Adolescence represents a critical transitional period between childhood and adulthood, marked by profound physical, psychological, and social development[1]. A pivotal biological milestone for girls during this stage is menarche, the onset of the first menstrual cycle, which signifies reproductive maturity and serves as a key indicator of overall health and well-being[2].The establishment of regular ovulatory cycles post-menarche is often preceded by a phase of physiological anovulation and irregularity. However, a significant proportion of adolescents experience menstrual disturbances that extend beyond this expected normalization period. Studies indicate that between 20% to 40% of adolescent girls grapple with menstrual disorders, which can adversely impact their physical comfort, mental health, academic performance, and social engagement[3,4]. These irregularities encompass a wide spectrum, including oligomenorrhoea (infrequent periods), polymenorrhoea (frequent periods), menorrhagia (heavy menstrual bleeding), and amenorrhea (absence of periods)[5]. Beyond the immediate discomfort and inconvenience—such as missing school and a diminished quality of life—persistent irregularities can be the harbinger of underlying endocrine pathologies. They are often early clinical markers for conditions such as polycystic ovarian syndrome (PCOS), thyroid dysfunction, metabolic syndrome, and potential infertility in later reproductive life[6, 7].Traditionally, the focus of etiological research has been on hormonal imbalances and organic medical conditions. However, there is a growing body of evidence underscoring the significant influence of modifiable lifestyle factors on reproductive health. [8] In the contemporary environment, adolescents are increasingly exposed to factors such as altered dietary patterns characterized by high consumption of junk food and skipped meals, sedentary behaviours, excessive screen and social media usage, and disrupted sleep hygiene[9, 10]. These factors are known to contribute to obesity, insulin resistance, and chronic stress, all of which can disrupt the delicate hypothalamic-pituitary-ovarian (HPO) axis, leading to menstrual dysfunction[11, 12].Despite the high prevalence and potential long-term consequences, menstrual problems in adolescents are frequently underreported and normalized[13]. Barriers such as lack of awareness, cultural stigmas surrounding open discussion of menstruation, and hesitancy to seek medical advice often led to delayed diagnosis and management[4]. While the medical causes are relatively well-documented, the role of contemporary lifestyle changes, particularly within the unique socio-cultural context of India, has not been extensively investigated. Therefore, the current study aims to bridge this gap in knowledge by comprehensively evaluating the impact of key lifestyle factors—including body mass index (BMI), dietary habits, sleep patterns, and social media usage—on the prevalence and patterns of menstrual irregularities among adolescent girls. The findings from this study are vital for developing targeted preventive health strategies and effective educational interventions to promote better menstrual health and overall well-being in this vulnerable population.

Study Design and Setting A prospective observational study was conducted for a period of six months from January 2025 to June 2025. The study was set in the Gynaecology Outpatient Department (OPD) of the Department of Obstetrics and Gynaecology at Government General Hospital (GGH), Kurnool, a tertiary care centre that serves a large and diverse population. Study Population and Sampling The study population comprised adolescent girls aged between 11 and 19 years who presented to the Gynaecology OPD with complaints of menstrual irregularities. A total of 91 participants were enrolled in the study using a random sampling method to ensure a representative sample [14]. Adolescent girls with known medical disorders (e.g., diagnosed endocrine diseases, chronic illnesses) or bleeding disorders (e.g., von Willebrand disease) were excluded from the study to isolate the effect of lifestyle factors and avoid confounding by these underlying conditions. Ethical Considerations Prior to the commencement of the study, ethical clearance was sought and obtained from the Institutional Ethics Committee. Informed consent was obtained from all participating adolescents. For those below the age of 18 years, assent was obtained from the participant alongside written informed consent from their parent or legal guardian[15]. Confidentiality of all participant data was strictly maintained throughout the research process. Data Collection Tools and Techniques Data were collected using a pre-tested, structured questionnaire administered through a face-to-face interview to ensure completeness and clarity. The questionnaire was divided into several sections: 1. Socio-demographic Profile: This section recorded details including the participant's age, place of residence, and socioeconomic status. Socioeconomic status was determined using the Modified Kuppuswamy Scale, which incorporates the education and occupation of the head of the family along with total family income to classify families into five classes (Upper, Upper Middle, Lower Middle, Upper Lower, and Lower)[16]. 