Biopsychosocial Factors Associated with Dysmenorrhea among High-School Girls in Makassar, Indonesia

  • Ruqaiyah Ruqaiyah Diploma III Midwifery Study Program, Faculty of Health Sciences, Institut Ilmu Kesehatan Pelamonia Kesdam XIV/Hasanuddin, Makassar, Indonesia
  • Ayatullah Harun Diploma III Midwifery Study Program, Faculty of Health Sciences, Institut Ilmu Kesehatan Pelamonia Kesdam XIV/Hasanuddin, Makassar, Indonesia
  • Alamsyah Alamsyah Diploma III Nursing Study Program, Faculty of Health Sciences, Institut Ilmu Kesehatan Pelamonia Kesdam XIV/Hasanuddin, Makassar, Indonesia
DOI: https://doi.org/10.56338/jphp.v6i2.10643
Keywords: Dysmenorrhea, Adolescents, Physical Activity, Psychological Stress, Menstrual Cycle, Indonesia

Abstract

Introduction: Dysmenorrhea is a common menstrual disorder among adolescents and constitutes a significant public health concern due to its adverse effects on school attendance, academic performance, and quality of life. In low- and middle-income countries, including Indonesia, school-based evidence examining associations between biological, psychological, and lifestyle factors and dysmenorrhea remains limited. This study aimed to investigate associations between selected biopsychosocial variables and dysmenorrhea among senior high-school girls in Makassar, Indonesia.

Method: A school-based cross-sectional study was conducted among 45 female students at SMA Bajiminasa Makassar using a total sampling approach. Data were collected through a structured, self-administered questionnaire assessing dysmenorrhea status, physical activity level, psychological stress, family history of dysmenorrhea, age at menarche, and menstrual cycle regularity. Descriptive statistics were used to estimate prevalence. Associations between variables were examined using bivariate analyses, including chi-square or Fisher’s exact tests when appropriate, and effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: The prevalence of dysmenorrhea was 82.2%. Bivariate analyses indicated statistically significant associations between dysmenorrhea and inadequate physical activity, psychological stress, positive family history of dysmenorrhea, earlier age at menarche, and irregular menstrual cycles.  Adolescents reporting psychological stress or a family history of dysmenorrhea demonstrated particularly high proportions of menstrual pain within this sample.

Conclusion: Dysmenorrhea is highly prevalent among senior high-school girls in Makassar and was associated with several biological, psychological, and lifestyle variables examined in this exploratory analysis. These findings are consistent with biopsychosocial perspectives on adolescent dysmenorrhea, although the cross-sectional and bivariate analytical design limits causal interpretation. The results highlight the potential relevance of integrated school-based screening and health education initiatives addressing physical activity, psychological well-being, and menstrual health. Given the small sample size and single-school setting, findings should be interpreted cautiously and warrant confirmation in larger multi-site studies.

