Mini Review

Experiences of Papuan Teenagers when Menstruating

Diyah Astuti Nurfaizah¹, Yunita Kristina¹, Korinus Suweni², Wahyuningsih³ and Agussalim⁴*

¹Department of Medicine, Cenderawasih University, Papua, Indonesia

²School of Nursing, Jayapura Health Polytechnic, Papua, Indonesia

³Department of Medicine, Cenderawasih University, Papua, Indonesia

⁴Parepare School of Nursing, Makassar Health Polytechnic, South Sulawesi, Indonesia

Submission: March 13, 2023; Published: May 19, 2023

*Corresponding author: Agussalim, Parepare School of Nursing, Makassar Health Polytechnic, South Sulawesi, Indonesia

How to cite this article: Diyah Astuti N, Yunita K, Korinus S, Wahyuningsih, Agussalim. Experiences of Papuan Teenagers when Menstruating. Anatomy Physiol Biochem Int J: 2023; 6(3): 555689. DOI: 10.19080/APBIJ.2023.06.555689.

Abstract

Background: Adolescence is marked by puberty which is one of the characteristics of women with the occurrence of menarche or the first menstruation as a sign of maturity of the sexual organs and the achievement of the ability to reproduce. Menstruation is periodic bleeding that occurs from the uterus which starts about 14 days after ovulation periodically due to the detachment of the uterine endometrial lining Objective: To identify the experiences of Papuan adolescents during menstruation in Jayapura City.
Methods: This study uses a qualitative descriptive method. The number of participants there are six people who participated in this study were selected using purposive sampling method with data collection techniques with in-depth interviews with unstructured interviews.
Results: This study found five themes, namely
a) adolescent view of menstruation as a sign of puberty
b) complaints that are felt during menstruation.
c) fear of adolescents experiencing menstrual changes
d) adolescent self-care during menstruation
e) traditions during menstruation.
Conclusion: Teenagers understand when they are menstruating and how to take care of themselves. Teenagers’ perceptions of menstruation affect attitudes and behavior during menstruation and their reproductive health. So, it is advisable to provide education related to menstruation so that teenagers do not easily believe in information that is not certain the truth.

Keywords: Experience; Youth; Menstruation; Hormones; Menstrual Cycle

Introduction

Reproductive health is the starting point for maternal and child health development that can be prepared from an early age, starting from the menstrual period in adolescence [1]. According to the Population and Family Planning Agency (BKKBN) the age range of adolescents is 10-24 years and is not married. Adolescence is marked by puberty which is one of the characteristics of women with the occurrence of menarche or the first menstruation as a sign of sexual organ maturity and the achievement of the ability to reproduce [2].

According to [3] menstruation is periodic bleeding that occurs from the uterus which starts about 14 days after ovulation periodically due to the release of the uterine endometrial layer. Menstruation in adolescents is inseparable from menstrual disorders where the occurrence of menstrual irregularities is closely related to reproductive health which is influenced by many factors such as stress factors, nutritional status, physical activity, hormones and disease. This is related to changes in steroid hormone levels which are factors in the process of menstrual regulation [4].

Menstruation is said to be irregular for <21 days or >35 days and is said to be regular for 21-35 days and the duration of menstruation is 3-7 days [3]. The regularity of menstruation for women is very important because it has something to do with the level of fertility in adolescents [5]. Menstrual irregularities can cause menstrual disorders in adolescents, one of which is the occurrence of dysmenorrhea, complaints of pain associated with menstruation accompanied by abdominal cramps and pain during long menstrual periods that can result in infertility [6]. In the research, [7] said that the menstrual cycle is one of the factors for infertility. Infertility can occur if the menstrual cycle is irregular, resulting in disrupted ovulation and hormonal imbalances can occur which have a major influence on ovulation [8]. Infertility can be experienced by women of childbearing age including adolescents who have experienced menstruation [9].

