Menstrual Cycle Relates to Diverse Profession and Age Cluster Discrepancy in Menstrual Cycle Relates to Diverse Profession and Age Cluster of District Mardan Khyber PakhtoonKhwa, Pakistan

— Menstruation cycle is the discharge of blood from the inner uterine lining of female reproductive tract. About 500 females from 6 different professions from district Mardan were included in this study. These 500 working females were divided into different age groups starting from 13 to 50 years to examine the length of menstrual cycle in relation to different professions and age. Number of Menstruating days of each female was recorded. Observation was recorded from the 1 st day of menstruating till the end of menstruation period. An unlimited relation of profession and menstruation period was observed in this study, a decreased or prolonged menstrual period was observed in those women who were having more physical or mental activities as compare to sedentary ones. The same case is also found in start of teenage and in aged women. In different professional females about 29.2% respondents were reported with 3-4 days of menstrual period, 40.4% respondents were observed with 5-6 days of menstrual period, 23.2% respondents were reported with 7-8 days of menstrual period while only 7.2% respondents were observed with the longest menstrual period i.e. 9-10 days. About 15.49% Teachers and 15.39% Maids had the longest menstruation periods i.e. 9-20 days. A fairly normal menstruation (5-6 days) period of 69.31% respondents was observed in household females while in students about 48.63% respondents had least days of menstruation period i.e. 3-4 days. In different age groups about 32.8% female population had 3-4 days’ menstruation period which is measured to be short period, a total of 44.4% female population had 5-6 days’ menstruation period, 15.6% female population had 7-8 days’ menstruation period while only 7.2% female population of this study had the longest (9-10 days) menstruation period. About 11.11% aged female population had the longest menstruation periods i.e. 9-20 days. A comparatively normal menstruation (5-6 days) period of 59.09% respondents was observed in age group 26-30. About 37.41% respondents of age group 21-25 and 37.70% respondents of age group 31-35 had least days of menstruation period i.e. 3-4 days. This reveals that the mental activity as well as the age has also an effect on menstruation period. This study reveals that the menstrual period is also reliant upon the nature of the job/profession of a female. Period may be shortened as 3 days or prolonged as 10 days depend upon the nature of physical and mental activity.


INTRODUCTION
Menstruation cycle also known as menstrual period and it is an example of biological rhythm of natural changes that occurs in the female reproductive systemin the uterus and ovariesfor about 28 days throughout the reproductive phase of women from puberty to menopause that make pregnancy possible (Seenivasan and Priya, 2015;Silverthorn, 2013). The cycle is obligatory for the production of oocytes, and for the preparation of the uterus for pregnancy (Silverthorn, 2013). Menstruation cycle also called menstrual period is the liberation of blood from female uterus (Dye and Blundell, 1997;Ellison and Menstrual Cycle Relates to Diverse Profession and Age Cluster Lager, 1986). Bleeding usually lasts around 2 to 7 days (McCarroll et al., 2015;Nelson, 2009). The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women and 21 to 35 days in adults (an average of 28 days) (Diaz et al., 2006;Nelson, 2009). The first period usually begins between twelve and fifteen years of age, a point in time known as menarche (Dye and Blundell, 1997;Zareen et al., 2016a). They may occasionally start as early as eight, and this onset may still be normal (Nelson, 2009). Menstruation stops occurring after menopause which usually occurs between 45 and 55 years of age. Amenorrhea refers to a condition which is characterized with lack of menstrual periods from three to sixmonths during a women's reproductive years (Burger et al., 1985;Soleymani et al., 2014).Short or tremendously small periods are termed as hypomenorrhea while those which last more than 7 days are called hypermenorrhea (Fraser et al., 2007). This cycle can be reformed/changed by using contraceptives ( oral or injectable) (Klump et al., 2013). Premenstrual syndrome is recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. Menstruation period is totally controlled by hormones (McCarroll et al., 2015). Up to 80% of women report having some symptoms during the one to two weeks prior to menstruation (Biggs and Demuth, 2011). Common symptoms include exhausted sensation, touchiness, mood-swings acne, tender breasts, bloating, feeling tired, irritability and mood changes (Biggs and Demuth, 2011). These symptoms interfere with normal life and therefore qualify as premenstrual syndrome in 20 to 30% of women. In 3 to 8%, they are severe (Biggs and Demuth, 2011). The menstrual cycle is governed by hormonal changes (Zareen et al., 2016b). In human, the levels of these ovarian hormones during the menstrual cycle have been found to influence binge eating (Klump et al., 2008) . Females have been found to experience different eating habits at different stages of their menstrual cycle, with food intake being higher during the luteal phase than the follicular phase (Buffenstein et al., 1995;Dye and Blundell, 1997). Food intake increases by approximately 10% during the luteal phase compared to the follicular phase (Buffenstein et al., 1995). These changes can be altered by using hormonal birth control to prevent pregnancy (Klump et al., 2013). Each cycle can be divided into three phases based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle) (Silverthorn, 2013). The ovarian cycle consists of the follicular phase, ovulation, and luteal phase whereas the uterine cycle is divided into menstruation, proliferative phase, and secretory phase. Physical activities have a great effect on menstrual period as physical activity induces bleeding (Ellison and Lager, 1986;Shangold et al., 1979). Basic objective of this study was to investigate the number of days of menstruation period as well as the effect of profession on the duration of menstruation period in females of different areas of district Mardan.

