Key findings:

Key findings of this study on nursing students' self-care practices for primary dysmenorrhea include: a high prevalence of primary dysmenorrhea among participants, with common self-care methods being warm compress application and rest; paracetamol was the most frequently used analgesic, emphasizing the importance of educating students on effective self-care strategies for managing menstrual pain.

What is known and what is new?

The known aspect in this abstract is the prevalence of primary dysmenorrhea among nursing students and the use of self-care practices to manage it. The new contribution is the evaluation of nursing students' specific self-care techniques, including both non-pharmacological methods like warm compresses and pharmacological options such as paracetamol, highlighting the importance of tailored self-care strategies in this population.

What is the implication, and what should change now?

The implication of this study is the need to educate nursing students about effective self-care practices for primary dysmenorrhea, including both non-pharmacological methods like warm compresses and pharmacological options like paracetamol. Changes needed include incorporating this knowledge into nursing curricula and promoting health professional consultation to help students manage dysmenorrhea and improve their quality of life and educational experience.

One of the most common causes of pelvic pain and menstrual disorders is dysmenorrhea, which is defined as recurrent spasmodic pain in the lower abdomen during menstruation [1]. Primary and secondary dysmenorrhea are the two clinical subtypes of dysmenorrhea [2].

Primary dysmenorrhea is characterized by excruciating menstrual cramps that are unrelated to any uterine pathology and are frequently accompanied by headaches, back pain, fatigue, nausea, vomiting, and unstable emotions [3]. Primary dysmenorrhea affects 45–95% of women worldwide who are childbearing age, with a 2–29% pain prevalence [4]. beginning in the first eight to seventy-two hours of the menstrual cycle. Up to 75% of women experience it at some point in their reproductive lives [5].

Based on the most recent update to the WHO's guidelines for self-care practices. The ability of individuals, families, and communities to maintain health, prevent disease, and deal with illness and disability with or without the assistance of health professionals is known as self-care [6].

Self-care is a new primary healthcare strategy that is easy to learn and affordable. It also has the potential to save resources for the health system by lowering the costs of patient care and follow-up [7-10).

Self-care has been shown to be beneficial for patients with chronic illnesses and has a significant impact on their prognosis and clinical outcome. It is commonly utilized by postpartum women, people with spinal cord injuries, people who have had cancer surgery, and others [11-12]. In the meantime, it has been demonstrated that nursing students, as a unique group, can benefit from adopting self-care behaviors in order to relieve stress, facilitate their transition to nurse status, and collaborate with patients to establish a safe clinical setting [13].

The creation and application of personal health routines and coping mechanisms for enhancing one's own health, averting or reducing illness, and preserving wellbeing is known as self-care. Most of the time, these tasks are carried out without expert assistance [14]. 

There is a dearth of available research in Iraq regarding the self-care strategies employed by women to ease the discomfort associated with menstruation. Regretfully, knowledge is prioritized over practices in the majority of published international studies. Thus, the purpose of this study was to assess how nursing students took care of themselves when they had primary dysmenorrhea.

From February to July 2023, a descriptive study was carried out among B.Sc. nursing students at the College of Nursing at Al-Diwaniyah governorate, who were chosen using a non-probability convenience sampling technique. Participants in the study were B.Sc. Nursing students enrolled from first through fourth grade who reported having primary dysmenorrhea, or menstrual pain, during the previous three periods. Students with a history of pelvic pathology who declined to participate were not allowed to participate. The relevant literature was concerned in the development of a semi-structured questionnaire. It included sociodemographic information and self-care techniques for students to manage the discomfort of primary dysmenorrhea; responses to these items were categorically answered (Yes, No). SPSS version 27 was used for the data analysis process. To present the study findings, descriptive statistics such as frequencies and percentages were employed.

Table (1): Distribution of Socio-demographic & Menstrual Characteristics of the samples

Table (1) shows that (30%) of the students were between 18-20 years age group with (22%) of them were studying in the second year of the academic program and (68%) of them were urban residents. Regarding menstrual characteristics (47%) of participants five days and less their  menstrual flow duration , Approximately (62%) of participants experience a regular menstruation. Furthermore, roughly (66%) of participants reported a family history with primary dysmenorrhea.

Table (2):  Self-care Practices for the Students to Relieve Primary Dysmenorrhea

Table (2) demonstrates how students used self-care techniques to treat dysmenorrhea. These included applying a warm compress or hot water bag to relieve pain (78%) and relaxing or resting on their beds (70%) as non-pharmacological methods. Paracetamol (84%) was the most often used analgesic by students for primary dysmenorrhea, followed by mefenamic acid (53%) and ibuprofen (35%).These are the pharmacological practices used by students to relieve pain during dysmenorrhea. 