According to the World Health Organization (2020) about one-fifth of the world’s population are teenagers aged 10-19 years. About 900 million adolescents are in developing countries. The prevalence of the Indonesian population based on the Indonesian Central Statistics Agency in 2020 is 10.09% male while 9.69% female (Sidabung & Sibayang 2021). Based on the National Survey of Family Growth (NSFG) in the United States, the percentage of infertile women in 1982, 1988 to 1995 continued to increase from 8.4% to 10.2% (6.2 million), this incidence is expected to continue to increase to reach 7.7 million in 2025 [10]. The highest prevalence of infertility in Indonesia is at the age of 20-24 years as much as 21.3% [7]. Based on Riskesdas (2013), most of the 68% of women in Indonesia aged 10-59 years said their menstruation was regular and 13.7% experienced irregular menstrual problems [11]. The number of adolescent girls in the province of Papua based on the age group of women 15-24 is around 497,103 thousand teenagers [12].The percentage of irregular menstruation is 9.4% (Penny et al, 2021).

Menstrual irregularities can also cause anxiety in adolescents. Most women who are experiencing irregular menstruation are very vulnerable to stress because this situation can cause uncertainty that causes anxiety [13]. This is because the knowledge and experience experienced by adolescents can affect their attitudes and perceptions towards menstruation where perception can be interpreted as the ability of adolescents to distinguish, classify, and interpret things [14].

According to the results of research by [15], adolescents’ knowledge about menstruation is influenced by the source of information obtained. Lack of information or inappropriate information about menstruation will lead to unhealthy behavior and during the next menstrual period. The wrong perception of menstruation will have an impact on the attitudes and behavior of young women in dealing with menstruation and the subsequent development of reproductive health [2]. Based on a preliminary study conducted by researchers on one Papuan teenager, he said that during menstruation he often felt abdominal pain and missed his period, the teenager thought that he was not normal as a woman. This is what attracted researchers to conduct research on “Papuan Adolescent Experiences during Menstruation in Jayapura City”.

Method

In this study is using a qualitative descriptive method. This research was conducted in Jayapura City, with the number of participants 6 Papuan teenagers determined by using purposive sampling technique. Participants were selected by taking into account the inclusion criteria that were met. Participants who did not meet the inclusion criteria were not included in this study. The inclusion criteria in this study were Papuan adolescents who had experienced menstruation, Papuan adolescents who were willing to become participants. The exclusive criteria are teenagers who are sick, teenagers who are mentally ill. Collecting data in this study is using in-depth interviews with unstructured interviews in the form of interview guidelines whose questions will be developed by researchers. Data analysis is using collazzi model. Credibility, transferability, dependability, and confirmability tests were used to test the validity of the data.

Results

Participant characteristics description

The data on the characteristics of the participants are presented in the form of a table as follows. Based on (Table 1) above, it shows that the participants in this study amounted to 6 participants, with an age range of 13-22 years, the last education was junior high and high school, coming from different ethnic groups namely Pasema, Hubla, Abun, Paniai, Nimboran and Serui. Manarche in the age range of 12-14 years.

Table 1:Characteristic of Participants.

Thematic analysis

Based on the results of research that has been done the researcher identified five themes, namely (1) adolescent view of menstruation as a sign of puberty, (2) complaints felt during menstruation, (3) fear of adolescents experiencing menstrual changes, (4) adolescent self-care during menstruation, (5) traditions during menstruation.

Teenagers view menstruation as a sign of puberty

In this study, based on the results of the study, there were three categories of adolescent views on menstruation, namely puberty, perspective, menstrual cycle and physical changes, which the six participants said were different, including age to adulthood, dirty blood discharge, bloody discharge from the genitals, blood that comes out every month, one week, 3 days, every month the breasts, hips and thighs enlarge and the body weight contains. The following is an explanation of each category:

a) puberty

In this category, two out of six participants described their views on menstruation by mentioning the age of becoming an adult which is a sign of puberty. Following are participant statements: “… I’m getting older so’’( P1)
“I think I’m an adult”( P4)

b) Perspective

In this category, there are four out of six participants who describe their views on menstruation by mentioning the discharge of dirty blood and blood that comes out every month which is the perspective of teenagers. Following are participant statements:
‘’…means like we have dirty blood like that, dirty blood that will come like that’’ (P2)
‘’… like bloody discharge from the genitals’’(P3)
‘’That’s for giving out dirty blood like that’’ (P6)
‘’Ohh, according to me, the blood that comes out every month is three days, some a week, I think so’’(P5).

