Anxiety on Dealing Final Examination as Determinant Changes of the Menstrual Cycle to Female Students of Sehat PPNI Mojokerto

Women will experience menstrual cycle changes during her productive life. In its effect on the menstrual cycle, anxiety involves the neuroendocrinology system as a major system of its role in female reproduction. This research aimed to determine whether the anxiety as the determinant of menstrual cycle changes in students of Midwifery Department Bina Sehat PPNI Health science institute Mojokerto. This research used comparative analytic design with cross-sectional approach. Its population was all student of Midwifery Department level III Bina Sehat PPNI Health science institute Mojokerto which is a final exam 128 people. The number of samples was 28 respondents using simultaneous sampling technique for 15 days. The data were analyzed by using chi-square test. The result showed that 6 respondents had moderate anxiety, most of them had normal menstrual cycle, 12 students (75%) and 7 respondents had severe anxiety, most of them had oligomenorrhea that was 5 students (71, 4%), chi-square test results obtained Ï = 0.003, means Ï <Î± (0.05) so that H0 is rejected means there is anxiety becomes the determinant of menstrual cycle. It is suggested to female students to be able to improve their knowledge about the menstrual cycle and excessive anxiety control with technical technique and hopefully can give motivation and good coping to students


INTRODUCTION
Basically, anxiety is a natural thing that has ever experienced by every human being. Anxiety is an emotional response to subjective judgments of individuals, influenced by the unconscious and not specifically known cause (Ini, 2009). Based on data from the National Institute of Mental Health (2005) in the United States there are 40 million people suffering from anxiety disorders at the age of 18 years until the elderly. In Indonesia the number of young girls who experienced emotional disturbance by 20% (Princess, 2007). Factors that can cause menstrual pattern disorders in Hestiantoro (2009) are Disturbed hormonal function, systemic abnormalities, anxiety, thyroid, excess prolactin hormone, physical abnormalities (reproductive organs) such as fertility disorders, recurrent abortion, and malignancy in organs reproduction.Based on previous research, that the menstrual cycle is strongly influenced by the level of anxiety experienced. This is in accordance with the results of research Luthfa (2014) that most students experience disruption at home at Pondok Pesantren Kuno Putri Gamping Sleman.
Based on preliminary study conducted on February 20, 2017, at Bina Sehat PPNI Health Science Institute of Mojokerto by using interview method to 10 female students of Midwifery department final level, got information that 3 people (30%) said irregular menstrual cycle, history of previous menstrual cycle is 28 day and is now ≤ 21 days, 2 people (20%) said the history of menstrual cycle is irregular, 1 person (10%) said no menstruation for 3 months and previous menstrual history is 28 days, this is due to anxiety because the activity of lecture which is packed, preparing for a series of tests, clinical practice, report targets to be met, as well as KTI preparation activities, and 4 people (40%) said regular menstrual cycles when students are busy. Based on the above background, researchers are interested to examine the anxiety of facing the final exam as a determinant factor of the menstrual cycle

METHODS
The design of this study used a comparative analytic design using crosssectional, the research design by measuring or observing at the same time (once) between the two variables (Hidayat, 2009). In this study analyzed the relationship between anxiety present the final exam with the menstrual cycle. The population is the object of research or object to be studied, (Notoatmodjo, 2005). Population in this research is all third grade students of Midwifery department Bina Sehat PPNI Health Science Institute number 128 student. The sample is partly taken from the entire research object that is considered to represent the population (Suyanto, 2008). The sample in this study is the third-grade obstetric DIII Bina Sehat PPNI Health Science Institute Mojokerto. Variables are the size or characteristics possessed by members of a group different from those of other groups (Notoatmodjo, 2010). In this study, the variables used there are two, namely independent variables and dependent variables. the independent variable is the anxiety of the final exam, the dependent variable is the menstrual cycle. A research instrument is a tool for researchers in using data collection methods (Arikunto, 2010). The instrument used in this study is a questionnaire. Method of data processing done through the process with stages as follows: Editing, done by distributing observation sheet to the respondent. Then the researcher corrected back the completeness of the data so that if there is lack of data can be completed immediately.Coding, classifying answers from respondents into categories.Scoring, the scores are summed up then the collected data are analyzed by giving a score of the two variables studied.
Tabulating, Preparation of data in the form of frequency distribution table. The data obtained is then inserted in the master sheet then the data is processed by using the frequency distribution table and cross table (Hidayat, 2009).Data Analysis conducted data analysis by using chisquare test. In terms of the data, kai square test can be used to determine the relationship between categorical variables with categorical variables. The results are presented in the form of frequency distribution and percentage.