2. Menstrual History: A detailed menstrual history was taken, documenting the age at menarche, cycle length (number of days from the first day of one period to the first day of the next), cycle regularity, duration of menstrual flow (in days), amount of flow (assessed subjectively as light, moderate, or heavy, and objectively by querying the number of pads changed per day), and the presence and severity of dysmenorrhea. 3. Assessment of Lifestyle Factors: o Dietary Habits: Dietary patterns were assessed using a Food Frequency Questionnaire (FFQ). [17] This tool evaluated the frequency of consumption of junk food (e.g., chips, pizza, burgers, sugary beverages), the habit of skipping meals (particularly breakfast), and the daily intake of fruits and vegetables. o Sleep Patterns: Participants were queried about their average sleep duration per night during weekdays and weekends, and their typical bedtime routine to identify sleep disturbances. o Screen Time: Daily screen time was assessed by quantifying the number of hours spent on mobile phones, watching television, and using computers for non-academic purposes. This was used as a proxy for sedentary behavior and social media usage. o Anthropometric Measurement: The weight and height of each participant were measured using a standardized digital weighing scale and stadiometer. Body Mass Index (BMI) was calculated using the formula: weight (kg) / height (m²). The BMI was then categorized according to the World Health Organization's BMI-for-age growth charts for adolescents[18]. 4. Ultrasonography: A transabdominal pelvic ultrasonography was performed for all participants to assess uterine and ovarian morphology and to identify any structural abnormalities, with a particular focus on features suggestive of Polycystic Ovarian Syndrome (PCOS) based on the Rotterdam criteria[19]. Data Analysis The data collected were entered into a Microsoft Excel spreadsheet for organization and management. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, version 22.0[20]. Descriptive statistics were expressed as mean ± standard deviation (SD) for continuous variables and as frequencies and percentages for categorical variables. Inferential statistical analysis was employed to determine associations between lifestyle factors (independent variables) and menstrual irregularities (dependent variables). The Chi-square test (or Fisher's exact test where appropriate) was used for categorical data. A p-value of less than 0.05 was considered statistically significant for all tests. Statistical analysis using the Chi-square test revealed a significant association (p < 0.05) between high junk food consumption and the presence of menstrual irregularities, particularly irregular cycles and menorrhagia. Similarly, a significant association was found between excessive social media usage and sleep disturbances with reported menstrual problems.

A total of 91 adolescent girls presenting with menstrual irregularities were enrolled in the study. The analysis of the collected data yielded findings on the demographic profile, patterns of menstrual dysfunction, investigative results, and associated lifestyle factors. Socio-demographic and Clinical Characteristics The age of the participants ranged from 11 to 19 years, with a mean age of 15.8 (±2.1) years. The distribution of participants across age groups[Table 1]. Most participants belonged to the 14-16 years age group (47.3%), followed closely by the 17-19 years group (44.0%). Only 8.7% of participants were in the early adolescent age group of 11-13 years. Table 1: Age-wise distribution of the study participants (n=91) Age Group (years) Number of Participants Percentage (%) 11-13 8 8.7% 14-16 43 47.3% 17-19 40 44.0% Total 91 100.0 Analysis of socioeconomic status using the Modified Kuppuswamy scale revealed that the vast majority of participants (67.0%, n=61) belonged to Class IV (Upper Lower). Classes II, III, and V each accounted for 11.0% of the sample (n=10 each). No participants were classified in Socioeconomic Class I[Table 2]. Table 2: Socio-economic status distribution of participants (n=91) Socioeconomic Class (Modified Kuppuswamy Scale) Number of Participants Percentage (%) I (Upper) 0 0.0% II (Upper Middle) 10 11.0% III (Lower Middle) 10 11.0% IV (Upper Lower) 61 67.0% V (Lower) 10 11.0% Total 91 100.0 Prevalence and Types of Menstrual Irregularities The most reported menstrual irregularity was an irregular cycle (61.5%, n=56), characterized