The WHO has defined adolescence as a distinct phase of life and comprises of individuals between 10 and 19 years of age [1]_.The adolescent period in females has been marked by the onset of menarche [2]. These girls may face many premenstrual problems like acne, tender breasts, bloating, feeling tired, irritability, and mood changes. They can be severe in 3 to 8% of females [3].

In India, various myths and superstitions have long been associated with menstruation. Even mentioning the topic of menstruation has been a taboo in the past and even today [4]. Hygienic practices during menstruation are essential as poor menstrual hygiene is associated with increased vulnerability to reproductive tract infections (RTI) [5]. Thus, girls should be educated about the proper hygienic practices as well as bring them out of traditional beliefs, misconceptions, and restrictions regarding menstruation [6]. Women who practice menstrual hygiene are less vulnerable to RTI and its consequences. Therefore, imparting knowledge about menstruation from the early adolescent period may turn into practice and persist throughout life [7,8].

Menstrual hygiene is rarely discussed at home or in schools. The problem is prevalent in both rural as well as in urban areas but more so in rural and poorly educated families. The present study is conducted to assess the perceptions as well as practices related to menstruation among adolescent girls of rural and urban schools and to find out the differences in these two groups.

• To find out the perception and practices regarding menstruation amongst adolescent girls in rural and urban schools
• To find out the difference between these two groups.

The present cross-sectional study was conducted over a period of 1 and a half years from 1^st January 2018 to 30^th July 2019 at selected government and private schools of the rural and urban areas as per WHO [9]. All the adolescent girls in the age group of 10-19 years who had attained menarche were included in the study. Girls who did not give consent were excluded from the study.

Attitude, perception of girls regarding menstruation are shown (in table 4). It was found that the majority of the girls were not ready when they got their first periods. Very few participants from both settings were not aware of how to respond to their first period. Knowledge regarding the physical changes taking place during menstruation was more among the urban area as compared to the rural setting.

Table-1: Demographic characteristics.

Table-2:- Details of menstrual cycles.

During the adolescent phase, the girls experience common menstruation-related problems and do not receive appropriate knowledge due to the lack of a proper health education program in schools. Moreover, the topic of menstruation is associated with taboo, and traditional Indian society discourages open discussion on these issues [10].

The present study showed that the age of attaining menarche ranged from 11-16 years with the maximum number of girls were between 12-14 years. In a similar study done in Rural West Bengal by Dasgupta et al, the age of attaining menarche ranged from 14 to 17 years, maximum (76.25%) number of girls being between 14 and 15 years of age group [5].

In the present study, only 17.1% in Urban and 12% of girls in rural settings had prior knowledge of menstruation before attaining menarche. The percentage is low in the present study as compared to previous findings of the study done in Rural Gujarat by Dasgupta et al in which the author showed 62.7% of the girls had prior knowledge of menstruation [5].

Literacy regarding menstruation among mothers in the present study is similar to the findings of Unni et al who observed that mothers who are the most common source of information to these girls were poorly literates and hence the quality of knowledge imparted might have been poor [11]. This is in agreement with the present study as the majority of the mothers from rural settings had limited school education as compared to urban areas.

Our findings are supported by Gupta et al in which the authors stressed traditional beliefs regarding menstruation still persist and menstrual hygiene among the adolescents was found to be unsatisfactory. It highlights the need for targeted interventions to raise awareness and provision of family health education package to all girls [14].

The strength of the present study is the large sample size and inclusion of both the urban and rural populations. The limitation being the exclusion of late adolescent as by that age they are no longer a school going students.

The menstruation is found to be associated with social stigma in both rural as well as the urban settings. There is a need to disseminate healthy menstrual knowledge at all levels and promote good menstrual hygienic practices.

Adolescents must be recognized as a priority target group. There are different types of misconceptions, myths, restriction, and lack of menstruation-related knowledge. There is a need for special policies and programs to address the problems of adolescents to prevent disease and promote good health in them. Education regarding reproductive health with more focus on menstrual hygiene should be made part of the school curriculum.

Dr. J. Dixit: Topic selection, Study design.

Dr. Anju Kapoor: Manuscript preparation, Topic selection. Questionnaire preparation.

Dr. Dinesh Mekle: Questionnaire preparation, Study design, Data analysis.

Dr. Richa Rathore: Data collection, Entry of data, and Analysis.