c) Menstrual Cycle

In this category, three out of six participants described their views on menstruation by mentioning every week and every month which is the menstrual cycle. Following are participant statements:
“Getting normal is a week’’ (P1)
“If it’s normal, it’s normal... you usually get it from three days to a week” (P3)
“That’s every month I get my period “ ( P6)

d) Physical change

In this category, five out of six participants described their pubertal characteristics about menstruation with enlarged breasts, hips and thighs and full body weight which is a physical change. Following are participant statements:
‘’The breasts and hips are also ohh, the breasts are getting bigger and so the hips are also getting wider, aren’t they big ?’( P1)
‘ ea ... there is a feeling that my milk is starting to get bigger if big hips are like that, that’s how I feel’’(P4)
‘’What’s wrong with the thighs, the hips of the cake are big and the breasts are also a bit big, so what else, yeah, that’s all for now ..’’ (P5)
‘’ If I think this is directly like the growth of this breast getting bigger’’( P6)
‘’There is a body that is getting bigger and bigger. what is it ? the waist increases the breasts and the ass’’(P3)

Complaints felt during menstruation

This theme explains how complaints are felt during menstruation. Participants experienced menstrual symptoms such as body aches, small sores in the mouth. and stomachache. The following is an explanation of the categories:

Painful

In this category, five out of six participants described their symptoms during menstruation, namely enlarged breasts, hips and thighs and full body weight which are signs of menstrual symptoms. Following are participant statements:
“… Body pain… Around this mouth there will be a small wound later” (P1)
“ My body hurts so bad”(P2)
“Usually I have a stomachache… usually I do ”( P4)
“ stomach pain but it’s like... but what about it’s like it hurts”(P5)
“ If you’re menstruating... all of a sudden, if your period comes, you’ll suddenly feel sick to your stomach” (P6 )

Adolescent fear of experiencing menstrual changes

This theme explains how teenagers are afraid of experiencing menstrual changes. Participants responded by mentioning fear, let it go, and unhealthy. The following is an explanation of the categories:

Worried

In this category, there are three out of six participants describing the complaints they feel during menstruation when experiencing changes in their menstruation, mentioning they are afraid, let it go, not healthy. Following are participant statements:
‘’I’m so scared’’(P1)
“I ‘m scared too... I think but I’ll just let it be, it will come again later”(P4)
“ Fear is a thought that might not be healthy… that’s kind of unhealthy”(P6)

Self-care for teenagers during menstruation

This theme explains how participants take care of themselves during menstruation. Participants perform self-care with the following theme categories:

Personal hygen

In this category, five out of six participants described self-care during their menstruation mentioning personal hygiene, bathing up to three times and changing underwear, changing panties twice, changing panties four times. Following are participant statements:
“Just take three showers in the morning and afternoon”(P1)
“I used to take a shower three times, I also changed sanitary napkins (P4)
“Bath three times, if you sleep use, it again”( P6)
“Menses is like changing sanitary napkins, only if you change the CD when you take a shower, it’s only twice” (P2)
“Sa, if I change the pads 4 times, I’ll change the CD too (P5)

Changing pads

In this category, five out of six participants described self-care during menstruation. Participants mentioned changing sanitary napkins up to six times, three or four times, changing mornings and evenings, mornings and afternoons. Following are participant statements:
‘’...if one day is six times’’ (P1)
“That’s if the first su takes up to two days, it’s like three or four times” (P2)
“I’ll change it later in the morning, I’ll use it in the afternoon, then I’ll change it in the afternoon and then I’ll change it at night “ ( P3)
“ Ah … four times changing sanitary napkins it seems”(P5)
“Usually in the morning or not at noon and night when changing sanitary napkins “ ( P4 )

Eat

In this category, two out of six participants described self-care during their menstruation stating that they eat a lot, don’t like to eat, don’t feel hungry, don’t eat enough. Following are participant statements:
‘’Sometimes I eat a lot and sometimes I don’t like to eat like I don’t feel hungry like one day I don’t feel hungry until it’s like night’’ (P3)
‘’It’s like not eating enough, so if you have menstruation, it’s like your body is weak, it’s like I prefer to rest, I don’t like to work like that’’ (P6))