References

  1. Psaki S, Haberland N, Mensch B, Woyczynski L, Chuang E. Policies and interventions to remove gender?related barriers to girls’ school participation and learning in low? and middle?income countries: A systematic review of the evidence. Campbell Syst Rev. 2022;18(1):e1207. https://doi.org/10.1002/cl2.1207
  2. Mcharo O, Kapesa A, Materu J, Luwayi J, Nahay F, Basinda N, et al. Effects of a comprehensive menstrual and sexual reproductive health intervention on RTI symptoms among adolescent girls in the Mwanza region: a mixed-methods analysis. Reprod Health. 2025;22(1):224. https://doi.org/10.1186/s12978-025-02087-x
  3. Harvey J, Western MJ, Townsend NP, Francombe-Webb J, Sebire S, Malkowski OS, et al. Adolescents, menstruation, and physical activity: insights from a global scoping review. BMC Womens Health. 2025;25(1):281. https://doi.org/10.1186/s12905-025-03825-w
  4. Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents, 2016. J Clin Child Adolesc Psychol. 2018;47(2):199–212. https://doi.org/10.1080/15374416.2017.1417860
  5. Le DTP, Pham TD. Colorectal cancer worldwide: epidemiological trends, economic burden, and the promise of AI-driven solutions. Explor Med. 2025; 6:1001371. https://doi.org/10.37349/emed.2025.1001371
  6. Baleke C, Mugenyi L, Nelson KA, Thomas KA, Ndekezi D, Enomut JR, et al. Associations of menstrual health with school absenteeism and educational performance among Ugandan secondary school students: A longitudinal study. medRxiv. 2025. https://doi.org/10.1101/2025.06.03.25328933
  7. Kumbeni MT, Ziba FA, Apenkwa J, Otupiri E. Prevalence and factors associated with menstruation-related school absenteeism among adolescent girls in rural northern Ghana. BMC Womens Health. 2021;21(1):279. https://doi.org/10.1186/s12905-021-01418-x
  8. Sumankuuro J, Molle MN, Domapielle MK. Adolescent girls’ menstrual hygiene management: evidence from rural northern Ghana. J Plan L Manag. 2022;2(2):50–59. https://doi.org/10.36005/jplm.v2i2.53
  9. Edet BE, Essien EA, Eleazu FI, Atu GE, Ogunkola IO. Childhood adversity as a predictor of depression and suicidality among adolescents in Calabar, Nigeria. J Glob Health Neurol Psychiatry. 2022;e2022005. https://doi.org/10.52872/001c.33811
  10. Uzoechi CA, Parsa AD, Mahmud I, Alasqah I, Kabir R. Menstruation among in-school adolescent girls and its literacy and practices in Nigeria: A systematic review. Medicina. 2023;59(12):2073. https://doi.org/10.3390/medicina59122073
  11. Shah V, Nabwera H, Sonko B, Bajo F, Faal F, Saidykhan M, et al. Effects of menstrual health and hygiene on school absenteeism and drop-out among adolescent girls in rural Gambia. Int J Environ Res Public Health. 2022;19(6):3337. https://doi.org/10.3390/ijerph19063337
  12. Michael J, Iqbal Q, Haider S, Khalid A, Haque N, Ishaq R, et al. Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Womens Health. 2020;20(1):4. https://doi.org/10.1186/s12905-019-0874-3
  13. Ghandour R, Hammoudeh W, Stigum H, Giacaman R, Fjeld H, Holmboe-Ottesen G. The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance. BMC Public Health. 2024;24(1):726. https://doi.org/10.1186/s12889-024-18219-0
  14. Stoilova D, Cai R, Aguilar-Gomez S, Batzer NH, Nyanza EC, Benshaul-Tolonen A. Biological, material and socio-cultural constraints to effective menstrual hygiene management among secondary school students in Tanzania. PLOS Glob Public Health. 2022;2(3):e0000110. https://doi.org/10.1371/journal.pgph.0000110
  15. Donayeva A, Amanzholkyzy A, Abdelazim I, Nurgaliyeva R, Gubasheva G, Saparbayev S, et al. The impact of primary dysmenorrhea on adolescents’ activities and school attendance. J Med Life. 2023;16(10):1462. https://doi.org/10.25122/jml-2023-0247
