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THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITIES
PARTICIPATION AND INTENSITY OF PRIMARY DYSMENORRHEA AND
RELATED MENSTRUAL SYMPTOMS AMONG YOUNG FEMALES IN HONG KONG
BY
LAU HIU CHING
09012737
AN HONOUTS PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE
REQUITMENTS FOR THE DEGREE OF
BACHELOR OF ARTS
IN
PHYSICAL EDUCATION AND RECRESTION MANAGEMENT (HONOURS)
HONG KONG BAPTIST UNIVERSITY
APRIL 2012
HONG KONG BAPTIST UNIVERSITY
2
25TH APRIL, 2012
We hereby recommend that the Honours Project by Miss Lau
Hiu Ching entitled “The relationship between physical
activities participation and intensity of primary
dysmenorrhea and related menstrual symptoms among young
females in Hong Kong” be accepted in partial fulfillment of
the requirements for the Bachelor of Arts Honours Degree in
Physical Education And Recreation Management.
_________________________ ___________________________
Associate Prof. Kim Seungmo Associate Prof. Louie Hung Tak
Chief Advisor Second Reader
3
DECLARATION
I hereby declare that this honours project “The
relationship between physical activities participation and
intensity of primary dysmenorrhea and related menstrual
symptoms among young females in Hong Kong” represent my own
work and had not been previously submitted to this or other
institution for a degree, diploma or other qualification.
Citations from the other authors were listed in the
references.
____________________________
Lau Hiu Ching
25th APRIL, 2012
4
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my chief
advisor Associate Professor Kim Seungmo, for his advices and
generous guidance through the entire preparation of my honours
projects. Special appreciation is given to Associate
Professor Louie Hung Tak, Lobo as my second reader.
In addition, I would like to give my gratitude to all the
interviewee who involved in this study. Without their
participation, this project might not have been made possible
and successful.
___________________________
Lau Hiu Ching
Department of Physical Education
Hong Kong Baptist University
Date: 25th APRIL, 2012
5
ABSTRACT
The purpose of this study was to investigate the
relationship between physical education participation and the
intensity of primary dysmenorrhea and related menstrual
symptoms among young females in Hong Kong, and see if physical
education is helpful in terms of relieving menstrual symptoms.
The study involved 104 university females who have different
sport participation habits. They answered the questionnaires
from the researcher regarding their sport participation, both
in the past and recently, and their menstrual characteristics.
Moos Menstrual Distress Questionnaire (MDQ) was used to
examining the intensity of menstrual distress in female during
menstruation. The results show that there are no relationship
between sport participation, either in the past or recently,
and their intensity of Primary Dysmenorrhea and related
menstrual symptoms.
6
TABLE OF CONTENTS
CHAPTER
1. INTRODUCTION . . . . . . . . . . . . . . . . . . . .
Statement of the Problem . . . . . . . . . . . . . . .
Definition of Terms . . . . . . . . . . . . . . . .
Delimitations. . . . . . . . . . . . . . . . . . . .
Limitations . . . . . . . . . . . . . . . . . . . .
Hypotheses . . . . . . . . . . . . . . . . . . . . .
Significance of the Study . . . . . . . . . . . . . .
2. REVIEW OF LITERATURE . . . . . . . . . . . . . . . .
Contributing factors associated with
primary dysmenorrhea . . . . . . . . . . . . . . . .
Applied treatment for relieving of
primary dysmenorrhea . . . . . . . . . . . . . . . .
Physical exercises and primary
dysmenorrhea . . . . .
3. METHOD . . . . . . . . . . . . . . . . . . . . . . .
Subjects . . . . . . . . . . . . . . . . . . . . . . .
Development of questionnaire . . . . . . . . . . . . .
Pilot study . . . . . . . . . . . . . . . . . . . . . .
PAGE
8
10
11
13
15
16
17
18
18
21
23
28
28
29
30
7
Procedures . . . . . . . . . . . . . . . . . . . . . . .
Methods of analysis . . . . . . . . . . . . . . . . . . .
4. ANALYSIS OF DATA . . . . . . . . . . . . . . . . . . . .
Demographics of the respondents . . . . . . . . . .
Relationship between physical activities
participation and primary dysmenorrhea. . . . . .
Relationship between physical activities
participation and menstrual symptoms . . . . . . . .
Discussion . . . . . . . . . . . . . . . . . . . . . . .
5. SUMMARY AND CONCLUSION . . . . . . . . . . . . . . .
Summary of results . . . . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . .
Recommendation for further
studies . . . . . . . . . . .
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . .
APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . .
A. Questionnaire of this study . . . . . . . . . . . . . .
31
31
33
33
37
41
49
55
55
55
57
60
62
62
8
Chapter 1
INTRODUCTION
In these days and ages, with increasing acknowledgement
of gender equality, people are paying more attention towards
the condition females face during menstrual period. Primary
dysmenorrhea (PD) is the most common menstrual disorder
experienced by female. It is chronic, cyclic, pelvic,
spasmodic pain associated with menstruation in the absence
of identifiable pathology and is commonly referred to as
menstrual cramps or period pain by lay people. Women typically
describe dysmenorrhea as a cramping sensation occurring
immediately prior to and or during menstruation, usually
beginning soon after menarche. (Daley, 2008) PD is onset
usually six to twelve months after menarche once cycles are
regular. The peak of PD is during late teens or early 20s.
(Alper & Forman, 2004)
While lower abdominal cramping is the most common
dysmenorrhea symptom, many adolescents experience other
menstruation associated symptoms, such as diarrhea, nausea,
9
facial blemishes, vomiting, loss of appetite, flushing,
headaches, sleeplessness, backaches, irritability, dizziness
and nervousness etc.(Harel, 2002) According to the research
done by Lee, Tang and Chong in 2009 in Hong Kong, 34.2% out
of 339 Chinese women in Hong Kong reported 10 or more menstrual
symptoms. Fatigue (62%), abdominal cramp (60.6%),
Irritability (54.4%), Stomachache (54.3%) are the most common
menstrual symptoms reported by participants. The Gender
Equality in Employment Law Chapter IV Article 14, it stated
that “When a female employee encounters job difficulty because
of menstruation, she may request a menstruation leave for one
day in one month.” which prove that these symptoms are greatly
limited the normal functioning of females social life, the
condition females face during menstrual cycle should not be
neglected.
In order to found out effectively treatments other than
clinical therapies to relieve the symptoms of PD, researchers
have done lots of studies in this aspect. Besides heat therapy,
compression and taking a rest, doing exercises were also found
10
to be beneficial to menstrual pain management. Dusek (2001)
found that more subjects in control group reported they have
higher intensity of menstrual pain compared with athletes.
