Literature On Yoga And Dysmenorrhea

“A great literature is chiefly a product of inquiring minds in revolt against the immovable certainities of nation “- Mecken H.C. Literature serves a number of important functions in the research process. It helps the researcher to generate ideas or to focus on a research topic. It also can be useful in pointing out the research design, methodology, meaning of tools and type of statistical analysis that might be productive in pursuing the research problem.

Review of literature of the present study is arranged under the following headings.

Review related to dysmenorrhea

Studies related to dysmenorrhea

Review related to yoga

Studies related to yoga on stress and dysmenorrhea

REVIEW RELATED TO DYSMENORRHEA

DYSMENORRHEA

Dysmenorrhea is a gynaecological medical condition characterized by severe uterine pain due to painful cramps during menstruation. Menstrual cramps usually last from a few hours to several days and ease as the cycle progresses.

TYPES OF DYSMENORRHEA

Primary dysmenorrhea

Secondary dysmenorrhea

PRIMARY DYSMENORRHEA

Primary dysmenorrhea means pain recurred regularly or within a year or two of the first puberty.

SECONDARY DYSMENORRHEA

It is associated with gynecological disorders such as endometriosis or pelvic abnormalities. Pain begins years after periods started.

Secondary dysmenorrhea can be caused by the following:

Endometriosis.

Blood and tissue being discharged through a narrow cervix.

Uterine fibroid or ovarian cyst.

Infections of the uterus.

Pelvic inflammatory disease (PID).

Intrauterine device (IUD).

PRIMARY DYSMENORRHEA

The causes of primary dysmenorrhea are:

Strong uterine contractions which is stimulated by increased production of the hormone prostaglandin by the lining of the uterus (endometrium).

Anxiety and stress.

Blood and tissue being discharged through a narrow cervix.

Displaced uterus.

Lack of exercise.

Associated factors in primary dysmenorrhea

Use of caffeine or nicotine.

Stress. The degree of dysmenorrhea may vary according to general health or mental state. While emotional or psychological factors don’t cause the pain, they can worsen it or cause some women to be less responsive to treatment.

Family history of dysmenorrhea.

Lack of exercise; poor diet.

Signs and symptoms

Diarrhea (occasionally) or constipation.

Sweating.

Nausea and vomiting (sometimes).

Cramping sharp pains in the lower abdomen, lower back and thighs.

Pain starts at the onset of menses and lasts for hours to days.

Lack of energy.

Urinary frequency.

Irritability, nervousness, depression.

Fainting.

Headaches.

Management

Nutritional

Nutritional supplements like omega-3 fatty acids (fat compounds found in oily fish, such as salmon and tuna), magnesium, vitamin E, zinc, and thiamine (vitamin B1) are effective in treating dysmenorrhea. Intake of plenty of whole grains, fresh fruits and vegetables, and avoiding saturated fats and commercial junk foods is also beneficial. Limiting salt may help to reduce bloating. Reduce caffeine, sugar, and alcohol intake will help in reducing the risk of dysmenorrhea.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The pain of primary dysmenorrheal is relieved by non-steroidal anti-inflammatory drugs. Aspirin is the most common NSAID

Non-drug therapies

Yoga Therapy, exercise, acupuncture, acupressure, behavioral therapy, Transcutaneous electric nerve stimulation (TENS) and chiropractic care are effective in treating dysmenorrhea.

Yogic Management

The pigeon pose, the hero pose the best way of calming the thoughts and relaxing the body and wide squat pose is very useful in reducing the hip pain.

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electric nerve stimulation (TENS) is a mode of treatment which uses low-level electrical pulses to suppress back pain. The standard approach is to give 80 to 100 pulses per second, for 45 minutes, three times a day.