  16. Ali HE, Tadesse TA, Beyene DA, Gebremariam GT. Prevalence, Characteristics, and Treatment Pattern of Menstrual-Related Headache Among Undergraduate Health Sciences Students at Addis Ababa University, Ethiopia. Int J Womens Health. 2024;16:707–716. https://doi.org/10.2147/IJWH.S454357
  17. Munro AK, Hunter EC, Hossain SZ, Keep M. A systematic review of the menstrual experiences of university students and the impacts on their education: a global perspective. PLoS One. 2021;16(9): e0257333. https://doi.org/10.1371/journal.pone.0257333
  18. Alsalami OA, Kamel S, Almatrafi RS, Alalwani BM, Alanazi AI, Algarni AD, et al. Enhancing Self-Hygiene Awareness and Practices During Menstruation Among Female Adolescent Students in Saudi Arabia: A Comprehensive Educational Program Initiative. Cureus. 2025;17(9). https://doi.org/10.7759/cureus.91541
  19. Sigdel D, Joshi A, Thapa T, Koirala P, Sharma K. Prevalence and predictors of dysmenorrhoea and its effects among adolescent girls in Chitwan, Nepal. J Chitwan Med Coll. 2023;13(1):15–23. https://doi.org/10.54530/jcmc.1251
  20. Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates. Korean J Fam Med. 2022;43(2):101–108. https://doi.org/10.4082/kjfm.21.0103
  21. binti Abdullah N, bin Abdul Aziz A, Mustafa WA, Almusawi M, Hussein AHA. Women’s Health Diary: Tracker System for Menstruation, Intermenstrual, Ovulation, and Postnatal Bleeding Using Rules-Based Technique. In: 2023 3rd International Conference on Mobile Networks and Wireless Communications (ICMNWC). IEEE; 2023. p. 1–5. https://doi.org/10.1109/ICMNWC60182.2023.10435769
  22. Ayubi N, Putri DRS. Aerobic Exercise and Omega 3 Supplementation to Reduce Primary Dysmenorrhea (Literature Review). Indian J Forensic Med Toxicol. 2021;15(3):1413–1417. https://doi.org/10.37506/ijfmt.v15i3.15503
  23. Fajarini YI, Ediati A, Abdullah AA, Pramono N. The Effect of Mindful-Start on Quality of Life in Adolescents Who Have Primary Dysmenorrhea. In: 1st International Conference on Community Health (ICCH 2019). Atlantis Press; 2020. p. 289–293. https://doi.org/10.2991/ahsr.k.200204.061
  24. Chhikara A, Jain M, Vats S, Kashoo FZ, Chahal A, Guliya S, et al. Role of yoga in minimizing stress and anxiety in women experiencing dysmenorrhea. J Lifestyle Med. 2023;13(2):90–98. https://doi.org/10.15280/jlm.2023.13.2.90
  25. Sudaryanti L, Mulyani N. During the Pandemic Experiencing Stress on the Dysmenorrhoea Scale. Int J Res Innov Soc Sci. 2023;7(12):1921–1930. https://doi.org/10.47772/IJRISS.2023.7012147
  26. Zapa?a B, Marszalec P, Piwowar M, Chmura O, Milewicz T. Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet. Exp Clin Endocrinol Diabetes. 2024;132(1):6–14. https://doi.org/10.1055/a-2201-8618
  27. Guimarães I, Póvoa AM. Primary dysmenorrhea: assessment and treatment. Rev Bras Ginecol Obstet. 2020;42(8):501–507. https://doi.org/10.1055/s-0040-1712131
  28. Pramesti WI, Sudaryanto WT. Is Effleurage Massage Effective to Reduce Menstrual Pain in Female Students? Indones J Med. 2024;9(1):91–97. https://doi.org/10.26911/theijmed.2024.9.1.714
  29. Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med. 2023;21(1):372. https://doi.org/10.1186/s12916-023-03076-2
  30. Puspitasari CND, Prajayanti ED. Penerapan Kompres Hangat terhadap Skala Nyeri Dismenore pada Remaja Putri di Desa Tanjung Sukoharjo. J Anestesi. 2024;2(4):149–159. https://doi.org/10.59680/anestesi.v2i4.1385
  31. Gambadauro P, Hadlaczky G, Wasserman D, Carli V. Dysmenorrhea and Adolescent Mental Health: A School-Based Cross-Sectional Study. BJOG. 2025. https://doi.org/10.1111/1471-0528.18187
