RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISERTATION

1.NAME OF THE CANDIDATE

AND ADDRESS

Ms. PUSHPALATHA. P.

I YEAR M. Sc NURSING,

E.T.C.M. COLLEGE OF NURSING,

P.O. BOX No. 4, KOLAR-563101,

KARNATAKA

2.NAME OF THE

INSTITUTION E.T.C.M. COLLEGE OF NURSING,

P.O. BOX No. 4, KOLAR-563101, KARNATAKA.

3.COURSE OF STUDY AND

SUBJECT

M. Sc NURSING,

OBSTETRICS AND GYNECOLOGICAL NURSING

4. DATE OF ADMISSION TO

COURSE

01/07/2011

5. TITLE OF THE TOPIC

“EFFECTIVENESS OF MINT LEAVES PASTE ON

DYSMENORRHEA AMONG ADOLESCENT

GIRLS”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

Adolescence is a transition period from childhood to adulthood and is

characterized by a spurt in physical, endocrinal, emotional, and mental growth, with a

change from complete dependence to relative independence. The period of

adolescence for a girl is a period of physical and psychological preparation for safe

motherhood. As the direct reproducers of future generations, the health of adolescent

girls influences not only their own health, but also the health of the future population.

Almost a quarter of India's population comprises of girls below 20 years. 1

One of the major physiological changes that take place in adolescent girls is

the onset of menarche, which is often associated with problems of irregular

menstruation, excessive bleeding, and dysmenorrhea. Of these, dysmenorrhea is one

of the common problems experienced by many adolescent girls.1

Globally adolescents account for 1/5th of the population that is more than 1

billion. 4 out of 5 adolescents live in developing countries. According to Population

Bureau in 1996, 30% of the total population was that of adolescents (284.02 million).

Due to gradual decrease in the growth rate of the overall population, there is little

increase in the number of adolescents in population projections till the year

2016(Population projection 1996-2016) census of India.2

The first menstrual period is called menarche. It usually starts between the ages

11 and 14. But it can happen as early as age 9 or as late as 15. Menarche is the sign of

growing up. In the days before the periods start, the adolescent may feel tense or

emotional, gain water weight and feel bloated, pain in the abdomen, back or legs that

lasts few hours or more.3

Menstruation is a normal, healthy occurrence for many years in life. Yet many

women, across a range of different cultures, experiences menstrual problem that range

from mild discomfort to acute pain. Although most women have some physical or

emotional changes or discomfort linked to menstrual cycle, a small number of about

5% find that the problems are more serious and may have to seek some kind of

treatment.2

The term dysmenorrhea is derived from the Greek words ‘dys’ meaning

difficult/painful,‘Meno’ meaning month and ‘rrhea’ meaning flow. Dysmenorrhea is

defined as pain or discomfort (cramps) during or just before a menstrual period. Two

types of dysmenorrhea are primary and secondary dysmenorrhea. When the menstrual

cycle begins prostaglandins are released by the endometrial cells as they are shed

from the uterine lining causing the uterine muscles to contract. If excessive

prostaglandin is present, the normal contraction response can become strong and

painful spasm. Uterine muscles deprive for oxygen and cause cramps.4

Dysmenorrhea is the most common gynecological problem in women in all ages.

Most adolescence experience dysmenorrhea in the first 3 years after menarche. Young

adult women ages 17 to 24 years are most likely to report painful menses between

50% and 80%of women report some level of discomfort associated with menses and

10 to 18% report severe dysmenorrhea. It has been estimated that up to 10% of

women have severe pain which interfere with their functioning for 1-3 days a month.5

Dysmenorrhea generally does not occur until ovulatory menstrual cycles are

established. Maturation of the hypothalamic-pituitary-gonadal axis leading to

ovulation occurs at different rates; approximately 18 to 45 % of teens have ovulatory

cycles two years post menarche, 45 to 70 percent by two to four years, and 80 percent

by four to five years. Dysmenorrhea occasionally accompanies anovulatory cycles,

especially if heavy bleeding and clots are present. The prevalence of dysmenorrhea

among adolescent females ranges from 60 to 93 %. Many adolescents report

limitations on daily activities, such as missing school, sporting events, and other

social activities, because of dysmenorrhea. However, only 15 % of females seek

medical advice for menstrual pain, signifying the importance of screening all

adolescent females for dysmenorrhea.6

Menstrual disorders are a common presentation by late adolescence, 75% of girls

experience some problems associated with menstruation. Dysmenorrhea is a common

problem in women of reproductive age. Primary dysmenorrhea is defined as painful

menses in women with normal pelvic anatomy, usually begins during adolescence. It

is unusual for symptoms to start within first six months after menarche. Affected

women experience sharp, intermittent spasm of pain usually concentrated in the

suprapubic area. Pain may radiate to the back of the legs or the lower back. Systemic

symptoms of nausea, vomiting, diarrhea, fatigue, mild fever and headache or light

headedness are fairly common. Pain usually develops within hours of the start of the

menstruation and peaks as the flow becomes heaviest during the first day or two of

the cycle. During the first two year after menarche, most cycles are an ovulatory.