STUDIES RELATED TO DYSMENORRHEA

Liliwat et al (2006) conducted a study to determine the prevalence of dysmenorrhea, its associated factors and its effects on school activities among adolescent girls in a secondary school in a rural district of Selangor, Malaysia. The prevalence of dysmenorrhea was 62.3%. It was significantly higher in the middle adolescence (15 to 17 years old) age group, girls with regular menstrual cycle and a positive family history. There was no significant association with mean age of menarche and duration of menstruation. The number of school and class absences increased with increasing severity of dysmenorrhea. The mean pain score was significantly higher in girls who reported to be unable to participate in sports and with poor concentration in class. Dysmenorrhea among the adolescent girls was found to be common. It had significant negative impact in their school performance and activities.

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Wilson et al (2003) stated that the majority of the female adolescents have been identified dysmenorrhea and premenstrual symptoms as problems that affect the academic performance and an important factor for school absenteeism. They surveyed eighty-eight female high school adolescents in two separate physical education classes at high school adolescents in Pune for the prevalence of dysmenorrhea and premenstrual symptoms. The results showed that 86% (76 out of 88) had premenstrual symptoms and 91% (80 out of 88) had dysmenorrhea and most of the girls were unaware of the causes and treatments of these symptoms. Subsequently, a model was designed to educate girls in self-help methods and to screen for and detect these problems.

Dittakarn et al (2003) conducted a study to determine the prevalence of dysmenorrheal and its impact on school attendance, academic performance, social activities and knowledge of treatment in Thai adolescents. Dysmenorrhea was a significant public health problem. It had an impact on academic activities. Most of the subjects knew that Paracetamol is the drug that help to relief their symptoms.

Anil K Agarwal & Anju Agarwal (2002) conducted an explorative study to assess the prevalence of dysmenorrhea its severity with associated symptoms in high school adolescent girls of the age group within 15 to 20 years at Gwalior. They concluded that the prevalence of dysmenorrhea was 79.67% and majority of them, 37.96%, suffered regularly from dysmenorrhea severity. The three most common symptoms present on day before and first day of menstruation were lethargy, tiredness, depression, inability to concentrate in work.

Wilson (2002) conducted a study to assess the prevalence of dysmenorrhea among adolescents of 14-16 years in Switzerland using questionnaire. Among 327 cases, 185 cases (56.6%) reported dysmenorrhea. Among them 95 (31.7%) had mild dysmenorrhea, 45(15%) had moderate dysmenorrhea and 17 (5.7%) had severe dysmenorrhea.

Martin et al (2001) conducted a study to assess the prevalence and severity of dysmenorrhea among adolescents. A 95-item menstrual Assessment Form was administered to 207 suburban-based adolescent females in Turkey. Subjects had a mean age of 17.6 years, 89% were white, 59% were in high school, and 28% were in college. Almost all subjects reported dysmenorrhea (96%) or moderate (89%) severity; while many reported changes they considered severe (59%) or extreme (43%). The most commonly reported changes in physical condition were general discomfort, water retention symptoms, fatigue, and autonomic physical changes. The most commonly reported changes in mood and behavior included impaired social function, depressive changes, and impulsive behavior. These changes were most severe in those adolescents who reported having dysmenorrhea.

Banikarim et al (2000) conducted a study to determine the prevalence of dysmenorrhea among Hispanic female adolescents its impact on academic performance, school attendance, and sports and social activities; and its management. A total of 706 Hispanic female adolescents, in grades nine to twelve, completed a 31-item questionnaire about the presence, duration, severity, treatment, and limitations of dysmenorrhea at a local urban high school. Dysmenorrhea was highly prevalent among Hispanic adolescents and was related to school absenteeism and limitations on social, academic, and sports activities. Most of the adolescents did not seek medical advice for dysmenorrhea.

Hillen et al (1999) conducted a study to explore the prevalence of dysmenorrhea and its impact on school, sporting, social activities, management strategies, and their knowledge of available treatment among senior high school girls in Perth, Western Australia. A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. it was found that the prevalence and impact of dysmenorrhea was high, and they lack knowledge and experience of effective treatment. Health education measures were needed to prevent unnecessary suffering and interruption to school routine.

REVIEW RELATED TO YOGA

Introduction to yoga

Yoga is becoming popular in all parts of the world. For the restless mind it gives solace; For the sick it is a boon; For the common man it is the fashion of the day to keep him fit and beautiful. Some use it for improving memory intelligence and creativity with its multifold advantages it is becoming a part of education. Specialists use it to unfold deeper layers of consciousness in their move towards perfection.