Rest

In this category, two out of six participants described selfcare during menstruation. participants mentioned rest felt uncomfortable, felt good. Following are participant statements:
“It’s a bit awkward, right, if you make a mistake or go back and forth, you’re afraid that’s all there is to it’’ (P5)
‘’Usually resting is good, especially when my stomach hurts so I just lie down and relax at home’’( P4)

Sleep

In this category, three out of six participants described selfcare during menstruation. Participants mentioned sleeping. They were surprised to wake up, not comfortable, afraid to go through. Following are participant statements:
‘’I sleep normally, but sometimes when I sleep, I like to be surprised when I wake up, so sometimes I wake up at 1 because I’m not comfortable and I’m afraid of going through’’ (P1)
‘’It’s like those nights when we suddenly wake up once we are aware of ourselves, don’t let it be too translucent like that’’ (P2)
‘’I like to wake up at night but when I wake up I still feel safe, it’s okay, it’s not disturbed, it’s just that if I don’t feel well, I’m very disturbed’’ (P6)

Tradition during menstruation

This theme explains the traditions believed by the participants during menstruation. Participants believe in the tradition of not drinking ice, not drinking coffee, freezing blood, not washing hair, pulling hair, not going for walks, not gardening, damaging plants. The following is an explanation of the categories:

Prohibited drinks

In this category, there are four out of six participants who describe the tradition during their menstruation that they are not allowed to drink ice water, they are not allowed to drink coffee. Following are participant statements:
‘’not allowed to drink ice water’’(P3)
“ You can forbid drinking iced water but I just drink it”(P4)
“ It’s normal to drink ice water when the blood clots”(P6)
“ Uh ... you can’t say anything... can’t you drink coffee?”(P5)

Cannot be active

In this category, three out of six participants described the tradition during menstruation. Participants mentioned that they were not allowed to go out, they were not allowed to garden, they were not allowed to hold plants. Following are participant statements:
“If the others are prohibited, don’t go out when you are menstruating” (P1)

like you can’t go to the garden like that”(P3)
“ If you ‘re menstruating or menstruating, you can’t hold the plant… then the plant will die”(P5)

Stay away from the opposite sex

In this ori category, one out of six participants described the tradition during menstruation; the participants said that it was forbidden to be near men. Following are participant statements:
‘’No, it’s just normal when you’re menstruating; you can’t prohibit it from being near men like that.’’ (P6)

Discussion

From the results of this study the researchers found 5 themes, namely: adolescent’s view of menstruation as a sign of puberty, complaints felt during menstruation, fear of adolescents experiencing menstrual changes, adolescent self-care during menstruation, traditions during menstruation. which is divided into several categories, there is also a discussion of these themes as follows:

Teenagers view menstruation as a sign of puberty

In the results of this study, adolescents’ views on menstruation include the age of becoming an adult which is a sign of puberty, dirty blood and blood that comes out every month which is the perspective of teenagers and every week, three days and every month which is the menstrual cycle, physical changes The things that are felt are breasts, hips, thighs, and body weight.

View can also be interpreted as perception. Perception is a cognitive process experienced by everyone in understanding information about the environment, either through sight, hearing, appreciation, hearing, and smell. The key to understanding perception lies in recognizing that perception is a unique interpretation of the situation, not a true recording of the situation (Jamil, 2021). Adolescence is a period of transition or transition where there is a transition from childhood to adulthood which is marked by changes in the body [4]. Menstruation is regular bleeding from the uterus as a sign that the uterus has fulfilled its function. Normal menstrual cycle occurs every 22-35 days, with the duration of menstruation for 2-7 days [16].

This study looked at menstruation, discharge of blood from the genitals and discharge of dirty blood. Menstrual blood flow is blood that is less than 25% containing endometrial tissue, tissue fluid and mucus [17]. This event occurs because there is no fertilization of the egg by sperm, so that the thickened lining of the uterine wall (endometrium) in preparation for pregnancy is shed. If a woman does not experience pregnancy, the menstrual cycle will occur every month [18]. Normal menstrual cycle occurs every 22-35 days, with the duration of menstruation for 2-7 days [16]. Some participants in this study viewed menstruation as the age of becoming an adult, the results of this study are in line with [19] conducted on adolescents aged 15-19 years in Rohtak City in line with the results of this study which stated that almost 30% of the research subjects knew menstruation as an important sign to reach maturity.