Despite this, they are somewhat regular within a range of approximately 21 to 42

days, in contrast to an adult woman, whose cycles typically range between 21 and 35

days. The mean duration of menses is 4.7 days; 89% of cycles last 7 days, the average

blood loss per cycle is 35 ml. 7

Dysmenorrhea is the most common of gynecologic complaints. It affects half of

all female adolescents today and represents the leading cause of periodic

college/school absenteeism among that population. A cross-sectional descriptive

study was conducted in Rewa, Madhya Pradesh to evaluate the menstrual problem

specially dysmenorrhea and its severity in female medical students and its effect on

their regular activities. The study was conducted among 107 female medical students,

all participants were given a questionnaire to complete; questions were related to

menstruation elucidating variations in menstrual patterns, history of dysmenorrhea

and its severity, pre-menstrual symptom and absenteeism from college and /or class;

to detect the severity of dysmenorrhea verbal multi-dimensional scoring system was

used, the participants were given 20 minutes to complete the questionnaire. The mean

age of subjects at menarche was 12.5 (±1.52) years, with a range of 10-15 years. The

prevalence of dysmenorrhea was 73.83%; approximately 4.67%of dysmenorrhic

subjects had severe dysmenorrhea. The average duration between two periods and the

duration of menstrual flow were 28.34 (±7.54) days and 4.5 (±2.45) days respectively.

Prevalence of other menstrual disorders like irregularity, prolonged menstrual

bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and

3.73% respectively. Among female medical students who reported dysmenorrhea

31.67% and 8.68% were frequently missing college & classes respectively.

Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08%

reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among

female medical students, it is related to college/class absenteeism, limitations on

social, academic, sports and daily activities. Maximum participants do not seek

medical advice and self treat themselves with prostaglandin inhibitors; like

Ibuprofen.7

A total of 1648 adolescent girls from six districts of Karnataka were surveyed

to find out the incidence of dysmenorrhoea in Karnataka state. The survey showed

that the incidence of dysmenorrhoea was 87.87 percent among the adolescent girls. 8

The treatment available in the present scenario is not giving enough relief

from dysmenorrheal estimates of the effectiveness of current treatments including oral

Contraceptives and nonsteroidal anti-inflammatory drugs ranging from 64 to 90% of

patients but some women have intolerable side effects like upset and infertility. The

available treatments decrease impairment but not to the non menstruating level of

productivity for all women. Some patients resort to surgical treatment. The long-term

and associated health risks of dysmenorrhea have not been studied. Using of treatment

with different mechanism of action for the treatment of dysmenorrhea may benefit

some women to have complete relief from dysmenorrhea.9

Menstrual problem is one among the commonly found health disorders in

women. Irregularity of menstrual cycle in women may occur as temporary or as

permanent. Depending upon the cause and occurrence of problem, irregularity in

menstrual cycle is divided into versatile types like dysmenorrhea, endometriosis,

oilgomenorrhea and amenorrhea. Symptoms shown by a person suffering from

menstrual problem vary from one person to another. Common symptoms shown as a

result of menses problem include irritability; back ache, bloating, acne and food

cravings.10

Herbal supplement is found to be very beneficial for the treatment of

menstrual problems. Prolonged result with zero adverse action on user is one among

the main advantages of using herbal cures. Some of the herbs like mint leaves,

sesame seeds, and bark extract of ashoka tree etc are best recommended cures for the

treatment of menstrual problems.10

Mint is one of the herbs.  It grows like a weed, is perfectly safe for use, and is

an excellent remedy for reducing symptoms related to digestion.  It is well known for

its properties related to indigestion, stomach cramps, menstrual cramps, flatulence,

upset stomach, nausea, vomiting, and colic in children. 11

A pre experimental study was conducted to assess the effectiveness of the mint

extract upon dysmenorrhea among the students at Apollo school of Nursing, Chennai.

Pre experimental design was adopted and purposive sampling method was used and

35 students were selected as samples. Self administered questionnaire on

dysmenorrhea was administered. The levels of dysmenorrhea were assessed before

and after mint extract administration for consecutive days, 5 days before menstruation

and 3 days after menstruation. The pre test level dysmenorrhea score of students wear

high, M =6.46, SD=2.57 in comparison with the score of post test were M=1.2,

SD=1.26 the difference between the experimental pretest and post test is found to be

statistically proven to be significant (p<0.001). There was no significant association

between the selected demographic variables and pretest post test level of

dysmenorrhea score. The result could be attributed to the effectiveness of the mint

extract.12

A study was conducted to assess the effectiveness of mint leaves paste on

dysmenorrhea among adolescent girls at selected schools kanyakumari district, An

experimental design was adopted and purposive sampling method was used based on

the selection criteria 34 adolescent girls in experimental group and 16 adolescent

girls in control group. No intervention was given to control group, so the effective

participants in experimental group was 30, pre and post test were conducted after the

mint leaves administration. The data were collected using self administered

questionnaire the obtained mean difference between the pre test and post test

regarding dysmenorrhea score was 15.3, the obtained ‘t’ value t=9.89 (P<0.05) was

significant. Data on post mean dysmenorrhea score among adolescent girls in

experimental on control group was 8.81. The obtained‘t’ value t=4.01 (P<0.01) was

significant. Therfore it was inferred that adolescent girls in experimental group had

significant reduction in dysmenorrhea score compare to control group and mint leaves

paste was effective in reducing dysmenorrhea.13

6.2 REVIEW OF LITERATURE.

The literature relevant to this is reviewed and arranged in the following section

