Journal of Psychosomatic
Research, Vol. 19, PD. 131 to 137. Pergamon Press, 1975. Printed in Great Britain
AMENORRHOEA
AND OTHER MENSTRUAL IN STUDENT NURSES*
SYMPTOMS
W. 0. MCCORMICK (Received 21 October 1974)
PSYCHOGENIC factors are frequently reported as common causes of secondary amenorrhoea. This group is regarded as the most common by Jeffcoate [l], who also states that amenorrhoea occurs in 50 per cent of young girls living an institutional life; he does not give data on which this high figure is based. Winter [2] described psychogenic amenorrhoea as ‘common’ in college women but gave no figures. Drew and Stifel[3] found amenorrhoea in 16 per cent of women entering a religious order and Drillien [4] found it in 25.4 per cent of recruits to the A.T.S. (the women’s section of the British Army). One purpose of this study was to find the frequency of amenorrhoea and other common menstrual disorders in student nurses. When the label ‘psychogenic’ is applied to amenorrhoea it implies that psychological factors contribute to the disturbance of menstrual rhythm. The subjects with amenorrhoea might differ from their peers whose periods are uninterrupted either by being more psychologically predisposed to upset or by having a menstrual cycle more easily disrupted by an average psychological upset. The two factors might both be relevant, the one more in some patients than in others. In this study psychometric measures are used to consider whether the amenorrhoea subjects differ psychologically from those with no interruption of periods. (It would be wrong to call these subjects ‘patients’: few of them seek treatment; they are encouraged to accept some change in menstrua1 cycIe as ‘normal’.) The main interest of the author was in amenorrhoea, but data on other menstrual symptoms were also collected. SUBJECTS
AND METHODS
The subjects for the investigations of frequency of cycle interruption were 211 student nurses in two general hospitals in Belfast. Detailed psychometric data were available on 142 subjects (some tables show results on slightly fewer than 142 because a few subjects did not answer every question). Students in the first l& yr of training were not included. The modal age was 20 (75 subjects) with 35 aged 19 and the remainder older. Nurses were approached in a classroom setting and asked to participate. The author explained the purpose of the study, showed the questionnaire to be completed and then withdrew leaving a clerical helper to collect the completed forms. It was hoped that nurses who might have been afraid to refuse to help a consultant with his research would feel free to slip out along with the male student nurses if a clerical helper only were watching, MENSTRUATION
DATA
Scores were obtained from the questionnaire prepared for this study (see appendix). This covered age of menarche, age of establishment of a regular cycle, dysmenorrhoea, other symptoms and missed periods. The subjects were also asked to indicate if they were taking a contraceptive pill. * From the Department
of Mental Health, The Queen’s University of Belfast, Northern Ireland. 131
132
W. 0. MCCORMICK
PSYCHOMETRIC SCORES The scores obtained were: Neuroticism (N) $raversion (E) Scores from Maudsley Personality Inventory (L,) (5) Anxiety Defensiveness Lie
(A) (K) (L,)
Malingering
(M)
(M.P.I.)
Scores from the Taylor Manifest Anxiety Scale (T.M.A.S.) (6) Scores from the Malingering scale described by Keehn (7) ANALYSIS
The results were analysed using The Queen’s University
of Belfast computer.
RESULTS The results will be considered under three headings: (a) Incidence of cessation of periods; (b) The association between cessation of periods and other menstrual symptoms; (c) The association between menstrual symptoms and psychometric scores-psychometric these nurses as a group. (a) Incidence of cessation of periods The frequency of the different degrees of disruption
of menstruation
scores of
are shown in Table 1.