Similarly, in Choi and Salmon (1995) research revealed that
higher exercise group had lower physical symptoms during
menstruation. However, researchers such as Lee, Chen, Lee &
Kaur(2006) found that the percentage of students having PD
are similar in both group having physical exercise and do not
having physical exercise.
Due to the wide variation in the estimation of the
relationship of doing exercise and menstrual pain management,
the researcher used the Moos Menstrual Distress Questionnaire
to measure the total scores of menstrual characteristics of
young females, thus, illustrated the intensity of primary
dysmenorrhea and related menstrual symptoms of young female
in Hong Kong.
Statement of problems
The main purpose of this current study is to find out the
relationship between physical activities participation and
11
their intensity of Primary Dysmenorrhea and related menstrual
symptoms among young females in Hong Kong.
According to the above, following research questions were
raised:
1. Is there any difference in the intensity of Primary
Dysmenorrhea and related menstrual symptoms among young
female in Hong Kong who are actively participated in
physical activities, illustrated by past school sports team
participation, and inactively or no participation in
physical activities in the past?
2. Is there any difference in the intensity of Primary
Dysmenorrhea and related menstrual symptoms among young
female in Hong Kong who are actively participating in
physical activities, illustrated by average sports
participation hours per week, and inactively or no
participation in physical activities?
Definition of Terms
The following terms were defined for this study:
12
Physical activities:
It refers to any bodily movement produced by skeletal muscles
that requires energy expenditure. (World Health Organization)
Primary Dysmenorrhea:
It refers to chronic, cyclic, pelvic, spasmodic pain
associated with menstruation in the absence of identifiable
pathology. (Daley, 2008)
Moos Menstrual Distress Questionnaire (MDQ)
It refers to the questionnaire developed by Rudolf H. Moos
in 1968 used to measure the intensity of menstrual distress
in female during menstruation. The questionnaires included
46 symptoms listed under eight factors. These factors, which
represent separate but empirically inter-correlated clusters
of symptoms, they were labeled pain, concentration,
behavioral change, autonomic reactions, water retention,
negative effect, arousal, and control. (Moos, 1968)
Young females
It refers to any female having normal menstruation cycle who
is aged from 15- 25 in Hong Kong.
13
School sports team participation
It refers to regularly participated in any kinds of sports
team during primary school or secondary school.
Actively participating in physical activities
For substantial health benefits, adults need to do at least
150 moderate – intensity activities per week. (U.S. Department
of Health and Human Services. 2008) Therefore, in this study,
the researcher refers actively participating in physical
activities to females who participated in physical activities
more than 2 hours per week.
Inactively or no participation in physical activities
It refers to females who participated in physical activities
less than or equals to 2 hours per week.
Delimitations
The delimitations would be defined as followings:
1. Subjects of this study contain female students in Hong
Kong who are actively participating in physical
activities and inactively or no participation in
physical activities.
14
2. The target group of the subjects is female aged from
15 to 25 having normal menstruation cycle in Hong Kong.
Other age group and male are excluded from this study.
Because Primary dysmenorrhea is usually is onset
usually six to twelve months after menarche once cycles
are regular in healthy women not related to any specific
problems with the uterus or other pelvic organs. Peak
of PD is during late teens or early 20s.
3. Self-constructed questionnaires were based on Moos
Menstrual Distress Questionnaire, which is a widely
used questionnaire containing 46-symptoms 6-point
scale under eight different factors contributing to
menstrual characteristics. They are pain,
concentration, behavioral change, autonomic reactions,
water retention, negative effect, arousal, and control.
Besides, questions regarding background information
and sport participations are added by the researcher
in order to complete the study.
15
Limitations
There might be some uncontrollable factors that might
affect with the results of the study:
1. Sample size was not big enough to represent the situation
in Hong Kong.
2. It was assumed that all subjects would answer the
questionnaire with their perceptions honestly. In other
words, there was a risk that the answers might not
reflect the real situation of the subjects.
3. Moos Menstrual Distress Questionnaire (MDQ) is a widely
used instrument for assessing menstrual affective,
somatic and behavioral changes of female. Since the
symptoms related to primary dysmenorrhea is basically
menstrual characteristics which can be measured by MDQ,
therefore researcher used it to illustrate the study
results. However, MDQ is not originally designed for
measuring the intensity of primary dysmenorrhea.
4. Self-constructed questionnaires may affect the
validity and reliability of the study.
16
Hypothesis
1. There would be significant difference in the intensity
of primary dysmenorrhea among young female in Hong Kong
who actively participated in physical activities and
inactively or no participation in physical activities
in the past.
2. There would be significant difference in the intensity
of primary dysmenorrhea among young female in Hong Kong
who are actively participating in physical activities
and inactively or no participation in physical
activities recently.
3. There would be significant difference in the degree of
menstrual symptoms suffering among young female in Hong
Kong who actively participated in physical activities
and inactively or no participation in physical
activities in the past.
4. There would be significant difference in in the degree
of menstrual symptoms suffering among young female in
Hong Kong who are actively participating in physical
17
activities and inactively or no participation in
physical activities recently.
Significance of the study
About 50% of menstruating women experience dysmenorrhea.
10% of them are incapacitated by dysmenorrhea for one to three
days per month, leading to absence from school or work.(Alper
& Forman, 2004) Besides decreasing working performance and
affect the mood and quality of life, menstrual pain are
obviously disturb the normal functioning of female.
If the study prove that regularly participating in physical
activity will have lower chances to get primary dysmenorrhea,
which may used to help female suffering from menstrual pain
to management and back to normal social life.
18
Chapter 2
REVIEW OF LITERTURES
Primary dysmenorrhea (PD) is a common menstrual disorder
among females that can deeply affecting their quality of life.
The present study was to examine the role of physical exercise
in the management of PD. The review of literature was focused
on the following sessions: a) contributing factors associated
with PD; b) applied Treatment for relieving symptoms of PD
and; c) physical exercise and PD; and d) summary.
Contributing Factors Associated with Primary Dysmenorrhea
PD thought to be due to the production of uterine
prostaglandins (PGs) in the endometrium and excessive
production of the hormone vasopressin. This, in turn,
stimulates uterine muscular contractions, ischemia and
sensitization of nerve endings during endometrial sloughing
(menstruation) and consequently heightens menstrual pain.
(Daley, 2008) Other Biological factors contributing to PD were
found in a research by Loto, Adewumi and Adewuya(2008). The
19
research assessed 409 first year students in a Nigerian
university, disturbing questionnaires asking their social
demographic, also menstruation variables such as time of onset,
frequency, severity and interference with normal daily
activity of their menstrual pain. Results shown that factors
such as younger age at menarche, longer length of menstrual
flow, lower BMI and not currently using oral contraceptive
pills were proved to be significantly associated with PD.
