complementary and alternative medicine .2011 june;2012 :1-3
Aromatherapy. [Internet] [Updated 2009 July 9 ; cited on 2011 Oct 22].
Available at http://www.umm.edu/altmed/articles/aromatherapy-000347.htm
Judy Lausch.Painful menstrual cramp-essential oils for dysmenorrhea [internet] [cited non 2011 Oct22].Available from: http://ezinearticles.com/?painful-menstrual-cramps---essential-oils-for dysmenorrhea&id=1321057
Aromatherapy oils for dysmenorrhea treatment [internet][updated on 2009 Dec 4; cited on 2011oct 22] . Available at http://www.aromatherapies.net/blog/tag/secondary-dysmenorrhea
Louis m Kowalshki s d, Susan D. Kowalski .Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Am j hosp palliate care. 2002 Nov-Dec; 19(6); 381-6.
Nabia tariq. Impact and healthcare –seeking behavior of premenstrual symptoms and
dysmenorrhea British journal of medical practitioners. 2009 Dec; 2 (4); 40-43.
Agarwal, Anil, Agarwal, Anju. A study of dysmenorrhea during menstruation in Adolescent girls. Indian journal of community medicine 2010 Jan; 35(1):159–164.
Aleattin unsal,Unal Ayranci,Mustafa Tozum,Gul arslan.Prevalence of dysmenorrhea and its impact on quality of life among a group of female university students. Upsala journal of medical sciences.[internet] 2009[cited on 2011 Oct 26] ; 115(2):138–145. Available from
Mario i. Ortiz. Primary dysmenorrhea among Mexican university students: prevalence ,impact and treatment. European Journal of Obstetrics & Gynecology and reproductive biology. 2009 Nov; 152(1):73-77.
Li Ping Wong .Attitude towards dysmenorrhea, impact and treatment seeking among adolescent girls: a rural school –based survey, Australian journal of rural health, 2011 Aug;19(40):218-223.
Anamika Sharma ,Devendr K Tanej2, Pragya Sharma , Renuka Saha .Problems related to menstruation and their effect on daily routine of students of a Medical college in Delhi. [internet] 2008 May 28 ; [ cited on 2011 Oct 30 ] . Available from http://aph.sagepub.com/content/20/3/234.abstract
Pais, Maria and Noronha, Judith A. A Correlative Study on Dysmenorrhea among Rural Village Women of Udupi District, Karnataka. International Journal of Nursing Education.2011 Aug ; 23( 4) :45-48.
Yoo –Jin Kim ,Myeong Soo Lee ,Yun Seok yang . Self aromatherapy massage of the abdomen for the reduction of menstrual pain and anxiety during menstruation in nurses: a placebo –controlled clinical trail. European journal of integrative medicine. 2011 Sept; 3(3):165-168.
Sun –Hee Han, Myung –Hur,Jane Buckle . Effect of aromatherapy on symptoms of dysmenorrhea in college students : a randomized placebo- controlled clinical trail , the Journal of Alternative and Complimentary medicine , 2006; Aug; 12 ( 6 ) :535-541.
Serap Ejder Apay, Sevban Arslan ,Reva Balci Akpinar. Effect of aromatherapy massage on dysmenorrhea in Turkish Students. American society for pain management nursing .2010 April 22; P11: S1 524-9042(10) 00067-6 doi: 10. 1016/j.pmn.2010 .04.002.
Burns EE, Blamery C, Ersser SJ. An investigation into the use of aromatherapy in intrapartum midwifery practice. J Altern Complement Med. 2000 April; 6(2):141-147.
Jung T. Kim, MD, Michael Wajda, MD, Germaine Cuff. Evaluation of Aromatherapy in Treating Postoperative Pain, World Institute of Pain, Pain Practice[internet [cited on 2011 Oct 28] .2006;6(4) : 273–277.Also available from http://www.aromatherapy.ir/article/16.pdf
9.0 SIGNATURE OF THE CANDIDATE:
10.0 REMARKS OF THE GUIDE
RECOMMENDED AND FORWARDED
11.1 NAME AND DESIGNATION OF GUIDE (in block letters)