1. Literature related to dysmenorrhea among adolescents.

2. Literature related to mint Leaves ( Peppermint)

3. Literature related to mint leaves on Dysmenorrhoea

1. Literature related to dysmenorrhea among adolescents

A cross sectional study was conducted from Jan 2011 to May 2011 among 183

Adolescent girls (14-19years) in Schools and colleges of Kadapa town to estimate the

prevalence of dysmenorrhea among adolescent girls (14-19yrs) and also to study the

various symptoms of dysmenorrhea and its impact on quality of life of adolescent

girls. Out of 183 adolescent girls 119 (65%) are dysmennorhic, 68.4% and 61.2% are

from the urban and rural areas respectively. 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 %).The study

was concluded that the dysmenorrhea is a very common problem among adolescent

girls; it affects their quality of life. It can be better managed by mental preparation and

by appropriate change in life style like regular physical exercise and with assurance to

the urban girls.14

A prospective study was aimed to investigate the prevalence of dysmenorrhea

in female college students in North Sichuan Medical College. Menstruation-related

diary data were obtained from 2640 female college students; dysmenorrhea and

related factors were analyzed. Dysmenorrhea occurred in 56.4% of students; 6.5% of

dysmenorrheal students suffered from “hard to bear” (unbearable) menstrual pain, and

6.5% had pre-menstrual dysmenorrhea. The more severe dysmenorrhea was, the

longer dysmenorrhea lasted, and the longer the duration of menstruation and the

larger the amount of menstrual blood flow appeared to be. Dysmenorrhea occurred on

37% of the menstrual dates on average and was unrelated to irregularity of menstrual

cycles. The percentages of students taking medicine with mild, moderate and

unbearable dysmenorrhea were 4.0%, 13.3% and 23.7%, respectively.15

A study was conducted to examine the prevalence, determinants, impacts,

and treatment practices of dysmenorrhoea, 664 female students in secondary schools

in urban and rural areas were studied. Data was collected through a self-

administered questionnaire. About 75% of the students experienced dysmenorrhoea

(mild 55.3%, moderate 30.0%, and severe 14.8%). Most did not seek medical advice

although 34.7% treated themselves. Fatigue, headache, backache and dizziness were

the commonest associated symptoms. No limitation of activities was reported by

47.4% of student with dysmenorrhoea, but this was significantly more reported by

students with severe dysmenorrhoea.16

An explorative survey was done among, 970 adolescent girls of age 15 to 20

years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior

shows that the prevalence of dysmenorrhea in adolescent girls was 79.67%. Most of

them, 37.96%, suffered regularly from severe 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.17

In an epidemiologic study of an adolescent population (aged 12-17 yrs), showed

a prevalence of dysmenorrhea of 59.7%. Of patients reporting pain, 12% described it

as severe; 37%, as moderate; and 49%, as mild. Dysmenorrhea caused 14% of

patients to miss school frequently. Although black adolescents reported no increased

incidence of dysmenorrhea, they were absent from school more frequently (23.6%)

than whites (12.3%), even after adjusting for socioeconomic status.18

A descriptive study was conducted among 26 high schools located in Erzurum,

Northeastern Turkey a total of 1951 single female adolescents, aged 13 to 18 years,

were selected for this study. The prevalence of dysmenorrhea was high among female

adolescents (68.1-72.2%). Pain mostly lasted for one to three days (56.6%), followed

by less than 1 day (23.5%) and more than 4 days (14.9%), respectively. Several

symptoms were observed including sweating, appetite loss, headache, distraction,

nausea/vomiting, dizziness, diarrhoea, and fainting. School performance was

negatively affected by dysmenorrhea. Findings of this research suggested that

dysmenorrhea prevalence was high among female adolescents. The duration and

intensity of pain adversely affected school and social attitudes towards their families

and friends.19

Most females experience some degree of pain and discomfort during menstrual

period, which can impact on their daily activities, and disturb their productivity at

home or at their workplace. During menstruation, they should consult a doctor and

take medications to relieve their pain and other relevant symptoms of dysmenorrhea.

Vomiting, diarrhea, headache, weakness and fainting. It is reported to be the most

common reason for females to visit a doctor in gynecology. According to reports, the

prevalence of dysmenorrhea is very high; at least 50% of women experience this

problem during their reproductive years. This problem not only causes discomfort in

approximately one-fifth of the female population, but also causes many social,

physical, psycho logic and economic problems for women all around the world. The

results of recent studies showed nearly 10% of females with dysmenorrhea

experienced an absence rate of 1 to 3 days per month from work or were unable to

perform their regular/daily tasks due to severe pain. Dysmenorrhea is considered the

main cause of absence from school, among young females.20

A Study on Prevalence of dysmenorrhea and its effect on quality of life

among a group of female university students in Turkey. A cross-sectional study was

conducted between 15 March and 15 April 2009 at Kutahya, High School. 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 > or =7 days. Dysmenorrhea is a common health problem, having

negative effects on the Health related quality of life among university female

students.21

A Survey was conducted by Dalhousie University, Canada to determine the

adolescents medication usage to manage menstrual discomfort in a Public high

school on a sample of 386 adolescent girls 93% reported menstrual discomfort during

the last 3 menstruations and 70% of these had used over-the-counter (OTC)

medications to manage the discomfort. Users of OTC medications reported greater

symptom severity and disability than non-OTC users. Seventy-five percent of the

OTC medication users took within the recommended dose of 1 to 2 pills, but 57%

took medication less often than the maximum daily frequency. Seventy-one percent of

the prescription drug users took the prescribed amount, 13% took less, and 16% took

more. The study was concluded that the adolescent girls frequently suffer from

menstrual discomfort and use OTC medications to manage the discomfort, but they

may not be using OTC medications effectively. There are possible explanations for

medicating behavior and future research directions should be considered.22

A Cross-sectional survey was done to determine the impact and healthcare-

seeking behaviour of women with dysmenorrhoea in a Medical college, nursing

college, hospital (staff and patient attendants), schools and suburbs of Islamabad of

Population 1236 women aged 16–50.showed Prevalence of premenstrual symptoms

that are low back pain 879 (72%), depressed mood 484 (40%), headache 268 (22%),

premenstrual fluid retention (body swelling) 218 (18%), and nausea 218 (18%).