Apart from biological factors, there were numerous
researchers had studied different life style habits
associated with PD. Fujiwara (2007) in her study conducted
with 716 female students at Ashiya College, Japan who aged
18 to 20 years old identified students into three groups
(students having no experience with dieting, students those
are currently on a diet and students having a history of
dieting). The result revealed that students having a history
of dieting had higher intensity of dysmenorrhea than the other
groups. Similarly, in another research of Fujiwara (2003) on
450 female student from the same college of same age group,
20
it showed that students who had breakfast only one to six times
per week and students who had breakfast less than once a week
had higher intensity of dysmenorrhea than students having
breakfast every day.
On the other hand, in a study about the exposure to
environment tobacco and dysmenorrhea (Chen, Cho, Damokash,
Chen, Li, Wang and Xu, 2000) of 165 non-smoking Chinese women,
it stated that there were significant dose and response
relationship between exposure to environmental tobacco smoke
and the increase of dysmenorrhea in young women. The percent
of dysmenorrhea occurred were 9.7% and 13% among female
non-exposed and exposed to environmental tobacco smoke.
Besides dieting habit, skipping breakfast and exposing to
environmental tobacco, work-related stress of female was also
one of the factors associated with PD according to Laszlo,
Gyorffy, Adam, Csoboth and Kopp (2008). They conducted a large
cross-sectional study with 2772 working women aged 18–55 years
in 2002. Well-trained district nurses conducted structured
interviews with subjects concerning their demographic data,
21
physical and mental health characteristics and attitude of
the subjects towards the health care system. The results shown
that Job related stress such as Low job control, low coworker
social support and also low job security were found to be
associated with higher risk for menstrual pain.
Applied Treatment for relieving symptoms of Primary
Dysmenorrhea
There were lots of clinical therapies effective for manage
PD. According to French (2008), there were three main types
of drugs therapies. First of all, the most established therapy
for PD is non-steroidal anti-inflammatory drugs (NSAIDs).
There were at least two possible mechanisms of NSAIDs: they
had a direct analgesic effect through inhibition of
prostaglandin synthesis and they decreased the volume of
menstrual flow which could help in easing menstrual pain.
Secondly, using oral contraceptives to reduce prostaglandin
release during menstruation, thus reduced the contractions
of the uterus was also one of the drug therapies. Besides,
using hormonal contraceptive products to suppress regular
22
menstruation or to facilitate uterine relaxation were
proposed to treat PD.
Similar to the above research, Harel (2002) stated in his
research that “The most common pharmacologic treatments for
dysmenorrhea are non-steroidal anti-inflammatory drugs
(NSAIDs).” NSAIDs are cyclo-oxygenase inhibitors and, as such,
reduce PG production. The reduction in PG levels leads to less
vigorous contractions of the uterus and, therefore, less
discomfort.” (p.800) In addition, Harel also mentioned in his
research that “oral contraceptives (OCs) could prevent or
improve dysmenorrhea by directly limiting endometrial growth
and reducing the amount of endometrial tissue available for
PG and LT production, and indirectly inhibiting ovulation and
subsequent progesterone secretion.” (p.800)
However, although there were many females suffering from
menstrual pain, they preferred having non-medical self-care
treatments instead of going to clinic and seek for
professional help. Chiou and Wang (2008) recruited 805
freshmen from three vocational nursing schools located in
23
southern Taiwan, conducted a survey with structured
questionnaires, and 760 valid questionnaires were obtained.
The main significant self-care actions they took when
dysmenorrheal occurred including use of hot compresses
(35.7%), Resting (32.9%), taking medicine (18.1%) and eating
chocolates (13.5%).
Similar finding were shown by Walsh, LeBlanc and McGrath
(2003), who did a research examined how women perceive and
cope with menstrual pain. 93 undergraduate women with a
regular menstrual period that suffer from menstrual pain
completed several self-reported questionnaires. Results
stated that 81% of them would take a rest, 58% of them would
use heat therapy, 57% of them would distract them and also
57% of them would do exercise.
Physical exercise and Primary dysmenorrhea
The belief of exercise is effective in preventing and
treating menstrual symptoms has prevailed for many years. Many
researchers conducted studies on this aspect and positive
results were shown to support that exercise is beneficial on
24
treating PD.
Using randomized clinical trial of 150 high school girl
students in Masged Solayman city who suffered from severe
dysmenorrhea, Abbaspour, Rostami and Najjar (2006) separated
them into exercise and control group. First of all, both groups
recorded the character of their menstruation at cycles 1 and
2 which included severity, duration of pain and duration of
bleeding. After recording two cycles, a prior diagnosis of
primary dysmenorrhea was made before beginning the evaluation.
After that, a two week exercise program was conducted in
exercise group such as lie face up with legs and knees bent
perform abdominal breathing about 10 times. After 2 cycles
with physical activity in exercise group and observation in
control group, the intensity of the pain in the exercise group
were recorded again. Findings showed that the intensity of
pain declined from 8.59 to 4.63 in the third period and 2.84
in the fourth period in exercise group. The average of the
duration pain declined from 7.15 to 4.22 in the third period
and 2.23 in the fourth period. (P.27-28) The study clearly
25
demonstrate that exercise can decrease the duration and
intensity of dysmenorrhea in high school girls.
Moreover, Dusek (2001) had investigated the PD condition
among 67 athletes aged 15-21 (10 volleyball players, 18
basketball players, 10 ballet dancers, and 34 runners) and
96 school girls who did not participated in any kind of sport
activities or physical recreation. Questionnaires was divided
into two parts, firstly asking their personal data and
characteristics of their menstrual cycle such as age at
menarche, duration of menstrual cycle and painful intensity
of menstruation cycle. The second part of questionnaire was
asking their sport participation such as type of sport,
training load per day and week etc. Results shown that the
prevalence of dysmenorrhea was two-fold lower in athletes than
in the control group, which meant that fewer athletes (n=18/67)
report high intensity of menstrual pain compared with control
group (n=55/96).
In addition, Choi and Salmon (1995) also conducted a
research to find out the relationship between regular exercise
26
and menstruation symptoms. Four group of women aged 15-48
including 35 competitive athletes, 33 female with high
exercise level,36 female with low exercise level and 39
sedentary women. The results revealed that low exercise group
had more physical symptoms during menstruation.
Although there were numerous researches supporting that
physical exercise was beneficial to menstrual pain management,
there were also lots of research showing opposing results.
