Menstruation-related participation difficulty and symptoms of depression and anxiety among adolescents and young women in Nepal
Based on a cross-sectional analysis of the 2024–25 Nepal Multiple Indicator Cluster Survey, nearly half of menstruating adolescents and young women in Nepal reported difficulty participating in daily activities due to menstruation, which was significantly associated with higher prevalence rates of depression and anxiety symptoms.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many people, the monthly cycle of menstruation is simply a biological fact, a routine part of life that requires management but rarely defines a person's entire day. However, for a growing number of health experts, the definition of "menstrual health" has expanded far beyond just having access to pads or tampons. It now includes a person's ability to live their life fully without interruption. This modern view suggests that true health means being able to go to work, attend school, and spend time with friends without fear, pain, or shame holding you back. When a person feels forced to stay home or hide during their period, it is not just an inconvenience; it is a sign that their health is compromised. This shift in thinking has led researchers to ask a difficult question: when menstruation stops a person from participating in their daily life, does it also weigh on their mind? While we know that missing school or work due to a period is common in many parts of the world, we have very little data on whether this struggle is linked to feelings of sadness or worry, especially among young women in developing nations.
A team of researchers in Nepal decided to investigate this connection using a massive, nationwide survey. They looked at data from nearly 4,000 young women and girls, aged 15 to 24, who had recently experienced a menstrual period. The study focused on two main things: whether these women had trouble doing their usual activities during their last period, and whether they had shown signs of depression or anxiety in the two weeks before they were interviewed. The researchers defined "trouble" broadly, asking if the period made it hard to work, go to school or training, or engage in social activities outside of those settings. They also used a standard set of questions to identify symptoms of mental distress, looking for patterns of feeling down, nervous, or unable to cope that were frequent enough to be concerning. By comparing the answers of those who faced restrictions with those who did not, the team could see if the two experiences moved together.
The results revealed a striking pattern. Nearly half of the young women surveyed reported that their period made it difficult to participate in at least one area of their life. This struggle was not limited to one type of activity; it affected work, education, and social life in significant numbers. When the researchers looked at the mental health side of the equation, they found a clear gap. Among the women who said their period did not stop them from doing what they needed to do, about 8 percent showed signs of depression or anxiety. In contrast, among those who said their period did cause them trouble, the number jumped to nearly 17 percent. This difference remained even after the researchers carefully accounted for other factors that might influence mental health, such as age, where the women lived, how much money their families had, and their level of education. The data suggests that the experience of being held back by menstruation is closely tied to a higher likelihood of feeling depressed or anxious.
The study also broke down the findings by age and type of activity to see if the story changed for different groups. The difficulty was slightly more common among the youngest group, those aged 15 to 19, particularly when it came to missing school or training. However, the link between this difficulty and mental health symptoms was consistent across all age groups and all types of activities. Whether a woman was struggling to work, to study, or to socialize, the association with mental distress was present and strong. The researchers also checked if the timing of the interview mattered, looking specifically at women who had just finished their period a few days before they were asked. The results held up, suggesting that the connection was not just a fluke of memory or timing.
Despite these clear connections, the researchers are careful to explain what their study does not prove. Because the data was collected at a single point in time, it is impossible to say which came first: did the struggle with menstruation lead to feelings of sadness, or did existing feelings of sadness make the physical experience of menstruation feel more difficult? It is also possible that a third factor, such as severe pain or a lack of support at home, is causing both the inability to participate and the mental distress. The study does not offer a simple cause-and-effect answer, but it does highlight a significant overlap. It shows that for many young women in Nepal, the barrier to participating in daily life is not just a physical hurdle but a mental one as well. The findings suggest that to truly support menstrual health, communities and policymakers must look beyond hygiene products and consider the emotional and social toll of being unable to live freely during a period.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.