Behind the Pain: Experiences and Coping Strategies to Primary Dysmenorrhea among Adolescent Girls in Selected Settings of Lusaka, Zambia

Nachizya Edith Namukanga^{1, 2,} , Joseph Mumba Zulu³, Margarate N Munakampe⁴ and Choolwe Jacobs¹

¹Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia

²School of Health and Applied Sciences, UNICAF University, Lusaka, Zambia

³Department of Health Policy and Management, Health Promotion and Education, School of Public Health, University of Zambia, Lusaka Zambia

⁴Health Policy and Management Department, School of Public Health, University of Zambia, Lusaka Zambia

Cite this paper:
Nachizya Edith Namukanga, Joseph Mumba Zulu, Margarate N Munakampe and Choolwe Jacobs. Behind the Pain: Experiences and Coping Strategies to Primary Dysmenorrhea among Adolescent Girls in Selected Settings of Lusaka, Zambia. American Journal of Public Health Research. 2025; 13(1):1-11. doi: 10.12691/ajphr-13-1-1

Abstract

Introduction: Primary dysmenorrhea, or painful menstrual cramps, affects many adolescent girls and can significantly disrupt their daily lives, school attendance, and social interactions. This study explored experiences and coping strategies with primary dysmenorrhea among adolescent girls in Lusaka, Zambia. Methods: Using a phenomenological approach, we conducted DrawingOut workshops and in-depth interviews among 20 adolescent girls in Lusaka in August 2024. These workshops allowed girls to visually express their experiences with menstrual pain and the strategies they use to manage it. The research team analysed these drawings and interview transcripts to identify recurring themes using thematic analysis with the aid of Atlas.ti software. Results: Findings show that primary dysmenorrhea affects many aspects of the adolescents’ lives. Pain often leads to missing school, social withdrawal, and emotional distress. Barriers to getting healthcare include dismissive attitudes from healthcare providers, reliance on traditional remedies, and a lack of family support or understanding. Misconceptions and minimal education on menstrual health further complicate these experiences, leaving girls with few effective ways to manage their pain. Common coping strategies include over-the-counter painkillers, traditional remedies, and personal adjustments, although these strategies are often only partly effective. Conclusion: The study underscores that primary dysmenorrhea is not merely a physical issue but also affects girls’ mental and social well-being. There is an urgent need for better menstrual health education, more accessible healthcare tailored to adolescent needs, and support systems that address cultural stigmas and misconceptions. Improved resources and understanding can help girls manage dysmenorrhea more effectively and enhance their quality of life.

Keywords:
Primary Dysmenorrhea Adolescent Girls Coping strategies Menstrual Health

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References:

[1]	Esan DT, Ariyo SA, Akinlolu EF, Akingbade O, Olabisi OI, Olawade DB, et al. Prevalence of dysmenorrhea and its effect on the quality of life of female undergraduate students in Nigeria. Journal of Endometriosis and Uterine Disorders. 2024 Mar; 5: 100059.
[2]	Arafa AE, Khamis Y, Hassan HE, Saber NM, Abbas AM. Epidemiology of dysmenorrhea among workers in Upper Egypt; A cross sectional study. Middle East Fertility Society Journal. 2018 Mar 1; 23(1): 44–7.
[3]	Emem E, Hassan H. Correlation between Quality of Life and Dysmenorrhea among Nursing Schools Students. International Journal of Nursing Science [Internet]. 2017; Available from: http://article.sapub.org/10.5923.j.nursing.20170706.02.html#Ref.
[4]	Hassan H, Gamel W, Sheha E., Sayed M, Arafa A. Menstrual disorders Necessitating Counseling among Students in 469 Beni-Suef University. Clinical Nursing Studies. 2019.
[5]	S. NG, Priyadarshini S, Shetty S. Dysmenorrhoea among adolescent girls - characteristics and symptoms experienced during menstruation. Journal of Health and Allied Sciences NU. 2014 Sep; 04(03): 045–52.
[6]	Hassan H, Ahmed W, Arafa A. Physical Activity and Menstrual Disorders Аmong School Girls in Southern Egypt. 2019;
[7]	Faramarzi M, Salmalian H. Association of Psychologic and Nonpsychologic Factors With Primary Dysmenorrhea. Iran Red Crescent Med J [Internet]. 2014 Aug 5 [cited 2024 Aug 22]; 16(8). Available from: https:// sites.kowsarpub.com/ ircmj/articles/ 55144.html.
[8]	Acheampong K, Baffour-Awuah D, Ganu D, Appiah S, Pan X, Kaminga A, et al. Prevalence and Predictors of Dysmenorrhea, Its Effect, and Coping Mechanisms among Adolescents in Shai Osudoku District, Ghana. Obstet Gynecol Int. 2019; 2019: 5834159.
[9]	Lumsden MA. Dysmenorrhoea. Women’s Health Medicine. 2005 Jan 1; 2(1): 40–3.
[10]	McCaffery M, Pasero C. Teaching patients to use a numerical pain-rating scale. Am J Nurs. 1999 Dec; 99(12): 2.
[11]	Barrett LF, Mesquita B, Ochsner KN, Gross JJ. The experience of emotion. Annu Rev Psychol. 2007; 58: 373–403.
[12]	Mendiratta V, Lentz GM. In: Comprehensive gynecology. 7th ed. Lobo RA, Gershenson DM, Lentz GM. Comprehensive gynecology. 7th ed. Lobo RA, Gershenson DM, Lentz GM, editors. Philadelphia (PA): Elsevier Inc; 2017. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder.
[13]	Nwankwo TO, Aniebue UU, Aniebue PN. Menstrual disorders in adolescent school girls in Enugu, Nigeria. J Pediatr Adolesc Gynecol. 2010 Dec; 23(6): 358–63.
[14]	Chinyama J, Chipungu J, Rudd C, Mwale M, Verstraete L, Sikamo C, et al. Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC Public Health. 2019 Jan 5; 19(1): 16.
[15]	Sambo J, Nyambe S, Yamauchi T. A qualitative study on menstrual health and hygiene management among adolescent schoolgirls in peri-urban Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development. 2024 Jan 9; 14(1): 15–26.
[16]	Leon-Larios F, Silva-Reus I, Puente Martínez MJ, Renuncio Roba A, Ibeas Martínez E, Lahoz Pascual I, et al. Influence of menstrual pain and symptoms on activities of daily living and work absenteeism: a cross-sectional study. Reproductive Health. 2024 Feb 19; 21(1): 25.
[17]	Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med. 2022 Mar 20; 43(2): 101–8.
[18]	Unnisa H, Annam P, Gubba NC, Begum A, Thatikonda K. Assessment of quality of life and effect of non-pharmacological management in dysmenorrhea. Ann Med Surg (Lond). 2022 Sep; 81: 104407.
[19]	Cherenack EM, Rubli J, Melara A, Ezaldein N, King A, Alcaide ML, et al. Adolescent girls’ descriptions of dysmenorrhea and barriers to dysmenorrhea management in Moshi, Tanzania: A qualitative study. PLOS Glob Public Health. 2023; 3(7): e0001544.
[20]	Cherenack EM. Stress, Coping, Mental Health, and Reproductive Health among Adolescent Girls Transitioning through Puberty in Tanzania [Internet] [Ph.D.]. ProQuest Dissertations and Theses. [United States -- North Carolina]: Duke University; 2020. Available from: https:// www.proquest.com/ dissertations-theses/ stress-coping-mental-health-reproductive-among/ docview/ 2583108752/ se-2?accountid=178985.
[21]	Gilda ML. Menstrual Practices, Beliefs, and Traditions of Menstruating People in Nepal: A Scoping Review of the Qualitative Evidence [Internet]. University of Pittsburgh; 2023 [cited 2024 Dec 3]. Available from: https://d-scholarship.pitt.edu/ 44695/1/Gildea%2C%20M.%20MPH%20Essay%202023.pdf.