Lee, Chen, Lee and Kaur (2006) conducted a cross-sectional
descriptive study carried out from June to August 2001 on 2,411
secondary school adolescent females in Malaysia, asked
background information about the respondents include age,
education level, ethnic group, height and weight. Also asked
questions related to menstruation variations in menstrual
patterns, for example cyclicity, cycle length, duration of
flow, amount of flow, premenstrual syndrome and its severity,
and pain with menstruation and its severity. The results found
that percentage of students having dysmenorrhea are similar
in both group having physical exercise(69.8%) and do not
27
having physical exercise(68.9%).
Furthermore, 2912 women aged 18-49 serving aboard US navy
ship were included in research done by Kritz-Silverstein ,
Wingard and Garland (1999), exercise behavior of them were
assessed by questionnaires and group into light, moderate and
heavy exercisers. It showed clearly that exercise frequency
was not associated with menstrual cramps.
28
Chapter 3
METHOD
The method of the study was presented in the following
sections: (a) subjects, (b) development of questionnaire, (c)
pilot study, (d) procedures and (e) methods of Analysis.
Subjects
Subjects were Hong Kong female aged from 15 to 25 who had
normal menstruation cycle. The researcher sent questionnaires
to 110 students and responses were received from 104 students.
Firstly, the respondents were divided into two groups, i.e.
females who actively participated in physical activities and
females who are inactively or no participation in physical
activities in the past. The participation in school sports
teams in primary and secondary school were used to illustrate
their past physical activities participation. 57 out of 104
respondents (54.8%) were participated in school sport team
before while 47 out of 104(45.2%) never participated in it.
Secondly, the respondents were divided into two groups,
i.e. females who are actively participating in physical
29
activities and females who are inactively or no participation
in physical activities recently. The average sport
participation per week in the past three month was used to
illustrate the recent sport participation. 50 of out of 104
respondents (48.1%) had participated in sports activities
less than or equal to 2 hours per week. 54 out of 104 (51.9%)
of them had participated in sports activities more than 2 hours
per week.
Development of questionnaire
This study was mainly conducted through a self administered
questionnaire. The design of the questionnaire was based on
the Moos Menstrual Distress Questionnaire, which was a widely
used questionnaire containing 46-symptoms 6-point scale under
eight different factors contributing to menstrual
characteristics. The main objective of the questionnaire was
to find out the relationship between participation in physical
activities and their intensity of primary dysmenorrhea and
related menstrual symptoms.
The questionnaire was divided into three parts: The first
30
part was asked for the general information about the subjects
which included the age, age at menarche, regularity of
menstrual cycle and duration of menstrual cycle. The second
part was asked about the sport participation of females which
included the past and recent sport participation. The third
part of the questionnaire was about the menstrual
characteristics. The fourth part of the questionnaires was
Moos Menstrual Distress Questionnaire, the experiences of 46
symptoms listed below eight factors labeled pain,
concentration, behavioral change, autonomic reactions, water
retention, negative effect, arousal, and control are asked.
Pilot Study
A pilot study carried out to ensure that the questions
the researcher set were understandable. In the pilot study,
6 subjects were recruited for doing the questionnaire and
asked them about their feeling toward the setting of the
questionnaire, whether they could complete it smoothly
without trouble in understanding the words and logic during
completing the questionnaire.
31
Procedures
The questionnaire was sent to 110 female students from
20th March and collected right after the participant finish.
Questionnaires were distributed to students with pencil to
mark answers. Students were directed to emphasize the
importance of answering the questions honestly. They were told
not to write their names on the surveys and were assured their
identities would be kept confidential.
Methods of Analysis
Data analyzed in this study was conducted using SPSS
(Statistical Package for the Social Science) for Windows. The
0.05 level of significance was used in all statistical
analyses. Descriptive Statistics was conducted for the
subjects’ general information including age, age at menarche,
and day of menstrual cycle and duration of menstrual cycle.
Quantitative statistics was computed to determine the
relationship between participation in physical activities and
their intensity of PD and related menstrual symptoms.
Independent T - test was applied to compare the sport
32
participation of female in the past or recently and their
menstrual characteristics or related menstrual symptoms.
33
Chapter 4
ANALYSIS OF DATA
This chapter presents the results of data analyses and
related finding in the following sections 1) Demographics of
the respondents 2) Relationship between physical activities
participation and lower abdominal pain 3) Relationship
between physical activities participation and menstrual
symptoms and 4) Discussion.
Demographics of Respondents
A total of 110 questionnaires were distributed. 2 of them
were excluded because the respondents were taken oral
contraceptive pill recently which will significantly affect
one’s menstrual characteristics. Besides, 4 of them were
incompletely and incorrectly done. After data cleansing
process, One hundred and four questionnaires (94.5%) were
returned and appeared to be comprehensively and appropriately
done.
Age
Table 1.1 showed the age distribution of the respondents.
34
Among 104 female students, the age range was from 18 to 25.
75% of them were within 21 to 23 years old.
Table 1.1
Age of respondents
Frequency Percentage
Age 18-20 19 18.3
21-23 78 75.0
24-25 7 6.7
Total 104 100.0
Menstrual information
The menstrual information, i.e. Age of menarche, length
of menstrual cycle and length of menstrual flow were recorded
and showed in table 1.2.
Table 1.2
Menstrual characteristics of respondents
Age of
menarche
length of
menstrual cycle
length of
menstrual flow
N 104 104 104
Mean 12.55 30.83 5.39
Std. Deviation 1.276 7.790 1.083
Minimum 9 7 3
Maximum 17 80 7
The range of first menarche was recorded from 9 to 17. 99
out of 104 respondents, which was account for 95%, started
their menstruation from 10 to 15 years old.
35
Besides, the statistic results reflected the length of
menstrual cycle were from 7 to 80 days, where nearly 90% of
them had their cycle within 25 to 35 days.
For the length of menstrual flow, all of the respondents
reported their menstruation would finish within 3 to 7 days.
Physical activities Participation
This research was basically conducted to found out the
relationship between physical activities participation and
intensity of lower abdominal pain. For physical activities
participation, the researcher defined it into two levels:
participated in school sports team in primary or secondary
school; and average physical activities participation hours
per week in the past three month.