by significant variations in cycle length. This was followed by menorrhagia (20.8%, n=19), amenorrhea (14.2%, n=13), and polymenorrhagia (3.2%, n=3)[Table 3]. Table 3: Prevalence of different types of menstrual irregularities (n=91) Type of Irregularity Number of Cases Percentage (%) Irregular Cycle 56 61.5% Menorrhagia 19 20.8% Amenorrhea 13 14.2% Polymenorrhagia 3 3.2% Total 91 100.0 Ultrasonography (USG) Findings Transabdominal pelvic ultrasonography was performed for all participants. The findings indicated that 8.8% (n=8) of the adolescents showed sonographic features suggestive of Polycystic Ovarian Syndrome (PCOS), such as polycystic ovarian morphology. The remaining 91.2% (n=83) had normal ultrasonographic findings [Table 4]. The age distribution of these PCOS cases[Table 5], with the highest number identified in the broad 12-19 years category. Table 4: Ultrasonography (USG) findings among participants (n=91) USG Finding Number of Cases Percentage (%) PCOS 8 8.8% Normal 83 91.2% Total 91 100.0 Table 5: Age distribution of participants with USG findings suggestive of PCOS (n=8) Age Group (years) Number of Cases 12-19 5 13-14 2 16 1 Total 8 Association with Lifestyle Factors The evaluation of lifestyle factors revealed significant patterns. High consumption of junk food, defined as intake more than four times a week, was most prevalent in the 17-19 years age group (n=37). Similarly, excessive social media usage, categorized as more than 4 hours per day for non-academic purposes, was overwhelmingly reported by participants in the 17-19 years age group (n=46), with much lower usage reported in the younger cohorts [Table 6]. Sleep disturbances, described as either less than 7 hours of sleep per night or inconsistent sleep routines, were reported by 15.4% (n=14) of the total participants. Table 6: Distribution of key lifestyle factors across different age groups Lifestyle Factor Age Group (years) Number of Cases Diet (High Junk Food intake) 17-19 37 14-16 29 11-13 5 Social Media Usage (Excessive) 17-19 46 14-16 9 11-13 2 Sleep Pattern - Disturbed - 14 - Normal - 77 Statistical analysis using the Chi-square test revealed a significant association (p < 0.05) between high junk food consumption and the presence of menstrual irregularities, particularly irregular cycles and menorrhagia. Similarly, a significant association was found between excessive social media usage and sleep disturbances with reported menstrual problems.

The present prospective observational study aimed to elucidate the impact of contemporary lifestyle factors on menstrual health among adolescent girls attending a tertiary care hospital in India. The findings highlight a high prevalence of menstrual irregularities, a notable presence of PCOS, and significant associations with modifiable lifestyle behaviours, underscoring a critical public health concern.The demographic profile of our study sample revealed that the majority of participants were in the mid-adolescence (14-16 years, 47.3%) and late adolescence (17-19 years, 44.0%) age groups. This distribution aligns with existing literature, which suggests that health-seeking behaviour for menstrual issues increases with age as cycles fail to regularize beyond the initial post-menarchal years[21]. Younger adolescents (11-13 years) often perceive initial irregularities as normal and are less likely to seek medical consultation, accounting for their lower representation (8.7%) in our study. In our study, irregular menstrual cycles (61.5%) emerged as the most predominant complaint, followed by menorrhagia (20.8%) and amenorrhea (14.2%). This pattern is consistent with the established understanding of adolescent gynaecology. The immaturity of the hypothalamic-pituitary-ovarian (HPO) axis in the years following menarche frequently results in anovulatory cycles, manifesting as irregularity[2, 22]. Our findings are corroborated by a large community-based study by Chhabra & Venkatraman, which also reported irregular cycles as the most common menstrual disorder among Indian adolescents[3]. However, the high percentage of menorrhagia and amenorrhea warrants clinical attention, as they are less attributable to physiological immaturity and may indicate underlying endocrine pathologies or haematological disorders[5].A key finding of our investigation was the identification of sonographic features suggestive of PCOS in 8.8% of the participants. This prevalence is within the range (3.7% - 22.5%) reported by various studies across India, which varies based on the diagnostic criteria used and the population studied [23]. The diagnosis of PCOS in adolescents is challenging due to the overlap of its features with normal pubertal physiology, such as transient insulin resistance and acne [24]. Our cautious approach, relying on ultrasonography alongside clinical presentation, aimed to avoid overdiagnosis. The cases