This study set out to find out how Al-Diwaniyah governorate's undergraduate female nursing students manage primary dysmenorrhea on their own.  According to earlier research, it was intriguing to learn that students employed a variety of non-pharmacological techniques to relieve their pain. As well as, our findings demonstrate that the high percentage of participants applied a warm compress or hot water bags, took their time for relaxation, and rested in bed during menstruation. Also, more than half of students took different types of herbs. While, a low percentage of students drank hot beverages or engaged in physical activity to cope with primary dysmenorrhea. All of these practices were thought to be safe and harmless ways to relieve primary dysmenorrhea. Consequently, it is advisable to promote the use of these practices. 

Nonetheless, the earlier findings align with the outcomes of a cross-sectional investigation conducted by Agrawal and Venkat (2009) and Al-Kindi and Al-Bulushi (2011) [15-16]. They found that while some teenagers with dysmenorrhea used non-pharmacological treatments like applying heat and sleeping, the majority of them self-medicated with drugs.

Non-pharmacological interventions to lessen the negative effects of dysmenorrhea are typically straightforward, risk-free, and affordable. A lot of these precautions ought to be taught by mothers, healthcare providers, and school nurses [17].

According to Pillitteri, 2010 [18], girls should get enough sleep and rest, engage in moderate exercise, and carry out all other regular activities. Certain menstruation discomforts can be relieved by applying heat to the belly, the lumbar region, the external genital organs, and taking warm baths.

Many young women manage their menstrual pain and other related symptoms with self-care techniques, avoiding the need to consult a doctor. These strategies involve rest, exercise, using herbs and using analgesics [19].

Previous research also revealed that rest was the most popular non-pharmacological approach for pain management [3,19,20]. 

Findings from the current study reflect those of previous research which revealed that young women usually use complementary and alternative therapies to reduce the need for analgesics [3].

Based on the students' pharmacological practices, it was found that the most commonly used analgesic is (paracetamol) which a high percentage of them used for the pain during dysmenorrhea. While, more than half of them used mefenamic acid, and the low percentage of students take ibuprofen which is considered a less commonly used analgesic. Nonetheless, these procedures save the money, time-consuming and need for clinical consultations by providing simple access to over-the-counter medications. For this reason to be concerned about safety regarding misdiagnosis, adverse effects, and drug abuse.

Sometimes self-medication can be dangerous if the patient doesn't know enough about the condition and the drugs they are taking [21].

According to a recent Lebanese study, the majority of female dysmenorrhea patients (76.4%) said they used analgesics to manage their pain [4].

The present findings seem to be consistent with a study conducted in Saudi Arabia, which found that about two-thirds of respondents reported using analgesics to relieve menstrual pain [22] 

In contrast, a study by Sarraf et al. found that the majority of students (90.48%) used mefenamic acid as their primary analgesic for dysmenorrhea [5].

Because over-the-counter medications are readily available, 38–80% of patients with primary dysmenorrhea self-medicate. This could result in the wrong medications being chosen and insufficient therapeutic dosage [23].

Primary dysmenorrhea is a significant and long-lasting factor affecting women's health and a major concern for students' academic performance and future fertility. Self-care techniques that are proactive and effective can help them feel less uncomfortable while also improving their quality of life and education. The nursing students enrolled in the study used a combination of non pharmacological and pharmacological self-care techniques, such as applying a warm compress or hot water bags, period of relaxation with bed rest, and using paracetamol as an analgesic to relieve pain during primary dysmenorrhea. However, performing self-medication without medical advice is considered inappropriate because they lack sufficient knowledge about the right therapeutic dosages and frequency of drug intake.

Recommendation:

Based on the study conclusions ,the following recommendations are presented: 
Raising awareness of primary dysmenorrhea's causes, treatments, and suitable self-care techniques is crucial. Promoting health professional consultation is necessary to assist students experiencing primary dysmenorrhea. 

Funding: No funding sources.

Conflict of interest: None declared.

Ethical approval: The study was approved by the Institutional Ethics Committee of University of Al-Qadisiyah

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2. Shabani, Fatemeh, et al. "The effects of Rosa foetida extract along with self-care education on primary dysmenorrhea: study protocol for a randomized clinical trial." Trials 23.1 (2022): 637. https://link.springer.com/article/10.1186/s13063-022-06583-4 

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