Ethical Consideration
Approval for this research study were got from Institutional Harassment Committee (Ethical Review Board) at Abdul Wali Khan University Mardan, Khyber Pakhtoon Khwa, Pakistan.

Data Collection
The Study was conducted in the Female population of district Mardan from May 2016 to August 2016. About 500 adult Menstruating females of different professions i.e. unmarried Households, Housewives, Teachers, Students, Tailors and Maids of district Mardan were included in this study. In addition to Profession the Respondents were divided into different age groups starting from 13 years as this age is considered to be an average age of start of menstruation. Number of Menstruating days of each female was recorded on questionnaire. Observation was recorded from the 1 st day of menstruating till the end of menstruation period.

Statistical Analysis
All data were compiled by Minitab 17 statistical software.

Contrast of Menstruation Period in Different Professions
About 29.2% respondents were reported with 3-4 days of menstrual period, 40.4% respondents were observed with 5-6 days of menstrual period, 23.2% respondents were reported with 7-8 days of menstrual period while only 7.2% respondents were observed with the longest menstrual period i.e. 9-10 days (Fig.  2).

Figure 2. Contrast of Menstruation Period in Different
Professions.

Variation in Menstruation Period In Relation To Age
Respondents were divided into different age groups starting from 13 years as this age is considered to be an average age of start of menstruation.

Contrast of Menstruation Period in Different Age Groups
About 32.8% female population had 3-4 days' menstruation period which is considered to be short period, a total of 44.4% female population had 5-6 days' menstruation period, 15.6% female population had 7-8 days menstruation period while only, 7.2% female population of this study had the longest (9-10) day's menstruation period (Fig. 4).

DISCUSSION
Current findings are parallel with the study of (Cooper et al., 1996;Harlow and Matanoski, 1991) who indicated that menstrual cycle is much variable in women who is involved in different activities, as compared to that female who is sedentary. The similarities to the results from the North Carolina study, which used a highly accurate surrogate for ovulation day based on urinary hormone metabolites, (Baird et al., 1991) suggest that bias caused by measurement error in our BBT-based marker of ovulation may be low.
A comparatively normal period of menstrual cycle 5-8 days was observed in household females, tailors and housewives who were almost free from studies as well as from job (Zareen et al., 2016c). Tailors, household and house wives showed least elevated menstrual periods as there is either no or less physical activity. Only 3.409% household, 3.12% house wives and 8.33% tailors have the longest menstrual period i.e. 9-10 days. A comparatively normal menstruation (5-6 days) period of 30.76% respondents were observed in maids, about 25.64% maids had shortest menstrual period (3-4 days). Physical job stress and mental job stress were not related to ovulatory disturbances in 156 Japanese student nurses (Nagata et al., 1986). No association between perceived levels of stress due to medical school and the prevalence of amenorrhea and Oligomenorrhea was found by evaluating questionnaire data in 159 medical students (Clarvit, 1988).
Physical activity of maids leads to prolong the menstrual period. About 15.39% maids had the longest menstruation periods i.e. 9-20 days in this ). An ovulatory cycles with unopposed estrogen stimulation may lead to endometrial proliferation and hyperplasia. Without sufficient progesterone to stabilize and differentiate the endometrium, this mucous membrane becomes fragile and sloughs irregularly. Estrogen also affects uterine vascular tone, angiogenesis, prostaglandin formation, and endometrial nitric oxide production (Livingstone and Fraser, 2002).
With the start of teenage (13-15 years), menstruation cycle is considered to be not normal, in this study almost half i.e. 40.91% of the teenagers had normal menstruation period, rest of the 59.09% respondents had irregular days of menstruation period either less than normal or it was higher than normal number of days. In 16-20 age group, 46.61% of the teenagers had normal menstruation period, rest of the 53.39% had irregular days of menstruation period, as these teenagers are mostly involved in studies. A comparatively normal menstruation (5-6 days) period of 31.65% respondents was observed in age group 21-25 while in same age group about 37.41% respondents had least days of menstruation period i.e. 3-4 days. About 59.09% respondents of age group (26-30 years) had normal menstruation period (5-6 days). Only 2.72% respondents of this group had longest menstruation period (9-10 days). 44.26% respondents had normal menstrual period in age group (31-35 years) while in same group about 37.70% respondents had shortest menstruation period (3-4 days). In 36-40 age group 50% respondents had normal menstrual period while 50% had irregular days of menstruation period. With the increasing age menstruation cycle is observed to be increased or decreased. Only 33.33% respondents of age group 41-45 had normal menstruation period, while rest had either short or long periods. About 11.11% respondents of same group and 9.091% respondents of 45-50 age group had the longest menstruation periods (9-10 days).

CONCLUSION
This study reveals that the menstrual period is not only dependent upon age but also on the nature of the job/profession of a female. Periods may be shortened or prolonged depend upon the age and nature of physical and mental activity. Furthermore it also indicated that the menstrual period can be as short as 2 days while as long as 10 days, and it is concluded and recorded that the normal period of menstruation cycle was 5-6 days in females of different areas of district Mardan.