Predictors of pain score (linear regression coefficients) were: low back pain (0.39),

headache (0.25), depressed mood (0.17) and nausea (0.17). Premenstrual symptoms

affected household chores in 441 women (37%), household income 129 (11%) and

social obligations 395 (33%). Students and self-employed women, 282 (63%) and 38

(63%) respectively, reported one or more days missed from school/work. Treatments

sought were: conventional medicine by 496 women (56%); household remedies, 285

(32%); herbal 90 (10%); and homeopathic 125 (14%). And the Conclusion was Low

back pain and headache contributed the most to severity of dysmenorrhoea. 

Headache and body swelling (fluid retention) were predictive of days unable to work.

Conventional medicine was used by more educated women and was perceived to be

effective more often than other modalities.23

Effects of acupressure on menstrual distress in adolescent girls at Chung Hwa

University of Medical Technology, Taiwan, showed that controlled trial provides

preliminary evidence that six-month acupressure therapy provides female adolescents

with dysmenorrhoea benefits and the relevance to clinical practice was Acupressure is

an effective and safe non-pharmacologic strategy for the treatment of primary

dysmenorrhoea. And they recommend the use of acupressure for self-care of primary

dysmenorrhoea. This is easy for adolescent girls to learn and practice.24

A study on Primary dysmenorrhea among Mexican university students its

prevalence, impact and treatment, it reveals that a total of 64% of the women

experienced dysmenorrhea. Dysmenorrhea was more prevalent among nutrition and

psychology students than among medicine, pharmacy and dentistry students.

Dysmenorrhea was 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 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. The most common medications used

were an over-the-counter (OTC) medication with paracetamol (an analgesic),

pamabrom (a diuretic), and pyrilamine (a histamine antagonist), another OTC with

metamizol (a non-steroidal anti-inflammatory drug [NSAID]) plus butylhioscine (an

antispasmodic drug) and naproxen (a NSAID). Of those women using prescribed

medications, 18.4% reported complete remission of their symptoms, while 78.1%

reported little to moderate alleviation, and 3.6% reported no effect on their menstrual

distress. Similarly, of the women who practiced SM, 23.4% reported complete relief,

75.5% reported moderate effectiveness, and 1.0% reported no efficacy.25

Dysmenorrhea is a problem that girls and women face and often manage

themselves with or without support from health professionals. A cross-sectional,

descriptive study was conducted among adolescents with dysmenorrhea (N = 150) in

Ile-Ife, Nigeria. The aim of the study was to determine their knowledge of

menstruation and primary dysmenorrhea, assess the severity of pain they experienced

during an episode of primary dysmenorrhea, and determine the management strategies

they adopted. 58% of respondents reported pain between face 4 and face 10 on the

Faces Pain Scale and the majority used inappropriate methods to manage primary

dysmenorrhea. School nurses are able to assist adolescents and their mothers in proper

management of primary dysmenorrhea.26

A Cross-sectional study was conducted by using a self-administered, 27-point

structured questionnaire on menstrual disorders in adolescent girls in Singapore. The

purpose of this study was to collect data on the characteristics of menstrual cycles

adolescents to determine the prevalence of menstrual abnormalities and the pattern of

use of medical treatments for these abnormalities and the setting was Sixty-two

secondary schools and junior colleges in Singapore from January to December

2004.Data from 5561 girls, 12 to 19 years old, were included in the analysis the

results shows Of the 5561 participants, 23.1% reported having irregular cycles.

Oligomenorrhea was the most frequently reported problem (15.3%), and

polymenorrhea was much less prevalent (2.0%). With increasing body mass index

(BMI), there was a significant increase in the prevalence of oligomenorrhea, whereas

polymenorrhea was more prevalent in the girls with a low BMI. Dysmenorrhea was a

significant problem, with 83.2% respondents reporting it in various degrees and 24%

girls reporting school absenteeism owing to it. Dysmenorrhea was severe enough to

require analgesics for pain relief in 45.1% of all subjects. In spite of menstrual

problems being common, only 5.9% girls reported seeking medical advice for them.

Traditional Chinese medications were used most commonly for menstrual cycle

problems, and over-the-counter medications for dysmenorrhea. The use of oral

contraceptives for menstrual problems was minimal.27

Anecdotal beliefs that exercise is an effective treatment for primary

dysmenorrhoea have prevailed for many years although evidence is

contradictory .Previous studies have also contained a number of methodological

inadequacies. A questionnaire that assessed menstrual pain and levels of exercise was

administered to 654 university students. Attempts were made to blind the purpose of

the study. A response rate of 91.3% (597/654) was obtained. Analyses showed no

association between participation in exercise and primary dysmenorrhoea.28

A prospective observational study was conducted on homeopathic treatment

of patients with dysmenorrheal in Institute for Social Medicine. Berlin, Germany with

2 years follows up method. The study was Prospective multicenter observational

study in primary care, using standardized questionnaires to record for 2 years

diseases, quality of life, medical history, consultations, all treatments, other health

services use and the results showed Fifty-seven physicians treated 128 women.