RESULT AND DISCUSSION
Results of research conducted on 128 respondents obtained results as in the following table:

Source: Primary data, 2017
Table 4.2 Above note that most respondents experienced moderate anxiety as many as 16 students (57.1%) and it is known that most of the respondents experienced normal menstrual cycle, which is as many as 18 students (64.3%).

Anxiety Level
Based on table 4.2 shows that the level of anxiety facing the final exam on the third-grade obstetric DIII students Bina Sehat PPNI Health Science Institute Mojokerto is the majority of students experiencing moderate anxiety that is as many as 16 students (57.1%). According to Dalami E (2009), anxiety is an emotional response to the subjective judgment of individuals, influenced by the unconscious and specifically unknown causes.
The results showed that most of the respondents experienced moderate anxiety as many as 16 students (57.1%), and a small number experienced severe anxiety as many as 7 students (25%). This is due to the age factor of almost 21 years old. In the opinion of Feist (2009), age is aligned with the individual psychological maturity that affects his anxiety, and according to Long (2009), the older the person becomes more constructive in using coping to the problem will greatly affect his selfconcept.
The students who experience severe anxiety due to family and environmental factors. From the aspect of the family, students feel pressured by the many demands of parents who expect graduation without giving real support, so that students feel a very heavy burden when facing the final exam, while from the environmental aspect greatly affects the way of thinking about yourself or others so that individuals feel anxiety because of uncomfortable feeling.

Menstrual Cycle
From the research results can be seen from table 4.2 that almost half of the respondents experienced a normal menstrual cycle that is as many as 18 students (64.3%).
The menstrual cycle according to Prawirohardjo (2011), is the distance between the first day of menstruation with the first day of the next menstruation. The first day of bleeding is calculated as the beginning of every menstrual cycle (day 1).
The menstrual cycle of students is mostly (64.3%) normal, that is 18 students. Students sometimes experience menstrual cycle changes caused by changes in hormone levels due to stress/anxiety or emotional state. Besides, that drastic changes in sports portion and drastic weight changes can affect the menstrual cycle because the system metabolism in the body does not work well (Hestiantoro, 2009).

Respondents
who experienced polimenore as many as 4 students (14.3%), this is because the hormonal function is disrupted. Respondents who experienced normal menstrual cycles of 18 students (64.3%) were due to previous menstrual history is normal and regular, and respondents who experienced oligomenorrhea as many as 6 students (21.4%), this is due to excess production of prolactin hormone thus suppressing the fertility rate of respondents and causing the respondent not to visit menstruation. Severe emotional stress can also cause irregular bleeding because when this happens, the body will produce stress hormones that will affect menstrual hormone release. The stress conditions experienced will greatly affect the hypothalamus because the hypothalamus is part of the brain that places various hormones that regulate the menstrual period, resulting in irregular menstruation (Elhert and Gaab, 2001). Respondents who experienced moderate anxiety mostly experienced normal menstrual cycles and a small percentage of menstrual cycle changes, this is due to factors such as disturbed hormonal function, systemic abnormalities, anxiety, thyroid, excess prolactin hormone, and physical abnormalities in the respondents so that the body's hormones do not work well or may be anxious about things other than facing a final exam such as not reaching the target specified as a graduation requirement, so that the anxiety it experiences is stacking and disturbing the hormone stability that causes the change of menstrual cycle. However, this is not felt by some other respondents, so there is a normal menstrual cycle. Of the respondents who experienced severe anxiety most of the menstrual cycle changes due to the greater the level of anxiety the more likely to occur menstrual cycle disruption.

Conclusion
Based on the research that has been done, the researchers can conclude that the anxiety facing the final exam is a determinant factor of menstrual cycle changes in students Midwifery