[22]	Sundari T, George AJ, Sinu E. Psychosocial Problems of Adolescent Girls during Menstruation. J Mental Health Educ. 2022 Apr; 3(2): 47–63.
[23]	Aziato L, Dedey F, Clegg-Lamptey JNA. Dysmenorrhea Management and Coping among Students in Ghana: A Qualitative Exploration. J Pediatr Adolesc Gynecol. 2015 Jun; 28(3): 163–9.
[24]	Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019 Apr; 8(2): 90–7.
[25]	Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. Sage publications; 2016.
[26]	Gameiro S, de Guevara BB, El Refaie E, Payson A. DrawingOut – An innovative drawing workshop method to support the generation and dissemination of research findings. PLOS ONE. 2018 Sep; 13(9): 1–19.
[27]	Aguilar Solano M. Triangulation and Trustworthiness —Advancing Research on Public Service Interpreting through Qualitative Case Study Methodologies. 2020 Apr 6; 7: 31–52.
[28]	Riffin C, Kenien C, Ghesquiere A, Dorime A, Villanueva C, Gardner D, et al. Community-based participatory research: understanding a promising approach to addressing knowledge gaps in palliative care. Ann Palliat Med. 2016 Jul; 5(3): 218–24.
[29]	Zulu JM, Goicolea I, Chavula P, Mulubwa C, Michelo C, Musonda P, et al. How does integration of comprehensive sexuality education in schools shape sexuality decisions among adolescents in Zambia?: A community based participatory research driven realist evaluation study protocol. Journal of Community Systems for Health [Internet]. 2024 Oct; 1(1). Available from: https:// journals.ub.umu.se /index.php/ jcsh/ article/view/505.
[30]	Ronzani C, Costa P, Silva L, Pigola A, Paiva E. Qualitative Methods Of Analysis: An Example Of Atlas.Titm Software Usage Análise Qualitatica: Um Exemplo Do Uso Do Software Atlas.Titm Análisis Cualitativo: Un Ejemplo De Uso Del Software Atlas.Ti TM. Revista Gestão & Tecnologia. 2020 Nov 25; 20: 284–311.
[31]	Mukumbang FC. Retroductive Theorizing: A Contribution of Critical Realism to Mixed Methods Research. Journal of Mixed Methods Research. 2023 Jan 1; 17(1): 93–114.
[32]	Mesele TT, Ayalew HG, Syoum AT, Antehneh TA. Impact of Dysmenorrhea on Academic Performance among Haramaya University Undergraduate Regular Students, Eastern Ethiopia. Frontiers in Reproductive Health [Internet]. 2022; 4.
[33]	Armour M, Parry K, Manohar N, Holmes K, Ferfolja T, Curry C, et al. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. Journal of Women’s Health. 2019; 28(8): 1161–71.
[34]	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 Mar 6; 24(1): 726.
[35]	Femi-Agboola DM, Sekoni OO, Goodman OO. Dysmenorrhea and Its Effects on School Absenteeism and School Activities among Adolescents in Selected Secondary Schools in Ibadan, Nigeria. Niger Med J. 2017 Aug; 58(4): 143–8.
[36]	Lee H, Kim J. Direct and Indirect Effects of Stress and Self-Esteem on Primary Dysmenorrhea in Korean Adolescent Girls: A Cross-Sectional Survey Study. Iran J Public Health. 2024 Jan; 53(1): 116–25.
[37]	Deshpande TN, Patil SS, Gharai SB, Patil SR, Durgawale PM. Menstrual hygiene among adolescent girls - A study from urban slum area. J Family Med Prim Care. 2018 Dec; 7(6): 1439–45.
[38]	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 [Internet]. 2021; 16(9 September).
[39]	Maulingin-Gumbaketi E, Larkins S, Whittaker M, Rembeck G, Gunnarsson R, Redman-MacLaren M. Socio-cultural implications for women’s menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review. Reprod Health. 2022 Jun 2; 19(1): 128.
[40]	Erchull MJ. You Will Find Out When the Time Is Right”: Boys, Men, and Menstruation. In: The Palgrave Handbook of Critical Menstruation Studies [Internet]. 2020. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK565640/.
[41]	Sooki Z, Shariati M, Chaman R, Khosravi A, Effatpanah M, Keramat A. The Role of Mother in Informing Girls About Puberty: A Meta-Analysis Study. Nurs Midwifery Stud. 2016 Mar; 5(1): e30360.
[42]	Ní Chéileachair F, McGuire BE, Durand H. Coping with dysmenorrhea: a qualitative analysis of period pain management among students who menstruate. BMC Women’s Health. 2022 Oct 5; 22(1): 407.
[43]	Wiggleton-Little J. “Just” a painful period: A philosophical perspective review of the dismissal of menstrual pain. Womens Health (Lond). 2024 Dec; 20:17455057241255646.
[44]	Olson MM, Alhelou N, Kavattur PS, Rountree L, Winkler IT. The persistent power of stigma: A critical review of policy initiatives to break the menstrual silence and advance menstrual literacy. PLOS Glob Public Health. 2022; 2(7): e0000070.