Women had dysmenorrhea received homeopathic prescriptions. Diagnoses and

complaints severity improved markedly and the study was concluded that patients

with dysmenorrhea improved under homeopathic treatment.29

A Cross-sectional Study was conducted to describe both non-pharmacologic

and pharmacologic treatments used by adolescents with dysmenorrhea in a Urban

academic medical center. The study was done among aged 19 years or younger (n =

76) with moderate to severe primary dysmenorrhea were included; they collected

baseline data via interview from adolescent girls at enrollment in a clinical trial of oral

contraceptives versus placebo for primary dysmenorrhea. They used the validated

pain subscale of the Moos Menstrual Distress Questionnaire and a 0-10 pain rating

scale to estimate pain severity. The Results Adolescents' mean age was 16.8 years

(SD = 2). Similar proportions described themselves as white (26%), black (30%) or

Hispanic (28%). Dysmenorrhea was moderate in 42%, severe in 58%, associated with

nausea in 55%, and vomiting in 24%. Of those attending school (n = 66), 46%

reported missing one or more days monthly due to dysmenorrhea. Nearly all

discussed their pain with someone; however, a minority sought formal medical care.

All used non pharmacological remedies such as sleeping and heat application. Nearly

all used at least one medication, 31% reported using two, and 15% used three

medications (not concurrently). Many participants reported using medication at sub-

therapeutic doses for pain. The conclusions were Adolescents with moderate and

severe dysmenorrhea reported high morbidity. Girls used numerous non-

pharmacologic remedies as well as medications for pain but infrequently accessed

formal medical care. Medication dosing was often sub-therapeutic.30

2. Literature related to use of mint leaves ( peppermint)

Mint (Pudina) is one of the popular spices which widely used in Indian

cooking these days. Mint is derived from Latin word "Minthae". It is widely grown in

the parts West Africa, India and Indonesia.100gm of mint leaves gives 48Kcal energy,

and it contains 84.9g of moisture and Protein 4.8g, Fat 0.6g, Carbohydrate 0.8g,

Crude fibre 2.0g, Iron 15.6mg, Calcium 200mg, Folic acid 114µg, Carotene 1620µg,

Vitamin C 27mg, other minerals 1.9g.31

Mint contains plenty of vitamins and is rich in minerals. Mint contains

calcium, phosphorus, iron, carotene or vitamin A, vitamin B3, vitamin B12. It also

contains vitamin D and vitamin E. Mint is cultivated in most parts of Europe, Asia

and Africa. Although there are different species of mint found all over the most

common among them are Peppermint, Spearmint, Wildmint, Pennroyal and Berg

mint. Mint was used as a remedy for ailments related to digestive tract, oral,

respiratory and skin disorders. Mint was often used as an air freshener. During the

middle ages powdered mint leaves were used to whiten teeth. Mint finds use in the

Ayurveda as ‘Ark Pudina’, which is generally prescribed after delivery as it is a

possessor of the property of uterus retraction. Mint has been considered valuable in

spasmodic dysmenorrhoea or painful menstruation, especially in young girls. Tea

made from mint when given four days earlier to expect menstruation period helps

treating pain during menstruation. Mint is much valued as a stimulant and as a drug,

which relieves flatulence. Mint is useful in strengthening the stomach and promoting

its action and also counteract in spasmodic disorders. It forms an ingredient of most

drugs prescribed for stomach ailments because of its digestive properties. It is good

for liver and helps dissolve gravel in kidneys and bladder.32

Pepper mint is an excellent source of magnesium, vitamin C and vitamin A,

the latter notably through its concentration of carotenoids, including beta-carotene.

Both VitaminC of carotenoids seems to play a role in decreasing colorectal cancer

risk. Vitamin C, the main water-soluble antioxidant in the body is needed to decrease

the levels of free radicals that can cause damage to cells. Some studies have shown a

link between increased vitamin C intake and decreased risk for Colon cancer, possibly

by as much as 40%, while other studies have shown that vitamin C intake can help to

decrease the incidence of colon tumors. Beta-carotene and carotenoids have been

shown in some studies to decrease the risk of developing both colon cancer and rectal

cancer. Caretonoids have also been shown to increase cell differentiation and protect

cells against carcinogenic chemicals that could damage DNA. Vitamin A which is

structurally similar to Beta-carotene may help to decrease risk by preventing

excessive colon cell proliferation and tumor formation.33

In addition to all of the above healing properties, peppermint emerged from

our food ranking system as a very good source of Dietary fibre, Folate, Iron,

Magnesium and Calcium, Vitamin B2 (based on its few calories and high nutrient

density). This high nutrient density and low calorie status qualified peppermint as a

good source of Omega-3 fatty acids, Vitamins B2, Potassium and Copper.34

Peppermint is recognized for its soothing action on the stomach and intestine.

It works on an antispasmodic, which helps to relieve nausea and other stomach

problems. Pepper mint relaxes the muscles of the digestive tract and stimulates bile

flow, which facilitates more constituent of pepper mint worth as a natural antifungal

and antibacterial used for menstrual cramps, irritable bowel syndrome, and itch.35

A study was conducted on pharmacological properties of the menthol extract

from menthepiperita. The study analyses the pharmacological activity in vivo and in

vitro models of methanol extract obtained from the leaves. This extract launched

toxiciter, but exhibited an analgesic effect in, model of chemical and mechanical

stimulation suggesting the inclusion of a peripheral analgesic response.36

Peppermint (Mentha piperita L.) is one of the most widely consumed single

ingredient herbal teas, or tisanes. Peppermint tea, brewed from the plant leaves, and

the essential oil of peppermint are used in traditional medicines. Evidence-based

research regarding the bioactivity of this herb is reviewed. The phenolic constituents

of the leaves include rosmarinic acid and several flavonoids, primarily eriocitrin,

luteolin and hesperidin. The main volatile components of the essential oil are menthol

and menthone. In vitro, peppermint has significant antimicrobial and antiviral

activities, strong antioxidant and antitumor actions, and some antiallergenic

potential.37

Throughout history different species of mint have been used across the globe for

their varying properties, both medicinal and culinary. Today, the commercial sales of

mints are expanding each year--and at the end of a large meal after-dinner mints are

frequently served. Peppermint (Mentha piperita) is usually taken after a meal for its

ability to reduce indigestion and colonic spasms by reducing the gastrocolic reflex. It

is a naturally occurring hybrid cross between water mint (M. aquatica) and spearmint