In this study, several participants viewed menstruation as a perceived physical change, namely enlarged breasts, hips and thighs, the results of this study are in line with [20] which was conducted on adolescent girls who were 8 years old, it was stated that they had reached the stage of breast development, this strengthens the results of this study where the average female adolescent in this study was aged 13-22 years who had felt the development of the breasts and the development of the hips and thighs. thigh. This study is also in line with research conducted by [21] where the results of this study are in line with research conducted on adolescent girls in Amsterdam in 2010 which reported that there was an increase in fat mass from 12 kg at the time of the first menstruation to 14.9 kg. after several menstruations.

Based on the assumption of researchers, adolescents who have reached puberty will experience menstruation. Most teenagers already understand what menstruation is, it’s just that education is still needed so that teenagers know the signs of puberty in menstruation, not just the age of becoming an adult, discharge from the genitals and adolescents who have puberty will experience many changes such as physical changes starting from breast growth, enlarged hips, enlarged thighs and emotional changes.

Complaints felt during menstruation

The results of this study some teenage girls experience complaints that are felt during menstruation such as body aches, small sores in the mouth and abdominal pain where you feel pain. Complaints are what feels like the occurrence of dysmenorrhea. Dysmenorrhea is often called menstrual pain. Menstrual pain occurs mainly in the lower abdomen, but can radiate to the lower back, waist, pelvis, upper thighs, and calves. Pain during menstruation is accompanied by severe abdominal cramps. The severity of dysmenorrhea is directly related to the length and amount of menstrual blood. Cramps come from very strong uterine muscle contractions when expelling menstrual blood from inside the uterus. This very strong muscle contraction then causes the muscles to tense up and result in cramps or pain [18].

The results of this study are in line with the research of [22] in middle-aged adolescents in Turkey who reported that menstrual pain began to be greater than one day before menstruation. [23] research that the physical symptoms felt by adolescents in their research include headaches, back pain, abdominal pain, backache, and fatigue.

Based on the researcher’s assumptions, complaints of body aches and abdominal pain are physiological during menstruation. If the abdominal pain that is felt during menstruation is very painful, it can be ascertained that you are experiencing a menstrual disorder commonly known as dysmenorrhea. Small sores in the mouth cannot be confirmed as a complaint during menstruation because it is necessary to carry out an examination, it could be a pathological menstruation.

Adolescent fear of experiencing menstrual changes

In this study, the fear of adolescents experiencing menstrual changes was feeling anxious. Anxiety is a feeling of fear that dominates adolescent girls when experiencing changes in the menstrual cycle. Fear in the Big Indonesian Dictionary (KBBI) is a feeling of insecurity, worry, and anxiety. Fear is a psychological disorder that is natural and can arise anytime and anywhere. Everyone must have experienced fear to different degrees. Fear usually arises because there is a situation that must be faced or resolved. Fear is a great power to move behavior, both normal behavior and deviant behavior , which is disturbed and both are statements, appearances, manifestations, and defenses against emerging fear (Bahy, 2017).

In this study, the feeling of fear when experiencing menstrual changes is in line with research conducted by [24] where the findings are that students at SDN 02 Semuli Jaya experience anxiety during menstruation with symptoms, fear, fluctuating feelings, restlessness, irritability, nervousness. pounding or pounding. The feelings felt by adolescent girls in this study tended to be due to the lack of knowledge about what to do as well as concerns when experiencing changes in the menstrual cycle.

Based on the researcher’s assumptions, the fear felt by adolescents when experiencing menstrual changes is due to a lack of knowledge and behavior of adolescents who easily believe in information about menstruation that is not yet certain, where adolescents need to be given education so that adolescents understand the causes and effects of the changes that occur in their lives. during menstruation.

Self-care for teenagers during menstruation

In this study, there are several self-care carried out by Papuan adolescents during menstruation. The theme of adolescent selfcare during menstruation is formed from five categories, namely changing sanitary napkins, personal hygiene, eating, resting and sleeping.