Among 104 respondents, 57(54.8%) of them were participated
in school sports team before while 47(45.2%) of them never
participated in any kind of sports team. (Table 2.1)
Table 2.1
Statistic of school sports team participation
36
Besides, when we considered the average sport
participation hours per week in the past three month, 50 of
out of 104 respondents (48.1%) had participated in sports
activities less than or equal to 2 hours per week. 54 out of
104 (51.9%)of them had participated in physical activities
more than 2 hours per week. (Table 2.2)
Table 2.2
Statistic of average physical activities participation Frequency Percentage
Average PA
participation
per week (hours)
<=2 50 48.1
>2 54 51.9
Total 104 100.0
Relationship between physical activities participation and
intensity of primary dysmenorrhea
The intensity of primary dysmenorrhea was illustrated
mainly by the frequency of lower abdominal pain suffering
during menstruation (LAP frequency). Besides other menstrual
characteristics, when the lower abdominal pain would be
started (LAP started) and how long it would be lasted for (LAP
Frequency Percentage
school sports
team participation
yes 57 54.8
no 47 45.2
Total 104 100.0
37
lasted for), would also be taken into consideration.
This section was divided into two parts, regarding the
relationship between intensity of primary dysmenorrhea and
i ) school sports team participation in primary and secondary
school
ii) average physical activities participation per week in past
three month.
i) Relationship between school sports team participation
in primary and secondary school and intensity of primary
dysmenorrhea
In order to found out the relationship between school
sports team participation in primary and secondary
school and one’s degree of LAP, independent T-test was
applied. (Table 3.1)
Mean difference of LAP frequency was observed between
two groups, (M = 2.74, ex-school sport team members; M
= 3.13, no school sport team participation). LAP
frequency was reported by the respondents as follow,
38
1 = never, 2 = seldom, 3 = sometimes, 4 = very often and
5 = always. Results showed that ex-school sports team
members reported that “between seldom and sometimes”
best describe their situation of LAP suffering while
non-school sports team member reported that “between
sometimes and very often” best describe their situation.
Generally, there were no significant difference
between school team participation and the frequency of
LAP suffering (t=-1.691, p=.094), when LAP would started
(t= .018, p=.751) and how long would it lasted for
(t=-1.711, P=.09).
Table 3.1
Independent t- test between school sports team participation
and lower abdominal pain characteristics. (n=104)
School Sports
team
participation
N
Mean
SD
T Sig.
LAP
frequency
Yes 57 2.74 1.218 -1.691 .094
No 47 3.13 1.115
LAP
started
Yes 57 2.63 .975 .318 .751
No 47 2.57 .827
LAP
lasted for
Yes 57 2.32 .848 -1.711 .090
No 47 2.62 .945
39
ii) Relationship between average physical activities
participation per week in past three month and intensity
of primary dysmenorrhea
Table 3.2 showed the frequency distribution of how
often the respondents suffered from LAP between people
who participated in physical activities less than or
equal to two hours and more than two hours per week
averagely in the past three month. The results revealed
no significant differences under different degrees of
LAP suffering between two groups were found.
Similar to above, independent T-test was applied in
order to found out the relationship between people who
participated in physical activities less than or equal
to two hours and more than two hours per week averagely
in the past three month. Again, no significant
differences was found between average physical
activities participation and the frequency of LAP
suffering (r=-.550, p=.584), when LAP would started(r=
-1.366, p=.175) (Table3.2).
40
Table 3.2
Independent t- test between average sport participation and
lower abdominal pain characteristics. (n=104)
Relationship between physical activities participation and
related menstrual symptoms
Besides the degree of lower abdominal pain (LAP) during
menstruation, related menstrual symptoms occurred during
menstruation were also analyzed in this research.
Related menstrual symptoms were illustrated by Moos
Menstrual Distress Questionnaire (MDQ), which was a widely
adapted questionnaire developed by Rudolf H. Moos in 1968,
used to measure the intensity of menstrual distress in female
during menstruation. The questionnaires included 46 symptoms
Average sport
participation
per week
(hours)
N
Mean
SD
T Sig.
LAP
frequency
≤2 50 2.98 1.152 .550 .584
>2 54 2.85 1.219
LAP
started
≤2 50 2.48 .735 -1.366 .175
>2 54 2.72 1.036
LAP
lasted for
≤2 50 2.54 .952 .958 .340
>2 54 2.37 .853
41
listed under eight factors. These factors, which represent
separate but empirically inter-correlated clusters of
symptoms, they were labeled pain, concentration, behavioral
change, autonomic reactions, water retention, negative effect,
arousal, and control.(Moos, 1968) Detailed information was
shown in table 3.3.
Table 3.3 Table of Symptoms during menstruation
Factor 1:Pain 2:Concentration 3:Control
Symptoms
under
group
Muscle
Stiffness
Headache
Cramps
Backache
Fatigue
General
aches
Insomnia
Forgetfulness
Confusion
Lowered
judgment
Difficulty
concentrating
Distractible
Accidents
Lowered motor
coordination
Feeling of
suffocation
Chest pain
Ringing in
the ears
Heart
pounding
Numbness
Fuzzy vision
Factor 4:Autonomic
Reaction
5:Water Retention 6:Negative Effect
Symptoms
under
group
Dizziness
Cold
sweats
Nausea
Hot
flashes
Weight gain
Skin
disorders
Painful
breasts
Swelling
Crying
Loneliness
Anxiety
Restlessness
Irritability
Mood swings
Depression
Tension
42
Factor 7:Arousal 8:Behavior change
Symptoms
under group
Affectionate
Orderliness
Excitement
Feelings of
well-being
Bursts of energy
Lowered school or work
performance
Take naps
Stay at home
Avoid social
activities
Decreased efficiency
Similar to the previous chapter, the analysis would be
conducted based on former school sports team participation
and average physical activities participation per week in the
past three month. The average score of different factors, i.e.
pain, concentration, control, autonomic Reactions, water
retention, negative effect, arousal and behavior change were
calculated. Mean comparison and independent T-test were
conducted to see if there were any relationships can be found.
i) Relationship between school sports team participation
in primary and secondary school and related menstrual
symptoms
Revealed from the data obtained from independent T-test,
no significant difference were found between former
school sports team participation and one’s menstrual
43
symptoms, i.e. pain(t=-1.460,p=.147) ,
concentration(r=-1.572,p=.119), control(r=-.268,
p=.789), autonomic reactions(r=-1.160, p=.249), water
retention(r=.024, p=.981), negative effect(r=-1.945,
p=.055), arousal(r=-1.595,p=.114) and behavior
change(r=-1.578,p=.118)(Table 3.4).
Table 3.4. Independent T-test between past school sport team
participation and related menstrual symptoms. (n = 104)
School Sports
team
participation
N M SD t Sig.