  32. Liu H, Han D, Hu Y, Huang L, Wang J, Zhu D. Association between stress and dysmenorrhea among Chinese female adolescent students: a cross-sectional epidemiology study. Sci Rep. 2025;15(1):22180. https://doi.org/10.1038/s41598-025-05152-4
  33. De Sanctis V, Soliman A, Bernasconi S, Bianchin L, Bona G, Bozzola M, et al. Definition and Self-Reported Pain Intensity in Adolescents with Dysmenorrhea: A Debate Report. Riv Ital Med Adolesc. 2016;14(2).
  34. Oksuz Yalvac C, Akda? Topal C, Boztepe H. A comprehensive investigation of biopsychosocial determinants influencing primary dysmenorrhea among university students. Women Health. 2024;64(5):392–403. https://doi.org/10.1080/03630242.2024.2349558
  35. Gagnon MM, Moussaoui D, Gordon JL, Alberts NM, Grover SR. Dysmenorrhea across the lifespan: a biopsychosocial perspective to understanding the dysmenorrhea trajectory and association with comorbid pain experiences. Pain. 2022;163(11):2069–2075. https://doi.org/10.1097/j.pain.0000000000002649
  36. De Rubeis V, Bayat S, Griffith LE, Smith BT, Anderson LN. Validity of self-reported recall of anthropometric measures in early life: a systematic review and meta-analysis. Obes Rev. 2019;20(10):1426–1440. https://doi.org/10.1111/obr.12881
  37. Alahakoon AMSS, Wickramarathne DBM. Prevalence of dysmenorrhea, its association with overall academic engagement, and management among nursing undergraduates at Peradeniya University, Sri Lanka: a cross-sectional study. J Endometr Pelvic Pain Disord. 2021;13(2):127–135. https://doi.org/10.1177/228402652199368
  38. Kasongo B, Mukalay A, Molima C, Makali SL, Chiribagula C, Mparanyi G, et al. Community perceptions of a biopsychosocial model of integrated care in the health center: the case of four health districts in South Kivu, Democratic Republic of Congo. BMC Health Serv Res. 2023;23(1):1431. https://doi.org/10.1186/s12913-023-10455-1
  39. Kesmodel US. Cross-sectional studies—what are they good for? Acta Obstet Gynecol Scand. 2018;97(4):388–393. https://doi.org/10.1111/aogs.13331
  40. Jamil A. Beyond the Physical: Understanding the Emotional, Psychological, and Social Factors Affecting Women’s Health Today. Cureus. 2025;17(4). https://doi.org/10.7759/cureus.81874
  41. Y?lmazer E. Hormonal underpinnings of emotional regulation: Bridging endocrinology and psychology. J Neurobehav Sci. 2024;11(2):60–75. https://doi.org/10.32739/uha.jnbs.11.1539123
  42. Ganie AUR, Handa S. Menstrual hygiene, caregiver challenges, and human rights concerns for adolescent girls with intellectual disabilities: a state-of-the-art review. Int J Dev Disabil. 2025:1–14. https://doi.org/10.1080/20473869.2025.2597836
  43. Bick S, Davies K, Mwenge M, MacLeod C, Braun L, Chipungu J, et al. WASH and learn: a scoping review of health, education and gender equity outcomes of school-based water, sanitation and hygiene in low-income and middle-income countries. BMJ Glob Health. 2025;10(5):e018059. https://doi.org/10.1136/bmjgh-2024-018059
  44. Situmorang M, Anastasya M. Analysis of the Relationship between Stress and Dysmenorrhea in Female Students. Int J ObGyn Health Sci. 2024;2(3):125–133. https://doi.org/10.35335/obgyn.v2i3.182
  45. Matos JC, Brandão K de SAL, Britto RL, Oliveira LV, de França Barreto RA. Reproductive and Metabolic Aspects of Women in a Public and University Reproductive Counseling Program. Hum Reprod Arch. 2025;40: e000224. https://doi.org/10.4322/hra.000224
  46. Jusuf EC, Octaviani D, Husain MG, Jumrah. The influence of physical activity, body mass index and urinary levels of prostaglandin (PGF2?) with the incidence of primary dysmenorrhea in adolescents. J Obstet Gynaecol Res. 2024;50(5):909–913. https://doi.org/10.1111/jog.15914