TABLE1.-INCIDENCE OF CESSATION CESSATION OF PEBIODS
NO. OFSUBJEXXS
6-12 weeks
46
% SUBJECTS
22.0
months
8
3.8
6-12 months
4
1.9
12+ months
1
0.5 -
3-6
Any cessation
NolIe
59
28.2
1.50
71.8
209
100.0
-
The incidence of any interruption is 28 per cent but if amenorrhoea (as opposed to oligomenorrhoea) is taken to mean a cessation of three months or more only 6.2 per cent of these girls had experienced amenorrhoea. (b) The association between missed periods and other menstrual symptoms No significant association was found between cessation of menstruation and the following: Age of menarche, age of establishment of regular periods, self-rating of amount of loss, usual duration of memtruation, usual duration of the cycle, pain, other symptoms, and incapacity. There was significant association between cessation and description of periods as ‘irregular’. This remained even when subjects who reported a cessation of over three months were excluded, (chisquared = 20.9, P -C O+Ol). This is probably an artefact in that irregularity of periods only has to include some gaps of over six weeks for the subject to rate cessation. One might have thought that there would be a negative association between cessation and incapacity: one is not incapacitated so much if periods are absent. No such association was found. Chisquared = 3.2 (N.S.)
Amenorrhoea
133
and other menstrual symptoms in student nurses
(c) Psychometric scores and menstrual symptoms All of the mean psychometric test scores except N (from M.P.I.) and A (from T.M.A.S.) were similar to those of a Northern Ireland normal (non-patient) sample. The nurses’ N scores showed a mean of 15.0 S.D. 4.4 compared with a Northern Ireland control sample mean N of 9% S.D. 4.5. The nurses’ A scores had a mean of 19.9, SD. 7.4 while controls’ A mean was 13 with S.D. of 9. (i) Psychometric scores-associated with menstrual symptoms. No significant association was found between cessation and the following: N and L, (from M.P.I.); A, K, and Lz (from T.M.A.S.). An association was found between cessation and lower E scores on the M.P.I.-see Table 2.
%
Lt.1
0.3
6-12 weeks
34
12.4
0.9
Over 3 months
10
12.2
1.2
NON
t between tNonetand 6-12 weeks = 2.27; P
Research, Vol. 19, PD. 131 to 137. Pergamon Press, 1975. Printed in Great Britain
AMENORRHOEA
AND OTHER MENSTRUAL IN STUDENT NURSES*
SYMPTOMS
W. 0. MCCORMICK (Received 21 October 1974)
PSYCHOGENIC factors are frequently reported as common causes of secondary amenorrhoea. This group is regarded as the most common by Jeffcoate [l], who also states that amenorrhoea occurs in 50 per cent of young girls living an institutional life; he does not give data on which this high figure is based. Winter [2] described psychogenic amenorrhoea as ‘common’ in college women but gave no figures. Drew and Stifel[3] found amenorrhoea in 16 per cent of women entering a religious order and Drillien [4] found it in 25.4 per cent of recruits to the A.T.S. (the women’s section of the British Army). One purpose of this study was to find the frequency of amenorrhoea and other common menstrual disorders in student nurses. When the label ‘psychogenic’ is applied to amenorrhoea it implies that psychological factors contribute to the disturbance of menstrual rhythm. The subjects with amenorrhoea might differ from their peers whose periods are uninterrupted either by being more psychologically predisposed to upset or by having a menstrual cycle more easily disrupted by an average psychological upset. The two factors might both be relevant, the one more in some patients than in others. In this study psychometric measures are used to consider whether the amenorrhoea subjects differ psychologically from those with no interruption of periods. (It would be wrong to call these subjects ‘patients’: few of them seek treatment; they are encouraged to accept some change in menstrua1 cycIe as ‘normal’.) The main interest of the author was in amenorrhoea, but data on other menstrual symptoms were also collected. SUBJECTS
AND METHODS
The subjects for the investigations of frequency of cycle interruption were 211 student nurses in two general hospitals in Belfast. Detailed psychometric data were available on 142 subjects (some tables show results on slightly fewer than 142 because a few subjects did not answer every question). Students in the first l& yr of training were not included. The modal age was 20 (75 subjects) with 35 aged 19 and the remainder older. Nurses were approached in a classroom setting and asked to participate. The author explained the purpose of the study, showed the questionnaire to be completed and then withdrew leaving a clerical helper to collect the completed forms. It was hoped that nurses who might have been afraid to refuse to help a consultant with his research would feel free to slip out along with the male student nurses if a clerical helper only were watching, MENSTRUATION
DATA
Scores were obtained from the questionnaire prepared for this study (see appendix). This covered age of menarche, age of establishment of a regular cycle, dysmenorrhoea, other symptoms and missed periods. The subjects were also asked to indicate if they were taking a contraceptive pill. * From the Department
of Mental Health, The Queen’s University of Belfast, Northern Ireland. 131
132
W. 0. MCCORMICK
PSYCHOMETRIC SCORES The scores obtained were: Neuroticism (N) $raversion (E) Scores from Maudsley Personality Inventory (L,) (5) Anxiety Defensiveness Lie
(A) (K) (L,)
Malingering
(M)
(M.P.I.)