Pain Yes 57 2.75 .979 -1.460 .147
No 47 3.04 1.025
Concentration Yes 57 2.14 .901 -1.572 .119
No 47 2.43 .948
Control Yes 57 1.66 .832 .268 .789
No 47 1.62 .798
Autonomic
reactions
Yes 57 1.99 1.101 -1.160 .249
No 47 2.26 1.305
Water
retention
Yes 57 3.19 1.450 .024 .981
No 47 3.19 1.428
Negative
effect
Yes 57 2.52 1.177 -1.945 .055
No 47 3.08 1.738
Arousal Yes 57 1.64 .968 -1.595 .114
No 47 1.94 .921
Behavior
change
Yes 57 3.12 1.317 -1.578 .118
No 47 3.55 1.462
44
In the questionnaires, the respondents were asked to
rate their degree of suffering from those menstrual
symptoms, by chosen the score that best represents the
extent to each item corresponds to them during
menstruation.
In this part, 1 is equivalent to “no experiences” while
6 is equivalent to “Always”. In other words, the highest
the mean score means the respondent suffered from the
symptoms most. In order to obtain a better comparison,
average mean scores of different menstrual symptoms of
two groups were calculated and compared.
A slightly difference was observed between two group,
while a majority of the mean scores of former sports team
members are lower than those of respondents who never
participated in school sports team, i.e. pain (M = 2.75,
yes; M = 3.04, no), concentration (M = 2.14, yes; M =
2.43, no), autonomic reactions (M = 1.99, yes; M = 2.26,
no), negative effect (M = 2.52, yes; M = 3.08, no),
arousal ( M = 1.64, yes; M = 1.94, no) and behavior change
45
( M = 3.12, yes; M = 3.55, no). It means that the degree
of menstrual symptoms suffering of former sport team
members are lower than who never participated in school
sports team. Line chart was plotted to show the
relationship between them. (Graph 1.1)
Graph 1.1 Line chart - Average mean score of menstrual
symptoms comparison under whether participated in
school sports team or not.
Yes
No
46
ii) Relationship between average physical activities
participation per week in past three month and related
menstrual symptoms
Revealed from the data obtained from independent
T-test, there are no significant difference were found
between former school sports team participation and
their related menstrual symptoms, i.e. pain (t=.473,
p=.638), concentration (t=.088, p=.930), control
(t=.711, p=.479), autonomic reactions(t=.321, p=.749),
water retention (t=-.067, p=.946), negative effect
(t=.670, t=.505), arousal (t=.371, t=.752) and behavior
change (t=.496, t=.621) (Table 3.5). Similar to above,
average mean scores of different menstrual symptoms of
two groups were calculated and compared. The results
between two groups are so closed to each other.
47
Table 3.4 Independent T-test between past school sport team
participation and related menstrual symptoms. (n = 104)
Average sport
participation
per week(hours)
N M SD t Sig.
Pain ≤2 50 2.93 .979 .473 .638
>2 54 2.84 1.025
Concentration ≤2 50 2.28 .901 .088 .930
>2 54 2.26 .948
Control ≤2 50 1.70 .832 .711 .479
>2 54 1.59 .798
Autonomic
reactions
≤2 50 2.15 1.101 .321 .749
>2 54 2.07 1.305
Water
retention
≤2 50 3.18 1.450 -.067 .946
>2 54 3.20 1.428
Negative
effect
≤2 50 2.88 1.177 .670 .505
>2 54 2.68 1.738
Arousal ≤2 50 1.80 .968 .317 .752
>2 54 1.74 .921
Behavior
change
≤2 50 3.39 1.317 .496 .621
>2 54 3.25 1.462
48
Another line chart was plotted to show the relationship
between them.
Graph 1.2 Line chart - Average mean score of menstrual symptoms
comparison under whether participated in school sports team
or not.
0 - 2
hoursmore than
2 hours
49
Discussion
The present study was aimed to investigate the relationship
between physical activities participation, either in the past
or present, and their intensity of primary Dysmenorrhea and
related menstrual symptoms among young females in Hong Kong.
104 questionnaires were analyzed with various approaches.
These findings will be used to describe the situations in Hong
Kong and will be compared with the review of literatures if
possible.
Primary dysmenorrhea is chronic, cyclic, pelvic,
spasmodic pain associated with menstruation in the absence
of identifiable pathology and is commonly referred to as
menstrual cramps or period pain by lay people (Daley, 2008).
In the questionnaire, the researcher used “lower abdominal
pain” instead of “primary dysmenorrhea” to ensure every
respondent understood what the questionnaire was forcing
about.
In this section, the discussion would mainly focused on
the relationship between physical activities participation
50
and
i) Intensity of Primary Dysmenorrhea;
ii) Related menstrual symptoms.
Relationship between physical activities participation the
intensity of primary dysmenorrhea
There were former studies shown that the intensity of
primary dysmenorrhea is related to physical activities
participation, regarding type of sport and training load per
day and week. For example, Dusek (2001) had investigated the
PD condition among 163 school girls. Results were shown that
the prevalence of dysmenorrhea was two-fold lower in athletes
than in the control group.
In the present study, the results shown that there were
no significant differences between sport participation,
either in the past or recently and the degree intensity of
Primary Dysmenorrhea. However, the researcher noticed that
the result from T-test regarding LAP frequency and past school
sport team participation was quite close to 0.05, i.e.
51
(t=-1.691, p=.094), and mean difference was observed, but not
for recent sport participation, i.e. (r=-.550, p=.584).
Therefore, the researcher believed that significant
difference regarding the suffering from lower abdominal pain
and past sport participation could be found if the sample size
was increased.
This result showed that intensity of PD may not directly
affected by participation of physical activities, which
showed consistent with the previous literatures of Lee, Chen,
Lee & Kaur(2006) which found that the percentage of students
having PD are similar in both group having physical exercise
and do not having physical exercise.
Daley’s review of literature in 2008 could explain the
finding. He stated in his research that PD is thought to be
a biological problem due to the production of uterine
prostaglandins (PGs) which stimulates uterine muscular
contractions during menstruation and consequently heightens
menstrual pain. Therefore, the most effective treatment for
PD are hormone in-takes, most likely oral contraceptive pill,
52
to regulate the level of uterine prostaglandins and reduce
muscular contractions.
Besides, other literatures also shown that there were lots
of life style habits associated with PD, such as having
breakfast (Fujiwara, 2003), dieting (Fujiwara, 2007) ,
exposure to environment tobacco (Chen, Cho, Damokash, Chen,
Li, Wang and Xu, 2000) and work-related stress of female
(Laszlo, Gyorffy, Adam, Csoboth and Kopp, 2008). Therefore,
physical activities may not be the main factor to affect the
intensity of PD.
Relationship between recent physical activities
participation and the intensity of Primary Dysmenorrhea and
related menstrual symptoms
The menstrual characteristics were divided into eight
factors, which included physiological, physical and also
emotional aspects. However, in the present study, the results
of independent T-test showed that there were no significant
53
differences between physical activities participation and
related menstrual symptoms.