were predominantly identified in late adolescence (12-19 years), which is consistent with the natural history of PCOS, as symptoms often become more pronounced and persistent in later teenage years[25]. This underscores the necessity for early screening and intervention in at-risk adolescents to mitigate long-term metabolic and reproductive consequences. The most significant contribution of this study lies in demonstrating the strong association between lifestyle factors and menstrual irregularities. Our data indicate that high junk food consumption and excessive social media usage were concentrated in the 17-19 years age group (37 and 46 cases, respectively). A diet rich in ultra-processed foods, high in refined carbohydrates and unhealthy fats, is a known driver of insulin resistance and chronic inflammation[26].This can disrupt the HPO axis, promote hyperandrogenism, and exacerbate menstrual dysfunction, a mechanism strongly supported by our findings and those of Shanthi et al. [10].Similarly, excessive social media usage, often leading to sedentary behavior, sleep displacement, and psychological stress, has emerged as a novel determinant of adolescent health. Kaur et al. directly linked increased screen time to sleep disturbances and menstrual problems, a correlation our study strongly reinforces[9]. The psycho-physiological stress from constant connectivity can elevate cortisol levels, which may interfere with gonadotropin-releasing hormone (GnRH) pulsatility and consequently, ovulatory function[27]. Furthermore, sleep disturbances reported by 15.4% of our participants likely compound these issues. Circadian rhythm disruptions can alter the secretion of hormones like melatonin and leptin, which play modulatory roles in reproductive function[28].The interrelationship between poor diet, sedentary behaviour, insufficient sleep, and stress creates a vicious cycle that significantly jeopardizes menstrual health.The socioeconomic distribution of our cohort, with 67% belonging to Class IV (Upper Lower) on the Modified Kuppuswamy scale, provides a crucial contextual layer. This finding highlights that adolescents from lower socioeconomic strata bear a disproportionate burden of menstrual health challenges. This disparity can be attributed to a confluence of factors, including nutritional deficiencies, lack of awareness about normal versus abnormal menstrual patterns, cultural taboos that stifle open discussion, and limited access to qualified healthcare providers[4,29]. While obesity is often linked to menstrual issues in high-income groups, in our setting, the poor nutritional quality of affordable food (high in calories, low in nutrients) likely contributes to problems even in the absence of overt obesity, a phenomenon increasingly observed in transitioning economies[30]. Strengths and Limitations: A key strength of this study is its prospective design and the use of both subjective questionnaires and objective ultrasonographic evaluation. However, certain limitations must be acknowledged. The sample was drawn from a hospital-based setting, which may not be fully representative of the general population, as it captures only those who sought medical help. The assessment of dietary intake and screen time relied on self-reporting, which is susceptible to recall and social desirability bias. Furthermore, the cross-sectional nature of the analysis, despite being prospective, allows for the establishment of association but not causality.

Conclusion and Implications: In conclusion, our study confirms that menstrual irregularities are highly prevalent among adolescent girls, with irregular cycles being the most common complaint. A significant proportion of these irregularities are associated with modifiable lifestyle factors, including unhealthy dietary patterns, excessive social media use, and inadequate sleep, particularly in late adolescence and lower socioeconomic groups. These findings call for a multi-pronged approach: 1. Integrated Adolescent Health Programs: Schools and community centers should implement structured health education programs that demystify menstruation and emphasize the importance of a balanced diet, physical activity, and sleep hygiene. 2. Clinical Screening: Healthcare providers should proactively screen for lifestyle habits during consultations for menstrual complaints and incorporate lifestyle modification counselling as a first-line intervention. 3. Public Health Policy: There is a need for policies aimed at improving nutritional literacy and creating healthier environments for adolescents, especially in lower socioeconomic communities. Future longitudinal studies are recommended to establish causal relationships and to evaluate the effectiveness of lifestyle intervention strategies in improving menstrual health outcomes in this vulnerable population.

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