Definition

The term yoga comes from a Sanskrit word which means yoke or union. Traditionally, yoga is a method joining the individual self with the Divine, Universal Spirit, or Cosmic Consciousness. Physical and mental exercises are designed to help achieve this goal, also called self-transcendence or enlightenment.

On the physical level, yoga postures, called asanas, are designed to tone, strengthen, and align the body. These postures are performed to make the spine supple, healthy and to promote blood flow to all the organs, glands, and tissues, keep all the systems of the body healthy.

On the mental level, yoga uses breathing techniques (pranayama) and meditation (dyana) to quiet, clarify, and discipline the mind.

Purpose

Yoga is used to alleviate problems associated with high blood pressure, high cholesterol, migraine headaches, asthma, shallow breathing, backaches, constipation, diabetes, menopause, multiple sclerosis, varicose veins, carpal tunnel syndrome and many chronic illnesses. It also has the ability to promote relaxation and reduce stress.

As of late 2002, yoga is increasingly recommended for dysmenorrhea, premenstrual syndrome, and other disorders. Hatha yoga, a path of yoga is based on physical purification, strengthening and self-transformation. It encompasses a system of asanas (postures), which helps to promote mental and physical well-being, with particular emphasis on making the spine supple and healthy and increase circulation and allow the mind to focus and become free from distraction for long periods of meditation, along with pranayama (breath control). It is a highly developed system of nearly 200 physical postures, movements and breathing techniques designed to tune the body to its optimal health.

Yoga counters menstrual problems

Yoga encompasses breathing techniques which relaxes the body, which is helpful in relieving stress due menstruation. Performing the various positions in Yoga promotes body flexibility, the muscles become supple helps eliminating pain due to menstrual cramps and other causes.

Yoga improves the well-being. Yoga teaches women not to focus too much on the problem, rather it teaches them to learn to accept the inevitable changes in life.

Yoga, being a physical breathing exercise, promotes good blood circulation. As a result, menstrual cycle will not be a problem anymore, thus minimizing pain.

Yogasanas effective in reducing dysmenorrhea and stress

Cobra Pose (Bhujangasana) is one of the very powerful backward bending asana in Hatha Yoga beneficial for people with lower back aches. This posture decreases stiffness in the lower back, enlarges the chest, and strengthens the arms and shoulders. This Asana is also good to combat menstrual irregularities, and helps relieve stress. It has a huge amount of benefits which cover all the body systems. In women it tones the ovaries and the uterus and helps to alleviate gynaecological disorders such as leucorrhea, dysmenorrhea and amenorrhea.

Adho mukha Virasana (hero’s pose) reduces fat around the thighs & calves. It improves the digestion quietens the mind and reduces tension and congestion in pelvic organs.

Corpse Pose (Shavasana) the body parts are progressively stretched and relax muscles. It aids in complete relaxation.

Dhanurasana strengthens the back muscles and gastro intestinal problems associated with menstruation.

Pigeon pose opens the hips and help to prevent lower back pain.

Wide squat pose opens tight hips, releases tension in the lower back and stretches out the muscles in the feet.

STUDIES RELATED TO YOGA ON STRESS AND DYSMENORRHEA

Berger et al (2009) conducted a study to assess the effect of yoga on wellbeing, stress due to dysmenorrhea among fourth and fifth-grade students in Bronx, New York. The majority of students participated in yoga reported enhanced wellbeing, as reflected by perceived improvements in behaviors such as strength, flexibility, balance. The results suggested that yoga is a preventive intervention as well as a means of relieving dysmenorrhea and stress.

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Hartfiel et al (2009) conducted a study to assess the effectiveness of yoga in enhancing emotional well-being and resilience to stress among university employees at Dru Education Centre, Snowdonia, United Kingdom. Six-week yoga intervention resulted in significant improvements in feelings of clear-mindedness, composure, elation, energy, and confidence. In addition, the yoga group reported increased life purpose and satisfaction, and feelings of greater self-confidence during stressful situations. It was concluded that even a short program of yoga was effective for enhancing emotional well-being and resilience to stress in the workplace.