Similar to the above finding, although no significant
difference can be found using independent T-test, some
significant level regarding past sport participation and
related menstrual symptoms were closed to 0.05 and mean
difference of some factors were observed from the data. Those
factors were concentration (r=-1.572, p=.119), negative
effect(r=-1.945, p=.055), arousal(r=-1.595, p=.114) and
behavior change(r=-1.578, p=.118). The results indicated that
significant difference could be found if the sample size was
increased.
The results showed that past physical activities
participation might to manage related menstrual symptoms in
terms of psychological and emotional factors. The results were
consistent with the previous study of Demicheli, Petignat and
Sekoranja (2004), which suggested that regular exercisers
achieved significantly lower mean scores than the
non-exercise women on psychological variables, for instance,
54
negative effect, concentration, behavior change and pain.
However, the two groups were similar for positive affective
states and other physical symptoms (autonomic reactions,
water retention and arousal) during the menstrual and
premenstrual period. Their study showed significant benefits
of exercise for the physical and psychological symptoms. The
changes may reflect a physiological modulation in
neurotransmitter levels, representing a hypothalamic
adaptation to conditioning physical activity.
55
Chapter 5
SUMMARY AND CONCLUSIONS
The present study attempted to investigate the
relationship between physical activities participation and
their intensity of Primary Dysmenorrhea and related menstrual
symptoms among young females in Hong Kong. Physical activities
participation was divided into two parts, i) former school
sports team participation in primary and secondary school and
ii) average physical activities participation per week in the
past three month. 104 questionnaires were collected and the
results were mainly analyzed by Pearson correlation test of
SPSS version 16.0.
Summary of results
Revealed from independent T- test:
1. There was no significant difference in the intensity of
primary dysmenorrhea among young female in Hong Kong who
actively participated in physical activities and
inactively or no participation in physical activities
in the past.
56
2. There was no significant difference in the intensity of
primary dysmenorrhea among young female in Hong Kong who
are actively participating in physical activities and
inactively or no participation in physical activities
recently.
3. There was no significant difference in the degree of
menstrual symptoms suffering among young female in Hong
Kong who actively participated in physical activities
and inactively or no participation in physical
activities in the past.
4. There was no significant difference in in the degree of
menstrual symptoms suffering among young female in Hong
Kong who are actively participating in physical
activities and inactively or no participation in
physical activities recently.
Conclusion
The present study found that there are no significant
difference between physical activities participation, either
in the past or recently, and their intensity of Primary
57
Dysmenorrhea and related menstrual symptoms revealed from
independent T - test.
However, with respect to the mean difference found between
groups support that past physical activities participation
help in term of managing related psychological and emotional
menstrual symptoms.
Primary Dysmenorrhea and related menstrual symptoms are
greatly limited normal functioning of female’s social life
which cannot be neglected. The results implied that
participated in physical activities may not directly
beneficial to menstrual pain management, female who suffered
from menstrual pain problems are suggested to find any
treatments, i.e. regulating life style, taking oral
contraceptive pills or seeking doctors for further
recommendations.
Recommendation of further study
1. In the present study, only 104 questionnaires were
collected for further analyzed. In order to increase the
validity, recruiting more respondents is recommended to
58
obtain a more comprehensive result.
2. In the present study, physical activities participation
history was illustrated generally by the participation
in school sports team without considered the type of
sport and average training load. Further investigation
is suggested to focus on physical activities
participation in terms of types of sport and average
training time.
3. Similar to above, recent physical activities
participation was only illustrated by the time of
physical activities participation, without considering
which types of sport they are participated in. Further
investigation is suggested to focus on recent physical
activities participation in terms of the types of sport
and average training time.
4. In the present study, females who participated in
moderate physical activities more than 150 minutes per
week are considered to be actively participating in
physical activity. However, since the present study are
59
conducted in university which basically offered 100
minutes physical activities participation per week, 150
minutes may not be enough to considered as actively
participating in physical activity.
Further investigation is suggested to rise the physical
activity participation time considered as actively
participating in physical activity.
60
REFERENCE LIST
Abbaspour, Z., Rostami, M. & Najjar, Sh.(2006). The effect
of exercise on primary dysmenorrhea. Journal of research in
health science. 6(1), 26-31.
Chen, C.Z., Cho, S.I., Damokosh, A. I., Chen, D.F., Li, G,
Wang, X. B. et al. (2000). Prospective study of exposure to
environmental tobacco smoke and dysmenorrhea. Environmental
health perspective, 108(11), 1019-1022.
Chiou, M.H. & Wang, H.H.(2008). Predictors of dysmenorrhea
and self-care behavior among vocational nursing school
female students. Journal of Nursing Research, 16(1), 17-24.
Choi, P.Y. & Salmon, P.(1995). Symptom changes across the
menstrual cycle in competitive sportswomen, exercisers and
sedentary women. British Journal of Clinical Psychology,
34(3), 60-447.
Daley, A.J. (2008). Exercise and Primary Dysmenorrhea, A
Comprehensive and Critical Review of the Literature. Sports
Medicine Journal, 38(8), 659-670.
Demicheli, F. B., Petignat, P. & Sekoranja, L. (2004).
Benefits of exercise for premenstrual syndrome: A review
International SportMed Journal, 5(1), 26-36.
Dusek, T.(2001). Influence of high intensity training on
menstrual cycle disorders in athletes. Croatian Medical
Journal, 42(1), 79-82.
French, L (2008). Dysmenorrhea in adolescents: Diagnosis and
treatment. Pediatric Drugs, 10 (1), 1-7.
Fujiwara, T.(2003). Skipping breakfast is associated with
dysmenorrhea in young women in Japan. International Journal
of Food Sciences & Nutrition, 54 (6), 505-509.
Fujiwara, T.(2007). Diet during adolescence is a trigger for
61
subsequent development of dysmenorrhea in young women.
International Journal of Food Sciences & Nutrition, 58(6),
437-444.
Harel, Z(2002). A contemporary approach to dysmenorrhea in
adolescents. Pediatric Drugs, 4 (12), 797-805.
Kritz-Silverstein, D., Wingard, D.L. & Garland, F.C.(1999).
The association of behavior and lifestyle factors with
menstrual symptoms. Journal of Women's Health & Gender-Based
Medicine. 8(9), 1185-1193.
Laszlo, K. D., Gyorffy, Z., Adam, S., Csoboth, C., & Kopp,
M. S. (2008). Work-related stress factors and menstrual pain:
A nation-wide representative survey. Journal of
Psychosomatic Obstetrics & Gynecology, 29(2), 133-138.