(M. spicata) and is best known for its role as a popular flavouring agent.38

3. Literature related to use of mint leaves in dysmenorrhea.

A study was conducted to assess the effect of mint extract on muscle pain and

blood lactate levels among 16 physical education students. The group selected for the

intervention was given the mint extract of 5ml and the effect on the muscle pain and

blood lactate levels was recorded. The findings shows a considerable reduction in the

muscle pain and blood lactate levels (P<0.01) levels.39

Consuming a mixture of dried mint leaves and honey is an excellent cure for

menses problems. It is found to be very effective for relieving painful cramps during

menstrual time. Curing dysmenorrhea is another advantage of using this herbal

mixture. Apart from relieving menstrual problems, use of mint leaves and honey also

helps in preventing headaches, curing acne and reducing free radical mechanism.

Drinking vegetable juice is a safe remedial measure for alleviating the risk of

menstrual problems.11

Mint was originally used as a medicinal herb to treat stomach ache and chest

pains, and it is commonly used in the form of tea as a home remedy to help alleviate

stomach pain. In Rome, Pliny recommended that a wreath of mint was a good thing

for students to wear since it was thought to "exhilarate their minds". During the

Middle Ages, powdered mint leaves were used to whiten teeth. Mint tea is a strong. A

common use is as an antipruritic, especially in insect bite treatments often along with

camphor. The strong, sharp flavor and scent of mint is sometimes used as a mild

decongestant for illnesses such as the common cold Mint is also used in some

shampoo products.40

Mint tea can be used for curing Dysmenorrhea. Mint tea can be had twice or

thrice a day for best results. The cooling properties of this herb helps to relieve pain

and tension associated with Dysmenorrhea. Mint candy will give for day long relief.

Using peppermint, spearmint or wintergreen can be used for relieving Dysmenorrhea.

For preparing mint tea, take a tablespoon of dried mint leaves and boil it along with a

cup of water. Cover it and steep it for fifteen minutes in order to prevent the oil from

evaporating. Drink hot for great results. Mint is also calming and relaxing which is

again good for Dysmenorrhea.41

The medicinal uses and pharmacological effects of mint leaves. It was found

that it is widely used in the food cosmetics and medicines. It is used in the relief of

common cold, irritable bowel syndrome, dyspepsia, nausea, head ache and as a topical

analgesic. This mint leaves are generally identified as safe herb to consume without

side effects.

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of mint leaves paste on dysmenorrhea

among adolescent girls in selected colleges, Kolar”.

6.3 OBJECTIVES OF THE STUDY

1. To assess the level of dysmenorrhea among adolescent girls, before

administration of mint leaves paste.

2. To assess the effectiveness of mint leaves paste on dysmenorrhea among

adolescent girls.

3. To find the association between the selected demographic variables and post

level of dysmenorrhea among adolescent girls.

6.4 OPERATIONAL DEFINITIONS

Dysmenorrhea

Dysmenorrhea refers to the discomfort among adolescent girls such as

spasmodic lower abdominal pain and other physiological symptoms such as nausea,

vomiting, fatigue, diarrhea and headache appears few hours before menstruation and

last for maximum of 48 hours.

Mint leaves paste

In the study it refers to the paste prepared from 5 grams of dried mint leaves

powder, a piece of tamarind and a pinch of salt and administered twice a day, 4 days

before menstruation and 3 days after menstruation.

Effectiveness

It refers to the outcome of the mint leaves paste upon dysmenorrheal among

adolescent girls. It is measured in terms of level of dysmenorrhea among adolescent

girls before and after administration of mint leaves paste.

Adolescent girls

It refers to the pre university girls who had attained menarche and between the

age group 13-17 years at selected colleges of kolar.

6.5 ASSUMPTIONS

Dysmenorrhea is a painful menstruation.

The experience and expression of pain will be unique to each individual.

Mint has an antispasmodic and analgesic effect.

Mint leaves paste administration will reduce the dysmenorrhea among

adolescent girls

6.6 NULL HYPOTHESES

H01 There will be no significant difference between the level of dysmenorrhea

before and after administration of the mint leaves paste among adolescent girls.

H02 There will be no significant association between the selected demographic

variables and the post test level of dysmenorrhea among adolescent girls.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

Data will be collected from adolescent girls (13-17yrs) with dysmenorrhea at

selected colleges, kolar.

7.1.1 RESEARCH APPROACH

Evaluative Research Approach

7.1.2 RESEARCH DESIGN

Pre experimental research design with one group pre test and post test design.

7.1.3 VARIABLES UNDER THE STUDY

Independent Variable - Mint leaves paste administration

Dependent Variable - Adolescent girls having dysmenorrhea

Extraneous variables - Selected demographic variables, Age, Religion, Type of

family, Educational status, family income, residence, family members suffering from

dysmenorhea, who suffers from dysmenorrhea, diet preferences.

7.1.4 SETTING OF THE STUDY

The study will be conducted in selected colleges, kolar.

7.1.5 POPULATION

Target Population

The target population for the study will be the adolescent girls with

dysmenorrhea.

Accessible Population

In this study the accessible population will be the adolescent girls with

dysmenorrhea who are studying in selected colleges, kolar, and were available during

the period of data collection.