Self-care during menstruation is an effort that must be done by young women to improve and maintain health during menstruation so that they can get physical and psychological well-being and to improve their health status [25]. Good selfcare is necessary during menstruation; this includes changing clothes and underwear regularly, changing sanitary napkins every 3-4 hours, bathing every day especially during dysmenorrhea, washing the genital area after defecating or urinating, continuing normal activities of daily living. day, and maintain a balanced food intake [25].

Changing sanitary napkins in this study, three participants stated changing sanitary napkins six times a day, three or four times, changing in the morning, noon, night, morning afternoon. This study is in line with [23], adolescent girls pay attention to the cleanliness of the sanitary napkins used and use disposable sanitary napkins with an average of 3-4 times changing the sanitary napkins. Personal hygiene carried out in this study were bathing three times and changing clothes. Two times changing underwear four times changing underwear. This is in line with the research of [23] in Kenya who reported that one participant said that he often bathed and found it difficult to hide this when menstruation arrived.

Based on the assumptions of the researchers, adolescent girls already know about self-care during menstruation because it can affect reproductive health. Self-care that needs to be considered by teenagers is maintaining the cleanliness of sanitary napkins by changing, bathing three times a day to maintain personal hygiene and always changing underwear at least three times during menstruation, maintaining the intake of food that enters the body so that menstruation is smooth, adequate rest can relieve symptoms such as abdominal pain experienced, and sleeping during menstruation it is normal to wake up in the middle of the night because of the discomfort of wearing a sanitary napkin.

Tradition during menstruation

In this study, the traditions during menstruation that are believed by Papuan youth are the prohibition of drinking ice water, not washing hair, drinking coffee, pulling hair to stop menstruation, not gardening, holding plants and not being close to men.

Tradition can be interpreted as a true inheritance or legacy of the past. Tradition is the religious habits of the life of an indigenous population which include cultural values, norms, laws, and rules that are interrelated, and then become a system or regulation that has been established and includes all conceptions of the cultural system of a particular culture to regulate social action (Putra, 2018). The tradition of menstruation is a habit that is carried out during menstruation, both in the form of prohibitions and actions. In this study states the prohibition of shampooing, this is in line with [26] in his book that there are also groups in our society who have the belief that menstruating women are prohibited from washing their hair, even such a prohibition is believed to be a religious teaching.

This study also states that you should not handle plants. This is also in line with [26] statement, quoted in Pliny’s book Natural History, which states that if a woman who is menstruating touches the grapes, the grapes will rot, the plants before the harvest they come to become gabug, and the fruits on the trees fall. Based on the assumptions of researchers, traditions or beliefs during menstruation from certain cultures do exist. Belief in a tradition that has been passed down from generation to generation makes teenagers carry out traditions during menstruation such as prohibiting the consumption of drinking iced water, not washing hair, drinking coffee, pulling hair to stop menstruation, not gardening, holding plants and not being close to men [26-51].