Scores from the Taylor Manifest Anxiety Scale (T.M.A.S.) (6) Scores from the Malingering scale described by Keehn (7) ANALYSIS
The results were analysed using The Queen’s University
of Belfast computer.
RESULTS The results will be considered under three headings: (a) Incidence of cessation of periods; (b) The association between cessation of periods and other menstrual symptoms; (c) The association between menstrual symptoms and psychometric scores-psychometric these nurses as a group. (a) Incidence of cessation of periods The frequency of the different degrees of disruption
of menstruation
scores of
are shown in Table 1.
TABLE1.-INCIDENCE OF CESSATION CESSATION OF PEBIODS
NO. OFSUBJEXXS
6-12 weeks
46
% SUBJECTS
22.0
months
8
3.8
6-12 months
4
1.9
12+ months
1
0.5 -
3-6
Any cessation
NolIe
59
28.2
1.50
71.8
209
100.0
-
The incidence of any interruption is 28 per cent but if amenorrhoea (as opposed to oligomenorrhoea) is taken to mean a cessation of three months or more only 6.2 per cent of these girls had experienced amenorrhoea. (b) The association between missed periods and other menstrual symptoms No significant association was found between cessation of menstruation and the following: Age of menarche, age of establishment of regular periods, self-rating of amount of loss, usual duration of memtruation, usual duration of the cycle, pain, other symptoms, and incapacity. There was significant association between cessation and description of periods as ‘irregular’. This remained even when subjects who reported a cessation of over three months were excluded, (chisquared = 20.9, P -C O+Ol). This is probably an artefact in that irregularity of periods only has to include some gaps of over six weeks for the subject to rate cessation. One might have thought that there would be a negative association between cessation and incapacity: one is not incapacitated so much if periods are absent. No such association was found. Chisquared = 3.2 (N.S.)
Amenorrhoea
133
and other menstrual symptoms in student nurses
(c) Psychometric scores and menstrual symptoms All of the mean psychometric test scores except N (from M.P.I.) and A (from T.M.A.S.) were similar to those of a Northern Ireland normal (non-patient) sample. The nurses’ N scores showed a mean of 15.0 S.D. 4.4 compared with a Northern Ireland control sample mean N of 9% S.D. 4.5. The nurses’ A scores had a mean of 19.9, SD. 7.4 while controls’ A mean was 13 with S.D. of 9. (i) Psychometric scores-associated with menstrual symptoms. No significant association was found between cessation and the following: N and L, (from M.P.I.); A, K, and Lz (from T.M.A.S.). An association was found between cessation and lower E scores on the M.P.I.-see Table 2.
%
Lt.1
0.3
6-12 weeks
34
12.4
0.9
Over 3 months
10
12.2
1.2
NON
t between tNonetand 6-12 weeks = 2.27; P