7.1.6 SAMPLING TECHNIQUE

Purposive sampling technique will be used.

7.1.7 SAMPLE SIZE

Sample size consists of 40 adolescent girls (13-17yrs) at selected colleges,

kolar.

7.1.8 CRITERIA FOR SELECTION OF THE SAMPLE

Inclusion criteria

The study included adolescent girls

between age group 13 – 17 years.

Who had attained menarche.

Who has regular menstrual cycle 28 – 30 days, with the history of

dysmenorrhea.

Who are willing to participate in the study.

Who are able to read and understand English.

Exclusion criteria

The study excluded adolescent girls who are

under medical treatment for dysmenorrhea.

participating in yoga and exercises.

sick to participate.

7.2 METHOD OF DATA COLLECTION

7.2.1 DATA COLLECTION TOOL

The instruments used in this study are demographic variables performa and

clinical variable performa.

Part I - Demographic variables

Demographic variable included in the performa are Age, Religion, Type of

family, Educational status, family income, residence, family members suffering from

dysmenorhea, who suffers from dysmenorrhea, diet preferences.

Part II – Clinical variable Proforma

The clinical variables included in this Proforma were age at menarche, weight,

Body mass Index, number of days of menstrual flow, duration of pain, quality of pain,

home remedies and medical treatment.

Part III - Screening form

Screening form it deals regarding menarche and related issues based on which

the eligibility of the participants will be selected.

Part IV - Dysmenorrhea scale

Dysmenorrhea scale, is information related to dysmenorrhea which will be

rated in a 4 point scale the responses ranged from none ‘0’ to ‘3’ .The maximum score

will be 60.

DESCRIPTION OF THE INTERVENTION

Mint leaves paste

Mint leaves paste was prepared from 5 grams of dried mint leaves powder, a

piece of tamarind and a pinch of salt. It was administered to eligible adolescent girls

in the colleges twice a day 9am and 4pm for 4 days before menstruation and 3 days

after menstruation

7.2.2 DATA COLLECTION PROCEDURE

The written permission from the authorities of the selected institution will be

obtained prior to data collection. The study participants will be selected by using

purposive sampling technique based on sample selection criteria. Formal permission

will be obtained from study participants after explaining the objectives of study. The

adolescent girls from the selected colleges will be given screening form regarding the

dysmenorrhea. Based on the selection criteria 40 adolescent girls will be selected. The

purpose and procedure will be explained. Individual’s informed consent will be taken

from the study sample. Pretest will be conducted using dysmenorrhea scale among all

selected adolescent girls. Intervention through mint leave paste will be administered

for 4 days before menstruation and 3 days after menstruation in the college at 9am

and 4pm. post test will be conducted on 4th day of menstruation by using

dysmenorrhea scale.

7.2.3. METHOD OF DATA ANALYSIS

Demographic data will be analyzed by using descriptive statistics like

frequency distribution, percentage, mean and standard deviation.

Analysis of effectiveness of mint leaves paste on dysmenorrhoea by

comparing pre test, and post test level of dysmenorrhea will be assessed by

using inferential statistics like paired‘t’ test.

Chi – square test will be used to find the association between selected

demographic variables and post test level of dysmenorrhea.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENT OR OTHER

HUMANS OR ANIMALS?

Yes, non – invasive intervention will be done. Pretest will be conducted using

dysmenorrhea scale among all selected adolescent girls. Intervention through mint

leave paste will be administered for 4 days before menstruation and 3 days after

menstruation in the college at 9am and 4pm. post test will be conducted on 4 th day of

menstruation by using dysmenorrhea scale.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

1. Permission will be taken from the Research Committee.

2. Permission will be taken from the authorities of selected colleges at kolar.

3. Informed consent will be obtained from the subjects before the study

8. LIST OF REFERENCES

1. Anil.k agarawal and Anju Agarwal. Astudy of dysmenorrehea during

menstruation in adloscent girls. Indian journal community medicine.2010

january.35(1).159-164.

2. Gulani.k.k.Community Health nursing.1st edition. Kumar publishing house. New

Delhi;2009.

3. Bobak Lowdermilk and Perry. Maternity Nursing. 5th edition. Mosby,

Philadelphia.

4. D.C.Dutta. Text book of Gynecology .4th edition. New central book

agency.Calcutta.

5. Lowdermilk and perry.Maternity and Womens Health.9th edition.Mosby

publishers.

6. Chantay Banikarim. Primary dysmenorrhea in adolescents. Last Literature

Review version19.3.September 2011.

7. Amita singh. Dukhu Kiran. Harminder singh. Bithika Nel, Prabhkar singh and

Pavan Tiwari. Prevalance and severity of Dysmenorrhea. A problem related to

menstruation,among first and second year female medical students. Indian journal

physiol pharamacol 2008.52(4).89-397.

8. http://www.we-asc.org/anice

9. Jennifer.s.et.al, Treatment of primary Dysmenorhea. The Journel of the

Americian Board of Family Practice;17. 240-246. 2004.

10. Dr. Easton patric, How to cure menstrual problems treat painfull periods. Article

world. 2011. Available at http://myarticles world.com/rss.

11. http://wwww.gardensablaze.com/HerbMint med. Htm.

12. Ramya M,. Effectiveness of Mint extract upon dysmenorrhoea, Student at Apollo

school of nursing, Chennai (2008).

13. Sharmila, Effectiveness of mint leave paste on Dysmenorrhoea Adolescent girls at

selected school, Kanyakumari district (2010).