References

1. Septiani P, Minata F, Afrika E (2021) Analysis of Factors Associated with the Incidence of Menstrual Disorders in Women with Mental Disorders. Faculty of Midwifery and Nursing Universitas Kader Bangsa Palembang p. 1-16.
2. Romana ABYH, Tat F, Subani ND, Rindu Y (2021) The Role of Parents on the Perception and Knowledge of Young Women About Menarche in Kuanheun Village. Jurnalpoltekeskupang 1(1): 60-64.
3. Rahayu PP, Hartini CMW (2020) The Relationship between Nutritional Status and Menstrual Cycle Disorders in Third Semester Students of Midwifery Study Program at Respati University, Yogyakarta 8(1): 50-58.
4. Armayanti D (2021) Factors Affecting the Regularity of the Menstrual Cycle in Young Women at Sma Negeri 2 Singaraja. Journal of Health Media 14(1): 75-87.
5. Rihardini T (2019) Recognizing the Regularity of the Menstrual Cycle to Detect Reproductive Health Disorders in Adolescents in Gunung Anyar Tambak Village, Surabaya. National Seminar on Research Results and Service 2: 266-274.
6. Andalas M, Maharani CR, Shafithri R (2019) Repeated Abdominal Pain During Menstruation, Risk of Infertility? Syiah Kuala Medical Journal 19(2): 115-121.
7. Yuliarfani N, Nina (2022) The Effect of Work, Stress, Obesity, and Menstrual Cycle with Incidence of Infertility in Women. 7(1): 21-31.
8. Ilmi AF, Selasmi EW (2019) Factors Associated with the Menstrual Cycle in Adolescent Girls Class XI at SMA Negeri 6 Tangerang Selatan. Edu Masda Journal 3(2): 175.
9. Ulfah RD, Nufus H, Sandi DF (2019) Relationship between body weight and the incidence of secondary infertility in women of childbearing age. Journal of Scholar Borneo 3(2): 40-46.
10. Indarwati I, Budihastuti UR, Dewi YLR (2017) Analysis of Factors Influencing Female Infertility. Journal of Maternal and Child Health 2(2): 150-161.
11. Ambriani, Melly N, Erik E (2020) The Relationship between Nutritional Status and Menstrual Cycle in Midwifery Students at Gunadarma University, Depok. Scientific and midwifery journal 10(1).
12. Central Bureau of Statistics (2020) Number of adolescent girls by age group in Papua Province.
13. Fadhli K, Azhari A, Thohari MH, Firmansyah K (2021) Improving Menstrual Understanding through Women's Fiqh Studies in Barong Sawahan Village. Journal of Community Service 2(2): 66-67.
14. Juwita FI, Jatnika Y (2021) Perception of the Selection of Turmeric Acid Herbal as an Alternative to Halal Preparations to Accelerate Menstruation. Scientific Journal of Pharmacy 4(2): 59-65.
15. Diaris NM, Pramita I (2019) Qualitative Study of Experience, Perception, and Readiness of Children in Facing Early Menarche. Journal of Integrated Health 3(1): 31-35.
16. Sunarsih (2017) Relationship between Nutritional Status and Physical Activity on Menstrual Cycle Regularity of Midwifery Study Program Students at Malahayati University, Journal of Midwifery 3(4): 190-195.
17. Andrews G (2009) Textbook of Women's Reproductive Health. Translated: Sari K, Jakarta: EGC.
18. Sinaga E (2017) Menstrual Health Management. National University: IWWASH Global One.
19. Manish KG, Kundan M (2011) Psycho-Social Behavior of Urban Indian Adolescent Girls during Menstruation. Australas Medical Journal 4(1): 49-52.
20. Carol R, Maisonet M, Kieszak S, Monteilh C, Holmes A, et al. (2009) Timing of Maturation and Predictors of Menarche in Girls Enrolled in a Contemporary British Cohort. Journal Compilation of Pediatric and Perinatal Epidemiology 23(5): 492-504.
21. Vink EE, Van Coeverden SCCM, Mil EGV, Felius BA, Van Leerdam FJM, et al. (2010) Changes and Tracking of Fat Mass in Pubertal Girls. Article Obesity 18(6): 1247-1251.
22. Eryilmaz G, Funda O (2009) Evaluation of Menstrual Pain Management Approaches by Northeastern Anatolian Adolescents. Pain Manag Nurs 10(1): 40-47.
23. Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, et al. (2013) We Keep it Secret So No One Should Know-A Qualitative Study to Explore Young Schoolgirls Attitudes and Experiences with Menstruation in Rural Western Kenya. PLoS One 8(11): 79132.
24. Suliyaningsih (2021) The Relationship between Nutritional Status and Menstrual Cycle in Nursing Students at Brawijaya University. Thesis. Nursing study program, Faculty of Medicine, Universitas Brawijaya, Malang.
