Abstract:
Background: Until now, no previous study has addressed the menstrual patterns among female international
students in China. In this present study, our objectives are to ascertain the menstrual characteristics and address the
menstrual problems together with their associated risk factors among international students in China.
Methods: A cross-sectional survey was carried out with 500 previously piloted self-structured questionnaires which
were administered to female international students enrolled in 15 universities in Zhejiang Province, China from May
2–August 31, 2016. Participants were required to provide answers to a semi-structured questionnaire which asked
questions about their socio-demographics and their menstrual characteristics while in their home countries.
Relevant changes in their menstrual pattern in terms of amount of flow and duration, regularity, length and
suggestive symptoms for premenstrual syndrome in the months after coming to reside in China were also inquired.
Respondents indicated changes in eating habits and selected stressors relevant to them from a given list. Their
stress levels were assessed and further categorized with the help of the Perceived Stress Scale (PSS). Measurements
for the main outcomes included the characteristics of menstrual patterns after arrival in China, stress levels, stressors
and new lifestyle patterns.
Results: Four hundred and nine (81.8%) out of the 500 questionnaires met the criteria and constituted the
population for this study. The respondents’ mean age was 21.405 years. Almost half of our respondents (49.1%)
reported varying changes in their menstrual pattern after arrival to China. Although, menstrual regularity, normal
menstrual length (21-35 days) and duration of flow (3–7 days) remained fairly normal among most of the
respondents, disorders like premenstrual symptoms (PMS) (33.82%); abnormal amount (17.97%) and dysmenorrhea
(16.38%) were prevalent. There was a significant association between high stress (PSS > 20) and menstrual change
0R = 1.636, 95% CI 1.051–2.547, p = 0.029) and dysmenorhea (p = 0.037). Common stressors included language
barrier 81(25.88%), food 64(20.45%), and loneliness 56(17.89%).
Conclusion: Menstrual disorders are high among international students in China. We established premenstrual
symptoms as the most common menstrual disorder. High levels of stress (PSS > 20) emanating from factors
including the language barrier, diet and loneliness was significantly related to the disruptions in their menstruation.