14. Suresh.k.kumbhan, mrudula Reddy Sujana B, Roja Reddy k, Divya Bhargavi k,

Balkrishna. Prevalence of dysmenorrhea among adolescent girls (14-19) of kadapa

district and its impavt on fuality of life. A cross sectional study .National journal

of community medicine.vol 2 issuse. 2 july –sep 20ll. 265 page.

15. Hong- Gul zhou, Zheng-weiyan. Prevalence of dysmenorrhea in female students

in a Chinese university. A Prospective study. Health>> vol.2, No.4. April 2010.

Pg no-311 -314.

16. A.H.EI – Gilary, k.Badaw and S.EL.Fedawy Epidemiology of dymenorrehea

among adolescent students in mansoura,Ezypt. March 2005.

17. Available at http://www.ijcm.org.in/artiercal.asp?issn=0970-0218.2000.

18. Andeysch b, Wilson J On epidemiological study of young women with

dysmenorrhoea, Obstetrics and gynaecology, 1982, P-144-185.

19. Erylimaz G,Ozdemir F, Pasinlioglu T. Dysmenorrhea prevalence among

adolescences in eastern turkey, its effects on school performance and relationship

with family and friends. Journal of pediatr Gynecol . 2010 oct; 23(5); 267-72,

2010 MAY 21.

20. Mohamed PoureslamPhd, Farzaneh Osati- Adhtiani Phd, Attitudeof Female

Adolescents about Dysmenorrhoea and menstrual hygiene in Teharan Sub urbs.

21. www.medicaljournal.com

22. Campbell M A, Mc Grath P J, http://www.uptodate.com/content/primary

Dysmenorrhoea-in-adolescent/abstracts/

23. Nabia Tariqu,M, Jawad haslin, Tara jaffery, impact and health care-seeking

behavior of premenstrual symptoms and dysmenorhoea, 2009.

24. Chen H M, Chen C H, Effects of acupressure on menstrual distress in adolescent

girls. Chung Hwa University of Medical Technology, Tainan Taiwan. Journal

Clinical Nurse.2010 Apr; 12 (7-8);998 – 1007.Available at :

http://www.ncbi.nlm.nih.gov/pubmed/20492044.

25. Ortiz MI, Primary dysmenorrhea among Maxican University students. Prevalence,

impact and treatment.Eur J obstet Gynecol Reprod Biol.2010 Sep; 152(1):73-7.

PMID: 20478651.

26. Ogunfowokan A A, Babatundc OA. Management of primary dysmenorrhea by

school adolescents in ILE-IFE.Nigeria.J Sch Nur.2010 Apr;26(2):131-6.

PMID:19850951.

27. Agarwai A, Venkat A. Questionnaire study on menstrual disordersin adolescent

girls in Singapore. J Pediatric Adolesc Gynecol.2009 Dec; 22(6): 365-71.

PMID :19647453.

28. Balkey H el.at, Exercise associated with primary dysmenorrhea in young

women .BJOG.2010 Jan; 117(2):222-4. PMID 19459861.

29. Witt CM, Ludtke R Willich SN. Homeopathic treatment of patients with

dysmenorrhea. Arch Gynecol Obstet. 2009 Oct ;280(4): 603-11. PMID 19229544.

30. O’Connell K, Davis AR, Westhoff C. Self treatment petterns among adolescent

girls with dysmenorrhea. Journal of Pediatrics Adolescent Gynecology. 2006 Aug;

19(4): 285-9. PMID: 16873033.

31. Mint Popular Plant With Great Nutritional

Value http://www.sooperarticles.com/health-fitness-articles/mint-popular-plant-

great-nutritional-value-570062.html#ixzz1gWtINsFk

32. http://valuefood.info/Herbs-and-Spices/Nutrition-Health-Benefits-Herbs/health-

benefits-of-mint.html

33. Bergner P et. al., (2001), “Female Herbs and dysmenorrhea”, Medical Herbalism,

9(3): 5-15.

34. www.medicaljournal.com

35. www.google.com

36. www.google.com

37. McKay DL , Blumberg JB. A review of the bioactivity and potential health

benefits of peppermint tea (Mentha piperita L.).USDA Human Nutrition Research

Center on Aging at Tufts University, 711 Washington St., Boston, MA 02111,

USA. diane.mckay@tufts.edu

38. Spirling LI , Daniels IR. J R Soc Promot Health. 2001 Mar; 121(1):62-3.

Botanical perspectives on health peppermint: more than just an after-dinner mint.

Epsom General Hospital, Surrey, England.

39. Somez G et al., (2010), effects of oral supplementation of mint extract on muscle

pain and blood lactate,” Biomedical human kinetics,2 (2): 66-69.

40. www. Wikipedia.com.

41. http://www.Ayushveda.com/cure-dysmenorrhoea-with-these simple tips/

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE The research topic selected is

relevant and feasible for the study.

11. NAME & DESIGNATION

11.1. GUIDE

MS.JEYALAKSHMI

ASST.PROFESSOR

E.T.C.M. COLLEGE OF NURSING,

P.O. BOX NO. 4, KOLAR-563101,

KARNATAKA.

11.2. SIGNATURE OF THE GUIDE

11.3 CO–GUIDE (If any)

11.4. SIGNATURE OF THE CO–GUIDE

11.5 HEAD OF DEPARTMENT

MS.JEYALAKSHMI

OBSTETRIC AND GYNECOLOGICAL

NURSING DEPARTMENT

11.6 SIGNATURE OF THE HOD

12

12.1 REMARKS OF THE PRINCIPAL

The topic was discussed with the

members of research committee

and was finalized. She is permitted

to conduct the study.

12.2 SIGNATURE