Laura (2008) said that stress due to dysmenorrhea can have an impact on student’s academic performance. He conducted a study to assess the impact of stress factors due to dysmenorrhea on college students academic performance. Twenty students of University of North Carolina at Charlotte participated in the study. They were asked to complete a survey, including the perceived stress scale. Most of the students reported inadequate sleep and absenteeism.

Brown (2000) said that Dysmenorrhoea is characterized by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhea. He conducted a study to assess the effectiveness of yoga therapy on dysmenorrhea at New Zealand. He found that yoga reduced the Moos’ Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and a sustained decrease in symptoms over the three observed cycles.

Anice George, (1998) conducted a study to estimate the incidence of dysmenorrhea , relationship between stress and dysmenorrhea and the effect of planned yoga therapy for 12 weeks on dysmenorrhea and stress of adolescent girls in Karnataka state. An explorative survey technique was used for the first phase, and the second phase used evaluative approach with pre-test post-test control group design, where a 12 weeks yoga therapy was used as the intervention. She concluded that the incidence of dysmenorrhea was 87.87%. A significant positive correlation (r= 0.1275, P < 0.01) between the severity of dysmenorrhea and stress was found. Yoga therapy was found to be a highly effective intervention in reducing the occurrence of dysmenorrhea, the intensity of pain during dysmenorrhea, and the dysmenorrhea and stress scores.

CONCEPTUAL FRAMEWORK

The conceptual framework of the present study was developed by the investigator based on Ludwig Von Bertanlanffy’s General System theory of learning (1968). A system is a set of interrelated parts that come together to form a “Whole”. Each part is necessary to make a complete, meaningful whole. This consists of components like,

Input

Throughput

Output and

Feedback.

In the present study the adolescent girls were considered as an open system. The system uses input to maintain homeostasis.

INPUT

The first component of a system is input, which is the information, energy or matter, which enters a system. For a system to work well, input should contribute to achieve the purpose of the system. It refers to demographic data of adolescent girls (age, order of birth, religion and occupation of the mother or primary care giver), pre test level of stress during dysmenorrhea, level of dysmenorrhea and plan for yoga therapy. These factors are taken into consideration as input for assessing the level of dysmenorrhea, stress during dysmenorrhea of the adolescent girls.

THROUGHPUT/ PROCESS

It is the process that allows the input to be changed, so that it is useful to the system. The action needed to accomplish the desired task. The task is to implement yoga therapy and to assess the post test level of stress and dysmenorrhea.

OUTPUT

Based on the input and throughput, the system returns to the environment in an altered state, the end result of product of the system. Outputs vary widely depending on the type and purpose of the system affecting the environment. Therefore the output refers to the reduction of the stress and dysmenorrhea. Level of stress and dysmenorrhea was interpreted as no, mild, moderate, and severe.

FEEDBACK

It refers to determine whether or not the end result of the system has been achieved. Feed back emphasizes the effect of the input, throughput and output. It shows that, whether no stress or mild stress or moderate stress or severe stress, no dysmenorrhea or mild dysmenorrhea or moderate dysmenorrhea or severe dysmenorrhea is experienced by adolescent girls.

FIGURE 1: CONCEPTUAL FRAME WORK

INPUT

OUTPUT

PRE TEST

Age of the adolescent girl

Order if birth

Religion

Occupation of the mother or care giver

CLINICAL VARIABLES

Age at menarche

Regularity of menstrual cycle

Menstrual cycle

Number of pads used per day

use of medications

Assessment of level of stress

using perceived stress scale and the level of dysmenorrhea using menstrual distress checklist

Plan for Yoga therapy

THROUGHPUT

FEEDBACK

After the yoga therapy

reduction in

the level of stress and

dysmenorrhea among adolescent girls

POST TEST

Assessment of level of stress and dysmenorrhea among adolescent girls using structured interview questionnaire.