  47. Gagnon MM, Brilz AR, Alberts NM, Gordon JL, Risling TL, Stinson JN. Understanding Adolescents’ Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study. JMIR Pediatr Parent. 2024;7:e54658. https://doi.org/10.2196/54658
  48. Kho KA, Shields JK. Diagnosis and management of primary dysmenorrhea. JAMA. 2020;323(3):268–269. https://doi.org/10.1001/jama.2019.16921
  49. Shrestha S, Paudel P, Manandhar R. Menstrual health affecting school absenteeism during menstruation among adolescent girls in Nepal. Int J Public Health Asia Pac. 2023;2(3):102–114. https://doi.org/10.62992/ijphap.v2i3.49
  50. Tinsley H, Parten AL, Smith-Ryan AE, O’Neal EK, Lyons TS, Waldman HS. Acute strength training, not menstrual cycle phase, increases lipid oxidation rates following exercise in well-trained, eumenorrheic females. 2025.
  51. Baber K, Rodriguez KAO. Cognitive behavioral therapy for functional abdominal pain disorders. In: Handbook of Cognitive Behavioral Therapy for Pediatric Medical Conditions. Cham: Springer; 2019. p. 201–217. https://doi.org/10.1007/978-3-030-21683-2_14
  52. Yang NJ. Examining the Predictive Validity of Adolescent Complete Mental Health on High School Academic Performance. 2025. https://doi.org/10.26076/aae5-ddb2
  53. Nakakawa A, Krist LC, Stutterheim SE, Englebert S, Rinkleff K, Beer D, et al. Access to HIV prevention, testing and care among people with a migration background in Euregio Meuse-Rhine: a needs and assets assessment. AIDS Care. 2025;37(3):480–503. https://doi.org/10.1080/09540121.2024.2446697
  54. Abuhammad S, Al-Natour A. Mental health stigma: the effect of religiosity on the stigma perceptions of students in secondary school in Jordan toward people with mental illnesses. Heliyon. 2021;7(5):e06957. https://doi.org/10.1016/j.heliyon.2021.e06957
  55. Kempers EK, van der Zande JA, Janssen PM, Cornette JMJ, Roos-Hesselink JW, Kruip MJHA. Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review. Res Pract Thromb Haemost. 2024;8(1):102295. https://doi.org/10.1016/j.rpth.2023.102295
  56. Ssemata AS, Ndekezi D, Kansiime C, Bakanoma R, Tanton C, Nelson KA, et al. Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study. PLOS Glob Public Health. 2023;3(11):e0002665. https://doi.org/10.1371/journal.pgph.0002665
  57. Sharma S, Mehra D, Brusselaers N, Mehra S. Menstrual hygiene preparedness among schools in India: a systematic review and meta-analysis of system- and policy-level actions. Int J Environ Res Public Health. 2020;17(2):647. https://doi.org/10.3390/ijerph17020647
  58. Donayeva A, Amanzholkyzy A, Abdelazim I, Kurmangazin M, Khamidullina Z, Kurmanalina M, et al. The effect of vitamin D on adolescents’ primary dysmenorrhea. J Med Life. 2023;16(11):1658–1665. https://doi.org/10.25122/jml-2023-0290
  59. Mann P, Pradeep TS. Premenstrual syndrome, anxiety, and depression among menstruating rural adolescent girls: A community-based cross-sectional study. Cureus. 2023;15(12):e50385. https://doi.org/10.7759/cureus.50385
Published
2026-07-01
How to Cite
Ruqaiyah, R., Harun, A., & Alamsyah, A. (2026). Biopsychosocial Factors Associated with Dysmenorrhea among High-School Girls in Makassar, Indonesia. Journal of Public Health and Pharmacy, 6(2), 370-382. https://doi.org/10.56338/jphp.v6i2.10643
Issue
Vol. 6 No. 2 (2026)
Section
Articles

Copyright (c) 2026 Journal of Public Health and Pharmacy

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:

  1. Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.

  2. Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.

  3. License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.