25. Tantry YU, Solehati T, Yani DI, (2019) Description of Knowledge, Attitudes, and Behavior of Self-Care During Menstruation in Students of SMPN 13 Bandung. Journal of Nursing 10(1): 146-154.
26. Subhan Z (2004) The Nature of Women: Destiny or Myth? Yogyakarta: Pustaka Islamic Boarding School.
27. Afiyanti, Rachmawati N (2014) Qualitative Research Methodology in Nursing Research. Jakarta: Rajawali Press.
28. Akhila G, Shaik A, Dinesh KR (2020) Current Factors Affecting the Menstrual Cycle. International Journal of Research in Hospital and Clinical Pharmacy 2(1): 18-21.
29. Alhamid T, Anufia B (2019) Resume: Data Collection Instrument.
30. Amenda PSSS (2021) The Relationship Between Nutritional Status and Menstrual Cycle in Adolescent Girls at SMA Bina Warga 2 Palembang. Jurkessutra (Surya Nusantara Health Journal) pp. 270-277.
31. Anggreini (2021) GAY (Homosexual Men) Perception of Their Life in Jayapura City Area. Thesis. Nursing Study Program, Faculty of Medicine, University of Cenderawasih, Jayapura City, Indonesia.
32. Donsu T (2016) Nursing Research Methodology. In: Yogyakarta: Pustakabarupress, Indonesia.
33. Day NM, Adiningsih S (2019) The Relationship Between Nutritional Status and Menstrual Cycle in Students of MAN 1 Lamongan. Amerta Nutrition 3(4): 310.
34. Efni N, Fatmawati TY (2021) Adolescent Health Management Education during Menstruation at SMP N 5 Jambi City. Journal of Abdimas Kesehatan (JAK) 3(2): 215.
35. Fatmawati (2017) Understanding Adolescent Psychology. Journal of Reform 6(2).
36. Ismail AG (2020) The Correlation Between Learning Interest and Learning Outcomes of Students on the Concept of the Human Reproductive System. Thesis.
37. (2017) Qualitative Nursing Methodology. Bandung: PT Remaja Rosdakarya.
38. Mekarisce AA (2020) Data Validity Checking Techniques in Qualitative Research in the Public Health Sector. Journal of public health scientific 12(3): 145-151.
39. Nugrahani (2014) Qualitative Nursing Methodology. Surakarta
40. Nurhayadi (2021) Mrs. Yanh's experience is hampered in exclusive breastfeeding in Bhayangkara Village. Thesis. Nursing Study Program, Faculty of Medicine, University of Cenderawasih, Jayapura City, Indonesia.
41. Prananda (2019) The Relationship between Body Mass Index and Menstrual Cycle in 2016-2018 College Students, Faculty of Medicine, University of North Sumatra. Thesis. Doctoral Education Study Program, Faculty of Medicine, University of North Sumatra. Medan.
42. Princess (2018) The Relationship between Stress Levels and Dysmenorrhea (Menstrual Pain) in Students of SMP Negeri 1 Jember. Thesis. Nursing Undergraduate Study Program, Faculty of Nursing, University of Jember, Indonesia.
43. Ratnasari (2020) Untirta Students Perception of Reproductive Health and Its Problems. Journal of Biology and Learning 15(1).
44. Ross WJ (2009) Introduction to Corporate Finance. In: (8 edn.), Jakarta: Salemba Empat, Indonesia.
45. Septiani (2019) Experience of Exclusive Breastfeeding for Primiparous Mothers in the Koya Barat Health Center. Thesis. Nursing Study Program, Faculty of Medicine, University of Cenderawasih, Jayapura City, Indonesia.
46. Suarni L (2020) Description of Anxiety level of Adolescent women who experience manarch at integrated islamic smp kholisaturrahmi binjai. Jumantik journal 5(1): 46-55.
47. Sudiarja A (2006) Religion (in the Age) That Changed Yogyakarta: Kanisius.
48. Sugiyono (2013) Quantitative, Qualitative and R&D Research Methodology. Bandung. Alfabeta.
49. Susilawati D, Restia V (2019) Relationship between Obesity and Menstrual Cycle with Infertility Incidence in Couples of Childbearing Age at Dr. Hj Clinic. Putri Sri Lasmini Spog (K) Period January-July 2017. Journal of Lighthouse Health 2(1): 101-106.
50. Vijaya RA (2020) Description of Adolescent Anxiety During Menstruation at sdn 02 Semuli Jaya.
51. Yuwanti, Mulyaningrum FM (2017) Perceptions of adolescent girls about menstrual personal hygiene with female adolescent behavior during menstruation in class xi students of SMK YPPM Boja.