Lee, L. K., Chen, P. C. Y., Lee, K. K. & Kaur, J.(2006).
Menstruation among adolescent girls in Malaysia: A
cross-sectional school survey. Singapore Medical Journal.
47(10), 869-874.
Loto, O. M., Adewumi, T. M. & Adewuya A.O. (2008).Prevalence
and correlates of dysmenorrhea among Nigerian college women.
Australian and New Zealand Journal of Obstetrics and
Gynaecology, 48, 442–444.
Moos, R.H.(1968). The Development of a Menstrual Distress
Questionnaire. Psychosomatic Medicine and Research. 15(6),
853-867.
Pullon, S., Reinken, J. & Sparrow, M.(1988).Prevalence of
dysmenorrhea in Wellington women. New Zealand Medical
Journal. 101(839), 4-52.
Walsh, T.M., LeBlanc, L. & McGrath, P.J.(2003). Menstrual pain
intensity, coping, and disability: The role of pain
catastrophizing. Pain Medicine, 4(4), 352-361.
62
APPENDIX
Questionnaire of this study
Hong Kong Baptist University
Physical Education and Recreation Management Program
The aim of this questionnaire was to investigate the relationship between physical
activities participation and menstrual symptoms (運動參與與月經時身體症狀的關
係), assessing menstrual affective, somatic and behavioral changes among Hong
Kong females. The collected data was using on research purpose only. All personal
information was kept confidentially and anonymous.
Part One – Background information
1. Age: □15-17 □18-20 □21-23 □24-25 □>25
2. Age of menarche (first time of menstruation): _______________
3. Length of menstrual cycle ( e.g. 28days): __________________
4. Length of menstrual flow (e.g. 5 days): ___________________
5. Taking oral contraceptive: □ yes □ no
Part Two- Physical activities participation
1. Have you ever participated in any of school sports teams?
□ Yes
□ No (please go to question 4)
2. Please specify the sports team you used to participated in.
□Basketball □Football □volleyball □Handball
□Tennis □Badminton □Table Tennis □Squash
□Swimming □Gymnastics □Athletics □Golf
□Rugby □Others:___________________________________
3. Please specify the sports team you participated in each age period.
Primary school: __________________________________________
Secondary school: ________________________________________
Associate degree or university: ______________________________
63
4. In the past three months, your average sport participation hour per week was:
□ No □ < 1 Hour □ 1-2 Hours □ 2 – 3 Hours
□ 3 – 5 Hours □ 6 – 8 Hours □ > 8 Hours
5. In the past three months, the sport(s) which you always participates in
(no more than three choices)
□Basketball □Football □volleyball □Handball
□Tennis □Badminton □Table Tennis □Squash
□Swimming □Gymnastics □Athletics □Cross-country
□Golf □Rugby □Others:______________________
Part Three – Menstrual characteristics
Please answer the following question base on your general experience.
1. How often would you suffer from lower abdominal pain during menstruation?
□Never □seldom □sometimes □very often □always
1. When would the lower abdominal pain start?
□no experience □1-2 days before □1st day □2nd day □3rd day □after 3rd
day
3. How long would it last for?
□no experience □ 1 day □2 days □3 days □ >3 days
Part Four - Moos Menstrual Distress Questionnaire
Following is Moos Menstrual Distress Questionnaire aiming to investigate menstrual
characteristics. For each of the following items, circle the number that best
represents the extent to which the item corresponds to you with respect to your
symptoms DURING menstruation identified below.
64
Group 1: Pain no experience Always
Muscle stiffness 肌肉僵硬 1 2 3 4 5 6
Headache 頭痛 1 2 3 4 5 6
Cramps 抽搐 1 2 3 4 5 6
Backache 背痛 1 2 3 4 5 6
Fatigue 疲勞 1 2 3 4 5 6
General aches and pain 一般性疼痛 1 2 3 4 5 6
Group 2 : Concentration no experience Always
Insomnia 失眠 1 2 3 4 5 6
Forgetfulness 健忘 1 2 3 4 5 6
Confusion 糊塗 1 2 3 4 5 6
Lowered judgment 判斷力減低 1 2 3 4 5 6
Difficulty concentrating 難以集中 1 2 3 4 5 6
Distractible 易於分心 1 2 3 4 5 6
Accidents 易生意外 1 2 3 4 5 6
Lowered motor coordination 肌力協調減低 1 2 3 4 5 6
Group 3: Control no experience Always
Feeling of suffocation 難以呼吸 1 2 3 4 5 6
Chest pain 胸口痛 1 2 3 4 5 6
Ringing in the ears 耳鳴 1 2 3 4 5 6
Heart pounding 心跳加速 1 2 3 4 5 6
Numbness 麻痹 1 2 3 4 5 6
Fuzzy vision 視野模糊 1 2 3 4 5 6
Group 4 : Autonomic reactions no experience
Always
Dizziness, faintness 頭昏眼花 1 2 3 4 5 6
Cold sweats 冒冷汗 1 2 3 4 5 6
Nausea, vomiting 嘔吐 1 2 3 4 5 6
Hot flashes 潮熱 1 2 3 4 5 6
65
Group 5 : Water retention no experience
Always
Weight gain 體重增加 1 2 3 4 5 6
Skin disorders 皮膚情況轉差 1 2 3 4 5 6
Painful breasts 乳房漲痛 1 2 3 4 5 6
Swelling 身體腫漲 1 2 3 4 5 6
Group 6 : Negative effect no experience Always
Crying 哭泣 1 2 3 4 5 6
Loneliness 寂寞 1 2 3 4 5 6
Anxiety 焦慮 1 2 3 4 5 6
Restlessness 難以休息 1 2 3 4 5 6
Irritability 容易被刺激 1 2 3 4 5 6
Mood swings 情緒不穩定 1 2 3 4 5 6
Depression 意氣消沈 1 2 3 4 5 6
Tension 繃緊 1 2 3 4 5 6
Group 7: Arousal no experience Always
Affectionate 深情 1 2 3 4 5 6
Orderliness 有條理 1 2 3 4 5 6
Excitement 興奮 1 2 3 4 5 6
Feelings of well-being 自我感覺良好 1 2 3 4 5 6
Bursts of energy, activity 充滿活力 1 2 3 4 5 6
Group 8 : Behavior change no experience Always
Lowered school or work performance 工作能力減低 1 2 3 4 5 6
Take naps 午睡 1 2 3 4 5 6
Stay at home 留在家中 1 2 3 4 5 6
Avoid social activities 避免社交活動 1 2 3 4 5 6
Decreased efficiency 工作效率減低 1 2 3 4 5 6
This is the end of the questionnaire, thank you for your participation!
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